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32A-123 (7) V City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: 63 SAm-T The debris will be transported by: RSSoc-m .p The debris will be received by: Building permit number: Name of Permit Applicant kooas �Ory"VUI �wG. -��� '� �JpJ►.F � Date Signature of Permit Applicant Project Title: Pure Barre- King Street Report date: 08/12/15 Data filename: D:\2015 Physical Year\15-A090 Pure Barre- King Street-Northampton, Massachusetts\15-A09( Page 12 of 12 2012 IECC COMCheck.cck 2012IECC Final Inspection Complies? Comments/Assumptions C405.5.2 Interior installed lamp and fixture ❑Complies See the Interior Lighting fixture schedule for values. [F118]1 lighting power is consistent with what ❑Does Not is shown on the approved lighting plans, demonstrating proposed watts ❑Not Observable' are less than or equal to allowed ❑Not Applicable watts. C408.2.1 Commissioning plan developed by ❑Complies Requirement will be met. [F128]1 registered design professional or ❑Does Not approved agency. ❑Not Observable; ❑Not Applicable C408.2.4 Preliminary commissioning report ❑Complies Requirement will be met. [F129]1 completed and certified by registered ❑Does Not design professional or approved ❑ agency. Not Observable'. ❑Not Applicable C408.2.5. Final commissioning report due to ❑Complies Requirement will be met. 4 building owner within 90 days of ❑Does Not [17130]1 receipt of certificate of occupancy. ❑Not Observable ❑Not Applicable C408.2.3. HVAC equipment has been tested to ❑Complies Requirement will be met. 1 ensure proper operation. ❑Does Not [F131]1 ❑Not Observable' ❑Not Applicable C408.2.3. Economizers have been tested to ❑Complies Requirement will be met. 3 ensure proper operation. ❑Does Not [F132]1 ❑Not Observable' ❑Not Applicable C408.3 Lighting systems have been tested to ❑Complies 'Requirement will be met. [17133]1 ensure proper calibration,adjustment, ❑Does Not programming, and operation. ❑Not Observable ❑Not Applicable C406 Efficient HVAC performance, efficient ❑Complies Requirement will be met. [F134]1 lighting system, or on-site supply of ❑Does Not renewable energy consistent with what is shown the approved plans. ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: �1�High Impact(Tier 3 o Impact(Tier 3) Project Title: Pure Barre-King Street Report date: 08/12/15 Data filename: D:\2015 Physical Year\15-A090 Pure Barre-King Street- Northampton, Massachusetts\15-A09( Page 11 of 12 2012 IECC COMCheck.cck 2012IECC Final Inspection Complies? Comments/Assumptions C403.2.4. Heating and cooling to each zone is ❑Complies Requirement will be met. - 2 controlled by a thermostat control. ❑Does Not [F147]3 Minimum one humidity control device ❑Not Observable per installed humidification/dehumidification ❑Not Applicable system. C403.2.4. 'Thermostatic controls have a 5 °F ❑Complies Requirement will be met. 2 deadband. ❑Does Not [F138]3 ❑Not Observable'. ❑Not Applicable C403.2.4. 'Temperature controls have setpoint [ Complies Requirement will be met. 2 overlap restrictions. ❑Does Not [F120]3 ❑Not Observable ❑Not Applicable C403.2.4. Each zone equipped with setback ❑Complies Requirement will be met. 3 controls using automatic time clock or ❑Does Not [F139]3 programmable control system. ❑Not Observable ❑Not Applicable C403.2.4. Automatic Controls: Setback to 55°F ❑Complies Requirement will be met. ' 3 (heat)and 85°F (cool); 7-day clock, 2- ❑Does Not [F140]3 hour occupant override, 10-hour ❑Not Observable backup ❑Not Applicable C408.2.5. Furnished HVAC as-built drawings ❑Complies Requirement will be met. 1 submitted within 90 days of system []Does Not [F1713 acceptance. ❑Not Observable ❑Not Applicable C303.3,C4 Furnished O&M manuals for HVAC ❑Complies Requirement will be met. 08.2.5.2 systems within 90 days of system ❑Does Not [F18]3 acceptance. ❑Not Observable ❑Not Applicable C408.2.5. An air and/or hydronic system ❑Complies Requirement will be met. 3 balancing report is provided for HVAC ❑Does Not [FI43]1 systems. ❑Not Observable ❑Not Applicable C408.2.3. HVAC control systems have been ❑Complies Requirement will be met. 2 tested to ensure proper operation, ❑Does Not [FI10]1 calibration and adjustment of controls. '❑Not Observable'. ❑Not Applicable C403.2.2 HVAC systems and equipment ❑Complies Requirement will be met. [F]27]3 capacity does not exceed calculated ❑Does Not loads. ❑Not Observable ❑Not Applicable C408.2.5. Furnished as-built drawings for ❑Complies Requirement will be met. - 1 electric power systems within 30 days ❑Does Not [FI16]3 of system acceptance. ❑Not Observable ❑Not Applicable C303.3,C4!Furnished O&M instructions for ❑Complies Requirement will be met. 08.2.5.2 systems and equipment to the ❑Does Not [F117]3 building owner or designated []Not Observable representative. '❑Not Applicable 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Pure Barre-King Street Report date: 08/12/15 Data filename: D:\2015 Physical Year\15-A090 Pure Barre-King Street-Northampton, Massachusetts\15-A09( Page 10 of 12 2012 IECC COMCheck.cck High Impact(Tier 1) ��Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Pure Barre-King Street Report date: 08/12/15 Data filename: D:\2015 Physical Year\15-A090 Pure Barre-King Street-Northampton, Massachusetts\15-A09( Page 9 of 12 2012 IECC COMCheck.cck 2012 IECC Rough-in Electrical Inspection Complies? Comments/Assumptions C405.2.2. Automatic controls to shut off all ❑Complies Exception: Lighting controlled by occupancy sensors. J- 1 building lighting installed in all ❑Does Not [EL22]2 buildings. ❑Not Observable ❑Not Applicable C405.2.1. Independent lighting controls installed ❑Complies Requirement will be met. 1 per approved lighting plans and all ❑Does Not [EL23]2 manual controls readily accessible and ❑Not Observable visible to occupants. ❑Not Applicable C405.2.1. Lighting controls installed to uniformly ❑Complies Requirement will be met. 2 reduce the lighting load by at least ❑Does Not [EL15]1 50%. ❑Not Observable ❑Not Applicable C405.2.2. Daylight zones provided with ❑Complies Exception: Requirement does not apply. 3 individual controls that control the ❑Does Not [EL16]2 lights independent of general area ❑Not Observable lighting. ❑Not Applicable C405.2.3 Sleeping units have at least one ❑Complies Exception: Requirement does not apply. [EL17]3 master switch at the main entry door ❑Does Not that controls wired luminaires and 'switched receptacles. ❑Not Observable ❑Not Applicable C405.2.2. Occupancy sensors installed in ❑Complies Requirement will be met. 2 required spaces. ❑Does Not [EL18]1 ❑Not Observable ❑Not Applicable C405.2.2. Primary sidelighted areas are ❑Complies Exception: Requirement does not apply. 3 equipped with required lighting ❑Does Not [EL20]1 controls. ❑Not Observable' ❑Not Applicable C405.2.2. Enclosed spaces with daylight area ❑Complies Exception: Requirement does not apply. 3 under skylights and rooftop monitors ❑Does Not [EL21]1 are equipped with required lighting ONot Observable controls. ❑Not Applicable C405.2.3 Separate lighting control devices for ❑Complies Requirement will be met. [EL4]1 specific uses installed per approved ❑Does Not lighting plans. ❑Not Observable ❑Not Applicable C405.3 Fluorescent luminaires with odd ❑Complies Exception: Requirement does not apply. [EL19]3 numbered lamp configurations that ❑Does Not are with 10 feet center to center(if recess mounted) or are within 1 foot ❑Not Observable' edge to edge (if pendant or surface ❑Not Applicable mounted)shall be tandem wired. C405.4 Exit signs do not exceed 5 watts per ❑Complies Requirement will be met. [EL6]1 face. []Does Not ❑Not Observable' ❑Not Applicable C405.2.3 Additional interior lighting power ❑Complies Requirement will be met. [EL8]1 allowed for special functions per the ❑Does Not approved lighting plans and is automatically controlled and ❑Not Observable separated from general lighting. ❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact{Tier 2) 3�Low Impact(Tier 3) '� Project Title: Pure Barre-King Street Report date: 08/12/15 Data filename: D:\2015 Physical Year\15-A090 Pure Barre-King