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13-073 (54) 111111111111111111111 BP-2005-0287 GIS#: COMMONWEALTH OF MASSACHUSETTS 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 PERMIT Permit# BP-2005-0287 Project# JS-2005-0373 Est.Cost: $39890.00 Fee: $116.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: 1B Contractor: License: Use Group: A3 DELPHI CONSTRUCTION INC 077994 Lot Size(sq.ft.): 492663.60 Owner: NEW ENGLAND DEACONESS ASSOCIAT Zoning: SR Applicant: DELPHI CONSTRUCTION INC AT: 25 COLES MEADOW RD Applicant Address: Phone: Insurance: 2250 MAIN ST (978) 371-9939 Workers Compensation CONCORDMA01742 ISSUED ON:10/8/04 0:00:00 TO PERFORM THE FOLLOWING WORK:RENOVATE EXISTING COMMERCIAL KITCHEN IN OLDER BLDG 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: Receipt No: Date Paid: Check No: Amount: Building 10/8/04 0:00:00 4201 $116.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2005-0287 APPLICANT/CONTACT PERSON DELPHI CONSTRUCTION INC ADDRESS/PHONE 2250 MAIN ST CONCORD (978)371-9939 PROPERTY LOCATION 25 COLES MEADOW RD MAP 13 PARCEL 073 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out �� 1// Fee Paid Typeof Construction: RENOVATE EXISTING COMMERCIAL KITCHEN IN OLD BLDG New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 077994 '�"Z„ 3 sets of Plans/Plot Plan „ 1, /24.41-"(9 THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFCMATION PRESENTED: j 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 ommission ZOO Signature of Building Official 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. Version1.7 Commercial Building Permit May 15, 2000 StK' u.Ys d ' `S r '' Y i •f Northampton ; `• z � `` p It g Department clia fl Araa�ty rmi ...� ., =. `�<l� ('� U ;V.� „W4 s .� , ; x kip.,, u i Main Street Serer,/ ep -44vaiilabilit z 4- -` w D. 0, ."t' ...-.,: '", tea -� 2004 om100 P 9 • • i�a e 0.4, -,?4,--,--�° ailability.���� � •No .ham��ton, MA 01060 _; � , tract a -e. 1` •• IN 11 .1487-1'40 Fax 413-587-1272 g oti, , � - � -.� z � ��a�J�4�..+ a t Y��,. �y`�i" � is p OF 9UI.D' N,MA O1J60 ,r,nthe.r` e �, � 'acg 1k .iglA k.,,. APPL 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 , -Thissertion to be completed by office 1.1 Property Address: CO Le M MCP O ova( . A-� Map P Lot ;. Unit 1-6 Zone C It< Overlay District Elm St District CB District SECTION 2- PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: ./4V.-vJ N/aL-A 41:) PEA-C-0,,1E55 4='" Icra't1o,-1 t917F-Ac0,-1E. Val 63/-dcop-o1 f1A OR-42_ Name 'nt) Current Mailing Address: igna re Telephone 2.2 Authorized Agent: SI4C0P 51MMonIS'i17EL-Pi4I 9f -U -1 tOr41 [46. ZZ50 f1bit4 9T) CC,lcoR-O, MA O1r42 Name(Print) Current Mailing Address: cile-591.c.-)9 39 Signature_ Telephone SECTION 3- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 418,Boo (a) Building Permit Fee 2. Electrical t 13,550 (b) Estimated Total Cost of Construction from (6) 3. Plumbing s 3,p0o Building Permit Fee 4. Mechanical (HVAC) 0 5. Fire Protection 4'4,450 6. Total = (1 + 2 + 3 +4 + 5) 4 39, 8 9a f Check Number fdil This Section For Official Use Only Building Permit Numb _, er: i'ar-�2 Date Issued: ,„ / ..-:„ . 4,,____,,, ,,, /461, Signature: Building Commissioner/Inspector of Buildings Date Versionl.7 Commercial Building Permit May 15, 2000 SECTION 4-CONSTRUCTION SER CESARR07ECTS LE55 THAN 35,000 CUBIC FEET OF ENCLOSED SPACE" `�" ~ , ? Interior Alterations Existing Wall Signs Existing Ground Signs Additions 0 Roofing 0 X ❑ 0 Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] 0 Accessory Building [ ] Repairs [ ] BRIEF DESCRIPTION: Fzs'DNIA-TE e.-. .rlr4(9 -.oMMs- i,o„t„ V•rrc►-kE� L 1/4 see-nor-1E,Rsee-nor-1 a jUIL.t i • 110 siv-uarv(2-01/4l,. Gb4A-4Ci ,. SECTION 5 -USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly I A-1 0 A-2 0 A-3 ' 1A I ❑ A-4 0 A-5 0 1B X B Business 0 2A 0 E Educational 0 2B 0 F Factory 0 F-1 0 F-2 0 2C ❑ H High Hazard 0 3A ❑ I Institutional 0 I-1 0 I-2 0 I-3 0 3B 0 M Mercantile 0 4 0 R Residential 0 R-1 0 R-2 0 R-3 0 5A 0 S Storage ❑ S-1 0 S-2 0 5B 0 U Utility 0 Specify: M Mixed Use 0 Specify: S Special Use 0 Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS;ADDITIONS AND/OR CHANGE IN USE Existing Use Group: A-3 Proposed Use Group: A-3 64o G111,416E IN USE) Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): 6— SECTION 6 BUILDING HEIGHT AND AREA I.. OFFICE USE ONLY 14 - � ` BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION �;i ,��w. ,..'