25A-182 (40) 94 INDUSTRIAL DR BP-2017-1376
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:25A- 182 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2017-1376
Project# JS-2017-002296
Est.Cost: $27000.00
Fee: $168.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: NEWMAN'S CONSTRUCTION 64690
Lot Size(so. ft.): 170319.60 Owner: 94 INDUSTRIAL DRIVE LLC
Zoning: 61(100)1 Applicant: NEWMAN'S CONSTRUCTION
AT: 94 INDUSTRIAL DR
Applicant Address: Phone: Insurance:
697 BRIDGE ROAD (413) 586-0273 WC
NORTHAMPTON MA01060 ISSUED ON:6/1/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:COVER OVER 1 LAYER OF ASPHALT/NEW
ASPHALT VENTING/FLASHINGS
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 ft 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 6/1/2017 0:00:00 $168.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Version!.7 Commercial Boddie:Permit Ma 15,2000
�� O City of Northampton r ;, ,
Building Department
i— 212 Main Street
Room 100
--- --""—Northampton, MA 01060
phone 413-587-1240 Fax 413-587-1272 .e,<9--c-,�?
APPLICATION TO CONSTRUCT,REPAIR RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
ItecnpNi-slaiNFhtthiATnobr
g '—i7-/3 ? (p
_Y.1 PropertAddress :-,-- • - talstaeFITGRIR' ecom -'_ +N�` z -
941 ,,,,,re pus `ritIa! 2_ S�"�`"�
i t` .,.,,- - `1.
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZEtt:AGENT
2.1 Owner of Record:
Tana MOec:44fi kfF I9_5�e.ov-->. fJ>s NAgny2kil
Name(Punt) Current Mailing Address:
iil3 -szli-- :3377 I
Telephone
2.2 Authorized Agent:
'Ntv rt. q ty j 7 r- jilit4.s,a:1/
Name(Print) Current Mailing Address:
eI13 --• s I
Signature Telephone�����
SECTION 3-ES ATED CONSTRUCTION COSTS j /R COO Co
Item Estimated Cast(Goners)to be OfijcsLUse4)nty
oompieted by permit applicant +— c
1. Building - 1 '(a)Buildlhg PermtFee 1
2. Electrical ' teTotal Cost Of r
C.ons'tntbhore7rom i`
(b�ESmad Cost '
3. Plumbing I i 8uiidhlg{'ei i{ifree
4. Mechanical(HVAC) / 1
5.Fire Protection I I J
& 7ofai {Y+2+3+4+5} 1 P� Check Number gbel / az"
/�'ITis Section ForOfiicial Use:Only
Buirdi igPeithlYl'lumb€i
T55ued
Signature:
„0 :ipr5,3o-/ 2
So�dvg m � __.. euitlkips :Date
Version1.7 Commercial Building Permit May 15,2000
'1111.
S, krTlO cnl'.§1.111:-ERWeEs- )00)9:1EBriBSES THAI.35,oaa
¢uBtb�Ero�'ENofsr'�Et>Q��G� .
Interior Alterations 0 Existing Wall Signs 0 Demolition❑ Repairs Additions 0 Accessory Building 0
Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 RoofinO Change of Use❑ Other 0 L _
Brief Description ;Enter a brief description here. Ji"L- /4vhc?/
Of Proposed Work:' 0el.lc '�GIr S tE. I.. n Ot,�nr,4S"Ja i jl s7tei, ifksill s.
CTIONS-USE GROU litcra NS'3f3UGYYQN' 1'PE �'' '.
F
SE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A AssemblyAri 0 A-2 0 A-3 0 1A ❑
❑
A4 0 A50 19 0
B Business ❑ - 2A 0
E Educational ❑ 2B ❑
F Factory 0 F-1 0 F-2 0 2C 0
H High Hazard ❑ 3A 0
I Institutional 0 I-1 0 1-2 0 1-3 0 3B ❑
M Mercantile 0 4 0
R Residential 0 R-1 ❑ R-2 0 R3 0 5A 0
S Storage 0 S-t ❑ S-2 0 55 ' 0
U Utility ''❑ Speedy.1 ._
M MixedUse ❑ Specify!
