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38B-083 (3) BP-2023-1348 161 SOUTH ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-083-001 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-2023-1348 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: Est. Cost: 7500 MILAN PEICH Const.Class: Exp.Date: Use Group: Owner: PEICH,MILAN P. JR. &FISHBEIN, LYNDSAY E. Lot Size (sq.ft.) Zoning: URB Applicant: C&M FINISHES LLC Applicant Address Phone: Insurance: 63 RUSSELLVILLE RD 6HUB-OW46907 WESTFIELD, MA 01085 ISSUED ON: 09/26/2023 TO PERFORM THE FOLLOWING WORK: STRIP AND REROOF 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: lb Fees Paid: $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner ,fi� RECEIVED ea4 SEP 76 2023 The Commonwealth of Massachusetts = @ �df��itXtrin did Inspections • Mu r c u _tts tari��4", dial:•(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: - 3 134f1 Date Applied: el-Ai 43 Building Official: SECTION 1:LOCATION No and Stre V City,/Town Zip Code Name of Building(if a plicable) (01e4POVII (' 1,0 3 Assessors Map# Block#and/or Lot # c9vit. SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Building❑ Repair❑ Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 2) Change of Use ❑ Change of Occupancy ❑ Other E' ecify: //1o^7 r- Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No B---- Is an Independent Structural Engineering Peer Review required? Yes 0 No R -- Brief Description of Proposed Work: i))/91 -511Inc, ,Rei/ate ShinyleS 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) ❑ 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.) a C SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational 0 F: Factory F-1❑ F2❑ H: High Hazard H-1 0 H-2 0 H-3 ❑ H-4❑ H-5❑ I: Institutional I-1 0 I-2❑ I-3 0 I-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3 0 R-4 S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 IB ❑ IIA 0 IIB 0 IIIA 0 IIIB 0 IV ❑ 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 Disposal Site❑ Public L Check if outside Flood Zone Q/Indicate municipal ErA trench will of be P Private 0 or indentify Zone: or on site system❑ required or trench or sp cify: permit is enclosed❑ rjecye Railroad right-of-way: Hazards to Air Navigation: MA historic Commission Revie%d-Process: Not Applicable D'' Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No Yes❑ No ❑ 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: r City of Northampton _ r• Massachusetts iAtir� ,+ DEPARTMENT OF BUILDING INSPECTIONS ". ' 212 Main Street • Municipal Building Northampton, MA 01060 44 45°' 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 and Address of rop rty Owner Milan. Vc(ch 63 /gvssell0'ile 1t s i-e1 t: 1cl ,19fi ©l s— Name(Print) No.and Street City/Town Zip Property Owner Contact Information: /r 'f ' /v�( 14f'1 AiCh g7 nC �l3 _ 7947 - - ( 6 6410i) ,COrkl 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 O. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the rofessional coordinating document submittals) /11Wah Ad., 913 -1T_ 7'-to7 Milan�t 8 (411 2-01f 2 Name(Re aC/hvl yl` �� Tg pCb e 1 C I� email add;e a - RL -lion Number .,).1 y Street Address s G(Ciity/Town State Zip Discipline Expiration Date 10.2 General Contractorct / I CA /-Ivlishcs L,Lc- Company Name 1'1i lam ,C,'cL, /07 INV Name of Perso esponsible for Constru on License No. and Type if Ap licable ( 3 nouctivritc / tocA6 t 0 a M/i- 4'Pi's-- Street Address '`/� City/Town Zip L - - Gj s'7q 7 y o'? /%j�oe/fj t14 dr_/ 6�,at' 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 D No D SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor ['�� and Materials) Total Construction Cost(from Item 6)=$ /) C " 1.Building $ Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)=$ . 3.Plumbing $ a'VCTV 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ 7 coo (contact municipality)and write check number here 1 j SECTION 14: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 th e of knowledge and understandin rri d1ilan Aich lid' (�' vr�cr Coylr4c16r t`j3 _,5�/ 7�07 A P1 se print And signnam Titl le h e o. Date '3 p ,4vg i l/v1 name,t / 1Nggic d ,�l/ Q)D�'� "II 1 i�cu . �N�g .��.�r a�J Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: ft qv v v..• �' �' 4 /D 6/a3 I 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 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: I4 o id A41,4 The debris will be transported by: c Name of Hauler: vsCC/1/ 1,sky Signature of Applicant: Date: q463 — (.4,. ... ,,,,,... The Commonwealth of Massachusetts 2.,........ tszy t.it 1..., Department of Industrial Accidents I congress Street.Suite 100 Boston,MA 0211,1-2017 .....„ .„ e- ,v......,...,---y.....-- ww,kmass.gooidia ,..... 5k.,,,,. 'Vim-kers' Compensation Insurance Affidavit:Buitilers.Contractors/Electriciansfrkinthers. '1-0 DE FILED WITH Tilt PEIIMIED‘iti.At TIIORITV. Anolicant Inforritation Please Print Legilitv N mile thittstiteaN.Organtzattuttintiot-tqual): 6-2 ,44- is:14iklg-.0 Address; 6 3 4i2 .56./(VI'ik 0 _,... City/State/Zip: tt)t)Nic) - m A- Phone '... 11)'3 - 5761- 71(97 ' Nre you all whey er?t beek the appropriate bat: Type of project(required): (full andmi partgintiq„-* 7 0 New emistruction 2.01ain a Ante prnpriehar or partrimehip arid have no eiryloyees.. winking for rise in /4, 0 Remodeling any capacity.ENu*driers,'comp.insommor required.] 0 DelnOlitiOn 30 I ain a homeowner doing all work myself [ o w r conc.i i uit. Norkei' niumnce itqail" 100 Building addition 4.0 1 am a horramsamer and will be hiring contracturatu oviduct all work on nw vivacity, I will emu=Mat all contracture either lene v./niters'compensationtlINtirunce man role 11.0 Electrical repairs or additions proprietrita with no empluyem. l la Plumbing repairs or additions 51:1 I au a Romani t unta.actur and I have hued the suh-cuntracturs limed on the anachedahret i 3.0Rouf repairs Thew sub-itellirattOM haw etimktyeta and ham wurkeri.-'einrip.inoniinet,z 1 4.1::::10ther 6.0 We area Ceprperatidtt and lb..4:,fliecix lin e exert:ow.d then nein of exemption per b161..c. 152.,§114),and we have au CrITierecr,iNi."wurkars°comp,ireoaruswe requited„,1 *Any appihmat Mat chocks box al mint also fill mit the seetiou below shoo tog tkezr w mixes't:Ontpatiation polity inionnation t lionieuwnere*to Siktrelii this affidavit tratheating they are anion all wink arid awn hoe()nisi&connactin4 moo auburn a ninv affidavit inditiffing such. IContincioni that check ilia hoa must an-wised ariallatitirad sheet shooing the name of the sui,eoritractura and nate whether or nut thaw intittioi ha.: empluyeel, lithe sab-Loraractire leave enipluyees,they thrust pmvide Moir workers"camp,ru.Ly Istartiser. - 1 um art employer that&providing workers'compensation insurattce for my employees. Below is the policy and job site inforatation. istsuturwe Company Name: So v4-h(A)(kl< Tr).5 L'ronte. A-gency Policy#or Self-ins.Lie.#: 6 true-aw q(09674_ as Expiration Date: 1*/ Job Site Address: ‘:C,' ON' '11.- City'StateZip: AJOr thavriffesi A A 6)O ;? - Attach a copy of the workers'compensation pallet declaration page(showing the policy number and expiration date)... Failure to secure coverage ai required under MOE e. 152.*25A is a criminal violation punishable by a tine up to S1,500.00 anchor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of up to S250.00 a day against the violator.A copy of thts butement may be forwarded to the Office of Investigations of the DIA for insurance coverage s critiention. , — i do herekr certify nil th. I°i ii and penalties of perjury that the information provided above i‘trite and correct / -7 dI Ilat- ef--A...- , _.) Signature: PI-.one t: II/3 C74 7ro7 Official Lust unly. Du not write in this area.to be completed i city or lawn oak ial ('as or !own: Perinitflicense Issuing Authority(circle one): I.Board of Health 2.Building Department 3.Cityttinivn Clerk 4.Electrical Inspector 5.Plumbing,Inspector 6.Other Contact Person: Phone#: From: C -1.7(4 r:( t • l�C / .<00n1 ,cok 464-hecfritaelt/i 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 e the requirement for construction control of the project at �Lf .50t- t S% 4V1ha1i , because the work is of a minor nature, will not affect structural elements, health, accessibility, life or fire safety, and will be done in accordance with the prescriptive requirements of th- code. Thank you for your consideration. • • I alo/a3 Respectfully,