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32C-171 (24) 256 PLEASANT ST-FIT OUT BP-2019-1502 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:32C- 171 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category:renovation BUILDING PERMIT Permit# BP-2019-1502 Proiect# JS-2019-002433 Est.Cost:$261377.00 Fee:$1827.00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor. License: Use Group, SALOOMEY CONSTRUCTION 018780 Lot Size(sa.R.1: 17119.08 Owner: LUMBERYARD NORTHAMPTON LIMITED PARTNERSHIP tonin¢CB(100)/ Applicant: SALOOMEY CONSTRUCTION AT.- 256 PLEASANT ST- FIT OUT ADnlicantAddress: Phone: Insurance: P O BOX 1203 (413)269-4360 WC WESTFIELDMA01086 ISSUED ON:612712019 0:00:00 TO PERFORM THE FOLLOWING WORK.1 ST FLOOR OFFICE SPACE FIT OUT 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 HE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of OccuoancY Signature: FeeTvpe: Date Paid: Amount: Building 62720190:00:00 $1827.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-1502 APPLICANT/CONTACT PERSON SALOOMEY CONSTRUCTION ADDRESS/PHONE P O BOX 1203 WESTFIELD (413)2694360 IIIIIIOOO���--- 1 PROPERTY LOCATION 256 PLEASANT ST-FIT OUT O MAP 32C PARCEL 171 001 ZONE CB(I OOV T11- THIS "rTHIS SECTION FOR OFFICIAL USE ONLY PERMIT APPLICATION CHEC ENC ED �t ZONING FORM FILLED T , 1EQIRED DATE Fee Paid Buildine Permit Filled not Fee Paid Typeexf Construction: I ST FLOOR OFFICE SPACE FIT QVT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included Owner/Statement or License 018780 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9RMATI0N 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 DDelay, 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 1.7 Commercial BuildinR Permit May 15,2000 Department use only ity of Northampton Status of Permit: RECEIVED B riding Dapartment Curb CuUDr veway Permit 212 Main Street Sewer/Septic Availability JUN 2 6J2019 Room 100 WalerM/ell Availabili y No hampton, MA 01060 Two Sets of Structural Plans 41 87-1240 Fax 413-587-1272 Plol/Site Plans Dr Other Specify r REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION I -SITE INFORMATION 1.1 Property _ This section to be completed by office Map 3 Lot 1-71 Unit /STF/Gc !if MCPS zone overlay District Al Pk/7a/11h><L'/7 m� OiU�U 1—------ - Elm St.District CB District SECTION 2.PROPERTY OWNERSHIPIAUTHORIZED AGENT 2/.1 Owner of Record: Nsms Name(Prioi � ((� /� P� CumMeLarp rime: YAA) TNephoria 2 LJ/CC... DYrK ___ fix Via( , lL�I�S t iJA9 C�/O�lo Name(Print) --_---_ C�nantpdrN Atltlms: Signsusm Telephoto / T Item Estimated Cost(Dollars)to be Oficial Use Only completed b permit applicant 1. Building (a)Building Pard Fee I--_--� 2. Electrical ` .___ _______. _..._. ki On (b)Estimated Total m(6 of Construction from 6) _J 3. Plumbing �tT r(S\ Building Permit Fee 4. Mechanical(HVAC) � 5. Fire Protection 6. Total=(1 +2+3+4+5 Check Number This Ssellon Fw Olflclal Use Only Building Permit Number Dab Issued Signature: BulMing Commesionernnspector of BuiMMgs Date 713, It _ _ , ,:, _. i 'Uin S � 50:3 i Versionl.7 Commercial Building Permit May 15,2000 SECTION 4,CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations Existing Well Signs ❑ Danoiltion❑ Repalrs❑ Additions Accessory Building[3 Exterior Alteration ❑ Existing Ground Slgn❑ 111sw8lgns❑ Roofing❑ Clangs Muse❑ Otlar❑ _ Brief Description EnteUf �ptioeItee OIprop s /7 SECTION S-USE GROUP AND CONSTRUCTION TYPE USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembh/ 1:1A-1 13A-2 13A-3 1-1111A A4 ❑ AS ❑ IS ❑ B Business ❑ 2A ❑ E Educational ❑ 28 ❑ F Factory ❑ F-1 ❑ F-2 Q 2C ❑ H Hiah Hazard ❑ 3A ❑ 1 Institutional ❑ 1.1 ❑ 1-2 ❑ 43 ❑ 3B 11 M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 Q 5A Q S Storage ❑ S-1 Q S-2 Q 5B ❑ U Utilry ❑ Specify. M Mixed Use ❑ Spew.E S Special Use ❑ Specify: II _J COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS ANDIOR CHANCE IN USE Existing Use Group: i -_._ -- Proposed Use Group: i_ J _.___ Existing Hazard Index 780 CMR 34). _ _ Proposed Hazard Index 780 CMR 34): SECTION 5 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Fluor Ares par Fluor(sg II 2, 2- 3,a _ �— —_ -----� 41, Total Area(sQ _ � Total Proposed New Construction(aQ Total Height(ft) Total Haight ft 7.Water Supply(M.G.L.c.40,154) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private 0 Zone 1 Outside Flood ZoneC3 I Municipal ❑ On site disposal systemQ Version 1.7 Commercial Building Permit May 15,2000 S. NORTHAMPTON ZONING Existing Proposed Required by Zoning This col.b be filled w by r-- Bedding Depalmeat Lot Sim Frontaire Setbacks EMM L_-.l Building Height ��� ,_ 3 Bldg Square Footage 'A Open Space F __1 _ (Lot(Lotue mumu bids #ofP Spaces r-, voume aCocetion) —.._.___-_ _______. A. Has a Special Permit/Variance/Finding ever been Issued forfon the site? NO O DONT KNOW Q YES O IF YES, date issued: r IF YES: Was the permit recorded at the Registry of Deeds? NO © DON'?KNOW O YES 0 IF YES: enter Book L _ _ _ 1 Pagel I and/or Document gI_^__. 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 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. NAI the construction ecav"diaturb(clearing,grading,excavation,or filling)mer 1 acre or ise pad of a common plain that will disturb over lam? YES O NO O IF YES,then a Northampton Storm Water Management Perart from the DPW is required. Verfionl.7 Commercial Building Permit May 15,2000 SECTION S.PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 178 CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE 8.1 Ra Isbrad Architect: t . I - 6 S��IAL,t.t..%!/iChJ _... _.. - otApplicable DlA �� ... D/ Aware Ct Signa re T na SR Iatened Professional En Iftee f: Name Arae of RefponflbYlty Add.. Registration Number i sipretbf Telephone E*Yatbn Dab Nems Area of ROsporroDRty Add.. Regiatrallon Nunber Telephone expiratica Dab Name Ane of Reeponab111y Adam Raglidation Number signature Expinalon Data Name Alae alRwpomlNlay Address Reghlra0cn Number Signature bPIN m I Eopireflon Dela 9ApOnwral Contractor WAppcewe❑ ComParc7 Wma: _.. na- bCMps dCanbudbn /` / Address e Tabpron i Versionl.7 Commercial Building Permit May 15,2000 SECTION 10.STRUCTURAL PEER REVIEW(760 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No SECTION II -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, __ _ _. _ •n - ,aa Owner of the subject property hereby authorize i_, I �.Il._ IF- 1, to act on my behalf,in all matters relative to work ammaked by this building permit application. Signature of Owner ny Data MEN— I, 7- 1�L/J`._. ._____ as Owner/Authorized Agent hereby declare that the stateme nd Information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed urW�r thspin and ppena�ylti�e(sof penury.____ Z .-... __. _.II.C�_t_L.. Print Name S urorH r/Agent Date SE -CONSTRUCTION SE ES 10.1 LicensedCo Not Appllceble ❑ Name of Licenaa Holder:I-Z/ _ o—t- _._. f — 1 __ Lkanee Nu tber Z a — -- — oiokb _ I /i z Adtlme Eaplrahan Dat Ta @Oh SECTION 15-WORKERS'CN. ATAN INSURANCE AFFIDAVIT(M.G.L.c.15Z§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 budding permit. Signed Affidavit Attached Yea O 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 disposal facility, as defined by MGL c 111, S 150A. Address of the work: 624h7o I/e'G-5641) / I �f The debris will be transported by: i2dblalaO111-26 The debris will be received by: Building permit number: i Name of Permit Applicand Ue PO n, . Date Signature of Permit Appl nt The Commonwealth of MassaehuseOs Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 01114-1017 www.mass.gov/dia \\orkers'Compensation Insurance Rdavit:Builders/Contmctors/Electricians/Plumbers. TO BE FH.ED THE PERMITTING AUTHORITY. Applicant Information n A c- can Print Latailtly Name(nusiness/Or m,*r tionnndividuel). Address: _�1 &Jy �// 9/} City/State/Zip: (' GS4hone#: y1d- 6 -y3.oC% fqzT A.amployrrr Cbuk the opproprl.te bar: 'type of project(required): laemployer with employas(Nil and/or pan-time)• 7. ❑New construction 9tem a sole proprinor or pamcnhip and have no anployar working fmna,in 8. Remodeling arty capacity,live waken'camp.inmaanm reauiredl 3.❑l an a homrowner doing all work myself.Mo workers'comp.insurencenusturd.11 1 Demolition 4.❑l nn a Immeownar and will has hiring contractors to conduct ell work at my propesty. 1 sill 10❑Building addition ansae that all contractors either have workers'comadenthon insurance or are sole 11.❑Electrical repairs or additions proprvalms wim no employees. 12.❑Plumbing repairs or additions 5. 1 am a general contractor and I have hired the subcontractors listed on me reached shot. Thee sul.wntrwtmo hive employees and have workers'comp.iruaance.t I3. Am Roof repairs ,,OO 6.❑we areacarpontien and its officers have enrcised their right of exemption per MGL.. 14' Other t../ 152.Wall and we have rw atooyas.(No wodee'caw.memartce agWmd.] *Any @Mia i that checks box al mot also fill out the section below showing their woken'comperuation policy information. t Homeowners who submit his affil evil indicating they are doing all work and than hire ounide contractors most submit a new affidavit maintains such. Contractors that check this box must attached an additional shut slwwing the.of the sub-contncmn and mute wherk,or not hose entities have employees. If me sub.contmcmrs have emPloytts,they must provitle their workercomp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Information. Insurance Company Name: Policy 4 or Self-ins.Lic.N: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy deciarstion 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 foe up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the foot of a STOP WORK ORDER and a fine of up to 5250.00 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. /db hereby c IJ under theligIns a dpe/nalties ofperjury that the information preavidedabove Is nue and correct. Si�mre' q_/ / ���� N �1(,C.� Date: Official use only. Do not write in this arta,to be completed by city or town official. City or Town: Permit/License h Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone a: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for thew employees. Pursuant to this statute,an employee is defined as"_.every person in the service of soothe under any contract of him, express or implied,oral or written." An employer is defined a"an individual,partnership,association,corporation or other legal entity,or my 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 mora than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,contraction or repair work on such dwelling!rouse or on the grounds or building appurtenant thereto shall not because of such employment he deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local lkmsiog agency shall withhold the issuance or renewal of•Because or permit to operate a business or to construct buildings in the commonwealth for any applicant who ban not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MOL 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 insurence 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-cordractor(s)name(s),address(w)and phone numbers)along with their certificates)of insurance. Linked Liability Companies(LLC)or Limited Liability partnerships(LLP)with no employees other than the members or partners,aro not required to carry workers'compensation insurance. If sn LLC err LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidmts for confirmation of insurance coverage. Also basset Wallis 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 my questions regarding the law a if you are required to obtain a workers' compensation policy,please all the Department at the number listed below. Self-insured companies should enter them self-insurance license number on the appropriate line. City or Town Officials Please be sure thin 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 M confect you regarding the applicant. Please be we M fill in the permit/lio mw number which will be used as a reference number. In addition,an applicant that most submit multiple pomit/licew:applications in my given year,need only submit one affidavit indicating carnet policy information(if necessary)and under"lob 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 M the applicant as proof that a valid affidavit is on file for filum permits or licenses. A new affidavit must be filled not 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 bun lava etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax nuenber: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suits 100 Boston,MA 02114.2017 Tel. #617-727-4900 exL 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.inam.gov/dia ------ SALOCON-01 A`O CERTIFICATE OF LIABILITY INSURANCE °12filrAlB YNM CERT W M IEEMU AE A MATTER OF KOIMM11M1 ONLY ANO CONFERS NO MKS UPON THE CERTeRGTl HOLDER.THIS CERTIFIWTE DOES NOT AFFM:MATNELY OR REWTINELY AMEND, EXTEND OR ALTER THE COMERAOE AFFORDED BY TIEPOLIdES MELOW. THIS CERT NAW OF NSUMNOE GOES NOT COR INIE A CONTRACT EETINEEN THEM RAW INSURERISI,AMMORIED RENiNEMATVE OR PRODUCER,ANDTTL CERTMICATE HOLDER. IMPORTANT: XiM ONIYMehtldNYw AOpTONALINSURED,MR paIIryIWImYM Nva AODITN)MLINEUREO PIUYIMonexMwdOME. M EUBNOW110NM WAIVED, wgeM tD Ule nllln alld ` ..em ofW Pollry,eRlYln RMeIMr maY nplYRMI aIIdDIREIrIMIL AeIaYIIIFll1M DNe CadMCME dow nEl CDIrIaF (O QIe CRIeR1AY IIPNYFIn IMVNwmwdO F. ��. ERSINCT Chrislims Sufliven RMMW Imaxa RI Apm,,Ina ^ 11a eEKEM :Ha VU4401 CICMW srlE.l enN{D IIMIRMIIUe.rNlll v C4a%N.MA DIOL] I leets Sr. D Cacamaytlm,tn<. MF.DIIreMDDnW PO Mw tEpD WaSIIIMd,IM D10S6 0IMMIN : T M lE TO CERTIFY TMT THE POLICIES OF INEURNiCE LISTED BELOW NAIVE BEEN ISSUED TO THE INSURED NAMED ASTM FOR THE POLICY PERIOD eQICATED. NOIWRN6IANDIMG aaIY REQUIREMENT,TERM OR COIUITION OF Ntt CONTRACT OR OTHER DOWMEM HATH RESPECT TO NHICH TI'S CERVFMATE MY BE MIXED OR MAY PERTAIN,THE INSIJ. AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL TIE TERMS, DXCLUNONS AND CONDITIONS OF SUCH POLICIES.LIMITS 8110NN MY WIVE MIEN REDUCED BY PND CLAMS. 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