S Special Use ❑ Specify I
COMP LEtE1}ISBECMO IEEl05 SO]LDMG UtSERClkaRENOVAAtONSADDfIONS'AND/ORCHANGE INFUSE
Existing Use Group: 1 ( Proposed Use Group: '
Existing Hazard Index 780 CMR 34):i —1 Proposed Hazard Index 780 CMR 34):
SECnbtns01GD1NCaHEIGR{.,7,WD71R_Ek, _
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION ?' - b
Floor Area per Floor(sf) 75
gm '- tai I -fix- r. s
2nd 2^^ •... ..... i .> _ .+ fSa
31° ' i 3i° ' a
4t i i 4e
Total Area(sf) 1 Total Proposed New Consbuction(sf) Ts
I I ar r Yi
Total Height(ft) 1 .Lap'5 a
Total Height fl �'11.1f ` � - -+
li
7.Water Supply .G.L e.40,§54) TA Flood Zone Information: 7.3 Sewage Disposal System: ^
(M
Public 0 Private 0 Zone, Outside Flood Zone❑ Municipal 0 On site disposal system[
Version1.7 Commercial Building Permit May 15,2000
a f@m' -ga9.ea5 1sst) f,.
Existing Proposed Required by Zoning
This column to be filled in by
Building Dcpaemmnt
Lot Size I H _
I • i •
Frontage '
Setbacks Front
Side L: � 12: L i^I 2� �.
Rear ___i —
-Brill Reign i .
—J
Bldg.Square Footage II I % rnI. rr
Open Space Footage
(Wt area minus bldg&paved nn I 1
pvtin;)
#of Parkine Spaces nn _J
Fill: ��II
(volume&Location) -
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW et YES ® '
IF YES, date issued: I
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KJ
KNOW YES 0
IF YES: enter Book Pager and/or Document S,
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW YES
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 0 NO Q
IF YES, describe size, type and location: iI an [,,sled)ytQ 3 XH ApprZtX. !
D. Are there any proposed changes to or additions of signs intended fdr the property? YESf'O NO eig
IF YES, describe size, type and location: 1 1
E. Will the construction activity disturb(clearing,grading,excavation,or filling)overt acre or is ii part of a common plan
that will disturb over I acre? YES O NO Qs
IF YES,then a Northampton Storni Water Management Permit from the DPW is required.
Version1.7 Commercial Building Permit May 15,2644
SECTION 4 PROFESSIONAL,DESIGN titr,C,f)NS7RucnoNsERVIGEs•FOR BUtalNGSAN¢STRUCmRERMIJECCSD
CONSTRUCTION CONTROLPURSUAN 'T'O YBP-GMR t'i6 tCON7NNIF2i,MORE TTi/f1136,OORC.R ORM/ICU/SEW
9.1 Registered Architect
. Not Applicable 0
Name(Registrant):
I Registration Number _.. _
Address i
I I Expiration Date
Signature Telephone ,
9.2 Registered Professional Engineer{s):
F 1 t
Area ea of Responsibility
1 I1
Address Registration Number
_ I 1 i
Signature Telephone Expiration Date
I 1
Name Area of Responstbray
II
Address Registration Number
I II I
Signainre Telephone Exphation Date
Name Area of Respon6Sigry
l I
Address Registration Number
1 I 1
_
Signature Telephone Expiration Date
i
Name Area of Responsm'dity
Address Registration Number
i
Signature Telephone Expiation Date
9.3 General Contractor
1 Not Applicable❑
Company Name:
I 1,
Responsible in Charge of Construction
1 r
Address
1
Signature Telephone
Version1.7 Commercial Building Permit May 15,2000
SEOTION10+STRUCTURAL PEER REVIEW(teeCMRti011j'-';- -
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 1t.-OWNERAUTHORIZATION-TO BECOMPLETED--:.WHEN:
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING'PERMR
L _ as Owner of the subject properly
hereby authorize .. Ito
act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of()wmer — Date
(
I, `v' Cr.(e"U✓h 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,
rr a Y�e � ,+�IM1N
PrintName J
<I36/17 I
Signature r/Agent /Date
SECTION -CONSTRUCTION;SERVICES
10.1 Licensed Construction Supervisor. ♦ � Not Applicable 0
Name of License Holder:' `�t'I-t+.'..D. tV Ejx'rn,4 it/
/
License Number
I inir
b9 (. ✓z;h...._� — . , iw ,_�,_ k .CLt1hd 0
Address .. ;
y/3 -576 -/093
Signetu Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAV(T(PA G,L c.152425C(e))
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
1
!, �� e (viii of Northampton r
1-g`iti S f $tu stelncdl.' '_
�.T. . _
q - D£PMiM ENT OP BUILDING INSPECTIONS
�_•
212 Main Street ' Municipal Bolding
Northampton, Mass- 01060 OM
WORKER'S COMPENSATION. U' SURAN(LK Al7FWAyTf
__
Qiavi's/lznfilrtm)
(phonon)
(SUC&d ry/naulap)
do hereby certi?„ under the pains and penalties of perjury. ha:
( ) I am an employer providing the following worker's compensation coverage for my ,
employees working on this job.
' (Ronan=Comca:) (Foie:Number) (xpinlion Dave)
( ) I am a sole proprietor, general comracror or homeowner (cicie one) znd have hued
the contractors listed below who have the following workers compensation policies_
(`lame of Co.*.=aorl (Insuranuo Company/Ponca Number) (Emirx on Date)'.
(Name of Coouanor) (Inslranc Company/Policy Namlbcr) (E pir..don Dom)
(Name of Conanom) ('IIlivtanc Company/Policy Numbed) (Espirrios Dale)
(Name of Contractor) ((osuranc Comnany/Poficy Number) (Eapirauoo Dale).
acid)m:;c¢uJ aK iflthecthryif to bc'u&ioiormtico vcuwoc u.0 vm+cof)
() I am a sole proprietor and have no one woridng for me.
( ) I am:a home owner performing all the work myself.
NOTE:plccirrwai NS€_Ic bcno}aam ubo cloy paths w do^•:•••-• •.. c , cmyth/work m.d..cJin or
otter ihLO '.nee vtia in utm ibe l Ai c cc m Nc vt sop 2-3713-aa'.c tbeen c m CC C HY o c# aJ u
=ploy=uo'c the uxkth-A- enAO(GU 91n I(5)).=ppi;..nno M a howoaoaa ro,sear,a prTM rr=r c ems Sc
irpr.t,..of.a.ploy r ung dv wo.eor.r.,-..y.,,.I:on Ax
I 3°4ctao4t4 a copyf thi cot®®c y S.I - ' dt tha p.p sad of L.4.3ni Att4.md Omm or l.cw^m for W.
Cups YmGctioa M nu EiAac u swain'm.mjc troth=miw]S A of MOL 151 co lath to the' r 'w ofmxJn.l pmiltio
mairinof.Gna ofupw SI300.00.odror ncnsaoa plop w orc y...Lod awl pvlua it 6cf ora Sop Watt O.da.a .
futh of SI W.W.LY.F?ioa mu
Fe-dm.nn.Juc oily
Pcrmil Number
Map:__ —Lot: �{
Signature of Limrs rulr
/Pcmcc -- fate f=
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
_x 600 Washington Street
=`ail= Boston, MA 02111
wwrv.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
r /q
Name (Business/Organization/Individual): Cts �r�(,U,y11q-4,41 Arll.ihn,'+./q/rj Lfri
Address: 6 7 7IAnl
City/State/Zip: _, • =,„ ,`h ' Attie) Phone #: A'l'3 - Si6— it)", 3
Are you an employer? Check the appropriate box: Type of project(required):
I.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. New construction
2.XI am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
workingfor me in anycapacity. employees and have workers'
P tY t 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 123g(Roof repairs
insurance required.] ' c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must 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:
Policy#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 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.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Signature: Date: S/3d//7
Phone#: Ht-3 - Ste -/d ?3
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#:
ti
City of Northampton
MassachusettsEr
w 'c'c�
ti ® c
`? DEPARTMENT OF BUILDING INSPECTIONS i
212 Main Street • Municipal Building CD
Northampton, MA 01060 'SY)..'"yj '
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her
construction supervisor. The state defines "Homeowner' as, " Person(s) who owns a parcel on which
he/she resides or intends to be, a one or two family dwelling, attached or detached structures
accessory to such use and/or farm structures. A person who constructs more than one home in a two-
year period shall not be considered a home owner."
