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32C-043 (22) 58 PLEASANT ST BP-2020-0021 GIS#: COMMONWEALTH OF MASSACHUSETTS Map,Block:32C-043 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Pencil: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categorv:demolition BUILDING PERMIT Permit# BP-2020-0021 Proiect# JS-2020-000030 Est.Cost.$15000000 Fee:$1050.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JON E HENDERSEN 084113 Lot Size(sa.ft.): 6229.08 Owner: SUHER PROPERTIES LLC Zoning:CB(100)/ Applicant. JON E HENDERSEN AT: 58 PLEASANT ST Applicant Address: Phone: Insurance: 9999 E EXPLORATION COURT (262)638-6000 STURTEVANTWI53177 ISSUED ON.-711012019 0:00:00 TO PERFORM THE FOLLOWING WORK.INTERIOR AND EXTERIOR DEMO, FAQADE REPAIRS 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 signature: FeeType: Date Paid: Amount: Building 7/10/20190:00:00 $1050.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner File#BP-2020-0021 ( 61'J APPLICANT/CONTACT PERSON JON E HENDERSEN ADDRESS/PHONE 9999 E EXPLORATION COURT STURTEVANT (262)638.6000 G 0 PROPERTY LOCATION 58 PLEASANT ST / MAP 32C PARCEL 043 001 ZONE CB(IOO)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid TvoeofConstruction: INTERIOR AND EXTERIOR DEMO,FACADE REPAIRS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included' Owner/Statement or License 084113 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: _eApproved_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 Delay 4k�- � 7/10/19 Signature of BIlilding Offitial 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 or 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. Venionl.7 Commercial Building Permit May 15.2000 Department use only ✓ ;City Northampton Status of Permit: C3 219 BUlldl Department Curb CuHDrivewey Permh ja12 In Street Sewer/Sepik Availablllry oom 100 Water/Well Availability rthampton, MA 01060 Ivo sets of Structural Plana p e 413-587-1240 Fax 413-587-1272 PIOVSiIa Plans ONar Specify A ATION 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 ProeeMA4drosa: This section to be completed by o ice 58 Pleasant St. Map �� Let 0'1 � unit Northampton,MA 01060 Zana Overlay District Elm St District CB Dismal SECTION 2.PROPERTY OWNERSHIPIAUTHORIZED AGSM 2.1 Owner of Record: Suber Properties,LLC Box 771,Holyoke,MA 01041 Name(Print) Curtent Malling Addnaa: (413)552-0776 Slitrifiv. Telephone 2.2:Dsvid�A. horias Aeont: Levy&Ass 345 Springside Dr.,Akron,OH 44333 Naent) Current Melling Addese: (330)666-6767 Sige Teepinne SECTION J MATED CONSTRUCTI S Item Estimated Cost(DolleI be Official Use Only oom leted a Permit a nt 1. Building $150,000.00' (a)Building PennN Fee 2. Electrical (b)Estimated Total Cent of Construction from 8 3. Plumbing Building Permit Fee /f 4. Mechanical(HVAC) S.Fire Protection B. Total=(1+2+3+4+5) I $1SODOO(Demol Check Number ,S This Section For Official Use Only Building Penna Number Dale Named Signature: Building CommNsionernnewelorof8ulldfrils Date Version 1.7 Commercial Buildlog Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 33,000 CUBIC FEET OF ENCLOSED SPACE Interior Altentlons ❑ Exiating Wall Signs ❑ DomollUon® Repair,❑ Additions ❑ AccessaryBuilding❑ Exterior Alteration ❑ Existing Ground Sign❑ New Slgm❑ Rooting❑ Change df Use❑ Other Bdef oesorlption InterlortE%terior derrto a Proposedwork: Facade Tepairs SECTION 3-USE GROUP AND CONSTRUCTION TYPE USE GROUP Check asapplicable) CONSTRUCTION TYPE A AssemblyElA-1 13A-2 13A-3 ❑ 1A ❑ A-4 ❑ A-5 121B ❑ B Business ❑ 2A ❑ E Educational ❑ 213 I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1-1 ❑ 1.2 ❑ 1-3 ❑ 3B 13 M Mercantile ® 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ 8-2 ❑ 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: 'Mercantile Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION S BUILDING HEIGHT AND AREA BUILDINGAREAEXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(a0 V, 5,420 1. 2"' 5,420 2N 3m 31 4" 6°i Total Are.