Loading...
32C-346 (9) 2 RANDOLPH PL BP-2020-0537 GIS#: COMMONWEALTH OF MASSACHUSETTS MW:Block:32C-346 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category: ROOF BUILDING PERMIT Permit# BP-2020-0537 Proiect# JS-2020-000926 Est.Cost: $31700.00 Fee:$222.00 PERMISSION IS HEREBY GRANTED TO.- Const. O.Const.Class: Contractor: License: Use Group: FAMILY TREE AND HOME - JILLIAN SOUTHWICK - HALL 112720 Lot Size(sg. ft.): 59677.20 Owner: SPENCE GEORGE A Zoning: URC(108)/WP(63)/SI(1)/ Applicant. FAMILY TREE AND HOME - JILLIAN SOUTHWICK - HALL AT. 2 RANDOLPH PL Applicant Address: Phone: Insru n�tce: PO BOX 3699 (413) 478-8159 WC' AMHER5TMA01004 ISSUED ON.10/29/2019 0.00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF 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: FeeTyve: Date Paid: Amount: Building 10/29/2019 0:00:00 $222.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner u-Vn'ts -f-() Mvl 60ed. -11tl 30K Cta se-, cck, GC w l t " G,p,j VvtS,' Versionl.7 Commercial Buildin Permit May 15,2000 Department use only City of Northampton Status of Permit: OCT 2 8 2019 Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability DEp OP SUILDING INSPECTIONS Northampton, MA 01060 Two Sets of Structural Plans _. N RTHA44PTON.Asa 2'— `_ ,h ne 413-587-1240 Fax 413-587-1272 Plot/Site 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 x SECTION 1 -SITE INFORMATION a d- 53 7 1.1 Property Address: This section to be completed by office �f 40 P f j Map C Lot /Lf Unit d� N0 Zone Overlay District -- - - Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Re d: Name(Print) Current Mailing Address: ro Signature ------_ _ _______ Telephone 2.2 Authorized A en 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 ` `,0� � O� (a)Building Permit Fee 2. Electrical I / lJ (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee {{ 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number Date Issued Sign Build g Commissioner/Inspector of Builligigs Date V Versionl.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 36,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing Change of Use❑ Other ❑ Brief Description Enter a brief description here. SV`�` '�'�`^y Of Proposed Work: O S S CC)."n n ( a 0 SECTION 6-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 ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 3B M Mercantile ❑ 4 ❑ R Residential ->� R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-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(so 1St 1St 2nd 2nd 3`d I 3rd L 4t" __w., 4th Total Area(so Total Proposed New Construction(sf) Total Height(ft) Total Height It 7.Water Supply(M.G.L.c.40,§64) 7.1 Flood Zone Information: F7.3 Sewage Disposal System: Public ❑ Private E] Zone Outside Flood ZoneE] unicipal ❑ On site disposal system❑ 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 36,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number _ Signature Telephone Expiration Date Name Area of Responsibility Address R istration Number I Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name ;reaof Address Registration Number Signature Telephone I Expiration Date 9.3 General Contractor rr v",\Y ci`�C ✓�t'�-� Not Applicable ❑ Company Name: ! 1 L It Responsible In Charge of Construction C) Dix 3G9? © 140 Address Signature Telephone 8. NORTHAMPTON ZONING Versionl.7 Commercial Building Permit May 15,2000 Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: - R: L: R: Rear Building Height Bldg.Square Footage Open Space Footage % (Lot area minus bldg&paved parking) #ofParking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW © YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW ® YES O r._ IF YES: enter Book L Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW 0 YES 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. 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 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No SEC 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OW AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property h r authorize !U G1� � i`�wlCjS �`�(�� to act y behalf,in all matters relative to work authorized by this building permit application. P Signal f er Date I. 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. Print Name Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Superviso(1r: Not Applicable [3Name of License Holder: Ui� i m SoLyiyiCK �yi yll Q-1 i 2-72=) License Number jllu - &1CPbka)Y1, MIS Divo 1 L0/2'/22 Addre s Expiration Date I �i&-2yy-2318 Sig ure Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§26C(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 b ilding permit. Signed Affidavit Attached Yes No 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: o, 4,,cio L The debris will be transported by: F"vQ 1 y 7� G. ww4f, The debris will be received by: Building permit number: Name of Permit Applicant M c C-'t�*-L./<< ��'`��ti �� 5 ii S✓� c/( Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 't www mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. AAvolicant Information n Please Print Leeibly Name (Business/Organization/Individual): �� �j j�—�✓�� L��� rlUr Address: - , St. City/State/Zip: j_11e��u1n M0 (1l Oo 7 Phone #: yi,3 yoy-4110 Are you an employer?Check the appropriate boa: Type of project(required): 1.dI am a employer with ,_employees(full and/or part-time).' 7. []New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. [:1 Demolition 3M I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 Q Building addition 4.❑I 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. Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑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.n We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(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. :Contractors 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 information. /� Insurance Company Name: CGt-I�-I0— f/?�50,-.4-/?Ck 00 Policy#or Self-ins.Lic.#: mlgeg�00�l yq Expiration Date: Job Site Address: ��'� °I� ` p L 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. I do hereby certify under the pains and penalties of perjury that the information provided above is tru�eia�dcorrecf. Si afore: Date: 2� Phone 9: W ?� �1�9 Official 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.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton Massachusetts ` A w' ; yr F= I DEPARThZENT OF BUILDING INSPECTIONS �t 212 Main Street •Municipal Building Northampton, MA 01060 �sy �1a Deb is Disposal Affidavit In accordance of the pro 'sions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting rom the construction activity governed by this Building Permit shall be disposed of in a properly licensed s lid waste disposal facility, as defined by MGL c 111, S 150A. The debris from constructio work being performed at: (Please print house number and treet name) Is to be disposed of at: (Please print name and locatio of facility) Or will be disposed of in a dumpster on ite rented or leased from: (Company Name and Address) Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indi ted; the Applicant or Owner shall notify the Building Department as to the location where the debris will a disposed. From: nll �b,(A L2 59,-/ 4t, ` To: Louis Hasbrouck Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 The Massachusetts 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 i2,c,,, JoIP4 pL , 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, CCK �a ��vr C'a�s� .