31B-159 Demo app 101 King Rectory 2012-05-17 (2)v . 1 C erSlOn .7 . I B 'ld' P . M 15 2000 ommerCla Ul mg enmt ay ,
Department use only
---~~ ..... ,City of Northampton Status of Permit:
REC Building Qepartment Curb CutlDriveway Permit ..
1 212 Main Street Sewer/Septic ." .m. LV
MAY I 4 2012 Room 100 Water/Well Ibilitv
N rthampton. MA 01060 Two Sets of Structural
41 -587-1240 Fax 413-587-1272 PlotlS.ite Plans
WI. OF BUILDING 1r:2f£~ . 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
1.1 ~~~~~'~~"'.'"'-"'''-'''''~''''.-~'''''.''~~'~'''7''--''-
99 King Street -Sacred Heart Parish
This section to be completed by office
Map :; 1" Lot
Zone Overlay District
~_..-.:.=----========-=-=========~~E~lm St. District I
CB District
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
.St. Elizabeth Ann Seton Parish
Name (Print)
• Signature
Name (Print)
, Signature
. SECTION 3· ESTIMATED CONSTRUCTION COSTS
I Item
1. Building
2. Electrical
3. Plumbing
I 4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5)
Elm Street
CU~flt..~~Clil.il'l.R Address.~:; .............. ~ .•..•. ~ ..
i( 4 !.~5~4-7310.~ ~ .. _ .. _ .
Telephone
Telephone
Official Use Only
(a) Building Permit Fee
(b) Estimated Total Cost of
Construction from 6
Building Permit Fee
This Section For Official Use Onl
I Building Permit Number
Signature:
Building Commissionerllnspector of Buildings
Date
Issued
I Date
Unit
.. =
00
I
I
Versionl.7 Conm1ercial Building Pennit May 15, 2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
I CUBIC FEET OF ENCLOSED SPACE
Interior Alterations 0 Existing Wall Signs 0 Demolition [2] Repairs 0 Additions 0 Accessory Building 0
Exterior Alteration o "''''<>LII'1:I Ground Sign 0 New Signs 0 Ruufiil~D Change of Use 0 Other 0
Brief Description Demolition ofthe Fonner Sacred Heart Parish Rectory ! ;
Of Proposed Work: : .. " .•.....•.•.....• ~. ..~ ....
SECTION 5 -USE GROUP AND CONSTRUCTION TYPE I
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 0 A-2 0 A-3 0 1A 0 0 A-4 0 A-5 0 I 1B 0
B Business 0 :1 2A 0
i E Educational 0 I 2B I 0
F Factory 0 F-1 0 F-2 0 I 2C 0
H High Hazard 0 I 3A 0
~ I Institutional 0 1-1 0 1-2 0 1-3 0 I' 3B 0 I
M Mercantile 0 4 0
R Residential 0 R-1 0 R-2 0 R-3 0 5A 0
S Storage 0 S-1 0 S-2 0 5B 0
U Utility 0 Specify: I ":-~"]
M Mixed Use 0 Specify: I
...•. 1
S Special Use Specify: ! ........
0 .... -.. " ... ~-.. • ........ ·m.w ...... • •.•••••
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: I J I Proposed Use Group: I
I
Existing Hazard Index 780 CMR 34):! j i Proposed Hazard Index 780 CMR 34): [ ..•••••• 1' .......................... )
SECTION 6 BUILDING HEIGHT AND AREA 1
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor (sf)
15t I .J 1st I ......... _J
2nd
; .. J 2nd I ............ J
3'd I j 3'd I i
4th ! 4th I J
Total Area (sf) L .. ~ .. i Total Proposed Nt:w Gum:ilfuction (sf)
I
Total Height (ft) I !
Total Height ft l !
7. Water Supply (M.G.L. c. 40, § 54) 7.1 FI9..QcI~QJ1~Jnformation: 7.3 Sewage Disposal System:
Public [2] Private 0 ZoneL .......... H,,,,,,,,,," 1 Outside Flood Zone [2] Municipal [2] On site disposal system 0
Versionl.? Commercial Building Pennit May 2000
~----------------------~ 8. NORTHAMPTON ZONING
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
<lrkin )
# of Parkin S aces
Fill:
volume & Location
Existing Proposed
A. Has a Special PermitIVariance/Finding ever been issued farlan the site?
NO 0 DONT KNOW @ YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW YES ; •. ~_ ••. "" ••..... "'::c;.
