32C-140 (52) 351 PLEASANT ST -SUITE A BP-2019-1110
GIS u: COMMONWEALTH OF MASSACHUSETTS
Map-Block:32C- 140 CITY OF NORTHAMPTON
Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:Building BUILDING PERMIT
Permit n BP-2019-1110
Proiect 4 JS-2019-001687
Est.Cost: $95000.00
Fee:$665.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Grouo: C & T CONSTRUCTION 062884
Lot Size(sa. R.): Owner, MILLBANK PLACE ONE CONDO
Zoning:GB(93)fURC(7YW IIy Applicant. C & T CONSTRUCTION
AT. 351 PLEASANT ST - SUITE A
Applicant Address: Phone: Insurance:
15 Fairway Drive (413) 5864965
FLORENCEMA01062 ISSUED ON.411112019 0.00.00
TO PERFORM THE FOLLOWING WORK:RENO SPACE INTO 2 OFFICES WITH SHARED
BATHROOMS AND KITCHENETTE
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 k Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: FireDemarimen[ FireplacdChimuey:
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.
Certfcate Of Occupancy Siemature:
FeeType: Date Paid: Amount:
Building 4/1120190:00:00 $665.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019.1110
APPLICANT/CONTACT PERSON C&T CONSTRUCTION
ADDRESS/PHONE 15 Fairway Drive FLORENCE (413)586-4965
PROPERTY LOCATION 351 PLEASANT ST -SUITE A
MAP 32C PARCEL 140 000 ZONE GB(93VURC(7VWP(IV
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT
SNCL D QUIRED DATE
ZONM F FILLEDOUT
Fee Paid
Building Bemnit Filled out
Fee Paid
Tveeof RENO SPACEMT FI WIT 5 BATHROOM N KITC}IE ETTE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 062884
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
ATION 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 Store Water Management
Demolition DDelayla��`/�/�/1
Signature Official Dat
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all seeing
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 May 15,2000
Department use only
of Northampton Status of Permit:
RECEIVED BDiI ing Department Curb Cut/Dnveway Permit
2 2 Main Street Sewer/Septic Awilability
APA 82019 Room 100 Water/Well Availability
rth mpton, MA 01060 Two Sets of Structural Plans
phone 41 58 -1240 Fax 41&587-1272 Plot/Site Plans
DEPT.D�6UILDIN(.INSPECTIDNa Other Specify
AIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION t -SITE INFORMATION
1.1 Property Address: This stolon to be completed office,
by oc
7 e
JC�S( �'��i.5ar1'f Sf Map Lot Unit
.Jtil Zone Owday District
Elm al District CB District
SECTION 2.PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record: D q,rid/q g,/, �o y4Cy
LLC
Name(Pari - Cunent Mailing Address:
�/ l� �lC}Sd
Signature Telephone / 6- zS
2.2 Authorized Ardent-
S.ent-S K2�lc°�l �f ✓Wn� L7i'C
JName(Print) Cunent Mailing Address:
Y _ )C:�/ae-lce� a1W- d106Z
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical 6'r0d (b)Estimated Total Cost of
Construction frau 8
3. Plumbing b/ J C� Building Permit Fw
4. Mechanical(HVAC)
5. Fire Protection
6. Total ell +2+3+4+5) -M do Check Number o17
This Section For Official Uw Only
Building Permit Number Date
Issued
Signature:
Building Commissionernnspecta of Buildings Date
1��j �� Caw,
Versionl.7 Commercial Building Permit May 15,2000
SECTION4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations 12'Existing Wall Signa ❑ Demolition Repairs Additions ❑ Accessory Building
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Rooflng❑ Change of Use❑ Other❑
Brief Description Enter a brief description here QebV 0jycrces
Of Proposed Work: SLr.q.vgd. ft[f-G(.Txu1.S w..d_._l�.free.-.� .4n/ yScv
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly11A-1 ❑ A-2 11A-3 ❑ 1A ❑
A4 ❑ A-5 ❑ IS ❑
S Business 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ IJ ❑ 3B
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ SA ❑
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 0 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
1. 1"
3- _ - 3m
q'^ --..-.. 4. ...
Total Area(s1) Total Proposed Naw Construction(sf)
Total Height(ft)
Total Height ft
7.Wabr SuPPIY(M.G.L.c 40,$SQ 7.1 Flood Zona Information: 7.3 Sewage D spoaal System:
Public PdvaOe 0
Zone Outside Flood ZonearMunicipal lK On site disposal system❑
Vcrsionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
'ILis column to be filled in by
Building Depemnmt
Lot Sim
Frontage
Setbacks Front
Side L: R: LR:
Rear
Building Height
Bldg.Square Footage
Open Space Footage -
(tar.min.bids a paved
#of Parking Spaces
Fill:
volwoc a tocaoum
A. Has 8S at Permit/Variance/Finding ever been issued for/on the site?
NO (F DON'T 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 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO0 DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained O Date Issued:
C. Do any signs exist on the property? YES (� NO O
IF YES, describe size, type and location: y�f—dGvjJ
r r7
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. Wil 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 O NO O
IF YES,then a Northampton Storm Water Management permit from the DPW is required.
