24D-146 215 STATE ST BP-2018-0007
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24D- 146 CITY OF NORTHAMPTON
Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Stair BUILDING PERMIT
Permit# BP-2018-0007
Project# JS-2018-000020
Est. Cost: $2000.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group:
MARK ALBRIGHT 079655
Lot Size(sct.ft.): 9452.52 Owner: VERSON ALAN&PAULA
Zoning: URC(100)/ Applicant: MARK ALBRIGHT
AT: 215 STATE ST
Applicant Address: Phone: Insurance:
481 KENNEDY RD (413) 259-5015 0
L E E D S MA01053 ISSUED ON:7/6/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACEMENT OF OLD ENTRY STAIR - 5 STEP
LANDING - NO CHANGE TO FOOTPRINT
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 Occu Banc si•nature:
FeeType: Date Paid: Amount:
Building 7/6/20170:00:00 $100.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2018-0007
APPLICANT/CONTACT PERSON MARK ALBRIGHT
ADDRESS/PHONE 481 KENNEDY RD LEEDS (413)259-50150
PROPERTY LOCATION 215 STATE ST
MAP 24D PARCEL 146 OW ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
-C.[JCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
���JJJ /\I
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REPLACEMENT 0 NTRY STAIR-5 STEP LANDING-NO CHANGE TO
FOOTPRINT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 079655
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
1/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
Demolition Delay
77i/ 7
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 40A.Contact Office of
Planning&Development for more information.
Version17 Commercial Buildings Permit May IS,ZO0D
Department use any
City of Northampton Status d Pen*:
r3 ' % Building DeparlrnBM aro Pam..... -
/ 212 Main Street Serorlsepac AvMlboly
* ' Room 100 wereANen k- -' ry
�- Northampton, MA 01060 Two Seta d StucSsal Rees`�,
hi
phone 413-567-1240 Fax 413-557-1272 MUGU Ms
Other Smelly -
TO CONSTRUCT,REPAIR, RENOVATE,CHANGE TME I1SE OR OCCUPANCY OF,OR DEMOLISH ANY BIIR.DING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Properly AOAYefs' Pass section to be cos.plsbd case
oee
3o Fran 51., NcrrbAdt$ton lisp ? FI.J Lot /``(e int
-). .A.-- 5r4c J - Zone Overlay District
E3m a Markt Ca Diner
SECTION 2-PROPERTY ORNERSMWAURIORIZ£D AGENT
Z,1 Owner of Resort
RIan Verb/( 9° Co -Z• st.
Nene(PM) cleat Mrig Actress:
Sitnakta -,9A " ^ y-m i Tag 5Y6 13 48
2,.2 A Worked Aped'
47 hr fl(brl` V}
Mane Irmrq .'I/ farrere Mains Address:
signalise �- I .... Teleplme
$ECT10N 3-ESTIMATED CONSTR.. •d COSTS
r
Ilam Estirnaaad Cost(Dollars)lobe Official use Only
canpleted M permit apgicant
1. ®ril6rg A
/ - OGS (a)Baring Permit Fee
2. Elaoid (b)Parmelee Taal Cor d
Construction tom(6)
3. Parroting Bota6lp Perna Fee
•
4, Mechanical(HVAC)
5. Fire P,aoc on �l
6. Told=(1 +2+3+4+5) N '}G60 Caedr Number quo i ` on
This Section Foe Mittel use Only
Sulkier()Perna Minter Date
Issued
Signalers-
k1i3y Qrnsiebsmrepadndauldge Date
C ) 'ai ye;yrr to plan'Vio r,Xho, Re'
Version1.7 Commercial Building Permit May I5,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS IRAN b5,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing NMI Skew 0 DMmNOon❑ sepAYA❑ Amdo.a ❑ Accessory Bulking
Exterior Marren ❑ Lalling Ground Sgn 0 New Signs 0 RoolIng❑ Change of Use❑ Omer 0
Brie Description Enter a brie(description here. Kee1Ct went of cid cnty- Sjuir - 5 fyrp53 but dint .
