32A-138 (15) 25 MAIN ST BP-2017-0207
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao: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# BP-2017-0207
Proiect# JS-2017-000349
Est.Cost: $4500.00
Fee:$100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
use Group: KOHL CONSTRUCTION 073313
Lot Size(sq. ft.): Owner: CHAMISA CORPORATION TO: HAMPSHIRE PROPERTY GROUP
Zoning:CB(100)/ Applicant: KOHL CONSTRUCTION
AT: 25 MAIN ST
Applicant Address: Phone: Insurance:
31 Campus Plaza Rd (413)256-0321 Workers Compensation
HADLEYMA01035 ISSUED ON:9/13/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE GLASS ELEVATOR TOP WITH WOOD
FRAMED ROOF STRUCTURE
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:
FeeTvpe: Date Paid: Amount:
Building 9/13/2016 0:00:00 $100.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
AA C-
File#BP-2017-0207
" 61.11d
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APPLICANT/CONTACT PERSON KOHL CONSTRUCTIONN d� tSclY.c �W'/"
ADDRESS/PHONE 31 Campus Plaza Rd HADLEY01035(413)256-0321 0„ ,n i N6(e S
PROPERTY LOCATION 25 MAIN ST X/,`�. _ f F Rw"
MAP 32A PARCEL 138 000 ZONE CB(IO0)/ UI M I_/
It
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT ,�/
Fee Paid /015-7140015
Building Permit Filled out
Fee Paid
Typeof Construction: REPAIR SKYLIGHT&ROOF AS NECESARYr c(�. SVC]
v-Fv Re'
New Construction cn p � a �S e b Csl
Non Structural interior renovations /� i
Addition to Existing / �
Accessory Structure ' *i.l-I` (I) O /\
Building Plans Included: 4„J , 't �/
Owner/Statement or License 073313
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
✓Approved 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
V
S t• '. a .' I uil.mg a"cia 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 Ruddily Permit May 15,2000
1
Department use only
City of Northampton Status of Permit
AUG � Ll) E Building Department Curb Cut/Driveway Permit -
212 Main Street Soepermit ability
Room 100 VdateiriVen mailability ar
u
xosnn rr , v. __� Northampton, MA 01060
'
Two Sets of Strpcturai Ptapst
phone 413-5874240 Fax 413-587-1272 PbUSiteftans' ;Ra.
Othetaaeity
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
25 Main Street Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
21 Owner of Record:
Chamisa Corporation 31 Campus Plaza Rd. Hadley, MA 01035
Name(Print) Current Mailing Address:
(413)256-0321
Signature Telephone
2.2 Authorized Anent:
Theodore Parker 31 Campus Plaza Rd
Name(Print) Current Mailing Address:
(413)2564)321
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)BuildingPermit Fee
$4,500.00
2. Electrical (b)Estimated Total Cost of
$0'00 Construction from(6)
3. Plumbing $0.00 Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection $N'OO ,/p
6. Total=(1 +2+3+4+5) y 50O Check Number !fl,4 / sm.& ,
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
Version i 7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs 0 Demolition 0 Repairs 0 Additions 0 Accessory Building 0
Exterior Alteration 0 Existing Ground Sign 0 New Signs❑+ Roofing 0 Change of Use❑ Other 0
Brief Description Remove leaking skylight well cover, frame opening, sheath, exterior roof trim at eave and gable,
Of Proposed Work: new rooting on repair and as necessary to patch into existing roof
SECTION 5•USE GROUP AND CONSTRUCTION TYPE N/A NO C+infJ&E it VSE 6RZOAUSO lyre
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 0 A-2 0 A-3 ❑ 1A ' 0
A-4 0 A-5 ❑ 18 0
B Business 0 2A 0
E Educational ❑ 2B ❑
F Factory ❑ F-1 0 F-2 0 2C 0
H High Hazard 0 3A 0
1 Institutional 0 I-1 0 1-2 0 I-3 0 38 0
M Mercantile 0 4 0
R Residential 0 R-1 0 R-2 0 R-3 0 5A 0
S Storage ❑ S-1 ❑ S-2 0 58 [ ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: N/A No CHGY,.B E Proposed Use Group: N/A No CN4n,G
Existing Hazard Index 780 CMR 34): N/A NO CN4A4Z Proposed Hazard Index 780 CMR 34): N/A 4'O C'/44,,C$
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sh
131
si
2nd 2w
3'd
Total Area(sf) 34,000 Total Proposed New Construction(sf)
33,400
Total Height(ft) 60
Total Height ft 60
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 ❑ 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 N/A N/A
Frontage N/A N/A
Setbacks Front
Side L: R: L: R:
Rear
Building Height 60 60
Bldg. Square Footage
•
Open Space Footage
(To(area minus bldg&paved
parking)
#of Parking Spaces
Fill: . .
