24B-089 (13) BP-2021-2009
261 KING ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24B-089-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-2009 PERMISSIONIS HEREBY GRANTED TO:
Project# INTERIOR RENO Contractor: License:
LACROSSE CONSTRUCTION
Est. Cost: 100000 SERVICES 065409
Const.Class: Exp.Date:01/30/2022
Use Group: Owner: 413NOHO PROPERTIES LLC
Lot Size (sq.ft.)
Zoning: HB Applicant: LACROSSE CONSTRUCTION SERVICES
Applicant Address Phone: Insurance:
444A NORTH MAIN ST#125 (413)246-2093 6ZZUB5R91219721
EAST LONGMEADOW, MA 01028
ISSUED ON:10/15/2021
TO PERFORM THE FOLLOWING WORK:
ADD WALLS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
l;ndcrground: 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.
Signature:
311
.>2
•
Fees Paid: $700.00
212 Main Street, Phone(413) 587.1240,Fax:(413)587-1272
Office of the Building Commissioner
oLLf„b -eL1,8
RECEIVED , ivakt
OCT - 7 2021 The Commonwealth of Massachusetts
r =
Office of Public Safety and Inspections
Massachusetts State Building Code(780 CMR)
H�1° ��1� iit Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only)
Building Permit Number:B p a) Mate Applied: Building Official:
SECTIONTI 1:LOCATION
2(tl k(v1 ST A, DvTAFtwip+or Tyr otirri Lc44' Cein}etr
No.and Street City/Town Zip Code Name of guilding(if applicable)
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 Ver Addition❑ Demolition ❑ (Please fill out and submit Appendix 2)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes e...No ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No
Bficf Description of Proposed Work: ii� W+uo t Qaf L or *Yt Ib€ PII 143
Lvpt
CZ r-ncvn v eirter 1bor. fie 44LaonrYlod4te 1 €-4 Pt-)14116
ur 44i .4,14.4Arri-4 4.51Ating l w4 A wdd..-d plugs 4 sw'I
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): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft) ' t O5D ' IS FO
Total Area(sq.ft.)and Total Height(ft)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0
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 0 I-3 0 I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3❑ R-4 0
S: Storage S-1 0 S-2 0 U: Utility❑ Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONST CTION TYPE(Check as applicable)
IA 0 IB ❑ IIA ❑ IIB IIIA ❑ IIIB ❑ IV 0 VA 0 VB 0
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Suppl Flood Zone Information: Sewage Disposal:
Trench Permit: Debris Removal:
A trench will not be Licensed Disposal Site le
Public V. Check if outside Flood Zone 0 Indicate municipal 1�required 0 or trench or specify:
Private❑ or indentify Zone: or on site system 0 permit is enclosed 0
Railroad right-of-way. Hazards to Air Navigation MA Historic Commission Review Process:
Not Applicable Is Structure within airport ap roach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or Nog Yes 0 No sr'
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 o Property Owner
. l D d het 2t•t 14 StJoi
Name(Print) No.and Street City/Town Zip
Pro erty Owner Contact Information:
5A 1 On kn - -?�2-�D6- l ob0 5 &-tvaA►noi l.e,4. e evrietg •tart
I itle Telephone No.(business) Telephone No. (cell) e-mail addf ss
If applicable,the property owner hereby authorizes:
Gzt 2- VK. u glyyr Al VgAtt lr *VS 1.L01511912.4a7 A4A dim
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 0.
Otherwise provide construction control toy ms(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
LAC-1099e -nove..--S-tor) vitt.5
Company Name
ems, 05 -vcosio9'
ame of Pe so Res nsible fo onstruction 11 License No. and Type if Ap licable
1 ggit /J NLA�1 T 45125 L.
eta' , Ol o2g
Street Address City/TowW State Zip
t113 2114 —Wg3 - - A 3zru 6mhti,, cow)
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11: w'Ol{Ki,R.S'COMt'1::NSA"'ION INSURANCE Aril I MN/l'T(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 thelverice of the building permit.
Is a signed Affidavit submitted with this application? YesUT No 0
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building - $ S 5,0O0 Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ '2.021 O00 appropriate munic. al fac r)=$ .
3.Plumbing $ .247 , O
Note:Minimum fee=$ (contact municipality)
4.Mechanical (HVAC) $ a,40p'(7
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost , $ (,Ot7 t Ors° (contact municipality)and write check number here ;-cto /
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 knowledge and understanding.
eage print a ign me "th 17s L L mgo Title 8 Telephone No. Date
1 A h•Nl � � G��
Street Address City/Town State Zip Email Address
602E SZ /L1KLQG44,4.t2 .cci3
1 '+Municipal Inspector to fill out this section upon application approval: ` try ► . 14= 10 /5
Name I Da e
City of Northampton
o , la,
"° Massachusetts 1../ � ,sf.,`
DEPARTMENT OF BUILDING INSPECTIONS
'�'?" 212 Main Street • Municipal Building .)f 4a
\ ., a." Northampton, MA 01060 sf'}.Pl .ti\`�
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:
Location of Facility: W g12eAre)Cill ii/V
The debris will be transported by:
Name of Hauler: 6514'ntA0__.J
Signature of Applicant: Date: 1�"",s'2/
The Commonwealth of Massachusetts
1*` 1 r Department of Industrial Accidents
il i sa s h / Congress Street,Suite 100
Boston, MA 02114-2017
www.mass.,gntr/dim
Vi takers'('ompensatiun Insurance Affidavit:Builder/ContracturstElectririansrPluniber'.
'I'()HE FILED%V WI THE PERMITTING'At"t'l1010' l`.
Applicant information Please Print 1.egibls
Name(Husm s.ths,ancurticn indnvictual): Lp1c_sc, e evil mewlt vs-co
,Address:4/411,4 Alm ST_ 'a' LZS.
dot „„
City`Stattr:'Zip:.a f. e1q _,Afi F'lWnr N.13—70
i.rc,,,n,an eyaislq,re?i`teat the ite tiim: Type ofprciject(required)..
..D I;an a employer with ............._........erripiogres(taill ifiid=" part-Min -, New construction
I am a sole gxuprieter or partnership and have nu employers ers worittng fur eras in
8. ctdcling
arty city.[No a'urkcrs' unnp.nnsiwtanca: required.]
^� 9. 0 Demolition
'.,,�t 1 ant a homeowner thing all wort myself.(. tr workers`comp-iminancc morning
4.0 I dint a Inimootvner and will he hiring,contractor's IV eundue4 ail work on my pc :ray. I will lJ Building addition
ensue that all contractors either hate workers`compensation insurance tx are stak 11.1:3 Electrical repairs or additions
proprietors v,ith no employes,
i 2.®Plumbing repairs or.t+l.iiticros
gC21 of a Yeai).:.i:tonnaitar and I have hired the sub,co stnteturs listed urn the attached she+.!
These sub-contraetc rs have employees aril have workers'corm.insurance., 13.®Roof repairs
6.0 Ike are a corporation and its idioms have etiiiiased their rived of exemption per NAIL e_ 14. O-ther
I52,f It 4).and u e::. ru erriOlyetS.1N6 worktft.comp.insurance required.I
*Any applit m that chirlo.box u I rout alai till out the section below slumimg their workers'compensation police information.
f liemeown ins who submit tliis affidavit tndieatitrg they are cuing:all hark and then hire o txid.contractors must satbinat a new affidavit indicants such.
IC'uniraktins that.Inch this.Box must attached an additional sheet slam urg the name eat the gals-et'ntr tetra acid state whether in not thou entitles have
employees. If th.sib-casniczetcwx have env l.„e.s.they must provide their notk rs".tivmp.roll y rutnt.i
I am an employer that is providing workers'compensation insurance for my employees. Below is the polity and job site
information.
Insurance Company Name:_ (. '..._ZV s—1./ j iM.e(t4414
Policcy 1 or Self-ins.Lie.#: ( 40 Si 5 e 01 _\of .Zl Expiration Date: ed:i — ( 5"2.02z
Job Site Address:2( l Vier) 61 (7re' r irt) CitytS 'Zip:
Attach a copy of the workers'compensation pit icy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under m( L c. 152.*25A IN a criminal violation punishable by a line up to S I.500.00
and`or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.tki a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
eoverage verification. ,
I do hereby certify under nrrlties of perjure that the Information provided above is true and correct
Signature. r NAr9/If R Date: l0-- 6 -2I
Phone#: �7 0 9�
,z
Official use only. Do not it-rife in this area.to he completed by city or town official.
(its or Town: Permit/l.icenset
Issuing,authority(circle one):
1. Board of Health 2.Building Department 3.C frown Clerk 4,Electrical Inspector 5, Plumbing Inspector
b.Other
Contact Person: Phone#:
-1c
Tl..
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
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SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
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1 BUILDING ■
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NEW BIT CONC.CU•:TO r II ,, w
- DEFINE PLANTING BEDS • L�� _ �� g -
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.N8' I� ISLAND TO REMAIN- EXISTIN
LOCATION FOR TENANT
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� �, , 1E6 STEELEOLLARDS ` `TTP.0 0�I��h:. DO NOT ENTER'- B9c D
N.. N•'�T.'& /.;_/./ "Y'- -�� SIGN g m I-
ENCLOSURE.MATCH _lfy ',//�. 'I
WMPSTER ENCLOSURE ,a Iffit� I 4 a I d
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fi(I�R•Ii ORNNTO NEW �T S it STEPS ADD NEW ACCESSIBLE/0
8•PVC D NDERGROU ND I�III " �, RAMP&HANDRAILS / r
CRAM CONNECTIONS �i` -,..•�F I I g
E 1�1 "' RAMP&CONCRETE SIDEWALK j a E
SIDEWALK TC BE REPLACED �.`.:. ` ,� V / / / "�
FO_OWI NG UTILITY
I NSTALIATON /`
RENOVATED.SEE ARCH 1 MP.. IgwlIllpIIIIIII , i ---------- '-------
DRAWINGS1 ,
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F ` KING STREET 2.,.I-
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Office of Consumer Affairs and Business Regulation
1000 Washington Street- Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: LLC
GEORGE'S RENOVATIONS LLC Registration: 152176
155 BROOKDALE DR. Expi ration: 08/24/2022
2ND
SPRINGFIELD,MA 01104
Update Address and Return Card.
SCA 1 0 20M-05117
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:LLC before the expiration date. If found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
152176 08/24/2022 1000 Washington Street -Suite 710
GEORGE'S RENOVATIONS LLC Boston 2118
GEORGE T.ABDOW "� L
155 BROOKDALE DR. a gr
2ND Not valid without signature
SPRINGFIELD,MA 01104 Undersecretary
Commonwealth o?Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Constr .o .§u ory sor
CS-065409 Expires:01/3012022
GEORGE T ABDOW
155 BROOKDALE DR
SPRINGFIELD MA 01104 f°
Commissioner . � "�--