38C-026 (2) BP-2022-1236
335 SOUTH ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38C-026-001 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-2022-1236 PERMISSION'S HEREBY GRANTEI TO:
Project# ROOF Contractor: License:
Est.Cost: 24790 TIMOTHY LUCE 100515
Const.Class: Exp.Date:07/15/2024
POLACHEK DANIEL W&TRACEY I CO-
Use Group: Owner: TRUSTEES
Lot Size (sq.ft.)
Zoning: URB Applicant: TIMOTHY LUCE
Applicant Address Phone: Insurance:
90 WOODBRIDGE ST (413)387-9800
SOUTH HADLEY, MA 01075
ISSUED ON:09/30/2022
TO PERFORM THE FOLLOWING WORK:
STRIP AND RE-ROOF
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 VIO ATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: !Al
CP •
4' • • •• 2 (f
I
Fees Paid: $175.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
f ~�
The Commonwealth of M sachus +
Office of Public Safety and I ections
Massachusetts State Building Code( 0 CMR),, c90(
Building Permit Application for any Building other than a One-or T FamilyVwe ing ,
(This Section For Official Use Only) •
Building Permit Number-^ I)' Date Applied: Building Official: ?r_ ogs
SECTION 1:LOCATION Ake"
orbt 0(0l2O W Poo .l<
No.and Street City/Tow� Zip Code Name of Building(if applicable)
Assessors Map# Block#and/or Lot #
SECTION 2 PROPOSED WORK
Edition of MA State Co used If New Construction check here 0 or check all that apply in the two rows below
Existing Building Repair C3/I Alteration 0 Addition 0 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 0 No Er",
Is an Independent Structural Engineering Peer Review required? L Yes 0 No C3'
Brief Description of Proposed(Work: p 4.- �¢,iC�`4� r tb eoOi
InAdtAk
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.)
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 ❑ A-4❑ A-5 0 B: Business 0 E: Educational 0
F: Factory F-1 ❑ 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❑ R-4 0
S: Storage S-1 ❑ S-2❑ U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 0 IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV 0 VA 0 VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Trench Permit: Debris Removal:
Water Supply: Flood Zone Information: Sewage Disposal: Licensed 15is sal Site 0
Public 0 Check if outside Flood Zone 0 Indicate municipal 0
A trench will not be Po
Private 0 or indentify Zone: or on site system❑ required 0 or trench or specify:
permit is enclosed 0
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Retiew 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 C:I
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
Daniel W. FBIOCIT' 'Trust 335&Nutt,' Sr• Northaryr w mA oD(oo
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
un is (t). idaet, kat 40 _58't- 3 365 = _ tasty e d w poi a c hek,Cad
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
h 3- (-10C4— 90 fib,l` - - &)�,1/11 N 0 5-
Name Street AEidress 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 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 1
1
1irne3ittl,
.
Company
e
L.0 cam— )Cnsl 5— M t... uk.bc
Name of Per Responsible for Construction Lic nse No. and Type if A licable
.b it ' i'4 St,)6
Street Address City/Town State Zip
- /13 3S7 -7 •I/U02404st° climeti. 60"'
Telephone No.(business) Telephone No.(cell) e-ndil 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 CI No 0
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$ _
1.Building $ 2-y ,70 Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal*tor)_$ .
3.Plumbing $ if
4.Mechanical (HVAC) $ Note:Minimum fee=$ l 1 (contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ Z/,7pd°� (contact municipality)and write check number here j )1446
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.
P
d
?,61 C ' Si naa 7 U�"' N UI a075, '1 f 1 c (t!/''—
`/qq
Street Address City/Town MStacte Zip Email Addrecs
Municipal Inspector to fill out this section upon application approval: ��''�— /"i ZOZZ
Name i Date
City of Northampton
#°a 'ti S S • ,S
' Massachusetts 4,+ ' �'<<
( t'1 1 DEPARTM NT OF BUILDING INSPECTIONS sA 7 9 ,,
r 4. 212 Main Street • Municipal Building JtiWitNorthampton, MA 01060 sf11' 10\
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:
U7Location of Facility: V a keer117
The debris will be transported by:
Name of Hauler: Ark eildditA'ilfk
Signature of Applicant Date: Y 2? 24'MZ
==
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street.Suite 100
lama. Boston. MA 02114-201
www.muss.gov/dia
1l or ke rs' ( o rn pr nsa t ion Insurance Affidavit:Builders/'oatracwn•Ekct ririans:Plu nibers.
