32C-163 (33) 23 RANDOLPH PL I I I BP-2018-1340
GIS 4: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32C- 163 CITY OF NORTHAMPTON
Lot-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorr REPAIR BUILDING PERMIT
Permit4 BP-2018-1340
Proiect# JS-2018-002379
Est Cost: $19446.00
Fee: $136.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: MARK SMITH 104325
Lot Size(sq. ft): Owner: TAYLOR PAT
zonine,URC(105)/WP(53)/ Applicant: MARK SMITH
AT: 23 RANDOLPH PL 111
AonlicantAddress: Phone: Insurance:
5 ANNA ST (413) 531-7342
WAREMA01082 ISSUED ON:6.11812018 0.00:00
TO PERFORM THE FOLLOWING WORK REPLACEMENT OF WOOD GUARDRAILS ON
DECKS
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 4 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 Occuoancv sienature:
Fee'IWDe: Date Paid: Amount:
Building 6/18/20180:00:00 $136.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File 4 BP-2018-1340
APPLICANT/CONTACT PERSON MARK SMITH
ADDRESS/PHONE 5 ANNA ST WARE (413)531-7342
PROPERTY LOCATION 23 RANDOLPH PL 1 I 1
MAP 32C PARCEL 163 000 ZONE URC(105VWP(53)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED RED DATE
ZONING FORM FILLED OUT
Fee Paid
Builditua Permit Filled out
Fee Paid
Typeof Construction: REPLACEMENT OF WOOD GUARDRAILS VN D S
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building PlansIncluded:
Owner/Statement or License 104325
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOMATION 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&
ariance-Received&Recorded at Registry of Deeds Proof Enclosed
_Other Permits Required:
Cub 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
D r lition Delay
Si eof Buildmg to Date
Note:Issuance of a Zoning permit does not relieve a applicanPs 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.
Versionl.7 Commercial Building Permit May IS 2000
uce
City of Northampton gt,9Wnj
JUN 1 4 2018 Building Department iupRArhr }Mt+ —
212 Main Street
Room 100
DEPT OF BUILDING+INSPE OTION5 N rthampton, MA01060 T1yad „
NORTHAMPTON.MA01 _567-12Q0 F8X Q13-567-1272
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 PPr000eM Address: This section to be complial by office
T�Rr�Jj�6 c P tt �kC2 C O�SDo S mop G Lot I C2 3 Unit
za overlay Distrbt
, ttit/t'.... _ Eanx DIMCI CB Dlwmt
SECTION 2.PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 n r of Record,
-rzjjor
Name(PrIM) Cunerd Meiling Address:
<413G�O . CQp(g
Sign Telephone
2.2 O M:
pIV- SPrL S A 11.)
Name(Pdnt) Cunent Melling Admen:
l E( 3' Sal I3 {2
SlgnaNre Telephorre
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
corinDleted ov Permit applicant
1. Building r r,(/ oo ',. (a)Building PemTit Fee
2. Electrical -:- (b)Estimated Total Cost of
Construction from e
3. Plumbing Building Permit Fee pp
4. Mechanical(HVAC) - 1
5.Fire Protection ff
8. Total=(1 +2+3+4+5) .� Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signahrre:
BWId salonedl tldkga Data
Versionl.7 Commercial 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 (:3 Demolition Repairs❑ Additions ❑ Accessory Building
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other,o
Brief Description Enter a brief description here. 1 /l 1
Of Proposed Work: , JCC ACQIt4CrJ'I C�- __.WOOD `-i�Uft('C��(((�g ori 4ej-S_
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Chock as applicable) CONSTRUCTION TYPE
A Assembly13A-1 13A-2 11A-3 13 IA ❑
A4 ❑ A-5 ❑ 18 ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H Hi h Hazard ❑ 3A ❑
1 Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 R-3 ❑ 5A
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Unity ❑ 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 _I I I ... . .. . .. Proposed Use Group: .
Existing 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(sl)
2n02m
30 . . - 3m
Total Area(sf) Total Proposed New Construction.(sf).
Total Haight(ft) _
Total Height it
7.Water Supply(M.G.L.c.40,$54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ I Zone ' Outside Flood Zone[] Municipal ❑ On site disposal system[]
Vmionl.7 Commercial Building Permit May 15,2000
g. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This columv w filed in by
Building Rpertmmt
Lot Size _.
Frontage
Setbacks Front
Side L:-R:— L_R:
Rear
Building Height
Bldg.Square Footage - _... %
Open Space Footage % -
av area minus bids a pevcd _.
psiidsut)
#of Parking Spaces
Fill:
volume A atim _..-
A. Has a Special Permit/Variance/Fin�din(g ever been issued for/on the site?
NO O DONT KNOW NV YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book '. Page, and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 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 10(70( NO O
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
IF YES, describe size, type and location: .
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or Is R part of a common plan
that will disturb over 1 acre? YES O NO
UY
IF YES,then a Northampton Storm Water Management Pem t from the DPW is required.
Versionl.7 Commercial Building Permit May l5,2000
SECTION 9.PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 776 CONTAINING MORE TNAN 95,009 C.F.OF ENCLOSED SPACE
9.1 Registered Arehltect:
Not Applicable ❑
Name(Registrars):
Registration Number
Address
Expiretion Date
Signature Telephone
9.2 Registered Profeeslonal En Ineer(s):
Name Arae of Responsibility
Address Registration Number
Signature Telephoro Expiration Date
Name Area of Responsibility
,..Address _. _.. Registration Number
SignaNre Teleptrorre Expiration Date
Name Am of ResponsibiNty
Address Registration Number
-Signature Telephone Donner Data
Name Area of Responsibility
Address Registration Number
Signature Telephone F)Orebon Date
9.3 General Contractor tom
oobsm l-t-ws Not Applicable❑
Comp any Name..
Responsible In Charge of Coretiuctlon _
� /SNR �• �°de-r {��V'
Address
signsture Telephone
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(730 CMR 110.11)
Independent Structural Engimumng Structural Peer Review Required Yes 0 No O
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
/ p1 awe m if of the subject property
hereby authonze t -A nf� t�{ bC ' Oc?obbS M 17k5. to
act on m hat,in all madam relative Yprk authorized by this building permit application.
ftela41 I$
u of Amer Date
1 .. .. Nod IV: ,J`+M(Til ,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 unndof=t�he pains and penalties M perjury.
Print Name
Signature of Amer/Agent Data
SECTION 12-CONSTRUCTION SERVICES
10.1 I G ;�\--+ ter ' Not Ap licable ❑ 2
Name o Lleenee Holder. Ptr� r/R'(•[1 r'1 .... ��._.
LioNNe Number
5 F� Ntt rcfc GUA 12 L3119
Address E�IreU�
Signature Talephsns
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.152,S 25C(3))
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 No O
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: Qv ba-PC'bo s
The debris will be transported by:�� pp
The debris will be received by: NO(w4r'LQAO
Building permit number:
Name of Permit Applicant �1Af KtQ4l
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department offndustrial Accidents
1 Congress Street Suite 100
Boston,MA 02114-2017
www.massgov/dia
ulkrken'Compenstation Insurance Affidavit:Builders/Contractors/ElecMciamfPlumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Asailicant Information ase Print Legibly
Name(am vac./orgea eation/lndividua0: SS,1 cTK Ll r&A o Oa5 AA Cl H S
Address: 1 / 5 ry NnJA 5f
City/State/Zip: WAteI MA Ol6Bti Phone#: `f13- 531' -73` 2—
Are you so employer±Check tie.pproprime box: Type of project(required):
I.[]I am a employer wiN employees(fol mdlm paaaime).* 7. ❑New construction
z I mawlepmprie mpm hipandhavewo loyeeswwking fvencin 8. Remodeling
y uweity.[No workers'cowry.insuence re9uirM.7
3.❑lamah orcr doing ell work myself.Mo worker'comp.humane required.]' 1 [1 Demolition
4.❑l em a hommwnmevd cora be hiring wvtractomm conduct ell work on my pmKnY. I will 10 F]Building addition
cnmue met all cxom chher have woh 'cempeaudion imutmee or are sole I1.❑Electrical repairs or additions
leo,oiebn with ro employees.
12.❑Plumbing sepsis or additions
50 1..general oeatracterand I have hired the mbembumes listed en the attached shat ;❑Roof re ahs
rise subsontractoes have era,1'ees and have wrM
orke 'co .insurance .
s P
6.❑We are a coryonoon and in oRicers have exemisai their right ofexenrytion per MGL o 14. Other
152,§I(4),asst we have no employees.[No worker%comp.insurance requved]
*Any applicant that checks box 41 matt aim fill out the sats.below showing thein worker'co nper sane.polity iofmmaaon.
f Hommwmers who submit Nu afidavit indicating Nay are doing all work and Wen hire outside connector must submit.new affidavit indicating meth.
;C .aactms Nm check ria box moat duchedmadditional A.showing the some afNesub touiors anduse whether or not thou meets have
employees. Ifthe sub<oaammm have employees,Nry mart povide their workers'comp.polity number.
lam an employer that is providing workers'canpensadon insurance for my employees Below is the policy andjob site
information. /� ( //.� Co.Insurance Company Name: CorJTlde k� �s`-dl/l/kRC
Policy p or Self-ins.Lia#: (A)- 01U { L�0 ;3-ISs Expiration Date: 7 ELL4 �,1 rt
Job Site Address: �r1{1dLPi4 1' ACP. City/Smte/Zip: ��O("Yv�ft%4{3�X{ MA
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiation date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby ceoder the n a afperjury that the infarmadon provW/ed alIffbove is nae and correct
S'mture' 1111 2 I 1q lr� Date'
Phone M K� S • 5') \- �I ? T�
Official use only. Do not write in this area,to be completed by city or fawn oj/tciat
City or Town: Permk/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 M: