32A-138 (14) 25 MAIN ST-SCHOOL FOR CONTEMPORARY DANCE BP-2017-0773
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32A-138 CITY OF NORTHAMPTON
Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit it BP-2017-0773
Project# JS-2017-001285
Est.Cost: $2500.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: STEPHEN YOSHEN 88490
Lot Size(sq. ft.): Owner: CHAMISA CORPORATION TO: HAMPSHIRE PROPERTY GROUP
Zoning:CB(l00)/ Applicant: STEPHEN YOSHEN
AT: 25 MAIN ST - SCHOOL FOR CONTEMPORARY DANCE
Applicant Address: Phone: Insurance:
P O BOX 41 (413) 695-7801 0
C U M M I N GT O N MA01026 ISSUED ON:12/19/2016 0:00:00
TO PERFORM THE FOLLOWING WORK SUBDIVIDING SINGLE ROOM INTO 2
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 Occu a anc Si nature:
FeeType: Date Paid: Amount:
Building 12/19/2016 0:00:00 $100.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0773
APPLICANT/CONTACT PERSON STEPHEN YOSHEN
ADDRESS/PHONE P O BOX 41 CUMMINGTON (413)695-7801 ()
PROPERTY LOCATION 25 MAIN ST-SCHOOL FOR CONTEMPORARY DANCE
MAP 32A PARCEL 13,8 000 ,ZONE CB(IOO)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED 0 alk
F Paid 41111FAilMeillI
Building Permit Filled outallialI/
Fee Paid
Typeof Construction_ SUBDIVIDING SINGLE ROOM INTO 2
New Construction
Non Structural interior renovations
Addition to Exia ing
Accessory Structure
Biding Plans Incl d d:
Owner/Statement or License 88490
3 sets of Plans f Plot Plan
THE F�LLOW ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFQRMATION PRESENTED:
} Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:¢ i
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
[Jemoliti ,�°' fj
,;1/ �i_ / /7
Signa n- of Building O'tcia 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
Harming&Development for more information.
Version l.7 Commercial Boildin: Permit May IS,2000
/ - Department use only
; City of Northampton Status at Permit:
/// , aJ Building Department Curb Cut/Driveway Permit -
LV' 212 Main Street Sewer/Septic Availability,,,,,,
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
�,`; phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICAwON 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
2,05 MAtIN PI: SLA. (T Q( ( Map Lot Unit
I3Ot2-n4Amp-ri,/.)f O
O{ 60 Zone Overlay District
Elm St Distrtct CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
CAPfBi)SA Cod)' 3) t4h?VS PLAZA, N4D120
Name(Print) Current Mailing Address
Signature Delia"— Telephone 53,2.
2.2 Authorized Agent:
Name(Pant) Current Mailing Address _.
Signature , ... Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
I. Building P 2^r 1 O O O ! (a) Building Permit Fee
2 Electrical 0 a (b)Estimated Total Cost of
Construction from(6)
3. Plumbing .- Building Permit Fee
4. Mechanical(HVAC) /^
5.Fre Protection
6_ Total=(1 +2+3+4+5) 2 t5-00 Check Number >' it Ii
This Section For Official Use Only
Building Permit Number Date
Issued
I
Signature:
Building Commissioner/Inspector of Buildings Date i
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 ❑ Demolition]] Repairs/Additions 0 Accessory Building 0
Exterior Alteration 0 Existing Ground Sign❑ New Signs 0 Roofing Change of Use❑ Other❑
Brief Description Enter a brief description here.
Of Proposed Work: S 'Pa DiV (g)IBJ 6 SfUb LE- tooµ, loam M.)0
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
A-1
USE GRO P(Check ass 2 0 A-3 0 1A
applicable) _ r CONSTRUCTION TYPE
A Assembly
A-4 ❑ A-5 0 1B
B Business 2A 0
E Educational 0 2B 0
F Factory 0 F-1 ❑ F-2 ❑ 2C ❑
H High Hazard 0 3A ❑
I Instifuaonal ❑ 1.1 0 I-2 0 !-3 0 38 0
M Mercantile ❑ 4 ❑
R Residential 0 R-1 ❑ R-2 0 R-3 0 5A ❑
S Storage ❑ 8-1 0 S-2 ❑ 5B 0
._ . _..
