32C-014 (7) 100 MAIN ST-NORTHAMPTON BP-2020-0093
GIS#: COMMONWEALTH OF MASSACHUSETTS
MW:Block: 32C-014 CITY OF NORTHAMPTON
Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2020-0093
Proiect# JS-2020-000151
Est.Cost: $8000.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group FORREST DEVINE 95779
Lot Size(sq.ft.): Owner. BALLYBUNION REALTY LLC
Zoning: CB(100)/ Applicant: FORREST DEVINE
AT. 100 MAIN ST - NORTHAMPTON
Applicant Address: Phone: Insurance:
20 HARTLAND HOLLOW RD (413) 214-8629 WC
GRANVILLEMA01034 ISSUED ON.7/29/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.-ENCLOSE FRONT ATM VESTIBULE FOR STORE
FRONT ACCESS
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 7/29/2019 0:00:00 $100.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2020-0093 (�
APPLICANT/CONTACT PERSON FORREST DEVINE
1
ADDRESS/PHONE 20 HARTLAND HOLLOW RD GRANVILLE (413)214-8629
PROPERTY LOCATION 100 MAIN ST-NORTHAMPTON N j;vS �c-
MAP 32C PARCEL 014 000 ZONE CB000V r1S
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
CLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: ENCLOSE FRONT ATM IBULE FOR STORE FRONT ACCESS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 95779
3 sets of Plans/Plot Plan
THE LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION 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 Delay
-7- z9- Z019
Sigidkun o Bui mg fficial 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 Building, Permit May 15,2000
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability_
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 4��- -j�272 Plot/Site Plans
R F cl
APPLICATION TO CONSTRUCT, REPAIR,RENOVA4E,CfANGE THE PAN Y OF,OR DEMOLISH ANY BUILDING1
E, r
OTHER THA A 0 E OR TWO FAMILY DWE LING
JUL
2 'j 20011,
SECTION 1 -SITE INFORMATION 3�C' - 0"'�
Thin,beclin to be completed by office
1.1 Property Address: DEP, OF:BUILDING INSPECTIONS
rTo��
T 'P"� M
0 tc Q\, �NOO'RTHAWTON.IVIAOio6�0 Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record,
A Q
Name(Print) Current Mailing Address: old
3 61 el;
Signature Telephone
2.2 Authorized Agent:
L"?
Name(Print) Current Mailing Address:
signature:�
Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total=(l +2 +3+4+5) heck Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
zq-
Building Commissioner/inspector of Buildings Date
E
Version 1.7 Commercial Buildins Permit May 15,2000
f
SECTION 4-CONST ,UCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENC LOSED SPACE
Interior Alterations'Existing Wall Signs ❑ Demolitlon❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration (Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other ❑
Brief Description ` nter a brief description here. 0� 1c-loye. �c oN Pr-1-M Ve_1�4,kOf Proposed Work: y }i , � ..
SECTION 5-USE GA DUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑'' 2A ❑
E Educational ❑' 2B ( ❑
F Factory ❑'i F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑'` 3A ❑
Institutional ❑' 1-1 ❑ 1-2 ❑ 1-3 ❑ 36 ❑
M Mercantile ❑ 4 ❑
R Residential ❑!£ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑I S-1 ❑ S-2 ❑ 58 ❑
U Utility Specify:
❑'t
M Mixed Use ElSpecify:
S Special Use ❑ Specify:
COMPLETE THI SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: _ Proposed Use Group:
Existing Hazard Index x;80 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDIN , HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(s.
2nd ...,_ 2nd
3rd 3rd
4m 4th
Total Area(sf) Total Proposed New Construction(sf)
Total Height(ft)
Total Height ft
7.Water Supply(M.G .c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system[]
J
Version 1.7 Commercial Building Permit May 1.5,2000
8, NORT AMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
i
Frontage is
Setbacks
Front
Side L: R: L,: R:
Rear
Building Hight
Bldg.Squa e Footage %
Open Spacj Footage
(Lot area minds bldg&paved
parking)
if of ParkinSpaces
i
Fill:
(volume&LAA ation
A. Hai€ a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW YES 0
E
IF YES, dale issued:
IF YES: C Was the permit recorded at the Registry of Deeds?
