38B-083 (2) BP-2023-0712
161 SOUTH ST COMMONWEALTH OF M SSACHUSETTS
Map:Block:Lot:
38B-083-001 CITY OF NORTHA PTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2023-0712 PERMISSION IS HEREBY GRANTED TO:
Project# stairs 2023 Contractor: License:
Est. Cost: 6000 MILAN PEICH 109494
Const.Class: Exp.Date: 06/06/202
Use Group: Owner: PEIC ,MILAN P.JR. &FISHBEIN, LYNDSAY E.
Lot Size (sq.ft.)
Zoning: URB Applicant: C&M F NISHES LLC
Applicant Address Phone: Insurance:
63 RUSSELLVILLE RD 6HUB-OW46907
WESTFIELD, MA 01085
ISSUED ON: 06/01/2023
TO PERFORM THE FOLLOWING WORK:
REPAIRS TO 2ND EGRESS STAIRS
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:
14 • A . 3-
Fees Paid: $100.00
212 Main Street,Phone(413)587-1240,Fax (413)587-1272
Office of the Building Commissi i ner
JUN - 2023 T e Commonwealth of Massachusetts
Office of Public Safety and Inspections
Massachusetts State Building Code(780 CMR)
EaT of BUj�Duui1 t ApIlication for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only)
Building PermitNumber:r7 /2 Date Applied: Building Official:
SECTION 1:LOCATION
I / 5 ut'h srNail/Apr/on
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 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify: $ A'1d E're.SS 5 J. i'fS
Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No L�
Is an Independent Structural Engineerin,g Peer Review re uired? Yes 0 No 0
Brief Description f Proposed Work: .5ccem jgl'e.SS ��G(if S eKkriar,
nnO/t9/ S/iifs 2 " y- _Jew
2x£f >r Landig) Pao
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUIcLDDING 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 ANL)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 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❑ I-2❑ I-3 0 I-4 0 M: Mercantile 0 R: Residential R-10 R-2 0 R-3❑ R-4 0
S: Storage S-1 0 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 ❑ HA IIBD IIIA ❑ IIIB ❑ IV 0 VA 0 \BD
SECTION 7:SITE INFORMATION(refer to 780 CMR 10$.3 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal:
Trench Permit: Debris Removal:
Public 0 Check if outside Flood Zone 0 Indicate municipal❑
A trench will not be Licensed Disposal Site 0
Private 0 or indentify Zone: or on site system 0 required 0 or trench or specify:
permit is enclosed 0
Railroad right-of-way: Hazards to Air Navigation: MA Ilistoric 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 0 No 0
SECTION 8:CONTENT OF CERTIFICATE 0?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
141
1 DEPARTMENT OF BUILDING INSPECTIONS
w "" � 212 Main Street • Municipal Building
Northampton, MA 01060 .'
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
A
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Add
Ass of Property Owner
fil Ilan 41311sk/)v4llL 0 ilue__1 c) plitt- 04
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
0Wi le-c r -.5i-- `r4Io 7 /r "_ '" /1 twetri Pic 8rea l l ,
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 C.
Otherwise provide construction control forms(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control(the pro ssional coordinating document submittals)
/itII Ian Ri‘Cil !3 S/ 7QO /!'I►'an c,� .c �7 C5 - olo,�ly to' /
y ?
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
IOgy917
Na
me ame
e 114 tier Mks C$ aa l y ��p_ 01 /4.1'3
Name /vss4
rson Responsible for Cotruction '' I �lLicense No. and Type if Applicableli
!�3 I a1I h� W�.)7J¢��c-W /I1/T . /or
Street Address City/Town State Zip
�/l 571 79d7 - ' /i'lr)an /9-ttjh g7 @ �mail ,00/1 .
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 In&istrial 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 D No D
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)=$ .
3.Plumbing $ 1
6
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ 6''dQ 0 (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I hereby attest u der e pains and penalties of perjury that all of the information contained in this
application is true and curate to the b o A.'owledge and understanding.
Ar lu g r'GA f . �u r,,u/ W S7q 7q 7 64-A5
Pl ase pr' t and sign e Wed Kit I CI la 6'
c felep e a to
fo,
Street Address City/Town State Zip Email Address 1
Municipal Inspector to fill out this section upon application approval: ✓��� 6" l' ZOZ3
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
t, r�F
"� �;, Massachusetts crr
DEPARTMENT OF BUILDING INSPECTIONS ',
. 212 Main Street • Municipal Building -%�; �
Northampton, MA 01060 ¢�j'+,,n lr.1%
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: Wcs C a7,C1 C / C A-
f�
The debris will be transported by:
Name of Hauler: 1)N4- A cc yt,),vi
Signature of Applicant: Date: o-/— 9 3
. .\ The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
s f
. =LI Boston, MA 02114-2017
IF= ti
wwIstntass.gov/dia
ti,arker.,' t 0 napensation Insurance Affidavit:Buihlert/ContractorstElectricianstPlumbers,
TO DE FILED With I DE PERM!I I INC;AUTIIORITV.
