23A-134 (7) 83 PINE ST BP-2017-0135
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23A- 134 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2017-0135
Project# JS-2017-000219
Est. Cost:$23800.00
Fee: $167.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Grouo: CYRUS NEWMAN 064690
Lot Size(sq. ft.): 74052.00 Owner: Hill Institute
Zoning: URB(100)/ Applicant: CYRUS NEWMAN
AT: 83 PINE ST
Applicant Address: Phone: Insurance:
697 Bridge Road (413) 586-1093 Workers Compensation
NORTHAMPTONMA01060 ISSUED ON:8/1/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:STRI P & SHINGLE ROOF
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 8/1/2016 0:00:00 $167.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File N BP-2017-0135
APPLICANT/CONTACT PERSON CYRUS NEWMAN
ADDRESS/PHONE 697 Bridge Road NORTHAMPTON01060(413)586-1093
PROPERTY LOCATION 83 PINE ST
MAP 23A PARCEL 134 001 ZONE URB(1001/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT /
Fee Paid Ziff 016'1
Building Permit Filled out
Fee Paid
Tvpeof Construction: STRIP&SHINGLE ROOF
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 064690
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORjAYION PRESENTED:
pproved 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
D-nation D- . '
71// a
/
o B 'ding 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 40k Contact Office of
Planning&Development for more information.
i C t II Version I.7 Commercial Buildin_ Permit May 15,2000
Department use only
City of Northampton Status of Permit:
r
9 2016 8uildiny Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
I
G INSPECTIONS Room 100 Water/Well Availability
NOR FTON."mw? ' rrthampton, MA 01060 Two Sets of Structural Plans_,.,,,,
phone 413-587-1240 Fax 413-587-1272 PIoUSite 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
1.7 Property�Address: Si- This section to be completed by office
r3 r wt Map Lot Unit
Ftoatvtct d A- Zone Overlay District
I r�.i. 7"l Ot062
-- -- -- - Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
/U�LS Chia-,' 7.244/.$ ) FS .17.4122- jf W�ztnc
Name(Print) Current Mailing Address:
Signature Telephone
2.2 Authonzwe gent: t p /�
et-tint/4A/ u+.rhns Cis in atv t ..a.� o
Name{P ) Current Mating Addre
Signature V
(/---- 06 -.tall...
Telephone/�h
SECTION a`!MATED CONSTRUCTION COSTS /d3 TOO —CJV ~ ... .
Item Estimated Cost(Dollars)to be 1 Official Use O, 4
completed by permit applicant
1, 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 71-47
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissionerllnspector 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 0 Existing Wall Signs 0 Demolition Repairs 0 Additions 0 Accessory Building 0
Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Roofing Roofing< Change of Use❑ Other 0
Brief Description Enter a brief here. sr-nip to i.-4 %K5 O
,/✓/
Of Proposed Work: Cta' %p f//.....5Ile bl (25 /'LG2 t..w g V�446,10
....
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 0 A-2 D A-3 0 1A 1 0
A-4 0 A-5 0 1B 0
B Business 0 2A 0
E Educational 2B I 0
F Factory 0 F-1 0 F-2 0 2C 0
H High Hazard ❑ 3A 0
I Institutional 0 I-1 ❑ 1-2 0 I-3 0 38 0
M Mercantile 0 4 ❑
R Residential 0 R-1 0 R-2 0 R-3 0 5A 0
s Storage 0 S-1 0 S-2 0 5B 0
U Utility ❑ Specify:
M Mixed Use ❑ Specify.
S Special Use 0 Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group Sc-'to.01 i 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(st)
1:
151
3rd
4th ...
4th _._ _
Total Area (sf) Total Proposed New Construction(sf)
Total Height(f)
Total Height ft
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private 0 Zone Outside Flood Zone Municipal 0 On site disposal system E]
Versionl.7 Commercial Building Permit May 15,2000
9. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
The column to be filled in by
Building Department
Lot Size .. _...
Frontage
Setbacks Front
Side L: R __ L
Rear _. ..
Building Height ---- -
Bldg. Square Footage % - ---
Open Space Footage
(Lot area minus bldg&paved 1
parking) __. _...
NofParking Spaces
Fill:
(yokel&Location)
A. Has a Special Permit/Variance/Findin ever been issued for/on the site?
NO O DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the{R�e�gristry of Deeds?
NO 0 DONT KNOW Y?% YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO p(/ DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained Q , Date Issued:
C. Do any signs exist on the property? YES As NO CO
IF YES, describe size, type and location: 14,l( mS'�. `v
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO f^
IF 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 I acre? YES 0 NO 1'
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
VersionI 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 ApplicablePi
.... . .
•
Registrationtion 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
Not Applicable Y�
Company Name: r
Responsible In Charge of Construction
Address ..... .. .._.
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 pp��V NO 0
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR) BUILDING PERMIT
1, _n r .��1 .O,yW,Q,,.,�� qy� . .. as Owner of the subject properly
hereby authorize ..... ` . -. "" "" '- ./-+' ii`.tl Y' K 5 / z �✓ 5 i to
act on mybehalf, In all matte relative to work authorized bythis building permit application.
9 P PP
6 16
Signature of Owner ate
,as OwnerfAuthutized
Agenthereby 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
�offperjury
Print L..) rivlT+�
Pdnl Nam
nt 6/g�6
SECTIOnature of ri ent Date
SECTION 12- ONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: 33 }} J Not Applicable 0 n
Name of License Pptder: Cir S' ' AlruaI CS -o4.4b'TQ
r _r{ License Number
Address V Expiration Date
915-516 ',di!
Signature Telephone
SECTION 3-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.I..c. 152,§25C(e))
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 0 No (
iyafor
r
iifN/hY 5-1-01 --Ir
The cornn¢onweattf of Massachusetts
-'., Department of Industrial Accidents
rte - Office of Investigations
.:..
+—Lr—T_-
f 600 Washington Street
Boston, ALA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organisation/Individual): t-/��9J/T'R $/ i�'4;Atilt'
Address: L.4L.47 8.1-r+0 KA.. .
• City/State/Zip: ,i. II . �Ki ni tL Phone#: tf.,15 — La as ......
Are you an employer?Check thea propriate box: Type of project(required):
L l am a employer with 4. 0 I am a general contractor and
},,,/
have hired the sub-contractors6. E New constiuetion
employees(5211 and/or part-time).'
2.V1 I am a sole proprietor or partner- listed on the attached sheet. 7. (_ Remodeling
`ship and have no employees These sub-contractors have g, ❑ Demolition
working for me in any capacity. employees and have workers'
9. Building addition
[No workers' comp. insurance comp.insurance.Z
required.] 5. [] We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their ILO Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MCL 12,0 Roof repairs
insurance required" t c, 152, §I(4),and we have no
employees. [No workers' Is.❑ 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 en additional sheet showing the nam of the sub-contractors and state whether or not nese entities have
employees. fftbe 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:
Policy#or Self-ins.Tic.#: Expiration Date:
Job Site Address: City/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 the pains and penalties of peiffay that the information provided`abboovvve'ist
true and correct.
}
Simature: ,?. "/ Date: st
�i
110
Phone#: y/3-56 joVS .
Officiat use only. Do not write in this area, to be completed by city or town officiaL
City or Town: Permit/License if
Issuing Authority(circle one): i
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
NEWMAN'S CONSTRUCTION
697 BridRd.
Northampton,MA 01060 1206
413-586-1093
PROPOSAL SUBMI ED TO PHONE DATE
A47/ <,te,,a i/ CAPti. s, sa, -'vr— O Vc//6
STREET JOB NAME
�t3 tilya 5-f- Pnr)F _ -c‘wsrc (l ncei Tg4 Vico2
CITY.STATE napeCODE JOB LOCATION
F—InntIACL MA- ain6,2-- Sam
ARCHITECT DATE OF PLANS JOB PHONE
We hereby submit specifications and estimates for.
