17D-012 (57) 491 BRIDGE RD UNIT 2112-MEADOWBROOK BP-2016-1468
GIS 4: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17D-012 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Bath reno BUILDING PERMIT
Permit- BP-2016-1468
Proiect# JS-2016-002330
Est.Cost: $5500.00
Fee:$100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: KEVIN D O'BRIEN 49810
Lot Size(sq. fl.): 1169150.40 Owner: MEADOWBROOK PRESERVATION ASSOCIATES LTD PARTNERSHIP
Zoning: URB(I00)/WP(28)/ Applicant: KEVIN D O'BRIEN
AT: 491 BRIDGE RD UNIT 2112- MEADOWBROOK
Applicant Address: Phone: Insurance:
66 GRALIA DR (413) 538-1556 Liability
SPRINGFIELDMA01128 ISSUED ON:6/13/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE TUB, INSTALL ADA SHOWER,
INSTALL NEW SINK
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:
FeeTVPe: Date Paid: Amount:
Building 6/13/2016 0:00:00 SI0000
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1468
APPLICANT/CONTACT PERSON KEVIN D O'BRIEN
ADDRESS/PHONE 66 GRALIA DR SPRINGFIELD (413)538-1556
PROPERTY LOCATION 491 BRIDGE RD UNIT 2112-MEADOWBROOK
MAP I7D PARCEL 012 001 ZONE URB(100)/WP(28)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT K
Fee Paid CK-* ,2035 W / /St
Building Permit Filled out
Fee Paid
Typeof Construction: REMOVE TUB, INSTALL ADA SHOWER. INSTALL NEW SINK
New Construction
Non Structural interior renovations
Addition to Existing.
Accessory Structure
Building Plans Included:
Owner/Statement or License 49810
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOB.MATION PRESENTED:
s.--"'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
ElElm/Street Commission Permit DPW Storm Water Management
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.
Vermonl9 Commercial Building Permit May IS,2000
r� Department use only
.sfi City of Northampton StaNa at Permit.
z,-/ Building Department Curb QNDdveway Permit -
r_% � 212 Main Street Sewer/Sepik Availability
r,:�. " : Room 100 WaterN/eft Availability
c / Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
--LICA'f+s N 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 PropertyAddpress: //�'' (J 4o>AThis section to be completed byotfice
y 8.
9I �1 h Map Lot Unit
i-toiChcCai 6-/ A zone Overlay District
2- Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
X
9 � �.J..f," -'^Y�cJ"L I Te i. ,i-,c, €% .b
X Name(Pmt) y E' Cunem Mailing Address4-r I
Signatures^c"Ilk k �s94 - I'S'? V
..�� '
2.2 Authorized 'Gent ^, Q
Name(Pdrt) K&'4 ol e"f Current Mailing Address: 'J Ac go 57,37
0/4"..022;--
�-per,., , S�,:ea ytA�^
Signature \--)14---fl-r, 4/'/ ' ..- Telephone y(3 — .?.3�-/-PSC.
SECTION a-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
TT-
2. Electrical _ Ib)Estimated Total Cost of
Constriction from(S)
3. Plumbing 5.50a) TO Building Permit Fee
4. Mechanical(HVAC) _
5.Fre Protection /�
S. Total= (t +2+3+4+5) 5.)$c l fro Check Number 4053 ",/�[/
This Section For Official Use Only
Building Permit Number Date
issued
Signature:
Budding Comrtdbroner/napector of Buadings Date
VersionL7 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❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑
Brief Description Enter a brief description here.
Of Proposed Work: deeric / 7✓b — 7 57ALL Aq LSAla - Zns774AliA ✓Sinll-
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) r CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A I 0
A-4 ❑ A-5 ❑ 18 0
B Business 0 2A ❑
E Educational ❑ 28 0
F Factory 0 F-1 ❑ F-2 ❑ 2C 0
H High Hazard 0 3A 0
1 Institutional 0 IA ❑ k2 ❑ I-a ❑ 3B 0
M Mercantile 0 4 0
R Residential 0 RA ❑ R-2 ❑ R-3 ❑ 5A 0
S Storage 0 S-1 ❑ S-2 0 5B 0
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)
1.,
1°
2n" 2m
3 e 3,e
4° 4m
Total Area(sf) 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 0 Private ❑ Zone Outside Flood Zone❑ Municipal 0 On site disposal system❑
Version! 7 Commercial Building Permit May 15.2000
A. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Dcpanmmt
Lot Size
Frontage
Setbacks Front
Side L'. R: L. R:
Rear
Building Height
Bldg. Square Footage
•
Open Space Footage /
(Lot arca minus bldg&paved
pacing)
f!of Parking Spaces
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW O YES O
IF YES: enter Book Page and/or Document ti
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O 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 O NO O
IF YES, describe size, type and Location:
E. WII the construction activity disturb(clearing,grading. excavaton, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Versionl.7 Commercial Building Permit May 15,2(100
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 Expiration Date
9.3 General Contractor
0 Si cram ConS7Q(/G7,oJ Not Applicable 0
Company Name:
Responsible In Charge of Construction
Po B01( SAddress
/6/35 Sid/ (111 w3?
4P3-538�/�S6
Signature Telephone
Versionl.7 Commercial Building Permit May 15.2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110-11)
Independent Structural Engineering Structural Peer Review Required Yes O No O
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIESIIEJFOR BUILDING PERMIT
1
—I--t ert .L"ei0 ,as Owner of the subject property
hereby a onze '!�-�J1 l"'t t6x-4 to
act on half,i all tters relative to work authorized by this building permit application.
signatu of/0Mw Date
!(enJ / 0 Q /
S(2r=N , 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.
Xvcyi Ai 0`6x/3-4
Sri t>� ��le
Signa re of OwnerlAgerR Date
SEC ION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor /P�/ ,,-�/ Not Applicableleu❑
Name of License Holder: f e1 4 ✓ &Jc7" Q / ""v
license Number
PO 4x solace - 4./J4
Address Expiration Date
(197/71,a--• if13 Si7a'11:56
Signature Telephone
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 vnll result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes No O
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: 4191 /gudge
The debris will be transported by: D,✓ -S,>£- .7)u milL5 Ali
The debris will be received by:
Building permit number:
Name of Permit ApplicantA/"! 02R?4
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
. Office of Investigations
1 Congress Street, Suite 101)
Boston,MA 02114-2017
www.nta.SSgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
o in
Name(; emasaorganineenana tdnal): tanttegrii etpetS a_gc7,/cel
Address: p D 60X SO/d.s
City/State/Zip: Sp"v''?JAid N1,q Phone#: 1103 -S-387S—SIC.
Are you an employer?Check the appropriate box: Type of project(required):
i.� )am a employer with4. I am a general contractor and I
)" have hired the subcontractors
employees(fill and/or part-Gime6. 0 New construction
2. i am a sole proprietor or partner- listed on lite attached sheet. 7. VI Remodeling
ship and have no employees These sub-contractors have ft n Demolition
workingfor me in anycapacity. employees and have workers'
P 7 9. 0 Building addition
(No workers' comp. insurance comp- insurance.:
required.] 5. 0 We are a corporation and its la Q Electrical repairs or additions
3.0 t am a homeowner doing all work officers have exercised their Ii.7'Pl u Bing repairs or additions
on-self. (No workers' cramp. right of exemption per MGL 12.0 Roof repairs
insurance requin:d.j r c. 152,§1(4),and we have no
employees. [No workers' 113,0 Other
comp. insurance required.]
*Any appticanl that checks lax must also fill out the sexton blow showing Pair vodkas'compaisatim party information.
I Homeowners who submit this affidavit indicatingthey are doing all work and then hire outside contractors must submit a new affidavit indicatingsuch.
'Contractus that check this box must attached an additional sheet showing the name ninth sub'contraelors and state whether or not those entities have
employers. S the sub-contactors have enploiees,theymusl provide thaw vodkas'comp.r bcvnumber
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. A
Insurance Company Name'....... 412-Z 2t.44 c1�-( -/^ tmet ctici ,
Policy#or Self-ins. Lie. #: OS : 1 IS{ `I ?a3 -s`ga Expiration Data. (75-j c. —/7
Job Sue Address:"ii 9/ f�~?zt die (24 City/State/ip: fl-04/e? MA
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 MGI_c. 152 can lead to the imposition of criminal penalties of a
tine up to$1,50200 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 certtfrrun//der the pains
.,annd�""penalties of perjury that the information provided above is true and correct.
Signature: �li ,.rt _ V7a` "'- Date.: 6/7/°/7/41'
Phone#: // 11/3 - 538 -/Sit
Official use only. Do not write in this area,to be completed by city or town official_ m
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
' &Other
Contact Person: Phone#:
4 $d CERTIFICATE OF LIABILITY INSURANCE WYE Rom Q76TI
hosieTHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TIE CERTIFICATE HOLDER 71118
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EJfiEND OR ALTER THE COVERAGE AFFORDED SY THE POLNDES
BELLOW. THE CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING WBUMER(8y AUTHORS=
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: ISN wIRkala holler Is an ADDITIONAL WBURED,the po4q(Me)must be endorsed. If SUBROGATION IS WAIVED,subject to
the*Me and cooddo.n of Me potty,certain pals nay nquir•to enloswrNnt A FIde,444 on MN certificate dose not confer fights to the
art/Rus holder Si IRM of sRNA endan.csnq .
NIS
Foley Insurance Group Inc. Nae N13121A-7d7A Ax pvJzi+-tNT
37 Its Street ...
REIROE
Nest Springfield NA 01089-2703 aStast PDIMeaa Ann rl30
It NMMw AM«In Street A2ariCa ]11•843,13 C9. 29939
Swab ..AMILi Qt Znserinoe Co._ _. 1E788
Navin O'Brien, DBA: O'Brian Cons traction JAMS: `._ . _.._
PO Sox 80125 MIM10: __ ----_
scud l: __...—
Springfield MA 01138 eeilear. •
COVERAGE$ CERTIFICATE NOE7BicL+1641909106 REVISIONMU/WEFT
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WRH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 4S SUBJECT TO AU.THE TERMS.
EXCLUSIONS AND CONDiTUONS OF SUCH POUCHES.UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _
Anotilluif IMgAIde1 Loan
Y1T-- MEW NMIRAEe ma SOUCY RMFM
R OOmMaM.eORICAL MEART EACH OCCIRREv4 s ....1,000.000
A I
---I CWMS++YJt EE OCCUR Pv $m00dg1_.._S_MAGE itro RENTED 500,000
I __ 40.241502 e/4/2015 H4/2016 MED EV pg>w RIGS I r 10.000
I PERSONAISAWJRY s 1,000,000
00
�GEm AGGR1-77 EGATEWRIT
iXJtOG UMpITAiPUY70
9 PER. 2RC.dJCTS.T»rNOP ALU 3 2.000.006
_ Yi
HT _.
- I3
I im:Li r_ LMT II
LLAXTfl-11111W�Ct sway sway(PR yeoq .1 100 000
B NY OWNED MITO - BCMEWIFD
L AUTOS
emsoresD 1 4nrLLAF 1/Y3/a0;6 1/12/IOb fi RtY Y i 3n0,000
moce
R HIVED AUTOS r I AUTOS —.
UHsndmbRIM ee MR 3 250,000
I i tnMlmYA iW 1 CatiW i EACH 0000PREN4E s
I non IAM __emn?E LwGRRiEGnATE S
le
CED R£TEMIM} - eTATUIE IE $
CCWaANJM
I INCMB MOIDIERR ILF !R VG.
WYRpWSCEp09CU0O? CIRIY4 ��NIA it FAO.ICCIDEM +3
MM_eYYMMij RIER p4U�m
1ER Ei_D15tAEE-En 6M'LOYE9t
OtItIRRIXII XSCPERATIOIR bylaw 1 BL DISEASE-Parer LIMIT I S
1
OEICCIMIgO CRORMTgIN t tocaTIa*IYMMate IAN6501,AMISS MRH lama ERR ba a44N M mu mom iimplindi
The certificate holder na*ad below is included as an additional insured f or Demirel liability coverage
for ongoing operations if required by written contract, permit, or agreement executed prior to a loss.
CERTIFICATE HOLDER «.. . TION
787-6023
MIDAS ANY Of M MOVE DESCRIED FOMCIEB SE CANCELLED SENSE
TIE EMIRATE( DATE TERECF, ND710E 'MLN SE DT:tAEPED M
ACCORBARCE INTI THE POuCY PEDVMNOM.
AUSW RNMremMaprtATee
Brian Foley/JOANN `` "M—` Z.._)
St 74883074 AGGRO CORPORATION. AE rights reserved.
ACORD 25(2010.1) The ACORD nem and logo are ngMMnd maks of ACORD
MEADOIA, 3ROOK APARTMENTS OPTION # 1
ACCESSI3ILITY IMPROVEMENTS 4/ 29/ 1 &
#Pmu- , s 2Q�,///maei'Vel -i{y te_Sfro
� �;�q1���6
��� eat ea
t( o +IceRcs,E � (.,.e.a_ /
0.J 04 (7
City of No mpton 10 W a-�Q S �'`�
Building De rtment � • 0
Plan Re ' / e'�/ , ,y, �.�) '�J
212 Main t -/// W
Northampton, A 01060
G"
k
X - -\ -,
1 T! OOS
ANDD FRAME
V V n
8 3LD6r # 21 APT # 12