32C-052 (7) IPEARL ST BP-2017-0124
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32C-052 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INTERIOR DEMOLITION BUILDING PERMIT
Permit# BP-2017-0124
Project# JS-2017-000208
Est.Cost:$6000.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: TEAGNO CONSTRUCTION INC 034716
Lot Size(sq. ft.): 11194.92 Owner: GLEASON HELEN C&PATRICK T TRUSTEES OF HELDON REALTY
Zoning: CB(100)/ Applicant TEAGNO CONSTRUCTION INC
AT: 1 PEARL ST
Applicant Address: Phone: Insurance:
228 TRIANGLE ST (413)549-0803 Workers Compensation
AM H E RSTMA01002 ISSUED ON:7/29/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:DEMO INTERIOR & REMOVE NON BEARING
WALL
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 7/29/2016 0:00:00 $100.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Version1.7 Commercial Building Permit May 15,2000
Department use only
ts BCity of Northampton Status of Permit.
uilding Department Curb Cut/Driveway Permit
e fy� 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
o „ Northampton, MA 01060 Two Sets of Structural Plans
tone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
�/� Other Specify
APPLE.]r'+ 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 Pro "e/CAA
This section to be completed by office
I l�I' /"� ----- - Map Lot Unit
ID ( Q�(y tyS I O p4e Zone Overlay District
-- - - - -- -- Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
GlFhsu BRaSC
Name(Print) ') rYj(+jj�, jr61 -r,`. SQ. Current Mailing Address
tie
Signature 4 �1ti" �I��// Telep / T Pet 4i R �`�L-
- aid 53o-49oa
2.2 Authorized Agent:
`-Fc-Prttt- O cnN - cxtO 3 0->t 245? 7Y2,fRTJ614-SC t's>`uLt is r
Nance(Prin) Current Marling Address
11- • ,Pn-0s qc _,%R---0803
Signature V an Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1- Binding / --- (a)Building Permit Fee
(,�LLS1.Ow7 6wW) fC7 000.
2. Electrical (b)Estimated Total Cost of
Construction from(6) -_.--.
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) -
5.Fire Protection yY ,t-y7-
6. Total=(1 +2+3+4+5) Check Number /t/.j(O ere
This
This Section For Official Use Only
Betiding Permit Number Date
issued
Signori 7-1/3-7/
'-/ ` C!
0• -' • ommissionera pector of Buildings Date 6
, .
Version l 7 Commercial Building Permit May 15,2000 ii
b.
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations 0 Existing Wall Signs 0 Demolition El Repairs 0 Additions 0 Accessory Building 0 P Exterior Alteration 0 Existing Ground Sign❑ New Signs❑ Roofing Change of Use❑ Other❑
Brief Description Enter a brief description here. pt/Let ON,/
Of Proposed Work: &PMtcc ey/tP4/y . .oe - err'7 rw.'4 f/OOr/7 . 7110 Pi„u1J e1 4-4
SECTION 5-USE GROUP AND CONSTRUCTION TYPE /
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 0 A-2 0 A-3 ❑ 1A I 0
A-4 0 A-5 0 10 0
B Business 0 2A 0
E Educational 0 2B I 0
F Factory ❑ F-1 0 F-2 0 2C 0
H High Hazard 0 3A 0 I
I Institutional 0 I-1 0 1-2 0 1-3 0 3B 0 I
M Mercantile 0 4 0
R Residential 0 R-1 0 R-2 0 R-3 0 5A 0
S Storage ❑ 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 "d1 4.16
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:
111
1
2nd
3,d
3r1 __ ._. -...
4m -
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 Zone Information: 7.3 Sewage Disposal System:
Public 0 Private 0 Zone ... Outside Flood Zone Municipal 0 On site disposal system
Versionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING Jy�
Existing r-1 Proposed Required by Zoning
This colon to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L:. R L R __.. ....
Rear
Building Height _— --.
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&pave;l
parking)
#of Parking Spaces
(volume&Location - -- - - -
A. Has a Special. Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW Q YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW Q YES Q
IF YES: enter Book Page and/or Document A.
B. Does the site contain a brook, body of water or wetlands? NO ♦.1 DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ( Obtained Q , Date Issued:
C. Do any signs exist on the property? YES NO Q
IF YES, describe size, type and location: ey-TSI!&9 L SGc atuen la 43e- tetb'wd
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO 3).
IF YES, describe size, type arid location: *3)..
E. Will the construction activity disturb(clearing, grading,excavation,or filling)over'I acre or is it part of a common plan
thatwill disturb over I acre? YES Q NO ttC"
E YES,then a Northampton Storm Water Management Permit from the DPW is required.
i
•
Version' 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 CF.OF ENCLOSED SPACE)
9.7 Registered Architect -- C �Q pl0e ,,n fA �/Tri
Not Applicable 0 _......
Name(Registrant): . .._... _.. . ..
Registration Number
Address
Expiration Date
Signatory iele}+hone
92 Registered Professional Engineer(s):
Name Area of Reeponstbmty
Address Registration Number
Signature Telephone Expiration bete
Name Area of Rea aons bJry
Address Registration Number _.. . .. .
Signature telephone Expiration Date
Name Area of Responsibility
.Address RagisVellen Number
Signature Telephone ExplratIon Date
Name Area of Responstbikty
. ___... .........
Address Registratitln Number
•
Signature Telephone Expiration Date
9,3 General Contractor /�
ea k/O.._ 1 ,1 JJ1-34./
C1)) - Not Applicable
Co party Nam
Responsible In Charge of Construction
A
„ a 3 Y92?'
Signature Telephone
Versionl.7 Commercial Budding Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED 94 P ed Yes Q No 0�1
ING WHEN
OWNERSfAGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I*
I, M7Ae u - Via.'^_' ,as Owner of subject property
hereby orte 1-&7.14-0 CBhJ çram—c- 1-C ).. . , eA [� _. in
act(12ji4jhalt,`"n r ( tees relative to work authorized by this building permit applaratton
/&gnaws of Own Date
t. OCIAW) 1••
j - `TPRpe 0 ,, J - C1 _... ,as Gismeshttuthonzed
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and oehef.
Signed under the pains and penalties of penury
Ocwarced-0 Ti--.7707 ,0
Pdrt,me
712^-{of(c,
Stun.Lure of is sr/Agent Date
—
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction�Supervisor:i,so.r:, Net Applicable 0
Name of License Hoide(,1DeSis's�..... J. 'Th5sikartbio Cc 634- 1lfv
License Number
5?6evK 2 f A test- wtA 6tooce i ( tojr2
Address Expiration Dale
-e / tft3-3b�e-i'-7cp
Signature b aL 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 will result
in the denial of the issuance of the building permit. _
1 Signed Affidavit Attached Yes K No 10
•
The Commonwealth of Massachusetts
Department of Industrial Accidents
-s, , Office of Investigations
i
)t_r 600 Washington Street
_ Boston, MA 02111
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders,/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
p
Name(Business/Organization/Individual): l [• [�,�JJ ��(/ v7 7,tk (/�!`/��/U l
Address: Il_♦. - r it...-. , - d-`J - ,p
City/State/Zip:_6I j Y(r. i O/001 Phone#: _ 7' r' ,,.1 0_.?
Are you an employer?Check;l
theppr
4. ❑ S am a general contrasmr and I rpriate box: Type of project(required):y
1.
t� 1 am a employer with
/ employees (full and/or part-time).* have hired the sub-contractors b- [,,,,j New commotion
listed on the attached sheet, 7. E Remodeling
2.❑ I am a sole proprietor or partner-
stip
arinen
ship and have no employees These sub-contractors have g. ❑ Demolition
workingfor me in anycapacity. employees and have workers'
9. ❑ Building addition
[No workers'comp.insurance comp. insurance
required.] 5. [ W e area corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions •
myself.[Noworkers'co right of exemption per MGL
y comp. 12.0 repairsinsurance required.]t c. L2,e 1{4),and we no
employees.[No workers' 13.0 Other,-„_
comp.insurance required.]
*Any applicant that checks box WI must also fill out the section below showing their workers'compensation policy information.
t Homeowners to submit this affidavit indicating they are doing all work and then hire outside contractors must sifting a new affidavit indicating such.
teensactors that.check this box nwst attacied an additional sheet showing the arc of the sub-contractors and state whether or not those entities have
employees. If die 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 sire
information. /{�
Insurance e Company Name: 1 t l
Policy ft or Self-ins, Tic,ti: Ail”; • D test 0 ,q /if^t$'xpiration Dale: �y�. *N�,Cie�/[7
Job Site Address: L ' . City/State/Zip:y{/pi e I l eY+ g f'/,t,„/6) .„
Attach a copy of the workers' compensation policy declaration page(showing the policy number and exppiiraticu/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 8250.00 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 'erfify under the pains and penalties of pedal)!that the information provided is tru and correct.
Ilk, 7 0 / b
Signature: � .-� --td 1. Date:
Ty
Phone#: .. C7/ "- 7/ OM) &97
..
OfTcial use only. Do not write in this area, to be completed by city or town official
City or Town: PermitiLicense 5
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. Cit'/Lown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone Y.:
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.
X Address of the work: l — ?CICU 612 'et
The debris will be transported by: DO *fl)
x The debris will be received by: yao
1_p pyo/1,4-?,_
Building permit number:
Name of Permit Applicant le-)A-6.A.) o s 4Y ca-ZtP A.,
Date Signature of Permit Applicant
l ' TEAGNO
CONSTRUCTION
INCORPORATED
July 27. 2016
Commissioner Hasbrouck
Subject: Request for Waiver— 1 Pearl Street, Northampton, MA
I request that you grant a modification to waive the requirement for control construction
for the 1 Pearl Street Bar Demo project at 1 Pearl Street Northampton, MA 01060
because the work is of a minor nature, will not affect health, accessibility, life and fire
safety, or structural requirements and is impractical in that the cost of control
construction is considerable when compared to the cost of the proposed work.
All work will be completed within the prescriptive requirements of 780 CMR.
Thank you for your consideration.
"Mass Amendments, sections 107.1 allows for an exclusion from control construction for
this project" All plumbing and electrical demolition subcontractors will file respective
demo permits.
Respectfully,
Donaldl'eagno
Teagno Construction, Inc
228 Triangle Street
Amherst, MA 01002
228 Triangle Street
413.549.0803 Amherst, MA 01002 .:
413.549.2628 fax www.TeagnoConstruction.com \�� ENER64 s1A8
g 4TM ese PAWNEfl