31A-065 PARADISE RD j BP-2016-1330
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 3 1 A-065 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2016-1330
Project# JS-2016-002296
Est. Cost:
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SCAPES BUILDERS & EXCAVATION LLCO21087
Lot Size(sq. ft.): 20603.88 Owner: SMITH COL_,LEGE OFFICE OF TREASURER
Zoning: EU(100)/URC(100)/ Applicant: SCAPES, BUILDERS & EXCAVATION LLC
AT. PARADISE RD
Applicant Address: Phone: Insurance:
P O BOX 469 (413) 665-0185 O WC
DEERFIELDMA01373 ISSUED ON.512012016 0:00:00
TO PERFORM THE FOLLOWING WORK.-LIGHT DEMOLITION, FIT & FINISH
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final•
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 5/20/2016 0:00:00 $100.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1330
EXCAVATION
APPLICANT/CONTACT PERSON SCAPES BUILDERS&EXCAVATION LLC
ADDRESS/PHONE P O BOX 469 DEERFIELD01373 (41';3)665-0185 Q
PROPERTY LOCATION PARADISE RD
MAP 31A PARCEL 065 001 ZONE EU(100)/URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: LIGHT DEMOLITION FIT&FINISH,
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 021087
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
pproved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDEk:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street CommissionPermitDPW Storm Water Management
Demolition Delay
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board odf'Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
i
!BECEIVED Version l.7 Commercial wilding Permit May 15,2000
Department use only
ow City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/SepticAvailabiility
og;i OF SU lNSPECTIONB Room 100 WaterA/Veil Availability
NoATH6MPTQ&MA 91080
rthampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
Map Lot (p�J Unit
Zone Overlay District
N i acA �m Pik 01063
. _1111... ... . .11__11..__/ _1.111... ._1111.,_.... .. 11.1_...1.. Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
GAp.37LS�` i'�t,.1�/Cn' p��� rt�/If
Name(Print) 'FP �
—Tei{ r°� � h r / Current Mailing Address:
cj
Signature Telephone
2.2 Authorized A ent:
1111
Name(Priinn Current Mailing Address
Signature Telephone
7—
SECTION 3-E TIMAT CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical
{b}Estimated Total Cost of
._ 1111... . ..
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number 14 q
--- .. — --_._.—,_This-Section_ForOfficiaJ,Use_Onl _—
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ w
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑`
Brief Description (Enter a brief description here.
Of Proposed Work G f We' �� f� ��
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A AssemblyC] A-1 ❑ A-2 ❑ A-3 F-11Ar-1
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ( ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
1 Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 38 ❑
M Mercantile ❑ 4 ❑
R Residential &6 R-1 ❑ R-2 R-3 ❑ 5A [] i
S Storage ❑ S-1 ❑ S-2 ❑ 56
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
. ...... _.. . ._..___ . . ......_ ...._...
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Proposed Use Group: :.....,
Existing Hazard Index 780 CMR 34):1Proposed Hazard Index 780 OMR 34): '.
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
..__ . ....__... 1st
......
2nd
2nd .
3rd
3rd .,. ....,, .._...... <.>.._
,
„ _. 4th _n
4in . ........ ... . .........
.........._..............................._....._.........................,
Total Area(sf) Total Proposed New Construction(sf)
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zorie Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone;_ ' Outside Flood Zone[] Municipal ❑ On site disposal system[]
C
!
^ ` |
~ � Vcrsioul7 Commercial Building Permit May l5.2OO8
S. NORTHAMPTON ZONT��
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
A. Has a Special Permit/Yahance/Rndingever been bsuedfor/on the site?
y�\ �=�
/—\
NO \�/ DON'T KNOW �~� YES �_�
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
0NO DONT KNOW
'--------�--� 7-------- -
-----
|FYES: enter Book Page and/or Document#
�� �_���
B. Does the site contain a brook, body ofwater orwet�nds ��NO t.~� DONT KNKNOW \~�/ YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
---
Needs to be obtained �-\ Obtained y~� Datebsued�� �--- ---
C. Doany signs exist on the property? YES �-\ NO 0
IF YES, describe size, type and location: /
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO —
E, Will the construction activity disturb(clearing,grading,excavation, or filling)over I acre or is it part of a common plan
that will disturb over 1acre? YES \~//r� NO *_���
�
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
.. _ . ,.._._....._ _,,,.,...... _....,,..,,,. Not Applicable ❑
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
i
Signature Telephone Expiration Date
._......
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
......-.................. _. ..............i _ ...............__.._
Signature Telephone Expiration Date
NameArea of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable ❑
--Company-Name----
Responsible In Charge of Construction
_....
Address
Signature Telephone
i
Version 1.7 Commercial!Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property
_.. _
hereby authorize j Zt� S' C` C c t lL (�I U
_. 'to
J
act on my behalf, in all matters relative to work authorized by this building permit application.
Signatur �c,,�. �D
as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under_the pains and penalties of perjury.. .__... . _.._... .. . ...... .. __..... _.
Print Name
Sig ure of ner gent Date
SE ION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor. Not Applicable ❑
.....
Name of License Holder. CbD6LA S... A". .BtOt�P—
License Number
Address Expiration Date
41-7-66, " 01 _1�'
Signkture Telephone
�r
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M',G.L.c. 152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the bu'Iding permit.
Signed Affidavit Attached Yes No 0
The Commonwealth of Massachusetts � •~
Department o f lndustr ial Acciderxts
Office of Investig atiorxs
6009 7ashing tori Street
Boston, MA 02111
- _ www.mass.govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leaibly
Name (Business/Organization/Individual): 3e, Lt C _
Address: 116
Deems. , p1hon
City/State/Zip: tom=- `�t r �J �� Phone#: 6113 � ����,&5—
Are y u an employer?Check the appropriate bog: 'Type of project(required):
1. I am a employer with /,5- 4. ❑ 1 am a general contractor and I 6 ❑New construction
employees (full and/or part-time).* have hired the sub-contractors
listed on the attached sheet. 7. ❑ Remodeling
2.❑ I am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers' 9 ❑ Building addition
[No workers' comp.insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.7 Electrical repairs or additions
officers have exercised their 11. Plumbing repairs or additions
3.❑ I am a homeowner doing all work '
right of exemption per MGL
myself. [No workers' comp. 12.❑ Roof repairs
employee �--�
insurance required.] t c. 152, 1(4),and we have no fA,4
es. [No workers' 13• Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. if the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance•for my employees. .Below is the policy and job site
information.
Insurance Company Name: dC ;'G .C-0 l�((1.c^i/- �`crS
Policy#or Self-ins.Lic. #: JA-2.-Rn �D( ,4 Expiration Date: f? 12 f
I
Job Site Address: I {U_ �Y� OCity/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I
do hereby certify under thepains and penalties of perjury that the information provided above is true and correct.
d ! /
a
Sienature• 4,1`' 1 _ Date._—�_—_—_�
v �
Phone#:
Official use only. Do not write in this area, to be completed by cioj or town officiaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
I
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