Loading...
17C-254 (5) 21 NORTH MAIN ST BP-2020-0009 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block: 17C-254 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category:ADDITION BUILDING PERMIT Permit# BP-2020-0009 Pro ject# JS-2020-000009 Est.Cost:$38920.00 Fee:$273.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group EDWARD RICKEY 96159 Lot Size(sa.ft.): 28488.24 Owner: ALL NORTH LLC Zoning:GB(100)/ Applicant: EDWARD RICKEY AT: 21 NORTH MAIN ST Applicant Address: Phone: Insurance: P O BOX 62 (413) 695-7059 WILLIAMSBURGMA01096 ISSUED ON:7/9/2019 0:00:00 TO PERFORM THE FOLLOWING WORK BUILD NEW 14X30 ENTRANCE 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 It 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 Sienature: FeeType: Date Paid: Amount: Building 71920190:00:00 $273.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 66V PLai PLAN ut�j File#BP-2020-0009 I DINER S1 APPLICANT/CONTACT PERSON EDWARD RICKEY W ADDRESS/PHONE P O BOX 62 WILLIAMSBURG (413)695-7059 PROPERTY LOCATION 21 NORTH MAIN ST MAP I7C PARCEL 254001 ZONE GB(100V THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid n Building Permit Filled out Ile Fee Paid TvoeofConstruction: BUILD NEW 14X30 ENTRANCE New Construction Non Structural interior renovations Addition to Lxisting Accessary Structure Building Plans Included: Owner/Statement or License 96159 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO,PMATION PRESENTED: _LZApproved_Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate ProjecU 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 Cm 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 Delay O`'�`- 7 911 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. Versionl.7 Comme ermrt a 15,2000 Department use only City of Nortam Iscr' us f Permit: Building De art ant z 2p1� C Driveway Permit 212 Main tre JUL er/S plic Availability Room 1 0 er II Availability Northampton, AO 06 a""Fc oWSets 1 Structural Plans phone 413-587-1240 x 4" qa^p01 Ie Plans 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 �UL 1.1 Property Address: This section to be completed by office 21 no, W6-. . .,let. Map /7C Lot 2sy Unit a,/ -4 . " 010( 2- Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: "(2- 1C .S6 G ,l A, J ST PI-AlWF1U'u-i Name(Print) Current Mailing Address 01070 Signature Com" i vv'L' Telephone 2.2 Authorized Adam, (5dcw -1w, / 'd C Baty 6 2 L.�cQQtanu�in,o 7 ?m Olo% Name Print) {f Current Mailing Address. d - Signature Telephone y/3-695-7asr SECTION 3-ESTIMkKED CONSTRUCTION COM Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 38/ 920,on (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 3.00 5.Fire Protection 6. Total=(1 +2+3+4+5) 38 720 1 Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissionerllnspector of Buildings Date (lane-y \D�tmpro,re menyse �Cnw�t ' \ � ...o . . � �. �. _ � _]� ] 1 .�x'J 1� Vcrsionl.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 Wall Signs ❑ Demolition❑ Repairs-4 Additions ❑ Accessory Building® Exterior Alteration .® Existing Ground Sign❑ New Signs❑ Roofing® Change of Use❑ Otherp❑`, Brief Description Enter a brief description here. *w—% i W ~ f f Of Proposed Work: 11"up, Iyg 36' d pun SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check es applicable) CONSTRUCTION TYPE A Assembly11A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ 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 ❑ 3B M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ SA ❑ S Storage ® S-1 13S-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(sf) 69a v, 9pO 2"' 3 zo 2"d 3L0 3'd 3 d 4m 4m Total Area (sf) 940 Total Proposed New Construction(sf) //Z24 Total Height(In 25, Total Height ft 26' 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone[] Municipal ❑ On site disposal system[] .. ., •,, . .