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24C-192 (2) BP-2022-0629 442 ELM ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24C-192-001 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-2022-0629 PERMISSION IS HEREBY GRANTED TO: Project# DOORS Contractor: License: Est. Cost: 3500 MARK SARAFIN 053434053434 Const.Class: Exp.Date:04/28/202304/28/2023 Use Group: Owner: A TENCZAR JEFFREY J&JENNIFER Lot Size (sq.ft.) Zoning: URB Applicant: SARAFIN BUILDERS Applicant Address Phone: Insurance: 85 RUSELLVILLE RD (413)563-9256 0 WCC-500-50 19027 SOUTHAMPTON, MA 01073 ISSUED ON:06/03/2022 TO PERFORM THE FOLLO WING WORK: REPLACE 2 EXTERIOR 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I )2 cs- • f 1 . Fees Paid: $100.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner The Commonwealth of Massachusetts »11�' JUN - 2 2022 ( Office of Public Safety and Inspections ;'' F' Massachusetts State Building Code(780 CMR) Building Pe i 't Application for any Building other than a One-or Two-Family Dwelling riFPT OF Stilt DINS iNSPFCT ON (This Section For Official Use Only) D'f1«TNAn,� ry (Li Building 'er°ii it T�tumber�- 1_. ate Applied: Building Official: SECTION 1:LOCATION i�11t�& l Ll� a 5 '4 4tN1 ,_,0 a* O\Of 00 �C�7 QYGa 5 4`► j 11��l No.and Street City iown_!qZ_ Zip Code NaiYte 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% Repair 0 Alteration 0 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 0 Noll Is an Independent Structural Engineerin. eer Review required? Yes 0 No ;tit Brief Description of ProposedWork: ! - i\ C 6 a e 'e rl s u-c_ goo as 5 ti S i z-to V1 b C 1...-cE,. 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): S 1 Proposed Use Group(s): — 1 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 ❑ 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❑ I-3❑ I-4❑ M: Mercantile❑ R: Residential R-10 R-2 0 R-3 0 R-4 0 S: Storage S-1)1( 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 IIA ❑ IIB ❑ IIIA ❑ IIIBA• IV CI VA CI VB0 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 Public 0 Check if outside Flood Zone 0 Indicate municipal 0 required flkor 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 Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes❑ or No k Yes 0 No ❑ 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 pates M•r�. S ...�5 .. Massachusetts �� _ << 0 , *.0 DEPARTMENT OF BUILDING INSPECTIONS �. R w , 212 Main Street • Municipal Building y`�. .• \:- ;rsa+' Northampton, MA 01060 �3'i,, 3'.-" 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. 13. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton SECTION 9: PROPERTY OWNER AUTHORIZATION `amd Address of Property Owner Name(Print) No.and Street City/Town Zip Property Owner Contact Information: 0 W--ve2 `113-60i 1194 - Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Vvl,A-L\e_ 4..z_vvc..,, 9,5 Q..A4,�(‘.).kl-e %PI' So �, ` oil, 01043 Name Street Address City/ own 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) Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor S W��nF\.,. �v.\cknn .40-t s Company Name 1MNA..<._\I 5\026.�A<..,. CS - 05344 3 •l Name of Person Responsible for c�ppnstruction License No. and Type if Applicable Street Address City/Town \ State Zip 1 1-I I3-4 - gl a LI 13 (0S- Qa S(Q 'S a 2ci}.v. CB k Q Q�a ter(,vi-t. 1- 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? YesL No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ 3 .SOb. Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate muni '.. . .sr)=$ . 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee= (contact municipality) 5.Mechanical (Other) $ 6.Total Cost $ 3� iC� , Enclose check payable to 7 O , ' (contact municipality)and write check number here /0 Q 6�(2 SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I here attest under e pains and penalties of perjury that all of the information contained in this application�and accurate to �►C y wledge and understanding. w�c �2wc.v." OL..),,.e.L L1-3 -Sa75 —C •C(o Please int and signname n I' Title Tele e o. Datel BS p14tx�•e1v. I\•PSIC6) "t ►w�n�A OM- 010 � So,eel I eClAaT-tee . Street Address City/Town State Zip Email Address '� P T f4 Municipal Inspector to fill out this section upon application