31B-311 (21) 42 GOTHIC ST BP-2017-0861
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:31B-311 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2017-0861
Project# JS-2017-001449
Est.Cost: $1000.00
Fee: $0.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: CITY OF NORTHAMPTON CENTRAL SERVICES
Lot Size(sq.ft.): 16814.16 Owner: NORTHAMPTON CITY OF CITY PROPERTY
Zoning: CB(100)/ Applicant: CITY OF NORTHAMPTON CENTRAL SERVICES
AT: 42 GOTHIC ST
Applicant Address: Phone: Insurance:
Memorial Hall (413) 587-1260 O
NORTHAMPTONMA01060 ISSUED ON:1/17/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:interior renovation to office area. Close off wall,
extend 2nd wall
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 1/17/2017 0:00:00 $0.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0861
APPLICANT/CONTACT PERSON CITY OF NORTHAMPTON CENTRAL SERVICES
ADDRESS/PHONE Memorial Hall NORTHAMPTON (413)587-1260 Q
PROPERTY LOCATION 42 GOTHIC ST
MAP 3IB PARCEL 311 001 ZONE CB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: interior renovation to office area.Close off wall,extend 2nd wall
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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
••oliti. O ay
ifirati/ _ /7-7rSi: : : • o:uilding Official 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.
T Verson L7 Convne¢ral Buddmo Pcrmrt May b 0000
�
` \ '\ _Department use only
$ , City or Northampton States of Permit -
\ 0\ fit' 5Uflding Department crib Outhtnveway-Permit -
\ 212 Main Street Sewer/Septic Availability
i
\ - Room 100 Water eptAvadai�Wy
Northampton, MA 01 060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 1=16tfsde Plans
Other Spec[ry
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
4ut 1C'.5 _ _... _____ Map - Lot Unft
1orLiF\Aw PC2t•-11 U}°c Ol ob o
Zone Overlay District
-- — -.Elm St_-0strict - CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
C,C(` OC4611'tTAV,Wre —,- TD Aw yU�Ds DlD6o
Name(P It^O t . �Uw"itY-r�nl`tom Cuneat Mailing Ada
An).5 ttlVDca,
yin
_nature If, . Telephone _—
2.2 Auth• izeWlak\\
J______..___.__-____ _.__ _ ___ .__ ..
Name(Pant) Current Mailing Address-
signature
ddressSignature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant -
1. Building W (a)Building Permit Fee
2 Electrical (b)Estimated Total Cost of
_ Construction Construction from(6) ________.__.____
3. Plumbing BVJding Permit Fee
4. Mechanical (HVAC) --
5. Fire Prot tion -- -----
6. Total=(1 +2+3+4 +5) ( 110110•1D - � Check Number
This Section.For Official Use Only
Budding Permit Number Date
Issued
Signature_:
-:mono Comm:ss.onefilnspector of Baildinos Date .. - _
Version 17T(.ommercial Saddam Fenian 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 Repairs Additions Accessory Building
Exterior Alteration ❑ Existing Ground Sign 0 New Signs 0 Rooting Change o Use Other ❑
Brief Description Watt a brief description here. Q-l"Q1J1- `40000 11) Q Ct AMI.
.
Of Proposed Work: y th$ yl O5tCsb4b WALL
SECTION 5 -USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE +
A Assembly ❑ A-I 0 A-2 ❑ A-3 0 IA ❑
A4 ❑ A-5 ❑ 13 0
B..Business ❑ 2A
E Educationzi ❑ -.......... — 23 I' ❑
F Factory 0 F..1 ❑ F-2 ❑ 2C ❑
L. Hazard ❑ 3A ❑
I Institutional 0 I-I 0 1-2 ❑ 1-3 0 3B ❑
M Mercantile ❑ 4 ❑
R....Residential 0 R1 0 R-2 0 R-3 0 5A ❑
s....Storage ❑ s..l ❑ S-2 0 5B 0
U UtllitY ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify: • 14 -
COMPLETE-THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS ADDMONS 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 EMS VINO PROPOSES)NEW CONS(RUCTION OFFfCE USC ONLY
XI
Floor Area per Floor(sf)
1
int
3i° _. ..
3r7
_______.._..____--_.—... _.__
Total Ales{sf) Total Proposed New Construction(sf?
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L. c.40,§54) 7.1 Flood 2on4,lnformation: 7.3 Sewage D spasm System:
Pubilc ❑ Private❑ " Zone_�,,,,, Outside Flood Zone❑ Municipal fl On she disposal system
Version',7 Comercial Building Permit May 15,2000
I SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTIONSERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116.(CONTAINING MORE THAN 35,000 CI OF ENCLOSED SPACE) .
9.1 Registered Architect _ 7
Not Applicable ❑
Name 4 aah pf,_— ____..._..___..—. _...