U Utility ❑ Specify
M Mixed Use D 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 341 __,. Proposed Hazard Index 790 CMR 343
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sit
i" 11 F4' 1.44 C. 111 1 t r/ 1 rt tip,
Pk G tt f 2110 13rau.' kV ran
3,,1 31 L' b't eG. o "teat
4° 4111 1(0 44d.,,e7 ..
fatal Area(sr) Total Proposed New Construction(si)
Total Height{fl) 1 ID {-f- P's
Total Height ft I p14-
my
7.Water S pply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage D posal System:
Public Private❑ Zone Outside Flood Zone[ Municipal On site disposal systern❑
Version t.7 Commercial Building Permit May 15,2000
8 NORTHAMPTON ZONING
Existing Proposed Required by Zoning
Skscote=to be filled in by
Building Department
Lot Size
Frontage _.
Setbacks Front
Side L. R L _. R.r.. . . _...
Rear
Building Height - --
Bldg. Square heritage _' °6 - _.
Open Space Footage
(Lot area minus bldg&paved
parking)
hi of Parking Spaces
Fill
(volume&Location)
A. Has a Special Permit/Variance/Finding er been issued for/on the site?
NO 0 DON'T KNOW YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW O YES 0
IF YES: enter Book Page aril/or Document A
B. Does the site contain a brook, body of water or wettands? NO DONT KNOW 0 YES O
IF YES, has a permit been or need to he obtained from the Conservation Commission?
Needs to be obtained Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 3 NO d
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 4l /
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading,axed. nv n or filling)over 1 acre or Is it part of a common plan
that will disturb over 1 acre? YES Q NO 0
IF YES,then a Northampton Storm Water Management Permit from Me DPW is required.
Version7.7 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 Cate
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
Sk''a.v. jos\---,-. Not Applicable 0
Company Name:
S \-cp LEA.. oa
Responsible In Charge of Construction
9) 3(13o-r.-- y3. Ctln,,...rs 4n MA 01124 .
Address
I Ajizt
YIC Hi36`75 ?TO 1
Signature Telephone
Version 1.7 Commercial Building Permit May IS,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes fl No 0
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
i._....- 114EOn+if,
r �� 6In.Sit'!T�'.�/.ay �U�. MI.S/�C�A (tsit9 -- as Owner of the subject properly
hereby authorize. SI_ I VS fl ed _ _.. _ to
act on my behalf,in I mailers relative to work authorized by this building permit application
Signature of Owner Date
StallaSIC
I, _ ,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 pequry
Print Name _.. _.
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Heider-
License Number
Address Expiration Date
Signature Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§250(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
-
SignedAffidavitAttachedYes 0 No 0 J
__ The Commonwealth 6f Massachusetts
it _ Department of Industrial Accidents
-h = Office of Investigations
4 _ 600 Washington Street
Boston, AIA 02111
www✓nass.gov/dia
Workers' Compensation Insurance Affidavit: Bnilders/ContractorsfElectricians/Piambers
Applicant Information Please Print Legibly
Name(Business/Organiz.atioedlndividual): ]' QS
te
Address:
City/State/Zip: Phone#: _
Are you an employer?Check the
appropriate box: Type of project(required):
1.01❑ I m P a employer with 4. El I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractorsb ED `
vconslnlciion
2. I am a sole proprietor or permed- listed on the attached sheet. 7. Remodeling
6.6
ship and have no employees These sub-contractors have g, m Demolition
working for me in any capacity. employees and have workers'
9
cornu insurances ri Building addition
[No workers' comp.insurance b
required.] 5. ❑ We are a corporation and its 10. 771 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I L❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees. [No workers' i-.❑Other_m_
comp.insurance required.]
'Any applicant that checks boa PI must also fill out the section below showing their workers'compensation policy information_
t Homeowners who submit this affidavit indicating the are doing all work and then hire outside cost:mu rs must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet sho vingthe Hann of the aub-contmcmrs and state whether or not those entities have
employees. If Cr sub-contactors have employer,they must provide their workers'comp.policy number.
I an an employer that is providing markers'compensation insurance for air employees. Below is the policy and job sizer
information.
insurance Company Name:
Policy fi or Self-ins.Lic.#: Expiration Date:
Job Site Address: Cftv!StatelZip:,,,,, •
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 ofa 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 DLA for insurance coverage verification.
y caitiffpainsand penalties o e,jur that the information provided above is true as
Ldo het eb ort! under the fp 1 y f p � and correct.
