25C-085 (22) 238 BRIDGE ST BP-2019-1050
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25C-085 CITY OF NORTHAMPTON
Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category renovation BUILDING PERMIT
Permit# BP-2019-1050
Project# JS-2019-001712
Est.Cost: $15000.00
Fee: $105.0 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group CARL WOODRUFF 109983
Lot Size(sa ft), Owner: MALZONE WESLEY
Zoning: URB(100)/ Applicant CARL WOODRUFF
AT. 238 BRIDGE ST
Applicant Address: Phone: Insurance:
122 PLEASANT ST#109 (315) 854-4024 WC
EASTHAMPTONMA01027 ISSUED ON:4/3/2019 0:00:00
TO PERFORM THE FOLLOWING WORILFRAMING PERIMETER WALLS WITH
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: OB: 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 Occuoancv Signature:
FeeTvpe: Date Paid: Amount:
Building 4/3/20190:00:00 $105.00
212 Main Street,Phone(413)587-1240,Fax:(4U)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-1050
APPLICANT/CONTACT PERSON CARL WOODRUFF
ADDRESS/PHONE 122 PLEASANT ST#109 EASTHAMPTON (315)854-4024
PROPERTY LOCATION 238 BRIDGE ST
MAP 25C PARCEL 085 000 ZONE URBO00V
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
CLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildina Permit Filled out
Fee Paid
T eof Construction: FRAMING PERIMETER W LS SOLATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 109983
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF MATION 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 Delays
_ > ( % 4f -3
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.
Versiont.7 Commercial Building Permit May 15,20M
RECEIVEDDep'nmentuse only
City of Northampton Status of Psmgt:
uilding Department Curb Cummveway Pemtit
MAR 2 5 2019 212 Main Street Sewer/Septic Availabilay
Room 100 WaterMell Availability
No hampton, MA 01060 Two Sob of Structural Plans
0EP* c 3 tij " 13 87-1240 Fax 413-587-1272 Plwaae Plans
mr. 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 Pmoerty Address: This section to be completed by office
238 Bridget Street Map d 5C Lot og6 Una
Northampton, MA 01060 zone Overlay District
Elm St.Dlsbic C8 District
SECTION 2-PROPERTY OWNERSHIP/AUTHORRED AGENT
2.1 Owner of Record:
Wesley Malzone /uo GJ I I/;cn i S� , .�/a) 6 l
Name(Print) Current Mailing Address:
�/-
a-IV - )-I/-?k)
Signature Telephone
2.2 Authorized Agent:
Carl Woodruff' 122 Pleasant Street, Suite 109,Easthampton,MA
Name(Print) Curets Mailing Address:
-- (413) 527-9000
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION 9 T9
Item Estimated Cost(Dollars)to be Official Use Only
completed bv Pennit applicant
1. Building $15,000.00 (a)Building Permit Fee
2. Electnug (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee �1JJ ff
4. Mechanical(HVAC) Jy I6 J
5.Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Building Pennit Number Date
Issued
Signature:
Building Commiseianerlmpector a(BBuldingsII Date
Nr I @Gl
Ox6Wt5`1yh�v:ld . Gayh
Version L.7 Commercial Building Permit May 15,2000
SECTION 4 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations [D Existing Wall Signs ❑ Demolition Repairs❑+ Additions Accessory Building
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑
Brier Description Framing perimeter walls with insulation on-60% of exterior walls. Sheetrock and priming.
Of Proposed Work: Minor floor patching. Heating,electric,and plumbing to be provided by others.
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly11A-1 ❑ A-2 ❑ A-3 131A ❑
AJ ❑ A-5 ❑ 1B ❑
B Business ❑+ 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
1 Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 30 +
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: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION a BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(so
1. 1,100 1u
2w2"°
3t°
4e
4s'
Total Area(so Total Proposed New Construction(s0
Total Height(/t)
Total Height fl
7.Water Supply(M.G.L.c.40;§54) 7.1 Flood Zone Infomwtion: 7.3 Sewage Disposal System:
Public ❑+ Private ❑ Zone Outside Flood Zone❑ Muniapal ❑+ On site disposal system❑
VersionL7 Commercial Building Permit May 15,2000
R. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
lids column m be filled m by
BuildingD urmseni
Lot Size
Frontage
Setbacks Front
L R: L R:
$4BI
Building Height
Bldg. Square Footage %
Open Space Footage %
(W ares minus bldg&pawd
psulumm
#of Puking Spaces
Fill:
volume&Localion
A. Has a Spedat Permit/Variance/Finding ever been issued for/on the site?
NO ® DONT KNOW O YES O
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 O DONT KNOW O YES O
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
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 O
IF YES, describe size, type and location:
E. Will the construction adiv'dy,disturb(clearing,grading,excavation,or filling)over t acre or is it part of a common plan
that will disturb over 1 acre? YES ® NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10•STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineefing Structural Peer Review Required Yes No •
SECTION 11 .OWNER AUTHORIZATION-TO HE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. :Wesley Malwne as Owner of the subject property
hereby author" Carl Woodruff to
act on my behaff,in all madeMmlpfive to work authorized by this building permit application.
Signature of owner Date
Carl Woodruff ,as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowdedge
and belief.
Signed under the pains and penafbes of peralry. .
'Carl Woodruff
Pant Neme -
A. Ll Zof�
sign of /Agan Data
SECTION 12-CONSTRUCTION SEROCES
10.1 Ueansed Construction Supervisor. Not Applicable ❑
Naar of Ucerse Holder: Carl Woodruff 'CS-109983
Ucense Number
122 Pleasant Street, Suite 109,Easthampton,MA 01027 .03/04/2020
Address _ .. . Ex0ration Date
(413) 527-9000
Sign /i Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 182,$28C(e))
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 Arm ad Yes No 0
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRICTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 118(CONTAINING MORE THAN 38,008 C.F.Of ENCLOSED SPACE)
9.1 Reglatered Architect:
Noah Modie Not applicable ❑
951421
11fP1eass'Street, Suite 109, Easthampton,MA 01027 Registration Number
08/31/2019
Address
�� (413) 527-9000 . Ezplreuen Data
slgnatuif Telephone
9.2 Registered Professional Enginser(s):
Name Area of Responsibility
Address Registration Number
Signanue Telephone E pration Date
Name Area or Reeponeibility
Address Registration Number
Signature Telephone Expiration Data
Nam Area of Responsibility
Address Registration Number
Signature Telephone Expiration Dale
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Dale
9.3 General Contractor
Not Applicable ❑
Company Name:
Responsible In Charge of Corelruollon
Address
SlgnaWre Telephone
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: 238 Bridge Street
The debris will be transported by: Oxbow Design Build
The debris will be received by: Alternative Recycling
Building permit number:
Name of Permit Applicant: Oxbow Design Build
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department ss SreetSIndust"Accidents
1 Congress Street,Suite 100
Boston,MA 02114-1017
www.mass gov/dla
W\I'rkers` Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbera
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leeibly
Name Business/OrgmimtionMdividuap:Oxbow Design Build
Address: 122 Pleasant Street, Suite 109
City/State/Zip: Easthampton, MA 01027 Phone#:413-527-9000
Areyeu®employer?Cheek sees ap,.,daw boa:
Type of project(required):
I.O 1 am a employe with 4 employees(full sed/or pert-time)• 7. ❑New construction
1❑I am a mlc propricros or permcrship arvi lune no ewloyecs working for rw in 8. O Remodeling
any cepaci,IN.workers'camp.uaurenee requ'imd.]
3❑I ern a lwrrcowner doing all work myself.[No workas'wrnp,insurance rcqumedl t 9. ❑Demolition
4.�1 am a uomenwner and coca be hiring wvtmctms m conduct ell wrork un my property. 1 will 10(]Building addition
ensure tMt all co ueao eia bve work.rs'compensmion msurwsce or ere sok 11.[]Electrical repairs or additions
proprietors come rw employees.
12.E]Plumbing repairs or additions
5.❑1..a g.t contrnemr and I Mve lural the vb-controUors uvcd on the wmcMd sheet. IJ ❑ROof repairs
These aubcontrectors have employees end Mve wo .'comp.insurencs.t
fl❑We areae csfianend its officers Mve exercisalIhe'v right of exm:ption perMGL c. 14.QOlher
152,§I(4),and we love no employees.IN.workers'mnry.uuwance reyuved.l
'Any applicant duet.becks box Ml must efw allow are wctsev below showutg thew woders wvpensacioe'I'.Y information.
