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24D-119
206 KING ST BP-2019-0109 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block:24D- 119 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-2019-0109 Project JS-2019-000039 Est Cost $15000.00 Fee $105.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SCOTT CANEY 105347 Lot Size(sp.ft.): 15942.96 Owner: VALLEY BUILDING COMPANY INC zoning HB(100)/URC(OV Applicant. SCOTT CANEY AT. 206 KING ST Applicant Address: Phone: Insurance: 21 DEXTER ST (413) 374-7619 SOLE PROPRIETOR HOLYOKEMA01040 ISSUED ON.•7/27/2018 0:00:00 TO PERFORM THE FOLLOWING WORK FRAMING AND DRYWALL OF PARTITION WALLS AND INSTALL INTERIOR DOORS AND TRIM 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: FeeTYDe: Date Paid: Amount: Building 7/27/20180:00:00 $105.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0109 APPLICANT/CONTACT PERSON SCOTT CANEY ADDRESS/PHONE 21 DEXTER ST HOLYOKE (413)374-7619 PROPERTY LOCATION 206 KING ST MAP 24D PARCEL 119 001 ZONE HB(100)/URC(O/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST E OSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Tvpeof Constnuction: FRAMING AND DRYWAlklOF PARTITION WALLS AND INSTALL INTERIOR DOORS AND TRIM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 105347 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFRRMATIOn,�RESENTED: 1/Approved�f�/�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 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. Version L7 Commercial Building Permit May l5,2000 oapaDrnem °fir City of Northampton o� rn Building Department Curb Perils . no 212 Main Street "` I o NRoom 100 p c to m Northampton, MA 01060 Tina+ Pte 9 r� <6 e413-587-1240 Fax 413-587-1272 PloVS > de II . m m "r'vr'F I, ATION TO � RUCT, REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING m OTHER THAN A ONE OR TWO FAMILY DWELLING BE kRUN 1-SITE INFORMATION 1.1 Property Address'. This section to be completed by ONca G V-n Sf _.. -._... Map Lot Unit iU o r L,oma--? (-..A ✓y1 c- Zone oveday District --.._.. ---------- _--_ .__._ _ Elm St.District CB Districtl SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Ownero Racord: 0. tldl�j Name(Pont _! � ('1 � Current Mailing Address OI OjS Sign re Telephone 2.2 Autho zed Agent: Name(Pnnp Curter Mailing Address Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by pemnit applicant 1. Building _ - — (a) Building Permit Fee -- - - -- -- - 2. Electrical (b)Estimated Total Cost of Construction from fi '.__._. 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) - - - Ito- ' 5. Fire Protection -- -- 6. Total=(1 +2+3+4+5) Check Number /OS, GO This Section For Official Use Only Building Permit Number Date Issued Signature: Building Coman luonedlnspe lar of Building. Date Versionl.7 Commercial Building Permit May 15,2000 SECTION 4 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE ,4 Interior Alterations El Existing Wall Signs ❑ Demolition❑ Repairs[3 Additions ± Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use ElOther❑ Brief Description Enter a brie description here. G r-a..� ,:. o f Pa.J-.{--�.o wocU s. Of Proposed Work: fJr•.�WMIA S'av Luau$ KsI�X. I "^ /�LDT �FiBy-$ /7 vin, SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly11A-1 13A-2 E] A-3131A [I A-4 ❑ A-5 ❑ 1B ❑ 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 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ 5 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 ANDIOR 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) St 2nd 9' ._.. 4 _. 4m Total Area(sf) Total Proposed New Construction (st)_ Total Height(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 ❑ Zone Outside Flood Zone[] Municipal 0 On site disposal system I-1 Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING PExisting Proposed Required by g This col hfi1IW by 0und elmNornt F ks Front Side L: --- R:,, -_ ---. Rear Building Height Bldg. Square Footage --' - - % --- --' - Open Space Footage _.- .. -_.._. ---_ -------, #of Parkin aces --- ( olume&Locatiov -- A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW ® 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 ® NO -0 IF YES, describe size, type and location: 7a rX 72, 'i PC G Ur� h D. Are there any proposed changes to or additions of signs intended for the property? YES O NO 0 ---... IF YES, describe size, type and location: 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 1 acre? YES O NO IF YES,then a Northampton Ste"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 118(CONTAINING MORE THAN 38,000 C.F.OF ENCLOSED SPACE 9.1 Registered Architect: Not Applicable 13 Name(Registrars) _. . — _ _""___". ___..__... ... Registra-Number Address Fxpiratidn Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of ResponsOiGly Address _ _ Regrska(an Nwnber Signature TelephoneExpiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date' 9.3 General Contractor _. Not Applicable Company Name JOHN UtiRrJt? Respons ble In Charge of Coremnotion too ({ Sh4-A,---- ._ -a_.__- ...... CPT 144 Addre �t zt 7yY12_ tore TelePnone Versianl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER RENEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes © No SECTION II -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize --J b 14(q ba C&L(.k(LbL) �to act on behalf, ip all matt relative work authorized by this building permit application L 7- 25 - zorg Si grallae.f0wrer Date MEN— 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. 6igMe77Tk1Wt1ne_pfns_anc1 n ies of pe0ury P i Na e +ce ar 6011 Signature of OwnerlAgent Date SECTION 12.CONSTRUCTION SERVICES 10.1 Licensed Construction Suoerv'sor: Not Applicable ❑ Name of License Holder SZO 7-1'-- 64A_e y.. ` � � 10 53 `0 I License Number 2 � Trr Sr _ rtl 0(o�ro ( 51�p Atltlress Expiration Date y�3 -3 �6ry Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.152,§25C(S)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide[his affitlavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes 0 No 0 City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, 554, 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: The debris will be transported by: CO The debris will be received by: Building permit number: Name of Permit Applicant i Date Si nature of mit plicant �\ The Commonwealth of Massachusetts Department oflndustrla[Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. A Gcant Information Please Print Le 'bl Business/Organization�Name: rrIa WN �II it/-CG Address: � O y L/n(M r City/State/Zip: , C Id Mq d (0 �'4 Phone#: `I t 3 214 - 19 94 D Are you an employer?Check the appropriate box: Business Type(required): 1.❑ 1 am a employer with employees(full and/ 5. ❑Retail lc/7 or part-time).' 6. []RestauranhBar/Eating Establishment tf1 2. I am a sole proprietor or partnership and have no 7, ❑Office and, 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 c. 152,p1(4),and we have 10.❑Manufacturing no employees. [No workers'comp.insurance required]* 11 ❑Health C re 4.❑ Weare a non-profit organization,staffed by volunteers, with no employees.[No workers' comp.insurance req.] 12. S Other .Any applicant that checks box#1 must also fill ow Ne section below showing amGwodcem'compensation policy infomution. "Ifthe wryomte oR m have exempted ihemselvcs,but the wspomtion has oWcr employees,a wod,en'compensation policy is required and such an organization should check box#i. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information Insurance Company Name: Insurer's Address: City/State/Zip: Policy#or Self-ins.Lia# Expiration Date: 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 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 insurance coverage verification. do hereby cev under the sins andpenatti of perjury that the information provided above is nue and correct Su t ( okn.� rDate -7-2,9 -20(3 phone 4 Official use only. Do not write in this area,to be completed by city or fawn 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 Once 6.Other Contact Person: Phone#: www.masa.eo�raia Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, coal or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any 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 or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall 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)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely, by checking the boxes that apply to your situation and,if necessary,supply your insurance company's time,address and phone number along with a certificate of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have 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 Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate 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 information(if necessary). A copy of the affidavit that has been officially stamped or marked by the city or town may be provided 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 owner or citizen is obtaining a license or permit not related to any business or commercial venture(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street Boston, MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 www.mass.gov/dia Foon Revised 02-23-15 q oil W-V x a BREAK'RM I. \ gTQ%A . + ROOM2 P-1 , 7� ° ROOM E a.ii•Xa2" REGt�T�01d \ li J_ O'RX9�1 49'X6'2" pp LM"AREA ' 100'I 3t7FY' .. inn Rr R Ro� � `BItL RM � " � rxs.e• 57DRAC,� ROOM 2 q-j�•Xat f' ROOM RQOM 1. p l / MLLt MFA iiR9 � . LIYIxb ARZoN ip0'i 9Q i*f 2 3