Signature: 1� „ W� _ .... Date: yvr. 91 2,01 (a _
I
Phone#:
Official use only. Do not write in this area,to be completed by Ell:y or town official
cial
City or Town: Permit/License M1
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#:
•
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: 23- ✓Ylq,t;1 Si- Sv Ie 94 ti
The debris will be transported by: ..J/t4I'STE1Q-- /NI 134-C-OEALDW) G
The debris will be received by:
Building permit number: 1
Name of Permit Applicant JCnni W Q,r4t •
aick I (0 511 IP
Date Signature of Permit Applicant
Ctt new wwllf - Sler/ groyne_
s781"^ i42 code,
drt,vrau
DRESSING ROOM RENOVATION PLAN /ZC chane/t.. nn9'p
Bird's Eye View .flw.L deadniev board /0
3'6" <---3'--i
1 I — -___J ,
41/peck/di..., j?-y-4(
City of Northampton
Building Department 11.11"
Plan Review ^'
212 Main Street
Northampton, MA 01060
DRESSING
AREA
HALLWAY 4'1' (DUCT(
� 1 i
DRESSING ROOM RENOVATION PLAN S NN
Southwest Wall A
'/i
is N
16'
T I
LED STORAGE (EXISTING ouc17
recessed I
C -
A J C J
— -. _0- -. II. _O _ 0.
10
DRESSING DRESSING DRESSING G3"
ROOM 1 T6" ROOM 2 ROOM 3 O O O
O
CUBBIES
0 0
Stephen Yoshen,General Contractor
I request that you grant a modification to waive the requirement for control
construction for the SCDT Construction Project at 25 Main Street in Northampton
because the work is of a minor nature, will not affect health, accessibility, life and
fire safety, or structural requirements and is impractical in that the cost of control
construction is considerable when compared to the cost of the proposed work.
Thank you for your consideration. "Mass Amendments, sections 107.1 allows for
an exclusion from control construction for this project"
Respectfully, "��i /���1,7
Your Name '�>G C`
Stephen Yoshen
PO Box 41
Cummington, MA 01026
Versionl 7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(Tait CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes n No 0
SECTION 11-OWNER AUTHORIZATION-To BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1. as Owner of the subject property
hereby authorize to
act on my behalf,in ell matters relaiva to work authorized by this budding permit application.
Slgrotum or Owner Date
1. as OwnerAuthorrsed
Agent hereby declare that the statements end 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
Scrotum of Oxer/Apert Data
SECTION 12-CONSTRUCTION SERVICES
10.1 licensed Construction Supervisor: SJoshe4, Not Applicable 0
Hun of license Holder:) l.)o iTC+%9t) Gan.. C-S— Ott K 9p
License Numbs
el
'I ..,I I /0/ 1 /201 7-
Address_ W X 4I)CwHN1;34 MA of p Gy N'2 /a025- y£O J
Telephone
EiDiraEon DateSignalise (A / 1
SECTION 1S-WORKERS'COMPENSATION INSURANCE AFFIDAVT(M.G.L 0.152,§25C(ry)
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 bu ng permit
Signed AffidavitAttached Yes \✓J No 0
Versionl.T Co m ercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) /� /�
Independent Structural Engineering Stmcbral Peer Review Required Yes C) No C)
SECTION II.OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. as Owner of the subject property
hereby authorize to
act on my behalf,in all matters relative to work authorized by this bullring permit appficaion.
Sianetue of Owner Date
!tlriiY relalYlt
(, _ as Owner/Authorized
Agent hereby declare that the statements and informebon on the foregoing application are hue and accurate,to the best of my Imowledge
and belief.
Sired under the pains and penalties of perjury.
Pen Name
Signature of Omer/Agent Date
SECTION 12-CONSTRUCTION SERVICES 11-Y�-'� V/
101 Licenceuoer 4 d ConNntctlon S : S J' o$he-r-, Not Applicable
Nem.w uc.n.e Hela.r j Skp hcv.9uc l--s, cS— oFB K v o
Lemma Number
/o/ f J2o1 4-
Expiration Data
ation
Marna Tox (4I) Cwtv. .t3I.r 4 osnk ‘41,3 tray /Sei
signature /c- \ C1/1}-f-
A / Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L o.152,525C(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 bu ng permit
Signed Affidavit Attached Yes No 0