24B-048 (9) BP-2023-0416
306 KING ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24B-048-001 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-2023-0416 PERMISSION IS HEREBY GRANTED TO:
Project# 2023 RENO Contractor: License:
Est. Cost: 5000 ROY OMASTA 006763
Const.Class: Exp.Date: 10/10/2023
Use Group: Owner: MESSER INVESTMENTS INC
Lot Size (sq.ft.)
Zoning: HB Applicant: ROY OMASTA
Applicant Address Phone: Insurance:
21 North St (413)247-5666 6ZZUB4N73070821
HATFIELD, MA 01038
ISSUED ON: 04/10/2023
TO PERFORM THE FOLLOWING WORK:
INTERIOR RENO FOR WILD ROOTS
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:
)\SI
Fees Paid: $200.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
C cut ( 1-011-t ac6i
The Commonwealth of Massachusetts
Office of Public Safety and Inspections
�y r 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:...13.9 Lf(Y Date Applied: Building Official: _
SECTION 1:LOCATION
364 l44G AID/rri 11' 0/0 bo Aktatiuths. nc- Gill- ---
No.and Street City/Town Zip Code Name 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 0 Repair 0 Alteration 1 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 No CE"
Is an Independent Structural Engineering Peer Review required? Yes 0 No 0
Brief Descr' tion of Proposed Work:
a1Aii, /s Poi; d y •r 6-41 p tivvtcy w.Ka
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):
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❑ Nightclub 0 A-3 0 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 0 I-4❑ M: Mercantile❑ R: Residential R-10 R-2 0 R-3❑ R-4 0
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 CI IBD IIAD IIBC IIIA0 IIIBC IV CI VAC VBD
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 Dis osal Site 0
Public 0 Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be P
required 0 or trench or specify: ,
Private❑ or indentify Zone:_ or on site system 0 permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review 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❑ No 0
SECTION 8:CONTENT OF CERTIFICATE OP 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
Massachusetts .‘„,, , ,e,
_
r 1 A., ,`,.,,.
_,: . .
,,
,r.
°` , DEPARTMENT OF BUILDING INSPECTIONS � ,- b
212 Main Street • Municipal Building l
,t't Northampton, MA 01060F �,t1��
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
N e and Address of Property Owner
,/ Iu #L 1�1I 771' 30i 4,)I, Si No l - N Aff ,,,o G,,
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
aF.Sr 04 *3 511- 7Sbo (/3 .33 r ?-57o P,,r1 fss.row)C efi is rit
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the roperty owner hereby authorizes:
Ff uy ✓jiff .2 it 64 cfT /1/nxirmi ,M1- NO 1.
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 apflication.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) f
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
0/41.4W.i aviLALrt-S-
Co pany Name
ito y 0r ;pf Oo 474, 3
Name of Person Responsible for Construction License No. and Type if Applicable
21 /boa >F ST Pletrk E /'' o f 034
Street Address City/Town State Zip
s/ _34-Z .1V4 9/3 .4T7_ 046
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 Il No 0
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ _3 7 c c. Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ /0 G 0 appropriate municipal factor)=$
3.Plumbing $ 30 v
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical (Other) $
Enclose check payable to
6.Total Cost $ S ob 0 (contact municipality)and write check number here
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 accura o t e best
of my knowledge and understanding.rs
i My Mf ssS ''�`�/j�K�,. J"2f S r Act) y�3 33s a5'70
Please print an i name / 'J Title Telephone No. ^ Date
36C #Q N17inilsjl%4' n/1- i/060 Asti_ssf,ca 4.. KcfY......f,_
Street Address City/Town State Zip Email Address
SI_
Municipal Inspector to fill out this section upon application approval: I J. / IV d•S
Name to
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
,{:11 r,
l'
C Massachusetts ? %,
DEPARTMENT OF BUILDING INSPECTIONS .., „r 212 Main Street • Municipal Building ~f;
�'� Northampton, MA 01060t .r�+� �. ?
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: b dAtPs��/�. 03 NA��,✓ 4,Tic C L"e
The debris will be transported by:
Name of Hauler: U.C.
Signature of Applicant: Date: 17,1/2-3
-.0.--, The Commonwealth of Massachusetts
',--
I-4 .-
,
1.,Is
..._
Akv
—F-'"-- 1,-' Department of Industrial Accidents
-,,
1 Congress Street,Suite 100
Boston,MA 02114-2017
www.ntass.gorldia
11 orkers'Compensadon Insurance Affidas it:Hu iklers1ContractorstElectriciansfPluni hers.
10 BE FILED WITH'I IIE PERM!rut'. ;A I flIORIll.
Annheant Information Please Print Legilds
Name(ousuto.s'Organuanonlndividual): Alf 3S.fit. ..ZU41 -577i-c Air).
Address: 3 0 _/1-4A11,- Sr
City/State/Zip: AlOerrillfln/reof Alit Phone#: `ti 3 - C75-- g5--44c
' 61 04 4
Are,tron an employ er?I`kikrk the appropriate bac
Ts pe of project(required):
LC]I Jill a employer with , employees(fun aniden peg-timer• 7_ El :cs:,:-o. construction
20 1 am a nrk proprietor trr puristinsinp and haw no tniployeth working tin rue m 8. CB Remodeling
any capacity,Nu*trans'wrap.insuranee required]
.
313 I ant a homeowner Joins all work myself[No*odor&cony us%uranoc(coma)' 9 El Demolition
i 0 0 Building addition
4.0 1 ant A horntraunet and will he hiroig ountraicior%to conduct all w oak on rily propel ty. 1 will
mitre that all contrib.-tors either ha%c wrnlicTs"431111fel:IMSLIAlll 111%unit:we or are sole I i.0 Electrical repairs or additions
proprietor%with no earipluyees.
1 2.E1 Plumbing,rerairs or additions
SC]lam a ex-in:rat contractor and I have hard the sub-contracturs listed en the attached thcet.-
13.0Roof repairs
Them:sob-contractor%baie empkry,eth and kith e workiars:comp,iresurtince.
kV We an,a corporation and it,43 liken o ha%c thareised then right r exemption per W i4_0 Other
it c. ..
152.,‘,.I i 43.anti a e h.a%e no cnrployecs.[No workers'contr.MN tzurwr required.I
*Any applicant that cheeks boii '1 must alma fill out the section below show trig their worker,:compensation policy information
*klarmawkitera who sohnan this atlida%it unhcating they are doing all Mork and then hue outside contractor%matt submit a new Aida.*it itslica*rig such.
It`uninictoN that check dui box mum attached an aldtuonit1 sheet lityik trig the name ui the satis.eutursciers and ALA.:whether ur not trick,,e eniitn..-$have
cmpluyevs. If the sob-contractins Isaac employ Lica thcy must provide their v.s-ork CM*vamp,policy number.
/am an employer that is providing peorLers compensation insurance fir my employees. Below is the polity and job site
information. .......-""
cri\ Insurance Company Name: /4/1“- S _
011'1'0/5 Policy#or Self-ins.Lk.#: 2.. ti 8 LIN 7:3070 7.,_/ i01- --Expiration Date. /91 7 / -,
1311% Job Site Address: 3°0 4)4/4 97-- A/D,17-174 MAY/ City'State.,Zip: /1/4- -0/ 0 477)
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage.t required under MGL c. 152.*25A is a criminal violation punishable by a fine up to S1,500.00
antior one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine°Cup to$250.(X)a
day against the violator.A copy l.I hit', statement may be forwarded to the Office of Investigations of the DIA for insurance
011Verap.:,.creation.
I do hereby c•• if/under pains and pen vies of jury that the information provided above is true and correct.
Slim:dun: / Da
Phone C /3 - ait7 -sze4
Official lit'only. Do not write ill this area.if he'c-oinpleted by city or twin official
City or Town: Permititicense a —
iIssuing Authority(circle one):
I. Board of Health 2.Building Department 3.Cityaown Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
('ontact Person: Phone#:
Initial Construction Control Document
tl - To be submitted with the building permit application by a
Registered Design Professional
for work per the ninth edition of the
( . ,.,4\*
...)., 4„.
, ...1(
il,i.... $ ,
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 concerningl:
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
electronic signature arid seal:
Phone number: Email:
Buildulg Official Use Only
Building Official Name: Permit No.: Date:
Note 1.Indicate with an'x'project design plans,computations and spedfications that you prepared or directly supervised,If'other is
chosen,provide a description.
Version 0 1_01_201 8
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
Name(Registrant) Telephone No. e-mail address Registration Number
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
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.
°d 44qa
it'
etjNi
/11\
4c �hA Kok
53o l s /Lop -2/s --2h '-1-3341 sN
d rd