23B-014 (8) 125 LOCUST ST-DPW BP-2017-1221
GIS n: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23B-014 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorv: renovation BUILDING PERMIT
Permit# BP-2017-1221
Project# JS-2017-002058
Est.Cost:$1800.00
Fee:$0.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
use troop: Homeowner as Contractor
Lot Size(sa.ft.): 730501.20 Owner: NORTHAMPTON CITY OF BOARD OF PUBLIC WORKS
Zoning: SI(100)/ Applicant: NORTHAMPTON CITY OF BOARD OF PUBLIC WORKS
AT: 125 LOCUST ST - DPW
Applicant Address: Phone: Insurance:
125 LOCUST ST
NORTHAM PTONMA01060 ISSUED ON:4/27/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:INTERIOR RENOVATION TO THE DPW
ADMINISTRATIVE BUILDING
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 4/27/2017 0:00:00 $0.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
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File k BP-2017-1221N ��
APPLICANT/CONTACT PERSON NORTHAMPTON CITY OF BOARD OF PUBLIC WORKS znV.�°4
ADDRESS/PHONE 125 LOCUST ST NORTHAMPTON '�
PROPERTY LOCATION 125 LOCUST ST-DPW
MAP 2313 PARCEL 014 001 ZONE S1(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
Iypeof Construction: INTERIOR RENOVATION TO THE DPW ADMINISTRATIVE BUILDING
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
INFO 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
Demolitio eta
iii <� y
Signature of Building 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 40&Contact Office of
•Planning&Development for more information.
- - Versionl.7 Comznercml BuSIdm¢l'ermit Mav Id 2000 -
- Departrrergiese
City of Northampton Status of Penna
, Building Department Curb CUVOnvewwarFerma -
o-�
212 Main Street Sevier:Septic Avaiabt3;
Room 100 UYSter/Well Availa6Jay
`.r . Northampton, MA 01060 Iwo Sets of Structural Plans
phone 413-58761240 Fax 413-587-1272 plolsde Plans
��. jOUSer Specs;
A-•LIQATION 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 Prooert_y Atldress This section to be completed by office
r� _gg_' dr s ,�( �j zz /, ['
\✓� U"c4 1. _... _—__.. . .—_._...__... Map "1 /3 Lot O '7 Ueit
140i1.A>l3(}}.rvIU W 0)0(0° Z
one Onrlay Distract
__........._.__..._..� -.-_--_.�._ .Elm St O stf ct Cs District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT.
2.1 Owner of Record:
Cl 0? i\kkti' W -
Name(Penn nen
Co t Mailing Add
tv'11}
Signature i telephone
2.2 Authrii 1. ent
Name(Pont) C ftX tog Add es
Signature telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Ofaai Use Only
completed by pel mit applicant
1 Building l f r1Opo (a) Bulldinig Permit Fee
Electrical f
'L _F J"— b Esf maled Total Cost of
__- ConstrYrtcfron from(Fi) _.,. _ ._____
3. Plumbing ' Bdildmg.PermltFee
4. Mechanoe (HVAC) .c
5. Fee Protection l
6. Total e. (1 +2 +3+4 +5) Check Number
This Section For Official Use Only _
Badding Permit Number Fate.
Issued
Sian-tures
i.. 3uiidino Corn miss loneelesperlor of Boeings Date • _ _.
•
Versionl.7 Gonunercial Building Permit.May 15. 2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35;000
CUBIC FEET OF ENCLOSED SPACE n
Interior Alterations ❑ Existing Wall Signs 0 Demolition❑ Repairs Additions ❑ Accessory Building
Exterior Alteration 0 Existing Ground Sign 0 New Signs❑ Roofing❑ Chance of Use❑ Other❑
Brief Description Enter a brief description here. Ii-tt g_tprt-. -rb " 5
Of Proposed Work:- A' N cIMccn
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 0 A-2 ❑ A-3 ❑ IA ❑
A-4 0 A-5 ❑ le ❑
B Business ❑ - 2A r ❑
E Educational ❑ - 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C r 0
H High Hazard -❑ 3A ❑
I Institutional 0 14 ❑ I-2 ❑ I-3 ❑ 3B ❑
M Mercantile 0 4 0
R Residential 0 R-I ❑ R-2 0 R-3 ❑ 5A ❑
S Storage ❑ S-1 0 S-2 ❑ 58 ❑
U Utility ❑ Specify
M Mixed Use ❑ Speciry: ._..
S Special Use ❑ Specify: .
COMPLETETMS SECTION.IF EXISTING BUILDING UNDERGOING RENOVATIONS ADDITIONS AND/CR CHANGE IN USE
Existing Use Group Proposed Use Group:
Existing Hazard Index780 CMR 34):1.. _ Proposed Hazard Index 780 CMR 34):L.__.—_____.____
SECTION.6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE^UBE=:E7NLY
FloorArea per Floor(sf)
2".
4th
4th
Total Area(sf) Total Proposed New Construction(-f)
Total Height(ft)
Total Hecht ft
7.Water Supply(M_G.L. g.40,§54) 7'I Flood Zone Information: 7.3 Sewage-Disposal System:
Public ❑ Private ❑ - Zone'____ Out ide Flood Zone❑ Municipal ❑ On site dsposal system
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO TSA CMR 116(CONTAINING:MORE THAN 35,000 C.F.OF ENCLOSED SPACE) S�
9.1 Registered Architect
Not Ap licable ❑ _. .
FasistraGoo Number `
Address •^ ....,___...
Expimtian Date
Spnature Telephone
9.2 Registered Pro€essionai Engineer(s):
.