Ol Proposed Work: r 3(' ukbve Fndc
SECTION 5-USE GROUP AND CONSTRUCTION TYPE 1
USE GROUP(Chock as moulted.) CONSTRUCTION TYPE
A Aasemby ❑ A-1 0 A-2 0 A-3 0 IA ❑
A-4 0 A-5 0 1B 0
B Business 0 2A 0
E Educational 0 2B 0
F Factory 0 F-I ❑ F-2 0 2C 0
H High Hazard 0 3A 0
I Institutional 0 1-1 ❑ 1-2 0 1-3 0 3B 0
M Mercantile 0 4 0 _
R Resile tial 0 R-1 0 R-2 0 R-3 0 5A 0
S Storage ❑ S-1 0 S-2 0 5B 0
U Ulhty ❑ 4e0ty:
M Meed use ❑ specify:
S Special Use ❑ Specify:
COMPLETE TI-NS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
E9sOlg Use Group: Proposed We Group:
Fang Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION S BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sr)
t° 1000 r{ 19 � )6sf
2` - l Doo 7
a'° r- loo rf 0"
4th
Trial Area(s0 n }300 5f TOWS Prcposed NeW Cavan-bon (N)
IV 36 .71
Taal Height(0) /- I(0'
Twat He1ghi a 6r
7.Water Suppy(mat_c.40,S 54) 7.1 Flood Zone Inlonrtelon: 7.3 Swage DYpool Swam:
Pubic ® Private 0 Zone Outside Flood Zone® Municipal N On site deposal system❑
Versionl.7 Commercial Building Permit May 15,2000
S. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
%Na cka,pf,s Building Department
Loi Size 6.111 at
Frontage p'7.7-j"'
Setbacks Front 3o'
Side L: 1e1 R 6S L: R:
R IP'
Building Height tto'
Bldg. Square Footage . 10oocf '`t0.0 °
Open Space Footage
(Lot area minus bldg&paved Srootf rp.0
Parking)
N of Parking SFices S
Fill:
od®c&lur uoa)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW YES O
IF YES: enter Book Page and/or Document I
B. Does the site contain a brook, body of water cc wetlands? NO DON!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 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO
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 •
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading.excavation,or filing)over 1 acre or is it pan of a common plan
that will disturb over 1 acre? YES 0 NO •
IF YES,then a Northampton Storm Water Management Penntt Intim 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 799 CYR 116(CONTAINING YORE THAN 36,009 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable S
Name(Refl :
Registration Number
Address
Expiation Date
Signature Telephone
9.2 Re}aleled Professional Engineer(s):
Name Area at Resparisbilility
Address Registration Number
Signature Telephone Expiation Date
Name Area of Respalsid&y
Address Registration Number
Sigelve Telephone Eptadon Date
Name Area at Responsibility
Address Registration Number
Signalise Telephone Expiation Date
Name Area of '—,,mibiNy
Address Registration Number
Signature Telephone Epiration Date
9.9 General Contractor
Not Applicable it
Company Name:
Respans3le In Charge of Construction
Address
Signature Telephone
Versionl.7 Commercial 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 APPUES FOR BUILDING PERMIT
I,
At Vtrfc✓) 1 {� as Owner of the subject property
hereby authorize Marr' A I bri yIt to
act on my behalf,in all(matatteerrss relative to work authorized by this building permit application.
I/UYY I tel"'✓M i 7/5717
Slgnehnof One& Date
I r `ac k PI LC\di , as Owoes/Aut ohzed
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Sighed thepains'.f 1 ilk -
Print Name /
Sigrabee of Owner/{bent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Con tuctIon Supervisor Not Applicable ❑
Nemec*LicweWider: MCCC Allir`: 11,C1-
1
� CSPA-07765'5-
License
FI + qgo7 ss
1 /CY€20/S
Address 11SSj /f�CC.,n 1 R2\- ( /3)zn— co, Expiration
Signature 6/l/",- Telephorhe
SECTION 13-WORKERS PENSATION INSURANCE AFFIDAVIT(M.CvL.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 mance of the building permit
Signed Affidavit Attached Yes ja No 0
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 150k
Address of the work: 30 F;nn 5r.
/
The debris will be transported by: /Vali?
