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42-089 (4) 170 GLENDALE RD BP- 2012 -0166 GIs #: COMMONWEALTH OF MASSACHUSETTS Map:Bloc 42 - 089 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: CITY -NO FEE BUILDING PERMIT Permit # BP- 2012 -0166 Project # JS- 2012 - 000250 Est. Cost: $30000.00 Fee: $0.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ABINGTON GROUP 081332 Lot Size(sq. ft.): 2265120.00 Owner: NORTHAMPTON CITY OF LEACHATE TREATMENT FACILITY zoning: SR(100)//WP/WSP 11 Applicant: ABINGTON GROUP AT. 170 GLENDALE RD Applicant Address: Phone: Insurance: P O BOX 5060 (978) 777 -9938 WC PORTSMOUTHNH ISSUED ON :8/11/2011 0:00:00 TO PERFORM THE FOLLOWING WORK: MOUNT RADIATOR, REINSTALL ENGINE 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 8/11/20110:00:00 $0.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner File # BP- 2012 -0166 APPLICANT /CONTACT PERSON ABINGTON GROUP ADDRESS/PHONE P O BOX 5060 PORTSMOUTH (978) 777 -9938 PROPERTY LOCATION 170 GLENDALE RD MAP 42 PARCEL 089 001 ZONE SR(100) / /WP /WSP II THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: MOUNT RADIATORREINSTALL ENGINE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 081332 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: pprroved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR 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 ?/I, Signature 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, Department 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 Office of Planning & Development for more information. Version 1.7 Commercial Building Permit May 15, 2000 DEBtED Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit - 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability IL WLDING INsPEc -noNs Northampton MA 01060 Two Sets of Structural Plans "^P1r0N. 13 587 - 1240 Fax 413 587 - 1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address This section to be completed by office 170 Glendale Road Map Lot Unit Northampton MA 01060 Zone Overlay District Elm St. District CB District S ECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record City of Northampton Name (Print) Current Mailing Address: Signature SEf Telephone 2.2 Authorized Agent: Ameresco Northampton LLC 111 Speen St. Framingham MA 01701 Name (Print) �_ l/� �� YVL,; K Current Mailing Address: (508) 598 -3 Signature _ Telephone SECTION 3 - ESTIMATED CONSTRUcT46N COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) - - - - -- _ --- -- _ -__ -- -. . �a i 5. Fire Protection 6_ Total = (1 + 2 + 3 + 4 + 5) Check Number This Section For Official Use Onl Building Permit Number /�,(� j � Date / ✓(/`� / (p t Issued Signature: Building Commissioner /Inspector of Buildings Date 1� � ,. ._..t... _..�> !! � � Versionl.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alterations Existing Ground Sign ❑ New Signs ❑ Roofing Change of Use ❑ Other Brief Description Enter a brief description here. Of Proposed Work:: KauNT IZ'1 b(A SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B ❑ U Utility � Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1St 1St 2nd 2 nd 3rd 3 rd 4th 4m Total Area (sf) ,j0 0 Total Proposed New Construction (sf) 216- Total Height (ft) lGf � Total Height ft h3 ` 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone.Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone' Outside Flood Zone[ Municipal ❑ On site disposal system❑ Version 1.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size F - Frontage Setbacks Front Side L: R: L: R: Rear Building Height 7 Bldg. Square Footage % Open Space Footage % (Lot area minus bldg & paved p arkin g) # of Parking Spaces Fill: volume & Location A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO () DON'T KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW Q YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained 0 , Date Issued: C. Do any signs exist on the property? YES (�) NO 0 IF YES, describe size, type and location: 3 x 4 Company name sign on container &equipment D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO Q IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Re gistered Architect: Not Applicable ❑ Name (Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility i I Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor ✓! ✓t�_ -. TEi<!l.� �`U c.' 1 -- . _ _ Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone Versionl .7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes No O SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Owner f the subject property hereby authorize A I J N& T6 N Gi O �,A to act on my half, in all matte s r lative to work authorized by this building permit application. Signature of Owner to 1, �' �.� • - - ,Ptf -lt aic:. _ _.. as Qw /Authorized en ereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under . ,e - pains and penalties of perjury. _yam._ _ ... ___.. _✓__ _- .. - -_..._ . _. _ _.___ _ _ _ __ __._ __.. _ _ __ _ _ ___ _.____ ___ _ .. _ __.. ___ Print Name Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor Not Applicable ❑ �,� �••� , �s_r�.� / rc ( (flaiSTA Gs oS t 332 Name of License Holder - - -- - License Number 0,0 _ _` *RfC) . _ RP M Address Expiration D to Signature Telephone SECTION 13 - WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L, c. 152, § 25C(6)) Workers Compensation Insurance affidavit 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. Signed Affidavit Attached Yes 0 No Fax Server 8/11/2011 10:08:40 AM PAGE 2/002 Fax Server Clisnt0: BOOM ABINGGRO ACORD. CERTIFICATE OF LIABILITY INSURANCE °" W11111 THIS CERTIFICATE 8 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO MGM UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES HOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF IISURANCE DOES NOT CONVITTUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PR O DU CER, AND THE CERTIFICATE HOL DER. IMPORTANT: If the owls t ell holder b an ADDITIONAL INSURED, the poicy(ios) rrmrst be endorsed. H SUBROGATION IS WAIVED, aub,Nct to the bens and condktons of the Policy, cerbin Pommies may regWm an *ndofse mnL A obbommt on" oertill does not confer rtpids to the certificate holder In Isu of such PRODUq:tl CONTAur NAME- USI lrmm ance Svcs of NE, Inc. PO 6 825 - 1100 PO Box 6380 — Manchester, NH 031086360 603 626.1100 nHgIRE AFFORDINe00VEAkBE NAIL• tNaU1rED OW NER A Trawlers Insurance C Abington Group Inc Y A18674 Corpora O ft*: Road wmm,ts: TravMOrs Inauranc Company A18674 P.O. Boot :1080 mW EAC: Applied UnderMrtibars A51322 Portsmouth, NH 03802 IAA : Sleaftst Cornpany 26387 AEAE: I A COVERAGES CERTIFICATE NUMBER REWSIONNUi ! THIS IS TO CERTWY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN TO THE AwmD NAMED ABOVE FM THE POLICY PERIOD INDICATED. NOTWRHSTANDING ANY REQUMEMENT, TERM OR CONDITION OF ANY =MV= OR OTHER DOCUMENT VOTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAK THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEM IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCNES. 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North I lanlpbon, MA sibs work. I CERTIFICATE HOLDER CANCELLATION sH AK rar THE PAD DOCRIUMPONC BS CANCSUAD BEFORE Ammesm AO arn w Tw POLICY PROYlEM". YErIED M 111 Spoors Street I Frw"kWhm% MA 01701 ADD 0111116,2009 ACORD CORPORATION. AN rights meo ed. ACORD 25 00WM 1 of 1 The ACORD nano and tope an mgbbfed nlsrlwl of ACORD 98630116411M6464564 MECCA