NIp 0 DON'T KNOW YES
IF YEI: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO QP DON'T KNOW 0 YES
IF YS, has a permit been or need to be obtained from the Conservation Commission?
Nee; s to be obtained 0 Obtained Date Issued:
C. Do an, signs exist on the property? YES NO
IF 41 describe size, type and location:
D. Are th�re any proposed changes to or additions of signs intended for the property? YES NO
IF Y describe size, type and location:
E. Will the J.Ponstruction activity disturb(clearing,grading, excavation,or filling)over 1 acre or is it part of a common pian
that will; isturb over 1 acre? YES NO
IF YE ,then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 Commercial Building Fermat May 15,2000
SECTION 9-PROFE SIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CO TROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Archi ict:
Not Applicable ❑
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Prof Tonal Engineer(s):
Name "I,[ Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
f
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 Contract`r
Not Applicable ❑
Company Name:
Responsible In Charge of Construction
Address
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRU URAL PEER REVIEW(780 CMR 110.11)
I
Independent Structure)Engineering Structural Peer Review Required Yes 0 No
SECTION 11 -OWNEIR AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT O CONTRACTOR APPLIES FOR BUILDING PERMIT
a
I, as Owner of the subject property
hereby authorize £ O A, 67 O AJ to
act on my behalf,in all matters ril to work authorized by this building permit application.
t
Signature o er Date
as Owner/Authorized
Agent hereby declare plat the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief. I
Signed under the pain' and penalties of perjury.
Print Nam
Signature of Owner/Age 'E Date
SECTION 12-CONS N SERVICES
10.1 Licensed Const coon Supervisor: Not Applicable ❑
Name of License Holder �� �� E' ( /
License Number
'1 j (,G c,%�.t :, l � rte........,,......__. �'` /`?-..t✓x./t.�' �% (,�'`>.S�j'` �i f i`� .cam"-�✓
A ss Expir ion Date
Signature Telephone
SECTION 13-WORK S'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 ing permit.
Signed Affidavit Attached Yes No 0
City of orthampton 212 Main Street, Northampton, MA 01060
I Solid Waste Disposal Affidavit
In ac ordance of the provisions of MGL c 40, S54, I acknowledge that as
a coni lition of the building permit all debris resulting from the construction
activit t governed by this Building Permit shall be disposed of in a properly
iicens�ed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Addr``ss of the work: 9n
The d bris will be transported by: (it A z... s &yc c
t
The d6bris will be received by: t} (e
Builditig permit number:
Namlof Permit Applicant L'c _
E
Date Signature of Permit Applicant
I
i
The Commonwealth of Massachusetts
{ Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.govl dia
arkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PER'bIITTING AUTHORITY.
Applicint Information 'e-� / Please Print Le 'bl
Name (Rusin slOrganizarien/Individual): 1 C.)r•",p . ( �c?-e rr c C".: CSS &
AddreSS: 61 L C
City State/Z p: Ut 4 +t Phone#: �jl
Are you an emplo ee?Check the appropriate box: Type Of project(required):
I�1 am a empl `er with _employees(full andior part-time):* 7. []New construction
[am a sole oprietor or partnership and have no employees working for me in
2.Q any capacity'1Nd workers'camp.insurance required.] 8. 2emcxfel ing
9. Q Demolition
3711 am a homeq wrier doing all work myself.1No workers'comp.insurance required.i t
1.0 Q Building addition
4.Q I am a home wrier and will be hiring contractors to conduct all work on my pmperty. I will
ensure that a contractors either have workers'compensation insurance or are sole 1 IQ Electrical repairs or additions
proprietors m th no employees.
12.E]Plumbing repairs or additions
5.❑I am a--enen I contractor and I have hired the sub-contractors listed on the attached sheet. 13 QRoOf repairs
These sub-cctractors have employees and have workers'comp.insurance3
6.Q We are a co ' ration and its officers have exercised their right of exemption per MGL c. 14.[:]Other
152.§I(4), `d we have no employees.(No workers'comp.insurance required.]