Registration Number
Andress _
Expi2fion Date
Signature Telephone
9.2 Registered Profession&Engineer(s):
Name u Area of Respon tdey
Address R gsfption Number
ignature Telephone Experattort Date
Name nrea of Responsibility
Address „ Registration Number _-
Signature Telephone Expiration Date
Name Area or Rvspane dirty
Address R=gistrd'Jpn Number
Siynature - Telephone Expiration Date
Name Area of Rasponsbility
Address Registration Number
Signature - Telephone Expiration Date
9.3 General Contractor
-.0141.)-VS6 Not Applicable ❑
Company Name'
1' ut+je?o6(1.44ry —
Responsible In Charge of Constmctton
li ,lA C6t tOII."fkk A1J tA V•AK
Address
Vbk ► _51 nM
V,r Store .Telephone -
j _
Vermont Commercial Buildne Permit May li,2000..
S NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This cabmen to be filled m by
Building Deparnnent
Lot Size
Frontage _______ — __—_._..._:
Setbacks Frans —'
Side L: R— --
Rear
_Reaz
Building Height
Bldg. Square Footage
Open Space Footage _-- % -- ---
(Lot area minus bldg&paved _ ---
parkin¢)
#of Parlang Spaces
Fill:
(volume&Lamborn
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES
IF YES, date Issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0 "
IF YES: enter Book : , Faoe and/or Documentn:'
B. Does the site contain a brook, body of water or wet'.ands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained , Date Issued:
C. Do any signs exist on the property? YES 0 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 0 NO 0
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grad'mg,excavation,or filing(over 1 acre or Is it part of a common plan
that will disturb over 1 acre? YES 0 NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required
s.- - The Commonwealth oyfMfassachz:setts
-_ Depar.ment of Industrial Accidents__. -. .
"` Office ofIto estigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia.
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
An clicant Information Please Print Lee-idly
INane (Business/OrqunizsdoMndividuv):
Address:
City/State/Zip: Phone 4:
Are you an employer?Check the appropriate box: Type of project(required):
1.0 I am a e nloyer with 4. 0 I am a general contractor and I
ernployees(fun audios part-time ' have hired the soh-contractors 6. New mn5tmcfion
}
2.! 1 I am a sole proprietor or partner- listed on the attached sheet. 7: E Remodeling
shin and have no employees These sub-contractors have g. 0 Demolition
working for me is any capacity. employees and have workers'
9. Building addition
[No workers'conga insurance comp.insurace7
required.] d. [3 We are a corporation and its 10.! Electrical repairs or additions
3.El I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself [No workers' right of exemption per MGL r
Y comp. 1' Roof repairs
insurance required.] t empl2,oyees.
and we have no
emplogoyees.('No workers' 13.0 Other
comp.insurance required.') _
'Any applicant that checks box ail most also fill out the section below showing Moir workers'compeusadon policy inforrmzton-
t Contrmwrswhocheck
submit this saffidavitindicatingadayare shoot all work andalt hireeusub-de urntreerorzmust
state
wrntanew not ose m titles suck
;Contractors that check!his box must attached on additional shoot showing the rant of the sub-mncmmrs and sore whether or not those mdtles hzvr.
errploya. If the sub-con actors have employees,they nustprovide thea workers'conic.policynumbe.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job the
information,
Insurance Company Name:
Policy it or Self-ins.Lic.#: 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 ofIvMGL 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 DLA for insurance coverage verification.
i do hereby certify under the pains and penalties of peduty that the information provided above is true and correct
Siomature' �t
Phone#:
Official as'e 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 Ileairh 2, Ruifding Department 3.City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector
6. Other
. Contact Person: Phone o:_
•
Version1.7 Cormnercial Building Permit May 15,2000
•
SECTION 10-STRUCTURAL PEER REVIEW(780.CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11 - OWNER AUTHORIZATION TO-BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property
herebyauthorize ___.—_..._—-_ —_— __..___ ____.____ __.... _._....._.__—_____to
act on my behalf, in all matters relative to work authorized by this building permit application. _
Signature of Owner Date -
, as Omer/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belie`..
Signed under the pains and penalties of perjury_ ________.._—
Print Name
Signature of Owner/Agent Date
SECTION 12 CONSTRUCTION.SERVICES - {
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
SECTION 13 WORKERS"COMPENSATION INSURANCE AEFIDAVITJM G L.c 1521§ 25C(S))
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
- ... __ F Il o '
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STAFF WORKSTATIONS
CUT OPENING I
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CABINETS (� 4" 3,�„ RACK
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OPENING IN WD. ! L-J
FRAMED WALL q I {
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STAIRWELLa c /
STAFF ROOM
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REPLACE WITH N
FIRST FLOOR PLAN
C SCALE: 1/4" = I'-0"
lireAl
as slo� / ( 71',
City of Northampton
Building Department
Plan Review
212 Main Street
Northampton, MA 01060