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32A-162 (12) 33 HAWLEY ST BP-2021-1331 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:32A- 162 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2021-1331 Project# JS-2021-002203 Est.Cost: $250000.00 Fee: $1750.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: D A SULLIVAN & SONS INC 053667 Lot Size(sq.ft.): 20211 .84 Owner: Northampton Community Arts Trust Zoning:CB Applicant: D A SULLIVAN & SONS INC AT: 33 HAWLEY ST Applicant Address: Phone: Insurance: 82 NORTH ST (413) 584-0310 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:5/14/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:MECHANICAL RENOVATIONS TO THEATER SPACE 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: Cas: 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 I Certificate of Occupancy signatu ' • V ' )2 n tIT FeeTvpe: Date Paid: Amount: Building 5/14/2021 0:00:00 $1750.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 11\ The Commonweal+h of MaSS2chiicotto \ , Office of Public Safety and Inspections Massachusetts State Building Code(780 CMR) Buiaing Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit NumberreA•.7Jr`3,4JDateApplied: Building Official: SECTION 1:LOCATION 3,3 Ha 1 _y lr 61,60 Ce, wt ��� r v r vct No.and Street Ci Town Zip Code Name of Buil ng(if applicable) at7- - I6z Assessors Map# Block#and/or Lot # SECTION 2 PROPOSED WORK Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Building[ ' Repair❑ Alteration CAI Addition El Demolition ❑ (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy El Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes Etil No ❑ Is an Independent Structural Engineering Peer Review required? Yes 0 No Brief Description of Proposed Work: Av'S ie/tz ea GGr ,11c`f lc v,S e. C]l 4' >JY1 11 Lett l c4 L 4)1Dvoinds 'T fritmrff< vita SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0 Existing Use Group(s): A 3 Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft) 2 /d,r v Total Area(sq.ft.)and Total Height(ft) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2 0 Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business 11 E: Educational ❑ F: Factory F-1 0 F2❑ H: High Hazard H-1 0 H-2 0 H-3 ❑ H-4❑ H-5❑ I: Institutional I-1 El 1-2❑ I-3❑ 1-4 El M: Mercantile❑ R: Residential R-10 R-2❑ R-3 0 R-4 0 S: Storage S-1 ❑ S-2❑ U: Utility 0 Special Use Land please describe below: Special Use Description: Y� 5,4 �,k SECTION 6:CONSTRUCTION TYPE(heck as applicable) IA ❑ IB ❑ IIA ❑ IIB 0 IIIA " IIIB ❑ IV 0 VA 0 VB 0 SECTION 7: SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public 57j Check if outside Flood Zone 61/ Indicate municipal A trench will not he Licensed Disposal Site 14( Private IDor indentify Zone: or on site system ❑ required Efor trench or specify: permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes 0 or No Yes❑ No IV "1/4k Z4)1.5. SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: 4%ri -244Aise Group(s): /A?j Type of Construction: V g Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: ( � c;eP h� G SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner i 33 . cA zy '4- lY�;•-�„cvrtQ L tUN-'►- o �'� S ✓w�. 1'6 -L� ?vt p-z.Z (es4 Name(Print) / .and Street City/Town Zip Property Owner Contact Information gtat." ", to K 9- 9✓/c" - Title Telephone No.(business) Telephone No. (cell) e-mail address Iff applicable,the property owner hereby authorizes: Y Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here D. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control (the professional coordinating document submittals) 120(14 QS q - c- o L4 t 4.ets /6L5- vT 4-4 Name(Registrant) ✓ Telephone No. a-rail address -�01. Registration Number �4b CTr,� M Ntsbn A.M.,.ti (*c_t �1z1 Street Address City/Town State Zip Discipline Ex irati n Date 10.2 General Contractor t�.,R,, ,)1/ Sb.._s t . Company Name pI f A /J� t.vAti.. oS3L 1 ezwu ,- i ✓ee- Name of Person Responsible for Construction License No. and Type if Applicable R z g's-{ jsioa it. Si /J>a� M 161- ©/ Lcr Street Address City/Town State Zip ` 57& 8H7`4 'L-1ZjY767 e:sor1r, 5� it VON nwc Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of theAuance of the building permit. Is a signed Affidavit submitted with this application? Yes O No 0 SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 2.5oy 06Q.' 1.Building 61 $ 2`t j 13all. Building Permit Fee=Total Construction Cost x. (Insert here 2.Electrical $ appropriate municipal factor)=$ 17S 3.Plumbing $ 4.Mechanical (HVAC) $ dQ�, y Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ l5O.10.dt5 — (contact municipality)and write check number here_6111V SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my wledge and understanding. nww Luee - r. a- i- �z-7 z z-t Please print and si name Title Telephone No. ate $'z S-1 ✓ - 7 Mi Nob- v 1l wits&,. Street Address City/Town State Zip Email Address OWL r U r� Municipal Inspector to fill out this section upon application approval: 171 4Z Name to City of Northampton f`..