17C-231 (26) File #BP-2023-0123
APPLICANT/CONTACT PERSON:KUEL MCQUAID
131 FERRY ST EASTHAMPTON, MA 01027 41335375063
PROPERTY LOCATION 34 NORTH MAPLE ST
MAP:LOT 17C-231-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $1,820.00
Type of Construction: INTERIOR RENO FOR CANNIBUS CULTIVATION FACILITY
New Construction
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved )( Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§ 3S G - aa.5
Intermediate Project: Site Plan AND/OR I Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
51
: 6A,, • .-s . '› 23
Signaure of Building Official ' Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Depatment
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Offic; of
Planning&Development for more information.
- :r
FEBfl
The Commonwealth of Massachusetts
2023 ; Office of Public Safety and Inspections
Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only)
Building Permit Number:as.?5 /A Data Applied: Building Official:
SECTION 1:LOCATION
No.and Str et City/Ioowwn `7 11 ,n^ Zip de Name of Building(if applicable)
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA Statee Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building le Repair 121 Alteration I I Addition 0 Demolition 0 (Please fill out and submit Appendix 2)
Change of Use Ell Change of Occupancy i Other 0 Specify:
g 8 P cYP �':
Are building plans and/or construction documents being supplied as part of this permit application? Yes to`No 0
Is an Independent Structural Engineering Peer Review required? Yes 0 No 0
Brief Descriptiop of Propose ork: `i° ' '^' - .S,mo SF # \ P
1S iv tioN rat I1
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) C
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.tt.)
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 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 0 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 0 Special Use❑and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 0 IB ❑ IIA ❑ IIB 0 IIIA ❑ IIIB ❑ IV 0 VA El VB 0
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 Check if outside Flood Zone® Indicate municipal fly A trench wjH not be Licensed Disposal Site 0
Private 0 or indentify Zone: or on site system 0 required or trench or specify:
permit is enclosed 0
Railroad right-of-way Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable l% Is Structure within airport ap oach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No I Yes 0 No Er el V)
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Ye 5 Special Stipulations:
Design Occupant Load per Floor and Assembly space:
PIPPF
City of Northampton
Massachusetts � —.
w , * s,
1 DEPARTMENT OF BUILDING INSPECTIONS ^S
212 Main Street 4. Municipal Building '.
�-.ig 4,44.„, Northampton, MA 01060 - jt"t
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
/
Name an I G�j pCerty Owner e J L nt O 1.0. `��'l, 1 1 l'� cicQ� o`O 11
.� /s P Q iHcT -
Name(Print) No.and Street City/Town Zip
Pro Owner Con t Information: '
"eR,o G S-ri L/3- SSa 0916 413 0.7rcre 25Jhe R.6 e.SS K—S. C_
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 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)
AQ
" rwl 4DL Z We) 41t3- z`1f- 4G(o —4'C041.A< 441 .64.404 w1.1 1 L0
Name `(Registrant Telephone No. e-mail address Registration Number
Zr �4f nw..klir J►0,(><. — \iG.cf`44-4,1i" k. 01 o01" 3,.
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor QD
kV Ilkt QuZat
Company Name
16ie4 MC_ alga De. OS134'F C_o 64-cucI sc� .c;;se;
Name of Person Responsible for Construction License No. and Type if Applicable
/3/ ctcr s4-- b-s ewt 4o A_ MAG(0 2-7
Street Address City/Tow'n State Zip
It13 _43 _ So63 hittovccJ. &mil. GWVZA , C.4
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 $ ` " O e O Building Permit Fee=Total Construction Cost / 9(Insert here
,(. 2.Electrical $ .0 ) 000 appropriate municipal factor)=$ _
. 3.Plumbing $ ;o
1, 4.Mechanical (HVAC) $ 41C o o Note:Minimum fee=$ (contact municipality)
4_ 5.Mechanical (Other) $ . Enclose check payable to
6.Total Cost $ a60 t C)0 0 (contact municipality)and write check number here qt
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.