(sr) 10,840 Total Proposed New ConsWclion(s0 Total Height(h) Total Height it 7,Water Supply(M.G.L.c.40,§84) 7.1 Flood Zone Information: 7.3 Sewage Disposal Syntsm: Public ❑ Private 13 Zone, Outside Flood Zona❑ Municipal ❑ On site disposal system❑ City of 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: 6B Pieasant street Noabemptw,wu 01060 The debris will be transported by: DOSEeW -M Q r WCA The debris will be received by: �f LLe4A XeLiLu144- z s4 E. HAeMrQ`4 aD• Building permit number: Name of Permit Applicant David A.Lew&Assoc. on t\ C� &-� Date Signature of Permit Applicant The Commonwealth of Massachusetts Prim norm w Department of Industria[Accidents Office of Investigations I Congress Street,Suite 100 Boston,MA 01114-1017 wwmmass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print I,egibiv Name (Business/organira6oMndividmi):Horizon Retail Construction,Inc. Address:9999 E. Exploration Ct Ci /State'Zi :Sturtevant,Wi 53177 phone it:262-638-8000 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ✓❑ I am a general contractor and 1 employees(full and/or part-time)' have hired the sub-contractors 6. New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet 7. ❑✓ Remodeling ship and have no employees These subcontractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' y tY• 9. ❑Building addition Inquired] workers' comp.insurance comp.insurance.: corporal required.] 5. ❑ We are a corporation and its 10.[] Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers comp. right of exemption per MGL 12. Roof repairs insurance required.]t c. 152,§1(4),and we have no ❑ employees. [No workers' 13.❑Other comp. insurance required.] 'Any applicml oat checks box sl nice also fol out ae wetion below showing theirworkers'compen¢ution policy irdmmarion. ° nnmenwnerx who submit ais effidnvir indicating they ere doing all wnM end am hire outride contractors must submit s new efadevit indicating such. 'C onuacton Elul chook this box most attached an additional shoot showing ae name of the snbroctocuss and nam ,t,"ht,or ret lhosc entft cs have employees. ll the sub-connoxtoes have amp,.,the-,mos,provide their workers'comp.policy number. Jam an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site information. Insurance Company Name:Zurich American Ins Co Policy#or Self-ins.Lic.#:5919209 Expiration Date:03/29/2020 Job Site Address: 58 Pleasant Street City/State/Zip: Northampton, MA 01061 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to stsure coverage as required under Section 25A of MGL c. 152 cam lead to the imposition of criminal penalties of a fine up to 51,500.00 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. Be advised that 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 and enalties oft,ei x that the information provided above is true and correct. SienaNrc: Dope 6-3-19 Phone#:242.63.-6000 Oficial use only. Do not write in this area,to be completed by city or town ofciaL City or Testa: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cin'/fawn Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: a� The Commonwealth of Massachusetts Frim Form Department of Industrial Accidents PA Office of Investigations I I Congress Street,Suite 700 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organiration/Individual):Horizon Retail Construction.Inc. Addregs:9999 E. Exploration Ct. Ci /State/Zi :Sturtevant,WI 53177 Phone#:262-638-6000 Are you an employer"Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. ✓❑ 1 am a general contractor and 1 employees(full and/or part-time)' • have hired the sub-contractors 6. New construction2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ✓❑Remodeling ship and have no employees These subcontractors have g, ❑Demolition workingfor me in as capacity. employees and have workers' yap b i req 9. Building addition workers' comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.C]Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12. Roof ars insurance required.]r c. 152,§1(4),and we have no ❑ employees. [No workers' 13.0 Other comp. insurance required.] if 'Any applwaid that cheats,box#1 must also fill out the section below showing theirworkers'comm paation policy information. 'Homuwnen who submit this affidavit indicating they we doing all work and Nen hitt outside contmcmta mart submit a raw affidavit indicating such. 'Comtactare that chock chis boa mut ince had an additional short showing the name of the sub-contnctors and me whether or not those entities have engdoyees. Ifthe,sol conaachers have employau,they most provide thea workers'sorry.policy number. lam an employer that L providing workers'compensation insurnsice far my employees. Below is the policy and job site information. Insurance Company Name:Zurich American Ins Co Policy#or Self-ins.Lic.#:5919209 Expiration Date:03/29/2020 Job Site Address: 58 Pleasant Street City/State/Zip: Northampton, MA 0106, Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 the Coi��penafties of perjury that the information provided above is true and correct. Sienarure� �_ —� IDaie 6-3-19 Phone 40:262-6�-6000 Ojrcial 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): I.Board of Health 2.Building Department 3.Citylrown Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Ctmtact Person: Phone#: Versioni.7 Commeciel Building Permit May 15,2000 8. NORMAMPTON ZONING Existing Proposed Required by Zoning ThbeMumneae rtllNla aY aullana DePNmwl Lot Size F Setbacks FrEM $1gP L•_R:_ I::_R:_ Rem Building Haight Bldg.Squaw Footage ,QS C, % Open Space rootage % lWresats,. !d,&Tw P.&MR) 0 ofFarking Spaces Fill: wNma a laeraaal A. Has a Special Permit/Variance/Finding ever been Issued for/on the site? NO Q DONT KNOW O YES 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 BookPage and/or Document# B. Does the site contain a brook,body of water or wetlands? NO O DONT KNOW © YES 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 arry 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 7 YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb(Gearing,grading,excewNen,or filling)over 1 acre or Is It on ora common plan 01etwIll disturb wer lam? YES O NO ee IFYES.than a Northampton Sronn Water Management Permit from Ne DPW Is required. Versionl.7 Commercial Building Permit May 15,2000 SECTION 0.PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES.FOR BUILDIN03 AND STRUCTURES SUBJECTTO CONSTRUCTION CONTROL PURSUANTTO 790 CMR 116(CONTAINING MORE TNAN 35,000 C.F.OF ENCLOSED SPACE) 0.1 Registered ArdhiteaL David A.Levy N01 Applicable El N..a(Reg1so- U: :9655 David A. Vy RpMmllon Number 08312019 (330)6666767 LVlmft Date glonawy T 9 glotemd Proreasbnel Name Nes of ReeponvOtigry Md.. Registration Number slommun, TeMplrme Faplration came Name Nes of Reepomlbllity Md... Registration Number Slonewre TaaOwn. Expiration Data Nam. Arae of Reaponaftnay Md" R"IenBtinn Number signal. Tebphone ExpWitan Deb Nem. "a of Respommeay Md.. Regemaon Number smoltun, Telephone Expiration Data 9.3 General Contnetun Horizon Retail COn3L,Inc. Not Applicable Cl Company Name: Jon E.Herdsmen RespomlNe In Change al Construction 99991x.Exploration Court,Sturtevant,W1 53177 Address _ 263-03&9000 Sipnewm Telephone e Versioal.7 Commercial Building Pormit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(730 CMR 110.11) Independent SaudEn hreadn B"No"21Peer Review Required Yes No (• SECTION 11 .OWNER AU HORRA ION- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I. �' V r� as Omer of the subject p�oPeny hereby authodn David A.Levy& Assoc, to act on Y behalf.InjiPwitters,rela0ve m work authorized by We building permit application. / / Sipa WOwner /� IS I. David A. Levy as Owner/Aulhorlaad Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of^V'knsvdedge and belief. Signed under the pain.aal Of dury. David . Levy f.0 Si na9anl Dau SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Suoarviser. Not Applicable ❑ Nem,of License Hader: J.E.Handereen CS-054113 License Number 9999 E.Exploration Court,Sturtevant,WI 53177 00.05-2020 Atldmu _ EVIradon Date -5388W0 SignaNr Ta6phons SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.152,§25C(S)) Workers Compensation Insurance a5ida,11 must be completed and submitted with this application.Failure to provide this affidavit will result In the denial of the Issuance of Ne uWin pen-d-t.1 Signed ASdavll noted Yes No I