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31C-047 (4) File#BP-2018-0685 APPLICANT/CONTACT PERSON D A SULLIVAN&SONS INC ADDRESS/PHONE 82 NORTH ST NORTHAMPTON (413)584-0310 PROPERTY LOCATION 88 VILLAGE HILL RD MAP 3 1 C PARCEL 047 001 ZONE PV THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST LOSED REQUIRED DATE ZONING FORM FILLED OUT -n Fee Paid 11 Building Pemtit Filled out Fee Paid Tvveof Construction, RENOVATE COACH HOUSE NEW FIRE PROTECTION PLUMB MECH ELECTRIC STRUCTURAL REPAIRS _ New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included Owner/Statement or License 54080 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON 7RMATION 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 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 nel 8D 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. =!!. oial Buildin Permit Ma 15,20(16 Deparbnent use only City of North 0 StaeniblPerme: Building Department Curb CuUDrhnwey Permit 212 Main Street SewedSopgcAvallabitlb Room 100 watenwolAysaw I 111 I Northampton, MA 01060 Taeeatnof5bubd"PlerM phone 413-587-1240 Fax 413-587-1272 Plot/Sits Plans, .- Dow SpecHy APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING (`{, '`1 SECTION I-SITE WFORMATION 1/ tJ� Moil) 1.1 Property Address: This aectlrsn to M compNtad by olncs 0,i V! GCff{fE I W I- 12.0,10, Map J� C Lot 0-1-7 Unit /210�TN9" �N l -! i i. Zone overlay Distriot 0/0('p - - - — - -- ' Elm SI OISWct CB Dlatrlel SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: �� 1R 47pWaTY6a4v� gb /vc�.ZTH 57. N'TDN Name(Prix) Current Mailing Address: `fl3-SV q--0310 Signature —AUTelephone 2.2 Authorized Anent: Name(Pnnt) Curren Mailing Address: Signature Tele/phone §ECTION: -E TI TE S R ST �/oO QQ/j,00 /•� _ 5 ✓/tires Item Estimated Cost(Dollars)to be Official Use Only completed by vermit agmlicant 1. Building �j a/000 06 (a)Building Permit Fee i 2. Electrical (b)Estimated Total Coat of Construction from 6 _... 3. Plumbing l90' Off,V Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection I. �✓f C906) 6. Total=(1 +2+3+4+5) 000,00 Check Number G This Section For Official Use Only Building Permit Number Dale Issued Signature. Building Commissionmilrepector of Buildings Date Versionl.7 Commercial Building Permit May 15,2000 SECTION 4 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLO D SPACE Interior Alterationsxlsting Wall Signs ❑ Demolition Repairs❑ Additions El At ory Building❑ Exterior Alteration Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use 00ier❑ Brief Description 1 Enter a brief description here. NbvsrT� LU�jCF/f{-oUSC Of Proposed Work: Ne ij, �izo]SGT/�/�GViYI �( RiAY/ -�2/Gl'.7T/w GT SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A AssemblyElA-1 11A-2 ElA-311131A A4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ -1 ❑ 1-2 ❑ 1-3 ❑ 313 M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ SA ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ ... U Utility ❑ Specify: '. M Mixed Use Specify ❑ ' 1^6 mewr V_' OW F�y Q �G _,�rF3 S Special Use Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: 14*" VA;ev Proposed Use Group Existing Hazard Index 780 CMR 34) : I 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) 1n ' Sl/d 5F 2 5/fro ma 2� A�✓�/SFr `� /�o+ 3p 3'° �FT _ 4m 4u /Q� /67/ Total Area(sit � 30 Total Proposed NeW kitNchon_(sf) / rYl�s.L Total Height(ft) Total Height it 7.Water ply(M.G.L.c. 56) 7.1 Flood Zone Information: 7.3 Sawa D osal System: Public Private ❑ Zone Outside Flood Zone Municipal On site disposal system❑ Version1.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONBVG Existing Proposed Required by Zoning This column m be IDW m by Buildwg Dclwwent Lot Size Frontage Setbacks Front Side L R: L R:. Rear Building Height Bldg.Square Footage % Open Space Footage % (Lar vee minus bldg&yavud puking) I #of Puking Spaces Fill: volume&l.ocatiov A. Has a Special Permit/Variance/Finding er been issued for/on the site? NO © DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the/R�eg{i�strY of Deeds? V NO © 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 0111DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained © , Date issued: ) C. Do any signs exist on the property? YES O NO V 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,ex on,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from 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 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant): Registration Number Address Expiration Dale Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responslbility Address Registration Number Signature Telephone Fxpirsdon Date L Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date L Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone Versiom1.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes O No O SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR ,APPLIES FOR BUILDING WHEN 1 MAI A �yG//,,` l0r' ", 'l ,as Owner of the subject property hereby authorvefT� FL"m //U 'to act on my 41If,in al a s relative to work authorized by this building permit application. //(/ 1z. lL l� Signature of Owner Date I, J011AI /A/ _ as OwnerfAuthonzed 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 / r url Pont Name UST/�v / /� Vt3 //�✓" Signature of OwnerlAgem Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction u llmisl ,r: �j may/ Not ttlAJpplicable [IName of License Holder `'�'V r ." '.�N `1 6 License Number . /Z05PEGT vT_ /Ln/ ff�w/PI'A'+/� &q Address Expiration Dale 71713-575-6c,35-6_-?,c Signato Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.' §26C(S)) Workers Compensation Insurance a t must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the bLKding permit. Signed Affidavit Attached Yes No Q SQ\ I rat, LVUtUIV/INcus," Vf IY/NJJUC/tUJC{W SQ Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name (Business/Organization/Individual): Denmark Property Group, LLC Address: 88 Village Hill Rd. City/State/Zip: Northampton, MA 01060 Phone#: 413-584-0310 Are you an employer? Check the appropriate box: Type of project(required): 1.Q I am a employer with 25 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. t 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required,] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp. insurance required.] *Amy applicant that checks box NI must also fill out the section below showing their workers'compauation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then him outside contractors must submit a new affidavit indicating such. lContraaors that check this box most attached an additional sheet showing the name of the subcontractors and thein workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the polity and jab site information. Insurance Company Name: AIM Mutual Policy#or Self-ins.Lie.#: MCC20020000932017A Expiration Date: 7/112018 Job Site Address: Coach House 88 Village Hill City/State/Zip: Northampton MA 01060 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 tine 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 12/21/17 Phone#. 413-584-0310 QKwial use only. Do not write in this area,to be completed by city or town official City or Town: Pervait/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other 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: b u' l (A,&—Y f�-EGYCU N& The debris will be transported by: VA TUU ( V'I-rj The debris will be received by: Building permit number: Name of Permit Applicant M l G ftocoalty lS w oL)� G 2-21 -I Date ignature of ermit Ap ' nt