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32A-263 (2)
Client#: 22549 WMSCHULT ACORD,. CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDD/YYYY) 11/17/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Amsure - A Division of ATCFSI PHONE ) 5 18 4 58 -1800 FAx (A/C, No, Ext : (A/C, No): 518 458 -8390 12 Computer Drive West ni r ss: dsharpe @amsure.net PO Box 15044 INSURER(S) AFFORDING COVERAGE NAIL # Albany, NY 12212 -5044 INSURERA: Travelers Ind. Co. of America 25666 INSURED INSURER B : Travelers Indemnity Company 25658 W.M. Schultz Construction, Inc. INSURER C : Travelers Prop /Cas. Co.Amer. 25674 PO Box 2620 Ballston Spa, NY 12020 -8620 INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR , INSR WVD POLICY NUMBER (MM/DD /YYYY) (MM/DD/YYYY) LIMITS A GENERAL LIABILITY C0925K8239 06/30/2011 06/30/2012 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES R $ 300 occurrence) , 000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $10,000 X PD Ded:1,000 PERSONAL &ADVINJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $2,000,000 — 1 POLICY X, PRO LOC $ JECT B AUTOMOBILE LIABILITY 810925K8239 06/30/2011 06/30/2012 COMBINED SINGLE LIMIT 1 000 000 (Ea accident) $ , , X ANY AUTO BODILY INJURY (Per person) $ x AL AU L TOS AUT OWNED SCHEDOS ULED BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED PROPERTY DAMAGE $ AUTOS (Per accident) C X UMBRELLA LIAB X OCCUR CUP680K1407 06/30/2011 06/30/2012 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $5,000,000 DED X RETENTION $10000 $ A WORKERS COMPENSATION UB925K8239 06/30/2011 06/30/2012 W C STAT OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER /EXECUTIVE Y / N E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? [ N N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Bradford Street Wastewater Pumping Station Replacement. The City of Northampton, SEA Consultants, Inc. and Massachusetts Dept. of Conservation and Recreation are named as additional insureds on a primary basis with regard to general liability as required by written contract. CERTIFICATE HOLDER CANCELLATION City of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y P THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Northampton Dept. of Public Works ACCORDANCE WITH THE POLICY PROVISIONS. 125 Locust Street Northampton, MA 01060 AUT�H�ORRIIZE�D REPRESENTATIVE p © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S101820/M101773 DLS Ill. M. SCHULTZ COUSTRUCTIoU, Inc. -iiii; H EAVY CONSTRUCTION SERVICES February 9, 2012 City of Northampton Building Department Room 100 212 Main Street Northampton, MA 01060 Re: Bradford Street Wastewater Pumping Station Enclosed please find building permit application information for the above referenced project. If further information is required, please contact our office. Thank you. Sincerely, , J? Bonnie Masker Construction Admin 831 Route 67 • Curtis Industrial Park � PO Box 2620 • Ballston Spa, NY 12020 8,8$5.0060 • Fax 518.885.0744 • www.WMSchultz.com t _ ` Commonwealth of Massachusetts 11 Manufactured Buildings Program - Plan Identification Number Assignment Name of Manufacturer UNITED CONCRETE MC Identification ' Number