- Massachusetts �V 3... :',t. 1 l �: _ N; DEPARTMENT OF BUILDING INSPECTIONS , t r_.''=k. 212 Main Street • Municipal Building J, � \ ` Y i ,,,, , a Northampton, MA 01060 'ilii-iri5c0 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: 7 Location of Facility: �' r eL it'll Pc- The debris will be transported by: Name of Hauler: e°-C1, k/0a`5"tom , c1 J`ci l Signature of Applicant: Date: V/zfri 1 \ The Commonwealth of Massachusetts It !t+ Department of Industrial Accidents j1 Congress Street,Suite 100 Trail?;= Boston, MA 02114-2017 wwii;mass.go►/dia 11urkers'Compensation Insurance Afftdasis:liuildersl(bntractors/ElectriciansiPlutnbers. AO BE I-11.E1)W f111 771E PERtlll-Ili(:Al'lllORlll. Applicant Information 1 Please Print Legibly Name(Business,organnation individual): P.. 4 . Sill Ugzy1z . . Sewks, t Address: Z. - `� ca,r�-t J�+rs e-t't-L c,,t t 0 to City./State/Zip: Nieyc k\ft .�l t_�i ^,�.,-ti MA 1Pht a#: j rj', 7 Are you an rmplo Of?011ek the appropriate box: Type J project(required): L❑lam a empkrytr with employees(full and ur part-tire:l..• 7. p New construction 20 1 am a sok pro Inemr or p:rrrnership and hate no cnnpkwtrs working for me in K. Ci Remodeling any capacity.[No workers'comp.Manama: aquin:Li 9. ❑Demolition 3C 1 am a honawowair doing all aunt myself. No*minas'comp.ua+uruay.required.i i(1[] Building addition 4.0 I am a bunion,.nes and will be hiring uurur..torska conduct all wtnk on my propertj. I will tenure that all ceunract.rs either hose workers'compensation immune:IN are sole I I.0 Elextrital repairs or additions proprietors'with no employees_ Plumbing repairs or additions i am a general contractor and I hate hind the sub-contraewn listed on the attached sheet These sub-contractor,hate employees and have wurters"camp.insurance. 13.nRlwt h'pairs sir we area eimo rraliun and its officers have cxtrciseti their right of exemption per AI(iL c. 14. theti KQ,yos( `p 132,y 1(41.and we hate au tatiplo)s cn [No wu&c m"camp.insta ancc rcgoutvl.) 'Any apphtax that Chocks bus vl most also till ant die stcction helms showing their*otiose ottitperrroeion polity information.. t Honna,wars who submit this atli b..ii indicating dray art a ing all work and then hire c idltoontrreturs mow submit a nm atfuhasit indicting such. '('untracwrs that check this box rnu4t attached an adiallail Abu shaming the name of die f ub-otrtarat'Trus mud stale miw-thcr to not those entities hate emplotyccn hike sub-coatrooms lmvc crrgdottcs."hey meat provide their workers'comp.polity number_ l am an employer that is providing workers"compensation insurance form),employees. Below is the policy and fob site Information. Insurance Company Name: Ali fri.13 Ste` Policy or Self--ins.Lit.#: Q .0 GO Cj Q T Z-02 xpiration Dale: -till Z1 Job Site Address: 3' }{n i.414.4 S{- CilyiStale Zip: Af��"-at,v1 et, MA ,131Db0 Attach a copy of the workers'comps policy declaration page(showing the policy number and espira ion date). Failure to secure cos erage as required under MUL c. 152. §25A is a criminal tiolation punishable by a tine up to$1.5(K).00 ant-or one-year imprisonment.as well as civil penahics in the form of a STOP WORK ORDER and a line of up to S250.00 a day against the violator.A copy of this statement dray be forwarded to the Office of Investigations of the DM for insurance coteraf"e verification. I do hereby certify and r the pains alt f perjury that the information presided above is true and correct Signature: Date_ Lj` `�i Z'//z I Plume#: Y15_S t . 2 y'7 (lJjelal us only Do not write in this area.to be completed by city or town official al City or Town: Permiel.icense# Issuing Authority(circle one): I. Board of health 2.Building Department 3.City(town Clerk 4.Electrical Inspector 5. Plumbing Inspector ti.Other ( outset Person: Phone#: Appendix 1 Construction Documents are required for structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where applicable No. Item Submitted Incomplete Not Required 1 Architectural 2 Foundation ./ 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing(include local connections) 9 Gas(Natural,Propane,Medical or other) 10 Surveyed Site Plan(Utilities,Wetland,etc.) 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review(521 CMR) 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction. Registered Professional Contact Information Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date - - Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Please follow this link for construction control forms to be used by Registered Design Professionals.