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25-015 (62)
{.-x I SA' City of Northampton Building Department Plan Review 212 Main Street ± ! Northampton; MA 01060 ! k ( 2 1 J�%,0; y I ��C Client#: 12617 ELMEL DATE(MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 1 7/02/2014 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 Anne Dale T.P. Daley Insurance Agency, Inc PHONE (A/C,No,Ext):413 788-0971 FAX 413 739-2645 _ (A/C No): _ 1381 Westfield St, E-MAIL ADDRESS: annedaley@tpdaleyinsurance.com dale Y msurance.com P.O. Box 1150 _..... INSURER(S)AFFORDING COVERAGE NAIC# West Springfield, MA 01090 _ _ -- _- INSURER A:Valley Forge Ins Co. ..._... ..._...--- _......... __ ......... _ - -_... - ---- INSURED INSURER B:National Fire Ins. Co. Elm Electrical, Inc. INSURER C:Continental Casualty 68 Union Street INSURER D:MA Employers Ins.Co. Westfield,MA 01085 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 CONTRACTOR 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 LIMITS TYPE OF INSURANCE — INSR WVD- ___ __POLICY NUMBER (MM/DD/YYYY MM/DD/YYYY) _.__... LTR..... _. - --— ---- _..- - --- A GENERAL LIABILITY C5084491987 5/30/2014 05/30/201 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED $5OO OOO X COMMERCIAL GENERAL LIABILITY PREMISES.-(Ea occurrence __ )_ ....-......__—__t.......................______._............. CLAIMS-MADE i X OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $11,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 LPOLICY� XJ PRO LOC $..-- -..--- - -- .._..-.. _ - --— COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 5084492007 05/30/2014 05/30/201 Ea ac B cident $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ' ALL OWNED --- SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ I X PROPERTY DAMAGE $ X HIRED AUTOS AUTOS (Per accident) �I - _ - $ C t X UMBRELLA LIAB X__, OCCUR C5084491990 05/30/2014 05/30/201 EACH OCCURRENCE $5,000,000 _ _...- ........ .... -- EXCESS LIAB CLAIMS-MADE AGGREGATE s5,000,000 DED I X RETENTION$10,000_ D WORKERS COMPENSATION MCC20020000842014A 7/01/2014 07/01/2015 Y WC STATU- T 0TH AND EMPLOYERS'LIABILITY —SQRY MITSL. ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N E.L.EACH ACCIDENT $2,000,000 _ OFFICER/MEMBER EXCLUDED? NIA _.... - --- (Mandatory in NH) E.L_DISEASE-EA EMPLOYEE s2,000,000 _2,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) General Certificate CERTIFICATE HOLDER CANCELLATION Elm Electrical, Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 68 Union Street ACCORDANCE WITH THE POLICY PROVISIONS. Westfield, MA 01085 AUTHORIZED REPRESENTATIVE .._-- ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S111409/M110256 JXE 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 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Robert Bacon as Owner of the subject property hereby authorize Ronald, annah o i act on my a/in A hers r ti f work authorized by this building permit application. j ;04/27/2015 t Signature'of wn Date I, _ . ... �a . r .._e ..... . .._ . �..... ....m__ _�.. 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 Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Ronald Hannah CS 096240 Name of License Holder: License Number '2 John Mason Road 04/03/2016 Expiration Date (413)454-7840 Si Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§26C(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 G) No 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 ❑ Name(Registrant) _. ... ... i Registrati on Number Address _ �..�e... . "....... Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): 4 Name Area of Responsibility Address Registration Number t _ Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number ., .... P L.......... 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 ;One Construction& Development Not Applicable ❑ Company Name: Ronald Hannah Responsible In Charge of Construction ,..... �__. �. ........ ,68 Union Street Westfield, Ma 01085 ress (413) 485-4056 E Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONN�-] Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage ._.._.. . ..__, _ ..._.: Setbacks Front Side L:- ,.,. ... R. L. R......., f._.,_,.. ...'' Rear Building Height Bldg. Square Footage % _ .... Open Space Footage % (Lot area minus bldg&paved �I - ' t �R_ parking) ...® . . .... _ #of Parking Spaces =.. ._. _ .... _._... Fill: ? volume&Location ....... . ._ A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON T KNOW 0 YES _ w ........,.. ..._.. . IF YES: enter Book Page; and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 Date Issued C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and location: 'v D. Are there any proposed changes to or additions of signs intended for the property? YES NO Q 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 U NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version l.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 Alteration ❑✓ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other ❑ Brief Description 'Remove and Replace Existing Deck Stairs Of Proposed Work: 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 El 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): L._. .._... SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) St 15t 2nd 3 2nd Iw .. ., �....... .. ..-.... ..�. 3rd 3rd th 4th Total Area(sf) Total Proposed New Construction.(.s Total Height(ft) , Total Height ft 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 3-7 1`�°� �j5513 Versionl.7 Commercial Building Permit May 15 2000 IL C y� p r� J r < SN Aii�r'r� A r , City of Northampton �I ll 1CR 2 7 2015 E Building Department trrb i ttt(t rue ��t e 212 Main Street llsbi F � EI tr c, &Gas Inspections Room 100 1Neter f Il*vdi tii�3 r,;;;;01000 Northampton, MA 01060 P x phone 413-587-1240 Fax 413-587-1272 „ �cify 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 160 Old Ferry Rd,Northampton,MA 01060 Map Lot Unit Zone Overlay District _._......_.. ........__.. Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Rec .... ...... ..a _.. _. . ._ ....., . `Robert B co 1 160 Old Ferry Road Northampton,Ma Name Print ] Current Mailing Address (413) 584,-7980 Signature Telephone 2.2 Authorized Agent: I .......... m_.... Name(Print) Current Mailing Address Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building Permit Fee i $5,000 00= 2. Electrical mmm µ' (b)Estimated Total Cost of Construction from 6 h ---. 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) _.__._... i 5. Fire Protection 04 4 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-2015-1031 APPLICANT/CONTACT PERSON ONE CONSTRUCTION&DEVELOPMENT ADDRESS/PHONE 68 UNION ST WESTFIELD01085 (413)485-4056 PROPERTY LOCATION 160 CROSS PATH RD-AIRPORT MAP 25 PARCEL 015 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out L Fee Paid Typeof Construction: REPLACE DECK STAIRS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 096240 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9RMATION 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 f Delay Signature of TuildmCOfficial 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. 160 CROSS PATH RD-AIRPORT BP-2015-1031 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 25 -015 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2015-1031 Project# JS-2015-001965 Est. Cost: $5000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ONE CONSTRUCTION & DEVELOPMENT 096240 Lot Size(sy. ft.): 43560.00 Owner: SEVEN BRAVO TWO LLC Zoning: Applicant: ONE CONSTRUCTION & DEVELOPMENT AT. 160 CROSS PATH RD - AIRPORT Applicant Address: Phone: Insurance: 68 UNION ST (413) 485-4056 WESTFIELDMA01085 ISSUED ON:51112015 0:00:00 TO PERFORM THE FOLLOWING WORK.REPLACE DECK 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: 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 5/1/2015 0:00:00 $50.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner