17C-218 (6) 29 NORTH MAPLE ST BP-2019-0343
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C-218 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-2019-0343
ProLct# JS-2019-000556
Fes,Cut;W700.00
Fee:$100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor., License:
Use Gronp: JOSUE LOPEZ 103342
Lot Size(sq.ft.): 6490.44 Owner: LAFRANCE GERALD D& SANDRA K
Zoning:GB(10o)/ Applicant: JOSUE LOPEZ
AT. 29 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
24 LAWLER ST (413) 885-4296 SOLE PROPRIETOR
HOLYOKEMA01040 ISSUED ON.9/21/2018 0:00:00
TO PERFORM THE FOLLOWING WORD:OFFICE RENO
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:
FeeTvpe: Date Paid: Amount:
Building 9/21/2018 0:00:00 $100.00
212 Main Street,Phone(413)587.1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
)to /utw
File#BP-2019-0343 Conyrw*r��QQ,,
APPLICANT/CONTACT PERSON JOSUE OPEZ -f as 01 t—
ADDRESS/PHONE 24 LAWLER ST HC ,YOKE (413)885- 96 jqerm J �,�QQ /�•
PROPERTY LOCATION 29 NORTH MAP 3 ST
MAP 17C PARCEL 218 001 ZONE GB(NOZ
THIS SECT ION FC 7Z OFFICIAL USE ONLY:
PERMI T APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT AN
Fee Paid
Buildina Permit Filled out
Fee Paid
T eof Construction: OFFICE REN
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 103342
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFQIFMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§- 1
Intermediate Project: Site Pliti AND/OR Special Permit With Site Plan
Major Project: Site Pian 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.
90
Versionl.7 Commercial Buildin Permit Ma 15,2000
RECEtV�p ityofNortham ton Departmentuse only
P Status of Permit.
0ding Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
SEP 18 2018 Room 100 Water/Well Availability
No hampton, MA 01060 Two Sets of Structural Plans
hone 413 587-1240 Fax 413-587-1272 Plot/Site Plans
DEPT OF BUILDING INSPECTIONS
N 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
This section to be completed by office
1.1 Property Address.
/00fL� MQP1>L Is) Map 17C-- Lot �/ Unit
Zone Overlay District
--- -------- - - - (� Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
y �...
Name(Print) Current Mailing Address: f ��-� 4A
yl, ,>-y7- 6_ol Joh'
Signature Telephone
2.2 Authorized Ascent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 00 (a) Building Permit Fee
2. Electrical C'L (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+ 3 +4 +5) / p Q — Check Number Zia
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
o ao remoe&6 P ria L . G
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-�:::
UCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEELOSED SPACE
Interior Alterations Existing Wall Signs ❑ Demolitions Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration fl Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use 0 Y„Other❑
_..
Brief Description Enter a brief description here.
Of Proposed Work:
��..�'� (RC1
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 ❑ 113
❑
B Business 2A ❑
E Educational 2B I ❑
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
El
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: Proposed Use Group 1b --_
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)
w.
St
St
0 2nd
2"d ��j - ALv bac
3rd 3rd
4th 4t
Total Area(sf) Total Proposed New Construction�sf)
AA A40NU
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L. c.40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private 0 Zone Outside Flood Zoned Municipal ❑ On site disposal systemE]
x � e�,�{ogees.
�l� t tbelr t
VIS o{o uac
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Not ��fto con coo
�� a workers aptbet y pt�Ot
a�10� 1oYets 00
to n�e set�tce of e ndtY 01296 (At
�pY reAutes all
P,09 etY person er legal e ed em4 �owevec,
« ev ,on or ote °f a dece logees t°{the hov
s cvaptet aef�ned ��at�°n,c0�e�ese�tat�etn410 e o the°�S p{i dwetem4toy�
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riven" netslv�clua the tr 1,1�w�o to desoheepa�L`Naedtobe a� e°r
Yursu�to�irnPlied'or individual'tise,anri sociation o eats and sVNA j mentbe issvapc
exFres defined as a joint ent netsbipa vtee a4 aA enance�o f S cb em4toY �tbbold t eaito{Ov Sul
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teA
the f°r g s,ee of'house e�ploYs peth et°shall eepsirig a� s ivtb ce cove subdjv's
°eceivet°rad eUin%o met vivo ujtenant er ststo of iOc%to g etbOO the f its Q°1it�c� withtbe in`
owner°f louse as o building apQ es that«ev� s of {c�ISto T t nor anc of corn4liance
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ter 152'�2 ot(Qet�t Ito d acceptabi tes lyeitveo k o"ti1 a°ceau °ritY"
claof aviceos o°t 4Yodv 2��25C��)�e of public�e contracting lY to Your s�
tepewai t vii'°U.S claptet 15 etfor►nan ented to
Xes that ap ettificate°f
a4pVeaD a11Y,Mr'L t for the 4 bee"'Pres ng the b° with a° et tha
Addition anY contra chapter nave by clecld abet alongem4loYees have etc►
enter into eats of tb's avis cOmpletelaod ploneLLp�wit�C or lip dpescidents f
tequiretn ensation affi� e,addr p nershlp�e• 1f 2A us Indus T be tetumedc�
A4pbcapts v,�orkers' c°me company itedT,iabili tion insur�epartmer'tdavit svoul dusttcal Acct
t the saran or L,m , comljet' ed to the Tie aff� etre of n poli
please fill osu4plY Your'ja,panjes(LLC) viorkers be subtnitt ada,�t� the Depattm CO'npensato ance be
nece v'- Lbilit�o eA'tea tfi s a rialCarry s a d date tb quested,UP d to rain a`�r°rket their self-insu
OT nets Be advice A�o be sett ool'cegse ou aregeAuompaVve ssbillvh°o1d enter
is teAuiuecovetag-.for the Per h favi°t Self-insured c
insuran lication ding belovi ed a
teas Ptovid r
that the ap4A estions umber listed men ou
lave anment at the n Tl,e Depa to contact Y
�pF priat,e line• d pr'nted legl�vestigat'Onstwo
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p{ficials avis is comp evert the O �h wiOWO llve e ne
City of a sate that th u to�01 out In the number w g1Yell y
please b of y° itAlcellse ns In any
affidavit f the p� licat10 ffdavit
of the
be sate to file perm. licen$e'4 copy
of the a
pleas
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Versionl.7 Commercial Building Permit May 15,2000
S. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size N 1,4
Frontage
Setbacks Front
n NA_ I
Side L: R: &)tr L_ n'/► R: /1A_
Rear f V($__ hi
Building Height , tN�
Bldg.Square Footage % A,*
Open Space Footage
(Lot area minus bldg&paved „l�h N R NA ,.
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW 0 YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO tr'�N DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES
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 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 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 ® 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 ❑
Na Registrant):
Registration Number
150 Expiration Date
ig atu Telephone
9.'1 Registered Professional Engineer(s):
Name Area of Responsibility
.....................................
Address Registration Number
Signature Telephone Expiration Date
i
Name Area of Responsibility
Address Registration Number
i
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
t
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable
Company Name:
Responsible In Charge of Construction
._..l
Address
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 10)
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I �. yILL as Owner of the subject property
hereby authorize _ m s_ to
cf
act on my behalf, in all matters relative to work authorized by this building permit application.
W..
Signature of Owner Date
I, 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 under the pains and penalties of pew.
Print Name
_A�
SignatuWof Owner/Age Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: 1,93-3 Y'
License Number
{
Address Expiration Date
Signat Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152, §25C(6))
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.
tw
Signed Affidavit Attached Yes K No 0
t
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: 'Jori'1. IYWOC'
The debris will be transported by: pi Lt crtjA �i0e, Rr,C�jL Q
The debris will be received by:
Building permit number:
Name of Permit Applicant
Date Signature of Permit Applicant
s
The Commonwealth of Massachusetts
x Department of Industrial Accidents
s I Congress Street,Suite 100
Boston,MA 02114-2017
s� www mass.gov/dia
Workers'Compensation Insurance Affidavit: General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Business/Organization Name: 7aQ SV-Q I Q pe-
Address:
eAddress: L( I IiLU `fX— 5+ ,
City/State/Zip: 0' �V� M+ Phone#:
Are you an employer?Check the appropriate box: Business Type(required):
1.❑ I am a employer with employees(full and/ 5. ❑Retail
or part-time).* 6. ❑Restaurant/Bar/Eating Establishment
2.K I am a sole proprietor or partnership and have no 7.N Office and/or Sales(incl.real estate, auto,etc.)
employees working for me in any capacity.
[No workers' comp.insurance required] g• Non-profit
3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment
their right of exemption per c. 152, §1(4),and we have 10.❑ Manufacturing
no employees. [No workers'comp. insurance required]** 11.E] Health Care
4.❑ 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#1 must also fill out the section below showing their workers'compensation policy information.
**If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an
organization should check box#1.
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.Lic.# 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.
I do hereby=tifynder the pains and penalties of perjury that the information provided above is true and correct
Si nature: Date:
Phone#: �3
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#:
www.mass.gov/dia
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,oral 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 name,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 Fgarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number".Ih 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 stardped 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 burn 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
1 Congress Street
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
www.mass.gov/dia
Form Revised 02-23-15
Initial Construction Control Document
'To be submitted with the building permit application by a
Registered Design Professional
for work-per the ninth edition of the
Alassachuseffs State Building Code, 780 CMR, Section 107
Project Title: Renovations to 29 North Maple Street Date: 9/10,12018
Property Address: 29 North Maple Street.Florence.Massachusetts
Project. Check(x)one or both as applicable. New construction X Existing Construction
Project description:
1,Jody Barker,AIA, MA Registration Number.50885 Expiration date: August 2019,am a registered
design professional, and I have prepared or directly supervised the preparation of all design plans,
computations and specifications concerning):
X Architectural Structural Mechanical
Fire Protection Electrical other.
for the above named project and that to the best of my knowledge, information, and belief such plans,
computations and specifications meet the applicable provisions of the Massachusetts,State Building Code, (7J
CNIR), and accepted engineering practices for the proposed project: I understand and agree that I (or my
designee)shall perform the necessary professional services and be present on the construction site on a regular
and periodic basis to:
1. Review, for conformance to this code and the design concept, shop drawings, samples and other
submittals by t.he contractor in accordance with the requirements of the construction documents.
Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. He present at intervals appropriate to the stage of construction to become generally familiar with the
progress and quality of the work and to determine if the work is being performed in a manner
consistent with the approved construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of W CMR 107.
When required by the building official, I shall submit field/progress reports (see item 3.) together with
pertinent comments,in a form acceptable to the building official.
Upon completion of the work, I shall submit to the building official a"Final Construction Control Document".
Enter in the space to the right a"wet" or
electronic signature and seal:
Phone number. 617-21&5988 Email: iodybarkenaia(iilgmailcom
flu i Iding Offit ia I Use it
N CF
Ouilding Official Nares: Permit Nm-. Date:
Note 1.Indicate with an'x' project design plans,computations and specifications that YOU prepared or dim-fly supervised,If other' is
chosen,provide a description.
Vemion 0 1-0 1 2018
PROJECT DESCRIPTION:
RENOVATE AN EXISTING BUSINESS TENANT SPACE FOR FUTURE TENANT ("VANILLA
BOX", NEW TENANT TO BE DETERMINED.)
NEW FINISHES WILL BE INSTALLED THROUGHOUT THE TENANT SPACE. NEW
WINDOWS WILL BE INSTALLED IN EXISTING, INFILLED WINDOW OPENINGS. A BEAM
AT THE FRONT OF THE RETAIL SPACE WILL BE REPLACED - THE EXISTING BEAM
APPEARS TO BE UNDERSIZED.