(volume&Location) _. . .._
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW O YES 0
IF YES: enter Book Page 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 0
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. WII the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre oris 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 I.7 Commercial Building Permit May 15,2046
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
N/A Not Applicable C
Name(Registrant): _
N/A Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
N/A
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
Kohl Construction Inc
Not Applicable C
Company Name:
Theodore Parker/Fred Meyer
Responsible In Charge of Construction
31 Campus Plaza Rd. Dadley,MA
Address
(413) 256-0321
Signature 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 O No O
SECTION 11-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
TAeribl>6 .E Y'an.�.�,� OE C.j-Lfy.M(SA 4t4R C4L•A•tt trJ ,as Owner of the subject properly
hereby authorize KONI- C°14%-r jaCt WM 1,NC to
act on my behalf,in all matters relative to work authorized by this building permit application.
-._ OS - l6 • Ib
Signature of Owner Date
Theodore Parker ,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 undo the�a{os and penalties of perjury.
Print Name L�,e`)
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable 0
Frederick R.Meyer CS-073313
Name of License Holder
License Number
16 Lover's Lane Princeton, MA (H 541 03131/2013
Address Expiration Date
(413) 256-0321
Signature Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.752,§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
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: Z5 Ml1 i kJJ 5/-
The
TThe debris will be transported by: & ats; -re uc)c,426
The debris will be received by: LicFvset sono umrrz O)sRosm _ noi-try
Building permit number:
Name of Permit Applicant� 4enErec,t ,t ilre/et
U7-Pt. i( f/%-��� P
Date Signature of Permit Applicant
(..\ The Commonwealth of Massachusetts
1°�pI Department of Industrial Accidents
'"ice 1 Congress Street,Suite 100
Wit Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit fluliders/Contractors/E lee tricians/Plumbers.
TO RE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Lezibty
Name(Business/Organization'Individual)f Kohl Construction, Inc.
Address:31 Campus Plaza Rd, Suite 3
City/State/Zip:Hadley, MA 01035 Phone#:413 256 0321
Are you an employer?Check the appropriate box: Type of project(required):
LQ I am a employer with 9 _employers(fail mid/or pan-time).` 7. 0 New conutmetion
201am a sole proprietor or partnership and have no employees working for rue in 8. [3 Remodeling
any capacity.[No workers'comp_insurance required]
3❑1 am a homeowner doing all work myself.[No workers'comp.insurance nqulred.]' 9. ❑Demolition
4.01 am ah owner and will be hiring contractors to conduct all work on my property. Iwip IU❑Building addition
ensure that all contractors either have workers compensation insurance or are sole 11.❑Electrical repaint or additions
pmpriiitors with no employees.
12.❑Plumbing repairs or additions
5.0 I am a general contractor and I have him]the subcontractors listed on the attached sheet. 131:1 Roof repairs
These sub-contractors have employees and have workers'comp.insuanee:
6.0 We arca corporation and its officers bare exercised their right of exemption per MGL c. 14.❑Other
152.§1(4),and we have no employees.[No workers'comp.insurance expired]
"Any applicant that checks box'II must also fill out the section below showing their workers compensation policy information.
f Homeowners who submit this affidavit indicating they are doing all work and then hire outside connectors must submit a new affidavit indicating such.
Contactors that check this box must anaehed an additional sheet showing the name of the subcontractors and slate whether or not those entities have
employees. lithe subcontractors have employees,they most provide their workers'comp policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the polity and job site
information.
Insurance Company Name:AIM Mutual Insurance Company
Policy#or Self-ins.Lic.#:'psrMZ 8008002872-2016.0 Expiration Date:2/10/2017
Job Site Address: 25 Main St City/State/Zip:Northampton, MA 0106
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MOL c. 152,§25A is a criminal violation punishable by 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$2.50.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
Ida hereby certify under thei ins And penalties of perjuty that the information provided above is true and correct
Sienature: C./Pl,!f/ /� 1 Date:
as-0 Y•/6
Phone#:413 256 0321 ext 109
k
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):
I.Board of Health 2,Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
gm Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-073313
Construction Supervisor
FREDERICK R MEYER
16 LOVERS LN
PRINCETON MA 0154/
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Expiration
1 Commissioner 03/31/2018
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Kohl Construction
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31 Campus Plaza Road, I ladlcy, MA 01035 ph(413)256-0321
ix(413) 256-0130
Commissioner Hasbrouck August 16, 2016
Subject: Request for Waiver
I request that you grant a modification to waive the requirement for control construction for the
Masonic Building roof repair 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.
All work will be completed within the prescriptive requirements of 780 CMR.Thank you for your
consideration.
"Mass Amendments, sections 107.1 allows for an exclusion from control construction for this project"
Respectfully,
Frederick R. Meyer
Kohl Construction Inc.
31 Campus Plaza Rd
Hadley, MA 01035