Responsibility__... _.-....: Area of
None .........,_ .�.�_—
Address RegstrabanNumber �^
Signature Telephone Expiration Date
Name Area of Responsibility
Address � Registration Number
^Signature Telephone Expiration Dale
Nar.e Area of Respons bt ty
_ _:.ram•_
Advlress Registration Number
Signature Telephone Expiration Date
--._. ._._
Name Area of Responsibility
Address Registration Number
Signature lel phone Expiration Date
$.3 General Contractor
^�,_ �y����p� __ ___.. _..
`,O Th.N'_t .W—}l'C.`^" SN1LND1 Not Applicable ❑
Company Name
Responsible In Charge of Construction
f)Ip 4'�VJ LAtJ�Z
Ei.1 A3.5 •nsc
Telephone - •
Version 1.7 Commercial Building Permit May 15, 2000.8. NORTHAMPTONZONING .. :
Existing Proposed Required by Zoning
Tdis commie.°be tilled in by
Building Department
Lot Size
Frontage ______—... : _.___.._....__...__
Setbacks Front - .....
Side ti:—: R:— L:_—_ R:.�__.
Building Height -- --- --' _
Bldg. Square Footage
Open Space Footage "/o .
I (Lot arta minus bldg&paved __. --_.._-
parking)
#of Parking Spaces -- ---
Rib
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
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 .: Page; and/or Document#
B. Does the site contain a brook, body of water or wetlands? 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 Obtained
, Date Issued:
C. Do any signs exist on the property? YES Q 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 O
IF YES, describe size, type and Location:
E Will the construction activity disturb (clearing,Grading,excavation, orfilling)over 1 acre or is it part of e common plan
that will disturb aver 1 acre? YES O NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is raqubec_
'1
• V erion7.7 Commercial Budding 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'OR BUILDING PERMIT
I, ....__ _ ____——_--- — ____ __ —. _ ___..____.:,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
f
ll
I, M9w"'or-fin .___....____ __..__. s Owner uthorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
an ellef
Sig under the pains and penalties of perj�__
\: : V� � /
�y� - - ___ -- __
Si. at - - ereAg Late
SE ION 1• -CONS J CTION SERVICES
10.1 Licensed Constru ion Supervisor: Not Applicable 0
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
SECTION 13 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MG L O:152,§ 250(Z))
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
, The Common-wealth-of 3lassachusetts _
-- sji� _ -- Department of lndustrial.Acciders_. _ .. .
2 Office of Investigations -
i., 600 if ashinp ow Street
Boston, NIA 02111 - -
-.?-ay." www.massgov/dia.
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information - PIease Print Legibly
Name (Bodin ess/Ornnizari m✓]ndividoa]):
•
Address'
City/State/Zip: Phone#:
Are you an employer? Check the appropriate boy: Type of project (required):
1.❑ I am a emuloyer with 4- ❑ I am a general contactor and I
employees (full and/or part-time).*" have hired the sub-contactors 6. ❑New constructor
2.1 I I am a sole proprietor or partner- listed on the attached sheet. 7: ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. - employees and have workers' 9. LI Building addition
[No workers' comp-insurance comp. insurance.:requited.] 5.5. I I We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself.m seright of exemption per MGL
Y [No workers' comp. 12.7 Roof repairs
insurance required.] t c. lit, (A),and we have no
employees [No workers' 13.H Other
comp.insurance required.]
'Any applicant that checks box dl mist also nil out the section below showing their workers'compensation policy infonradon.
Horm_owners who submit this affidavit hidiennnh they are doing all work and then him outside contactors must submit a new athdavit indicating such.
;Contractors that check this box must attached an additional sheet showing the nano of he subcontractors and state whether or not those entities have
employees. li the subcontractors have employes,they must provide their workers'comp.policy number.
I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.'4: 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 of MGL c. 152 can lead to the imposition of criminal penalties of a
tine up to S1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. Be advised that a copy of tb s 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 perjury that the information provided above is true and correct.
Simature: Date:
Phone=:
II 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): .
1.Board of fealth 2-..Building Department 3..Cin/Town Clerk 4-Electrical Inspector 5,Plumbing Inspector
6.Other
Contact Person: Phoney:
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tl
City of Northampton, Massachusetts
tite Central Services
Memorial Hall, 240 Main Street
Northampton, MA 01060
David Pomerantz (413)587-1238 Fax: (413)587-1248
Director of Central Services
To: Louis Hasbrouck, Building Commissioner
From: David Pomerantz
Date: April 25,2017
Re: Construction Control Waiver
I request that you grant a modification to waive the requirement for construction control for
the project at 125 Locust Street,Northampton, MA. Central Services is performing interior
renovations at the DPW Administration Building.
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.
J�!/!/ 01 aci _� 7-� 7 City of Northampton
/� MS, , Building Department
r4r
> ham pton, MAStreet
Northampton, MA 01060
SCALE
;n i ge A. 1:410 fa MA-31AewM
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1118 I8 d a s III SCALE
II SI4114 . 01 O Q ,
MINo —.
1 El 111
W• 4 °
11 j REORMOVEEXJSDNGW/ T
DOREPLACE I
I
PARTIAL WALLS 11
WINDOW 1 '...
1 ; --
II 1
1illiwaitirr II
Os1:11
lNEW WINDOWS
1 NEW DOOR 1
I Ai NEW
EXISTING
DOOR REPLACE
WI WALL
l-ab, REMOVE EXISTING
1 ® iENTRY ENCLOSURE
REMOVE EXISTING
RECEPTION NEW COUNTER
PARTITION WALL FOR RECEPTION
CITY OF NORTHAMPTON
DEPARTMENT OF PUBLIC WORKS
ENGINEERING DIVISION Proposed Modifications
125 LOCUST STREET DPW BUILDING
NORTHAMPTON. MASSACHUSETTS 01060 PLAN VIEW
(413) 587-1570 FAX 587-1576
1