.�x��,,�, i,,��;� LL Ms ;, ,.,s , (t4e7 ala+4GE5) • Floor Area per Floor(sf] " Y °Mr -$=AsEM5A'r= I2,521 F - ° rp xa 4'3,2C.2 SF 2nd 1st r c ° `- # 2nd I-1,DID SF rd y ;- _ . � �3 II-, 410SF Y � . # 4th 4th 0 Total Area (sf) y 1 2(( sF Total Proposed New Construction (sf) I.n r Total Height(ft) 3�I-3) #/- - >y, L { . z� :r Total Height ft �d' ?v Versionl.7 Commercial Building Permit May 15, 2000 7. Water Supply(M.G.L.c.40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Private 0 Zone: Outside Flood Zone f8( Municipal X On site disposal system 0 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning t;N Buildingo G�l Pn16E5� This columnDepartment to be filled in by Lot Size 4s3,082 SF Frontage > ►25 LP Setbacks Front 155 Lr+/_ Side L: l40'y R: 19a'ti— L: R: Rear (0 4 f/- Building Height Bldg. Square Footage 451(9s5 .0 % Open Space Footage (Lot area minus bldg&paved 31-2.,}2O SF parking) #of Parking Spaces 85 Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW YES V. IF YES, date issued: Cv/2lo3 IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book /2'.-Co Page U8 and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW YES ✓ (INTE-{-t,oct ►.1017-1L dNLY) IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: Version1.7 Commercial Building Permit May 15,2000 SECTION 9 PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES FOR BUILDINGSAND STRUCTURES.SUBJECT TO CONS.heel pt CONTROL.PURSUANT T;0 780 CMR 1f6{CONTAINING MORE THAN 35 OOO C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable 0 Name(Registrant): Registration Number Address Expiration Date Signature Telephone 92 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 pEL? l GOn4ST1Z-ocrtO14, • Not Applicable 0 Company Name: AL E -r TRE.mt3Lay Responsible In Charge of Construction 2250 4 oft'/ 1.4A 01'fi42 Address "Ms-3+1.9969 Signature Telephone • Versionl.7 Commercial Building Permit May 15,2000 SECTION 10 STRUCTURAL PEER REVIEW(78D CMR 110 11) Independent Structural Engineering Structural Peer Review Required Yes ❑ No X SECTION 11 OWNER AUTHORIZATION'; TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING'PERMIT I, WMTE r1.- 1 7-11 US pc) -. NiEIo,J 54.46.(-Ar-IO p-40r413.5'S A SOG•, as Owner of the subject property hereby authorize t).L_1'Ir1 eo r•L' nz.0CTiONI, (14L. to act or my beh.. , in-all u- lativ- t/ ork authorized by this building permit application. SignY olMer `� D.te I, AL-F Elz-r b -rizeM15-AY - VELPI4i q O T1br•(, Inic. , 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. ¢L+E p--t- 1,- r i._A-f z , Print Name_ 9 -P-0 Signature of Owner/ e Date SECTION 12 CONSTRUCTaON SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : A. (Zr V. 1pEM EN-A"( e..5 -4-4 994— License Number VZ. M at,J T Lar4 GO A a } 2 I' III A-- Address Expiration Date �� 9 - �-I.999 Signature - Telephone SECTION'1 WORKERS°CO.MPE ISATIONmiNSi RANCE4FFIDAVIT(M G L 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 o�-(1Wfp2,O `�"" (cti of Northampton It _— A OFT-if-�' E gico.rcrhnsrlfa' ._ '). DEPARTMENT OP BUILDING INSPECTIONS 4 — 212 Main Strcct Municipal Building Northampton, Mass. 01060 rr WORKER'S COMTENSATION NSUR&NCE AFFD)AVIT I, 17ELP1•}I Co,-151-Focr)bn�' INL• (li ccvsccJperrni ttcc) - - with a principal place of business/residence at: Z250 MA-tr,1 ', 4614 c0R.o, MA a l'-4 Z (phone:=) ` $- 1-1-`)939 (arr.- /city/sta n/zip) do hereby certify, under th.c pains and penalties of perjury., that I am an employer providing the followine worker's compcnsadon coverage for 1ny employees woridng on'this job: ftPE(vIENIS It4Supilrice co. 4.1c.Ao09Z4,21-►t 1-11105 (lrsusanc Cocar-fly) (Policy Number) (.,-pirtiori Disc) ( ) I_am a sole proprietor, general contractor or homeowner (ci cie one) and have hired the contractors listed below who hzve the following worker's compen adon policies: (Narmc of Contractor) (lnsurancc CompasnyfP06ci Nu ±c) (r>;plydtion Dltc) (Name of Contractor) ( urance Company/Policy Namccr) (Expiration Date) (Name of Conn-acior) (Insurancz Compan)•/Palicy Numbs) (Expiation Date) (Name of Contractor) (Lasurance CompanyfPolicy Number) (Expiation Date) . (aaat tioril e3,- if Doc ass:y to cx!ude informaion per'• to.1.1 coon-azor-) ( ) I am a sole proprietor and have no one worli3.ng for me. ( ) I am.a home owner performing all the work myself. NOTE:plea be esvare tha wbjc home7.4vcra woo=ploy pezoar to d3 r�rr-te-,•,, cc-^.:eJoo a nrpciir work on.dwelling of not more tti.o to:tmrli in waida the boo:co+woc redo or on the grouoca zppurien at tLrr-n t.c oat --zlty oee:rsdmod to bO employe,ur ibc wot c xi per im Act(G1.152.s 1(5)).application by a botacoaxr for c lie a prnnit may r,-tdmcc ibc legal cumx of.n cxploy.r.under ttao Woriccet Comaomilioa Act_ I uadcztaad dud a copy of this m.t®cm clay be fo,.erded t..tbo pcgenm,,,of 1...6,rrid hccidem!Offioo of trY2 -soo for th- oovrr.ce vvi6etuoo.ad t t Littae to rc boveTrtge uadet too 25 A of MOL 152 cLn led to the i,-Tmei«t of oimiml peaaltio oomismg of a uoe of up to S 1_00.00 and/or iiicprisoccocat or up to one yor Lod cavil pr"t•,io io nc form of.Stop Wort Orde sod. find of S100.00 a city&purl me For nop.nzr lax only _8 -z--. Permit Num Mgr):: Loth ` .AcofRD„. CERTIFICATE OF LIABILITY INSURANCE CSR 19 DATE(MM/DD/YYYY) DELPH-1 07/13/04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Thomas Gregory Associates Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 601 Edgewater Drive S235 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Wakefield MA 01880 Phone: 781-914-1000 Fax:781-246-2601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Acadia Insurance INSURER B: Firemens Insurance Co. Delphi Construction, Inc. INSURER C: Mark Paronich 2250 Main Street INSURER D: I Concord MA 01742 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSH AUU'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRC TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 UAMAGt I HtNItU A X COMMERCIAL GENERAL LIABILITY CPA0079929-12 07/01/04 07/01/05 PREMISES(Ea occurence) $250,000 CLAIMS MADE X OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,0 0 0,0 0 0 POSTED GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 n POLICY n JECT X LOC EBL 1,000,000 AUTOMOBILE LIABILITY • $ ANY AUTO MAA0092622-11 07/01/04 07/01/05 COMc SINGLE LIMIT $ 1 000 000 CO(Ea acccNED ident) r r ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) X HIRED AUTOS Py BODILY INJURY X NON-OWNED AUTOS C (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $4,0 00,0 0 0 A X OCCUR CLAIMS MADE CUA0080130-12 07/01/04 07/01/05 AGGREGATE $ 4,000,000 DEDUCTIBLE $ X RETENTION $0 $ WORKERS COMPENSATION AND O I H- X TORY LIMITS ER $ EMPLOYERS'LIABILITY WCA0092621-11 07/01/04 07/01/05 E.L.EACH ACCIDENT $ 100000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 10 0 0 0 0 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500000 OTHER • ([77) E g \\,g DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS F ! JUL 15 2004 • I i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE David M. Thomas ACORD 25(2001/08) ©ACORD CORPORATION 1988 Dec 18 ,Q3 110: 18a Delphi Construction Inc 1 -978-371 -4944 p. 2 I. EGE " E t) oaTnmp;„ 04. s"..t 4°g SEP — 9 20atr 1 # Northampton thamptan _ ='' 4 Si' /016IT}t At se.chueatls __ ,e,. -__ DEFT Or Bull-1 "r> t i {{"4'10 ENT OF BUILDING INSPECTIONS ;g 11 NC°T — INSPECTOR 212 Main Street • Municipal Building `s Northampton,MA 01060 CONSTRUCTION CONTROL DOCUMENT (for professional Engineers/Architects responsible for Entire Project) Project Title:eaCveS0 Cor„�mn Oci AL 4-rc Datc: 9 LI/2,061 Project Location:zg Cues MEatut u aO.Map: ►'3- Parcel: O t'7 3 Zone: S tQ Scope of Project: Co„muse A. NSW WALL )N ESerSTro G Kiic NEN In accordance with the sixth edition Massachusetts State Building Code,780 CMR SECTION 116.0: I, C14P lei-AS 0. Gl I.FFIfr/ Mass.Registration Number 72/0 Being a registered professional Engineer/Architect hereby CERTIFY that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: XIEntire 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 arr#ptable 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 116.2.2: I. 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 manner 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. Signature and Seal of registered professional: .', 4%t kED Aqey/ 5 Q z t I, i7 y c. o Fax 413-587-1272 -phone 413-587-1240 �o, 4I rH OF WO' , • Z 'd e9O :O1 CO 8I oaa