24D-146 (3) 215-217 STATE ST BP-2018-0988
GIs n: 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 042A)
Category: REPLACEMENT STAIRS BUILDING PERMIT
Permit n BP-2018-0988
Project# JS-2018-001799
Est.cost $15000.00
Fee:$105.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: SOVEREIGN BUILDERS INCO60176
Lot Size(sa. ft.): 9452.52 Owner: VERSON ALAN&PAULA
zoning: URC(100) Applicant., SOVEREIGN BUILDERS INC
AT: 215- 217 STATE ST
Applicant Address: Phone: Insurance:
135 SOUTHAMPTON RD (413) 527-8001 Workers
Compensation
WESTHAMPTONMAO 1027 ISSUED ON:4/3/2078 0:00:00
TO PERFORM THE FOLLOWING WORK.REPLACE 1 STAND 2ND FLOOR DECK AND
STAIRS
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 N Foundation:
Drivewav 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 4/3/20180:00:00 5105.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
VgoD cl2File#BP-2018-0988NL P S
APPLICANT/CONTACT PERSON 3OVEREIGN B LDERS INC 61&
ADDRESS/PHONE 135 SOUTHAMPTON RD W' STHAMPTON (413)527-8001
PROPERTY LOCATION 215-217 STATE ST
MAP 24D PARCEL 146 001 ZONE URC 100 /
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
NCL D REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
B.ildma Permit Filled out
Fee Paid
TvpeofConstruction: REPLACE IST AND 2ND F0QORJarECK AND STAIRS
New Gnsn uction
!on Structural interior renovations
clition to Existing
Accessory Structure
Building Plans Included'
Owned Statement or license 060176
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFI)RMATION PRESENTED:
(/Approved Additional permits required(see below)
i
PLANNING BOARD PERMIT REQUIREDUNDER:§
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
--L � _ 3 3a
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.
FCEIVED
'TIfVcrsio 1.7 ommemial Building Permit May 15,2000
Department use only
o _. .. -af-Northamptorl Status of Permit:
---- Building Department Curb Cut/Driveway Permit -
212 Main Street Sewer/Septic Availability_
Room 100 WaterfWall Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/She 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
p
SECTION 1 -SITE INFORMATION /✓� l " ' / ��
1.1 Property Address'.
This section to be completed by office
Z IS — 2 1 '(r SAF—a--e st✓< or Map :ll,) Lot j--for; unit
v6 Zone Overlay
District Overla CB ct
Elm tnct
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record
A tan Ve✓sor)
Name(Print) Curren)Mading Addr
s
rF �W //(��/ 14414 O1C760
Signature Telephone
2.2 Authorized Agent: I
io�>-L:> CeIIvVq 135 soJtva 4�
Nana;iPrrU Current Mailing Address.
10A Owl
Sigriawro �' /
_ Telephone
SECTI�TIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
om leteit b ermit applicant
1_ Building / S /Jo0 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plom6mq Building Permit Fee
p`
0 Mechanical(HVAC) /OJ
5. Fire Protection
6. Total= (1 -2+3*4+5) 1 Check Number
This Section For Official Use On!
Buii (ding Permit Number Date
ssued 1
Signature.
Building Commissioneeinspectorof Buildings Dale
Vemion1.7 Commemiel Building permit May 15,2000
SECTION 4.CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other ❑
Brief Description Enter a brief description here.
Of Proposed Work:
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ! ❑
B Business ❑ 2A }0
E Educational ❑ 25 ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential L) R-1 ElR-2 ❑ R-3 ®, 5A ❑
S Storage ❑ 5-1 ❑ S-2 ❑ 5B ❑
U Utility, ❑ Specify.
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
LCOMPLETE 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 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
15i 1s�
2,d 2 a
3. 3"
4m 4'n
I
ITotal Area(sf) Total Proposed New Construction(at)
Total Height(fe
Total Height ft
U Nk n e 7
7.Water Supply(M.G.L.a 40,4 54) 7.1 Flood Zone Information: 1 7.3 Sewage Disposal System:
Public Private ❑ _ Zane Outside Flood Zonso Municipal_ On site disposal system❑
Version].7 Commercial Building Permit May 15, 2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This calami to be tilled in by
ouldlnF ly icnoenr
Lo! si,
Fronta ge
Setbacks Front
Side L: R: L R
Rear
Building I Iciaht
Bl uaru F,d1hg,
Open Space Footage °o
(Lm aaz minusbid,&pacul
rarkin l
:I ul Parking S aces
I
I'iIP.
nc h ln�rmnl
A. Hasa Special Per ever been issued for/on the site?
NO Q DONTKNOW YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONTKNOW O YES O
IF YES: enter Book Page and/or Document !!
