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32C-149 (52)
287 PLEASANT ST BP-2017-1190 GIS g: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C- 149 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-2017-1190 Project JS-2017-002013 Est. Cost: $12000.00 Fee: 5100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ROY OMASTA 006763 Lot Size(sq.ft.): 10715.76 Owner: peter grandonico Zoning: CB(I00)/ Applicant: ROY OMASTA AT: 287 PLEASANT ST Applicant Address: Phone: Insurance: 21 North St (413)247-5666 Workers Compensation HATF I ELDMA01038 ISSUED ON:5/3/2017 0:00:00 TO PERFORM THE FOLLOWING WORK: REPLACE WITH NEW TEMPERED GLASS UNITS, RETRIM EXTERIOR STORE FRONT: REPORT FROM RDP REQUIRED BEFORE WORK IS CONCEALED**ENGINEER OR ARCHITECT MUST INSPECT STORE FRONT HEADER BEFORE PROJECT IS COMPLETE 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 Occu.anc SUnature: FeeTvpe: Date Paid: Amount: 6� 7 eg/cp, 212Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File 4 BP-2017-I 190 C5 i C05 i APPLICANT/CONTACT PERSON ROY OMASTA ADDRESS/PHONE 21 North St HATFIELD (413)247-5666PROPERTY N ANT ST 66D �� 1 6 ,� 5 ?Pa(2.' MAP 32C PARCELO149N0017 ZONES CB(100)/ E NGE AJ' 070-, E0‘QQ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT ,,ff�� Fee ui Paidig 1 \ I Building Permit Filled out Uv Fee Paid lypeofConstruction: REPLACE WITH NEW TEMPERED GLASS UNITS,RETRIM EXTERIOR STORE FRONT fTor,'Nir.(T- a2 A2Cttrilcl MUST 114Seerr Ytoatfnan,T he-ADM- 6E for E New Construction V COC CT i S GJ MPLETEOJ Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 006763 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON ISSUE pe fi Nit\ INFORMATION PRESENTED: r Approved Additional permits required(see below) 0E ', HAVE PLANNING BOARD PERMIT REQUIRED UNDER:§ _ (1fqu 7d prPt'ff — (o NptT1 °P Intermediate Project: Site Plan AND/OR Special Permit With Site Plan WO 26f 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 Demolition Delay C73/1-7 Signature of BuildingOfficial 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 Planning& Development for more information. . . , N m Versionl.7 Comerrlal Bulidin_Permit May 15, 2000 Department use only / 'IT t. City of Northampton Status of Permit ,/ :yt\ Building Department Curb CuttDnveway Permit 4 212 Main Street Sewer/Septic Availability // Q V Room 100 Water/Well Availability Q . Northampton, MA 01060 Two Sets of Structural Plansi-„ phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans_,_,,,' N 7,N Other Specify - r APP CATION 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 7 77 p/r4s- r- sJ. Map 3eACiLot / `1 9 Unit NJ/21,44—ff f PNti' AAA zone Overlay District -- --- --- --I Elm St.District CB District SECTION 2'PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 40/(era p rive fryF,c/�ri � 7 f7�3- ;8fecl++/- (zc f.. . ,r Z% P/CG3HA '- Si'. ...404.7,54- M�'l 6M'i2 Name(Print) PcyCr Gasynao.i.eG Current Mating Address �� . = Version!.?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 0 Demolition❑ Repairs Additions ❑ Accessory Building 0 Exterior Alteration ❑ Existing Ground Sign 0 New Signs❑ Roofing 0 Change of Use❑ Other 0 Brief Description Enter a brief description here. etp?a« +""Ty A"^' Tnopc t'{ G",s5 •+''-1 cis/- Of Proposed Work: 2,74rn C 1 {. SECTION 5 -USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable} 7 CONSTRUCTION TYPE A Assembly A-1 0 A-2 0 A-3 0 1A 0 A-4 ❑ A-5 ❑ 18 I}4 ❑ B Business � 2A I 0 E Educational 0 28 0 F Factory 0 F-1 0 F-2 ❑ 2C ❑ _ H High Hazard ❑ 3A ❑ I Institutional 0 I-1 ❑ I-2 0 1-3 0 3B ❑ M Mercantile 0 4 0 R Residential V. R-1 ❑ R-2 0 R-3 0 SA ' 0 S Storage 0 s 0 S-2 0 5B J 0 U Utility ❑ Specify - 1 M Mixed Use ❑ Specify: _ S Special Use ❑ .� Specify COMPLE f E THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND!OR CHANGE IN USE Existing Use Group: ._._ ._-..._ .. Proposed Use Group: cAr C Existing Hazard Index 780 CMR 34): ._ Proposec Hazard Index 780 CMR 34): _... SECTION 8 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1' 2 ^ _._ Total Area(sf) Toiai Proposed New Construction(sfl Total Height(ft) _ _. Total Hecht ft 7.Water Supply(M.G.L. c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone_._. Outside Flood Zone Municipal 0 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 Frontage _. .. Setbacks Front Side L R'-- LR Rear — Building Height ------ ..