IF YES: enter Book and! or Document #
B. Does the site contain a brook, body of water or wetlands? NO @ DON'T KNOW 0 YES 0
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 o 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 ®
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 0 NO ®
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Versionl.7 Commercial Building Pennit May 2000
I SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES· FOR BUILDINGS AND STRUCTURES SUBJECT TO
I CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE)
! 9.1 Registered Architect:
Address
Signature Telephone
9.2 Registered Professional Engineer(s):
Name
Address
Signature
Address
Signature
Name
Signature Telephone
Telephone
9.3 General Contractor
Not Applicable 0
Version!.7 Conunercial Building Pem1it May 15, 2000
SECTION 10-STRUCTURAL PEER REVIEW (780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required
I
· SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I
Yes 0 No (!)
J. as Owner of the subject property I
II
hereby .1 J
act on my behalf, in all matters relative to work authorized by this building permit application.~~ .• , .. _.~ ...........• l '-V~-___ T~_~~_
~ _______ ·_·····_·~··_··_~_····_"~·_·~·_·'_··_··· __ D_a_te_"_.,·_"·_···_····_·~_·· _____ ---'
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.
ft-""'w--''''_t='''#~o-_-c_'_''''"_'_'w_-_
L '~"~' .. ~ ........ _ ....... ~.. . ......... "
Signature of OwnerlAgent Date
SECTION 12 -CONSTRUCTION SERVICES
Not Applicable 0 •••.........• _ ............... .
rew Mirkin Name of License Holder :~~=====================§
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 (!) No 0
hl\ The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
N arne (Business/Organizationiindividual): ____ A_s_s_oc_i_a_te_d_B_u_i_Id_i_n_g_W_re_c_k_e_rs_, _In_c_. __________ ~-_
Address: __ 3_52_A_lb_a-=ny~St_re_e_t __________________________ _
City/State/Zip: Springfield, Massachusetts 01105 Phone#:
Are you an employer? Check the appropriate box:
1. ~ I am a employer with 26 4. 0 I am a ~eneral contractor and 1
employees (full andlor part-time). * ~ave hIred the sub-contractors
2. 0 I am a sole proprietor or partner-lIsted on the attached sheet.
ship and have no employees These sub-contractors have
working for me in any capacity. employees and have workers'
[No workers' compo insurance compo insurance':!:
required.] 5. 0 We are a corporation and its
3. 0 I am a homeowner doing all work officers have exercised their
myself. [No workers' compo right of exemption per MGL
insurance required.] t C. 152, §1(4), and we have no
employees. [No workers'
413 732-3179
Type of project (required):
6. 0 New construction
7. 0 Remodeling
8. ~ Demolition
9. 0 Building addition
10.0 Electrical repairs or additions
11.0 Plumbing repairs or additions
12.0 Roofrepairs
13.0 Ot_h .• e_r_. _____ _
I I compo insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy infOlmation.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. lfthe sub-contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy alldjob site
illformation.
Insurance Company Name: Great Divide Insurance Company
Policy # or Self-ins. Lic. WCA 154516510 Expiration Date: 02/0112011
Job Site Address: qq r, ~SbreeA (RfQ~~ City/State/ZiP:_J,.\n~tc!Lqpb< ,vtA 0l6bO
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 ofMGL C. 152 can lead to the imposition of criminal penalties of a
fme up to $1,500.00 andlor one-year imprisonment, as well as civil penalties in the fonn of a STOP WORK ORDER and a fine
of up to $250.00 a day against ~he violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for' ,surance coverage verification.
I do hereby e~ ify under the ~kirS :nd ~enalties ofperj~~ that t/~e information provided above is true and correct
f:'\/ "A Ai / Andrew Mlrkm, PreSIdent Date:){Q Of l.
phone #: 413 732-3179
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. Cityffown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other ____________ _
Contact Person: Phone #:
i
l\ioct~t of ~pringfitlb
65 Elliot Street -P.O. Box 1730
,i)prfngfitlb -:f!I~~acbusttt~ 01102
OFFICE FOR FISCAL AFFAIRS
will iam.labroad@diospringfieId.org
Mr. Andrew Mirkin, President
Associated Building Wreckers, Inc.
352 Albany St
Springfield, MA 01105
Re: St. Elizabeth Ann Seton Parish, Northampton
Dear Mr. Mirkin:
Tel: (413) 452-0687
Fax: (413) 785-5449
April 24, 2012
Enclosed is an original, fully executed Contract between the Roman Catholic Bishop of
Springfield and Associated Building Wreckers, Inc. for demolition ofthe former Christian
Life Center and Rectory at S1. Elizabeth Ann Seton Parish, Northampton.
By copy of this letter, I am sending an original ofthe fully-executed Contract to Rev. John
E. Connors, Pastor of St. Elizabeth Ann Seton Parish. We have retained an original for our
file.
Thank you and if you have any questions, please give me a calL
/j
Enclosure
Sincerely yours,
William F. LaBroad, Jr.
Finance Officer
c: Rev. John E. Connors, Pastor, S1. Elizabeth Ann Seton Parish (w/enclosure)