Street-Northampton, Massachusetts\15-A09( Page 8 of 12 2012 IECC COMCheck.cck Section Mechanical Rough-In Plans Verified Field Verified # Inspection 9 Value Value Complies? Comments/Assumptions & Req.ID C403.4.7 Hot gas bypass limited to: <=240 ❑Complies Requirement will be met. [ME3511 kBtu/h-50% >240 kBtu/h -25% ❑Does Not ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 1�High Impact(Tier 1)� r2�Medium Impact(Tier 2) �3 Low Impact(Tier 3) Project Title: Pure Barre-King Street Report date: 08/12/15 Data filename: D:\2015 Physical Year\15-A090 Pure Barre-King Street- Northampton, Massachusetts\15-A09C Page 7 of 12 2012 IECC COMCheck.cck Section Mechanical Rough-in Plans Verified Field Verified # Inspection Value Value Complies? Comments/Assumptions & Req.ID C403.2.3 HVAC equipment efficiency Efficiency: Efficiency: ❑Complies See the Mechanical Systems list [ME55]2 verified. ❑Does Not for values. ❑Not Observable ❑Not Applicable C403.2.5. Demand control ventilation ❑Complies Exception: Systems with 1 provided for spaces >500 ft2 and ❑Does Not design outdoor air of less [ME59]1 >25 people/1000 ft2 occupant than 1200 cfm. density and served by systems ❑Not Observable with air side economizer, auto ❑Not Applicable modulating outside air damper control, or design airflow >3,000 cfm. C403.2.7 HVAC ducts and plenums R- R- ❑Complies Requirement will be met. [ME60]2 insulated. Where ducts or ❑Does Not plenums are installed in or under a slab, verification may need to ❑Not Observable occur during Foundation ❑Not Applicable Inspection. C403.238 Thermally ineffective panel ❑Complies Requirement will be met. [ME41] surfaces of sensible heating ❑Does Not panels have insulation >= R-3.5. ❑Not Observable ❑Not Applicable -- - —.. ..._.......... .......... — C403.2.7 Ducts and plenums sealed based ❑Complies Requirement will be met. [ME10]2 on static pressure and location. ❑Does Not ❑Not Observable ❑Not Applicable C403.2.7. Ductwork operating >3 in. water ❑Complies Requirement will be met. 1.3 column requires air leakage [ME11]3 testing. ❑Does Not ❑Not Observable ❑Not Applicable C403.3.1, Air economizers provided where ❑Complies Requirement will be met. C403.3.1. required, meet the requirements ❑Does Not 1 for design capacity, control [ME62]1 signal, ventilation controls, high- ❑Not Observable limit shut-off, integrated ❑Not Applicable economizer control, and provide a means to relieve excess outside air during operation. C408.2.2 Air outlets and zone terminal ❑Complies Requirement will be met. 1 devices have means for air [ME53]3 balancing. ❑Does Not ❑Not Observable ❑Not Applicable C403.4.2 VAV fan motors >=7.5 h to be ❑ VSD ❑ VSD 2 P ❑Complies Exception: Requirement [ME66] driven by variable speed drive, ❑ Vane axial ❑ Vane axial ❑Does Not does not apply. have a vane-axial fan with fan fan variable pitch blades, or have ❑ Other ❑ Other ❑Not Observable controls to limit fan motor []Not Applicable demand. Exhaust air energy recovery on ❑Complies -- -- - [ME57]1 systems meeting Table C403.2.6 ❑Does Not ❑Not Observable ❑Not Applicable C403.2.11 Unenclosed spaces that are ❑Complies Exception: Requirement [ME71]2 heated use only radiant heat. ❑Does Not does not apply. ❑Not Observable ❑Not Applicable 1 High Impact(Tier 1) --� 2 (Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Pure Barre-King Street Report date: 08/12/15 Data filename: D:\2015 Physical Year\15-A090 Pure Barre-King Street- Northampton, Massachusetts\15-A09( Page 6 of 12 2012 IECC COMCheck.cck 2012 IECC Footing/;Foundation Inspection Complies? Comments/Assumptions C403.2.4. Freeze protection and snow/ice ❑Complies Exception: Requirement does not apply. 5 melting system sensors for future []Does Not [FO913 connection to controls. ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 1 r igh Impact(Tier 1) � 2 Medium Impact(Tier 2) � 3 Low Impact(Tier 3) Project Title: Pure Barre- King Street Report date: 08/12/15 Data filename: D:\2015 Physical Year\15-A090 Pure Barre-King Street-Northampton, Massachusetts\15-A09( Page 5 of 12 2012 IECC COMCheck.cck COMcheck Software Version 4.0.0 Inspection Checklist Energy Code: 2012 IECC Requirements: 100.0% were addressed directly in the COMcheck software Text in the "Comments/Assumptions" column is provided by the user in the COMcheck Requirements screen. For each requirement, the user certifies that a code requirement will be met and how that is documented, or that an exception is being claimed. Where compliance is itemized in a separate table, a reference to that table is provided. 2012 IECC Plan Review Complies? Comments/Assumptions C103.2 Plans, specifications,and/or ❑Complies Requirement will be met. [PR211 calculations provide all information ❑Does Not with which compliance can be ❑Not Observable determined for the mechanical systems and equipment and ❑Not Applicable document where exceptions to the standard are claimed. Load calculations per acceptable engineering standards and handbooks. C103.2 Plans, specifications, and/or ❑Complies Requirement will be met. [PR4]1 calculations provide all information ❑Does Not with which compliance can be determined for the interior lighting []Not Observable and electrical systems and equipment ❑Not Applicable and document where exceptions to the standard are claimed. Information provided should include interior lighting power calculations, wattage of bulbs and ballasts, transformers and control devices. Additional Comments/Assumptions: JL 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Pure Barre-King Street Report date: 08/12/15 Data filename: D:\2015 Physical Year\15-A090 Pure Barre-King Street-Northampton, Massachusetts\15-A09( Page 4 of 12 2012 IECC COMCheck.cck COMcheck Software Version 4.0.0 Mechanical Compliance Certificate Project Information Energy Code: 2012 IECC Project Title: Pure Barre- King Street Location: Northampton, Massachusetts Climate Zone: 5a Project Type: Alteration Construction Site: Owner/Agent: Designer/Contractor: 63 King Street Elizabeth Rogers Kyle Henry Northampton, MA 01060 PB Fitness of Western Gerald P. Noe,Architect Massachusetts 399 Lucerne Drive 7 Fox Run Spartanburg, SC 29302 Easthampton, MA 01027 864.583.2215 ext.473 khenry @gpnarcht.com Mechanical Systems List Quantity System Type&Description 1 RTU-1 (Single Zone): Heating:1 each-Central Furnace,Gas,Capacity=150 kBtu/h Proposed Efficiency=82.00%Et,Required Efficiency=80.00%Et Cooling: 1 each-Single Package DX Unit,Capacity=94 kBtu/h,Air-Cooled Condenser,Air Economizer Proposed Efficiency=11.20 EER,Required Efficiency=11.00 EER Fan System: None Mechanical Compliance Statement Compliance Statement: The proposed mechanical alteration project represented in this document is consistent with the building plans, specifications,and other calculations submitted with this permit application.The proposed mechanical systems have been designed to meet the 2012 IECC requirements in COMcheck Version 4.0.0 and to comply with the mandatory requirements listed in the Inspection Checklist. -2 g�_ u1'.E� Name-Title f Sigryat re Date Project Title: Pure Barre- King Street Report date: 08/12/15 Data filename: D:\2015 Physical Year\15-A090 Pure Barre- King Street-Northampton, Massachusetts\15-A09( Page 3 of 12 2012 IECC COMCheck.cck A B C D E Fixture ID : Description/Lamp/Wattage Per Lamp!Ballast Lamps/ #of Fixture (C X D) Fixture Fixtures Watt. Track lighting 1:T-8: Wattage based on current limiting device capacity 0 0 45 45 Track lighting 1:T-8: Wattage based on current limiting device capacity 0 0 45 45 Track lighting 1:T-8: Wattage based on current limiting device capacity 0 0 45 45 Total Proposed Watts= 1818 Interior Lighting Compliance Statement Compliance Statement: The proposed interior lighting alteration project represented in this document is consistent with the building plans,specifications, and other calculations submitted with this permit application.The proposed interior lighting systems have been designed to meet the 2012 IECC requirements. COM heck Version 4.0.0 and to comply with the mandatory requirements listed in the Inspection Checklist. / 4/ter A. kr 7l -�--- Name-Title Si nature Dat Project Title: Pure Barre-King Street Report date: 08/12/15 Data filename: D:\2015 Physical Year\15-A090 Pure Barre-King Street-Northampton, Massachusetts\15-A09( Page 2 of 12 2012 IECC COMCheck.cck COMcheck Software Version 4.0.0 Interior Lighting Compliance Certificate Project Information Energy Code: 2012 IECC Project Title: Pure Barre-King Street Project Type: Alteration Construction Site: Owner/Agent: Designer/Contractor: 63 King Street Elizabeth Rogers « Kyle•Henry Northamp26n,M 4060 PB Fitnesf,of-Weptern _• ,±Gqrald P! Nod;Art?aitec't Massachusetts 399 Lucerne Drive 7 Fox Run Spartanburg, SC 29302 Easthampton, MA 01027 864.583.2215 ext. 473 khenry@gpnarcht.com Allowed Interior Lighting Power A B C D Area Category Floor Area Allowed Allowed Watts (f t2) Watts/ft2 (B X C) 1-Gymnasium/fitness center:Fitness area 1041 0.90 937 2-Retail:Sales area 926 1 .60 1482 Total Allowed Watts= 2419 Proposed Interior Lighting Power q B C D E Fixture ID : Description/Lamp/Wattage Per Lamp/Ballast Lamps/ #of Fixture (C X D) Fixture Fixtures Watt. Gymnasium/fitness center'Fitness area(1041 sq.ft.) Linear Fluorescent 1:A:46"T5 28W:Electronic: 3 2 84 168 Incandescent 1:C:Incandescent 60W: 1 9 60 540 Track lighting 1:T-8: Wattage based on current limiting device capacity 0 0 45 45 Track lighting 1:T-8: Wattage based on current limiting device capacity 0 0 45 45 Track lighting 1:T-8: Wattage based on current limiting device capacity 0 0 45 45 Track lighting 1:T-8: Wattage based on current limiting device capacity 0 0 45 45 Track lighting 2:T-4: Wattage based on current limiting device capacity 0 0 45 45 Track lighting 2:T-4: Wattage based on current limiting device capacity 0 0 45 45 Track lighting 2:T-4: Wattage based on current limiting device capacity 0 0 45 45 Track lighting 2:T-4: Wattage based on current limiting device capacity 0 0 45 45 Retail'Sales area(926 sq.ft.) Incandescent 2:D:Incandescent 10OW: 1 3 100 300 Track lighting 1:T-8: Wattage based on current limiting device capacity 0 0 45 45 Track lighting 1:T-8: Wattage based on current limiting device capacity 0 0 45 45 Track lighting 1:T-8: Wattage based on current limiting device capacity 0 0 45 45 Track lighting 1:T-8: Wattage based on current limiting device capacity 0 0 45 45 Track lighting 1:T-8: Wattage based on current limiting device capacity 0 0 45 45 Track lighting 1:T-8: Wattage based on current limiting device capacity 0 0 45 45 Track lighting 1:T-8: Wattage based on current limiting device capacity 0 0 45 45 Project Title: Pure Barre- King Street Report date: 08/12/15 Data filename: D:\2015 Physical Year\15-A090 Pure Barre- King Street- Northampton, Massachusetts\15-A09( Page 1 of 12 2012 IECC COMCheck.cck Massachusetts F�a sent of ? ,';c Safety, I1 S7C'T 5 1 Board of B:;i'.ding R2;�,ta ions .ind Standara g a� Contitrut'hon SuperN tNor OF License. CS-006892 JOSEPH P PAND(JLFQ;,, x 3 MEADOWCROFT RIB z a� Burlington MA 01803 �XPirati�°. 03/0812016 t s ooAa-y�z6taRe7��o�Ga � �( -omrnor)wealth of Massacf!usetts ��f! epar*r?�eni of Publfc Safety O_ fficeofConsumerAffairs&BusinessRegulation lloistint Engineer f°HOMEIMPROVEMENTCONTRACTOR Registration: 113748 Type: License: HE-047230 Expiration: 7/14/2017 Private Corporation JOSEPH P PANVO PANDOLFO CO INC 3 MEADOWCROF Burlington MA7018 JOSEPH PANDOLFO 3 MEADOWCROFT RD )t tit BURLINGTON,MA 01803 Undersecretary ���r issioner 03/08/2016 PANDO-2 OP ID: LH Aco�o CERTIFICATE OF LIABILITY INSURANCE DATE 12 0/201 5Y) 01120/2015 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). CONTACT PRODUCER Phone:978-433-2728 NAME, Brown&Brown(Pepperell) PHONE - —_- FAX _-- - P.O.Box 1497 Fax:866-848-6097 A/C No,ExtL— —-------- ILC Nof: Pepperell,MA 01463 ADDRESS_: BB of Hartford(DM) - — - - --- -T -- INSURERIS)AFFORDING COVERAGE _ _ NAIC# INSURER A:Acadia Insurance Company____ _ INSURED Pandolfo Company, Inc. INSURER B:Continental Western Ins CO ,10804 PO ox 1068 Buurlington,MA 01803-1019 INSURER C: 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. INSRI TYPE OF INSURANCE 'ADOL