10B-044 BP-2021-2174
45 RESERVOIR RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
10B-044-001 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-2021-2174 PERMISSIONIS HEREBY GRANTED TO:
Project# EGRESS Contractor: License:
Est. Cost: 3750 CONRAD NOEL 035620
Const.Class: Exp.Date:06/02/2022
Use Group: Owner: NOEL CONRAD REVOCABLE TR
Lot Size (sq.ft.)
Zoning: URB Applicant: CONRAD NOEL
Applicant Address Phone: Insurance:
27 CEDAR ST • 4136954316
NORTHAMPTON, MA 01060
ISSUED ON:11/15/2021
TO PERFORM THE FOLLOWING WORK:
NEW EGRESS DOORS
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:
• r ✓JAI r
Fees Paid: $100.00
212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
RECEIVED
N O V 1 0 2021
p The Colllimnon�usa(cMs ssa4husetts
fit� )1 office ro Ti ti�r�r A oio' ns
'4\ ! Massachusetts State Building Code(780 CMR)
�a
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only)
Building Permit Number `.?/'a7/74/ Date Applied: Building Official:
SECTION 1:LOCATION
45- RC-A-- a ve I R : O i—t p S Ma r;iC E,3
No.and Street City/Town Zip Code Name of Building(if applicable)
Assessors Map# Block#and/or Lot # r` �� .Gt G ° G�{()'°C I
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 Er Repair 0 Alteration 0' Addition 0 Demolition ❑ (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 IV No ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No 0
Brief Description of Proposed Work: le Z. x/5 T/ii%6 (4,1 N'noW5 FNAM F,ft) ( )
$e-r.,v/O &t i1 ec /7.)0/15/ i//vi5# Al iv A!? z o c/p t= ti 101 1 ou7/.
//v57A(C A/t'Gu Lidn/0/(4/ 57A/?zy' A/v1. f h/L//V65j C/- 3A" fod/t./Aiv/)
/ — 3z" Doc.)/2)
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 ❑ A-3 ❑ A-4❑ A-5 0 B: Business 0 E: Educational 0
F: Factory F-1 ❑ F2❑ H: High Hazard H-1❑ H-2 0 H-3 ❑ H-4❑ H-5 0
I: Institutional I-1 0 I-2❑ 1-3❑ 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❑ Special Use❑and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA IB ❑ IIA ❑ IIB ❑ MA ITIB ❑ IV VA VB ❑
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 ElA trench will not be Licensed Disposal Site 0
Private 0 or indentify Zone: or on site system 0 required❑or trench or specify:
permit is enclosed❑
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❑ 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:
City of Northampton
Massachusetts rj°'
" * cc
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3.4
DEPARTMENT OF BUILDING INSPECTIONS
��` .. 212 Main Street • Municipal Building
Northampton, MA 01060 s}j `1ti
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR COMMERCIAL &
MULTI-FAMILY NEW CONSTRUCTION/ADDITIONS/ALTERATIONS
1. Building Permit Application signed by legal owner and filled out by owner or authorized
agent.
2. One set of plans and specifications of proposed work (Digital & Hard copy).
3. Site Plan with location of proposed structure(s) and setbacks.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CSL and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (if applicable).
8. Note any Conservation and/or Special Permit requirements (if applicable).
9. Driveway Permit (if applicable).
10. Proof of Water and Sewer entry fees paid (if applicable).
11.Trench Permit(if applicable).
12.Initial Construction Control Documents filled out and signed by the Registered Design
Professional in responsible•charge.
4
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
(ON(42 D 1\)b E;L 2-1 C Di.-12 ,.`.;-1 rt'E=- NL 21 Hon li nil/ Mil 01 C(c.0
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
413 - 6;(6 U3) G q 614031L
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
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 f1.
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 01I3t 1;Pi Uw S--f-t ; er p. l b1),?-
• �_c?ilt2p�o Il4(:cI C•`� •0- 5(�A CC,i\5Arvd-itA , 4 ee t;' Sec
Name of Person Responsible for Construction License No. and Type if Applicable
1 (-Qckczc l f , 4I1in -t(-At/ Mil c i c(' e
Street Address City/Towr1 State Zip
__ LII3Leis_ LaiG
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 $ 34 0 v .O v
� Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ 3 50• o C) appropriate municipal factor)_$ .
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=t (U (contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ 3/7 6 0- O U (contact municipality)and write check number here 7O
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,1 hereby attest under the pains and penalties of perjury that all of the information contained in this
application is true and accurateat/ to the est of my owledge and understanding.
C:nN/2/t.D A1/W 4 �_ L ,i v t. 4L-)_-6??:' ¢3/( //_iA-Z/
Please print and sign name Title Telephone No. Date
Street Address City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval: feiJ\„sA :Ft .0-, )/)�/ i
Name 6 !!! Date
1 .
CITY OF NORTHAMPTON
SETBACK PLAN
MAP:_ LOT:
LOT SIZE:
REAR LOT DIMENSION
KEARYARD
9
SIDE YARD SIDE YARD
FRONT;ETBACK
FRONTAGE
14DICATE LOCATION AND DI ME NSJ ONS OF II OLE E.GARAGE.ADDITIONS OR ACCESSORY BUILDING. 11E
SURE TO INCLUDE FRONTAGE AND LOT SIZE(SQUARE FEET OR ACRIZS)
4
40
0 4r The City of Nthhamp ton
= ��r_(ir Building Department
,ri.:,,„)
; ' 212 Main Street
OR"`EOJ...,, Northampton, Massachusetts 01060
Phone(4I3) 587-1240
Fax (413) 587-1272
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVAT ION PROJECTS)
In accordance with the provisions of MGL c40, 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, s150A.
The debris will be disposed of in:
Location of Facility v/GLG7 n erict.,/Al6 Z34 6A5y-/A,Wr2J g/L . /j/ Al oto0'
The debris will be transported by:
Name of Hauler( ( /, ,ei0 xiti 6?_-
Signature of Applicant: eaffi Date: /k/D'Zo
1 .
`�'�� The Commonwealth of Massachusetts
o_ f. Department of Industrial Accidents
P. +t]= 1 Congress Street,Suite 100
- = Boston, MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): CO p n a; /k061_,
Address: J 7 c t Af,_ S7- /V
OJ $()
City/State/Zip: Joe )-11�A ifl'7 2'MA Phone#: 1-/3 e f,f ¢ /-1
Are you an employer?Check the appropriate box: Type of project(required):
LEI I,m a employer with employees(full and/or part-time)." 7. 0N w construction
2.EI am a sole proprietor or partnership and have no employees working for me in $, ]A j modeling
a y capacity.[No workers'comp.insurance required.] -u/
3. I am a homeowner doing all work myself.[No workers'comp.insurance required.]r
4. Demolition
10 Q Building addition
4.D I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
12.Q Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑RoOf repairs
These sub-contractors have employees and have workers'comp.insurance.t
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14, Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
1Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/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 fine 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 fine of up to$250.00 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 certifj,under he and penalties of perjury that the information provided above is true and correct.
Signature: / ` Date:// —/Cr -Z O L/
Phone#:
Official use only. Do not write in this area,to be completed by city or town officiaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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