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24C-019 (4) ? K . I� The Commonwealth of Massachusetts 1 i ' -..„ / „ City of Northampton .. , tY ton p Temporary Certificate of Occupancy In accordance with 780 CMR, Section 120.3 (The Seventh Edition of the Massachusetts State Building Code) this Temporary Certificate of Occupancy is issued to the premise or structure or part thereof as herein identified. Identify Name of Building of Space Within I Certificate No. Issued to BP- 2010 -0349 Hampshire Regional YMCA Identify property address including street number, name, city or town and county Certificate Located at Expiration 286 Prospect Street January 31, 2010 Northampton, Hampshire County, Massachusetts Use Group A -3 Assembly Allowable Classification(s) Occupant Load TBD This Temporary Certificate of Occupancy is hereby issued by the undersigned to certify that the premise, structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall allow for the temporary use as herein described and in conformance with any and all conditions as identified below. It shall be posted in a conspicuous place within the space as directed by the undersigned. Failure to post the certificate, failure to comply with conditions or, tampering with the contents of the certificate is strictly prohibited. Conditions of Temporary (30 Day) Certificate of Occupancy completion of work on the HVAC system Temporary Use Name of Municipal Louis Hasbrouck Date of Map /Plot: Building Official Inspection 12/21/09 Signature of Municipal Date of Building Official Issuance 12/23/09 24C -019 } $ The Commonwealth of Massachusetts r`S ` j t € , City of Northampton ,----..c.„ :, tY p Temporary Certificate of Occupancy In accordance with 780 CMR, Section 120.3 (The Seventh Edition of the Massachusetts State Building Code) this Temporary Certificate of Occupancy is issued to the premise or structure or part thereof as herein identified. Identify Name of Building of Space Within I Certificate No. Issued to Hampshire Regional YMCA BP 2010 - 0349 Identify property address including street number, name, city or town and county Certificate Located at I Expiration 286 Prospect Street January 31, 2010 Northampton, Hampshire County, Massachusetts Use Group A -3 Assembly Allowable Classification(s) Occupant Load TBD This Temporary Certificate of Occupancy is hereby issued by the undersigned to certify that the premise, structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall allow for the temporary use as herein described and in conformance with any and all conditions as identified below. It shall be posted in a conspicuous place within the space as directed by the undersigned. Failure to post the certificate, failure to comply with conditions or, tampering with the contents of the certificate is strictly prohibited. Conditions of Temporary (30 Day) Certificate of Occupancy completion of work on the HVAC system Temporary Use Name of Municipal Louis Hasbrouck Date of Map /Plot: Building Official Inspection 12/21/09 Signature of Municipal 1 ,`? Date of Building Official ~ 4 - L 4v ( f( ! Issuance 12/23/09 24C -019 ■ I .. / {'}""� a 6: ----- .,.w V ■ AAIPAA M. J. MORAN, INC. Mechanical Contractors October 8, 2009 Y.M.C.A. Miscellaneous Fire Damage 1. M.J. Moran miscellaneous ducts, piping $5,600.00 2. Novotny Painting $6,687.00 3. Pipe & duct insulation $38,316.00 4. Mercier Carpet $5,334.00 5. Kleeberg Sheet Metal $23,300.00 6. Yankee Technology $6,220.00 TOTAL: $85,457.00 Install Fire Protection system per Owner's direction. $67,400.00 This is not required. 