SUER POLICY NUMBER MMIODYIYYYY MM/DDlYYYY LIMITS LTR B X COMMERCIAL GENERAL LIABILITY iCPA01 OO2HO-21 01/01/2015 EACH OCC0RR ENCE $ 1000,00 GENERAL LIABILITY ! _ DAMAGE T012ENTECJ 01/0112016 PREMISES LEa occurrence +$ 250+00 CLAIMS MADE X"OCCUR L MED EXP(Any one persoTAGG $ 10,00 PERSONAL 8 ADV INJU 1,000,00 I-- - 2,000,00 GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS COMPI_OP 2,000,00 X POLICY PRO- LOC Emp Ben. 1,000,00 AUTOMOBILE LIABILITY COMBINED $ SINGLE LIMIT 1,000,00 ��a accidentj_ _ _ A ANY AUTO IMAA0100281-21 01/01/2015 01101/2016 BODILY INJURY(Per person) $ ALL OWNED !! X SCHEDULED BODILY INJURY(Per accident) $ AUTOS f;-X-]AUTOS ---- NON-OWNED PROPERTY — PERTY DAMAGE $ X HIRED AUTOS LX AUTOS Peraccid_enl-_ _ —_._— 1 $ X UMBRELLA LIAB X I OCCUR [AGGREGATE OCCURRENCE $ 6+000,00 A EXCESS _ CLAIMS-MADE ICUA0100283-21 01/01/2015 01/01/20161 AGGREGATE -- $ 6,000+00 TENTION$ 0 $ DED X�-RE-- �--- _ WORKERS COMPENSATION WC STATU- OTH- ANDEMPLOYERS'LIABILITY X QY LIMIT ER A Y WCA0100284-21 01/01/2015 01/01/2016 EACH ACCIDENT $ 500+00 ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ _ 500,00 If yes,describe under 500,00 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Equipment CPA0100280-21 01/01/2015 01/01/2016 Leased 25,00 Ded. 1,00 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION TBURLIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE -44 4e- ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD City of Northampton Massachusetts mod- DEPARTMENT OF BUILDING INSPECTIONS ; _ 212 Main Street + Municipal Building ' Northampton, Mh 01060 .iN A1E(,`1'f R Louis Hasbrouck Fax: 413-587-1272 Chuck Miller Building Commissioner Phone: 413-587-1240 Assistant Commissioner CONSTRUCTION CONTROL DOCUMENT (For professional Engineers/Architects responsible for Entire Project) Project Title: f" v t _. Y. t Date: _ ,0 Project Location: 6"—et Map: Parcel: Zone: Scope of Project: < elee ll'F �"' (I .,, ,�- In accordance with the Eighth edition Massachusetts State Building Code, 780 CMR Section 107.6: Mass. Registration# l ' Being a registered professional Engineer/Architect hereby CERTIFIES that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [ I ENTIRE PROJECT For the above named project and that to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable Laws for the proposed project. Furthermore, I understand and AGREE that I shall perform the necessary professional services to determine that the above mentioned portions of the work proceed in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 10.7.6.2.2: 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction documents as submitted for the building permit, and approval for the conformance to the design concept. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine, in general, if the work is being performed In a matter consistent with the construction documents. I shall submit periodically, in a form acceptable to the building official, a progress report together with pertinent comments. Upon completion of the work, I shall submit to the building official a final report as to the satisfactory completion and readiness of the project for occupancy. 41" Signature and Seal of egistered Professional ;gay of /cam z 20 / f' (feat) .e^ a 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): Address: 90 b0 X /1061 City/State/Zip: &�O TC)�, ft, 0.1503 Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.E�'I am a employer with 110 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ 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 g, ❑ Demolition working or me in an capacity. employees and have workers' g Y p n'• 9. E] Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.E] 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#I 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. Ifthe 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: Policy#or Self-ins.Lic.