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39A-020 (13) 118 CONI ST BP-2018-1108 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block: 39A-020 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-2018-1108 Project# JS-2018-001995 Est Cosi $144100.00 Fee: $1008.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Group: STEPHEN D ROSS 079160 Lot Size(sa.ft.): 20473.20 Owner: PICKNELLY PAUL Zoning:GB(100)/ Applicant: STEPHEN D ROSS AT. 118 CONZ ST Applicant Address: Phone: Insurance: 36 SERVICE CENTER RD (413) 584-1224 O WC NORTHAMPTON MAO 1060 ISSUED ON:413012018 0:00:00 TO PERFORM THE FOLLOWING WORIGREMOVE AND REPLACE 2 BATHROOMS AND BREAK AREA PER ELECTRONIC PLANS DATED 4/30/2018 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: FeeType: Date Paid: Amount: Building 4/30/20180:00:00 $1008.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2018-1108 APPLICANT/CONTACT PERSON STEPHEN D ROSS ADDRESS/PHONE 36 SERVICE CENTER RD NORTHAMPTON (413) 584-1224 Q PROPERTY LOCATION I I8 CONZ ST MAP 39A PARCEL 020 001 ZONE GB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T eofConstruction: REMOVE AN REPLACE2BATHROOMSANDBREAKAREA E2 _ C-TRONtC- PEAr45 New Construction DPTU) 30`10 Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 079160 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION PRESENTED: 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 beat 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 1 3oi Signa re 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. Version 1.7 Commercial Buildinc Permit MaY I S 2000 Department use duly. City of Northampton Statue of Permit Building Department Curb CuVDriveway.Permit 212 Main Street SevrerfSeptic Avaeabdity Room 100 Watedt'1611 Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 PIWSite 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 Prouertv Address'. This section to be compbfed by office MaP -3Lot vpvZ V Unit zone Overlay District Elm SL Dhitris CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGEMT 2.1 Owner of Record: Pau ONE tgb,,Afl P1i4ce . SPIel"Ptep H4 Name IF _ CunmtMiiwgndCruo: o71-4 f7(Ou0' 0I1W T�lxne "N4.-YOU 2.2 Authorized Agent: -3(, �r,,,r,r t/t`�„� (°-a.y-.-rl 'Z'- S-✓--Y •�v�. t> Izoss /Uo.r�G-o-.OM'�- .yr,�" oi�Go No..a iPn mint Mai Addr Signature TNephone SECTION 3-ES MATED CONSTRUCTION COSTS Item Estimated Cost tDollars)to be Official Use Only _ oleted b permit ap 1. Building 13 , 70<. c� (a)Building Permit Fee 2. Electncel _ —— ✓ (b)Estimated Total Cost of 7 1 , b O d. Construction from(6 3. Plumbing IU BUIMing Permit Fee 12�t pv' -$ 4 4. Mechanical(HVAC) 0 0 �� 7 Ger `� 1 {�C O b B 5.Fire Protection 6. Total=(14213+4♦5) / 0 i c Check Number This Section For Official Use Only _ Building Pernik Number Del. Issued Signature: Building CommissnrerMspnctor or BuRci 1 Date Versionl.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE I Manor Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs[I 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: f I.��V J �� Qµ a �✓ Q Q SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A4 ❑ A5 ❑ 18 ❑ B Business 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile 4 101R Residential ❑ R-1 ❑ R-2 ElR-3 El 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: µ 1, +..�5$ /Yl... Proposed Use Group a"r "'53 ten.. rr' .f: l... 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(sl) v, 0, 39 L) G? _... ... _.. 2m 2n° 3r° 3'tl 41" _.. 4m Total Area(sB ( �. $ Total Proposed New Construction(sl) Total Height(R) y / Total Height It .ti 7.Water SyPply(M.G.L.c.40,§54) 7.1 Flopd Zone I ormation: 7.3 Sewage Djsposal System: Public Q Private ❑ ZoneOutside Flood Zone Municipal [r'T On site disposal system❑ Versionl.7 Commercial Building Permit May 75,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This coWmn m be fill in by Bpildmg Denamnen, Lot Size Encourage Setbacks Front Side L R: L R: Rear Building Height Bldg.Square Footage % Open Space Footage (.m area morns bldg a paved -EEkin ) #of Parking Spaces Fill: (vowmc&Location) A. Has a Special Permit/Variance/Fin clungOVer been issued for/on the site? NO O DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the Reg ry of Deeds? NO O DONT KNOW YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO iz DONT KNOW O YES O 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 IF YES, describe size, type and location: / D. Are there any proposed changes to or additions of signs intended for the property? YES © NO V IF YES, describe size, type and location: E. Will the construction activity disturb(cleOanng,grading,exw tion,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES NO IF VES,then a Northampton Ste=Water Management Permit from the DPW is required. The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 r Boston,MA 01114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. ADDlicant Information / Please Print F eeibly Business/Organization Name: Address: -3 ii 55- is ,j t � 1Zo City/State/Zip: V.,✓ e t 0 -LPhone#: C/ 13 f811_is Z Z y Are yoy an employer?Check the appropriate box: Business Type(required): I.rV—J�/I am a employer with /7i employees(full and/ 5. ❑Retail or part-time)." 6. ❑RestautantBar/Eating Establishment 2.C3 I am a sole proprietor or partnership and have no 9. Office and/or Sales(incl.real estate, auto,etc) employees working for me in any capacity. [No workers'comp.insurance required] 8. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per e. 152,g](4),and we have 10.❑Manufacturing no employees. [No workers'comp. insurance required]¢ l l ❑Health Care 4.Q We are a non-profit organization,staffed by volunteers, with no employees. [No workers'comp.insurance req.] 12.0 Other "Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information, '•Ifthe corymte officers have exempted themselves,butte corporation has other employees,a workers comperaetom policy is rcgwrcd end such an organissma should check box at I am an employer that is providing/workers'c ¢enation insurance for my employees. Below is the policy information. Insurance Company Name: /V- O q,n re,", Insurer's Address'. City/State/Zip: Policy#or Self-ins. Lic. C L CG V at 107°U 2 o 1-7 4' Expiration Date: Attach a copy of the workers'compensation policy declaration page(showing the policy number Ad extiration 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 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 insumnec coverage verification. I do hereby certify,under thepitim,anndppond ries of perjury that the information provided a e is tru aad correct Si natur ( Z (� Date' "/42(. l0 Phone# C/( 3 5gV— l2Ztie 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.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: wwx.masz goy/dia Version L7 Conn mial Building Permit May 15,2000 SECTION 9•PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 790 CMR 11S(CONTAINING MORE TRAIN SS.93D C.F.OF ENCLOSED SPACE) 9.1 Rs9bbrad An bib t; DF-NNi'S CUti ELL , 317- Not Applicable ❑ Name(RegeazM): 507-16 3L_CENTQUL $t(fEr S�rTE Zo3 FDxBuRax N AR ow35 R"1M18dm"a"D8r a„ Au4u5 Zple W-Z41-2AZ2 ErPlration Dam SgraWre Tel,p 9.2 Rs9isbrsd Professionei En9lneer(s): Name - Area d Ras,tmaeJay AOOrtss Reg abalgn Number Sgnalure TNepiwro Eapa Dare Name Maad Resp biq AEarB6s Regia atan Numb Sgnaaua Te4prare F�Pualion DMe Name area d Resporrsbly Aa]r%4 Rpetralion Numbs, Syne�wa Telep p w F�Pinaon Date Name Area W Racpwaiaity AEtlreas Regitratinr Number Sgnaw. Teagwne Emratkm Date 9.3 GenMl CO naetor � D, R-s i.. C,...-✓ott -/I-I /s NotApp6wW9❑ c«npany A -o-y�, C>- 7q I (PC ReapaneAhin dCer¢vu tis, AtlNes Signa TeWh" Vmsionl.7 Commmcid Buildipg Peml¢:Kay 15,2080 SECTION 1Q STRUCTURAL PEER REVIEW(780 CMR 110.11) �indapadent SVUp �i O.__ Eng'iree�ir®51rucNtal Peer COM ZTED- wee NO 11• A1R�R OTRAP• LE F CON�TEp 'AN�'hr— OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILOING PERNR L ( t—Z��_ �K1a�s �.w7 ,_:,ae OtMeraNe aub(ad pmpnAy aG�p/n�_lmh�Oehatl n m rela6ue to aufhorkad Oy lllis WlldinS pmn�il vtlaa / Aganthemby darJam thatthe daU m M and inbnnatior Mw foregoing app sWn are the and ac mle,m dw pad a"kn adge i amt bepef. I. 3��ad Mdarfhe Pahlg arp penaM@a 0f perjtay.. SEC770N 12-CAtNRRUCTION SERVICES 1' 0.1 Lim W C.Mtmu tlon Su� ,vKw. +i Not APP#Mble �❑ ) iNomaMLxala`llo"leer �.. "`�'l•�/ � ��.3 / _ _. 7� �Lt�.V7 i 3—(: .�_✓ G-t. �-<s r.��i la-C.._�e,�f a. /bf,lj ��Z7� /.,�`L - um Telegmre SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(N.G.L c.152,82")) Wwkk.COrnpel On tneurdlc6 Httktaxt must pe mrtpktad aM 6ulimi(�atitl�this aytlica0on Fa9weta prv.Me bit aflpavilvaA[aug l inftdWal WMNissuam ofthepwTdingpa k Sgnau AlfdaWtAMadwl Yes No Q 4�d CERTIFICATE OF LIABILITY INSURANCE 6l20/g620' IS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS .:ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: H the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. R SUBROGATION IS WAIVED,wbjeot to Me tarme and conditions of Me policy,certain policies may require an endon amewt. A statement on this mrt&ate does not confer rights to the certReYe holder in lieu of such endoraeme a). 'Noon [ zj�m`Sazl`ars, 6ryldriewics RebLer 6 Grienell ffl _ (413)586-0111 'FAz ,purses-ua1 8 North Ria' Street .bgrynkieaicz@webbersadgrinaell.oom IX80 AFPoPOIXG NIB6V.E "Co Nortbun,ton HA 01060 e.RENAMrcel.io./Liberty 11045 MauREn M hhfRe Petherlands/Liber 124171 Construct Associates, Inc. BORERCFearleas Libez Attn: X:.. Clairezont MeuRERD]EE s/A.I.H. '13083 36 Service Canter Road WWRR E: Nor'tbalmpton SID 01060 COVERAGES CERTIFICATENUMBER 7/1/18 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NANED ASOVE FOR THE POLICY PERIOD INDICATED. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDMON OF ANY CONTRACT OR OTHER DOCUMENT HATH RESPECT TO WHICH THIS CERDFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EECLUSIONSAND CONDITIONS OF SUCH POUCIES.LIMBS SHOWM MAY HAVE BEEN REDUCED BY PAID CLAdAS, INR: TYP .O scURINOEpyy0y xyygEn RCl1CY 4Mhle 81_'`CPa1pRV .ame,'LLLV'yO}Y : IEYAi 0C:URRENCE I§ 11000,000 A OWMSMADE 8 OCCCR : PR 19ES 6 100,000 CHF689S698 3/1/20 7 3/1/2010 MEOE%Pl"omR,mnl :,S 5,000 : PERBONPI BAOV INJVm is 11000,000 GEN'LAGGREGAT_LiRMp:TAPUIMPER. : GENERAL AGGREGATES 2,000,000 POLICY I.. B jECT 'ICO 1, PRODUCS-OIWMPAGGIE 2,000,000 '-!nncsOBILELLBSJrY 5 1,000,000 A ANV AL'O BODILYINJUNYFxP-1) IS ,,=S EO 8 A?J�LEO ',818896698 3/1/2017 1 3/1/2018 800[YJNJURY 8 HIREDAUTOS 8 NONCNMED PROP ppMp E $ AVSCS Me3aIno. IS 5,000 8 WARELIA. E C<CUR :.EPLX occNREN E $ 1,000,000 L. :ErCE491Aa TCW MSMADE' : AGGREGATE IE 11000,000 .0 18 REIENTI E '0.000 1=897298 3/1/2017 3/1/201. g 1 MOrtIPRS WIPBISAIiW : : 8 T IERX- :AxO BPtO(61a'WWtt T/H'I i�yPROPRIEnJRTARTNEp/E%ECOI�c � ELEACX ACCIDENT IS 500,000 D :i O'FIC6Nr-®t E%CwOEY+ ''.X/a1 (YypW1yW. ¢CC600<000]80201]A ]/1/2CD 7/1/2018 EL.OISE>$E-EA EMPLOVEa E 500,000 CEBDRIPOON OFOPERATQNS Lvn I'EL NS E-PQUC LIMIT Is 500.000 D6CIWrpN OFOPEMMHS I IDLATgNB/VEXIC1Eg (gOpRp tOt,PG®Yaml RenvM Sehr46r,mvYBe tlhelletHmxavPw'v e5p,va61 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESC D POLICIES BE CANCELLED BEFORE *AFOL Insurance Info Only** THE EXPMATION DATE THEREOF, NODCE WILL BE DELIVERED IN ACCORDANCE WITH THE MUCY PROVISIONS. pVlHgl®REPIS¢NiaTVE I � n R Webber, C.0 CRIS/BA 0INS-2014 ACORD CORPORATION. All rightsreserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(xia , 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: I I e, CaNy The debris will be transported by: C� wk �Io,�,; -n2 �1 C tc The debris will be received by: t)A-camy �j a2�4C, t._ Building permit number: Name of Permit Applicant viz , Date Signature of Permit Applicant