CI c „AA
All 11}Illnillt Inkir li hi liii ii Please Print Letibl‘
......_ e 4 .
. . 14,5t1c, .
Nam.:Odusulcsi Or)tani.t.ilion In'v •i ,- ,c ..aw a , - 4I . 40,
iIII."'"7.'7"W- .'
• 0- SC-ifInglit' '— 4
I,
Address: ••41- `'''''`Ii"-rererNSA7gi&fr_lgril ..wWWw-amja--wir:77."---'---;,-;.-27--,=" , --,.....-.....••vii 7 (...AC...9
(A/I $f 'ciJ ,..' ;' 0 ov , ,
City/State/Zip: mawiral!rri----- c 4.-. Phone --5-7
lire"ti employer?t'Incl.the.1 ppropriat r t...:
Type of project(required):
Iima cuiptuver mat; ty 2p1usvus(full and tat pasi-timel.• I 7 rce-w constructiott
2 D I ant a auk propradin or pana,l,strip 2nd bavc no eingskiyeci.w inking for cm,in S. ?" Remodeling
s capacity.(Nu`rwortcra.comp.neruntnco rcipunal)
I 9. El Demolition
I am a lionsuow net dinnti all 44kirk mywIl.[Nos...mien.'comp insurance resiiinestr
! 100 Building addition
401 ant d Iturnerawnr...1 and Y.'ill b hunt*contraclura to conduct alL work on my propot2, I will
ensure that all contractors cithaT have,ivorkers'comfit-mat:on msurani.v of axe sole '' I I.0 Electrical repairs or additions
..,,,
prupraania,with DU employees_
', 12.0 Plumbing repairs or addition
5 1 am a iti.mcral curarractot and I have lured the sub-contractuts listed on the attached street
'.,. 13nRoof repairs
These sub-contractins Kase employetn.and base workers.'comp.irtsuranee. .
1400ther
6.0 We arc a corporattim and its 13frozeri have cat-remiss/then nem Of exemption per MC&c.
I$2...t I i 41.and Ns c has c no I.TrIpluy‘wh.(No*Awes°comp.insufance required I
'Any applicant that elsols Isso.g I must also fill out the iicetion beluw sliowinw their ullrkers compensation policy information
t lioninits Ma%VabLI Siihno(Ins atrichisli Ilichi:aints thi.,arc sluing all work and then hire Viltikldt tittit moo...ubrna a new atfulas it naticatinc such.
:Contractors that check thn Mix must attached an additional sheet show in w th....name ol ilic tatb-etnitrackes and state w hether of nut those spathes has.c
employees._ lithe sub-contractors hasc employees.they must pros idc their o o,kvra'comp.polky number
1 am WI employer that is proritfing peoriers•compensation insurance for any employees. fit/ow A the policy and fob site
information.
11. ..
Insuriat ! ,ce Company Name: 0.1)1 Wilde- -IiISIMeAli...4-C,
Policy#or Self-ins.Lir.tt. 6/406-ov1 iit, cidet Expiration Date: t-t<42-2 L(
Job Site Address: //Ff
SO())111 5?- CityState•Zip:kathaPIPidn *-
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under NIGL r. 152.USA is a criminal violation punishable by a tine up to SI,500.00
and or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line cif up to S250.00 a
day against the violator.A copy of this matt:men( may be 1orv.:irde.1 to the Office or Investigations,of the DIA for insuranc.e
ci.A er.4,,e‘eritication.
I do hereby certif. in r 1 •in tiN and penalties of perjury that the in fOrmation provided above ia true and corrett
S1,•11,1:1,R. Date: o'l )r3
ili 3 c 76t 7 ei a '7
Official use only. Do not write in this ore-a.to Ire ce,wateleteil by city or town official.
City or Town: Permit/License# .
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.Cityillown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
('oil tact Person: Phone#:
.......
Initial Construction Control Document
To be submitted Avith the building permit application by a
11411:
• Registered Design Professional
for work per the ninth edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Date:
Property Address:
Project: Check(xj 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 pro)ect. 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 750 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 and seal:
Phone number: Email:
Building Official Use Only
Building Official Name: Permit No.: Date:
Note L Indicate with an project desin plans,computations and specifications that you prepared or directly supervised.If'other'is
chosen,provide a description.
Version 01_01_201S
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.
From: /l4uJc Aich
63 Aussc)/ville {�
wes irC ic ii4t9- oto
To:
Jonathan Flagg
Building Commissioner
City of Northampton
212 Main Street
Northampton, MA 01060
The Massachusetts Building Code, section 107.1 allows for an exclusion from requirements for
construction control in certain situations. In accordance with code section 104.10, I request that you
grant a modification to waive the requirement for construction control of the project at
` � ILASS,
because the work is of a minor nature,wiitnot affect structural elements, health, accessibility, life or fire
safety, and will be done in accordance with the prescriptive requirements of the code.
Thank you for your consideration.
Respectfully,