23B-014 (17) 125 LOCUST ST BP-2020-0702
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23B-014 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: REPAIR BUILDING PERMIT
Permit# BP-2020-0702
Proiect# JS-2020-001202
Est.Cost: $38743.00
Fee:$0.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JOSHUA J KENNEY 087540
Lot Size(sq ft.): 730501.20 Owner: NORTHAMPTON CITY OF BOARD OF PUBLIC WORKS
zoning: SI(100) Applicant. JOSHUA J KENNEY
AT. 125 LOCUST ST
Applicant Address: Phone: Insurance:
P O BOX 2506 (413) 256-0400 WC
AMHERSTMA01004 ISSUED ON.121612019 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPAIR MASONRY
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 - Sip-nature:
FeeType: Date Paid: Amount:
Building 12/6/2019 0:00:00 $0.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Versionl 7 Cononerc:al Buildin-PCr riit:vlaV 15.2000
Department-use c)nly
City of Northampton Status of Permit: -
BUilding Department curb-CuVb.Tiveway-P.errrih _
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability"
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587=1240 Fax 413-587-1272 J�Plot(Sfte 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
1.1 Prooerty Address: This section to be completed by office
`� \ ��• _._. Map OZ Lot lJ Unit
14 Va a toot) Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Recor :
tw
Name{Prin Cur`ent Mailing Addr. g:
Sionature
Telephone
2.2 Authori d A nt:
Name(Pnnt) -�~ Current Mailinc Address:
Signature
Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed b ermit ao lic int
1. Building (a),Building Permit Fee -
2- Electrical •----. _ _._
(b}EstimatedTotal 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__
B61ding Permit Number Date
6 Issued
SicnaEC
BuilQiramiss:oner/Inspector of 8uiidi
Version 1.7 Commercial Building?-,.:.pit Mav 15,?OQp
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
nteriorAlterations ❑ Existing Wali Signs ❑ Demolition C3 Repairs Additions
Exterior Alteration ❑ Accessory Ing❑
❑ Existing Ground Sign❑ New Signs ❑ Roofing ,
_ _g❑ Change of Use❑ Other
Brief Description Enter a brief description here. �p� j ���,;R
Of Proposed Work:
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable)
A Assembly jo
q_1 ❑ A_2 ❑ A-3 CONSTRUCTION TYPE
A•4 Cl A-5 ❑ ❑ 1A []
B Business ?g ❑
E Educational 2A ❑
F Factory F-1 ❑ F 2 ❑ 2B f' ❑
H H' h Hazard 2C1 Institutional l-1 ❑ 1.2 3A ❑
M MercantiMaR
❑ 13 3B
R ResidentR-2 ❑ R-3 4 ❑
S StorageS_2 ❑ ❑ 5A ❑
U Utility -- —� 5i3 ❑
pecify:M Mixed Uspecify: '-S Special U
COMPLETE THIS SECTION IF'EXCSTING BUILDING UNDERGOING RENOVATIONS.ADDITIONS AND/OR CHANGE IN USE
xisting Use Group: - ___
Proposed Use Group: - -
Existing Hazard Index 780 CMR 34 ��......
-�..-•---._--.-...-.-_...-.-.. .__._ Proposed Hard Index 790 CMR 34): .___. •__
SECTION 6 BUILDING HEIGHT ND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE,ONLY
'loor Area per Floor(sf)
.... .._� _. _ ...._..,.J ,r- 2nd_
3 r _..__._ _ - .._ ..__.,._......... ..
4m -----------.___.�.__
taI Area(s`} ( Total Proposed New Construction (sl)
_...b _._. . .
tal Height(ft)
Total Height ft !i
Vater Supply(M.G.L.'c. 40, § 54) 7.1 Flood Zone Information: {
Prr✓ate'o zone 1 7.3 Sewage Disposal System:
Outside Flood Zoneg� Municipal � On size dis.posa,s
ester Cj
Version l.7 Commercial Build-M&PVMit May 15, 2004
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION'SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE T'r1AN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name (Registrant):
Registration Number
AdCress
Expiration Date
S icna to re
Telepncne
9.2 Registered Professional Engineer(s):
----------------
Nana _i]hj
Ansa of Responsibility -Address _— _P.egistration NumberSignature _Telxpiration DateName. Area_of Responsibrlity -_ .._.•._
Address
-...._.._.. _. _ Registration Number
Signature —
_�._� Teiepttone Exp;raticn Date
Name Area of eResponsibilir/
Address
Registration Number
Signature Tsle hone �-
p Expiration Date`
Name - - -
_ Area of Rasponsibitityn�
4ddress
Registratbn Number
>ignature _ Tele hone :.--- -
p Expiration pate
.3 General Contractor
' --------- •- Q
ompar►y Name:.. Not Applicable._.__... . _ .. ..._—.......,.-._._-.�_...__.�...._.__.__.._.. _.....,._.--
asponsible in Charge of Construction
1dress
mature Telephone
Version 1.7 Cotrunercial Building Permit May 15,2000
S- iNORTIL_-UMPTOIN ZON:LVG
Existing Proposed I Reauired by Zoning
1 This column to be�ilied in by
• I Building Department
Lot Size .-
Frontage
Setbacks Front -- - - -
Side L. R: L:._r` R:
Rear
Building Height - - i •-'
Bldg. Square Footage l e 5 --- %
Open Space Footage 1„ _
(Lot arca minus bidg&paved
arikine) .-
#of Parkins Spaces
Fill:
(volume$Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW- YES Q M
IF YES: enter Book Page and/or Document h ~
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained 0 , 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
IF YES, describe size, type and location: �w�•�-__.____.��-�-^���~•-- ~'•-•�-
E. VVdI the construction activity disturb (clearing,grading,excavation,or nl4ng)over 1 acre or is it pari of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 COT-rinercial Building Permit Flay 15,20+1t?
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Strlcturai Engineering Structural Peer Review Reouired v_S O
SECTION 11 -OWNER AUTHORIZATION -TO=BE UUMPLETED WHEN No
OWNERS AGENT OR CONTRACTOR APPLIES FAR BUILDING PERMIT
a s Owner of Une suta ecu property
h
ery authorize
to
n all, i I afters relative to work authorized by this buaki
inr permit application.
e
Oahe - -
- -•-�.. , .... - - _ _ _ -as Owner,'Ajkmwedge
Agent hereby declare that the statements and information on the foregoing application are true and accrete, to It•e best of mknowledge
and belief.
Signed under th�ains an penal&es of�e &
Print Name — -- - - - - - - - — -
5 nature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed ConstructionjSuoe_rvisor: �.. NotAppfic8ble ❑
Name gf License Holder: _cJ�� �_ t1!1,N/V ��M• - _
a _ license Number —
'-
Address
_ E*ratbn auto/
IZO 24
Sioature Telephone
- ;y-'�r. a. y ....
SECTION 13 - ORKERS COMPENSAT ON i ' URANCE AFFIDAVIT(M;G.L.c:152,,§250(6))
-------------
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit w41 result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes No O
The Commonwealth of 1lassachitsetts
Depat:m_ent oflndustrial.4ccidents.
Office ofInvestigarions
600 Washiij Cott Street
Boston, M4 02111
`- x'wh'.mass.govfdia
N orkers' Compensation Insurance Affllda„zt: Builders/Contractors/Electricians/Plumbers
Anolicant Information PIease Print Legibly
Name (Bus iness/OrganizaaorAndividual):
Address:
City/State/Zip: phone
L01
n employer? Check the appropriate box:
4. I am a s� Type of project(required):
a employer with y ❑ ,.neral contractor and I
loyees(full and/or part-bate).” have hired the sub-contractors 6 ED New construction
a sole proprietor or partner- listed on the attached sheet. 7. [v�'l�etnodeling
and have no employees These sub-contractors have 8. C]Demolition
ing for me in any capacity. employees and have workers'
workers' co 9. ❑Eu:.ildik addition
comp. insurance comp. insurance..'
red.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
a homeowner doing ail work officers have exercised their 11.❑Plumbing repairs or additions
lf. [No workers' comp. right of exemption per MGLnce required.] t c. 152, §1(4), and we have no
12.0 Roof repairs
emplovees. N- o workers' 13.[1 Other
comp, insurance regtured.]
Any appiicant that checks box#1 ra:st also fl out the section below showing:heir workers'compensation policy information.
t Hornmwners who subnit this affidavit indicating they are doing all work and then hire ouuidc contnctors must submit a new affidavit indicating such.
:Contractors that check this boa must attached an additional shit showing the name of the sub-cont-actors and state whether or not those entities have
empioycm If the sub-contractors have employees,they must provide their workers'come.policy nuirber.
I am an employer that is providing workers'compensation insurance for my employees Below is rhe policy and job site
information.
Insurance Company Name: f i� I-L l/�S 1/JS✓ie'lt'�✓cir
Policy"or Self-ins.Lic. ✓�W 55 '�?j6 3/U p
Expiration Date: Zv
Job Site Address: l2-Sr Z-6L-U5T Sj _City/State/Zip: U ly/? pa.,v A{ d/Q�o
Attach a copy of the workers' compensation policy declaration page(shooing 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 fume
of up to 5250.00 a day agatrst the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DLA for insurance coverage verification.
I do hereby ce �t er a' enalties ofperjuiy that the information provided above 's true and correct.
i afar :
Phone;E 7� yZ 7 0 7 Z_-
Of z
Official use only. Do not write in this area, to be completed by city or torn official
City or Town: Permit/License€
Issuing Authority(circle one):
1. Board of Health 2, Building Department 3. C,ITown Clerk 4.Electrical Inspector 5.,PIumbing Insnecior
6. Other
Contact Person: Phone
THESE DRAWINGS ARE THE
PROPERTY OP JACDS SMITH
ENGNEEPoNG AND DESIGN Q
Jli A/ Beat MAY NOT BE USED IN ANY
• \ S D)N GNAT MEA ENDS. WAY I I O NT MRITTEN
RS,AAM•'-O- C EA Y C.M.U.WALL CAP Bao eEAY ARE,ANCMreI eaTL
PFRNISSIa1 COPYRIGHT 2019.
N GENERAL SIRUCNRAL NOM
W CONCRETE MASONRY UMTS ICMU.INIASONRI':
Z N
Zb C •NleumyNl.Rd,.,bp lfllDNiamPdi<mmpli limlie
t: O1N AT •Cmva,rr,ry miwlCML�AS1M EvuN-I.Fbrimdd�Nrtifwcaemt JYlhpNcdv Pr+A lTakW bwAba Nwi�.
•NI r...rr.0 lwryyc s•. to
•Rwdramd:Tir®rNAel-ASTM A-32,9G.c,bddv ryyctl 16 ur8em mAc. W N
Ilefam,d�d.11 eergrelwl mr PratlnmM mbB PRw�ic clrAPlly..hdlMrm Wbr dimmx.VNp6 Lift G.aYNi 0 l0
7E r[QcImN6Plr•Wlbe pnnildmlbr pritim•YII Ee bubltlaeemrn WrlDl badiotles mrwwr spri8. Qsry LO
�[ •vrmlremfrcag br•sWD Ee pTwaEry
Z plvmimCopWic Brpmeiw.. M
•ATI BIrm.l.n.e T„plxa:I P.ri,e Tawe U.No _
Q o <
u S'IRUCIl1IW.ERECTION AND BRACING RE(HIDtEMENIS.
•llr•AaLlnl drruN.iBmsem 16e mmpNee wwrm.wia ee dmm iv Oei fv1 Pweim•.PIWw1Y wwwme and d•m6lb,w,o-aror,racpmpv tai
„gIIelRe.shNl Pl^I' p^Pr•h^•w ral..,:wrr.y le ngNivemArAxvc a,fmJ wmPbd•wlsNo,. W In
�` lfie.e pl®Yrve bem m�mPJ armWudioenme�MiW'eB.ie.BuNar®eAlLnspm.bAly Cu uedase plstlA.Y oav W Jj
dnbe.ec.Ple mn mllw aPef•uxnrmerrY Rar BRBAuq•ife weMN.psif miew by leeeAmv. IZy li a
•aIHw.NRr dr,.dni..,mrm;e r BmiRe sged er be Pw.r.Tmds.BA94Pp�I mrr Pae<Ir.n wie le e,m�...Tn a.mpmr �
A rae owd.apaeAtlwa DC hwn Wrre Awice.gemd Z W n
k W p
r n
I
o
N a
Jg_!w
1-1EXISTING ROOF PLAN WITH WALL REPAIRS
S Jj I aeG ncnI No mals sheet. E In
2.Cmtrechx shell,mi&shoring n s yuve m pafmn w 11 repro.
lY �
w/ O
I- LL,
o
m«% ::E:.° Exon w w
mMrcRs AxD r-D•Dc xEA r c.tlu.AAu cAP eE.n eEAA uu Awaa eats tY IY Q
Lu Z
xfr P..B-Lac eaLrs =
z D AHaaR I
1
(7 J Q
Au REK w/(21 N BAR z N
RE-ffT E.—CR
n)r r c.M.0.Nz..rr./ Ix MmIAR uDNI. Ab` a- O
AND
cP—AT xf..Au Ex p
Rs •-D-D.<
1A00[R EnSp 6'C.N..EAIEm ALLS
A mT
RE___ D.C.
TYPICAL. I I
EA
CM
Dwe AND PDRY HN[ `Ey511
DxD DDRiAl ALL
AL RExMaCRM BARS DRAWN BY:
I'll 6•EMBfDNFHI.u wCx
11A11 wi XY-31p-AbC3Af. aE •
rarlN wuL` J.F.S.
�/l ISsuE 11/21/19
REw4ai
E.—STAB-a-GRAa
2 EXISTING BUILDING SECTION WITH REPAIRS A.I. H Nga9 Al DDN H1pH4 SXALL BE 1
Sl Sa Me gmml nnleemaief m. uE:S-Ia R2RwIED BY aR—TTA—
TTAEPH
Att�°RoAl 1
2.GnmcNN Ahall pnrvide NsaiA6 n«qui,b pvfmm wWl repro. �1 BE RFOD iFn T.1H
rpE[aNNFNCuIG
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: dcus r ;r
The debris will be transported by: &LA�/ A(109L�-
The debris will be received by: �rk- �;waBuilding permit permit number:
Name of Permit Applicant Jas<� tArAl
Date Signatur of Perm' n