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22B-008 (6)
130 SPRING ST BP-2017-0309 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 22B-008 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 BUILDING PERMIT Permit# BP-2017-0309 Project# JS-2017-000513 Est.Cost: $168000.00 Fee: $2160.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MORTON BUILDINGS INC 099018 Lot Size(sq. ft.): 65775.60 Owner: PEASE THOMAS R&PEGGY-ELLEN Zoning:GI(100),WSP(100)/ Applicant: MORTON BUILDINGS INC AT: 130 SPRING ST Applicant Address: Phone: Insurance: 563 SOUTHAMPTON RD (413) 562-7028 Workers Compensation WESTFIELDMA01085-1329 ISSUED ON:9/8/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT POST FRAME BUILDING SHELL ONLY CONSISTING OF FOOTING, FRAMING & INSULATION FOR AUTO REPAIR 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: FeeTvpe: Date Paid: Amount: Building 9/8/2016 0:00:00 $2160.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner .. Version1.7 Commercial Building Permit May 15.2000 Pr-°- _ Department use only T-� ity of Northampton Status of Permit: :uilding Department Curb Cut/Driveway Permit - - 8 2016 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability DEPT.OF WILDING INSPECTIONS •rthampton, MA 01060 Two Sets of Structural Plans • NORTHAMPTON rv,o1 a'.. • _ , c-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 This section to be completed by office 1.1 Property Address: RA13 7 6f r vt5 - 1 cloy-cal or-cce- r Map Lot Unit Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Ow9 -- -- - ner of Record: + h ) 134 iV-1 i-Ce�r Ftocernee_. Current Mailing Address: Name(Print) _ Signature Telephone _. 2.2 Authorized Aaent: Ao-rizi.x___Bxhic).-13.1 _JA.c.- I543 Sa,,+L►p.� o-✓J _Roj 4C,eici f Name(Print) Current Mailing Address: I yi -ct2 loge' Signature j....:_AK, 1A. Telephone .SECTION 3-ESTIMAT-D CONSTRUCTION COS [Item Estimated Cost(Dollars)to be Official Use Only /\1 completed by permit applicant — 1. Building f .3 p (a)Building Permit Fee 2. Electrical l 0 (b) Estimated Total Cost of 1 UD i� Construction from (6) 3. Plumbing - i,5� ° Building Permit Fee l _ _ At (5)OLD 4. Mechanical(HVAC) A 5.Fire Protection —_.. _-__ 6. Total=(1 +2+3+4+5) i I) 5 ODO Check Number /oyr This Section For Official Use Only Building Permit Number Date Issued Signature: 1. '. 7-7/� Building Commissioner/Inspector of Buildings Date • ' Version 1.7 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 0 New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description Enter a brief desert tion here. �o vis4.*Jd.� Po*-t- Fra,""e l,3 U,icA vi- She,I 0.f Of Proposed Work: %O4.` ;'1G, c -rail ...1...yjr,!(J or ,451/��,-tp✓1 -F6! G.✓-16 r- pMM.t Sho ! P SECTION 5- USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A-1 ❑ A-2 ❑ A-3 0 1A I ❑ A-4 ❑ A-5 ❑ 1 B ❑ B Business ,N1 2A 0 E Educational ❑ 2B I ❑ F Factory ❑ F-1 E F-2 ❑ 2C ❑ H High Hazard 0 3A 0 I Institutional ❑ I-' ❑ 1-2 0 1-3 0 3B 0 M Mercantile 0 4 0 R Residential ❑ R-1 ❑ R-2 ❑ R-3 0 5A 0 S Storage ' S-1 S-2 0 5B 1 U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: i I 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) 1sc .i; tt 2. 2nd 2 3l b- 44_2 ------- – — 49' 4j^ -- _ Total Area (sf) Total Proposed New Construction (sf) Total Height(ft) I I Total Height ft __.,_a I__ b 7.Water Supply (M.G.L.c.40, § 54) 7.1 Flood Zone Information: 7.3 Sewa e Disposal System: RPublic Private 0 Zone Outside Flood Zone MunicipalOn site disposal system El cr- :. . :1Wersionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed .Required by Zoning This column to be tilled in by Building Department Lot Size t/ 4ev-C.S Frontage - -_____. -_.-- dao•.. __._ _ Setbacks Front y d _ Side La i R:- i L:>36% :> R: o _ 1 Rear f. 17s` t " Building Height 21` ` l Bldg.Square Footage % 1g49 - Open Space Footage % (Lot area minus bldg&paved i I t .__A _- -- parking) #of Parking Spaces Fill: AVA 1 (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES jg IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? 