17C-211 (50) F1-012E4C6 BP-2022-0672
81 MAIN ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17C-211-001 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-2022-0672 PERMISSIONIS HEREBY GRANTED TO:
Project# PARTITIONS Contractor: License:
Est. Cost: 81000 PIONEER CONTRACTORS 017890
Const.Class: Exp.Date:01/19/2024
Use Group: Owner: FLORENCE SAVINGS BANK
Lot Size (sq.ft.)
Zoning: GB Applicant: PIONEER CONTRACTORS
Applicant Address Phone: Insurance:
PO Box 1 145 (413)626-7267 WCC--50059570120018A
NORTHAMPTON, MA 01061
ISSUED ON:06/09/2022
TO PERFORM THE FOLLOWING WORK:
NON STRUCTURAL PARTITION 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:
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: . r . >2 . Cit .
( ,
Fees Paid: $570.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
The Commonwealth of Massach ett a
t
Office of Public Safety and Inspections -
Massachusetts State Building Code(780 C
Building Permit Application for any Building other than a Onel or Tit,0-,Faviixty pwelling
(This Section For Official Use Only)
Building Permit Number. 4 0?' t2 7a1 Date Applied: Building Official:
SECTION 1:LOCATION
c� s� viac i M h o(AP-- 0010i.Csu
No.and Street City/Town Zip Code Name of Building(if applicable)
jlc—aIi
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 Id Repair 0 Alteration Addition❑ Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ONo 0
Is an Independent Structural Engineering Peer Review required? - Yes ❑ No 18."
Brief Description of Proposed Work: Vi(M (y jL tL
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):_to
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft) - Z
Total Area(sq.ft)and Total Height(ft)
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 E: Educational 0
F: Factory F-1❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2❑ R-3 0 R-4❑
S: Storage S-1 0 S-2 0 U: Utility❑ Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA IBO IIAD IIBD IIIAcr— IMBD ND VAD VBD
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:
1 A trench will not be Licensed Disposal Site CIPublic Check if outside Flood Zone E3 Indicate municipal fd required Lpfor trench or specify: V 1`
Private 0 or indentify Zone: or on site system❑
permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission R iew Process:
Not Applicable Q" Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 12 or No 0 Yes 0 No C7'
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 of Property Owner c�
qO � Bctiw cA' lti 54' riorymAc2, 1 AAA. C)/ 6&2—
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
(1A , af)MA-01 � i- 1 In - - Pk<ALIC• G)61, 1 - -0 E^42-
Title Telephone No.(business) Telephone No. (cell) e-mail address ( '
If applicable,the property owner hereby authorizes:
Pt uv:ee r 60,,,'ITrcker5 P.a' So 1 li-ks' hoA ,. 1�A o/�r
Name Street Address City/To n 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)
- ► AAA T L, (_►. Midas sl'
Nane,l(Registralrt) ,' `_ ephone No. e-m ddress Re:'s 1 tion' umber
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
PIDlkejQ.r- C/4i -;
Company Name
Napfe of Person Responsible for Construction License No. and Type if Applicable
. au f(4N nD ALA OAAA
Street Address City own State Zip
11 r-4-_5 — S(i'l I q3- - 7W1 f( ram-i t .C"--
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 suance of the building permit.
Is a signed Affidavit submitted with this application? Yes ' No El
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Estimated Costs:(Labor
Item and Materials) Total Construction Cost(from Item 6)=$ CA i VVV
1.Building $ q. t INb'(fb Building Permit Fee=Total Construction Cost x 7 (Insert here
2.Electrical $ ZZ, appropriate municipal factor)=$ 51d-
3.Plumbing $ -- Cep OD
f
4.Mechanical (HVAC) $ 13 �,� ' �C/L,,, Note:Minimum fee=$...)$...)iC. (contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ k,U(27, (x) (contact municipality)and write check number here o.II 119
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
applica ' is true"c. rate to the best of my knowledge and understanding.
Please print and sip na Title Telephone No. Date
`bu�16 6./ Cf l6-bZ6-7267 6N/2:2—
Street Address Ci Tow St to ZipEmail Addres
Municipal Inspector to fill out this section upon application approval:
,�, 9
Name i ate
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
• for work per the ninth edition of the
fool% Massachusetts State Building Code, 780 CMR, Section 107
Project Title:Renovations for new finishes-Florence Bank Date: 04/21/2022
Property Address: 85 Main Street,Florence,MA 01062
Project: Check(x) one or both as applicable: New construction X Existing Construction
Project description:Renovation of existing office area
I Richard E. Katsanos MA Registration Number: AR 8355 Expiration date: 08/31/2022 , am a registered design
professional, and I have prepared or directly supervised the preparation of all design plans, computations and
specifications concerningl:
X Architectural 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'.
Enter in the space to the right a"wet" or Richard E. Digitally signed by
Richard E.Katsanos ECT
electronic signature and seal: Date:2022.04.21 PQ'
Katsanos 14:54:41 -04'00' QUO �SPNOS
Phone number: (413) 210-2086 Email: Richard.Katsanos rP ctZ Qs••,<\� 1
@HAIArchitecture.com
Building Official Use Only \ !,''
CpM0 A/4
Building Official Name: Permit No.: Date:
Version 01 01 2018
City of Northampton
• '" ,{} Massachusetts A,'?' ` t,'
C tiG
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DEPARTMENT OF BUILDING INSPECTIONS y:
212 Main Street • Municipal Building v,� '�
\ Northampton, MA 01060 'ASV''^�^ 4�
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: V Ck\I r7 d
I
The debris will be transported by:
Name of Hauler: 1)s 4
Oiz
Signature of Applicant: �� Date: G f�1
The Commonwealth of Massachusetts
1%`+r -_—•t Department of Industrial Accidents
:tea, E; 1 Congress Street,Suite 100
M: — 1 F•- '4` Boston,
�MAA 02114-2017�,�1/�•
ia
Winters'Compensation Insurance Affidavit:BuilderstContractorsclEketricians/Plumbers.
TO BE FILET)math THE PEI1MI'1'1'Iti(;Al l'HOR11'1'.
Applicant Information Please Print Letibly
Name Individual) e,lff w¢Q(.Get,1 et.Cv,A.T-
� 6 0 P. (2
Address: P 1!4%
city/State/Zip. (' �Vv�-) / /t Phone#: [.)13- z— f
ire.wt aw moiler?Chedt the appropriate bast Ty pe of project(required):
1.0 l am a employer with_ ._._+may.lluli andier part-lira 7. 0 New construction
2C1 l am a sole proprietor gar partnership and have no employees wwkiig tier roc in S_t.StRernodeling
any 4 acky.(Air workers'comp.insurance mammal]
9. ® Demolition
.30 I am a lonsoow net doing all wort myself[tin workers's'comp.imtairarace rryt*n d r
4.01 am a homeowner and will be hiring
exra furs to conduct all wank on myproperty_ I will 0 0 Building addition
ensue that all contractors either have worker;curuperisatiun iraumncr ur arc rule 11a Electrical repairs or additions
pnq metors with no employees.
12.0 Plumbing repairs or additions
50 I am a general can tactue and I hale hind the -contractors hated urn the attached sheet.
'these aub—contractun,base employee and brae wurkera coop net t 13.®Roof repairs
6.0 We-are a COgpormson and its officers hat c demised then nght of exemption n per M iL c. 14.❑Other
15.2 f If4k and we have nu employees,[No woken'comp.insurance respired)
'Any applicant that clucks box a1 must oho fill out the section below showing their workers'eompemevon polity infoinatiou.
e Bonin a nine who stal>rnit this affidavit iabcatirig,they are doing all work and then hire ottardc cawttrar.iuia Oro totem a new affrlas it andan tog such
t(`orr:ide s rift check this box roust attached an additional sheet showing the sane of tie and Nark whether or not drone amities base
employed. if the sub-tuniractws have employees.they mast pros ide their workers'comp.policy number_
I atilt an employer that is providing warders'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:_ N'559 it £Q) q4,., 3S e c,, —
Policy#or Self-ins.Lie.#: UtiCC,' ibg l S5'7- 202) l9 Expiration Date: 10‘30\1.o.
Job Site Address: �� 1 ' SJC' City:/State/Zip: U
Attach a copy of the workers'compensation policy declaration page(showing the policy number and a lion date).Z
Failure to secure coverage as required under MGL c. 152.§25A is a criminal violation punishable by a fine 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 S250.00 a
day against the s iulator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify 41 ,, of perjury that the information provided above is true aid correct.
Signature: Date: ,I 12-2—
Phone#: �//�� 5��~ -ct
r _.
Official use only. D.stet write li tbk ohs,r he completed by city or tow*official
ial
("its or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.Cltyrfown Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#: