32C-187 (4) 408 PLEASANT ST-UNIT C BP-2021-1478
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32C- 187 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-2021-1478
Project# JS-2021-002457
Est.Cost:$22000.00
Fee: $154.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BAYSTATE EXTERIOR RESTORATION INC CS-089485
Lot Size(sq.ft.): 15812.28 Owner: NIEDBALA STEVEN
Zoning:GB(100)/ Applicant: BAYSTATE EXTERIOR RESTORATION INC
AT: 408 PLEASANT ST - UNIT C
Applicant Address: Phone: Insurance:
87 SHATTUCK RD (413) 549-6824 WC
HADLEYMA01035 ISSUED ON:6/11/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:ROOF, KITCHEN & BATH RENO
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. ff
Certificate of Occupancy Signature:
FecType: Date Paid: Amount:
Building 6/11/2021 0:00:00 $154.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
•
The Commonwealth of Massachusetts J�`1
Office of Public Safety and Inspections
qb1. Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Two-Fatriily Dwelling
(This Section For Official Use Only)
Building Permit Number: 612-a1-/'{7bate Applied: Building Official:
SECTION 1:LOCATION
wag'/�Leczs��-z rc
No.and Street City/Town Zip Code Name of Building(if applicable)
32C - 18?
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building Repair P Alteration 0 Addition 0 Demolition 0 Please fill out and submit Appen ' �)
Change of Use 0 Change of Occupancy 0 Other ❑ Specify: Ie:.G/� �"!✓t}4Y �� 1
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ Now
Is an Independent Structural Engineeri Pee Review r uired? r %/"� Yes 0 No�B�
Brief D scription of Proposed Work: j� l
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) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business ❑ E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1❑ H-2 0 H-3 0 H-4 0 H-5❑
I: Institutional I-1 0 I-2❑ I-3 0 I-4❑ M: Mercantile❑ R: Residential R-10 R-2 0 R-3)2' R-4 0
S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ IIA ❑ IIB CI IIIA 0 IIIB 0 IV ❑ VA,f " 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 0 Check if outside Flood Zone 0 Indicate municipal 0
A trench will not be Licensed Disposal Site El
Private❑ or indentify Zone: or on site system 0 required 0 or trench or specify:
permit is enclosed 0
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable 0 Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes❑ or No 0 Yes 0 No 0
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Addr of Property ner
cfogA 45( q.,-5�-tk- POW,' 3. 0(67,--
Name(Print) No.and Street City/Town Zip
Pro erty Owner C ntact Information:
4e l J c(&f0, 3 -a16(- lO -
Title Telephone No..054 Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:eiza
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❑.
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)
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
p Nam
Citt 2.(11-"A--n°4N--( _..." 1..71'4 C_ _
C g¢ a
Ine of Pe�n R esponsible fc�Cgnstruction License No. and Type if ApplicableO0�.if
I�IJO�c , t PA—
CetAddress �3 3 9� �l/ City/To State Zip
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 the issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes 0 No 0
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ d.4)„/°CO Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)=$ .
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ V 0157> (contact municipality)and write check number here
ION :SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I by att(Ist ,, ,er the pains and penalties of perjury that all of the information contained in his
plicatio i ue and accurat• the e' of i ' knowledge and understanding.
1450046 -ft i‘, . 6c., 4(5 _314 All 9A
Please print aid sign name / / If LA
A603( Tele, one N Da�
1 DM
•
Yeet Address City/Town State Zip Email Address
1
Municipal Inspector Ins ector to fill out this section upon application approval: Z.& 6-ii+ Z)
Name Date
City of Northampton
'! Massachusetts �? i. "^•�
t.
DEPARTMENT OF BUILDING INSPECTIONS i 1
y,�,�j
212 Main Street • Municipal Building 0\ ^��
Northampton, MA 01060 fNii,...j.-
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:
k
Location of Facility: 6
The debris will be transported by:
Name of Hauler: LcS T"
i J
Signature of Applicant: Date: (074St
INN- The Commonwealth of Massachusetts
71,5111M, Department of Industrial Accidents
I f=1;7- ..-=;i 1 Congress Street,Suite 100
„I
Boston, MA 02114-2017
t......d. www.mass.govidia
- 'Workers'('ompensation Insu ace AMdavi ilders/ContractarsJEkctricians/Plumhers.
TO 13E Fl : win THE LER. !TING AUTHORITY.
applicant Information Please Print [x016
Name(13usitscss,OeltanizationfIndariduntl:
Address: r7 3ttax-7-cuck._ c (.
city/state/zip: it— 6(03 cPhone#: CP A rVF:le.9_eg:!/______
Are yaw it -.bniployer?Check the tippet) tittle box: Type of project(required):
I. I am a eniptuycr with 2...."‘."--enrpluyees(fall ari&or part-timer' 7. c] New construction
2.0 I am a sole proprietor or ponnership and have nu employees werlintg for me in 8. emodeling
any capactty.[No workers*comp.insurance required"
_ Ei Demolition
30 I am a honsiowner doing all work myself.(No workers'conp..insurance required.]"
10 0 Building addition
4.0 I ant a homeowner and will be hiring oontraelors to conduct all work ort my property. twill
mum:that all eon/moors either have workers'tmrripensation insurance or toe soh: II.0 Electrical repairs or additions
proprietom with no employees.
12.0 Plumbing repairs or additions
50 I am a ecneral contractor and I have hired the sub-contractors listed on the anached shed.
2eziffi.(x)f repairs
These sob-euntractors!woe einployee-s and lc worker.'comp.insurance.:
14.0 Other
6.0 vh-are a corporation and its officers ilaVe exercised their right of exesritxrun per MIGL c.
151,§1(4).and we have no employee>.INio workers'cuinp.insurance required.]
'Any applicant that cheeks box P I must alau rill uut the section below showing their workers',..orapensation policy information.
•I lorncownerii who submit this affidavit Oulu:aims they are doing all work and then hire outside contractors must submit a new affidav it usdiorang such.
ICuntractors that check this bus must attached an additional shim showing the manic of the SLI b-s'011trafj,t/r3 and state whether or nut LILUM:vanities have
employees_ lf the sub-contracturs hat.e employees.they must provide their workers',V11 Ir.l'oli,:)number.
I am an employer that Is providin workers'compe 'Ilion insurance for my employees. Below is the policy trnd fob sire
information.
Insurance Company Name: Ce )/----,6-frc 5 _
Policy#or Self ins Lic.#: LC? ' 61 6 9-I„ 331- Expiration Date: 3
Job Site Address: LOg i i-- (...cl—J City/StateqiP" Me'
Se1143 Attach a copy of the workers'compensation policy declaration page(showing the policy number an tpiration date).
Failure to secure coverage as -..; ired under MCiL c. 152,*25A is a criminal violation punishable by a fine up to 51,500.00
and/or one- — imprisonm t,a• ell as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a
day again iolator.A .py o 's statement may be forwarded to the 011ice of Investigations of the DIA for insurance
coverage . ti .
I do herebyi fify u ,er Q, L• in penalties of pedal:),that the information provided abut. is trig correct.
1 V110 .0
Signature: I • Date: ( Co
I Phone#: Lt I 3 - fs-Le:/ - Ce in-ti
Official use only. Do not write In this lat'll,to be completed by city or w1471 OfifiCliJi
or Toss ii: Permit/License#
Issuing Authority(circle one):
I. Board of Health 2.Building Department 3.Cityrfown Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
,_ __„
CONSTRUCTION CONTROL WAIVER
From: El a, -cPCL(
i
(6 S( (3, )4- Acpi 14324
14(4-4'
4620711*- 4ed 1/43S-
LA 3 — .S.741- A-7 t
To:
Jonathan Flagg
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, I request that you
grant a modification to waive the requirement for construction control of the project at
4-";N PUP-la-AT-
because the work is of a minor nature,will not affect structural elements, h alth,accessibility, life or fire
safety,and will be done in accordance with the prescriptive requirements of the code.
Thank you for your consideration.
Reis ec fully, 1 1(i,Abs‘