10B-086 (6) 237-239 MAIN ST-LEEDS BP-2017-0488
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: 10B-086 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:window replaced BUILDING PERMIT
Permit# BP-2017-0488
Project# JS-2017-000807
Est. Cost:
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JDR BUILDERS 074104
Lot Size(sa. h.): 12632.40 Owner: APRIL REALTY INVESTMENT LLC C/O 237-239 MAIN ST LLC
Zoning: URB(100)/ Applicant: JDR BUILDERS
AT: 237 - 239 MAIN ST - LEEDS
Applicant Address: Phone: Insurance:
P O BOX 4 (413) 665-7587 WC
NORTH HATFIELDMA01066 ISSUED ON:10/13/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE 2 VINYL WINDOWS - TEMPURED
GLASS & GUARD RAILS INSIDE
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 U 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 10/13/2016 0:00:00 $100.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
/, Version1.7 Commercial Building Permit May 15,2000
Department use only
/ �\� City of Northampton Status of Permit:
/(� o Building Department Curb Cut/Driveway Permit
/ c o
\ oi, 212 Main Street Seervartseptic Availability
Room 100 WaterNyell Availability
�.' �� Northampton, MA 01060 Two Sets of Structural Plans
�` phone 413-587-1240 Fax 413-587-1272 PIoUSite Plans
Other Specify
APPLICATION TO CONSTRUCT, REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
231-130 Map Lot Unit
,))j}t,J5.7• Zone Overlay District
j4c..7 5 Oto 5 3 Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2,1 Owner of Record:
X13'7-0139 MAIM' 5T.'7 LLc. 6 ix / 73/ Lf E, n14 01233
Name(Print) Current Mailing Address:
Signature a Ljf� 3 - Lb i(- 5-9 : (-t
N, ^ dj '� ne(p
& C4- ' r ( _CC
2.2 Authorize gent: en
7- 5S TN? 00MU)e$ 1Nki. R, Rok, 2l
Name(Print) / ' Current Mailing Address: VO. //H'/ r/eqs,"nil Ofacc.
. (IIYI//// C/ y/3 - 3 (-1- "7 q �3
Signature Telephone
SECTION 3-ESTIM TED 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
Construction from(a
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5, Fire Protection
6. Total=(1 +2+3+4+5) Check Number /a[/�
all �� / •
This Section For Official Use Only
Building Permit Number Date ;;te�rr
Issued Ft'r•f�tl,f''".+„r
Signa ` f `% 1�i
al, 70 4'1'A GSI 1 1
• Commissioner/Inspector of Buildings Date =`< "s
Version L7 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 Additions 0 Accessory Building
Exterior Alteration 0 Existing Ground Sign❑ New Signs❑ Roofing 0 Change of Use❑ Other 0 r t
Brief Description Enter a brief description here.Of Proposed Work: C
'jeH+tpr+'t A`c� n.5{4
tg vie(' 02 'C. no a its ! r✓s i io v
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 0 A-2 0 A-3 0 1A 0
A-4 0 A-5 0 19 0
B Business ❑ 2A ❑
E Educational 0 2B 0
F Factory ❑ F-1 0 F-2 ❑ 2C ❑
H High Hazard 0 3A ❑
I Institutional 0 I-1 ■ I-2 0 1-3 0 380
PA Mercantile 0 —
4... 0
R Residential ❑ R-1 ❑ R-2 ❑ R-3 5A ..... ❑
$ Storage 0 S-1 ❑ S-2 0 / 56 0
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use o Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERG G RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Pro sed Use Group:
Existing Hazard Index 780 CMR 34): Propos Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA i
BUILDING AREA EXISTING PRO'OSED NEW CONSTRUC N I OFFICE USE ONLY
Floor Area per Floor{-r)
Di
N
2a 25
3e
3'
4m
4"'
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❑
Version!.7 Conunercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Requiredo Zoning
This column tobefitted in by
buildingg Department
Lot Size
Fronta_c ---
Setbacks Front
Side L: R:
Rear
Building Height /
Bldg. Square Footage ran
Open Space Footage
•arkin.a minus bldg&paved _�_��_
OBEFIEM
"era
Fill: _,--
volume&Location)
A. Has a Special Permit/Variance/Fier been issued for/on the site?
NO O DONT KNOW ,! YES O
IF YES, date issued:
IF YES: Was the permit recorded a the Ret istry of Deeds?