PRODUCTS, INC. Third Party Identification Number 03 Project Title Bradford Street Pump Station Use Group U BBRS \DPS Identification Number 0494 Review by Program All plans are reviewed by MA and should be Director Required stamped as below when approved Date: 12/02/11 Manufactured Buildings Program From: Linda Shea Manufactured Buildings Program Re: Confirmation of Receipt of Building Plans & Assignment of BBRS \DPS Identification Number (BBRS \DPS I.D. Number) The Board of Building Regulations and Standards and Department of Public Safety (BBRS\ DPS) has received your building plans for the referenced project and has assigned the identification number noted above (in the block marked BBRS \DPS I.D. Number). This number has been assigned for purposes of internal tracking methods. This number shall be used in reference to this project and on all future correspondences, inquiries and plan revisions. ACCEPTED MASSACHUSE MANUFACTURED BUILDINGS PROGRAM STATE BOARD OF ILDINGS REG TIONS STANDARDS , /f%T /%' BIDNATU DA i BAST 0 THIRD • RTYCE'.� !CATION ONLY Thank you for your cooperation with this matter. EJECT To FURT'ER REVIEW Send all correspondences, inquiries and plan revisions to: BBRS / Dept. of Public Safety Linda Shea 1380 Bay Street Building B Taunton, MA 02780 Bbrs \forms2 \manufacturedbldgplanid - June 30, 2009 AL ....:. ... .. ._.. i i _. r ......___.._..._ _. .. _._._. i_. ._. _.- - -. ...._.... i ___.. _.. _ i _..__.. I/ _..- - - 1. MANUFACTURE a) NAME -- UMIEC CONCRETE PRODUCTS, NC I) BUILDING CODES b) ADDA S -- 173 CHURCH STREET , YAIESMLLE, CT 06492 8TH EDHDN OF MASSACHUSETTS BASIC BUILDING CODE c) PHONE -- 1- 203 - 289 -3119 2009 INTERNATIONAL ENE 1910 RGY CONSERVATION CUUE WEIR STATE AMENOMIN IS 41) UNITED CONCRETE MASSACHUSETTS CERTIFICATION NUMBER -- MC 1307, EXPIRATION DATE APRIL 30, 2012. 248 -CHAR MASSACHUSETTS UNIFORM STATE PLUMB/NO & FUEL CODE 2. iMND PARTY INSPECTION AGENCY '527 -{KIP 12.00 MASSACHUSETTS ELECTRICAL CODE 8) NAME -- TA. ARNOLD & ASSOCIATES, INC. 2011 NEPA -70 NATIONAL ELECTRICAL CODE WITH STATE AMENDMENTS T.R. ARNOLD & ASSOCIATES, INC. MASSACHUSETTS AUTHORIZATION NUMBER -- MA 521 -CIIR ARCHITECTURAL ACCESS BOARD • b) /03, EXPIRATION GATE; APRIL 30, 2011 3. INDEX OF ORA91NGS AND PERTINENT INFORMATION SHEET 5. HVAC SYSTEMS , SHEET DESIGNA11014 DE0 SCRIPTION DWG. DATE REV. DATE a) ELECTRIC UNIT NEATER IN CONTROL ROOM C -1 06 SHEET 11/22/11 • b) GAS UNIT HEATER IS N GENERATOR ROOM DP -/ DATA PLATE 11/22/11 • c) ELECTRIC EXHAUST FAN (1266 CFA) wMOTOPoZED DAMPER WITH STATIONARY LOUVER 0 -3 - CONTROL & GENERATOR BUILDINGS 2/22/11 5/06/11 64-6411 AN MOTORIZED DAMPER VAN STATIONARY LOUVER a i l EL -1 ELECTRICAL POKER DISTRIBUTION 3/11/11 • 6. EXTERIOR ENVELOPE 1•ER14AL PERFORMANCE CR-1 CONTROL ROOM WMDRAL 3/20/11 _ a) EXTERIOR THOROCOAT PO -1 GENERATOR BOLDING - PRODUCT/ON 3/25/11 5/08/11 __ 10-2 GENERATOR BLOC BASE & FLOOR SLABS - PRODUCTION 3/25/11 5/06/11 - 7. INTERIOR COATING • PO-3 CONTROL BUILDING - PRODUCTION - 3/25/11 5/06/11 a) 1 1/2 ENERGY SHELD RIGA INSULATION (69,6) & F.R.P. ON I/2' PLYWOOD PD-4 CONTROL BLDG BASE & FLOOR SLABS - PRODUCTION 3/25/11 5/06/11 & GENERATOR CAS PIPING a) 2 SCH.40 STEEL PIPING FOR GENERATOR AND HEATER • b) CONNECTION TO INCOMING NATURAL GAS 5ERNCE AHD STRUNG OF PPE TO BE COMPLETED N THE FIELD. NUMBER OF SHEETS IN EACH SET -- 9 SHEETS NOT REVISED AT THIS THE -- 6 9. ELECTRICAL _ _ AWNC a) SEE DR LL -1 ELECTRICAL POWER DISTRIBUTION. 2 4. BUILDING INFORMATION - _ T. R. ARNOI D & ASSOC:BIB% II3!a a) PROJECT NAME -- BRADFORD STREET PUMP STATOR 10. 00515AL NOTES: P. O. Box 1081 b) 110911 IDENTIFICATION - 25118 -8 At 25116 -B c PROPOSED LOCATION ADDRESS - CORNER OF BRADFORD ST. & MILL YARD ED., NCR FROM 5E OVER 15 THHAMPTO5 MA a) BULGING 56044 1111 111E RU f1E LEEA 10 FROM WES1 EAST ELE VATION AND NORTH EL EVATION. E LEV T ION , ear IN s , d) 11 CROUP CLASOFl TH CATION - U AND 25 FROM E SOUTH ELEVATION TO PROPERTY UNE, . Commonwealth of Massachusetts e) CONSTRUCTION TYPE CIASSIFICATON -- ITS t OR MID POINT BEIYIEEN TWO BUILDINGS ON 111 SANE PROPERTY. Accredited Evaluation 1) SQUARE FOOT AREA CF BUILDING b) BUILDING AluttIF REQUIRED BY OTHERS IN 111E FlF1D, Inspection Agency 1. 0001Rd, POOH MODULE -A' -- 212 S.F. 2. GENERATOR Roots MODULE - B - -- 189 S.F. Till armament is Clrtiflod es being In conformance 11. UNITED CONCRETE ENGINEERS STRUCTURAL OESION with Massechusens $Ma 9) AMOUNT OF ENCLOSED SPACE (VOLUME - CUBIC FEET) a) SEE STAMPED CALCULATIONS FROM UNITED CONCRETE Codas an - miens' 1. CONTROL ROOM LLE - A' -- 1906 C.F. PRODUCTS, / MLD NC. 2. GENERATOR ROOM MODULE - B - -- 1892 C.F. 173 CHURCH STREET h) HEIGHT OF BUILDING ABOVE GRADE YALESMLLE, CT, 06492 Approved - 8 . I. NUMBER OF STORIES -- 1 JOSEPH L TERMITE 0 MA PE / 49135 2. NUMBER OF FEET -- 15• -0 Date DEC 0 1 ' l 1 Approval of this deaxnsR does not aoNwrils or approve i) DESIGN OCCUPANCY LOAD -- NO PERMANENT OCCUPANT, 079111 12. -- T.P.I.A USE ONLY I 9 SPECIAL SYSTEMS BY TYPE taw omission or dev rwhwn Srees "°GleN et ri 1. NONE 'w.r-- -... I�ohc r -..._ : - •..� -mw•wv j ISSUE TAG k) BULONG DESIGN UYE LOADS AN. NO ovs ersour re 1. CONCRETE SIDEWAUS -- 9@RD LOAD 130 MPH, EXPOSURE CATADORY C 4 - 2. CONCRETE ROOF -- LAVE LOAD 90 PSF 3 3. CONCRETE 91000 -- LAVE LOAD 150 PSF CONTROL ROOM MODULE 'A / 0VE LOAD 250 PSF GENERATOR ROOM MIDDLE 'B' 13. GROUP DATA PLAITS AND LABELS - LOCATED ON INTERIOR OF ELECTRICAL PANEL. 2 - 4. SNOW LOAD -- 55 PSF GROUND SNOW. LOAD 1 - - j 5. ROOF TRUSS -- WOOD TRUSS 'MID 110 MPH, EXPOSURE CATAGORY C UNITED MOOD 151155 LAVE LOADOAD; : 50 P01 6. 0111C LOAD -- N/A 7. CORRIDOR -- N/A _ EAL UNITED CONCRETE PRODUCTS INC H STAIRS -- N/A / `'< .' 9. BALCONIES -- N/A V 173 Church Street Yelesville, CT 06492 10. OTHER -- N/A �i ', (800) 234 - 3119 FIX; (203) 265 - 4947 11. SEISMIC DESIGN GROUP C ', r c 1V NAT SCouLTZ CONSTRUCTION ^+ '/ E.... BRADFORD 00659,0 PUMP STATION 12. FOUNDATION DISCLAIMER -- FOUNDATION IS 111E RESPONSIBL OF THE SITE ENGINEER � „ D T ER E� S r 13. MINIMUM SOIL BEARING -- 2000 PSF F 060106 Tm R NORTHHAMPTON,MA 14. BUILDING CONCRETE PSI O 28 DAYS -- 5,000 PSI N1G1 - own e COVER SHEET 15. 00500011 TYPE -- SILICEOUS AGGREGATE CONCRETE. 9) eY 1 ):. v Imlr� CJS °^''' If/227 n C3$ lawxn 1 OO 81101916 NO 25115 sc NONE ^-1 DP -1 0 11 1. � . MANUFACTURER'S DATA PLATE 4110 FACTORY INSTALLED EQUIPMENT EQUIPMENT MANUFACTURER MODEL NO. Manufacturer UNITED CONCRETE PRODUCTS INC. Heating QMARK MUH - - Address 173 CHURCH STREET Cooling City, State, Zip YALESVILLE, CT 06492 RangeBumer LISTED INDUSTRIALIZED BUILDING Oven Model BRADFORD STREET PUMP STATIO]"� Refrigerator Occupancy Classification U Const. Class I IIB Water Heater Manufacturer's Serial No(s). 25118 -A & 25118 -B Dish Washer Date of Manufacture Plan Approval No. Disposal Date Data Plate Attached Hydro - Massage Tub Permissible Gas Type(s) NATURAL GAS VENTILLATION COOK EXHAUST FAN 14CV 11 D Electric Rating 400 AMP 480/277v 3 PHASE 4 WIRE Test Voltage/Time 1000v / 15 SEC. Water Supply: Test Procedure N/A Shipping Weight MODULE "A" 65,000 LBS. Floor Design Live Load 150 PSF Design And Ex Wind posur Speed e shipping Weight( 1 10 MPH C Shi m Wei ht s MODULE "B" 65,000 LBS ) Ground Snow Load 55 PSF R Li DLotd 50 PSF TRA Label No(s). Exterior Wall Fire Rating N/A Seismic Design C i State Insignia No(s). Category i Winter Design Temp.: Inside N/A Outside N/A U Ceiling 0.039 Wall 0.076 I Floor 1.5625 Follow precisely all instructions with this building. Foundations, Installation and Utility Connections are subject to inspection by local authorities. CODE REFERENCE PLATE 140 THIS MANUFACTURED STRUCTURE HAS BEEN CONSTRUCTED IN CONFORMANCE WITH THE FOLLOWING CODES: © 2011* NATIONAL ELECTRICAL CODE® ❑ INTERNATIONAL BUILDING CODE ❑ INTERNATIONAL MECHANICAL CODE ❑ INTERNATIONAL PLUMBING CODE 0 2009* INTERNATIONAL ENERGY CONSERVATION CODE ❑ INTERNATIONAL RESIDENTIAL CODE ❑ INTERNATIONAL FUEL GAS CODE ❑ INTERNATIONAL FIRE CODE ❑ UNIFORM BUILDING CODE ❑ UNIFORM PLUMBING CODE ❑ UNIFORM MECHANICAL CODE ❑ NATIONAL STANDARD PLUMBING CODE 0 8TH EDITION OF 780 -CMR MASSACHUSETTES BASIC BUILDING CODE 2 248 -CMR MASSACHUSETTS UNIFORM STATE PLUMBING & FUEL CODE O 527 -CMR 12.00 MASSACHUSETTS ELECTRICAL CODE p 521 CMRARCHITECTURAL ACCESS BOARD T. R. ARNOW L. AMaATES, aria STATE BUILDING INSPECTOR MUST WITNESS ALL ON -SITE TESTS b P. 0. r ix 1081 ❑ E : IN 46515 ❑ Conunonw04 of Massachusetts ❑ • valuation and ❑ Mspecti n Agency ❑ .= WITH STATE AMENDMENTS eel as being in conformance with Massachusetts State Codas and th- . ational Fa. - Approved By a Date L 0.1 g[, Approval of this document does not authorize or approve any omission or deviation from the re4uiramamt$ of applicabie Stall Laws. Commonwealth of Massachusetts `t r Board of Building Regulations and Standards • 1 ; F Manufactured Buildings Program • THIRD PARTY INSPECTION AGENCY CERTIFICATION This Section to be completed by Third Party Inspection Agency - PLEASE PRINT OR TYPE UNITS MAY NOT BE SHIPPED UNTIL THIS CERTIFICATION IS COMPLETED SECTION 1 - MANUFACTURER INFORMATION (S \Mfg \forms \mfgthirdpartycert - July, 2009) Manufacturer Name (r > CCNcR111 Pe. DUGrs r C . Street 1 - 73 (Itiore.CH STREET City/State/Zip YAIr ILLS (.1 6649 2. Manufacturer Number MC# W Telephone: a y Fax: a)3 114 / Third Party Agency 'Y"g A R No L D t A 55GU RTr - s TPIA # C5 3 Third Party Plant Inspector L e_,r ` j O A) ,rd ��- ! SECTION 2 - BUILDING INFORMAON I BBRS \DPS I.D. # 1 0474 — Street Name & Number 1RA p Fo1Z47`;'�ET City No g -1.r /4-Men pia A// state MA Zip 01060 Use Group U Construction Type In signing this form below, I hereby certify that the units identified in sections 1 through 3 have been inspected and are constructed in accordance with the following codes, as applicable. Massachusetts State Building Code (780 Massachusetts State Electrical CMR) Code(527 CMR 12) Massachusetts State Plumbing and Fuel Massachusetts Architectural Access Gas Code (248 CMR) Board Regulations (521 CMR) Mfg. P1 Inspe or's i; e Mfg. Plant Inspector's Name (Please Print) k 6- tu - 1+40 SECTION 3 - LABEL INFORMATION (Indicate number of boxes and number of labels required) Number of Units 2 Number of Labels Required Manufacturer's Serial 25 110A- Manufacturer's Model . 3rc�.d -ko rb. STf Number f3 Designation p(mp S T ano&N SECTION 4 - THIRD PARTY CERTIFICATION In signing this form, I hereby certify that the units identified in sections 1. through 3 above have been inspected and are constructed in accordance with 780 CMR R3.3 certification procedures. Third Party Inspector (Print Name) L , C'i+,►rd p Date: 1 Signature , This form shall be mailed to th BB t Department of Public Safety ATTN: Linda Shea 3:1 Bay Street, Building B Taunton, MA 02780 nR Version!.7 Commercial Building Permit May 15, 2000 SECTION 10 STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes Q No 0 SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Edwin A Shull as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury, Edwin A Shull Print Name N C 02/08/2012 Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable Name of License Holder License Number Address Expiration Date 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 0 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 Registered Architect: Not Applicable 0 Name (Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Joseph L. Tenedine Civil, Manufacturer Name Area of Responsibility 173 Church Street, Yalesville, CT 06492 MA. 49135 Address Registration Number (203) 269 -3119 Signature Telephone Expiration Date Ronald E. Hansing Electrical, Manufacturer Name Area of Responsibility Elkhart, Indiana MA. 34053 Address Registration Number Signature Telephone Expiration Date Steven A. LaPrize Electrical, Contract Drawings Name Area of Responsibility Kleinfelder SEA , Cambridge, Ma. MA. 43049 Address Registration Number (617) 497 -7800 Signature Telephone Expiration Date Vincent W. Sprada Sanitary, Contract Drawings Name Area of Responsibility Kleinfelder SEA , Cambridge, Ma. MA. 31436 Address Registration Number (617) 497 -7800 Signature Telephone Expiration Date 9.3 General Contractor W M Schultz Construction Inca Not Applicable ❑ Company Name: Edwin A Shull, Project Manager Responsible In Charge of Construction P 0 Box 2620, Ballston Spa NY 12020 Address ] r //1,--C- (518) 885 -0060 Signature Telephone Versionl.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 Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % , Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book Page and /or Document # Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES ( NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0 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 Q NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Version1.7 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 0 Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Enter a brief description here. Of Proposed Work: Construct new pump transfer station SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1A 1 ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B 1 IS F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 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 I ❑ 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) 1 1st 400 2 d 2 3rd 3 rd 4 th 4 Total Area (sf) Total Proposed New Construction (sf) 400 Height (ft) Total Height ft 14 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 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' Northampton, MA 01060 Two Sets of Structural Plans phone 413 - 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 RECEIVED section to be completed by office ECEt 1.1 Property Address: EC 1 Bradford Street Map 32A Lot 263 Unit Northampton, MA FEB 5 2012 Zone Overlay District Eim St. District CB District SECTION 2 - PROPERTY 0 1 �r 1 2.1 Owner of Record: City of Northampton Wastewater Treatment 125 Locust St. Northampton Name (Print) Current Mailing Address: (413) 587 -1570 Signature Telephone 2.2 Authorized Agent: Edwin A Shull for W M Schultz Construction Inc ; 0 Box 2620, Ballston Spa, NY 12020 Name (Print) Current Mailing Address: (518) 885 -0060 Signature � ' Telephone SECTION 3 - - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building $54,000.00 (a) Building Permit Fee 2. Electrical $55,000.00 ( b) Estimated Total Cost of Construction from (6) 3. Plumbing $28,000.00 Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection $5,000.00 6. Total= (1 +2 +3 +4 +5) Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2012 -0718 APPLICANT /CONTACT PERSON W M SCHULTZ CONSTRUCTION INC ADDRESS /PHONE P 0 BOX 2620 BALLSTON SPA (518) 885 -0060 PROPERTY LOCATION BRADFORD ST PUMP STATION MAP 32A PARCEL 263 001 ZONE 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: NEW PUMP TRANSFER STATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: ( p oved 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 1— 2. 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. BRADFORD ST PUMP STATION BP- 2012 -0718 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A - 263 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: NEW COMMERCIAL BUILDING BUILDING PERMIT Permit # BP- 2012 -0718 Project # JS- 2011 - 001780 Est. Cost: $251000.00 Fee: $0.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: W M SCHULTZ CONSTRUCTION INC Lot Size(sq. ft.): Owner: BOSTON & MAINE RAILROAD CIO 293 NORTHAMPTON REALTY LLC CIO WILLIAM LIA Zoning: Applicant: W M SCHULTZ CONSTRUCTION INC AT: BRADFORD ST PUMP STATION Applicant Address: Phone: Insurance: P O BOX 2620 (518) 885 -0060 BALLSTON SPANY12020 ISSUED ON:2/23/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: NEW PUMP TRANSFER STATION 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 2/23/2012 0:00:00 $0.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck— Building Commissioner