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32C-053 (16) BP-2023-0263 7 PEARL ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32C-053-001 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-2023-0263 PERMISSION IS HEREBY GRANTED TO: Project# ADD WALL 2023 Contractor: License: Est. Cost: 4000 LEARY BUILDING COMPANY CSL104806CSL104806 Const.Class: Exp.Date: 02/17/202402/17/2024 Use Group: Owner: GLEASON BROS INC Lot Size (sq.ft.) Zoning: CB Applicant: LEARY BUILDING COMPANY Applicant Address Phone: Insurance: 13 GLENDALE WOODS DR (413)336-2611 SOUTHAMPTON, MA 01073 ISSUED ON: 03/03/2023 TO PERFORM THE FOLLOWING WORK: ADD PARTITION WALL 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: Fees Paid: $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner e,s < / .. c_ .. The Commonwealth of Massach`fi . - c / • Office of Public Safety and Inspections',`rtiq�%nti l f - • Massaxhusetts State Building Code(78t)CMR) o�/A.%, / j Building Permit Application for any Building other than a One-or Two-Fai e1.ling .,'0 S• i' (This Section For Official Use Only) - Building Permit Number€P3" 2 G 3 Date Applied: - Building Otticial`�---- — SECTION 1:LOCATION No.and Street City/Town Zip Code Name of Building(if applicable) -- PeA(u, S T A jolemitAiMISAJ pro C. 0 Assessors Map# Block#and/or Lot -OS) 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❑ I Alteration k ' Addition 0 I Demolition CI (Please fill out and submit Appendix 2) Change of Use ❑ Change of Occupancy ❑ Other 0 Specify Are building plauis and/or construction documents being supplied as part of this permit application? \ear: 0 No IA Is an independent Structural Engineering Peer Review required? Yes 0 Node Brief Description of Proposed Work T—o Caw-) .NCIbtE.6 ` SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE iN USE OR OCCUPANCY C "-an.Existing Building Investigation and Evaluation is enclosed(See 780(MR 34) CI Existing Use Group(s: Proposes R- ep s: SECTIO • GHT AND AREA _ Existing T Proposed No.of Floors es(include basement levels)stir Area Per Floor(sq.It) 1 4 1 oral Area(scl-ft.)and Total Height(It.) 1 I SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub 0 A-3 ❑ A-4❑ A-5❑ B: Business 0 LE Elucational 0 F: Factory F-i❑ F2❑ FH: High Hazard H_-1 0 H-2 0 H-3 0 H- — H-5 CI — I: Institutional I-1❑ 1-2❑ I-3❑ I-4 C M: Mercantile< p R Residential R-10 R-2❑ R-3❑ R--1❑ S_ Storage S-1 0 S-2 0 --- U: Utility 0 ; Special Use 0 and please describe below: --- -- --- Special Use Description SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ i HA ❑ LIB ❑ G IILAk. LLIB ❑ IV ❑ VA CIVB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) — — — — -- r --— r--- — - Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal: ' Trench Permit Public' Check it outside Flood Zone 0 4 Indic ate municipal.CIA trench will not be Lac en, d Disposal Site El 4 required 0 or trench or specify: Private CI or indentifv Zone: or on site system 0 - 3 permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation ` . Not Applicable 0 1 Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0 SECTION 8:CONTENT OF CERTIFICATE OF OCCUP2K1Q Edition of Code: i- - ons zction: Does the building cOntain an Sprinkler System?: Special Stipu a _ Design Occupant Load per Floor and Assembly space: SECTION 9 PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner \164NIIk Girt_Girt_ I row, sr Noh-Tkltn�t.l'To.a/ 0/000 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: dll3 - Zo3- /Y49`/ yl3-..2Z- q96- -J6 STD coa . Con1 Title 'Telephone No. (business) 'Telephone No. (cell) e-mail addres If applic ,the property owner hereby authorizes: �00 /3 4'. u.c o . Woos