13-073 (24) 25 COLES MEADOW RD BP-2017-1140
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mart:Block: 13-073 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE
GUARANTY
D(FUND (MGL c.1144(2�A)�■T
Category:renpvation
BUILDING PERMIT
I
Permit# BP-2017-1140
Project# JS-2017-001934
Est.Cost:$28000.00
Fee:$196.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Gronp WILLIAM J HARNUM 102199
Lot Size(sq. ft.): 501462.72 Owner: NEW ENGLAND DEACONESS ASSOC
Zoning: Applicant WILLIAM J HARNUM
AT: 25 COLES MEADOW RD
Applicant Address: Phone: Insurance:
53 METZYER PLACE (413) 519-3593 VAC
SPRI NGFI E LDMA01104 ISSUED ON:4/1212017 0:00:00
TO PERFORM THE FOLLOWING WORK:TURN EXISTING MULTI PURPOSE ROOM INTO
2 ROOMS, ONE INTO A COMPUTER ROOM THE OTHER INTO A SALON. ALSO TURN EXISTING
ACTIVITIES ROOM INTO 3 ROOMS, TURN EXISTING SHOWER ROOMS INTO RESTROOMS
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 4/12/2017 0:00:00 $196.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Buiidine Commissioner
File#BP-2017-I 140
APPLICANT/CONTACT PERSON WILLIAM J HARNUM
ADDRESS/PHONE 53 METZYER PLACE SPRINGFIELD (413)519-3593
PROPERTY LOCATION 25 COLES MEADOW RD
MAP 13 PARCEL 073 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tvneof Construction: TURN EXISTING MULTI PURPOSE ROOM INTO 2 ROOMS,ONE INTO A
COMPUTER ROOM THE OTHER INTO A SALON.ALSO TURN EXISTING ACTIVITIES ROOM INTO 3
ROOMS, TURN EXISTING SHOWER ROOMS INTO RESTROOMS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildinc Plans Included:
Owner/Statement or License 102199
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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
D-• of ion D-lay
�j�` /1�
Signa ure of Buil:'rig S'ficial Date
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning& Development for more information.
Version!.?Commercial Building Permit May 15,2000
Department use only
- - —" -,-_ City of Northampton Status of Permit:
' ' 20 Building Department Curb Cut/Driveway Permit APR
212 Main Street Sewer/Septic Availability
L_ Room 100 WaterNVell 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 Proverb/Address: This section to be completed by office
25-37 Coles Meadow, RD Map Lot Unit
Northampton,MA Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
New England Deaconessn/� � 80 Deaconess Rd,Concord,MA 01742
Name(Print) eh-4,./e6 Aka Current Mailing Address:
(978) 402-8215
Signature 2 0141.4-Ci Telephone
2.2 Authorized Agent:
Charles Atencio /f� /� qq / t/o�} 80 Deaconess Rd, Concord,MA 01742
Name(Print) ,4' pzj l„>/T"/ %rvuec.>< � r4nG.w^ Current Mailing Address:
(978)402-8215
Signature '-r.(} / Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant _
1. Building $45,000.00 (a)Building Permit Fee
2. Electrical $11,000.00 (b)Estimated Total Cost of
Construction from(6)
3. Plumbing $10,000.00 Building Permit Fee
4. Mechanical(HVAC) ..
5. Fire Protection $28,000.00 \)6. Total=(1 +2 +3+4+5) - Check Number c..1Cfa Er*/
9
This Section For Official Use Only
Building Permit Number Date
Issued
Signature'.