*Any applicant that` ecks box#1 must also till out the section below showing their workers'compensation policy information.
Homeowners who bmit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
1Contractors that ch k this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the su -contractors have employees,they must provide their workers'comp.policy number.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Compny Name: LL
Policy#or Self- s.Lic.#: Expiration Date:
Job Site AddresCity/State/Zip:
Attach a copy os the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secureoverage as required under MGL c. lit,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year prisonment,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`.olator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
1 do hereby ce under enalties of perjury that the information provided above is true and correct.
Signature: Date: 7Z, tf
Phone#:
Official use osty. Do not write in this area,to be completed by city or town official.
ii
City or Townk Permit/License#
E
Issuing Auth4rity(circle one):
1.Board of lalth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Persn: Phone#:
Information and Instructions
Massachuse � General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to s statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or i ' lied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the forego g engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or tr istee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a di elling house having not more than three apartments and who resides therein,or the occupant of the
dwelling hou a of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the groi nds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGI,chapte 172,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a icense or permit to operate a business or to construct buildings in the commonwealth for any
applicant w " has not produced acceptable evidence of compliance with the insurance coverage required."
AdditionallyGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into ant.,f
ontract for the performance of public work until acceptable evidence of compliance with the insurance
requirementsthis chapter have been presented to the contracting authority."
t
Applicants
Please fill oul the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,su Pply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Li nited Liability Companies(LLC)or Limited.Liability Partnerships(LLP)with no employees other than the
members or r irtners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a 3olicy 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 the city or town that the application for the permit or license is being requested,not the Department of
Industrial Ac idents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensatiopolicy,please call the Department at the number listed below. Self-insured companies should enter their
self insuranc license number on the appropriate line.
City or Tow] Officials
Please be sur that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidav t for you to till out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sun to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must sub it multiple permit/]icense applications in any given year,need only submit one affidavit indicating current
policy inforrn ition(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A col y of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as I`roof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog li nse or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Departm is address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2417
Tel.#617-727-4900 ext.7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-1 www.mass.gov/dia
Ballybunion Realty
100 main Street
Northampton MA
(Guild)
GRANVILLE, MASSACHUSETTS
(413) 214-8629
The work is as follows, all pricing is provided per our discussion and
reflects a fully licensed and insured
Company.
Scope of work:
• Install 64" x 20" knee-wall to match
• Install 64"x 96" tempered glass panel (installed by lizzotte glass)
• Remove 64" non-load bearing wall and window to open up to inside the
storefront
• Level floor in new square footage
• Paint entire front entrance of store
Building Review:
Upon meeting with the building owner and tenant of 100 main street, we are
proposing to remove the existing atm vestibule and add the area back to its
original design as storefront. This has already been done and the building was
originally designed to be this way. There is a large steel beam carrying the load
all the way across the front of the building and we will not be adding or adjusting
any weight, point loads of the property. The previous owners had an atm
vestibule put in and put up a quick 64" x 104" wall that is non load bearing and
we propose to remove that and add a total of 40 square feet back to the
storefront as it was originally designed.
Forrest Devine- President
Devine Construction Inc.
P.O. Box 343
Granville, MA 01034
413.214.8629
devineconstruction413(a gmail.com
www.devineconstructioninc.com
Ballybunion Realty
100 main Street
Northampton MA
(Guild)
!i
1
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From: _
To:
Louis Hasbrouck
Building Commissioner
City of Northampton
212 Main treet
Northampton, MA 01060
j
The Mass*husetts Building Code, section 107.1 allows for an exclusion from requirements for
construction control in certain situations. In accordance with code section 104.10, 1 request that you
grant a modification to waive the requirement for construction control of the project at
because the work is of a minor nature,will not affect structural elements, health, accessibility, life or fire
safety, and will be done in accordance with the prescriptive requirements of the code.
Thank you for your consideration.
Respectfully,
"-- •f`oR,��f l�rrin-�
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