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32C-058 (10) 155 PLEASANT ST-FORMER 129 N'TON LODGE BP-2017-0153 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C-058 CITY OF NORTHAMPTON Lot: MO I PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS. Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:demolition BUILDING PERMIT Permit# BP-2017-0153 Project# JS-2017-000249 Est. Cost: Fee: $300.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Grouo: WESTERN BUILDERS INC 073697 Lot Size(sq.ft.): 50529.60 Owner: CHICOPEE KENDALL,LLC zoning: CB(100)/ Applicant: WESTERN BUILDERS INC AT: 155 PLEASANT ST- FORMER 129 N'TON LODGE Applicant Address: Phone: Insurance: P O BOX 587 (413)467-9171 Workers Compensation GRANBYMA01033 ISSUED ON: TO PERFORM THE FOLLOWING WORK:DEMOLISH BUILDING INCL FOUNDATION & A idCW4T 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: OI: 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 S300.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0153 H APPLICANT/CONTACT PERSON WESTERN BUILDERS INC 0 cI) PO P.‘ Hu'Ta ADDRESS/PHONE P O BOX 587 GRANBY01033 (413)467-9171 °� Nf PROPERTY LOCATION 129 PLEASANT ST-N'TON LODGING-ALSO KNOWN AS 155 /�J¢pasec _ MAP 32C PARCEL 058 001 ZONE CB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid /0/-7 ''/5S0 43t) Building Permit Filled out Fee Paid Tvoeof Construction: DEMOLISH BUILDING INCL FOUNDATION&ABATEMENT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 073697 3 sets of Plans/Plot Plan THE FOL TNG ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN ATION 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 -olition Delay S _ ure of Building Offi I 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. Version1.7 Commercial Building Permit May 15,2000 F; - • Department use only - - City of Northampton Status of Permit: AUG - 3 2016 L Building Department Curb Cut/Driveway Permit - 1W 212 Main Street Sewer/Septic Availability Room 100 WaterNVell Availability vBJwiNswsvacnor8 N< rthampton, MA 01060 Two Sets of Structural Plans NORTHAMPTON, p4ione n Id-587-1240 Fax 413-587-1272 Plot/Site Plans Other Spedty 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 129 Pleasant Street Map Lot Unit Northampton, MA 01060 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Peter Gagliardi, on behalf of Chicopee Kendall 0 322 Main St, Springfield, MA 01105 Name(Print) Current Mailing Address: z 7 (phos 233-1728 Signature 9' Telephone 2.2 Authorized Agent: Lance Bcmeche,on behalf of Western Builders 73 Pleasant St, Granby, MA 01033 Name(Print) Current Mailing Address: (413) 265-5600 Signature "//J�`--�� Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant _ t Building (a)Building Pelinit Fee 2. Electrical (b)Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee A Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4 +5) Check Number 415-7,53-6 $3az> This Section For Official Use Only Building Permit Number Date Issued Signature'. Building Commissioner/Inspector 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 ❑ Existing Wall Signs ❑ Demolition Repairs Additions ❑ Accessory Building Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing Change of Use❑ Other❑ Brief Description Abatement and demolition of existing building and foundation. Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ IA I ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational El 2B ❑ F Factory ❑ F-1 0 F-2 ❑ 2C ❑ H High Hazard ❑ 3A 0 I Institutional ❑ 1-1 0 1-2 ❑ I-3 ❑ 3B ❑ M Mercantile ❑ 4 0 R Residential 0 R-1 ❑ R-2 ❑+ R-3 0 5A 0 S Storage ❑ SA ❑ 5-2 ❑ 5B I ❑ 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: Multi-family residential proposed Use Group: Existing Hazard Index 780 CMR 34): n/a 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(s9 " 4,125 1: 2n51 4,125 2"° 351 e 3rd 41h m 4th Total Area(sf) 8,250 Total Proposed New Construction(s0 Total Height(ft) 20 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 systems Version1.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by 129 Pleasant St Building Department Lot Size .74 Acre Frontage 151.15' Setbacks Front 25.11 Side L: 7.6 S R: 87.11 L: R: Rear 80.11 Building Height 201-I6 Bldg. Square Footage 10,31 Open Space Footage (Lot area minus bldg&paved 56.9 parking) 11 N of Parking Spaces 19 Fill: n a (volume&Location) 0 A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES O IF YES, date issued: 11/21/2014 IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES O IF YES: enter Book 12033 Page 99 and/or Document # B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: Post Mounted in front yard "Northampton Lodging" D. Are there any proposed changes to or additions of signs intended for the property? YES O NO 0 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. 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 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable C Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Associated Building Wreckers, Inc Abatement& Demolition Name Area of Responsibility 352 Albany St, Springfield, MA 01105 Address Registration Number (413) 732-3179 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 Lance Bemeche Not Applicable C Company Name: Western Builders, Inc Responsible In Charge of Construction 73 Pleasant St, Granby, MA 01033 Atltlress /�//, RC2, f wi 41 _ (413) 467-9171 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 0 No O SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Peter Gagliardi,on behalf of Chicopee Kendall LLC -- - - as Owner of the subject property hereby authorize Western Builders, Inc to act on my behalf, in a 4 tters rel. ive ork orized by this building permit application. SIz-Ilto Signature of Owne Date Lance Berneche, on behalf of Western Builders, Inc , 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 Lance Berneche Print Name 8I Z/ I 1p Signa a of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Reiner: Lance Berneche CS-073697 License Number 48 Fletcher Circle,Chicopee, MA 01020 07/18/2018 Address Expiration Date (413) 265-5600 Signature ,/f 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. Signed Affidavit Attached Yes 0 No 0 tThe Commonwealth of Massachusetts l Department of Industrial Accidents __ M 1 I Office of Investigations _` _ Congress Street, Suite 100 �e _ «= Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Western Builders, Inc Name (Business/Organization/Individual): Address: P. O. Box 587 73 Pleasant Street City/State/Zip:Granby, MA 01033-0587 Phone#:413-467-9171 Are you an employer? Check the appropriate box: Type of project(required): 1.❑O I am a employer with 28 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g, Q Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. 9. ❑ Building addition re aired. 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 9 ] officers have exercised their 11.❑ Plumbing repairs or additions 3.III I am a homeowner doing all work myself. [No workers' comp. right of exemption per MGL 12 ❑ Roof repairs insurance required.] ' c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] "Any applicant hat checks box#1 must also fill out the section below showing their workers compensation policy Information. a Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. [Contractors 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 lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:The Travelers Insurance Companies Policy#or Self-ins. Lia #: DTEUB-7F91471-9-16 Expiration Date:June 1, 2017 Job Site Address: City/State/Zip:Northampton, MA 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 • u er the pains a hies of pe ry that the information provided abov is tr e and correct. Siunatu : Date: 2 2- /e, Phone#: 413-4 -917 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License it 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under"Job Site Address"the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 7-2013 www.mass.gov/dia 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: 129 Pl_tg5MN i Srr2cET The debris will be transported by: ASSoc1.9T£D i�uicr'iw6 I4/2EtERS The debris will be received by: Co/lipt-Erg PI5?oi 6516 MA/hi sr_ Hatvon/ MA Ologo Building permit number: Name of Permit Ap. icant LANCE BE R.NECNt Date 06//51/46 Signature of Permit Applicant