approval: 64101 £U P_ Name Date CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton Massachusetts S` s cee DEPARTMENT OF BUILDING INSPECTIONS i ti. 212 Main Street • Municipal Building vy_ Cam se^-" Northampton, MA 01060 ss ...W� 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: The debris will be transported by: Name of Hauler: 1NY2 ,a�=\..,\ i,. e�� Signature of Applicant: Date: 1-0-a^� The Commonwealth of Massachusetts Department of Industrial Accidents - Is I Congress Street,Suite 100 r� Boston,MA 02114-201.it T . wwmass goo/dle { 11 a kers'Compensation Insurance Affidavit:Brtlldersitentractors/ElectriciansiPlumbers. TO BE FILED VliIfll 1-IIE PI:R.MI11IM;AUTHORITY. Applicant Information Please Print Ixsibls Name it nusinesslorganuanoondividual I: Si,.,a c-‘ti ...:i; --k' Address: U� K.ri5.42k`..,.`V2 Yvon cD _ City/State/Zi6ti..A .c,,,,,,lp W\" alb j Phone#: 9 13--5103--9 a lo •a Are pre sselayer?Cheek� aNr e iir dila hs: Type of project(required): I./a l sae a empluver with 3 tapinynes(full and or tart-time)-• 7. 0 New construction 101 Rana salt pirupnetur or p art eniipaad base no employers working liar me in It.ARemodeling aayeapseity_(Nu nutters'crwap.immmicc required.( 301 ant a hrnuio ucr doing all w sur►my elf.(No nudism'comp.i.inwrattcc required.)' 9. © Dertwlitiun 1(I 0 Budding addition 4.lu Im a a Irmtnrwncr and will be hiring aroctur nr s to conduct all work on my pparty- I will album that all currmetun either tease workers'eiiu cnsatrurt tteiuramz or an:sole 1 1.O Electrical repairs or additions proprietors with nu employees_ 12.0 Plumbing riTairs or additions 50 I am a gallant contractor and I hate hired the sub-auntracWn listed on the attached slwcl Mcsc,rib-centocrs hose npto e workers' cs and base worrs'corgi.insurance.; I3.�ROt►tP:p.YtfS W at 6.0 We are annotation awl its officals hare exercised theirtight of exemption per M(iL c. 14.0Ot1tt't-.— 152,11(4).and we base no employees.[No workers'coop.insurance requind.l *Any serpent tint chocks box oI mint also till out the section below showing that workers'compensation policy irtformatiin. t lioateowaats who subset this affidavit indicating they arc doing all work and then hire oulsidc contractors mtnt submit a new of ri day a miliimilog suck lx1tm that cheer this box must attached an additional sheet showing the mane of the sulrconiractors and state Is eether or nut those entities base employees_ If the sub-eurstrackirs hose employees.they must pro..nit:their workers.aonp.policy number.. I oat an employer that is pen )ding workers'compensation insurance far any employees. Below is the policy pail job site information. A -.,.^ Insurance Company Name: F-1- .1.. W\ Policy#or Self-ins.Lic.#:WCG^5C0—ASb\erca1 - Q o?\ floe Expiration Date: -4-- 1" of a r i1, Job Site Address: LI 4 a �(vs" CitytStateIZip:11 i,1 __IAA A t D(e e con Attach a copy of the workers'co policy declaradan page(showing the peaky number and expiratiwt date). Failure to secure coverage as required under MGL c. 152.f 25A is a criminal violation punishable by a fine up to$1,500.00 andror one-year itnprismunent,as well as civil penalties in die form of a STOP WORK ORDER and a fern:of up to$250.0O 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 hereby71;ssyl,ce,r,gins ! of perjwry*Heat the Inforaration provided abort is trete and correctSi tune: Date: 6._c� r� 1i� Phone#: i 3 _ Co'3_.vq a 5C10 Ofcial use only. Do not write in this area,to be completed by city or town of tint ('its or Town: Permitll.icense p Issuing Authority (circle one): 1.Board of Health 2. Building Department 3.('ith.trfown(jerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: June 2, 2022 Johnathan Flagg Building Commissioner City of Northampton 212 Main Street Northampton, Ma. 01060 I request you grant a modification to waive the requirement for construction control of the project at 442 Elms Street because the work is small in nature, will not affect health, accessibility, life and fire safety and it is impractical in that the cost of construction control is considerable when compared to the cost of the proposed work. Thank you for your consideration. • I _ /2/9a Respectf Ily Mark Sarafin Sarafin Builders 85 Russellville Road Southampton, Ma. 01073