32C-046 (10) 96 PLEASANT ST-BARBER SHOP BP-2017-1220
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32C-046 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-2017-1220
Project JS-2017-002056
Est. Cost: $24000.00
Fee: $168.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: HANK SILVER 108530
Lot Size(sq. R.): 7056.72 Owner: HAP INC
Zoning: CB(l00)/ Applicant HANK SILVER
AT: 96 PLEASANT ST - BARBER SHOP
Applicant Address: Phone: Insurance:
53 Old Stage Rd (917) 902-2998 Liability
MONTAGU EMA01351 ISSUED ON:5/I/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:DEMOLISH EXISTING PARTITIONS, REMODEL
REAR OF STORE AS PER ARCHITECTS PLANS TO USE AS BARBERSHOP
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 5/1/2017 0:00:00 $168.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-1220
APPLICANT/CONTACT PERSON HANK SILVER I) /'� �
ADDRESS/PHONE 53 Old Stage Rd MONTAGUE (917)902-2998 � I IIINNN
PROPERTY LOCATION 96 PLEASANT ST-BARBER SHOP ✓
MAP 32C PARCEL 046 001 ZONE CB(I00)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid \4,b/
Building Permit Filled out
Fee Paid
Typeof Construction: DEMOLISH EXISTING PARTITIONS. REMODEL REAR OF STORE AS PER
ARCHITECT'S PLANS TO USE AS BARBERSHOP _
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 108530
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO$.MATION PRESENTED:
I/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
Icy „re
SPV
- _ ding 10 icial 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 Smldtn• Permit Ma 15,2000 )
De - ,
rtm nt •n r 1
City of Northampton Status of Permit
Building Department curb CuUDnveway Pe rt=;,- - -
212 Main Street Sewer/septic Availability
Room 100 Watenwell Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot'Sile Plans
Other Specify
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 Add�r�essy�: SiThis section to be completed by office
,a�Yi i �$7Urv�+A t Map 3� L. Lot 0416/ Unit
!v TU4MMTOU, tIA Zone Overlay Distdct
CB District
SECTION 2•PROPERTY OWNERSHIP/AUTHORIZED AGENT
241 Owner of Record:
11A? blw$iNG OK4 WAyFINVRS ) 32a PEA10ST sd1Te if I
Name(Print) Current Mailing Address.
S�RtniQ0c4D .-/ 01/05
Signature Telephone Ltt7j- ;33 -(60)
2.2 Authorized Agent:
EA it, Sit VCOL
S3cep sTq{;r QD
Name{Print) // '/ Current Mailing Address: `,fI
Signature 4--le"
rC""^T"� r/VaT9SiQC,y /.K.. a3iI I
Telephone 2/7 9 X228
SECTION 3•ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by Permit applicant
1. Building /�`G� (a)Building Permit Fee
2. Electrical ora 5-OC -' (b)Estimated Total Cost of -
d Construction from (6)
3 Plumbing Building Permit Fee
rJG�C�
4. Mechanical(HVAC} .? , .. ...... _.. ..
5. Fire Protection
G. Total=(1 +2+3 +4+5) '#2Y/c Check Number 5 R(/
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
r � '
Version l.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations LTJ Existing Wall Signs 15 Demolition'Repairs Additions Accessory Building
Exterior Alteration ❑ Existing Ground Sign❑ New Signs 0 Roofing❑ Change of Use❑ Other 0
Brief Description Enter a brief description tion here. soucl AXrs+u4 'p44' 7'6'4, ke (t Q.m (44z-
Of
¢Of Proposed Work: L CNin ecT .7,4.05 TO (a .., (jaRfo,p
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A.1 0 A-2 0 A-3 0 IA ' 0
A-4 0 A-5 ❑ .... 18 0
B Business ❑ _.... 2A ❑
E Educational 0 28 0
F Factory 0 At 0 F-2 0 2C 0
H Hirth Hazard 0 _.. _.. 3A -........ 0
Institutional 0 I-0 ❑ 1-2 ❑ -3 0 3B ❑
M Mercantile La' 4 0
R Residential ❑ R-i 0 R-2 0 R-3 ❑ SA 0 —�
S Storage 0 s1 0 S-2 0 i 5B 0
U Utility ❑ Specify:
M Mixed Use ❑ Spocify:'
S Special Use ❑ Specify ...
COMPLE IE This SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: _ _ . . Proposed Use Group:
Existing Hazard Index 780 CMR 34) _ Proposed Hazard Index 780 CMR 34): ._ .....
SECTION 5 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
_. _ 2 a "_ _,.,.
2nD
371 ... . r 3^D ...
4 . ._ . . .... .......v 4u _--
Total Area(sf) fatal Proposed New Construction(sf)
Total Height(ft) _ .
Total Height ft
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 0 On site disposal system❑
Versionl.7 Commercial Building Permit May I5,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Depamment
Lot Size
Frontage . . ._... .. __.. _ .
Setbacks Front
_
Side
Rear _ _. _,.
Building Height
Bldg. Square Footage `. % -- ._
Open Space Footage
(Lotnmus bldg&paved
n
par ng) in
#of Parking Spaces .. _a _ ---
Fill.
(volume&Location) ...._. ._.. ._ .. __.... .....
A. Has a Special Permit/Variance/Findin ver been issued for/on the site?
NO 0 DON'T KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Regi ry of Deeds?
NO 0 DONT KNOW YES 0
IF YES: enter Book Page and/or Document
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES a NO 0
IF YES, describe size, type and location: i VcIt1 ayu ,
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO CD
IF YES, describe size, type and location:
E. WII the construction activity disturb(clearing,grading,exca ation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Verlonl.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 OAR 116(CONTAINING MORE THAN 36,000 C.F.OF ENCLOSED SPACE}
9.1 Registered Architect:
{ vFIA InocC, tGcI5NotAppllcabie ❑
Name(Registrant) _ ..— .... _.
tt,� Registration Number
�1Pd('�� aj,_ wtZE o( � t�Mf6i;t� f�� _61GT��- ...
Address _. .
Signature Telephone
9.2 Registered Professional Engineer(s}:
Name Area of Responsibility
Address Registration Nurnber
Signature Telephone Expiration Date_._ .._._.. ..
Name Area of Responsibility
Address _ .. . Pegistrahon Number _
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
_. _ J _._ __. . . __. _..
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor -/
Q4111-b(/UGC Gw7r I< 71A�r(f vaRK5 _ Not Applicable 0
Company Name: w
1N� I v
Responsible In Charge of Construction
5 _ COLD St4. 6_ 'Qp� ligAmOvele—rA q36
Address
jPIT 9O) 299&
Signature Telephone
•
Version I.7 Commercial Building Perna May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes V No 0
SECTION 11 .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 building permit application.
Signature� of Owner /p Date
I, �/
4MY--,. NG-°+�. .- - - _ _. 1 , 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 perjury
4a-k �
Prim Name
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Constructio Supervisor: Not Applicable 0
Name of License Holder bJK _S/tvS�. __ _ LS "/o8S,`.'�G%..
License Number
33 OLP £14C � D , 1"ioiJ3AGtcX M 351 , J t1/ ,
Address Expiration Date
.uffidl(- v 9/7 90,2 22 8
Signature Telephone
SECTION 13-WORKERS"COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§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 bully g perm
it
,
Signed Affidavit Attached Yes Y NO LJ
C The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of In vestigations
tax-r7 600 Washington Sheet
Boston, MA 02111
wrmv.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plutnbers
Applicant Information II 1/ Please Print Legibly
Name(Business,Organizatichendividua1): 4#4/-4C-
Address!
r^)
Address: b.3 OLP ,"7 true RPS M
RPS , l OPTA-6( `1
( / V J` I
City/State/Zit: b /1 0(5 Phone #: }/7 902,. 2 99 8
Are you an employer?Check the appropriate box: Type of project(required):
I.Cij I an a employer with 4. 0 I am a general contractor and I
ployees(full and/or part-tune).* have hired the subcontractors $- Nein construction
2. I am a sole proprietor or partner-
These
on the attached sheet, 7. 2-1 errvdelin g
These sub-contractors have
ship and have no employees 8. emolition
working for me in any capacity, employees and have workers' 9. Q Building addition
[No workers' comp.insurance comp.insurannet
required.] 5. 0 We are a corporation and its 16.❑Electrical repairs or additions
3.0 I am a homeowner doing all work officers have exercised their I I,❑ Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL
12.[:Roof repairs
insurance required.] c. 152, §1(4),and we have no
employees.[No workers' 13.0 Other
_ comp.insurance required.]
'Any appiicam that checks box#1 mist also ill out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire autside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the nam of the sub-contractors and sate whether or not those entities have
employees. If the sub-caniracmrs have employees,they must provide their workers'corm.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:
Policy#or Self-ins,Lic.#: Expiration Date:
lob Site Address: 76 hen 9v 1 ,y_ ..__.,City/State/Zip: orC7izW'I71 IXd7
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 51 500.00 andtor 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 this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ido hereby certify under the pains and penalties of perjury that the information provided above is Prue and correct
2C-fri- 0°17
SW-natre: t1 ✓'�-"s✓' Date:
Phone#: 9/1 9o2 2 99 Q
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
b.Other
Contact Person: Phone#;
8
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: 28 TI-Gif9W r , c Morrwwtrc4 /14
The debris will be transported by: Att. Wlnacc TaucK0*
The debris will be received by: T 6t-(n 4c—CYCC1QP
Building permit number:
Name of Permit Applicant -4,0-4 c9i-da-
9-1-41 - pot, ocr
Date Signature of Permit Applicant
IFMassachusetts -Department of Public Safely
Board of Building Regulations and Start/Pods,
i C no, Kim S:ft]t;nn
License: CS 108530
t : ',
pANK SILVER '
" .I RATTLESNAKE . Ait . .
Leverett MA 01054
} 92- df • '""'1 - Expiration i.
Commissioner - 08/13/2018