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32C-058 (17) 155 PLEASANT STUNIT 104 BP-2019-1140 GIS# COMMONWEALTH OF MASSACHUSETTS a :Block: 32C-058 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 a BP-2019-1140 Project J6-2019-001849 Est Cost 596000 00 Fee: $672 00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JOHN J WALSH JR 070588 Lot Size(so.ft.): 50520 Owner. LIVE PLEASANT L(MITES PARTNERSHIP Zonine CB(t001/ Applicant: JOHN J WALSH JR AT: 155 PLEASANT ST -UNIT 104 Applicant Address: Phone: Insurance: 10 BRAINARD RD , 413),374.742$ O WILBRAHAMMA01095 ISSUED ON:417612019 0:00:00 TO PERFORM THE FOLLOWING WORMBUILD OUT FOR REAL ESTATE OFFICE - UNIT #104 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: Briveway Final: Final: Final: Rough Frame: Gas: F're _e rt iat Fireplace/Chimney: Rough: Pili Insulation: Final: Sm e: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy sin tore: FeeTyoeo Date Paid: Amount: Building 4/26/2019 0:00:00 $672.00 212 Main Street,Phone(413)587.1240,Fax: (413)587.1272 Louis Hasbrouck-Building Commissioner File#BP-2019-1140 APPLICANT/CONTACT PERSON JOHN J WALSH JR ADDRESS/PHONE 10 BRAINARD RD WILBRAHAM (413)374-7422Q PROPERTY LOCATION 155 PLEASANT ST-UNIT 104 (1/j MAP 32C PARCEL 058 001 ZONE CB[I00)/ THIS SECTION FOR OFFICIAL USE ONLY' PERMIT OPVE1 ION CHECKLIST NCLOSED REQUIRED DATE ZONING FORM FILLED T Fee Paid Building Permit Filled out Fee Paid Typeof Constmctiom BUILD OUT FOR MAL ESTATE OFFICE-UNIT 4104 New Construction Non Stmtural interior renovations Addition to Existing Accessory Structure Building Plans Included' Owner/Statement or License 070568 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 Pemrit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay /!✓I^,) 4 z5 t 9 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. r Verigoml 7 Cominciarcial Ruilding Poldrut May 15,2000 tree only City of North mp all,eRlllt Building De rtm Pit Cu CW dyeytey Ptlkmd �i"iii 212 Main treel APR 1 F 2019 is Avaiab ly Room 1 0 Wa nAN IAvailabft Northampton, AA0 Seta micturm Plata phone 413-587-1240 ax$r1°. �aifiPTr�ralr'in,�i, ite ns Pedfy APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING � / SECTION 7 -SITE INFORMATION 1.1 Property Address: This section W be completed by once lIS5L'1 . W -v— Map Set (r` Lot 069 Unit Wr I d (__' I,/I`r� Zone Otseday District 1. _A Wl 6-4 ...._. V•Itf ._. Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 er of Record: can 1 p Name(Print) Current Mailing Address 413.2�i3,6TN� Signature ._ _...... Telephone 2.2 Au � ;WM7flW F4ii Name(Pnnt) " Current Mailing Address'. Sign mire Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by intermit a licant 1. Building 2 00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of ©Qo Construction from 6 3. Plumbing _- Building Permit Fee 4. Mechanical(HVAC) ��� 5. Fire Protection 35J D0o 5. Total=(1 +2+3+4+5) to Check Number 1 73c This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date y� t (.;l2 Versionl.7 Commercial Building Permit May 15,2000 SECTION 4 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLO D SPACE Interior Alterations Existing Wall Signs ❑ Demolition Repairs Additions ❑ Accessory Building❑ Exterlor Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description Enter a brief description here. 4� al-ov Aa'I'q C�41Wf� 'PPA C;e� Of Proposed Work: i SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-0 ❑ A5 ❑ 1B ❑ B Business ❑ 2q ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 13L High Hazard El 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 38 M Mercantile ❑ 1 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ Sq ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Speciry'. M Mixed Use ❑ Specify: .. S Special Use ❑ Speciry. 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 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 2.21 c 11 ' 2nd 2r� 3rd 3m _ Total Area(sf) ( � �[y— Total Proposed New Construction(sf) Z Total Height(ft) 1t w_" �^'t C3'+ .... Total Height ft 7.Water S pply(M.G.L. c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Private E] Zone Outside Flood Zone[] Municipal (jKOn site disposal system❑ r Version L7 Commercial Building Permit May 15,2000 8. NORTHAMPt'ON ZONING Existing Proposed Required by Zoning This column m be fiI1M in by Building De,sabru ur Lot Size .__.. _.__.. Frontage --.... ...._. Setbacks Front Side L. R L:..._ R. _. _.. .. Rear Building Height Bldg.Square Footage "" '"" Open Space Footage (Lot area minus bldg&paved rbui #of Parking Spaces 11 Fill: ._. _. �dnme&. A. Has a Special Permit/Variance/Find�ing(ever been issued for/on the site? NO © DONT KNOW v 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 a DONT KNOW O YES O 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 a NO O IF YES, describe size, type and location: 1VZOA-li't— LqVc v59 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: bo'Cli 1/-L4CX0 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 O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version 1.7 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: I y p fA.r1 nt t � Not Applicable ❑ NaVmee(RReegitstrrant):JTifSwC _.. _._ .. Z2•L 1 Kr s-4J_.'-[ r JTc. 32yZ p U+ Registration Number Address ('q17-bN- t, I Expiration Date Signature Telephone W 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Dale Name Area of Responsibility Address Registration Number Signature Telephone Expiation Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.33 General rContractor ,' I L Not Applicable ❑ Comp^'any1Name: '' ,, ^^''++,, Responsible In Charge of Construction Addie s � Signal a Tele" phone Version L7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW 1780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes O No SECTION 11-OWNER AUTHORIZATION-TO BEE WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ._... .. 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 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 pequry Print Name ... .... ..._. Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder I—S 0-7 S 72) License Number l4 P116YAW i U V lbt (MA Atltl ss Expiration Date Si ur " ` Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§2SC(fi)) 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 bu;jding cannot. Signed Affidavit Attached Yes 0 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, 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 z disposal facility, as defined by MGL c 111, S 150A. �lf Address of the work: [SS rWa'"4- ':-L t7wIQR The debris will be transported by: 0AW&US- T1>UC6"lo The debris will be received by: //b Yltdr TQC/ ck"Ph Building permit number: \ Name of Permit Applicant iib1 ALA, �9 Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of lndustrialAccidents I Congress Street Suite 100 Boston,MA 02114-20177 kfv! www.mass.govIdia Workers'Compensation Insurance Affidavit Builders/ContractorsmE etricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibiv Name (6usinetwOrganimfiomIndividuap: Address: Ib�i d41M[�S City/State/Zip: l/J /Phone#: lit J."Its{', Xt?"1i Are you an employer?Check the appropriate box: Type of project(required): I. am cavalry.,am employees(fWl andImpertmaney* 7. ❑ ew construction 2.zam asole pmpnetororp mhip andhave no employees working formein R. Remodeling any capacity.[No workers'comp.insurance mquired] 1❑I am a Imneowner turns all work myself [No workerscom,memance reserved.l' 9. ❑Demolition 4.❑1 am a homeowner and will be hiring contractors to conduct an work on my facers Iwill 10 ❑Building addition nine chat all contractors either base workers''compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.[-]Plumbing repays or additions s❑1 am a gererel contractor and I have hived she sub-contractors listed on do winched sheet. 13,0Roof repairs These subcontractors have employees and have workers'comp_insuren 6.❑Weare cmpropuon and its officers have examsed their right of exemption per MGL c. 14.[—]Other 151.§r41,and we have no employees. Mo workersoomp marrowe required.I 'Any applicant that checks box#I must also fill out the section below showing thee,wnrkeri compensation policy information Homeowners who submit thes affidavit indicating they are doing all work and then hire outside contactors most submit a new affidavit indicating such. :Con tom that check Nis box most attached an additional sheet showing the time of the sub-conhanors and state whether or am those entities have employees. If the sub-co.v rs have employees,they most provide they workers'comppee hey number I am an employer that is providing workers'compensation insurance for my employees Below is the policy and jab site information. Insurance Company Name: Policy It 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 veri cation. Ido hereby ce fy under thel aimys and enalties of perjury that the information provided above is true and correct Siornatin, �I� Date q1 tZ- (q Ph 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.City/Town 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 written." An employer 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 ofa 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 ofpublie work until acceptable evidence ofcompliance 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-contractor(s)name(s),address(es)and phone currents)along with their cenificate(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 proofthat 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 tie.a dog license or permittoburn 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 `cam CERTIFICATE OF LIABILITY INSURANCE D a;;;019 " THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE ODES HOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUREWS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certN holder is an AWNTIONAL INSURED,the poNe kal most have ADDITIONAL INSURED provisions or N NWorsed. If SUBROGATION IS WANED,sLL}ect to the Mrns and conditbne of the polity,carsin policies may require an eYW5lrsement. A statement on this cMmificate does not confer rights W me carHRcate holler In Use of Much inwhora asee M). PROOI6ER xAME: Nicole LVm Edg9gton _ _ John M.Glover Agency080-35]-90]2 °uc,Nep.%0-356-0932 -- P O Box]00 Sm Norwalk CT 06852 Amex": nedilingforlfiohnmgloVer_mm__ IX9LK4RISIAFEQBIXG COVERAGE IMIC} wsu11ERA.Atlathc CBsual_Iy CWilre_nms 42646 INSURED W'4SHXVM NALMER John Walsh 10 Brainard Road NMuam G, Wilbraham MA 01095 MUMR o: YA9uR I N6U1¢R 1: COVERAGES CERTIFICATE NUMBER 15899]68]9 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF MY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CILAIMS. TYPE OF IWURAXCE AOOL WBR POLCVNWBE0. YOLIOYEFF YDECY" LIMITS X COMYFALULL4FlEMLLN&LT' LZ61DR1D65 6112019 OY32020 E EGGCURRENCE $1MLEE 'M`ONAAETO Nfl _.-._.. . CUIMSIMUE Xi�OceUR '.. 'I EMISEG IF,oconerae) 1100,000 i� I MEDE%P WIY cm Gasml 55.000 PERSONA.LLADVINJURY slow M _ GEN L AGGREGATE LINE APPLIES PER. GENEPALAGGREGAT_E _E3000.000 X PEXICV PEC LCC PRL-0I1CTx r.oVPIOPAGG 5100D000 OTHER AUIOMOaRE WONItt I CO161NE05 LIMI1 MgM5 U MY AUTO BODILY INIURv 1pp,ye,x„p s OWNED SCHEDULED gGpx1..IUG1 IIt ce11 S - REu OINLY ,;AUTOS .UYINED " PROPERTY DAMMiE $ AUTOS ONLY IAUTOS ONLY ''. ".IP✓xWNI $ UNBPRULIAB OCCU0. j EACHCCCURRENCE $ FFCESSLIAB CLANLA. E" AGGREGATE 5 DEG RETENTIONS 5 WORKERS COMPEMATMW PEO OIH ANDEYROVERe LIARILIN YINr_ STA U _ _ ER _. ANYPROWATWYSAmNERXXEOUTNE ❑ ISI E EACH CCp Ni 5 '..6ACERNEMVxCx.UOEOi NIA _ -..- .-.. 'yNe,anwyM XX) DSEASE-E EMPLOYEE $ D ESCRP I qN CFOPEPAIIONS ells LDISFASE-POLICY LIMIT $ OESCRIPTXNA OF OrtMNONS I LOC.SI VEHICLES IACg101N,AIffiW MilwEr Sa,NN.nMY EAtl1i1W YmwP tpae s rquYWl CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ESPIMTION DATE THEREOF, NOTICE WILL BE DELIVERED M ACCORDANCE WITH THE POLICY PROVISIONS. City of Northampton 212 Main Street Abri MREPRESEXTATIVE Northampton MA 01060 `^ lam'^' ®1988-2015 ACORD CORPORATION. AN rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marts of ACORD