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17C-231 (23) 34 NORTH MAPLE ST BP-2019-1334 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block: 17C-231 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Perron: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A) Category: Commercial renovation BUILDING PERMIT Permit# BP-2019-1334 Project JS-2019-000688 Est Cost: $103695.00 Fee: $726.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PINNACLE PIPING INC 111904 Lot Sc,e(sn. ft.): 59241.60 Owner: LHIC INC Zoning:SFI001/ Applicant: PINNACLE PIPING INC AT. 34 NORTH MAPLE ST Applicant Address: Phone: Insurance: PO BOX 523 (413) 454-4657 Liability EAST LONGMEADOWMA01028 ISSUED ON:5/28/2079 0:00:00 TO PERFORM THE FOLLOWING WORK:PHASE 2 - TASTING ROOM 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 sienattre: FeeTvpe: Date Paid: Amount: Building 5/28/2019 0:00:00 $726M 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File k APPLICANT/CONTACT PPLICANT/CONTACT PERSON PINNACLE PIPING INCMC ADDRESS/PHONE PO BOX 523 EAST LONGMEADOW (413)454-4657 PROPERTY LOCATION 34 NORTH MAPLE ST MAP 17C PARCEL 231 001 ZONE SI(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST E ED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Build'Buildme Permit Filled t Fee paid T"oof Construction, PHASE 2-TASTIN ROOM New Construction Non Structural iterior renovations Addition to Existing Accessory Structure Building Plans Included; Owner/Statement or License 111904 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQRMATION 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 a Registry of Deeds Proof Enclosed__ Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability gSeptic Approval Board of Health Well Water Pombility Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay J Signature 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 .7 C —r enn(t 15,2000 Department use only City of North I pton I ":.,� Building Depa en MAY 2 Z p Off= 212 Main Str at Room 10 water �y Northampton, M 0108&or euluo ,ris atRangphone 413-587-1240 F - 2ON 1nA T Deter 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 Property l Addrre�s�s: / L .This section to be completed by office 3 / 1Var'TUI Ic 5T _ Map t ( C Lot dZ-3/ Unit (-uyyu,e IM, of 00 13 -15 Zone Overlay District ..._.. ...... __ Elm St.District Ca Distinct SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: s SIC Name(Print) Current Mailing Address LU Signature Telephone 2.2 Authorized Attend, Name(Print) Current Mailing Address _. 413- Signature 13 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by pernnit aDDIrcant 1. Building (07 'T,/9,qmit q (a)Building PerFee 2. Electrical (b) Estimated Total Cost of 5000 Construction from 6 3. Plumbing '1 I "1 ��, Building Permit Fee 4. Mechanical(HVAC) cA ds '. . 1 � IF-7 5. Fire Protection ...__. 6, Total=(1 +2+3+4+5) 103 Check Number This Section For Official Use Only Building Permit Number Date Issued Signature'. Building Commissioner/Inspector of Buildings Date i Versionl 7 Commercial Building Permit May 15,2000 SECTION4.CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing[] Change of Ust Other❑ Brief Description Enter ,a brief description here. 7n, Of Proposed Work: V r4 L.� ' TC..1-moi �c-'r.... r^r der -79,Frh. .. SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly13A-1 ElA-2 E] A-3111A E3 A4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ElR-3 ❑ Sq ❑ 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 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(so ..__ _.. 1a ._... 1" 3 rd 4° ...... 4m ._ ....... Total Area(an Total Proposed New Construction (so _ Total Height(ft) Total Heightft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private❑ Zone Outside Flood Zane❑ Municipal ❑ On site disposal system❑ r f Versioul.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to bl filled in by Building Depmtm be Lot Size ._ Frontage ..--_.. Setbacks Front Side L:-R: L:_. R: .._.. _._... Rear __..... Building Height Bldg. Square Footage "-' % ' Open Space Footage % ..... - - (Lotareaminusbldg&paved lancing) #of Parking Spaces — Fill: (volume&Locoeon) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW © YES O ,.. IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DON'T 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 O NO O 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 activity distwb(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. t Versioul.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 Arehilect: Not Applicable Cl Name(Registrant): __............. - Registration Number Atltlress Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expionion 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 Signature Telephone Versionl.7 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 O UT SECTION 11 -OWNER AHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject properly hereby authorize P�rrysR�c + 1�/�. . to act on my behalf, n all matt/eJrs relative to work authorized by this building permit application. G S^ �- C= rG�"`ti �Jr �Z �aI / l 1 Sign of Owner (nI�1 Date as Owner/Authorized Agent hereby declare Mat 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 periurv. Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: - Not Applicable ❑ Name of License HolderItT�-O i1G(1. License Number Y 5a3Jcu. by 'ly�c- o(oa-8 rs - 111 '7� Address ���� Expiration Date -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 quilding permit. Signed Affidavit Attached Yes No 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: 3q /V,M, 5� The debris will be transported by: �w p�I f - n f The debris will be received by: t�)'A'-45 tir Ar--L4 Building permit number: Name of Permit Applicant Qcn Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02174-20777 www.mass.gov/dt'a Rockers'Compensation Insurance Affidavit:Builders/ContractorsMectricians/Plumbers. TO BE FILED WITH THE PERMITTING AETHOIHTV. Applicant Information Please Print Legibly Name(Business/Organleation/brdividuap: �an I �� t7U (26d: PN gx& t7 Address: Po S '� �r olcig City/State/Zip: L Phone#: <(I 3 ` Y 5 V- RUG_ G Are you an employer Check the appropriate box: Type of project(required)' L[3'fs in / a employer with xP employees(irlland/or par-rime).' 7. E]Ne construction 2M[...-le pmpnetorur pazm hip and have no employees working for me to $, emOdel Ing anY capacity.[No workers'corrmp vsurau'e ,eyuhed.] 9. ❑D ].M l mina homeowner doing all work myself,[No workcrscomp.insurance required.]t 10 Buuildinildin iOn 4.M oma homeowner and will be hiring cmtmcmrsto conduct all work on my,property. twill g addition ore that an combustion rawer have wo,kei comperrsapon winsome or an sole II.QElectncal repairs or additions imprudent with no employees. 12.Q Plumbing repairs or additions 5❑1 an a general contractor and 1 have hired the sub-conpactors listed on the attached sheet,Theo sub-contractors have employees and have workerscruip rourrance.1 13.F]ROof repairs 6.F-1 We arc a corporation and in officers have excreised them tight of exemption per MGL c. 14.QOthe[ 152,pl(4),mol we have no enploym ,(No workers'comp_insurance r,mud.] 'Any applicant that checks box#1 must also fill out me section below showing then workers'compensation policy information. 'homeowners who submit this affidavit indicating they are doing all work and then him outside coneactors most submit a new affidavit indicating such. :Connacmn that check this box must touched an iv damaral sheet showing the name ofthe sub contractors and state whether or not those entities have employees. If the sub-conmacmrs have employees,they must provide their workers'comp.policy minister. I can an employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site information Insurance Company Name: �h, � Policy#or Self-ins.Lic.#: -)(,, ul c(i , 1 G 4 Z �AK/ Expiration Date: 1 - I"1- zO Job Site Address: '�`J G/,1-in mel pig sr- EiCI®mpCity/State/Zip: Attach a copy of the workers' compensation POU4 declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL e. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or ane-year imprisonment,as well as civil penalties in the farm ofa 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 certify under thepains andpena/ties of perjury that the information provided above is true and correct Sign :':� Ph # t4ty- 8Y IG Official use only. Do not write in this area,to be completed by city or town offwial. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cit'/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 ofthe foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee ofan 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 ofthe 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 152,525C(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 ofeompliance with the insurance requirements ofthis 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-contractors)name(s),address(es)and phone number(s)along with their certificates)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 In lmanal 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 (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 1 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 Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the ninth edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Artifact Cider Project- Date:05/01/2019 Property Address: 34 North Maple Street, Florences, MA 01062 Project: Check (x) one or both as applicable: X New construction Existing Construction Project description: Phase 2, renovations to construct a tasting room open to the public. I Thomas C Chalmers MA Registration Number. 8317 Expiration date: 08/31/2019 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': X Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions'of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, I shall submit field/progress reports (see item 3.) together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a 'Final Construction Control Document'. Enter in the space to the right a "wet" or electronic signature and seal: �`�c Phone number: 413-624-9669 Email: tomc@austindesign.biz 9 Mew Building Official Use Only Building Official Name: Permit No.: Date: Note 1. Indicate with an 'x project design plans, computations and specifications that you prepared or directly supervised. If'other is chosen,provide a description. Version 0l 01 2018