° t /e rCo d�
The debris will be received by: Va lied Rec�s dint-
Building
Building permit number: 0 9
Name of Permit Applicant Mat at /e nb rl
7/ 5/ 17 I* 11/217
Date Signature of Permit Applicant
the Commonwealth of Massachusetts
R Department of IndustrialAccidents
I Office of Investigations
s=i1= "s
s.. ._ 1 Congress Street,Suite 100
st* t = Boston,MA 02114-2017
�a.. www.mass.gov/dia
Workag Compens3tidn InarranceAffidavit: Builder#Contrador&ElectridanSFlumbefs
Applicant Information // f Please Print Leeibly
Name(Business/OrgmizaticnMdividual): /19rA 7"1n/L rl qI k t'
Address: Lig/ k4llhe4 Ra -
V/
a . 1
City/State/Zip: �I
c Phone#: & 3) 2 CI SO/
Are you an employer?Check the appropriate box: "Project(requited):
I.0 I am a employer with 4. 0 I am a general contractor and I 6. a Icer(req )_
employees(full and/or part-time).• have hired the sub-contractors 6. ❑New construction
2.)4I am a sole proprietor or partner- listed on the attached sheet T 0 Remodeling
ship and have no employees These subcontractors have 8_ ❑Demolition
working for me in any capacity. employees ad ham Wahab' 9. 0 Building addition
[No wakes' corrp.inmate comp.insurance t
required.] 5. 0 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
12.0 Roof repairs
insurance required] t c_ 152,§1(4),and we have no
employes [No workers' 13.0 Other
comp.insurance required.]
'Ary anthem tri checks hen#1 meg dmfill at the section below Waving noir waked earpe®tim Nig inamalon.
t Homeowners who submit thin affidavit indicating they am doing all work and then him outside contractors must submit a new affidavit indioating such.
teontractr a that check this box mint attached an additional sheet showing the name of the sub-contractors and stale vrielher ornot those entities have
empbyta. If We submlradasteemcln,ee6 they m6 peoiidadtr wakes'carp polio/mumbo.
I an al employer that is prate.ngworkers' oanpensaden insurance for my employees Below is the policy and job ate
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy dedagice page(alowing the policy number and expiration dale).
Failure to secure coverage as required under Section 25A of MGI.c. 152 can lead to the imposition of criminal penalties of a
tine up to$1,500.00 and/or one-year inyniso®mt,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 for ins . : coverage verification.
Ido hereby • are , .- '4 of perjury that the infonnaaon providedMme• awe and correct.
ature: 1
nrete: 7 5 17
Phone#:
Official ire only. Do run write in this area,to be completed by city or tone official
City or Town: Permit/License#
Issuing Authority(circle one):
t.Board of Health 2.%Haim Department 3.Cily/rown Clerk 4.Floor cal Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone 0:
Information and Instructions
Massachusetts GaaM Lays chiller 152 requires al employers to provide wakes' compensation for their employees
Pursuant to this statute,an employee isttained m°...every person in the service of mother hurler ay coital of tire,
apses a implied,a9 or written."
An employer isddined m"an individual,partnership,axed aloe caporaion or other legal abty,a ay two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
a an the wands cc taking apputa ad thereto than not bemuse of such enploymad be banned to be ai employer."
MGL chapter 152,§25C(6)ase SaesttJ°every state or local licensing agency Milli withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.°
Additionally,MGL chapter 152,§25C(7)Sales'Neither the wnim medth nor ay of itspditical sbditi51cns9hal
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
rapiraneds of this chapter hat ben presided to the contrading aihaity."
Applicants
Reason!! out the workers' carpersalion diktat mrrplddy, by checking the boxesttta apply to yur situation aid,it
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificates)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
merrbas a panes ae not repirei to Cary workers co pe s iai inmate. If an LLC a LLP does hare
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Acddents Shand you hare ay questions rewiring the lay or if you ae required to obtain awakea
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the ay. I, ':to line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy idomhffiah(if rscessay) aid under'Job Ste Address" the applirad.hound write°SI !maims in (drys
town)." A copy of the afidaat that has been off idaly stamped a naked by the dty a town may beprovided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home ower or citizen is obtaining a license or pemrit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
the Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Depaunenrs address telephone an tae number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel. #617-727-4910 ext 7406 or 1-877-MASSAFE
Revised 7-2013 Fax#617-727-7749
wwwmass.gov/dia
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A d 1011
Mark Albright-Builder Gib ,,cJQ
(�h? / 3 t
I request that you grant a modification to waive the requirement for control construction for the entry
stair at 215 State St. 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.Thank you for your
consideration. "Mass Amendments, sections 107.1 allows for an exclusion from control construction for
this project'
Respectfully,
Mark Albright
481 Kennedy Rd.
Leeds, MA.01053