1()HI. I II I tt%%ftu tut.mum I"I INC;Al 1 IIOKI I 1.
\pnlicant Inlot illation Please Print Legibh
J
NImutualName(l3urtr.. >rha� mtauo , � ..__`L}w�;'� t
Address:J9' _
C'its 'State/Zip: Lai( /144" 0/051 Phony
err yew an e111ployer?('Yctl the appruprutr twis:
t pc eif pr njctt f required
l.a I am a e toycT with employees{tail and or patt-ttmci• 7. , view constructer .,
a sok promo:tcr't partnership and have no employees working lot tear in $. Q Remodeling
any capacity (No V.iuL'ra'l'tanp.ttsuranat mimed.)
9. ❑Demolition
a t am a hunnsawner doing all work mysrll (.Nu wsnttos'cony tntonartce matured)
*
100 Building addition
4.0 I am a hue nownrr and w ifi br:hrtmg contmeturs tU uuruhict all work un trey property. I Kitt
ensue that all contractors either hasY asrkers rexaprns4Uun uuutmnr ur We sole I.I Electrical repairs or additions
prupnetors with rr,cmploycn
l 2_0 Plu repairs or additions
!I:3 I am a general contractor and I hate hurd the sub-eaeabacturs toted on the attached sheet
These AM-contractorshass employee.and hate workers'camp tmurastce 1 e
3. out rCpairs
""" I4.0Or
6.0 tiYe arc a corporation and its otTrcen have erterrisrcl then right of exemption pet Wit.c. — ---
1 S 1t 01.and we have tso employees.(No u urlets'comp.insurance requited.
*Any applicant that chocks has a I mint also fill turf the seetioa bekus showwg then%utters'compensation pubs'information.
Homeowners who submit tins afrulavtt Indicatrttg they err eking all work and then hue outside:untractars must sabout a new aftlitin t taditaMg sorb,
�t..'utUt-r-iun that cheek this has must aiactwtd an aiklrhunal sheet show trig the manse of the suer ctaaractars and state whether or not Heise entities Barre
employees. If the curb-cuniracti.t,trade rmtpivacts.they must prosede ilea workers'..ity+ p<.Lcy number
1 ass an emplahvrr that is providing wort ers'compensation insurance for mi'employees. Below is the policy mid ►b site
inforntadon.
Insurance Company Name: _
Policy tt or Self-ins.Lie.4: __._. Expiration Date:
Job Site Address: City+'StateiZip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure crage.is required under MCiL c. 152.j25A is a criminal violation punishable by a line up to SI 5(/O.00
andor one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 250.O0 a
day against the s tut:itor.A copy of this statement may be forwarded to the Office of Investigations of the DIA for urance
erage ventication.
I do hereby rerti under the pains and penalties of perjury that the Information provided uh IT IN I tie and currier.
9 27 z v
Signatu I)<<t, �U
Phone /3 ;387 sco
Official we only. i)n not write in this area.to he completed by city or town official
( its or Iowa: l'erntitilicense It
Issuing authurit} (circle one):
I. Board of llralth 2. Building Department 3.('ityr'iowa clerk 4. Electrical Inspector 5. I'Iunihiit Inspector
G.Other
( intact Person: Phone 4:
Commonwealth of Massachusetts
it Division of Occupational Licensure
Board of Building Rye ulations and Standards
. ConstZvCZionTS rvIsor
•
CS-100515 v E*pires: 07/15/2024
TIMOTHY J LACE ....
90 WOODBRIbGE STREET
SOUTH HADLEY MA 01076
IP
Ccr m:;as:c cr Vl Ti, �v.C*07a147,,,
v.11 I J L.IVC
90 WOODBRIDGE STREET ''7
SOUTH HADL'EY MA 01076