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45-010 (10) 123 COMBS RD BP-2019-0515 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:45 -010 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:New Structure BUILDING PERMIT Permit# BP-2019-0515 Proiect# JS-2019-000839 Est. Cost: $5000.00 Fee: $0.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: CHADD MEERBERGEN 103548 Lot Size(sa.ft.): 14226696.00 Owner: MASSACHUSETTS AUDUBON SOCIETY INC Zoning: Applicant: CHADD MEERBERGEN AT: 123 COMBS RD Applicant Address: Phone: Insurance: 51 LINCOLN AVE (508) 221-4609 NORTHAMPTON MA01 060 ISSUED ON.1012912018 0:00:00 TO PERFORM THE FOLLOWING WORK:1OX10 SCREENED IN PORCH BEING ADDED ON TO AN EXISTING OUT BUILDING THAT IS 12X12 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: Douse# 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 10/29/2018 0:00:00 $0.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0515 APPLICANT/CONTACT PERSON CHADD MEERBERGEN ADDRESS/PHONE 51 LINCOLN AVE NORTHAMPTON (508)221-4609 PROPERTY LOCATION 123 COMBS RD MAP 45 PARCEL 010 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid , Building Permit Filled out Fee Paid Typeof Construction: 10X10 SCREENED IN PORCH BEING ADDED ON TO AN EXISTING OUT BUILDING THAT IS 12X12 New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 103548 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQRMATION 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 r� � ld 10 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 1.7 Commercial Building PermitMa 15,2000 RECEIVEDDepartment use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway PermitF - OCT 2 6 2018 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability N rthampton, MA 01060 Two Sets of Structural Plans DFPT OF SUILDlNG INSP & 413-587-1240 Fax 413-587-1272 Plot/Site Plans NORTHAMPTON.RAA 0 060 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 Q SECTION 1 -SITE INFORMATION / —G-/5- 1.1 1.1 Property Address: This section to be completed by office 123 Combs Rd Map �. Lot ()JO Unit Northampton, MA 01060 Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Mass Audubon 208 South Great Rd, Lincoln MA, 01773 Name(Print) Current Mailing Address: (413) 584-3009 Signature ✓ Telephone 2.2 Authorized Agent: Jonah Keane 127 Combs Rd, Easthampton, MA 01027 Name(Print) Current Mailing Address: (413) 276-7611 Signature Telephone SECTION 3--"ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $4,000.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of $1.000.00 Construction from 6 3. Plumbing $0.00 Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection $0.00 6. Total= (1 +2 + 3+4+5) Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date � ., {_._�. ,�. •- ,� ,. �.. .__ ., 'r i t 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 ❑ Demolition❑ Repairs❑ Additions ❑✓ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other ❑ Brief Description The structure is a 10x10 screened-in porch being added on to an existing out building that is Of Proposed Work: 12x 12. 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 ❑ 1B ❑ 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 ❑ 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: Arcadia Art Programs Proposed Use Group: Arcadia Art Programs 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) 1 St ' 144 1st 100 nd _....._.) 2nd 2 t 3'd 3 b L_... 4m 4tn Total Area (sf) 144( Total Proposed New Construction (sf) 100 Total Height(ft) 10' Total Height ft 10 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 ❑ On site disposal system❑ Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size 326.6 acres 326.6 acres Frontage 1.5 miles 1.5 miles Setbacks Front 2025 2025 Side L: 3800 R: 791 L:3800 R: 791 Rear 182 172 Building Height 10 10 Bldg. Square Footage 100 % 100 Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces 40 40 Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DON'T KNOW Q YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DON'T 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 Q DONT KNOW O YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO Q 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 it part of a common plan that will disturb over 1 acre? YES © NO Q 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 Date Signature Telephone 9.2 Registered Professional Engineer(s): 1 � M Name Area of Responsibility 3 Address Registration Number Signature Telephone Expiration Date 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 (((t Registration Number Signature Telephone Expiration Date 9.3 General Contractor __..... Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone Versionl.7 Commercial Building Pen-nit May 15, 2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes © No 0 SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property hereby authorize .., •_ _ to act on my behalf, in all matters relative to work authorized by this building permit application. 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 perjury. Print Name Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number z Address Expiration Date Signature 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. 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, 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: Corc , cr� tK Nj�-- The debris will be transported by: The debris will be received by: Building permit number: Name of Permit Applicant Date Signature of Permit Applicant