Versimi 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 119(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 Enginear♦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
I a�� O✓[Sl�v< ✓] Not Applicable [3
Company Name:
C h rt6 I<e 19 r�
Responsible In Charge of Constmdi n
1 r t of,,iG G/&?4c e
Adp�ess
he Telephone
Verdi Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes O No
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, I �'�L'� I V S Y/�/ / as Owner of the subject property
i
hereby auth _ �j,S Q _to
act o y be in all a re to work authorized by this building permit application.
S / /
gtZ�Ignature of Owner Date
L -- --- _✓`S 4 _----- ,as Owner/Authorized
Agent hereby declare that the statemen s and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed u der the pains and penalties of perjury.
4 e-f � (<aoA � �
Print Name
U _ � S y
Ing of Owner/Agent Data
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Su/oerAs/o : Not Applicable ❑
No..of Licence Holder l"/In l�'1LO9[� 06 2-Mc
License Number
LS �7ryoy �� K / Ia PHGY, yh ff U�JG �0� /PP�II
Mdress / ExprE�Date
o / A114
6 urs — Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Wodcers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in Me denial of the issuance of Me buildin permR
Signed Affidavit Attached Yes No O
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, 1 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 works' _-?-5—/ 5/- s' le ' ,1
The debris will be transported by: /f'//Nt`OT1 TK Ee�i
The debris will be received by: i1 ewc �f2C/c�N
Building permit number:
Name of Permit Applicant
Ata
g
Date Signature of Permit Applicant
�\ The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston, MA 02114-1017
wulmmass.gov/dia
VWorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Amalicant Information Please Print Leviblv
Name(Business/Or mmatiowlndividual): /
Addres : 15- F64'r
l!5WIf L
City/State/Zip: Phone#: / J
) ��t4�$
Are you an employer?Check the appropriate box:
Type of project(required):
1.E]I am a cmplvyer with employees lfWl md/m pvt-nmol' 7. []New construction
3.�'I amamk pmpriamor parme,ship avdhave po emplvyeeswaking fame. 8. FE'[femodeling
my capacity.[No workers comp.msumnce requhN.l
3.❑lamalommwnerdomgallworkmyself.(Noworion'comp.insutmcerequhed.l' 9. El Demolition
*F11 min ahomeowmaam will be hamconaactnrsmconductah wort,on my pmonty. lain 10❑Building addition
amac that all cwunamseither have workers'compeuvtion ios..or.mk 1 Lolleetrical repairs or additions
propnaors with m`mPwyee t 12. Plumbing repairs or additions
5.[]I am a general contractor and l hme hired the sub-conerwrors listed on theamchod shed' ]3.�ROOf repairs
These sub-cvntracmrs have employeesor
and have workers'comp.im wase
h.❑We m a caporetivv and in vR,cers lave exemixd Mab right vfeaernplivv per MGL c. 14. Other
lsz.S1Hh end we nave m emgoyaa.Mo workers'pomp_imams reynired.l
eAVY applicant that checks box glmua also fill out thef edon,all showing their woMerside comvsetbn anstsinf tion.
'Hmneowr,ers calm submit this want art indicating thry,art doing all work and Men hire outside wnmacmn most submit a new affidavit ientuting such.
employees that checkthisboamusse m plorradditionalnM1eashowing danametithe suoh,maors andstare whether anoc Mose entities have
emPloYees. If the submnuacmrs hare�mPlvyees,they moat provide Meir workers'romp.polity vmnber.
I am an employer thatis providing workers'compensation insurance for my employees Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: 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 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 seardei are pains and penahieesssoof peelmy that the information provided above is true ami correct
Signature: Dale, 7+C
Phone#: �3� 440'e C'
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.Cityf rowo Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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 wrinen."
An employ"is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in ajoint 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 sub-contraclor(s)camels),address(es)and phone numbers)along with their certificate(s)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 regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In 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)and under"Job Site Address"the applicant should write"all locations in_(city or
town)."A copy of the affidavit that has been officially stamped 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 bum 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
I Congress Street, Suite 100
Boston,MA 02114-2017
Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
From:
To:
Louis Hasbrouck
Building Commissioner
City of Northampton
212 Main Street
Northampton, MA 01060
The Massachusetts Building Code,section 107.1 allows for an exclusion from requirements for
construction control in certain situations. In accordance with code section 104.10,1 request that you
grant a modification to waive the requirement for construction control of the project at
because the work is of a minor nature,will not affect structural elements,health,accessibility,life or fire
safety,and will be done in accordance with the prescriptive requirements of the code.
Thank you for your consideration.
Respectfully, ./
U
*f