De. ,cau7u t pro NIA © o/ Name ( Street Address City/Town State ip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION ltk CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft of enclosed space andf or not under Construction Control then check here U_ Otherwise provide (see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals( Name(Registrant) Tel _ . ail addre Registration plumber Street City/Town State Zip Expuration Date 10.2 General Contractor tat £tflLAAJt 6 Coro e CS /vtkoc b u`' Name of Person Resp ible for Construction License No. and Type if Applicable 13 Oil.ENbAt6 tacos s De- L<u AMPT4A) Mat- 00013 Street Address City/Town State Zip ‘113--33frVolI 0 taitei$uruiI.Q Cap Telephone No. (business) Telephone No.(cell) email address SECTION II: _(M-G.L c.152.§25C(k)) 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 FLL Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ LOCO 1.Building $ tido° Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)=$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to /� 6.'TotalCost I $ 11000 I (contact municipality)and write check number here Z$0W 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 y l and understanding. � j _ Vas()(u W113- 35� 210// 2.N.23 Please print and sign name r y� MTit/lle 1 Telephone /� Date 1S 41 b woes! VI VVy /�iit 1P� f'I ft OL01) �M a l iC!iWt�^'{.•l Street Address City/Town State Zip Email Ad c:-., -----P l --T Municipal Inspector to fill out this section upon application approval: __ . _I'I i �3 Name / ate The Cute moup.-ealik of_tIuw#c hw rus lhyntrttntrttt erf intitotrial--fee-ideitts I f ran:re'+a Sleet[.Suitt' 100 Boston. 31.41/2 114-01" Irwo .+ttutA goiritlirt ))egi.ers't ueuprtr..;ttiou Iat+ti .*isrt-_1 id sit:iteutdrrr t etritrx!tars F:ila•tsit•i:tto PLutact>kss. tix ME to MI:i)VI till:LLU.rE1104111,t t At l;Ut ttRi t:L_ ittttiliraui/etture:t:riirtrr Mau-f'riatt tl\ Stab Zip: \ir aawa ate ttttj#+•ae". ttS.•appronatt.tat 9 st: _` !tot tei Iiratirct trowaan:stt _ - '+ s .:.":: :art. • :Z • I.gT_it;� I nm an cunpttmir that is pratidinv nutters'aetrnptnsutinn insurance for not employees. &bon is the polity ma Jjob site information. ...:etf,.: Jois tttaelt a colts ai tht• %turkey.'.untpprns rtittu p►4ia-s derf.tr:atit►n pa:•e tshty sin`w thy pniirb number Joist rtpiratitrn date). f..Ia,a_ •._.r a:�, ♦... ,tom k:. w�...,:ti.A;.�8»f.., 1 t i.`. .'. T._.` *t .6. _. 8 .5t" R.C364. J11,1 . �., 3is:• ..:! =`+.. ..r:i; :.ae:sa+ _.. :ia. _ .ci[a• a...it op ix tRk i:RIM.#i . .\ 't . . II::(y:::a..cI !.t s tt..c.. f)i `�.[...... 1 da here h ..f•err' rt! fir /set..1 i +yr pc:Vac„'llutllltt'iu/rravutiau pros ide d erhae e' 'Z '2y 23 r=: (-1 3� 4)/fie tiro! ..ritt in this(area.to he a ode-t rd itt 4-air 4-air'Sr ttnt'n s4/it lei t its ur i ulcer. Ptrntit I.ircnse= tssuing.luthttriis is i.rcie ttnri:. 1.%tart!Ili health 2. Hui/ding 1)riaart»tint[ 3.1 it, 3xi+,tt t krk 4. 1.1rririca)Itasitrettir 5, Ptunthin z)nspra•inr 6.itthrr t tiaalart Perutta: 1'*cease-: FORM 153 The Commonwealth of Massachusetts Di4 U Only Department of Industrial Accidents Office of Investigations -Dept. 153 I Congress Street,Suite 100,Boston.Massachusetts.02114-2017 i littp://wwwanass.gmardin InvestiSWO UT*: _. AFFIDAVIT OF EXEMPTION FOR CERTAIN CORPORATE OFFICERS OR DIRECTORS Chapter 169 of the Acts of 2002 amended Mal.. c_ 152, §1,(4)by adding the following paragraph: This chapter shall be elective for an officer or director of a corporatio. n who owns at least 25 percent of the issued and outstanding stock of the corporation.Notwithstanding section 46,these provisions shall apply only if the corporate officer provides the commissioner of industrial accidents with ajwritten waiver of his rights under this chapter. Said commissioner shall promulgate regulations to arry out the purpose of this paragraph. Violations of this paragraph shall subject the corporation to the penalties set forth in section 25C.- Pursuant to ivi.(i I. c 1 52, §i(4)as aniciftitta 1,111t- saw iiiitligi-N-d nflIcers- of Leary Building. Inc. 1039 East Mountain Road,Westfield,MA MOBS f Name of Corporation nod ihishiressi each holding at least 25%of The issued and outstanding stock in said corporation,do hereby invoke the right to be exempt from the provisions of M.G.i. c.. 152, §25A and therefore are not required to carry a workers' compensation policy covering the undersigned corporate officer(s)or diffector(s). L'We the undersigned do also waive any and all rights to make claims for benefits as defined in M.G.L. c. 152 for any injuries that may be sustained while in the employ of the above-named corporation. Further, i/we the undersigned do understand that;should the above-named corporation hire or have in its employ any employee(s)in addition to the undersigned corporate officer(s)or director(s said corporation is required to obtain workers' compensation coverage for the employee(s)as piscribed by M.G.L. C. 152, §25A. I/We the undersigned have read and understand the statements and obligations as delineated above and I/we have checked the appropriate box below my/our name(s)indicating my/our desire to he exempt or not to be exempt from the provisions of M.G.L.c. 152. ..., Signed under the pains and penalties of perjury: lifri(391.,A. L.eary,President OM 92914 Signature Print l'siame&"We Dow 011333/r.,*, ZI wish to exercise my right of exemption or 0 I wish NOT to exercise my right of exemption Signature Print Name&Title Date 4amarkiiityyr 11 I wish to exercise my right of exemption or 111 I wish NOT to exercise my right(A-exemption Signature Print Name&Title Dale(mm/iddi ) Ili I wish to exercise my right of exerrioion or 7 i wish NOT to exercise my right of Signature Prim Name& Title Date timn, ' ) 0 I wish to exercise my right of exemption or D I wish NOT to exercise my right of exemption Nutt:ALL EMIR! F CORP(iR STE OFFICERS MIST SIGN. THERE CAN Bit NO NIORE 111AN 4 SIGMA 11PRES. mW LflS on back. F 453-VIM eie C 0 r/ ( SOZ 16 c0 e .C.Dc'e.- Qopo,t-cy City of Northampton r f Massachusetts ,, fi R kit `k- DEPARTMENT OF BUILDING INSPECTIONS 7.'_� tUi ,, 212 Main Street • Municipal Building /r . -� '� � Northampton, MA 01060 ys';ti ;4; ' ' CONSTRUCTION DEBRIS Ar'r'ILAVII (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the prnvicinnc of M(;I r 4n, 554. a rendition of Building Permit Number is that all debris resulting from this work shall be disposed of in a nrnnnrlR! iironcnrl ,A,ctc rlicnncp.t fArility ac rlcfincrl by M(t1 r 111, C 1 C(lt The debris wiii be disposed of in: ‘11/Cq CEL/4-1--1A-1C-k i cation f Facilit.l. / /nS 4��� 1 1• o�v L 1 The debris wiii be transported by: 11k ameui Haul r: le./1e ,,�Dcuc,. ca Signature of Applicant: Date: ___"2 .2 '.Z_3 + « � � 1Aj,6fUbALZ � kJQ- ��wv Ap^P-P,4--) ^ o/c-I ( io� Jolinothant-kagg Lu|kUini� �kj::��|onio:mr City of Northampton 212 Main Street Northampton, iNAU1U60 cvx`i,ucUoncvvuv| "` cc,iuin -%iLuui'mu. inuLcv,Juxce `mii1, cvUc^rciiun1G4.1U, i 'cqueSiihuiyuu �ranL a oIod\i\cabon Lo wa\ve LhE; (ur consu/ucdu: conlio\ofO�e p/ojecA aL �^�� �l�k��u 41�� ��/0�6 ' '~-. -. ^ � ^ � because the work isofa minor nature, will not affect structural elements, health, accessibility, life orfire safety and will be done in accordance with the prescriptive requirements nfthe code. Thank yoo fo,ym/r cnn"i6p'ahon Respec��U\\