I It...wM sulxmt thisaffieixit usdlceaeg they ereMin,ell work and thee hhcoutsidecoevacmrs must submit amw.fiidavit indicatingsuch.
=Connectors that cheek du We mmt uu,hed m additional sheet suowi%aw Sarre ofaw sutrcommctors and wale wheN or not Wow emiries have
a Ioyees. If the wb-comrmmrs Mve employees,tlsey must provide them workers'comp.policy number.
lam an employer tludisprovidrrrg Workers'rnmpeneNion insurance for my emptoyeex Belowisthepokcyandjobsite
information.
InsuranceCompany Name:The Ohio Casualty Insurance Company
Policy#or Self-ins.Lia#:XWO(19)57 4128 82 Expiration Date:07/27/2019
Job Sim Address:238 Bridge Street City,/State/Zip:Northampton, MA
Attach a copy or the workers' compensation policy declaration page(showing the polity number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby ceq fy under the pains and penalties of perjury that rhe informadon provided above is true and correct
Siartature' ✓r DateMarch 21,2019
Phone#,413-527-9000
Oficial use only. Do not write in this area,to be completed by city or town ofciaL
City or Town: Permit/Ciceose#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Chytrown Clerk 4-Electrical Importer S.Plumbing Inspector
6.Other
Contact Person: Phone#:
mourners wwp<uaauuu tutu empruyers �armr ry rusureu.,. .._,
CoverSga b Provldad In: Pdlcy Number:
1�=
The Ohio Casualty Insurance Company �XWD 1791 67 47 2882
Lrior Peaky Number: '
NCCI Co.No. 71303 MA Risk ID 661087066
Workers Compensation and
Employers Liability Insurance Policy
Information Page
REIN 1:The hawed&Mailing Address Agent 111sfIn6 Address A Phase No.
OXBOW DESIGN BUILD LLC (413) 586.0111
122 PLEASANT ST WEBBER&GRINNELL MS AGCY INC
EASTRAMPTON, MA 01027 8 N KING ST STE 1
( NORTHAMPTON, MA 01060.1151
E
_Ire1hlNel,Partnashlp
X Corporation or Limited Liability Company FEDI:001176771 MOC36115
011W workplaces not slaws Shore:
IN
IM MA12 Toapo"p$dWisfrom 07/272018 to 0712712019 12:01am StandardTiznmttheinsurcd'smailinga Mress.
ITEM 9 A.Workers CWap mostlon Insurance: Pan One of the policy applies to the Workers Compensation Law
of the states listed here: MA
0.Etoplayi s Liability h ssisso : Part Two of the policy applies to work in each state listed In Item 3A.
The limits of our 0aarey under Part Two are: Bodily injury by Accident $100,000 each accident
Bodily Injury by Disease $500,000 policy limit
Bodily Injury by Disease $100,000 each employee
C.OMar StdU hwmaeoe: Part Three of the policy applies to the states, 8 any,listed here: See
Extension of Information Page
0.TOL lefty Inelades thaw BBdoreWBnts and scbWvles: See Policy Forma and Endorsements Summary
ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifice8ens, Rates and Rating
Piens. Ali information required below is subject to verification and charge by Suck.
Ck wksum Cods PreaklaBB$b-TOW Rd$per Eslho"
No. EsthmewAM" $10981 AN"
nommwao n Rewswafw P MMM
See Extension of Information Pages)
Tota( Estimated Annual Premium 1161059.00
Total Surcharges and Assessments $259.00
Mkdmm Pf9akm $500.00 MA Total Estimated Cast $6,318.00
It indicated below, interim adjustments of premiums shat) be made.
Deposit Premium $6,318.00
Countersigned by.
Issue Date
To report a eh7m, ea8 yowAganr or I-806,62-0000
WC 0000 OI A(WC 3010 E)
1987 National Council on Compensation Insurance, Inc.
rmtlap04 450 INSURED COPY x1$21 PAGE 11 OF 46