NO O DONT K, OW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a broo , body of water or w.tlands? NO O DONT KNOW O YES O
IF YES, has a permit be-n or need to be obtain-• rom the Conservation Commission?
Needs to be obtaine. O Obtained • , Date Issued:
C. Do any signs exist on the property? YES O NO O
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. 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 O NO O
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)
9d Registered hitect:
Not Applicable 0
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Enginee .}:
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telep •ne Expiration Date
Name Area of Responsibility
Address R.r islralion Number
Signature Telephone Expiratio •ate
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable 0
Company Name,
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) ,,,��y---���///
Independent Structural Engineering Structural Peer Review Required Yes O No �p
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN / \
OWNERS r
AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, IZ +i- Rant.IS r' ak-CAA(4k (y 02_51 c M(,(,16 S - Lie-
,as Owner of the subject property
hereby authorize t 'b• 29SS` 5 to
act o my behalf, in all matters relative to work authorized by this building permit application.
IO' 10/ 2C( CO
Signature of Ownerp Fti Favttcx--), Ma vaacvof 231 . 2'S1 Moan St. Date
I, v D (Z c 5 5 ,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
Signature of Owne gent Mate
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: J, b 705; S C -7 ( / /O
License Number
l2i C >c L/ .✓o, /h4nt E--ui 4 . 0/01--C- -9
-C- J/ - /2
Address / Expiration Date
� �— ? 1T 3
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 will result
in the denial of the issuance of the
�b(uilding permit.
/1C
Signed Affidavit Attached Yes No 0
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 150k
Address of the work: c2 3-7 N
The debris will be transported by: /I7Tne Cw^cr 5_ b��
The debris will be received by:
Building permit number:
Name of Permit Applicant
Date Signature of Permit Applicant
( The Commonwealth of Massachusetts
w= Department of Industrial Accidents
1 —1h L Office of Investigations
�l1 Congress Street, Suite 100
i..,---:::Nr..—`
• = Boston, MA 02114-2017
�. www mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information n /A, Please Print Legibly
Name (Business/Organization/Individual): ...11512._ gv/ 11.J � MI C.
Address: 7"U�' /n1C 6 6
City/State/Zip: ,,,d,9,-feij (MA ad5'3 Phone#: 66s- " 7�c`t-f
Are you an employer? Check the appropriate box: Type of project(required):
1.10 I am a emplo a with 14 4. El am a general contractor and 1
Y" T 6. ❑ New construction
employee full d/or part-time).* have hired the sub-contractors
listed on the attached sheet. 7. Remodeling
2.❑ I am a sol oprietor or partner-
ship and have no employees These sub-contractors have S. ❑ Demolition
workingfor me in anycapacity. employees and have workers'
P ty. t 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.
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 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
12.0 Roof repairs
insurance required.] t c. 152, §I(4),and we have no
employees. [No workers' 13.1:1 Other
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 arc doing all work and then hire outside contractors must submit a new affidavit indicating such.
tcontractors 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'_
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. /
insurance Company Name: lei 1\ fe hili 5— CO.
' r
Policy#or Self-ins. Lie. #: lel/9-2/1
L/ 9() 2 L{�{� 9 Expiration Date: —a9— 7
Job Site Address:/` -P117 /'" 51' City/State/Zip: /7S /1-7 71 '
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 S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the IIA,A for insurance coverage verification.
7 do hereby cerci der thcuain•a • s enalties of perjury that the information provided above is true and correct
/
Si•nature: Date:
Phone#: / _ -7Lee �JL�'8-
- ( `
Official use only. Do not write in this area,to be completed by city 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#:
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