4 South Main Street • P.O. Box 278 Telephone: (413) 268 -7251 MA Master Plumbers Lic. #7872 Haydenville, MA 01039 -0278 Fax: (413) 268 -9375 MA Master Pipefitters Lic. #11581 M. J. MORAN INC. AAIPAA4 Mechanical Contractors October 8, 2009 Y.M.C.A. Fire Damage As of October 6, 2009 General Condition Work 1. D.A. Sullivan — Fire rated wall, smoke and fire safing $17,290.00 2. Miscellaneous fire damage $5,200.00 3. Rocky acoustic ceilings $35,415.01 TOTAL: $57,905.00 4 South Main Street • P.O. Box 278 Telephone: (413) 268 -7251 MA Master Plumbers Lic. #7872 Haydenville, MA 01039 -0278 Fax: (413) 268 -9375 MA Master Pipefitters Lic. #11581 M. J. MORAN, INC. ' P44 Mechanical Contractors October 8, 2009 Y.M.C.A. Fire Damage Code Upgrade 1. Marney Electric- wiring & fire alarm code upgrade (to date) $84,608.00 2. Marney Electric- estimated cost to complete $45,000.00 Code Upgrade Total Wiring & Fire Alarm $129,608.00 3. Marney Electric -new switch gear upgrade $56,270.00 4. Marney Electric- fire damage wiring $95,797.00 TOTAL ELECTRIC $281,675.00 4 South Main Street • P.O. Box 278 Telephone: (413) 268 -7251 MA Master Plumbers Lic. #7872 Haydenville, MA 01039 -0278 Fax: (413) 268 -9375 MA Master Pipefitters Lic. #11581 A ARP/ A M. J. MORAN, INC. Mechanical Contractors October 8, 2009 Y.M.C.A. Estimate for Women's Locker Room & Stretching Room Renovation 1. Plumbing & H.V.A.C. $41,000.00 2. Electrical $30,000.00 3. Ceilings $16,000.00 4. Exterior Wall Insulation $4,200.00 5. Door Openings / Close -up $11,800.00 6. Tile Work $38,400.00 7. Walls / Sheetrock / G.C. Work $38,000.00 8. Painting $5,500.00 9. Misc. / Roof Repair etc. $10,000.00 10. Masonry walls — locker bases $10,000.00 11. New Sauna $12,000.00 TOTAL: $216,900.00 4 South Main Street • P.O. Box 278 Telephone: (413) 268 -7251 MA Master Plumbers Lic. #7872 Haydenville, MA 01039 -0278 Fax: (413) 268 -9375 MA Master Pipefitters Lic. #11581 M. J. MORAN, INC. ' PA Mechanical Contractors October 8, 2009 Y.M.C.A. Estimate for Men's Locker Room Renovation 1. General Condition Work $28,600.00 2. Tile Work $20,000.00 3. Plumbing $4,600.00 4. Electrical $3,500.00 5. H.V.A.C. $4,000.00 6. New Sauna Replacement $10,000.00 TOTAL: $70,700.00 4 South Main Street • P.O. Box 278 Telephone: (413) 268 -7251 MA Master Plumbers Lic. #7872 Haydenville, MA 01039 -0278 Fax: (413) 268 -9375 MA Master Pipefitters Lic. #11581 M. J. MORAN, INC. ' PA Mechanical Contractors October 8, 2009 Y.M.C.A. Recap. Sheet Estimated Cost of Construction 1. Men's locker room renovation $70,700.00 2. Women's locker room renovation $216,900.00 Sub -Total $287,600.00 10% Allowance $28,760.00 Total: $316,360.00 Electric wiring $281,675.00 General Condition Work $57,905.00 Miscellaneous $85,457.00 Total: $741,397.00 4 South Main Street • P.O. Box 278 Telephone: (413) 268 -7251 MA Master Plumbers Lic. #7872 Haydenville, MA 01039 -0278 Fax: (413) 268 -9375 MA Master Pipefitters Lic. #11581 A ARPA A M. J. MORAN, INC. Mechanical Contractors TO: Tony Patillo DATE: September 09, 2009 FROM: Jim Moran RE: Hampshire Regional Y.M.C.A. Good Morning Tony! Please see the attached in regards to the estimated cost for the fire damage and renovations for the Hampshire Y.M.C.A. Thap you! Teti Jim Moran 4 South Main Street • P.O. Box 278 Telephone: (413) 268 -7251 MA Master Plumbers Lic. #7872 Haydenville, MA 01039 -0278 Fax: (413) 268 -9375 MA Master Pipefitters Lic. #11581 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder :nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2004/06) 4. . ACCRa CERTIFICATE OF LIABILITY INSURANCE oT /3iz 0 ) PRODUCER (413)586 -0111 FAX (413) 586 -6481 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Webber & Grinnell Ins . Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 8 North King Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR g ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Northampton, MA 01060 INSURERS AFFORDING COVERAGE NAIL INSURED 0 A Sullivan & Sons Inc INSURERA: Acadia Insurance Company 82 -84 North St INSURER B: Firemen's Ins /Acadia Northampton, MA 01060 INSURER C: A•.I.M. Mutual INSURER D: Darwin Select Ins. Co. /REU INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR ADM TYPE OF INSURANCE ' POLICY NUMBE POLI%Y EFFECTIVE I P O L ICY EXPIRAT I LIMITS DATE IMM!DDrYY1 D riven O f l I GENERAL LIABILITY CPA130002421 07/01/2009 07/01/2010 EACH OCCURRENCE $ 1,000,000 X COf,4MERCIALGENERAL LIABILITY I DAMAGE TORENTED $ 250 000 PRFMISFS (Po nrruron,p) CLAIk45 MADE I X I OCCUR MED EXP {Any one parson) $ 5,00 t A 1 PERSONAL S ADVINJURY S 1,000,001 GENERAL AGGREC4TE $ 2,000,001 GENL AGGREGATE LIMIT APPUES PERI PRODUCTS - COMP /OP AGG $ 2,000,001 POLICY PRO 1 LOC JECT AUTOMOBILE LIABILITY MAA130002521 07/01/2009 07/01/2010 COMBINED SINGLE LIMIT $ ANY AUTO (Ea a 1, 000,000 X ALL OWNED AUTOS BODILY INJURY $ $ SCHEDULED AUTOS (Per perso, -t) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Pe accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT 5 ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG 5 EXCESS/UMBRELLALIABILITY CUA130002721 07/01/2009 07/01/2010 EACH OCCURRENCE $ 10,000,001 OCCUR ( I CLAIMS MADE AGGREGATE $ 10,000,00o. A $ DEDUCTIBLE $ X RETENTION $ 0 s WORKERS COMPENSATION AND MCC200009301 07/01/2009 07/01/2010 X I ra ht TF WI EMPLOYERS' LIABILITY C ANY PROPRIETORIPART LR1EX'E E.L EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? E.L DISEASE- EA EMPLOYEEI 5 500,000 ff es describe under SI�EC IAL PROVISIONS below E.L. DISEASE- POLICY LIMIT 1$ 500,000 OTHER 3043363 01/07/2009 01/07/2010 $1,000,000/$500,000 Pro Liability D Per Claim DED: $10,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR PIEPRESENTAT IVES. - --- INFORMATION PURPOSES AUTHORIZED REPRESENTATIVE f � c_ - Richard Webber, CIC/VICKI (� ACORD 25 (2001/08) © ACORD CORPORATION 1988 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub - contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self - insured companies should enter their self - insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit /license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617- 727 -4900 ext 406 or 1- 877 - MASSAFE Fax # 617- 727 -7749 Revised 4 -24 -07 www.mass.gov /dia The Commonwealth of Massachusetts Department of Industrial Accidents • Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): i' SO, Iii 1,/0.fl ? flS t Oa, _ Address: 2,2-M 4o (4 Sk - City/State/Zip: 1\o rsk- ftcil 1 AA 1t>r.°o Phone #: Li -5-2 .631 D Are an an employer? Check the appropriate box: Type of project (required): 1. Br I am a employer with 2.0 4. ❑ I am a general contractor and I employees (full and /or part- time).* have hired the sub - contractors 6. II] New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub - contractors have 8. [J Demolition working for me in it employees and have workers' g any capacity. p y . 9. ❑ Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. ❑ We are a corporation and its 10.111 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. ❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13. ❑ Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If the sub - contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: P 1 M M0 kat! 1(1Ai r Q fle Policy # or Self -ins. Lic. #: e '2 DC g 3 ( Expiration Date: 1/i /2 Job Site Address: MCA 1 a"y i "'c • No (-ktYti1 et-(? City /State /Zip: io D Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and /or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi / under th ' I ains Ind penalties of perjury that the information provided above is true and correct. Signature: � + \ � ' n Date: I a j j /2co 9' Phone #: 4113- - 0 3i 0 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 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 0 No el SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I , I ' ! ! ' r ► " ^ CA FC) as Owner of the subject property hereby authorize . A .. f ,,'/ I /9'U to act on my behalf, . I m tters lativ to work authorized by this building permit application. 1 /0///7 Signature of 0 , er Date I, Y ' iv '4R V( 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. Print Name ,,' % �� / y% 3 749 Signature of Owner/ gent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: 140,---w(--) Not Applicable ❑ Name of License Holder : J O r ) _ J . G � C5 5 - o License Number Address i �! Expiration Date / 2 yt u� , k 3-G75- 'c /),1s Signat a Telephone SECTION 13 - WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) Workers Compensation Insurance affid it must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the b ' ding permit. Signed Affidavit Attached Yes No 0 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 /Findin ver been issued for /on the site? NO 0 DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Regi ry of Deeds? NO 0 DONT KNOW YES 0 IF YES: enter Book Page and /or Document # e7 B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the property? YES ( NO 0 IF YES, describe size, type and location: (St'CZ —S £N Gut L ,A.:- / LOCH 0 D. Are there any proposed changes to or additions of signs intended for the property ? ( YES 0 NO t.J IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excav ion, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 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 E 'Demolition Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Enter a brief description here. 12_0 ((._7 Flae 1xtv14,iD 1 .2. 2 f 1 '1 Of Proposed Work: ; 1-064-&—Y2-- SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A-1 ❑ A -2 ❑ A-3 1A I 0 A -4 ❑ A -5 ❑ 1B 11 B Business ❑ 2A ❑ E Educational ❑ 2B 1 ❑ 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 l ❑ 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): 3 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 st 1 2 nd 2nd 3C/ 3rd 3 4 1 h 4th Total Area (sf) Total Proposed New Construction (sf) Total Height (ft) Total Height ft 7. Water S ply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage sposal System: Public Private ❑ Zone Outside Flood Zone El Municipal On site disposal system Version1.7 Commercial Building Permit May 15, 2000 Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit - 1 212 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 1.1 Property Address: This section to be completed by office '2- e a, l 6 2 cr sr-. Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: PSHI ! W rz �— ec . yov,Jfr© ( r. Name (Print) ?E S C +I�IE l _ � ., SOC I_ k t Mailing Address: Signature Telephone 2.2 Authorized Agent: fly F . 1414he /f C v `Pe, 6 /9 50 c '" Name (Print) Current Mailing Address: ( / /t 414 /c6 0 Signature Telephone y0) 6> L SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building /gOf am / (l a) (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of �� _ � Construction from (6) 3. Plumbing -Y / 5 0190 Building Permit Fee 4. Mechanical (HVAC) yam /y 5. Fire Protection '( / / 000/ 0 6. Total = (1 + 2 + 3 + 4 + 5) 2 Qe Check Number ) ° 3 / e j d ( ' ) This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2010 -0349 APPLICANT /CONTACT PERSON D A SULLIVAN & SONS INC ADDRESS /PHONE 82 NORTH ST NORTHAMPTON (413) 584 -0310 PROPERTY LOCATION 286 PROSPECT ST MAP 24C PARCEL 019 001 ZONE URA(15)/URB(85)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out J Q N /C � j Q 1/ Fee Paid J J Typeof Construction: REBUILD 2ND FLR FIRE DAMAGED WOMEN'S LOCKER ROOM 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 INFOpIATION PRESENTED: Approved 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 //7/(e 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. . , /,:;, (-ay. - liti37._7( ury 1 .'' , ```- 1 ' 1 ; / i , f i / c v y .1-ct. c V --I --I-C //' 7 - tf-y /_;-.--.--,/ ( 00 p. P-1- 51 Jrucio cfii 67 i / 7 Loo , ) ,, _ -r ...-,‘,.... „.... , - 1 1 S zks ‘, 1 . ) _ , i 1 1 1--( 1 ' '. L4 t C9 aP IP 0- 4 - ."*C ( `" -- ),_, , --n 7 c --rt.(' g 6 ,e9 li / " Of41.9/3 ' -e— /Dv - --g,?/ 5E1 pi 14 6-4 141/U }la V c--) 0:7 c. - - , (-qViivit:e01 $0 17 1S-11 ' D ) ,/ ) ''' 1 'el/ — '--- ?3 0/2 cr / / It . /,/ ,( ;y1 0, cz Z _2/ c) - 7-zi 6 , ry) ?7 ,,(Qi„y. . Jji, 286 PROSPECT ST BP- 2010 -0349 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24C - 019 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0349 Project # JS- 2010 - 000468 Est. Cost: $200000.00 Fee: $1200.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: D A SULLIVAN & SONS INC_ Lot size(sa_ Owner: HAMPSHIRE REGIONAL YOUNG MEN'S CHRISTIAN ASSOCIATION Zoning:URA(15) /URB(851/ Applicant: D - SULLiVAN 8, SONS iNC AT: 286 PROSPECT ST Applicant Address: Phone: Insurance: 82 NORTH ST (413) 584 -0310 Workers Compensation NORTHAMPTONMAO1060 ISSUED ON:10/13/2009 0:00:00 TO PERFORM THE FOLLOWING WORK:REBUILD 2ND FLR FIRE DAMAGED WOMEN'S LOCKER ROOM 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: Roy h: - House # Foundation: /1/ t J --- Driveway Final: Final: / Final: Rough Frame: Cas: Fire Department Fireplace /Chimney: Rough: + Oil: Insulation: Final: ) cry O moke: o 9 � y- ► 1 Final: ©K / °� -� 1 -O � tem z_/ -l/ l� t i c� - F £ f c THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of 3 o _ FeeType: D . to ° ai Amount: Building 10/13/2009 0:00:00 $1200.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo