Untitled 30 NORTH MAPLE ST BP-2017-0672
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C-308 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-2017-0672
Project# JS-2017-001100
Est.Cost:$5000.00
Fee:$100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
use croup: ROBERT SPELMAN 082172
Lot Size(sq.ft.): 7492.32 Owner: ARNOLD WILLIAM
Zoning: SI(100)/ Applicant: ROBERT SPELMAN
AT: 30 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
71 NASH HILL RD (413) 575-5703 0
W I L L IA M S B U R G MA01096 ISSUED ON::11/16/2016 0:00:00
TO PERFORM THE FOLLOWING WORK INSTALL 4 REPLACEMENT WINDOWS
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 11/16/20160:00:00 $100.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
� C - 3vs,/17C
VersionI.7 Commercial Building Permit May 15,2000
Department use only
------ - - City of Northampton Status of Permit:
_--- - Building Department Curb Cut/Driveway Permit -
I212 Main Street Sewer/Septic Availability
-1 ROorr1100 WoVSite Plansl Availability
L 1 No hampton, Pv1A 01060 Two Sets of Structure)Plans
^—t�13- 87-1240 Fax 413-587-1272 Plot/Site
`L' 3 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 69 17 ' Lt 7)-
1.1 Property Atldrets�s: This section to be completed by office
3 0 /`/l left' k srj Map Lot Unit
rt/0/414?—e) 177,9- Zone Overlay District
Elm St.District CE District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Malting Address
A ��y- 11/3 - se y- 3550
Signature _ /�/�"")'lefib _, Telephone
22 Authorized Agent:
Name(Pant) C- Current Malting Address:
1/nn, , 41)3 -316- 5-703
Signature _-/ tAirTelephone
It
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 4'y Cri2 (a) building Permit Fee
2- Eleotrtcal �- (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) 5'9VtJ Check Number c�E4 If/LoO
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:yd"� .� // /451:/7
Bui rommie•ione lnsp-ror 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 E Existing Wall Signs ❑ Demolition]] RepairsAdditions ❑ Accessory Building
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other D
Brief Description '•Enter a brief description here. . .. _
Of Proposed Work: /�j�,/Ivii .7 .geriiteh4gngr t/(/jl(/�', ✓S
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 0 1A 0
A-4 0 A-5 0 1B ❑
B Business ❑ 2.4 ❑
E Educational 0 2B I ❑
F Factory ❑ F-1 ❑ F2 0 2C ❑
H High Hazard ❑ 3A 0
I Institutional 0 IT 0 t-2 0 1-3 0 38 ,,,,, ■
M Mercantile "/ 4 0
R Residential ❑ RA ❑ R-2 0 R-3 0 5A ❑
S Storage 0 S-1 ❑ 82 ❑.. ._.. .. 5B 0
U Utility ❑ Specify_
M Mixed Use ❑ Specfy _.. _..
S Special Use ❑ Specify:.
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN 0.9E
Existing Use Group' _. . Proposed Use Group ,.,
Existina Hazard Index 780 CMR 347.' _ _ Proposed Hazard Index 780 CMR
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area oer Fier(sf)
1si _
2nd ._ ...
3,d
3`"
4a, .. 4'
Total Area (sf) Total Proposed New Construction HP
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 Otzside Flood Zone❑ Municipal ❑ On site disposal system❑
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 ._ L R
_
Rear '. _ .
Building Height
Bldg. Square Footage / — -- -
Open Space Footage
(Lot area minus bldg&paved
packing)
#of Parking Spaces -.. _.....
Fill:
(volume&Location) _... .. ._. _.. _. .
A. Has a Spec al Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW 0 YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW 0 YES 0
IF YES: enter Book Page. and/or Document ft
B. Does the site contain a brook, body of water or wetlands? NODONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO Cr
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO (:)----
IF YES, describe size, type and location
E. Will the construction activity disturb(clearing,grading, excav n,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO
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)
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
/OSZ97/)#t7
._. . .._ Not Applicable D
Company Name'.
g Gifr-#7f7Nv
Responsible In Charge of Construction
�/ /1Mgg Hatt- ,e/9 IN/Gr/l1426 ai e--4
Address
/12611/71/ b// 3 67S-57o3
Signature a I' Telephone
Version1.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
' Independent Structural Engineering Structural Peer Review Required Yes a No 0
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
/7�� �.art yL^�. .._...
I, 0+«` �j`N'/r�Ftlin! _ _,as Owner of the subject propedy
hereby authorize r/0% �J(� Y11/ to
act on my behalf,in alt mailers relative to work authorized by this building permit application.
Signature of Owner y� nl..t Date
L€'l7th e tarni�* _. ,as OwnerlAuthorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and Signed un
under the pains and penalties of perjury 12°07/11C
Print Name
139* 5/?1 k' ////57/
Signature of OwnedAyeat Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction�S�upgrvisor: Not Applicable 0
Name of Limn.Holder: 5'D 4geute /" (/.5 t' 1.1.22- _..
L cense Number
/ /1115.11 1/4661g1i5a -lam ' 67/77/7
Address Expiration ante
L1/3 ;cis-5`7&
Signature I 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 build g permit.
Signed Affidavit Attached Yes LJ No 0
•
The Commonwealth of Massachusetts
"'- Department of Industrial Accidents
•
Office of Investigations
tttions
-1•l - 600 Waslsinhton Sheet
Boston, MA 02111
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Btt$dens/ContraetorsfElectricians/Plumbers
Applicant Information/ MPlease Print
int Leably
Name(6usiness/OrganaationIndivtea): /2or ' / 2a gj/
Address: J /I & M/ /t o.Lt /&'sue /OA-
_
City/State/Zip: Phone el/5- �7p�
.............
Are you an employer?Check the appropriate box: Type of project(required).
1.❑ I am a employer with 4. ❑ I am a general contactor and I b, New con-avet9mr
proPtayees(full and/or part-time).* have hired the subcontractors --
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. E Demolition
working for me in any capacity. employees and have workers' 9. 0 Building addition
[No workers' comp, insurance comp.Lnsurame?
required.] 5. [] We are a corporation and its 10.E Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers'warp. right of exemption per MOL
12.0 Roof repairs
insurance required.]t in 152, §1(41,endive have no I3. Otnsr %* Ggayfl6414—
employees. [No workers'
comp. insurance required.] IM9ow:
-Any applicant that checks box Ill must also f out the section below showing their workers'compensation policy in ft'miadon.
(Hom eamers who submit this affidavit indicating they are doing all work and then him outside contractors must submit a new affidavit indicating such.
3Contractors that check this box must at shed an additional sheet showing the nano of the sub-contravos 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 polity and joh site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.'#: 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 LIGE.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 insolence coverage verification.
L do hereby certi p under the pains and penalties of perpny that the information
provided above istrueand correct
I� 67
SSW-nature, ! / _ Date //
Phone#: q/5 615-- 5703 -. l
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License H
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other ,.
Contact Person: ,_,,,, Phone at
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: go A-c moi. 57 ' ritir et to /)zs
The debris will be transported by:
The debris will be received by:
Building permit number:
Name of Permit Applicant )306 '3P '
/006 ikne-
Date Signature of Permit Applicant