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32C-016 (11) 90 MAIN ST, FLORENCE BP-2021-1488 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:32C-016 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: FIRE DOOR BUILDING PERMIT Permit# BP-2021-1488 Project# JS-2021-002475 Est.Cost: $18000.00 Fee: $126.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RICHARD DENNO 066189 Lot Size(sci. ft.): 4965.84 Owner: BRAZEAU KURT Zoning:CB(100)/ Applicant: RICHARD DENNO AT: 90 MAIN ST, FLORENCE Applicant Address: Phone: Insurance: 551 FLORENCE RD (413) 584-0852 FLORENCEMA01062 ISSUED ON:6/16/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL FIRE DOOR & 3 FIRE WALLS 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. 3)11 Certificate of Occupancy Si�2natg`. ' FeeType: Date Paid: Amount: Building 6/16/2021 0:00:00 $126.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner r i r ' The Commonwealth of Massachusetts jr'�,' " a Office of Public Safety and Inspections Ilt' Massachusetts State Building Code(780 CMR) o Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Perima umberSP-2.024-II4 0 Date Applied: (II4.(Z02I Building Official: l -_ - SECTION 1:LOCATION ge014.: � Sk O. e(4), mass ©f6L2 Midedfr fc's Noo..Z Street QCit Town Zip Code Name of Building(if applicable) 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 0 Repair 0 Alteration A► Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes I' No 0 Is an Independent Structural Engineering Peer Revie required? Yes ❑ o- Brief Description of Proposed Work: r►c�n �� Ys. �o✓ e ,� 7 fr. G _ 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) D 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❑ Nightclub 0 A-3 ❑ A-4 0 A-5 0 B: Business it E: Educational ❑ F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1 0 I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 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 0 IB 0 IIAD IIB 0 IIIA 0 IIIB 0 IV El VA 0 VB 0 SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Trench Permit Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal: Licensed Dis sal Site 0 Public 0 Check if outside Flood Zone 0 Indicate municipal❑ A trench will not be Po Private 0 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 0 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 Address/� s of Property Owner per, ^ 1 �C.� /v�'S#26-4e. C 3 _J�M,A/ S% , ( QC�Ci� ✓'zA Name(Print) No.and Street City/Town Zip Property Owner Contact Information: ow.,/,-/) 03 495- ?J_S_ 9/3-68G-8?6 €A949WC Gam, Cc Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: cA—2:21 ri b • S.si l e when, i 2 v i,c.. /✓I �c 6/e P.. 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 C. 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 Company Name -r24rhe Cs a a/89 Name of Person)j Responsible for Construction License No. and Type if Applicable Seri yG I ecih Eti► f�D 62_ • Nine_ e/B L 7i Street Address City/Town State Zip =_ 4/3 $31- 0 e6 ---oh 4h4,,eels-✓Q ably 4 CtiA„c . AV( Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes D No CI SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor v° and Materials) Total Construction Cost(from Item 6)=$ f1 000 1.Building $ Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)=$rp rr./oo 3.Plumbing $ 4/No o a 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $jirf/CS— (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the of my knowledge and understanding. e.. •-G: .eh?, 19$ .3 '- Cr 6) Please print and sign name Title Telephone No. Date Ste/ 12dyvh " Piopchov /s/e.>s 0/46L Street Address City/Town State Zip �/�J Email Address Municipal Inspector to fill out this section upon application approval: rWV fV C/J '7)01_ Ah5(aj_ Name Da e City of Northampton QYH OO iA- rod, �S,S ,•..`...sic,• Massachusetts 4'! x- < DEPARTMENT OF BUILDING INSPECTIONS � .. � 212 Main Street • Municipal Building Jtis oca Northampton, MA 01060 SbW1 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 Rp2024-/tog 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: Location of Facility: 1/41 Gtle,d byi //' nit The debris will be transported by: Name of Hauler: ..Zoo /yJQh j0)/s,. !� Signature of Applica . Date:4:)7". . 7 2G'2.1 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street.Suite 100 '• _ �' Boston. MA 02114-2017 - www:niass.gor/dire )lurkers'Compensation Insurance Affidavit: Buildersi('ontractorsfElectririans+Plunth►r.. "f(1 BE FILED WITH THE PERMITTING At'THOR T . Applicant Information Please Print t ei ihla Name(Business:Organtzationslndividual►: G 'ocenA Address: 537 i 2 eiTY/hvt '7ze..1_ City/StatefZip:/%20,I,� /1c t3/ar6 2- Phone TM: -4 3 / • p I C7 Are yea or tlnNtever°('hack the apprupriatc hot: Type of project(required): ].�I am a employer with erupluyees 1:lad andoi part-time ' 7. CI New construction =0 I am a sole proprietor or partnership and have nu employees working for ,-in 8. Q Remodeling any capacity.[Nu workers'comp.insurance requ final.) LJ 9. ❑ Demolition 30 1 am a hunxuwner doing all work myself.[No workers'comp_insurance required.) 10 0 Building addition a.❑I am a homeowner and will be hiring cxnurac1urs to conduct all work on my puoperty. I will ensure that all oontra'Iurs either hake workers'ournpensa1Ion insurance or an:sole 11.0 Electrical repairs or additions pruprictun with nu cnnpluyecs. 12.0 Plumbing repairs or additions 3 lam a general contractor and 1 take hued the sub-cuntractors listed on the atractlad sheet Thesa sub-cuttracturs hake employees and hake workers'comp.insurance. 1 3.12Roofrepain 140OtheiA b.,wirdj0y, 6. a are a corporation and its officers have oxen:ised their right of eamaptiun per h1Cit_e. r I .ti1(4).and we hake no employees.[Nu workers'comp.insurance nequi al.[ 'Any applicant that chucks boa al must also till uut the section below showing their worker'conupensatiun pukes information. t Homeowners who submit this atiidaart inelrcatrng they are doing ail work and then hire outside cuntracturs must submit a new aflulak it indicating such. 1Contractor.that cheek this boa must attached an additional sheet show inc the name of the sub-eontracturs and state whether or not those arlruu hate employees. If the sub-c..ntractors have employees.they must pros ide their workers'ournp.policy number. I am an employer that is p,/cwidiug workers'compensation insurance for my employees. Below is the policy and job site infrrrmation. Insurance Company Name: _ Policy#or Self-ins.Lie.#: _ Expiration Date: Job Site Address: City/Stale/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 tine 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 tine of up to S250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coa:erage verification. I do hereby certify under ill MN and penalties of perjarr that tire in/ornratiuu provided above ik true rind correct. St r attire: L Date: v44 '7 1.Q'I I Phone#: — 0B67 O1ficial use only. Dr,not write in this area.to he completed b1 city or town official ( it► or I osa n: Permit/License Issuing.authority(circle one): I. loam!of Health 2.Building Department 3.('its+fawn Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: • _ MIncocciocsfvfl /►/(;wd.x.C, wr“..,i.._ /A/5(447C=n ,1;A- tM ACC. S- 30' 64 2654.... '/ Oohs! -jA/7 vcli 6c a �e- par r< R&fic-, =- ° -_- 1 . _ Apo O.✓ CoS73 ? cPR?/s-;'FGAri Cc/ /'vG /3,-D 14/1)6L AA- 133 CC. /AD9_014. _.cGs7-s _ Or.-1_ _E�.t7?-- 'P `tvbvZ i. nRcx ryv,2,e"t./? • 1. . - 17 _ . - . -._. ,.} ., . • rn „:b.....r.4.1. s' 1Y.:.:'`S?15..i t�s r"-f. i ie.. Oil l 7-1faSii:ei t.:t_p'* r _ • !t• et, 1 1 ,, ,. i 1 , 1 !1 1 it x 14/ e1. 5 1 . 0,--Ce- . �r� wtt✓ e Pvii �1 Yt F ,.. � � I9 i 1 1 1 l' . to i kJ �' j . .fit 1 M1 +.----- I i ,.....--i- il - 1 , r ,i s_Tom."" I:+ k . 4 --.2.—..L..--tz---'-a. 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