'ROC RI Gr-E. sitrty� gnc4 $ /L. $ZCAiv
_55 p �.xf�f'1,� /3 -3 L-i9-Yens. op.. �OF.�+ - i-- ,+40vt-T biesg!/j-th s6T�..
nisi:// - wn-rrin�v+-r Dt21� /a} , kT 9-1 -1_ Wil-05. t 1¢hLS
tsfat)_ -cf___4 w4-r6- 3n- 1 n—fn-vEs62 owsS in JS1\of �
I7tr;�S;Di
u-i /LL/ alt,
/ caw° s/Cy/r A/3
-2-77564/ ��'s�cle 5/4 hicAL UN/D git7.4/2- ---oi ?gin/0)i>t?gin/ fainsuett tis
_tiiie/ ul,flAtvrS 9_ ,,, - r,- 1,„A, s .
ns21-all -,42411,7'�C6-1e/ .6 Ix)4 _et 9Jan2pp/zy K?�-1p/f7" 6 (0et,tObt).
COIL-5761- At,rin°to ,1T., e/��e/edli.Vini- -1-T ,a'o r/sr� -cf/h/�c N.
g}SS N�� e."1-#p j4 1,-2:3t.
5 I C- inlets" kJ si 772 - h72 2ccw�
9 0t,-s<^ OH 11R S1 G-1
We Propose hereby to furnish material and labor—complete in accordance with above specifications, for the sum of:
--(-'c.t-- — r S Silk'—ci LLIi- k Oil.N'e&to dollars($ a&; red °° ).
Payment o be made a f-knows:
iffalf 02 r.%?L9-effaQ ak0 13/M .i+-NC tjt)t u n7 cAvnp UVJ
d1
All material is guaranteed
to to be as es.Any
All work to be completed in a workmanlike Authorized j
accordingmanner to standard practices.Any alteration or deviation from above specifications
ing extra costs win be executed only upon written orders, and will become an extra
Signature r
charge over and above the estimate. All agreements contingent upon stokes, accidents
tp
Or delays beyond Our control.Owner 10 carry fire,tornado and other necessary Insurance. Note:This t accept ma
Our workers are fully covered by Workman Compensation Insurance. witM1tlrawn by us if not acceptetl w �� _ tlays. „
/2j Acceptance of Proposal %\/
The above paces,specifications jjj L
and conditions are satisfactory and are hereby accepted. You are authorized Signature `�`(• L[, O.
to do the work as specified Payment will be made as outlined above. / l(JI
Date of Acceptance' Signature r ✓
Re: control const exempt letters - llapointe@northamptonma.gov - City of Northampton ... Page 1 of 2
N'Nn Bolding docx vOpra
Mail as l of 2
Newmans LLC
COMPOSE Re: 69/Budge Rd newmans9
Nonnampmn,MA DIOEO newman69].4
Inbos (413)50.6-109]
Started sr
Important Commissioner Hasbrouck August 1.2016
Sent Mail Subject'Rep cost for Waiver
Dram CO
request that ynu grantc I'ca e t he requirement for for the Mill
Mare n. at 83 Pine Sin ce beta usestIe work is of aMnonh at ore wi Ocnot aliertnhealtq
xib0ry.]lie and lire safety.or structural and ital in that then of control
tlu poeor
consu
vtllon ismwork
considerable when
iwe compared
enent of Th GMths
thankyoudvoh.Ac onside illho
COMPls ted Amendmnlls sectors 10 1 al4ws for anescOCMR thank Mrstyou,mnn I or I IOP
his
Search people MsssPmendnm nts.sections lOLl albmlo�an emluzanfian control mnstmtl an for tnis peq ec['
Rnalen Parmentier Respectfully.
Heidi Sawicki
Mirfael E.Demand Cyrurl Newman
AIan®Vahlley Prop. Newman'c Construction
a Delisle 697 fins*Rd
Ale
Northampton.MA OIOCU
AnnMane Baron
Kim Carson
Louis Hasbrouck
oa Of
MPS
https://mail.google.com/mail/u/0/?shva=l 8/1/2016