__._. Bldg. Square Footage Open Space Footage _ Va -- (Lotareaminusbldg&paved Parking) #of Parking Spaces --- -- Fill, (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Regist of Deeds? ND l0 DONT KNOW YES Q IF YES: enter Book Page ! and/or Document N B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained 0 , Date Issued C. Do any signs exist on the property? YES eY1 NO la IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 9- NO IF YES, describe size, type and location: YP y�.. e c hiq So--4 E. W:8 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 (9 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 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 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 Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area o(Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expraton Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone Version 1.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(78D CMR 110.11) independent Structural Engineering Structural Peer Review Required Yes 0 No SECTION 11 .OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR�APPLIES FOR BUILDING PERMIT i, Re 74!r S2 rrre.e"a"P.-1 z[ ( Gf,. .r. .o uj•' CJ-t,te'S j as Owner of the subject Property hereby authorize1122.1 .. ( mast __.. -.... ...-. __.. ..... to act on my behalf,in all matters relative to work authorize°by this building permit application. y / Signa ist Owner Date - - £,v �/'�✓'fes -._. ...._.� ._.._ ,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 better `/ �- ,¢ Sig��neJd under the pains and penalties of perjury _. �C ""w ( /1`f inli'.7 anntName � . .... Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable 0 12 Name of License Holder 1 _ �.ydvr -- - _ ... _. t License Number -(/ A'^'4 Sr.- .. /4,6 6/676 4J61G3 ..- seeressJ Expiration Date Signature /`}:/ Telephone /6//d4 SECTION 13 -WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.I.c.153,§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 YesGE— No 0 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 wwrn.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumber's Applicant Information J� / Please Print Legibly Name(Pvsines/OrganizatioatIndividual): 0/51.*b kg a.l s-/,,, Address: .) I rt 'ti 4, City/Skate/Zin: i � — -UA / Phone#: `e —)76 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I mm a employer with 3 4. ❑ I am a general contractor and I employees(full and/or part-time).` have hired the sub-contractors 6. ❑ New consrtuetien 2.❑ I am a sole proprietor or partner- These on the attached sheet 7. Remodeling ship and have no employees 'chest sub-contractors have - 8. ❑Demolition working for me in any capacity. employees and have workers' comp. insurance.; 9. ❑ Building addition [No workers'comp.insurance required.] 5. ❑ We area corporation and its I ti j Electrical repairs or additions have exercised their 3.❑ i am a homeowner doing all work officersI I.E Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12,0 Roof repairs insurance required.]t c. 152, §I(4), and we have uo employees. [No workers' 13.1 Other comp. insurance required.] 'Any applicani that checks box#I rear;[also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing aft work and then him outside contactors must submit a new affidavit indicating such, I/Cant/actors that check this box must attached an additional sheet showing the nacre of the sub-contractors and state whether or not those entities have employees. If the sub-connctors have employe ,theyemust provide their workers'comp/policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: /c"'g-r - r'lr...,—Fi / f Policy k or Self-ins.Lic.A: GC.=_Cs, G /3l Expiration Date: 7/aix / 7 Job Site Address: :a1.f 0l'11a44 J/ City/State/Zip: 2/14/Ii q,Sol._ MitCr /a ° C. 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. SI do iunatnreby cer under the pins and penalties of perjury that the information provided vee fl7 and correct. Stsnatttre: '✓G' Date: / P _ • 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 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: a7S r The debris will be transported by: H,. ir,. t (2/--4, l The debris will be received by: 14/4- 7,4_,)- Building 'Building permit number: Name of Permit Applicant 64,1,49- zg);/4,‹ Date Signature of Permit Applicant 282 US-5-Google Maps httpsd/www.google.com/maps/place✓2S7+pleasant+St, Northampto... o . e 282 US-5 •HI TL _ � � �_ • • Google Image capture:Oct 2013 ©2017 Google Northampton,Massachusetts Street View-Oct 2013 1 of 1 421/20/7 9:43 AM i --� f F . 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