23B-044 (12) 41 LOCUST ST BP-2017-0463
GIS 4: COMMONWEALTH OF MASSACHUSETTS
Man;Block:23B-044 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:ADD BATFI BUILDING PERMIT
Permit 4 BP-2017-0463
Project It JS-2017-000765
Est.Cost;j38500,00
Ffcc:$270.00 PERMISSION IS HEREBY GRANTED TO:
Coast.Class: Contractor: License:
use croon: MICHAEL BISGROVE 0856661
Lot Size sg.8.7 23435.28 Owner: DAVID GARDNER
Zoning:NB(I_0P1 Applicant: MICHAEL BISGROVE
AT: 41 LOCUST ST
Applicant Address: Phone: Insurance:
8 HERRICK RD f413) 241.1757
BLANDFORDMA01308 ISSUED ON:10127/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVAL & DEMO OF BATHROOM, NON LOAD
BEARING WALLS, REMOVAL OF UTILITY CLOSET, INSULATION OF 2 ADA DOORS &ADA
BATHROOM
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 10/27/2016 0:00:00 $270.00
212 Main Street,Phone(413)587-1240, Fax:(413)5874272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0463
APPLICANT/CONTACT PERSON MICHAEL BISGROVE
ADDRESS/PHONE 8 HERRICK RD BLANDFORD (413)241-1757
PROPERTY LOCATION 41 LOCUST ST
MAP 238 PARCEL 044 001 ZONE NB(109)1
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING I:ORM F[•LLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
TvoeofConswction: REMOVAL&DEMO OF BATHROOM,NON LOAD BEARING WALLS.REMOVAL
QF UTILITY CLOSET. INSULATION OF 2 ADA DOORS&ADA BATHROOM
New Conatruction
Non Structural interior renovations
Addition to Existing
_ Aceessory Stmcture
Building Plans Included:
Owner/statement or License 0856619
3 sets of Plans/Plot Plan C
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO TION PRESENTED:
pproved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Nan 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
De itionpJ,r -
Dee
-Sig : - oft d g 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.
_, Versiont7 Commercial Buildin_Permit May 15,2,000
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit -
F
c ski) 212 Main Street Sewer/Septic Availability _
Room 100 Wafer/Weli Availability
la _ 4 Northampton, MA 01060 Two Sets of Structural Plans_
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
( ._ Other Specify
a 'PLICATION 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 tPr�operty Address This section to be completed by office
4\ Loc.&s Sfi Map Lot Una
t'Jor-I+u rnpttxm l Mo, ow d fe D Zone Overlay District
- - - -- - -- --- --' Elm St.District CB District
ISECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: 0/0y
—11>W id C6gcIl
dnt( 6 . se./%// AaJ L✓iliaMsdurq, /V1111Name(P nt Current Meiling Address
/��,�/,�/'//,/ �/ 97?-7th ISIS-
signature aj/H/s' �" /l/ ,- Telephone
2.2 Authorized Agent:
1Chae-I3
1'tis5r:ve_, )7,1r Heir)est ed 13lanclford A1A "CI
Warne(Pone Current Mene Address'
I�1',{� 9 r1LaNt, llS7
Signature 4 t r 1�L., Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building $Q.9 '. 0c) �.Co (a)Building Permit Fee
2. Electrical .-" n�owv (b)Estimated Total Cost of
-7y al_ 9 (5 � Construction from(6)
3 Plumbing 45 , OCA Building Permit Fee
4. Mechanical(HVAC) - -"
5-Fire Protection ) d /s'
6. Total (1 +2+3+4+5) ' 3 , ,(x} Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings ,_� Date
Version I.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE ,-,t
interior Alterations ❑ Existing Wail Signs tv+ Demolition Repairs Additions 0 Accessory Building
Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Roofing❑ Change of Use Other❑
Brief Description Enter a brief description here.- rsnnu ,a4 aai�i r,�n}t ern Gbikanin War' ‘u
Of Proposed Work: >�.Q..v„n? Liu:L .�.,1.,� I�k'y-n„ ai)c--� D2 W +A ( )U , tM^J..rJcJ trn 61 2 F
1
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A.1 0 A-2 ❑ A-3 0 1A T o --,
A-4 0 A-s 0 1B 0
B Business 0 2A 0
E Educational ❑ 2B ❑
F Factory ❑ PT 0 F-2 ❑ 2C ❑
H High Hazard 0 3A ❑ t
I Institutional ❑ r-1 ❑ c2 0 1-3 ❑ pp 3B ❑
M Mercantile 0 _._...,..,.... N4 0
R Residential 0 R-1 0 R-2 0 R-3 0 5A ❑
s Storage ❑ s-t 0 —... 92 ❑ 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)
2" .. .. -.
ae __... 3
4
Total Area (ef) Toter Proposed New Construction(s(2
Total Height
Total Height ft
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public Private ❑ Zon2'„__ __... Outside Flood Zone]] Municipal ❑ On site disposal system El
Vermont 7 Commercial Building Permit May 15, 2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
T6ir charm to be tined in an
Building Department
Lot Size
-
Frontage ...
Setbacks Front . �^
Side L R _ L -.... R.
Rear _ .__
Building Height ..
Bldg. Square Footage % -.
Open Space Footage .. o _ ---
(Lot arca minus bldg&paved
perking) —
=of Parking Sgaces s. _ '
Fill:
(vase&Yoram)
A. Has a Special Permit/Variance/Findm ever been issued for/on the site?
NO Q DON'T KNOW & YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Cl)lDONT KNOW ey YES a
IF YES: enter Book Page and/or Document N.
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained (3 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES gJ NO 0
IF YES, describe size, type and location:
D. Are there arty proposed changes to or additions of signs intended for the property? YES V NO V
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
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
VersionI 7 Commercial Building Permit May IS,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(Regisbant)_ ..__ .. . _...
Registration Number
.address ... .
_.. _._..... .._.. Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibday
..Address RegSStratton Number
Signature Teechone Expiration Date
Name Area of Responsibility-
_ _
_
Address .. Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Regrstration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Dale
9.3 General Contractor
BtSyloY_¢_ 5�_Cle_ 1s3C1_,. ._ ..�.._ . -- �_. Not Aaplicoble ❑
Company me
Responsible In Charge of Construc _
8 -(exric t. 2� ;�la.,,d-f rd, o1o4g
Add.-
fi%.. iia. 4/3.a41.115
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 No 0
SECTION 11 .OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, ^]Ce Cl nen.. . as Owner of the subject property
herebya ti +- AA
e 1Y.Al Ulu 2i ... Sts3roiAc.. _ to
a . f-atter lative,•wo authorized by this building permit application
•
ALA f
/d , t
Signature of Owner Date
,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 penury. __ _...
1(ihu-e1 I „IOU
• ' Name _ .. g _.
i‘ , , It - ,, 64). 1 (,, _
n.nature of Owner/.Agent il Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor Not Applicable 0
Name of license Holder' A tc/hay,zi ,(JIS rov{-__ -. __. _ . ..
License Number
errlc p ierbiladinedepr.d ft49_ _0 $ _ _
Expiration Date
ignature / 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 permritt..
Signed Affidavit Attached Yes 0 No ti,'1
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
- x-r_• 600 Washington Street
Boston, M4 02111
www.mass.jgav/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/OrganizaboNlndividualb I 46jcyjy'()a/( .... „
Address: D rso- Qc�
City/StatelZip: i �' ►� - • ; I Phone#: • 1 ,
Are you an employer?Check the appropriate box: Type of project(required);
1.❑ I am a employer with 4. El I am a general contractor and I 6 New consvuctinn
,,_/employees (fill and/or part-time),* have hired the sub-contractors
2.(vI t am a sole proprietor or partner- listed on the attached sheet. 7, Q Remodeling
ship and have no employees These sub-contractors have g. ❑Demolition
working for me in any capacity, employees and have workers' q C Building addition
[No workers'comp insurance camp. insurance./
required.] 5. :13We are a corporation and its 10.D filen-Mal repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.[]Plumbing repairs or additions
[No workers' comF
myself. right of exemption per MGL 1.. Roof repairs
Y - airs
insurance required.]t c. o, ees ), we no
employees. [No workers' 1150 Other
comp.insurance required.]
*Any applicant that checks box kl must also 11l out the section below showing their workers'compensation policy information.
Homeowners who submit this a£idavitindicating they are doing an work and ten him outside contactors must submit a new affidavit indicating Duch_
tContractors that check this box must attached an additional sheet showing the nave of the sub-contranors and state whether CIT not those entities have
employees, If the sub-contractors have einukyees,they roust 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.Lic.#: Expiration Date:
Job Site Address: Ci. /St'ate/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 ofa
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 fuse
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.
Ido hereby certify under t to , ins and penalties of perjury that the information provided above is true and correct
w.�
Si- amt's: aig Ar. :�1t7Olt I•aE.-At _... Date .3 .�
Phone 4: 413. aC{� (�S a
Official use anti'. Do not write in this area, to be completed by ciryt 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#:
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: , ` I Loc S st
The debris will be transported by: farVrBihove. (nSkfuc-htM
The debris will be received by: 1C) o(4ko.,m )rrt> cluv1tp
Building permit number:
Name of Permit Applicant a - a, _� A 1 i(hatI
/0. Y. /(o /4dI0 '/
Date Signature of Permit Applicant
Initial Construction Control Document
If•,l '� �. 'To be submitted with the building permit application by a
1;1 Registered Design Professional
for work per the 8'h edition of the
. v , Massachusetts State Building Code, 780 CMR, Section 107
Project Title: _._1411 G G' 7j_ _ , r. ______.. Date /c/-25271‘
.mss"
Property Address: ' 5
--C5j .,
- . /,2yL /. 4
2/1_1.. I itc.._
Project' Check one or both as applicable: New constmctionExisting Construction
Project description: ./t 9 '7�j �y--
G.�'i.=21,�r1.'7C�...._�.�.`j ?_-C%�(L'�__._1_ I.-1. _JtG�l.1-F—_�
1 (74-.. .eir- 1 orq• MA Regwhatton Number Ci6i: ' Expiration daleay /77ma
registreddesign jrojessaonat, and I have prepared or directly supervised the preparation of all design Inns,fft
computations and specifications concerning:
p(t Architectural [ j Structural [ ) Mechanical
[ ] Fire Protection [ ] Electrical LIhcr
for the above named project and that to the best of my knowledge, information,and belief such plans,computations and
specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),and accepted
engineering practices for the proposed project. I understand and agree that I (or my designee)shall perform the necessary
professional services and be present on the construction site on a regular and periodic basis to:
I. Review, for conformance to this code and the design concept,shop drawings, samples and other subinivals by the
contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and
quality of the work and to determine if the work is being performed in a manner consistent with the approved
construction documents and this code.
Nothing in this document relieves the contracts ' s onsib l ty regarding the provisions of 780 CMR 107.
,xg,RED Ago
When required by the building official, p t Gr. . rest reports(see item 3.)together with pertinent
comments, in a form acceptable to the e p "official�9a O,
y Z
Upon completion of the work, I shall - it to ire 61[Iing ala 'Final Constriction Control Document'.
rTON, a
Enter in the space to the right a"wet" �>?
electronic signature and sea .�„_ ,it' , .SSP
•
Phone number: Email:
Building Onldat Use Only
Building Official Name Permit No: D, e.
Vunian0a tI )m]
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