24C-019 (18) 286 PROSPECT ST-YMCA BP-2019-1061
G15 ft: COMMONWEALTH OF MASSACHUSETTS
MV.Block:24C-019 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit Buildinc DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorv:ROOF BUILDING PERMIT
Permit# BP-2019-1061
Proiect9 JS-2019-001728
Est Cost $46000 00
Fee: $322.00 PERMISSION IS HEREBY GRANTED TO:
Const Class: Contractor: License:
Use Groun: CLIFTON FROST 76497
Lot Sve(w. ft); 190792.80 Owner.• HAMPSHIRE REGIONAL YOUNG MEN'S CHRISTIAN ASSOCIATION
zoning URB(85)/UPA(15)/ Applicant: CLIFTON FROST
AT: 286 PROSPECT ST -YMCA
ApplicantAddress: Phone: Insurance:
89 MARSH HILL RD (4131478-6943 WC
BRIMFIELDMA01010 ISSUED ON.-4/212019 0:00:00
TO PERFORM THE FOLLOWING WORK:PARTIAL RE-ROOF
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: M 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 Sianalure•
FeeType: Date Paid: Amount:
Building 4I2R0190:00:00 $322.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
(2m (--
Version 1.7 Commercial Building Permit Ma I5,2000
_ ` ranw t we »ty;
�--
RF—t.-- j ,,/EQ
_--- ity of Northampton SMdna,Ofr%titik,
Wilding Department
Vp8 2 8 2019 212 Main Street
Room 100 Vim ,
No rthampton, MA 01060 Ties :Aim
�.n Dins lNsng1 _567-1240 Fax413-567-1272
WriON.W ID90
__ DtbBf '.
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 6 v('!nn
- 100 /
1.1 Preeerly Address: This section to be completed by office
A 5-}- Map o-2'Crl� Lot Q/7 Unit
GIc%l i; Zone Overlay District
- - -- - --- - - - - Elm St District CS District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
1-V\C Ngrr �>�a `.e_Il r.1ibr.-.1 / i\\ems ? � b PYv. 0^ � J � Il�.,�`}V\iw, Ol`•!\I
Name(Prim) ) v Cunem Mailing Address: 1
lei 7� 1-3
Signature Telephone
2.2 Authorized Anent:
Name(Print) Current Mailing Address
�' / 1-3 4a 3doe
Signature ��-- Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical - (b)Estimated Total Cost of
Construction from 6
3. Plumbing
Building Permit Fee
4. Mechanical(HVAC)
�a
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number /0 gr
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:ZZ
V- Z-2019
Building C missionedlnspector of Buildings Date
cLo li C�
Vemionl.7 Commcrcial Building Permit May 15,2000
SECTION4.CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 38,000
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 ''Enter a brief description here.
Of Proposed Work: S „c_ —. N r� X r,, c "q„, I _ (Y. ('h 0. I L o
SECTION 5-USE GROUP AND CONSTRUCTION TYPE -�C``""'"'
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
AA ❑ A-5 ❑ IS ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
1 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 8 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(so
1.
aro3b _
' _.
4m
Total Area(sf) Total Proposed New Construction(sf)
Total Height(ft) _
_ Total Height it _..
7.Water Supply(M.G.L.c.40,§84) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone[] Municipal ❑ On site disposal system[]
Version l.7 Commercial Building Permit May 15,2000
g. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column ro be fil1W in h,
Building Dep riment
Lot Size -
Frontage
Setbacks Front
Side 4 R:'-_. L R: _.i
Rear - - -
Building Height - _---
Bldg.Square Footage _ jgs
Open Space Footage % -
(Lot area minus bldg&pavM
,inkned
#of Parking Spaces
Fill: _ _ .. .
volume&t msm -
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 O YES O
IF YES: enter Book Pagel and/or Document#.
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:
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. 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 O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version1.7 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) __ _ _ s- - -
-- Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name _ Area of Responsibility
Address Registration Number
Signature Telephone Expeation 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 1
Not Applicable❑
Company Name r _.
Responsible In Charge of Consimcbon _
A res
413 4,A z
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10.STRUCTURAL PEER REVIEW 1780 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
I, - as Owner of the subject property
hereby authorize to
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
e^'"'.l V� ` ✓ _. . _. _. _. .. as OwnerlAuthorized
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 pealtiesof perjury.