B. Does the site contain a brook, body of water or wetlands? NO 0 DONTKNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES O NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO Y-r
IF YES, describe size, type and location: Y-�
E Will the construction activity disturb(clearing.grading, excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over l acre' YES O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required
Version L7 Commercial Building Permit May 15,2000
SECTION B.PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES•FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 760 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
L9.1 Reglatered Arcbltect O
1 I ��. I Not Appfoable ❑
m awlsu gfr q �b ?g // �//.1:210
1 --
ti,�- .i. er�a5 Viyni3--Ta'la-pAon�e
/ RE.pgrt1 at"elpn�O�rri
b sCe-
Vdrq��
DaleP2z
SfgPr,
ofessional
Enyineer(s) Tf
Aie. fRespon to,ly
jActle s RegsValoc Number
i $ e.a:__ __ Te;epFon I Expiration Dale
Apo ess Reghl tlpn Number
Signature Telepnona Explrallon Date
tame N rea QTRBSpOnslp,a!y
,
1 —
Adnr . Req 1 1 n Num:ce
I
$iqn Q TB1Q110one c eat ,Dste
f
VamQ Area of Responebilay
14d9ess ftegi9211pn Nember
Sgn ore_ Takp^.on I Expiration Date
9 3 General Contractor
_ � YLII ✓ $ Ts1C . -__ Not Applicable ❑
imp vry Q
Resp GbargeofG snpc6pn
AmreSe p —1
g9pawre '� Tekpnpne
Vurslun(.7 Lbmmm Gizl Building rcrunt Mar IS,2000
SFCTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Lndepend,tw St uctural Enyineenng SL ictural Peer Review Required Asia Q No
SFCTION11 .OWNER AUTHORIZATION-TORE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I
as Owncr o.'Ihc subjectpmpeny
hereov N ria_._ C �. � r L\u\�
act A Nbohalf In all matters relativc to wok au Honied by Ih s building permit applleat'on.
Sign tJwnei O-te
OwnadAulMrzed
Agent horeop declare drat the statements and Irtomtaliwl on the faegping application are true and accurate,to the bast or my knowledge
I'd holler
Shined 1-der the pa11s and panalliea pt perjury.
a
Pr �.�n
i!iN — -.
Date
SECTION 12 CONSTRUCTION SERVICES
j
10.1 Licensed Construction Spu,invoUtir. Not Applicable ❑
NameDruce se Bolder / LC (..L/l/LC I� l/><+'_ i_LS.L�.__
n LJ_
Lisense Number
1 n� as ,,
Td
Ad
Ery at r
l diet
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT none
e
(M.G.L c.162, §26C(6)f
'Norkc ComponsaLror Insu an' a&dav! rnuel be onicildred And submitted WIh this application.Failure to provide this aRlday.t veil reavlt�
n
in,,d I ihe'ssue a of the boiling'curnst,
Sig no APoh rr AnIred Yns _0 _ No
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: 2 1-,- - Z 1-7 f �/(e S�-'
The debris will be transported by: k�OC 1 {{(� 1�J �it JvcOce K
The debris will be received by: r,,dek A
11lyo/ee l4
Building permit number: )//
Name of Permit Applicant o -j> C(? �� ✓�F w✓� ve 5 r�'v (dt�se
r
Date Signature of Permit Applicant
_ ®`acThe Commonwealth of Massachusetts
,� T6 Department of lndustrfalAccidents
I Congress Street,Suite 100
t
a Boston,MA 02114-2017
�R wwwmass.gov/dia
Workers'Compensation Insurance Affidavit:General Businesses.
TO BE FILED WITH THE PERWITT1NG AUTHORITY.
ADDlicant Information Please Print Legibly
Business/Organization Name',_SIo ot P l e,,L, �e ke S (te r•
Address: U i5__ SOLJ rho wt(�(Z e� 6
City/State/Zip: / hone# r-//' -�7`7 — 6� (�Ie:9
Are ou en emperlevel?Check the appropriate box: Business Type(required)-
L i and a employw'ah_ __employees(full and; 5. ❑Retail
((( or pvvt-here).' 6. E]Restaurann Bar Lating Establishment2.❑ I am a sole propriner or partnership and have no 7, ❑Office and/or Sales(incl.real estate, auto,pit,
employees working for me in any capacity_
[No workers' comp, insurance required] 8. ❑Non-profit
3.❑ We arc a corporation and its officers have exercised 9. ❑Entertainment
their right of exemption per a 152, §1(4),and we have 10.❑ Manufacturing
no employees.[No workers'comp. insurance required]" 11,[]Health Care
4.F-1o
We are a nn-profit organization,staffed by vors
luntee ,
wish no employees. [No workers'campo insurance req_] 12.0 Other
'Am ,houcconcheek,boxvl nun elm fill out the section below ahownethos—orkers'mmpen orz
f policy infonnio
�'If0loeor,omte officers have exemptodhems --,hntfly ooryoration has otheremployee auorkasl'compensation pulley is regnire4 end such an
I,oho lot check box.91
pain an cmplop er thri n,prmiding nrkerc'cotnpensation ineurane fpr my,emw isp/oyees lothe policy information.
Insurance Company N,ion, ✓Gy
Irurcl \tdre... � �(to<1�I/
t,t, Ston,!Ipj-
Poll, or Self-ins. Lie. h __,__ Bxpimtion Data._ __
y:r _
Allach 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
tine up In S1.500,00 and or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fere
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
Ime,tign inns o f the D 1A for insurance wedge verification,
I do he, hr cerrtfy, ur the poins ermltias of perjury[hat the information provided bove 1 true and correct.
$i�namr L -� Date: f�L
r -
Phone:. —
Official use only. Do not write in this area,to be completed by city or town official.
City or Tmvn:_ Permit/License N
Issuing.Authority(circle one):
1. Board of Health 2. Building Department 3.Cityffnwn Clerk 4. Licensing Board 5,Selectmen's Office
6.Other
Contact Person: Phone k:
www two, v/dia