6 NO O DONT KNOW 0 YES IF YES: enter Book . Pagel and/or Document#' • B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW O YES o IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained © , Date Issued: C. Do any signs exist on the property? YES NO O IF YES, describe size, type and location: i3J.)ol.✓*A) 4ee.L.t.r) D. Are there any proposed changes to or additions of signs intended for the property? YES O NO la 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 O NO tR IF YES,then a Northampton Storm Water Management Permit from the DPW is required. I 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: D0„A'C �JpeA Not Applicable Name(Registrant): 3oc7q 3-- aA ,, ,,,f Registration Number Address "'3 l- 16 4Gf_ P1Av15 301_243^G300 Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): .P ,,k . eaf-,yl t C<< --- 5}r•vc l NameArea of Responsibility 252,_.Desk.-_ _Ada, 5 54 4or+O r, / 11, 1 'III;?1 Address Registration Number .ee. Pi avis 30-1-40-40-$ I G-30'11 Signature Telephone Expiration Date NameArea of Responsibility Address Registration Number F Signature Telephone Expiration Date - -- — _ Name Area of Responsibility i AddressRegistration Number _ Signature Telephone Expiration Date _ Name Area of Responsbility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor — _ . Not Applicable 0 Company Name:-- . ________-,-._. _________.__--________-._s.____ Responsible In Charge of Construction Address Signature Telephone Version 1.7 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 x I, (1"} A . , as Owner of the subject property hereby authorize fi/D,^a'oi✓►_.-. 015 / act on my be f, in all ma ers relative to work authorized by this building permit application. $ -.3 t7 . 0t® /6 Signature of Owner Date n I, - Ce _ �t{S ��— , 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 u er the pai and_penalties of perjury. Print Name -37 2_1/4361 Signature of Owner/Agent Date SECTION 12 -CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor. Not Applicable ❑ Name of License Holder:._."r�" 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 No 0 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: /30 1)),.:^5 S1., clw.cotz., 4tq The debris will be transported by: �,,,.y, Oje�-G 0:51006c11 The debris will be received by: Co,1101,A-c nA44aewi,4-1- f S /34rc-roo4 Rd . sov+ti ham,o�ec ,/''1 Building permit number: Name of Permit Applicant Date Signature of Permit Applicant The Commonwealth of Massachusetts P a+„' _6p, Department of Industrial Accidents I_ 1 Congress Street,Suite 100 ! Boston,MA 02114-2017 www tnass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WI'rll l`iiE PFRMIrriNG AUTHORITY. Applicant Information Please Print Leribty Name(Bosines iorganiz.ationllndividual):Morton Buildings,Inc. Address:252 W.Adams City/State/Zip:Morton, IL 61550 Phone#:309-263-7474 Are you an employer?('Berk tie appropriate toric Type of project(required): 36 1.0 I am a employer with 16 _employe (full and/or part-time).' 7. New construction 2.0 am a sok proprietor or partnership and have no employees ployees working for me in 8. ❑ Remodeling any capacity.INoworkers'comp insurance required] 9. ❑Demolition i.O t am a honeo caner doing all work myself Ido workers'comp.iusumixc required.j t 10 [] Building addition 4.❑I ant a hcrneowrter and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation nrsuanec or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.D Plumbing repairs or additions 50 I amt a general contractor and I have hired the sub-contractors listed on the attached sheet. 13 Roof repairs These sub-contractors have employees and have workers'comp.insurance; G.❑We arc a corporation and its offices have exercised their right of exemption per WI.c 14.❑Other • --_- 152.;1141.and we have no employees.INo workers comp.insurance required 1 *Any applicant that checks box 41 maw also till out the section below showing their workers'compensation policy information. t I lonteownees%knot submit this affidavit indicating they:rue doing all work and then hire outside contractors must submit a new affidavit indicating such. :C'on tra:tors that check thus box must attached an additional sheet showing the tame 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:Zurich American Insurance Companuy Policy#or Self-ins.Lic.#:WC937631212 Expiration Date:10/1116 Job Site Address: 130 Spring St City/State(?_ip:_Florence,MA 01062 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required tinder MGL c. 152,§25A is a criminal violation punishable by 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 tip to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify,wterthe pains and penalliiee f perjwy that the information provided above ' true/ and correct. / Si nate • . T. C+ s. _ Date: WA( I)u' Phone ii:309-263-7474 Official use only. Uo not write in this urea,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other •ontact Person: Phone#: — n A a® CERTIFICATE OF LIABILITY INSURANCE DATE;rrwDC;riv C511.;20-E THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on >m this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). c PRODUCER CONTACTNAL AOn Risk Services Central, Inc. PHO1E (866) 283-7122 FAX (800) 363-0105 m Chicago IL office (IUC.No.Est): WC.Ne.): -o 200 East Randolph EMAIL p Chicago IL 60601 LISA ADDRESS: M INSURER(S)AFFORDING COVERAGE NAIC$ INSURED INSURER A: Zurich American Ins Co 16535 Morton Buildings, Inc. INSURER B: American Zurich Ins Co 40142 252 west Adams Street Morton IL 61550 USA INSURER C: Great American Insurance Company of NY 22136 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570062549221 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 AU. THE TERMS. EXCWSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested INSR ADDL"SUBK POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IVSD MD POLICY NUMBER (MMIDD/TYY INDINYYYY) LIMITS A X COMMERCIAL GEHERALLIABILITY GLo937631812 10/01/2015 10/01/2016 EACH OCCURRENCE 52,000,000 DAMAGE TO RENTED CLAIMS-MADEri OCCUR PREMISES;Ea ccarencel $1,000,000 MED EXP(Any one person) 550,000 PERSONAL B ADV INJURY S1,000,1)00 r;, GENL AGGREGATE UNIT APPUES PER GENERAL AGGREGATE $2,000,000 W JPOLICY 7UE� Ei LOC PRODUCTS-COMP/CPAGG Excluded ,,T —tl OTHER S A AUTOMOBLE LIABILITY BAP 9376314 12 10/01/2015 10/01/2016 COMBINED SINGLE UMIT N (Ea acodenll S2,000,000 X ANY AUTO EMILY INJURY(Per oersnn) 0 Z — OWNED —SCHEDULED EOOILY INJURY(Per accident) to _AUTOS ONLY AUTOS re PROPERTY DAMAGE a _, X HIRED AUTOS X NON-OWNED ONLY , AUTOS ONLY S - P^r accident) a a C X Um3REA LIAB ' LLX OCCUR m34223218 10/01/2015 10/01/2016 EACH OCCURRENCE 52,000,000 U _~ umbrella Liability AGGREGATE $2,000,000 EXCESS LIAB CLAIMS-MADE SIR a lies pp per policy terns & condiTions DED I x 'RETENTION B WORKERS RSCOM LIABILITY Y!N AO37631112 10/01/2015 10/01/2016 x IVARTUTE I Ir - EMPLOYERS' ANY PROPRIETOR!PARTNER/EXECUTIVE E:.EACH ACCIDENT 51,000,000 A OFF CERAEMEEREXCLUDED' a NIA WC937631212 10/01/2015 10/01/2016 (Mandatory In NH) Retro-WI, MA, Excl OH E.L.DISEASE-EA EMPLOYEE 51,000,000 II res,describe under D=SCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 51,000,000— IN AI- DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101.Additional Remarks Schedule.may be attached If more space Is required) ate a-- EL.; .z.._- ."! ,I .k.-X --6..; L naps CERTIFICATE HOLDER CANCELLATION 4.-s SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. r+' AUTHORIZED REPRESENTATIVE Il r..J�O7b a` GdQe�ifit4EeG WWP eJ yiQ iggi 01988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Massachusetts - Department of Public Safety Boarb or Buiiaing s=ceguiations and Standards 1.1)11111 UI .)U1/e1 v'IM)I »- _ License: CS-099018 •`` tel. .ti ` CRAIG S ULIASZ:` 3 g ARTLAND RD �4t •� 1 `.�..G... J� JIM Expiration Commissioner 06/27/2017