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:
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 w 'r
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060
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: r ( 1 G * �� k-4 cX-c_ ç:; €
�
The debris will be transported by:
Name of Hauler: USA
Signature of Applicant: Date:
The Commonwealth of Massachusetts
r Department of Industrial Accidents
I Congress Street,Suite 100
Boston, MA 02114-2017
www.mass.gov/ilia
Workers'Compensation Insurance Affidavit:Builders/Contractors/ElectriciansiPlumbers.
CO RE FILED WITH THE PERMITTING AUTHORITI".
Aonlicant Information Please Print Legibly
Name tHusincas, ainzation Indsridual). Kt/ 14-4— C2iV14"ri
Address: f3 i 5 A--
City/State/Zip: a9k-(40.6.4,LA. MA to2.7 Phone#: ifq 3 -
Art yaw gm employer t heat the appropriate bat:
peuI p rujecl (required).
1.0 Ian,a employer with ensployeesrhuiId,n part-untet-* 7. 0 New construction
2 "1 Ions a itite pnaprotor or partnership and have MI employees working for me in 13. a Remodeling
an LWAIK:irY-[No*misers'ccinap.unnranoe requinail.)
9. Demolition
.0 I am a honieois net doing all work myself.[No workers comp./11,21r4314:e required.]
i Building addition
4.C3 am a homeowner and will he hiring oinuracturs to conduit all wasik on my property. I will
ensure that all contractom either hale siir.‘rkers'ceerivensaston insurance 11 Electrical repairs or additions
proprietors with iuemployerri,
12. j Plumbing repairs or additions
,a1 AM a general contractor and I haV. hired:he subsaintractors listed un the attached
13, IRoof repairs
These liab,cusstracturs 12:1St Cmploys-in and Isse,e*MILTS'L:SSILIp.insorance.
14 (Aber
6.0 We are a corpsTamits and its officeni hare exercised Men right or cleric:atm per NCI
I ./1(4),and*e lime no employ I Niik; oricrs'comp.insurance required.]
applicant that eiticelcs box al most aiko lit,knit lilt:NCI:QOM below showing their workers'compensation pubic:.information_
'HOITICO%tISTS Sir t1/1 Submit t this at1idaui nuilicating they are doing all stint and then hire smtside contractors must submit a or*affidavit indicating such.
;(Tontractors that diedhi,box mina attached an additional sheet showing the name of the otts-contractins and irate w heftier or nor&hieumluniai hate
employees, if the sish-contracsurs.base mplu t' a da. Intust pru+.idc their workers" nutrther
l am an employer that is providing workers'compensation insurance fir eery employer,. Below is the policy and job.site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.#: Expiration Date:.
Job Site Address: City,Stato!Zip:
Attach a copy oldie workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure cover-age as required under MGL c. 152.§25A is a criminal ‘iolation punishable by a line up to 51,500.00
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 violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage i.eritii.-ation.
l do hereby certifr under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone--t: f 3 - 53 7-.SO4 7
Official use only.. Do not write in this area,to be completed!by city or town offf.lal
City or Town: Permit/License
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Conflict Person: Phone 4:
Initial Construction Control Document
- ` To be submittedwith the building permit application t' a
+ Registered Design Professional
' ;'` for work per the ninth edition of the
' 4 Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Date:
Property Address:
Project: Check(x)one or both as applicable: New construction Existing Construction
Project description:
I MA Registration Number: Expiration date: ,am a registered design professional,and I have
prepared or directly supervised the preparation of all design plans,computations and specifications concerning=:
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 manrlrer consistent
with the approved construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 750 CNIR 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
electronic signature and seal:
Phone number: Email:
Building Off ezal Use Only
Building Official Name: Permit No.: Date:
Note 1.Indicate with an'x'project desist plans,computations and specifications that you prepared or directly supervised.If'other'is
chosen.provide a description-
Version 01 01 201E
Appendix 1
Construction Documents are required for structures that must comply with 780 CMR 107. The
checklist below is a compilation of the documents that may be required. The applicant shall fill out
the checklist and provide the contact information of the registered professionals responsible for the
documents. This appendix is to be submitted with the building permit application.
Checklist for Construction Documents*
Mark"x"where applicable
No. Item Submitted Incomplete Not Required
1 Architectural
2 Foundation
3 Structural
4 Fire Suppression
5 Fire Alarm(may require repeaters)
6 HVAC
7 Electrical
8 Plumbing(include local connections)
9 Gas(Natural,Propane,Medical or other)
10 Surveyed Site Plan(Utilities,Wetland,etc.)
11 Specifications
12 Structural Peer Review
13 Structural Tests&Inspections Program
14 Fire Protection Narrative Report
15 Existing Building Survey/Investigation
16 Energy Conservation Report
17 Architectural Access Review(521 CMR)
18 Workers Compensation Insurance
19 Hazardous Material Mitigation Documentation
20 Other(Specify)
21 Other(Specify)
22 Other(Specify)
*Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified
must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the -
authority having jurisdiction.
Registered Professional Contact Information
•
- �� _ `�-►you r
Name(Registrant) Telephone No. e-mail address , Registration Number
Discipline Expiration Date
Street Address Ci wn1/4A1 State Zip
'rot Z Ko 't'? 24/ "(Gab "evcc.c.r4(02 lr-Alcos4s4.4.c•h 5 1
Name(Registrant) Telephone No. e-mail address Registration Number
a{ SU.. ��<,� .�,r.we �h U(�"�- At cc(.,� ( .0,.
Street Address City/Town State Zip Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address
Registration Number
Street Address City/Town State Zip Discipline Expiration Date
Please follow this link for construction control forms to be used by Registered Design Professionals.
UU Initial Construction Control Document
�r
}� `�� To be submitted with the building permit application by a
Registered Design Professional
-,, for work per the 911'edition of the
F=• . J Massachusetts State Building Code, 780 CMR, Section 107
Project Title: 34 North Maple street Grow Date: 12.12.2022
Property Address: 34 North Maple Street,Florence Ma,
Project: Check(x)one or both as applicable: __New Construction X Existing Construction
Project description: New HVAC systems
I,James P Stroke PE,MA Registration Number: 20068 Expiration date:June 31,2023,am a registered design
professional, and I have prepared or directly supervised the preparation of all design plans,computations and
specifications concerning':
Architectural Structural X 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 will 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 will submit to the building official a `Final Construction Control Document'.
ok OF SW
I.yWfS>,
SFpO%f w
J NO
q `',1Wi Fss,i
Enter in the space to the right a"wet"or
electronic signature and seal:
Phone number:413-626-8752 Email: ddangelo@tjconway.com
I Building Official Use Only
i
IBuilding Official Name: Permit No.: Date: 1
Note I.Indicate with an'x'project design plans,computations and specifications that you prepared or directly supervised.If'other'is chosen, 1
provide a description.
Initial Construction Control Document
To be submitted with the building permit application by a
v Registered Design Professional
for work per the 9th edition of the
� '=�.+• Massachusetts State Building Code, 780 CMR,Section 107
Project Title: 34 North Maple street grow Date: 12.12.2022
Property Address: 34 North maple street ,Florence Ma,
Project: Check(x)one or both as applicable: __New Construction X Existing Construction
Project description: New Electrical systems
I,James P Stroke PE,MA Registration Number: 20068 Expiration date:June 31,2023,am a registered design
professional, and I have prepared or directly supervised the preparation of all design plans,computations and
specifications concerning':
Architectural Structural Mechanical
Fire Protection X 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 will 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 will submit to the building official a`Final Construction Control Document'.
.1”5Fmks
,uursp '
$TA6Kf t.;
a:
NO 20066 4
s Err
Enter in the space to the right a"wet"or
electronic signature and seal:
Phone number:413-626-8752 Email: ddangelo@tjconway.com
Building Official Use Only
4 Building Official Name: Permit No.: Date: !�
Note I.Indicate with an'x'project design plans,computations and specifications that you prepared or directly supervised.If'other'is chosen,
provide a description.