18-009 (3) BP-2021-2017
60 DAMON RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
18-009-001 CITY OF NORTHAMPTON
Permit: Addition
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-2017 PERMISSION'S HEREBY GRANTED TO:
Project# ADDITION Contractor: License:
Est.Cost: 38000 48078
Const.Class: Exp.Date:06/30/2022
Use Group: Owner: GREEN DELTA HOLDING LLC
Lot Size (sq.ft.)
Zoning: GI/WP Applicant: GREEN DELTAL HOLDING LLC
Applicant Address Phone: Insurance:
60 DAMON RD (410)370-6330
NORTHAMPTON, MA 01060
ISSUED ON:10/21/2021
TO PERFORM THE FOLLOWING WORK:
FOUNDATION ONLY FOR ADDITION
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.
Signature: I � O
iY � yQ
Fees Paid: $400.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
pia n.s /
�C�� 4 RO..LiT. 'Lf\AI
DST e Commonwealth of Massachusetts
202/ Office of Public Safety and Inspections
Massachusetts State Building Code(780 CMR)
RT q oN M3'Ming P rmi Application for Section any Building oher than a One-or Two-Family Dwelling
q n, onr,S (T� Only)
Building Permit Number /" /Date Applied: Building Official:
SECTION 1:LOCATION
No.and Street City/Town Zip Code Name of Building(if applicable)
g `I
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 0 Repair 0 Alteration 0 AdditionX Demolition 0 (Please fillil out and submit Appendix 2)
Change of Use CI Change of Occupancy 0 Other Specify ?6�',II�Td✓J
Are building plans and/or construction documents being supplied as part of this permit application? Yes No 0
Is an Independent Structural Engineering Peer Review required? //� Yes ❑ No 0
Brief Description of Proposed Work: C'C�t5j7Lt c 7 O✓t ii/ lci d c3.1
&i , l� 1.7 P(r/S /7v v s > S; of
c/cO"1904L.fi ci/ A (r r'f 7 ,,� iotp...�� k� %1 8 a
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) Cl
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.) J�_ ,/, A N/�
Total Area(sq.ft.)and Total Height(ft.) V
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 0 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❑ U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA D IB 0 HA JIB 0 IIIAEl IIIBD IV VA 0 VBD
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:
A trench will not be Licensed Disposal Site 0
Public 0 Check if outside Flood Zone 0 Indicate municipal 0 required 0 or trench or specify:
Private 0 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 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 d Address of Property Owner
N 66 &LAM 0- ALACLO4 111.914 0106,0
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
ilmasizzaekaivilztoi
Title Telephone No.(business) Telephone No. (ce ) e-mail address
If applicable,the property owner hereby auth s:
/l ift_T&vrA /y( rlcy f 4- &'tea - UA- 01223
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 O.
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)
IIla,t4 l'ilev 2/-A: 04741 1'AIM/0,/a.elPeu,earn Lfg tf113'
Dame(V IP n TelAphone�. e-mail ac)d;If 0/7c2 Registration Number Z z
Street AdUress City/Town State Zip Discipline p' ation Date
10.2 General Contractor
Company Name
Name of Person Responsible for Construction License No. and Type if Applicable
Street Address City/Town 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
Estimated Costs:(Labor Item CC()
and Materials) Total Construction Cost(from Item 6)=$J,3e'
1.Building $ •8fl Building Permit Fee=To onstructio Cost x (Insert here
2.Electrical $ /J appropriate cipaibtor) $ .
3.Plumbing $ �/vVL
4.Mechanical (HVAC) $ /(/ Note:Minimum =$ ontact municipality)
5.Mechanical (Other) $ /r Enclose check payable
6.Total Cost $ ,FgDO (contact municipality)and write check number here Hi
SECTION113: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.
Plea& 1-31\1441(4 • Own1 q(9 2 io 4330 z).
rint d sign a Title Telephone No. Da
NS 6( ,�, 'ec - &A 0f22 3 / �C_041
Street Address City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval: ill'° • l 'b, � io/9-i o�)
l Name 1 Date
CITY OF NORTHAMPTON
SETBACK PLAN
MAP:Le_ LOT: 9
LOT SIZE: Soc)j 9 Y0 5/-
REAR LOT DIMENSION:
REAR YARD
This column reserved
.for use by the Building
Department
EXISTING PROPOSED REQUIRED BY
r / ZONING
Lot Size S-0 0)9(4 0 S f. YI cooi cj t(l7
Frontage
Setbacks Front 76 (7 1 / / 7 9//> 1 / 0Z�% I
Side L:i?71 R: 261,�}1/,/S9L:302 71 R:2&/,CY CAS : j S—I R: /
Rear 5!- l&20i ) 6e,,o(7 2O ' ) 20 1
Building Height /L H 14
//114-
X.
Building Square Footage
12 oO SOA 31 e 0 56.
%Open Space: (lot area a o
minus building Et paved 20%
2-c�/O Z�
parking — —
#of Parking Spaces IJoi.&Ail hof 000 n c4- roSS
#of Loading Docks ( SpOD 57tp cf,tLsS
0 O -Oro r aLL'' —
Fill:
(volume 8 location) N k D
FRONT SETBACK
FRONTAGE
5n s. e / ,/ , try'Opt = c A:1' �t 1 A� ✓
PEEN f!J - s4�+5 - 1 CI
•
D 0'0. �'� � i PHASE LINE /
/ HI
sue''�� •: I / n 3. 1 ` .�_
006
0.
GPEEN 7 / !If 810 / / �.
6RZD 0. ..' •, PHASE I PROPOSED 1980 VfF �93,\ �
SQ.FT.ADDITION 1 / WF 8 / W
11
ft*VITIDW
EXISTING 600 SO Er / Oil° /\ �Q_ / , hF 8 /I
BUILDING TO REMAIN . '�.
' \7 , ( /1.EXISTING 700 SQ.FT ti� \ ' •
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BUILDING TO REMAIN \ -
y [PROPOSED WELL ) �¢ t'7A 18 �4
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,t� oo EXISTING \ EXISTING 1,200 1 /
9 p GRAVEL LOT APPROXIMATE- SQ.FT.BUILDING TO MW5
— O O TOR REMAIN LOCATION OF REMAIN WF Ho / SEWAGE TIGHT TANK \ W\A311.
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City of Northampton
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tiMassachusetts "'<<
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DEPARTMENT OF BUILDING INSPECTIONS yv I'
212 Main Street • Municipal Building
Northampton, MA 01060 3'11/ 41.)C‘1
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: Pe iSv✓I C uivp ')e'ø _ / WA
The debris will be transported by:
Name of Hauler: FIS Ste. LI
Signature of Applicant: Date: /0 t I /a)
The Commonwealth of Massachusetts
lj=.� 1 a Department of Industrial Accidents
•e. =;:�i I Congress Street,Suite 100
_life_y Boston. MA 02114-2017
1l#7 h
i‘ www.mass.gov/dla
'�':':.._all
SS miters'('ompensation Insurance Affidavit:BuiIders/Contractora/Eleclricians/Plumbers.
U)BE EMU WITH THE PERMITTING.111IIIORITY. •
Annlicant Information Please Print Leeibis
Name( ytrt��()rgaotzatronilndtvtduul): G B,r C -4i/ Dejjg rilict Ler4 r y C%
Address:
1�5,9 �, ed ,_.:
City/State/Zip: /,, v0�(I_ jvl4 o/223 Phone#: '/t9^ a 6 3,3 0
,%rr yea as employer?Cheek the appropriate boa:
-I)(nr of project(required):
1.0 I am a employer with cngaoyees(fill and+w putt-time)-' 7. 0 New construction
am a sole prupnetw of partnership and have nu employees working for me init capacity.(No workers'comp.utxuranct required.' g. 13 Remodeling
40 I am a homeowner doing all woi t myself.[No workers'comp.u nun tee re omit.J 9. ❑Demolition
t.�I am a homeowner and will be hang contractors to conduct all work on mrop y property. I will RI a Building addition
eneun that all c,rninictura either louse workers'conmetnsutrrm ununtnce or ate kilt 1 I.0 Electrical repairs or additions
prupneturs with no employees_
12.0 Plumbing repairs or additions
5
I ant a general contractor and I have hired the sob-contracture listed on the attadted sheet
These sub-contractors have employees and have workers'comp.insurance. 13.�Roofreptura
6.0 We are a corporation and its officer,have exerciaed their nghi of exemption per MGI.e. Pt Otherril ,({'ld '0,1 -
152.1144).and we have no employees.[No workers'cans insurance required]
'Any appheatu that cheeks boa al must al u fill out the section below showing their workers'compensation polity information
r Iknneownet-a Who submit this affielavrt indicating they are dung all work and then her outside catiractces mint submit a new atTidav it indicating such.
:Contracture that check this tot must attached tin additional sheet showing the name of the sub-contractors anti Male whether or not nose entities have
cnnrluyces If the sub-contractors hope crrtfrkwee'..then must pros ide their workers"crnnp policy number
1 am nn employer that Ls providing;►t'e►rbers'compensation insurance for rot•employees. Below is the policy and Job site
injurmutiun.
Insurance Company Name: _ _
Policy#or Self--ins.Lie.#: Expiration Date:
Job Site Address: CitytState,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 line up to SI.500.00
and/or one-year imprisonment,as well as civil penalties in the tarn of a STOP WORK ORDER and a tiro: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
coverage verification
I do hereby certify tinder the pains and tnalties of perjury that the informatie n provided nho`v/ee'iis true and correct.
aftllpe' f /2/L Date 2/
is_ , ,. �/7& -- 7C �33Q
Official use only. Do not write in this ere ti. to be completed by city or town iJ/hiut
('lay or Tows: Permit/License p
Issuing:tuthorits (circle one):
1. Board of Health 2. Building Department 3.CltyfIown Clerk 4.Electrical Inspector 5. Plumbing Inspector
b.Other
t untart Person: Phone#:
Initial Construction Control Document
MI *
To be submitted with the building permit application by a
$ ` Registered Design Professional
for work per the 9th edition of the
et('
9i-'v Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Foundation Plan I)ate:10/7/2021
Property Address: 60 Damon Rd.;Northampton,MA
Project: Check(x)one or both as applicable: New construction X Existing Construction
Project description: Foundation for Pre-Fabricated Steel Building
I Ivan Filev MA Registration Number: 48078 Expiration date: 6/30/2022 ,am a registered design professional, and I
have prepared or directly supervised the preparation of all design plans,computations and specifications concerning':
Architectural X Structural Mechanical
Fire Protection Electrical Other:
for the above named project and that to the best of my knowledge, information,and belief such plans,computations and
specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),and accepted
engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary
professional services and be present on the construction site on a regular and periodic basis to:
1. Review,for conformance to this code and the design concept,shop drawings,samples and other submittals by the
contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and
quality of the work and to determine if the work is being performed in a manner consistent with the approved
construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent
comments,in a form acceptable to the building official.
Upon completion of the work,I shall submit to the building official a`Final Construction Control Document'.
� oN of+ussc
Enter in the space to the right a"wet"or of IVAN B. t
electronic signature and seal: FILEV '
g STRUCTURAL
No.48078
1.9 (-1 1.
IONA.04
Phone number: (508) 287-0676 Email: ifilev@ivanfilev.com
Building Official Use Only
Building Official Name: Permit No.: Date:
Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen,
provide a description.
Version 1 1 2018