Signature of Owner/Agent Dale
SECTION 12-CONSTRUCTION SERVICES
101 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder C)t�+'� ��'S� C.`J V)1
License Number
c6`� 1'bVa r'SL�Ni�� P.o�� �'"t Siz°Iek t1� oID �.O C-6/07 / 201�
Add s Expiration Date
7V 413 A:)a 6,943_
Signature Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(8))
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 Wilding permit
Signed Affidavit Attached Ves No Q
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:
The debris will be transported by: U S
The debris will be received by: I / ✓�
Building permit number:
Name of Permit Applicant
iz51 19 �.
Date Signature of Permit Applicant
A
&C
parinit� Rnol'if�g lnr.
January 30, 2019
Hampshire Regional YMCA
286 Prospect St.
Northampton MA. 01060
Attention:Tim Daley
Re: Re-roofing of Upper High Roof Approximately 5,700 Sq. Ft. ( Includes small lower roof)
Dear Tim,
We are pleased to submit the following proposal for furnishing all the labor and material
necessary to re-roof the above referenced area.
1.Tear off existing membrane roofing and insulation down to the substrate and remove from
the premises.
2. Furnish and install two layers of 2.6 inch (R Value= 30.0) polyisocyanurate roof insulation
mechanically fastened to the deck,
3. Furnish and install a new Firestone .060 TPO membrane mechanically fastened roof system
complete with all associated flashings.
4. Refurbish existing roof drains as needed.
5. Furnish and install new .040 aluminum edge metal at the perimeter.
6. Furnish owner with a twenty year total system warranty on labor and material.
7. Includes cost of building permit.
8. Does not include material tax.
The above work would be completed for the contract sum of forty six thousand dollars,
($46,000.00).
If the adjacent stair roof is done, ADD $4,800.00.
If you have any questions please do not hesitate to call.
Sincerely,
MMC Specialty Roofing Inc
Donald Wurster
President \
50 Valley View Dr. Westfield Ma. 01085 "hone 4'!3-64 -3842 Fax 113-642-3955
The Commonwealth of Massachusetts
Department ofln lustruh/Accidems,
Office of Investigations
s I Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Elmtricians/Plumbers
_Applicant Information 1 t� Please Print Legibly
)`lame(Business/OrgmizalioMndividml):
Address: SD V� 1 vt
City/State/Zit): t ick ft,A d 1 Q Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1.1% I am a employer with I L) 4. ❑ I am a general contractor and 1
employees(full and/or par[-time).
: have hired the subcontractors 6. E]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 for me in any capacity. employees and have workers' y ❑Building addition
[No workers' comp.insurance comp.insurance.!
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 1 L❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12'.g Roof repairs
insurance required.] t c. 152,§I(4),and we have no
employees. [No workers' 13.0 Other
comp.insurance required.]
'My applicant that checks box 91 must also fill out the seema below showing their workers compensation policyinfannabon.
I Homeowners who submit this affidavit indicetingthey am doing all won,and then hie outside contactors most submit anew affidavit indicating such.
*Contactors that check this box must aaeched an additional shoe,showing the name ofthe sub-mntracmrs and state whether m not those entities have
employees. If the sub<mttedom have employees,Wry must pmvidetheir wmkem'comp.policy number.
I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site
information.
Insurance Company Name: fl 4-'M {11t.;+U � l nS L -nk1 Co
Policy#or Self-ins.Lic.#:j31.NC g'tA U3 0591f Expiration Data:1- 7 I Z 01 S
Job Site Address: '�?JIN 6 1 s"'S City/State/Zip: ItJ,+' '-,
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expire 'on 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 a DIA for insurance coverage verification.
I do hereb cerci um t and penalties ofperjury that the informalion provided)above is true and correct.
S' tw j I6 Date: 3/Z.sba
Phone# X13 1<•42. 3 x';'42
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#:
MMCSPEC-01 KAYLA
'�`"RE- CERTIFICATE OF LIABILITY INSURANCE ra7Mlrei/2gYl
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 cartl8cab holder is an ADDITIONAL INSURED,the policy(lac)most have ADDITIONAL INSURED provisions or be endo sed.
H SUBROGATION IS WAIVED, audec[ te q1a terms and conditions of OFF Policy,certain policies in"require an endorsement A abatement on
this nnDicate not confer nconfer ri his te the rartMeate holder in lieu of such endorsement a.
PRODUCER T Kayla Marie Drinkwine
Phillips Insurance Agi Inc. °Nac°Hei :1413 594-6984 FAc.1 413)$92-8499
97 Center Street
Chicopee,MA 01013 .ka prollipsinsurance.corn
qFF COVEMOE NNCY
INE RERA:First Mercury Insurance Co
INSURED estancRi,SelectiveinsCoolSO1nh Caro
MMC Specblty RooOng Inc RFA :A.L M. Mutual Ins.Co. 33758
60 Valley V1ew Drive Ix RERD:Accident Fund Insurance Co of America
Westfield,MA 01085
IN 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 RESPECTTO 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.
IXMI TIIEOFIX811MNCE r' WaR PoLICY HUMBER POUCYEFF POLICY E%P 11MTE
A X CpMMERGK OENFJtK LYPMTY E9CH P^CUR E E 11000,000
CLAIMSMADE ❑X OCCUR TX-CGL-0000078934-01 2/2112019 W2112020 DAM4GFg IFR ED E 100,000
MED EVP 5,000
PERSONAL&ADvlwu 1,000, 00
EN'L AGGREGA LIppMppIT"APPLIE6 PE0. NE A GREG4lE E 2'000'000
X POLICYj6pT LOC PR D CTS- OM /OPAGG 2,000,0001
oTHEa: TOTAL POLJCY AG 5,000,000
B AVMNOBRE Wa1l17Y COMBINED SINGLE UNIT 1,000,000
Ru
X ANYAUTO A 9105249 711712010 7/1712019 BOOILYINJURY Per f
OVMEO SCHEDULED
AUgTEOpSONLY AUpI 66y,N p BODILY INJ RY Par am
AUTO60NLY AUTOSDM PPeOieEVJE�ai�� S
A X UMBRELLA WB X OCCUR EACH OCCURRENCE f 2,013A0,000
FxcFas LuOCLAIMSMADE TX.EX0000076935-01 2121/2019 2/2112020 AGGREGATE 2'000'000
DED RETFMIONS f
C WORNIRBCOMpENBATON X PER OTM
AND EMPLOYER&LIABINTV
ANYp CpRlE W,EXCTNERIEXECOPVE YIN
WCJ00-7030584-2018A 617/2616 61712019 E.L EACH ACCIDENT f 11000'000
GFFIC IVMFI� E%CWOE09 O NIA ELDISEJUE EAEMMOY S 11000'000
IXelpeF dsaRbs�mx 1,000,000
DE6CRIPTION OF OFERATON6 Lelvx ELESSEASE-P UCY LIMIT
D Worker's Compeneaao RP12001591100 112412019 1/2M3020 1,000,000
DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES IACORD 101,AEE lksAl Ra I S1,010%mry M anchIY is mon apau is RsuhsA
CERTIFICATE HOLDER CANC CATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Evidence Of Insurance CCQUIDDgNiE WITH DAM
THE POUCYTHEREOF,
PROVISIONS.NOME WILL BE DELIVERED IN
AUTHORIZED REPRESENTATNE
�iY✓� W.Y
ACORD 25(2(P18103) ®1988-2015 ACORD CORPORATION. All righte reserved.
The ACORD dame and logo are registered marks of ACORD
r•
,
The Oi6clal Website of the Executive Office of Public Safely and Security(EOPSS)
Mass Gov Home State Aluli
nese Details
sul ame: aphic IPTON ROS
er Name:
nm ed
We: MA
ipcode: 01010
o nt : Li 'edaces
nhfign
(cense o: License Type: Construc9ion upervlsor
rofession: Building Licenses Date of Last Renewal: 6/132017
ssue Date: Expiration Date: 6!1/2019
icense Status: Active Today's Date: 2/21/2018
soondary License Type:
oing Business As:
tus Chane Ras License R ewal
o uisite Inforr scop
Close Wndow
®2011 Commonwealth of Massachusetts Site Policies I Contact Us
Massaclw%efts -Department of PUNIC Safety
Board of BuRding Regulations and Stand_Ards "
Conatcucnon 4rperr7s r �`
License CS47IM97
CLIFTON FROST s ro
SA MARSH'gILL�2D, -..
srim�aaxu
Expiration _
Cansnissianer 00/0711019
Spocialtt- Itool'ing hu.
April 2, 2019
To: City of Northampton MA
212 Main St
Northampton MA 01060
I request that you grant a modification to waive the requirement for control construction the Hampshire
Regional YMCA Upper High roof replacement, 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,section 107.6.1 allows for an exclusion from control
construction for the project", "Where work is performed by licensed trades people pursuant to M.G.L. c
112-81R,shop drawings or plans and specifications prepared to document that work shall not be
required to bear the seal or signature of a registered design professional.
Respectfully,
MMC Specialty Roofing Inc
Donald Wurster
President
50 Valley View Dr, Westfield Ma. 01085 Phone 413-642-3842 Fax 413-642-3955