The building department for the City of Northampton wants any person(s)who seek to use the home
owner exemption, to act as their own construction supervisor, to be aware that by doing so you
become responsible for compliance with state building codes and regulations. The inspection
process requires that the building department be called to inspect work at various stages, which include
foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection
(before work is concealed), insulation inspection (if required) and a final building inspection.
The building department requires these inspections before the work is concealed, failure to secure
these inspections can result in failure to obtain a certificate of occupancy until the work can be
inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas)the homeowner will be
responsible to make sure that the trades hired secure their proper permits in conjunction to the building
permit issued, and that they get their required inspections. Failure of the individual trades to secure
the permits and inspections as required can DELAY the project until such time as the proper permits
and inspections are made
understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit issued to me.
Date
Address of work location
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: 9Y 1 r,ouS -r.e,)
The debris will be transported by: gr,..,,,�,4.,vs , s }nuc ?cry
The debris will be received by: V a//r y /?c y tin
Building permit number: l�
Name of Permit Applicant
0607
Date Signa e of Permit Applicant
roposa[ Page No. Pages
lij IArH N
i NEWMAN'S CONSTRUCTION697 Brid []
Rd.
Northampton,MA 01060 12 2 9
41?-5867
PROPOSAL SUBMITTED TO {\ � .� DATE
71
,ti•CL 4-.1e.,, LJ Sa v-3-Z Y? �0/7
STREET JOBOBNAME
T,n t�r7g-�YI . Z � J/n 4JY)i= `--CO.:LIR—O Cni— 1 LEXYt 12
ITy.STATE and ZIP CODE JOB LOCATION /
A/C h.H.kaon' h::N1 ,M,4 r,tcbn'. 52m5 ARCHITECT ARCHITECT \\ DATE OE PLANS JOB PHONE
_
We hereby subi specifications and esti 'le or 1 u5
'
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n Slc-21t ALL:,Art C noun D2:'? z0\ a ccltj 4
Li_ 2K£5 C'�
k £ ' ns c sz. ,y '
rtn5-\c lI .A L.tet alta:n Q'" 3Ttc> # tb-, C.L \Dt\45%i LrN '5 Pi 2z.40—Oa fp
----Cr5\d\\ aa3ALk-,c�zt 6‘II%'r-kc. S 0L, fink. rat 06 Net P•
(CU lop 0_ Ho mnAc4 pk,r-n 1S ? s cbsa as ssi\,3\a
1
CC r Stet . 9+ jar flc c 1. . _Leis\e 1'1' VLoL. JE v1 k- (\�
CA? 1z; Q s 'k �c17AN Lc) s,t1 COi i
D abz:S nip ,o M.K.
oip 'CPJS
a3tD ® 7
q.�L StcCLc1VS. ... S� mom. . f35 flj.GJ�- '"_ .3 000
1bicA \ J e TLs1 4 cn* sL •A` It 6L`..C_ -J 6Obi o icyG. . ..
L/
,1 We Propose(}�ereby to furnish1material and labor—complete in accordance with above specifications,io/ for the sum et:
I i�£1,�- — `c�:. 4l�'y.�Sc vv 17k
OvA oo dollars($ - OOO. ccj ).
Payment to be m dens lolmws. /� g
14 al -O A4- S� a2.} 6t'(� \c, j /abq 1atL1-161Nc`_ boc �cv\ `:+wall.1 rcvl)
C.
All material is guaranteed to be as specified All work to be completed In a workmanlike Authorizedm1
Signature
according to standard practices.Any alteration or deviation tram above specifications
involving ng extra costs will be executed only upon written orders,and will become an extra si g
chargeover
and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry lire tornado and other necessary Insurance. Note:This proposal may be
\ Our workers are fully covered by workman s Compensation Insurance. withdrawn by us it not accepted within days.
\/J Acceptance of Proposal _ above pricesspecifications
and llaacceptedareauthorized work as specified. Payment will be made as outlined above.
Date of Acceptance: Signature /
Newman's Construction LLC
697 Bridge Rdw=-'"'
Northampton,MA01060 i4
{413}586-1093 " l
Commissioner Hasbrouck
May 31, 2017
Subject: Request for Waiver
I request that you grant a modification to waive the requirement for control construction for the Spaces
For Rent project at 94 Industrial Dr,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,
C ru . Newman
Newman's Construction
697 Bridge Rd
Northampton, MA 01060