#: Expiration Date: 01' a1 D CJ 1a Job Site Address: City/State/Zip: -gTO6 , rro f\ , o-1060 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 Gerd y uner th pains a penalties of perjury that the information provided above is true and correct. Si nature: JI'. Date: Phone# 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): L 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 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 of W [ on-, - 01" V of w oj�I1 J to act on be laNn all atters r tive to work authorized by this building permit application. UO ` � �� . Signature of Owner Date t MO(M 60 _ 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 pai an p alties of perjury. Print N e Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: . �. cs--00060�a License Number Address Expiration Date Sign ure Telephone SE ION 1 -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 q 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) 9.11/��Registered /�Architect: rr 1� -V Y• 00K Not Applliiccaablle ❑ Name(Registrant) 31 A 1 6 �r bd, Z i 1 3 V� Registration Number Address ",6 J 3:11-16, U 5p•3 2x15 Expiration Date Signature (� Telephone 9.2 Registered Professional Engineer(s): 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 Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor C�t� ►-� 1A1',mo i lot Not Applicable ❑ Company Name: (� I', ZL uKPAaGuf Auga��c�cJr�P tJ!.G�r� Responsible In Charge of Construction Address q Sign t re V V V Telephone 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 ErAdditions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description Enter a brief description here. Of Proposed Work: ..r .t.u v��zo� SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ,,f A-1 ❑ A-2 ❑ A-3 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ,❑,/ E Educational ❑ 2B LrJ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ I-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 } St 3' l J 2 2nd nd _ 3`d 3 rd 4 t 4tn Total Area(sf) �) Total Proposed New Construction (sf) 411 c Total Height(ft) � �- b 14 Total Height ft 7.Water Supply(M.G.L.c.40, §54) 7.1 Flood Zone Information: 7.3 Sewage isposal System: Public [� Private ❑ Zone Outside Flood Zone[ Municipal [ On site disposal system❑ Versionl.7 Commercial Building Permit May 15,2000 � Department use only D (� City of Northampton stat Building Department Curb - U 2 8 2015 212 Main Street Sew tic Availability_ Room 100 wat I Electric, Plumbing&Gus Inspections Northampton, MA 01060 Two ets f Structural Plans Northampton, ^�,et 13-587-1240 Fax 413-587-1272 Plot/ h>rtflumb &Gas►nsoectialls ham on,MA 01060 Oth 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 K-T Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 0 i Nt rr�PTO I _ G oc;t ( TZv $ IJK coo C, K��1 S C -- 0o ht\Tvq V60 >r� Name(Print) �u�aFz=L� �o������zv�r 13AIA K Current Mailing Address: \-UczL�.E F' GCROK (A '13 441�t Signature Telephone 2.2 Authorized Agent: / Fj\uQ)LV 10_ PJ � _ 'l�fry`� Name(Print) Current Mailing Address: Signature lnoelsl -� ►� `>.FO t., �1'!.( o fy-\ SECTION 3 STIMA ED CONSTRUCT N COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building {� / C (a) Building Permit Fee 2. Electrical {{ lfl J (b) Estimated Total Cost of 1,V Jl� Construction from 6 3. Plumbing �,� Building Permit Fee 4. Mechanical (HVAC) 7edd �� ��� OJ�-� 0,d 5. Fire Protection --' d 00.0 6. Total= 0 +2+3+4+ 5) '11 0 0 Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date 63 KING ST BP-2016-0318 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A- 123 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-2016-0318 Project# JS-2016-000511 Est. Cost: $115000.00 Fee: $805.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin: Pandolfo Company, Inc. 6892 Lot Size(sq. ft.): 24001.56 Owner: NORTHAMPTON CO-OPERATIVE BANK Zoning: CB(100)/ Applicant: Pandolfo Company, Inc. AT: 63 KING ST Applicant Address: Phone: Insurance: P O BOX 1068 (617) 908-1227 O WC BURLINGTONMA01803 ISSUED ON.911412015 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONVERT TO YOGA STUDIO 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 9/14/2015 0:00:00 $805.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner