296 Nonotuck ATC BP app 2020$605,000
$4235.00
Louis Hasbrouck Approved June 24, 2020
V I 7 C ers,on . ommercm Ul Inj? erm1t ay '
. I B 'Id' P . M 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 Structurat Plans
phone 413-587-1240 Fax 413-587-1 272 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
SECTION 1 -SITE INFORMATION
1.1 Pro12ertl£ Address This section to be completed by office ---
296 Nonotuck St. Map Lot Unit
Florence, MA ~-
Zone Overlay District -
Elm St District CB District
SECTION 2 · PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
No notuck Mill , LLC -.
296 Nonotuck St., Florence, MA -· Na me (Print) Current Mailin~ Address:
(413) 519-0765 I . Signature Telephone
2.2 Authorized Agent:
Seth Crocker 186 Stafford St., Springfield , MA 01104
Name (Prin t) Current Mailing Address: -A ~~L (413) 737-7803 .. Signa ture Telephone ~
SECTION 3 · ESTIMATED CONSTRUCTION COSTS
--Item Estimated Cost (Dollars) to be Official Use Only
completed bv oermit annlicant
. -1. Building
$350,000.00 (a) Building Permit Fee
I -I :"-~ 2 Electrical
$140,000.00 (b) Estimated Total Cost of
t Construction from (6) I -3. Plumb ing
$50,000.00 Building Permit Fee
4. Mechanical (HVAC ) I I $65,000.00 ' 5. Fire Protection
6 . Total= (1 + 2 + 3 + 4 + 5) ~
Check Number
This Section For Official Use Onlv
-Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Bu ildings Date
Version 1.7 Commerci al Building Permit May 15 , 2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
-
Interior Alterations 0 Existing Wall Signs D Demolition D Repairs 0 Additions O Accessory Building D
Exterior Alteration D Existing Ground Sign 0 New Signs D RoofingO Change of Use D Other D
Renovate a portion o f the second floor of the office bui lding for Couples Therapy -Brief Description .
Of Proposed Work: '
I -I
SECTION 5 · USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable ) CONSTRUCTION TYPE
A Assembly 0 A-1 D A-2 D A-3 D 1A D
A-4 D A-5 D 18 D
B Business 0 2A D E Educational 0 28 I D F Factor y D F-1 D F-2 D 2C D
H Hiqh Hazard D 3A D I Institutional D 1-1 D 1-2 D 1-3 D 38 D M Mercan tile D 4 D
R Residential D R-1 D R-2 D R-3 D 5A 0 S Storage D S-1 D S-2 D 58 D
U Utility D Specify: I -.. ---------
--~l M Mixed Use D Specify:
----------I s Special Use D Speci fy :
---.... . I -
COMPLETE THIS SECTION IF EXISTING BU ILDING UNDERGOING RENOVATIONS, ADDITIONS AND/OR CHANGE IN USE
-1 Ex i sting Use Group 8
Proposed Use Group: B
'
Proposed Hazard Index 780 CMR 34): [
-----I Existin g Hazard Index 780 CMR 34): 1 -
SECTION 6 BUILDING HEIGHT AND AREA
BUILD IN G AREA EXISTING PROPOSED NEW CONSTRUCTIO N
= OFFICE USE ONLY
Floor Area per Floor (s f) .
1 St
~1854 1 SI
-
2"0 --
' ' 2 "° I •
3'0 ---1: , 3'0
41h -... -41h
.
-. Total Area (sf) 8,854 Total Proposed N~w Construction (.~f) -< ·--
-
Total He ight (ft) --. -~ -Total He igh t ft -
'
7. Water Supply (M .G .L. c. 40 , § 54) 7.1 Flood Zo.ne Info rmation : 7.3 Sewage Disposal System : Pu blic [ZJ Private D Zone O utside Flood Zone 0 Municipal 0 On site disposal system D
XXXXXXXXXX XXXXXXXb
Building ATC LLC
Ve rs ion I. 7 Commercial Bui lding Permit May 15, 2000
8. NORTHAJ\1PTON ZONING
Existing Proposed Required by Zoning
This column to be fil led in by
Building Department
I --I • -J l I Lot Size
--~ Frontage I -
Setbacks front ._ -=i
I l Side L: R· L: R:_ I I I . .--
Rear I I
Bui lding Height
l
Bldg. Sq uare Footage Ofo [ -
-
Open Space Footage -%
f =i [ ~-(Lot a rea minus bldg& paved j
oarkiM)
.
# of Parking Spaces I _J
Fill: I
- -
I L (volume & Locat1onJ --
A. Has a Special Permit /Variance/Finding ever been issu ed for/on the site?
NO O DON'T KNOW {!) YES 0
IF YES, date issued:
IF YES: Was the perm it recorded at the Registry of Deeds?
NO O Do~·~ KNOW (!) YES O_
IF YES: enter Book . Page and/or Document #L
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW O YES ®
IF YES, has a perm it been or need to be obta in ed from the Conservation Commission?
Needs to be obtained 0 Obtaine d
C. Do any signs exist on the property? YES
IF YES, describe size, type and loca t ion:
0 , Date Issued: ,
NO 0
D. Are there any pr oposed changes to or additions of signs?intended for the property? YES Q
IF YES, desc r ibe size, type and location:
l
NO@
-,
E. Will the construction activity disturb (clearing, grad ing, excavation . or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO (!)
IF YES. then a Northampton Storm Water Management Perm it 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:
-I Not Applicable D I 16 Pleasant St, Suite 311, Easthampton, MA
-j6634-Name (Registra nt):
-
116 Pleasant St, Suite 311, Easthampton, MA Registration Number -----'
--
08 /31 /2020 Address
s~~/Je;d7{, ( 413) 529-9434 Expiration Date
-Signature Telephone
9 .2 Registered Professional Engineer(s}:
r J ---Name Area of Responsibility ------]
Address Registration Number
I --,-------_...=] . I •
Si gnature Telephone Expirati on Date
--,----..
-----J N ame Area of Responsibil ity -----
~
-j Address Registration Num~e~_ -, -I L -
Signature Telephone Expiration Date
. I --l Name Area of Responsibility ---
Address Registration Number
-----_J
Signature Telephone Expiration Date
-------, -]
--I --Name Area of Responsibility
--Address Reg i strati on Number
l
I -_J Signature Telephone Expiration Date
9.3 General Contractor
Crocker Building Company, Inc. .
Not Applicable D Company Name.
William Crocker
Responsible In Charge of Construction
186 Stafford St., Springfield, MA 01104
Address
-
(413) 737-7803
Signature Telephone
Version I . 7 C ommerci al Building Permit May 15, 2000
SECTION 10-STRUCTURAL PEER REVIEW (780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required
SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Yes 0
-~
No@
I, Doug l\1cVey
, as Owner of the subject property
h b th Seth Crocker t er e y au on ze _____ ___, __________________ -=::c;;..-----='-=---==------'=----=--o
act on my beh~all matY=rs lative to wo rk authori zed by this building perm it application ..
t/1_/; ..vf· I z 3/17/20
Signatu re of Owner
Date
I, Seth Crocker
, as Owner/Authorized
Agen t hereby declare that t he sta tements and informat ion on the foregoing applicati on are true and accurate, to the best of my knowledge and bel ief.
Signed under the p ai ns and pen al ties of pe rj ury.
Seth Crocker
Print Narn B u
Signa ture of Owner/Agent Date
SECTION 12 -CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor:
N f L. H Id William D. Crocker arne o 1cense o er : _____________________ _
186 Stafford St.. Springfield , MA 01104
Address
(413) 737-7803
Signa ture Te lephone
3/17/20
Not Applicable D
CS-067805
License Number
4/19/20
Expiration Date
SECTION 13 -WORKERS ' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c.152, § 25C(6))
J
Workers Compe nsation Insurance affidavit m ust be completed and s ub mitted with th is application. Failure to provide this affidavit wi ll result
in the denial of the iss uance of th e bu ild in g perm it.
Signed Affidavit Attached Yes (!) No 0
•
Versionl.7 Commercial Building Permit May 15, 2000
SECTION 10-STRUCTURAL PEER REVIEW (780 CMR 110.11)
Independent Structural Eng inee ring Structural Peer Review Required
SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
-----------------------
Yes 0 No{!)
1, Doug Mc Vey , as Owner of the subject property
hereby authorize Seth Crocker to
act on my beh~all mao/!rs lative to work authorized by this building permit application .
V1/ »· 7 3111120
Signature of Owner Date
I, _s_e_t_h_C_r_o_c_k_e_r _______________________________ , 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.
Seth Crocker
Print Name
Signature of Owner/Agent
SECTION 12 -CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor:
Name of License Holder: William D. Crocker
186 Stafford St., Springfield , MA 01104
Signature
Date
(413) 737-7803
Telephone
3/17/20
Not Applicable D
CS-067805
License Number
4/19/20
Expiration Date
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 th e denial of the issuance of the building permit.
Signed Affidavit Attached Yes (!) No 0
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:
116 Pleasant St, Suite 3404, Easthampton, MA
Name (Registrant): _
116 Pleasant St, Suite 3404, Easthampton, MA
Address
Signature
9.2 Registered Professional Engineer(s):
Name
Address
Signature
Name
Address
Signa tu re
Name
Address
(413) 529-9434 .
Telephone
----,
Telephone
Not Applicable D
6634
Registration Number . _, -----
108/31 /2020
Expiration Date
,-
Area of Responsibility ----
Expiration Date
Area of Responsibility
Registration Number -i r -----
Telephone Expiration Date
Area of Responsibility
Registration Number
----------------------L-=-=---===-=-c.=..cc;c___
Signature Telephone Expiration Date
-· l
Name Area of Responsibility
Address Registrat ion Number
Signatur e Telephone Expiration Date
9.3 General Contractor
Crocker Building Company, Inc.
Not Applicable D
C~mpany Name:
William Crocker
Responsible In Charge of Construction
186 Stafford St., Springfield, MA 01104
(413) 737-7803
Signature Telephone
,
-I
City of Northampton 2 12 Main Street, Northampton, MA O 1060
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: ]9 t Al, ,v /.v1;/.. {.t . >
The debris wi II be trans ported by : ___, . .._A'--->--._...L~,; ....... · l:_....,1 ...... c_!...;..l _4 >=', <...__ ___ _
The debris will be received by:
Building permit number:
Name of Permit Applicant _..,,.:;C ...:....r V:....,(...._h.=c .;_r --=/3'-'-c,_,,1 iox..fi ..... , 0~· _C...._c:..,_,~ ...... 1 ....... 11 ..... ( ._, -
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
www. ma ss.govl dia
\Yo rkers' Compensation In s urance Affidavit : Builders/Contractors/Electricians/Plumbers.
TO BE F'fLED \VITH THE PE R1\11 TTING AUTHORITY.
Applicant information Plea se Print Legibly
Name (Business/Organ ization /Indiv idual): Crocker Building Company, Inc. -------------------------------
Address: 186 Stafford St.
City/State/Zip· Springfield , MA 01104 Phone #·(413) 737-7803
Are you an employer? Check the appropriate box:
l.[ZJ I am a employer with 20 employees (full and/or part-time).*
2.0 I am a sole proprietor or pannership and have no employees work mg for me 111
any capac 1l) [No workers' comp msurance required ]
JO I am a homeowner domg all work myself (No workers ' C-Omp . insurance requ ired .] t
4 O I am a homeo\\11er and will be hmng contractors to conduct all work on my property . I wil I
ensure that all contractors enher have workers' compensation insurance or are sol e
proprietors with no employees
5 D I am a general contractor and I have hired the sub-contractors l isted on the attached sheet
These sub-contractors have employees and have workers· comp insurance l
6 0 We are a corpo rat ion and its officers hav e exercised the1r right of exemption per MGL c
152, *1(4). and we have no employees (No work ers' comp insurance required.)
Type of project (required):
7. D New construction
8. [ZJ Remodeling
9. 0 Demolition
IO D Building addition
11.Q Electrical repairs or additions
12. D Plumbing repairs or additions
13.0Roofrepairs
14. 0 0ther _______ _
• 1\ny appl i cant that checks box# I must also fill out the section below showing the ir workers ' compensation pohcy information.
t Homeowners who submit th is at1idal'it 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 shee t showmg the name of the sub-contractors and state whether or not those entities have
employees . If the ~ub-comracrors have employees. they must provide their workers' comp. po licy number
I am an employ er tit at is providing workers' compensation i11sura11ce for 1tty employees. Below is the policy and job sit.e
i11formation.
Insurance Company Name: The Ohio Casualty In surance Co.-Li berty Mutual Insu rance
Pol i cy# or Se l f-ins. Lie.#: XWO (20) 57 69 93 99 Expiration Date :_4_11_12_0 _____ _
Job Site Address:296 Nonotuck St. City/State/Zip: Florence, MA
Attach a copy of the workers' compensation policy declarati o n 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 civi l penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a
day against t he viola t or. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certifp under the pains and penalties of perjury that tlt e information provided above is true and correct.
Signature: Ai c~ Date: ]/ ;;_1/ 2 ~
Phone#: (413) 737 -7803 •
Official use only. Do not write in th is area, to be co mpleted by city or town official
C ity or T ow n: Permit/License# ______________ _
Is s uing Authority (circle one):
L Board of Health 2. Building Department 3. City/Town C lerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other -------------
Co ntact Perso n: --------------------