Building Commissioner/Inspector of Buildings Date
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:
DMS Design LLC Not Applicable 0
Name(Registrant):
DMS Design LLC Registration Number
Address
(978) 965-3470 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 Responsibilhy
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Harnum Construction Inc. Not Applicable 0
Company Name:
William Harnum
Responsible In Charge of Construction
53 Metzger Pl. Springfield,MA 01104
Address
//p/�{ (413) 519-3593
Signature /�lr' " Telephone
Version1.7 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 I.: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved
parking)
k of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW ® YES O
IF YES: enter Book Page and/or Document/t
B. Does the site contain a brook, body of water or wetlands? NO O 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 O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location: 4x5 on front lawn,wood sign
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
IF YES, describe size, type and location:
E. WII 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 Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version].?Commercial Building Permit May 15.2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations 0 Existing Wall Signs ❑ Demolition 0 Repairs Additions 0 Accessory Building 0
Exterior Alteration ❑ Existing Ground Sign❑ New Signs 0 Roofing Change of Use❑ Other 0
Brief Description Turn existing multi-purpose room into two rooms,one fur computers and other for salon,also turn existing activities room into
Of Proposed Work: three rooms.one for accounts receivable,activity day room and other to remain as nourishment kitchen.Turn two existing
shower rooms into restrooms.
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 5 A-3 ❑ 1A I 0
A-4 ❑ A-5 0 1B ❑
B Business ❑ 2A 0
E Educational 0 2B I ❑
F Factory 0 F-1 0 F-2 ❑ 2C ❑
H High Hazard 0 3A ❑
I Institutional 0 I-1 0 1-2 0 1-3 0 3B 0
M Mercantile 0 4 ❑
R Residential ❑ R-1 0 R-2 0 R-3 ❑ SA ❑
s Storage 0 s-1 0 5-2 0 SB I ❑
U Utility ❑ Specify:
NI 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)
Is 5,304 1m
2"° 5,304 2"a
3rd
5,304 3,a
4th
4'h
Total Area(sf) 15,912 Total Proposed New Construction(sf)
Total Height(ft) 26
Total Height ft
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public 0 Private 0 Zone Outside Flood Zone❑i Municipal 0 On site disposal system 0
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 O No Q
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT p
X I, Chat les A-knc SGS (
, .7,1 Rt" c I liaras Owner of the subject property
hereby authorize
William illiam Harnum with Hamum Construction Inc. to
act on my behalf, in all matters relative to work authorized by this building permit application.
0/7->,/4/1 'cc/ f/ Qflz 20(7
Signature of Owner Date
William Hamum 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 penury.
William Hamum
Print Na
I //
Signatu.Sf• R gent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: William Hamum CS-102199
License Number
53 Metzger PI. Springfield,MA 01 104 09/17/2018
Address Expiration Date
� (413) 519-3593
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 O No 0
11 Aar/7 Un7 ya_ 600 , ( Ort
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: 1 6.` 7 I4 /td ,7,-.4ArJ42
The debris will be transported by: U3/
The debris will be received by: OSA
Building permit number:
Name of Permit Applicant
Date Signature of Permit Applicant
_ The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
•
• 1 Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name {Business/Organization/Individual) Harnum Construction
Address:53 Metzger PI,
City/State/Zip:Springfeld,MA 01104 Phone#:413-519-3593
Are you an employer?Check the appropriate box: Type of project(required):
1.❑� I am a employer with 4 4. ❑ I am a general contractor and I
employees(MI and/or part-time).* have hired the sub-contractors 6. New construction
listed on the attached sheet. 7. ❑� Remodeling
2.❑ 1 am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers' 9 ❑ Building addition
[No workers' comp. insurance comp. insurance?
required.] 5. ❑ We are a corporation and its 10.5 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 1I.0 Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12 ❑ Roof repairs
insurance required.] c. 152,§1(4),and we have no
employees.[No workers' 13.5 Other
comp. insurance required.]
'Any applicant that checks box PI must also fill out the section below showing their workers'compensation policy information.
}Homeowners who submit this affidavit indicating they arc 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:A.I.M Mutual Ins. Co.
Policy#or Self-ins. Lic.#:AWC40070343322017A Expiration Date:3/25/18
Job Site Address: 25 Coles Meadow Rd City/State/Zip:Northampton,MA
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 certify under the pains and penalties of perjury that the information provided above is true and correct
4/10/17
Siunatme: a1Y L�l Date:
Phone#: 413519-3593
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#:
/- 14.1 WJHCO-1 OP ID:IR
ACRO CERTIFICATE OF LIABILITY INSURANCE
03/30/2017DATE YI
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 poliicy(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).
PROp11LER NAME°Ci_.Ilyssa Riley
PHILUPS INSURANCE AGENCY INC PHONE -_-97 CENTER STREET BMc w Ext 413-594-5984 jMM,rag:413-5924499
CHICOPEE,MA 01013 AOQQEss;ilyss
PHILLIPS INSURANCE AGENCY INC a�phillipsimurance.com
INSWREm51 AFFORDNG COVERAGE 1 NA1cS
INSURER EMC Insurance Companies '21415
e19LBE0 Harnum Construction INsORENO:A.I.M.Mutual Ins.Co. _ '33758
William Harnum -- --_
53 Metzger Place IN]LERC; -
Springfield,MA01104 /NsIRDI _. j
Ni
msuRERE: _.
sunER P.
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.
LTR TYPE OF INSURANCE WyDR POLICY NUMBER IMMD I IMS OMITS
A X COMMERCIAL GENERAL wLiTY , EACH OCCURRENCE5 1,000,000
CLAIMS-MADE X OCCUR 1 5D3894917 11/11/2016 11/11/2017.OAMAGRTORENTEo
PRBMlses res Axunencm s 500,000
MED EN.My one person). I 10,000
_ INJURY $ 1,000,000
GE AGGREGATE M APPLIES PER: GENERAL AGGREGATE E 2,000,000
POLICY •
rI CT I_I LOC I PRODUCTS COMPOP AGG s __ 2,000,000
OTHER I I S
I .COMBINED SINGLE LIMIT m $
OMOBILE LIABILITY
'LEN nO _
ANY AUTO I BODILY INJURY Terperson) 5
I`ALL OWNED SCHEDULED ,BODILY INJURY Is
AUTOS AUTOS _ __ �_HIRED AUTOS AUTOS NON-OWNED PROPERTY DAMAGE iE
ewS q
$
•
UMBRELLA UPS I „CNNEACH OCCURRENCE $
"EXCESS UAB CLAIMS-MADE 1 AGGREGATE S
i DED ONS 1 $
WORKERS COMPENSAITON_ PER
•AND L RTM_
B '!ANY PROP[ORRAARRTh EDu oEECLTEE YY rvIA AWC40070343322017A 03/25/2017 03/25/2018 E_.EACH ACCIDENT s 100,000
Inundatory lnl NH)PvC - -S - EA EMPLOYEE.5 100,000
DESCRIPNGNOFOPERATIONS below E DISEASE-POLICY LIMIT E 500,000
•
•
DESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES(ACORD I01.Additional Renmrt Schedule.mybeatta:Ma n,Iweayo is requIredl
CERTIFICATE HOLDER CANCELLATION
ROCKRID
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE `DILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Rockridge Retirement Community
25 8 37 Coles Meadow Road
TIVE
Northampton,MA 01060 A� ow'w' A
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-102199 A ,
S,ce:., 3
WILLIAM J HARNUM,JR 'y'
- t
53 METZGER PLACE "r
SPRINGFIELD MA01104
(i—�.k Expiration:
Commissioner 09/17/2019
Construction Supervisor
Restricted to:
Unrestricted-Buildings of any use group which contain
less than 35,000 cubic feet(991 cubic meters)of
enclosed space.
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
DPS Licensing information visit:W W W.MASS.GOV/DPS
HARNUM CONSTRUCTION INC.
Building Department (�
Puchalski Municipal Building 4g --.
212 Main St.
Northampton, MA 01060
April 11, 2017
I request that you grant a modification to waive the requirement for control
construction for the Rockridge Retirement Community at 25-37 Coles Meadow
Rd. in Northampton because the work is of a minor nature, will not affect health,
accessibility, life and fire safety, or structural requirements and is impractical in
that the cost of control construction is considerable when compared to the cost
of the proposed work. Thank you for your consideration. "Mass Amendments,
sections 107.1 allows for an exclusion from control construction for this project"
Respectfully,
Bill Harnum
H Harnum Construction
Inc.
53 Metzger Pl. PHONE 413-519-3593
EMAIL wjharnum@yahoo.com
Springfield, MA
01104
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