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31A-067 (37) EMERSON HOUSE- 1 PARADISE RD BP-2016-1334 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31A-067 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cate.ory: renovation BUILDING PERMIT Permit# BP-2016-1334 Project# JS-2016-002300 Est.Cost: Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SCAPES BUILDERS & EXCAVATION LLCO21087 Lot Size(sq. ft.): Owner: SMITH COLLEGE OFFICE OF TREASURER zoning: EU(100)/trRC(100)/ Applicant. SCAPES BUILDERS & EXCAVATION LLC AT: EMERSON HOUSE - 1 PARADISE RD Applicant Address: Phone: Insurance: P O BOX 469 (413) 665-0185 () WC DEERFIELDMA01373 ISSUED ON.5/20/2016 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-2016-1334 APPLICANT/CONTACT PERSON SCAPES BUILDERS&EXCAVATION LLC ADDRESS/PHONE P O BOX 469 DEERFIELD01373 (413)665-0185 Q PROPERTY LOCATION EMERSON HOUSE- I PARADISE RD MAP 31A PARCEL 067 001 ZONE EU(100)/URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ZONING FORM FILLED OUT ENCLOSED REQUIRED DATE Fee Paid �14'D Building Permit Filled out Fee Paid Typeof Construction: LIGHT DEMOLITION FIT&FINISH New Construction Non Structural interior renovations Addition to Existing AccessoEy 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 INFOXMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ 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 Commission Permit DPW 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 of 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. VersionL7 Commercial Building Permit May 15,2404 Department use only City of Northampton Status of Permit: uildin Department Curb Cut/Driveway Permit 12 ain Street Sewer/Se ticAvailabilit P y R Om 100 Water/Well Availability 1 ' No m on, MA 01060 Two Sets of Structural Plans phone 413-5 -1 40 Fax 413-587-1272 Plot/Site Plans ai suiwiNamsrcno Other Specify APPLI CT,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 2 � Lot �� Unit Zone _1 Overlay District �op r Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: SMA CO llTr^�s/r Wee `7 �rr,�e t-��U I�' Name(Print) �-�� 8,K,t 1I e-00 Current Mailing Address: Q Signature Telephone 2.2 Authorized Agent: S'ces Cdr ca , .Lt lea N if rle^ 7 �lf Name(Print) Current Mailing Address Lit ignature Telephone SECTIONrSTIMAT CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant I. Building (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number (} This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date Version 1.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 r CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory'Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description Enter a brief description here. ' Of Proposed Work: , Fy SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ( ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ i I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential R-1 ❑ R-2 R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B L�f 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}:. Proposed Hazard Index 780 CMR 34}: SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 2nd 2nd 3rd . 3rd 4th 4m ............. ; Total Area(so Total Proposed New Construction(so, Total Height(ft) Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone[-] Municipal ❑ On site disposal system[] f Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R:. R:' Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book Page, and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued __... . C. Do any signs exist on the property? YES Q NO 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 Q 1F YES, describe size; type and location: E. Will the construction activity disturb(clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version 1.7 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 Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number .. .._,...._.._. Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone I Expiration Date 9.3 General Contractor Not Applicable ❑ -Company Name:.._ Responsible In Charge of Construction Address Signature Telephone I k t s Version 1.7 Commercial Building Permit May 15,2000 i SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No Q SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize ; � Gu� 2c. L� CKCGi 1 6 T `- 1 to act on my behalf, in all matters relative to work authorized by this building permit application._,_ JCA/ _ Signature of Owner Date jC°L,)atas 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 an_ penalties of perjury. Print Name Signat of Owne Ag t Date SECN 12-G06TRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ ........ _ h Name of License Holder: Cs„ 010 97 License Number Address Expiration Date Signa Telephone SECTION 13 -WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§26C(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 building permit. Signed Affidavit Attached Yes No 0 x � The Commonwealth ofMassachusetts Department o f Industrial Accidents t ^'R` Office of Investigations - 'Y ' 600 Washington Street c Boston, MA 02111 www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information ��QQ� ) dd Please Print Legibly Name (Business/Organization/Individual): kw1 J *-Y etzJ FIC Cttf,e-A t--, � — Address: Ll (sto c K6" City/State/Zip: . U � Phone #: Are you an employer?Check the appropriate box: 'Type of project(required): 1.rM I am a employer with /5— 4. F-1 I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.insurance.t �• E] Building addition ire req ud. 5. [--][--] We are a corporation and its 10.F-1 Electrical repairs or additions ] 3.❑ I am a homeowner doing all work officers have exercised their I L❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no 13. Other i A�T.. rS4 employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t 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. J j� /'? Insurance Company Name: j 1't �K 'fl rUrU"'-Ce_ l.._CWP1-(A,, e.S Policy#or Self-ins.Lic. #J0M z.- W- R6b56 r "2—0 15A Expiration Date: .lob Site Address: �a r-�!✓ts PO 4, tV � ) City/State/Zip: E"k O N O 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. Ido hereby certify under the pains and penalties of perjury that the information provided above is true and correct. t � Sienature: Date: Phone#: Of ficial use onllr. Do not write in this area,to be completed by cit),or town officiaL City or Town: Permit/License# i 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#: