12C-010 (3) 320 NORTH MAPLE ST-SPRING GROVE CEMETERY BP-2019-0887
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 12C-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: renovation BUILDING PERMIT
Permit# BP-2019-0887
Proiect# JS-2019-001477
Est.Cost:
Fee: $0.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: CITY OF NORTHAMPTON CENTRAL SERVICES 054510
Lot Size(sq.ft.): 1306800.00 Owner: NORTHAMPTON CITY OF SPRING GROVE CEMETERY
Zoning: SR(99)/WSP(99)/WP(3)/RI(0O)/URA(0)/ Applicant: NORTHAMPTON CITY OF SPRING GROVE
CEMETERY
AT. 320 NORTH MAPLE ST - SPRING GROVE CEMETERY
Applicant Address: Phone: Insurance:
NORTH MAPLE ST
FLORENCEMA01062 ISSUED ON:2/14/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.-INTERIOR RENOVATIONS TO DPW
MAINTENANCE BUILDING - FRAMING, SHEETROCK, INSULATION
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:
FeeType: Date Paid: Amount:
Building 2/14/2019 0:00:00 $0.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-0887
APPLICANT/CONTACT PERSON NORTHAMPTON CITY OF SPRING GROVE CEMETERY
ADDRESS/PHONE NORTH MAPLE ST FLORENCE
PROPERTY LOCATION 320 NORTH MAPLE ST-SPRING GROVE CEMETERY
MAP 12C PARCEL 010 001 ZONE SR(99)/WSP(99 /�3)/RI(0)/URA(0)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid AL n
Building Permit Filled out
Fee Paid
Typeof Construction: INTERIOR RENOVATIONS TO DP AINTENANCE BUILDING-FRAMING,
SHEETROCK,INSULATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOj. ATION PRESENTED:
r 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
.X_ L 1
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 l.7 Commercial Building Permit Mav_ 15.2.000
_ Department rise only
City of Northampton status-of Perm Jt
uilding Department Curr Cvf/Dnueway Permrt
FEB /S-2Q19
Room 100 Waf212 Main Street sewer/se tic AvaJIa61iJ
P '
er/Weil Avarlabiity
E NO hampton, MA 01060 Two'Sets of Structural Plans-
L DFPT n,ill DING INSN
Nr , oN,raa61,j'�e S 413 87=1240 Fa.-413-587-1272 PIDvSrte Plans
Other Speci#y
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING 9
?
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
Map (a1 Lot Unit
�J W ■�•` �1 � �T 'Zbne Overlay District
CB.District:
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
N e Print ' Current
dres :
) 9 A
( ....___
Si- at Telephone
2.2 u o ized Aq t:
Name(Pent)
Signature Telephone
SECTION 3-ES:TIMATED'CONSTRUGTION-COST&
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (aj-Buil dincrPerm-it.Fee
2. Electrical (b)`Estimated`Total Cost of
Consfru on from (6)
3. Plumbing _ `Bdild.ing,Permit fee
4. Mechanical (HVAC) - - --
5. Fire Protection -
6. Total= (1 +2+3+4+5) Check:Number
This Section For Official Use Only
Building Permit Number Fsastueed
Signature:
building Commissioner/Inspector of Buildings Dale
Version 1.7 Commercial Building Permit May 15,2000
SECTION 4-.CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35;00.0
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Addition Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other
Brief Description Enteerlaa brief description here. %t- VAN
Of Proposed Work: . VW`jq%t%1`%J&'%Ln
SECTION 5 -USE GROUP AND CONSTRUCTION TYPE'' vwn
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 ❑ 26 �` ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C t ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 38 ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
UUtility ❑ Specify:: ._____._......_._ ______._._.__..W._.._.....�... .......__._.____.._________.._.....
M lAxed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE-THIS SECTION IF EXISTING BUILDING UNDERGQING RENOVATIONS,ADDITIONS AND%OR CHANGE IN USE
Existing Use Group: r„ . ...... .. ......___ __ _ 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 US'E ONLY
Floor Area per Floor(so
-. 5c —---
2nd .�._�__..�.�._._...,._...._..._..._..... .....__,_ 2nd
3rd - 3rd
4m __..._ 4
to
Total Area (so Total Proposed New Construction(sf)
Total Height(ft)
Total Height ft _...__.._.._-.._"..._.
- I
7. Mater Supply(M.G.L. c.40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone❑ I 1\4unicipal ❑ On site disposal system❑
Version 1.7.Commercial Building Permit May 15, 2.000
SECTION 9- PROFESSIONAL DESIGN AND CONSTRU.CTIONSERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 G-MR.1:16.(CONTAINING:MORE THAN 351000 C.F.OF EN.C:LOSED SPACE) . -
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant): -
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
........................__.-----_..._.-._.---..
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration 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:
Responsible In Charge of Construction
Address
Sicnature Telephone _
Version l.7 Commercial Building Permit May 15,2000 .
S. NORT'E ATS IPT'ON_ZO-NTUNj-G
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L:::_^ R: L:.._._- R w.._.. —
Rear
Building Height
Bldg. Square Footage --_.. %
Open Space Footage _._,. %
(Lot area minus bldg&paved -----
.__.
#of Parking Spaces --___.._. --- •— _..
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued: _..
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page _ and/or Document+r
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
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 0 NO O
IF YES, describe size, type and location:
E. WIII 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 0 NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
The Coinmonwealth of Massachusetts
{- Department of Industrial accidents.....
F— Offce o•f.£nvestigations
600 T'dshina ow Street
Boston, Ma 021111
== wxw.mass.gov/dia.
V orkers' Compensation Insurance Affida-it: Buitders/Contractors/Electricians/Plumbers
Drfflcant Information Please Print Legibly
Name(Business/Organization/Individual):
4 dd-F.-aS
City/State/Zip: Phone 4:
Are you an employer? Check the appropriate box: Type of project (required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full-and/or part-time).* have hired the sub-contractors 6. New construction
2.ElI am a sole proprietor or partner- listed on the attached sheet. 7: E]Remodeling
ship and have no employees These sub-contractors have g_ ❑Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp. insurance comp.insurance.$
required.] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions.
3.❑ I am a homeowner doing all work officers have exercised their 11.El Plumbing repairs or additions
myself. No workers' comp. right of exemption per MGL 12.7 Roof repairs
insurance required.] C. 152, §1(4), and use have no
employees. [No workers' 13.❑ Other
comp.insurance required.]
`Any applicant that checks box=1 must also fill out the section below showing their workers'compensation policy information.
r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew a5davit indicating such.
;Contractors that check this box must attached an additional sheet showing the narrn of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employes,they mustprovide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Eelow is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.r: Expiration Date:
Job Site Address: City/State/Zip-
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
rine 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 S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DLk for insurance coverage verification.
I do hereby certify under the pains andpenalties of perjury that the information provided above is true and correct
Signature: Date:
Phone#:
0,rTiiclal use onlh. Do not write in this area, to be completed by city or town officiaL
City or Town: Permit/License r
Issuing Authori*,(circle one):
1.Board of Health 21 Building Department 3. Cihy./T.o3?m C.leTk Electrical Inspector S,Plumbing InsBector.
6. Other
Contact Person: Phone F:
Version l.7 Commercial Building hermit May ld,?000
SECTION 10-STRUCTURAL.PEER:REVI.EW,(:7780.CTV1R 110.11
}
FICTION 10-
Independent Structural Engineering Structural Peer Review Required Yes No 0
SECTION 11 -OWNER.AUTHORIZATION-TO=BE COMPLETED -WHEN-
OWNERS AGENT OR CONTRACTOR APPLIES'F.OR BUILDING PERMIT
_........, _.___...__—_..-_-_---..___- , as Owner of the subject property
herebyauthorize....---...._..........._.._____.____.._._................._...____._...._.__......_._._..._...w_._.__.___________..__._.__._,__,w.. .....__...___.._.__...._...___._..___,._............._..._......_._...._..._.._._._......_....._____...-_- to
act on my behalf, in all matters relative to work authorized by this building permit application. _
Signature of Owner Date -
as Own /Authorized
A nt hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
belief_
nd p ns-and penalties of perLur
Pri t Na
1
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: ___.__----_--.—___--__._.__ __,_..,._.__ ._..-..._. _.___..,___._.._.___---_-. . .: _ .___......__._ ... .._.__.. ___._.._ _----
License Number
Address Expiration Date
Signature Telephone
SECTION 13 WORKERS'.:COMPENSATIOR:INSURANCE AFFIDAVIT(M G
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