23A-034 (2) 74 MAPLE ST BP-2019-1503
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23A-034 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:Zoning Permit BUILDING PERMIT
Permit# BP-2019-1503
Project# JS-2019-000111
Est.Cost: $850000.00
Fee:$4085.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JEFFREY BOTT 053157
Lot Size(sg.ft.): 35196.48 Owner: SEVEN SISTERS MIDWIFERY LAND LLC
Zoning: GB(100) Applicant. JEFFREY BOTT
AT. 74 MAPLE ST
Applicant Address: Phone: Insurance:
32 Pine Street (413)530-6920 () Workers Compensation
FLORENCEMA01062 ISSUED ON:8/6/2019 0:00:00
TO PERFORM THE FOLLOWING WORK: CONSTRUCT 5544 SQ FT 2 STORY MIXED USE
BUILDING....PHASED APPROVAL FOUNDATION AND SHELL
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 8/6/2019 0:00:00 $4085.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-1503
APPLICANT/CONTACT PERSON JEFFREY BOTT
ADDRESS/PHONE 32 Pine Street FLORENCE (413)530-6920 Q
PROPERTY LOCATION 74 MAPLE ST
MAP 23A PARCEL 034 001 ZONE GB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction:_CONSTRUCT 5544 SO FT 2 STORY
Mixft (kSC- `��tl+-OtN� `+H&Zb AffA9VAL- ) foAwCAV&dN AND StO[-
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 053157
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
�INFO ATION PRESENTED:
pproved 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
A
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 Commercial Building Permit May 15, 2000 _
RECEIVED Department use only
City of Northampton Status of Permit:
uilding Department Curb Cut/Driveway Permit
JUN 2 7 2019 212 Main Street Sewer/Septic Availability __ _
Room 100 Water/Well Availability
N rthampton, MA 01060 Two Sets of Structural Plans
DEPT.OF BUILDING,INSP t 41 587-1240 Fax 413-587-1272 Plot/Site Plans
NORTHAMPTON,MA _t
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
1.1 Property Address: This section to be completed by office
74 Maple Street Map Lot Unit
r-
Florence,MA 01062 Zone Overlay District
Elm St. District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Seven Sisters Land LLC P.0.13ox 9596 Fc�oti2L�'1ee— v�r�d� 0
Name(Print)\I LL li Current Mailing Address:
(413) 530-0581
Signature Telephone
2.2 Authorized Aq
Jeffrey Bott 32 Pine Street t=L-ev—B✓1 L+i= wM,A p
Name(Print) Current Mailing Address:
(413) 530-6920
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building $525,000.00 (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
$75,000.00 Construction from 6
3. Plumbing $100,000.00 Building Permit Fee Q
4. Mechanical (HVAC) a�0
5. Fire Protection $150,000.00
6. Total =(1 +2+3+4+5) Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
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 Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing E] Change of Use❑ Other ❑
Brief Description construct a 5544 sq. ft. two story medical building with two apartments on the second floor
Of Proposed Work:
SECTION 5-USE GROUP 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 I ❑
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 ❑D R-1 ❑ R-2 ❑ R-3 ❑� 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify: t
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
St 1" 2,772
2nd 2nd 2,772
3rd 3rd
4 th 4"
Total Area (sf) Total Proposed New Constructionisff
-- 5,544
Total Height(ft)
–_�
Total Height ft 34
7.Water Supply(M.G.L.c.40, §54) 7.1 Flood Zone Information: F773 Sewage Disposal System:
Public Private E] Zone Outside Flood Zone[Z] Municipal ❑✓ On site disposal system❑
Versionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size 14,869
Frontage 83.14'
Setbacks Front 18,
Side L: R: L:25'56 R:a_'_�
Rear
Building Height
Bldg.Square Footage % 3044 20.5 1
Open Space Footage %
(Lot area minus bldg&paved 6434 43.5
parking)
#of Parking Spaces '•9...
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO ® DON'T KNOW ® YES
IF YES, date issued: 09/18/2018
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® DON'T KNOW ® YES Q
IF YES: enter Book 13119 Page 181 and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO (F) DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ® Obtained ® , Date Issued:
C. Do any signs exist on the property? YES ® NO Q
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO e
IF YES, describe size, type and location:
E. Will the construction activity disturb(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 Q
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 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Name(Regisstm�,,. aple Street Architects Not Applicable ❑
y. .. ...,. [r , sv�n�j 2,06v Lt
;R-1 .. ithaniptonRegistration Number
Add,----- ,
A'�) -51 , z ori
Expiration Date
3213
Sign ure a.er!o.^s
9.2 Registered Professional Engineer(s):
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
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Jeffrey Bott Contracting Not Applicable ❑
Company Name:
Jeffrey Bott
Responsible In Charge of Construction
32 Pine Street, Florence, MA 01062
Address
1 (413) 530-6920
Signatu 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
SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Virginia Miller as Owner of the subject property
hereby authorize Jeffrey Bott to
act on my behalf, in all atter el ive to work authorized by this building permit application.
05/28/2019
Signatur of ner Date
Jeffrey Bott as Owner/Authorized
Agent hereby declare that 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 perjury.
Jeffrey Bott
Print Name
05/28/2019
Sig tWro er/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Jeffrey Bott CS_053157
License Number
32 Pine Street, Florence, MA 01062 09/06/2019
Address Expiration Date
(413) 530-6920
Signa re 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 building permit.
Signed Affidavit Attached Yes O 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: 74 Maple Street Florence MA
The debris will be transported by Jeffrey Bott Contracting
The debris will be received by: Valley Recycleing
Building permit number:
Name of Permit Applicant _Jeffrey Bott
Date 5�2 g �� I Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):Jeffrey BOtt Contracting
Address:32 Pine Street
City/State/Zip:Florence, MA 01062 Phone#:413-530-6920
Are you an employer?Check the appropriate boa: Type of project(required):
1.0 I am a employer with employees(full and/or part-time).* 7. Q New construction
2.Q I am a sole proprietor or partnership and have no employees working for me in 8. E] Remodeling
any capacity.[No workers'comp.insurance required.]
9. El Demolition
3.F1 I an,a homeowner doing all work myself.[No workers'comp.insurance required.]t
10 [] Building addition
4.[]l am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5.a I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§](4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check 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 sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
in formation.
Insurance Company Name:AIM Mutual
Policy#or Self-ins.Lic.#:WCC500004601218A Expiration Date:06/25/2019
Job Site Address:74 Maple Street, City/State/Zip:Florence,MA 01062
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.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Simature: Date: ,
Phone#:413-5 0-6
Official use only. Do not write in this area,to be completed by city or town officicd.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/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
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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)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
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 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 proof that 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 burn 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
City of Northampton
Massachusetts
DEPARMENT OF BUILDING INSPECTIONS �.
212 Main Street • Municipal Building
1. Northampton, MA 01060
INSPECTOR
Louis Hasbrouck Fax: 413-587-1272 Chuck Miller
Building Commissioner Phone: 413-587-1240 Assistant Commissioner
CONSTRUCTION CONTROL DOCUMENT
(For professional Engineers/A'rchitects responsible for Entire Project)
Project Title: 5 e%� 515-1ey i 3-.4 ` e�t�Cr Date: N. 260
Project Location: 7 !4 s,0 1 a 51--sa.j Map: Parcel: Zone:
Scope of Project: Gt4-/ Co..,S�z UCAL>ti �it`F�i C vv�Dk=
In accordance with the Eighth edition Massachusetts State Building Code, 780 CMR Section 107.6: / /
Mass. Registration# 2Q(� `7
Being a registered professional Engineer/Architect hereby CERTIFIES that I have prepared or directly supervised
the preparation of all design plans, computations and specifications concerning:
dNTIRE PROJECT
For the above named project and that to the best of my knowledge, such plans, computations and specifications
meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices
and all applicable Laws for the proposed project.
Furthermore, I understand and AGREE that I shall perform the necessary professional services to determine that
the above mentioned portions of the work proceed in accordance with the documents approved for the building
permit and shall be responsible for the following as specified in Section 10.7.6.2.2:
1. Review of shop drawings, samples and other submittals of the contractor as required by the
construction documents as submitted for the building permit, and approval for the conformance
to the design concept.
2. Review and approval of the quality control procedures for all code-required controlled materials.
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, in general, if the work is being performed
In a matter consistent with the construction documents.
I shall submit periodically, in a form acceptable to the building official, a progress report together with pertinent
comments. Upon completion of the work, I shall submit to the building official a final report as to the satisfactory
completion and readiness of the project for occupancy.
ED ARCy/T
ST
Qc��� E� Fc�
Signre a d 7Se �fftR9flqWred-ProfessionaI Q No 20604
CAM MA OE J�
� Day of ✓ 20 L �oy�FqtTH OF MPS�Pvs "
(seal)
City Of Louis Hasbrouck<Iasbrouck@northamptonma.gov>
Northamptm
.........
Re: 74 Maple St
Jeffrey Bott<jeffbott@aol.com> Tue, Aug 6, 2019 at 4:38 PM
To: Louis Hasbrouck<Iasbrouck@northamptonma.gov>
Thanks Louis
I am planning foundation for next week and then backfill and grading
The framers won't be there till the first week in September so I'll have the sprinkler calculations by then and I'll get you the
energy code information next week thanks a lot for expediting this I appreciate it
Jeffrey Bott
On Aug 6, 2019, at 2:09 PM, Louis Hasbrouck<Iasbrouck@northamptonma.gov>wrote:
Jeff,
The plans are set; we discussed fire rated doors and that's the only specific notes I made.Attached is
approved cover sheet and sheet A-2.8. I'll issue a permit for phased approval; foundation and shell. Full
permit once the sprinkler system and commercial energy code info is in hand.
I don't see the sprinkler system info (calcs and narrative). I need to get those and send them to the fire
department for review before we can issue the full permit.
I'm not sure if I missed it, but I can't find the energy code info for the commercial space (1 st floor and 2nd
floor offices). Based the thermal envelope and the mechanical equipment efficiencies, I don't see any
problems meeting the requirements.There's a few ways to approach the energy code requirements; we
usually see prescriptive path (IECC C401.2, option#2)or COMcheck (C401.2, option#1).
Louis Hasbrouck
Building Commissioner
City of Northampton
Town of Williamsburg
(413) 587-1240 office
(413) 587-1272 fax
<74 Maple approval 2019-08-06.pdf>