� • .� . .Ch . .. Y' .. 0 - Vcrsionl.7 Commercial Building Permit May 15,2000 S. NORTHAMPTON ZONING Existing Proposed Required by Zoning '[his wloum m be filled in by Bonding nepunnxnt Lot Size Frontage Setbacks Fmnt ,F1Qg L:U. R: IC LE2 R: L2. Budding Height 25 Bldg. Square Footage Open Space Footage „_,...� % �� -----; (Lot a,rxminus bldg&Owed ...._�i arkin N of Parking Spaces Fill: Im �Q volume a Locmion A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW O YES O IF YES, date issued: l ^� IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW 0 YES o IF YES: enter Book j Page and/or Document g B. Does the site contain a brook, body of water or wetlands? NO V 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 © , Date Issued: �� C. Do any signs exist on the property? YES © 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 0/ IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,exc ation,or filling)over 1 acre or is it pan of a common plan that will disturb over i acre? YES Q NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 760 CMR 116(CONTAINING MORE THAN 35,690 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: _...._.._...._..__ Not Applicable C Name(Registrant) - Registration Number Address Expiration Date Signature Telephone _J 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone ) ration Date Name Area of Responsibility Address Registration Number �J Signature Telephone Expiration Date Name Area of Responsibility r.. (Atltlress Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 Geni Contractor Not Applicable ❑ Company Name' Responsible In Charge onstruction A. 6" bz ZcG2la.bLew r 0/o9c Address Signature tl fill 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 0 No SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize to act on my behalf,in all mattrela8_ to work authorized by this building permit application. Sign of Owner Date as Owner/Authorized Agent hereby declar,that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Si=eppyyal1insnand penalties of perjury. Print Name Z 20 Signature ofa pent ate SECTION -CONSTRUCTION SERVICES 10.1 Licensed Construction S��upervissor:q Not Applicable ❑ Name of License Holder 45 r4,--a A:fUW GS- 07419 Liceense-Humber ( Address Expiration Date~ r Y/F.49S-7oS9 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 builtiling permit. Signed Affidavit Attached Yes No 0 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: 21 77m& Wiv s+ The debris will be transported by: 111x0.. &,Pd The debris will be received by: Building permit number: Name of Permit Applicant rro .Ou L6At4 t9 Date Sig ture of Permit Applicant �\ The Commonwealth ofMassachusetts Department of IndustrialAccidems 1 Congress Street,Suite 100 Boston,MA 02174-2017 wormmatesgov/dia V-X\.rkersl Compensation Insurance Affidavit:Builders/Contmetors/Eketricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print L s'bl NaMe(Business/OrgeniratioMndividurth: Address: /�s_�jc 62 City/State/Zip: sa& rl/1 010W Phone#: 4113 —675-7097 An you an employer?Cheek the approprid box: Type of project(required): 1.[3l am a em,k,,a wins employees(full and/or part-time).` 7. ❑New construction 2.�Iemasole proprietmmparaunhip end have no employers worldvg formein 8. Remodeling any cepaeity.IN.workers'amp.insmmta required.] In lam ahomeownerdoingall workeryself[Nn worker amp.insurance minimal 1 1 ❑0❑BuildinDildin ion 1g addition 4.❑soma home ownerandwillehiring antracwnmconductdlwork eor property. twill ensure nut ell contractors either have wmken'ampemarion ivsmna eor are sole 11.❑Electrical repairs or additions proprietors wins no empbyees. 12.❑Plumbing repairs in additions 5.❑l am a general const 2ormW l have hired the subcwtrecWn listed on the`unshed elder. ]3.❑RooflEpairS These arlaeovtmcmrs have employee. it have worker'comp.imuruseJ 6.❑Weare a ar,ormion and in officers have exercised their right of exemption per MGL c. 14.❑Other 152,§I(4),end we hive no employces.IN.warker'amp.iruummo,required] `Any applicant that checks box 41 must also fill out the section plow showing their workers compensation polity intonnation. t Homeowners who submit this affidavit indieating they me doing Al work and than hire outride anam n,,must submit a new affidavit indicating such. $Contractors that check this box mus atmat ed an additional sheet showing the name of tine subcontractor aad state whether or not those entities have cmplapas. If the sub-connectors have employa.,they must provide than workers'comp.policy number turn an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Daze: 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. Ido hereby cerafy under the pains and penalties ofperjuty that the information provided above is true and correct. Si Date: z 4 get" Phone#' 1//3• —lab-9 QKkial 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.Cityfrown 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 a Joint 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-contractors)camels),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 in partners,we 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 al6daviL 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 thein 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¢odour 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 BI]in the permit/license number which will be used as a reference number. In addition,an applifafn that most submit multiple permit/icense 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 forme permits or licenses. A new affidavit most 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 Departments 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 1-977-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia i �� Z9o10 b •vs Klvut ^rxpu. is i LS �tidW qVo N 9•0�� i i arnr� /awW ZBIZ ; jt 09p;O VAl'NOidWVµ�UOIv [SNOIoaasrm Baia une,u iaim Me s - Jnr a�ni��3a \hl s �aPP S8/ 9 OB 1 / a I <.J $ h E Z 1 0 I XT dl - I ""0 ..07/ ZIXZ � VUWG z • �-� 'fid 9 xZ • aa,�d" ,koodwrrry rvv I, d�+o T-ry-rN^/ ?d hxZ e '4°41 }"d" 'fid hxh 21 71ot& MAW 3T. }Io R MA 0/062 6AFly - ----- -- - • 12° SoncZxbu w/ 30" Fo.fv,�n 'd' /id2 d 0 gxa PKt J-0,. dt d'j, @ • Box a Pt u�z� PaOYo • 3' PLY 2x12 Hoo At, C l0,0" XCY SPAN • 2xd �"" d V 600nor s p Qetnni. .,w/ T, L.NE. °O �on�na.w # /famr�q X J;vkw a cxM7a. • 2X16 pqt. @ s�$n r✓Dk "�8 rl 2x12 PeAOCE ri _ . Li O LGne� EVTay £NTRw EAnR4 - S+ti ° 0 SPACE SPACE SPA b o• �Y )0'0 --------/ j0.0., o 1 ? a 415 •� o hl —� — — o s � o sx I `o I o M No _ + o ' i I 0 1 o_ D � A , Z 1 I ' 1 0 + . — —ND,hl 09� ��� ¢ °`°�.°"'"`�2/ /✓?l�'47 � 29o1D Y1//, """"DD's "?g" ^;"Z!L 'YZ"ll /Z 21 77CETH MAW ST. Tann l?M 01062. I 8anm a i.ow S-;zLL --- • IZ $on�udea u � 3�0 Sat y ' aaQ • $x47 Sampo. , boa &,,w a Uchad @ P/xnn w/%z" X l4 • gxBPts;L -t U a 1 • 3 PPa 2x10 MAS SPAN = ld o - 'Ic - 14 o" , 2x8 p "d alt Z 8 12 12 • 2x12 s ,e L /6, 0.c. w/ Ma eew ( MAX 5PAAl 0 zx (o a 5/8° C17X y • 'i f& , / f'!" # adaC ad d 2x8 .A.a e 2x$ _o NEW F_NTR4 'MAJN MAIN S PAGl= 15A RN (3ARN o - -=3= — ml - - --- >--- �— b1 v ite/'S'9 'S..�N?j/'N'3 ' 07 • Do3 S �nvs.Z, ww-i;/i ��s S5o/-v "0,4�cuay{iON �yfv/S :y�ui/ �/des 'MAI f �..oafP�rvy0 ,rnC/.) � d 'nAwD u! /o O v r� �y,t S & • S S�l.,i 'uot cJ+uoy�,/O/V ( »u�ia��� u i �cIl7J �O uOld � � � foor Y . N � aW ✓ ��X11 S r.. g � z y • ' � — � as x ,M • �e tJ� 0 S 5•� , � e tio\N I 0 Vz 0/ � •07 hN + a ��N/ h^'� OOOM 110/V N O O W N N (D W N D