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23A-063 69 MAPLE ST BP- 2012 -0069 GIs #: COMMONWEALTH OF MASSACHUSETTS Map:Bloc 23A - 063 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: windows replaced BUILDING PERMIT Permit # BP- 2012 -0069 Project # JS- 2012- 000102 Est. Cost: $10500.00 Fee: PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 26484.48 Owner: NORTHAMPTON CITY OF FLORENCE FIRE STATION Zoning: GB(100)/ Applicant. NORTHAMPTON CITY OF FLORENCE FIRE STATION AT: 69 MAPLE ST Applicant Address: Phone: Insurance: 69 MAPLE ST FLORENCEMA01062 ISSUED ON. 7119120110:00:00 TO PERFORM THE FOLLOWING WORK.- Replace Windows 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 7/19/20110:00:00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner ' . - � . . Version 1.7 Commercial Building Pernmit M 15,2000 City of Northampton ECEIVED Building Department 212 Main Street Room 100 12 2011 qorthampton, MA 01060 e 13-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING 1.1 Property Address: Florence Fire Station Maple Street Florence, MA UTH - A RTVA 2.1 Owner of Record: City of Northampton 1 12 10 Main Street, Northampton MA Name (Print Current Mailing Address: 1(413) 587-1260 Signature Telephone [Dav:1dXoirant_Z_\ V40 Main Street Northampton MA Name (Print) Current Mailing Address: 1(413) 587-1260 Signature Telephone Item Estimated Cost (Dollars) to be completed by permit applicant 2. Electrical WHO on X . ..... ..... .. ..... . .. . ..... ...... ...... . ..... iM 3. Plumbing 4. Mechanical (HVAC) 5. Fire Protection 5 �i Pi Ti ........... ..... ............. .. ...... ... ;i1MIN11, lm4iilnm lip! !11111ii el, . .1 0, um or ssue U ding 1 y Versionl.7 Commercial Building Permit May 15, 2000 SECTION +»+ QNS � l yy l' ■ y 1J0 , 7 �� 'l � f,?N ��Yy S �yy E yyi �/10E F1«!l iR E LF; X000 CUBI G'F,EP TGAF ..::.i. .. :. :...ek,......... ........:. .:.:........a........ .3 .::. ..a Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Remove existing windows and install new energy efficient ones. Of Proposed Work: P`. Y� ■Y /[X�■ yyy !�} �■r ■y�y� py ■y�y{�yyy {y ■/� ;�ryY yPyy y}y. .Y# I�/'N P 1R1Mf �ICIM'I I'!11F311TIRAIy�rt'll# 4 USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1A ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1 -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: C MPt�ETE THIS BE 1 ICON IF EXISTING Bl11LDING UNDERGOING F 3 F.v O�lATIONS, ADDITIONS ANI)IOR .... CHANGE IN tlSE.. .... Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): $EOTICIN 6 BUILD(NG ,# T �O AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Floor Area s er Floor P (fl 1 St 1 St 2nd 2nd 3rd 3rd 4th 4 th Total Area (sD Total Proposed New Construction s Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone 0 Outside Flood Zone[ Municipal ❑ On site disposal system[] Versionl.7 Commercial Building Permit May 15, 2000 Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size �— Frontage Setbacks Front Side L: R: L: R: Rear 0 Building Height Bldg. Square Footage Open Space Footage % (Lot area minus bldg & paved p arkin g) # of Parking Spaces = ation ) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO O DON'T KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES O IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO O DON'T 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. Version 1.7 Commercial Building Permit May 15, 2000 ?RQFESSICINA DES Glg A.". N CUNSTRUGTl4�N S 1/1 ES FCtE B (DING A Id 6 STRU�RE ` E1 1EGT TC) {may ■r y■[� ■y/�y }g� �y,�y■� aYyl{y�( y�y(y`y i � yMyry�,(� { E Y ...... ! ■ , ; }1�X�ryy yc .�± y am} : YI� MSl, ll„�,,�i ,,, ,!�T �l M _PU R�If ..`�„ M _ !-•ilk it TAININ I !,!� M!/�TT T; T1[ lE _dT•`�1I;!I�XRT;. }„ .� ....... . 9.1 Registered Architect: Robert H Not Applicable El 8039 Name (Registrant): 3 Converse Street Registration Number 08/31/2011 dfe $ Digitally signed by Robert S. Haveles W cn =Robert S. Haveles, o=ArchitecturalInsights, Inc, EX iration Date — 1= bob�architettural- insights.com,c =US ( 413) 283 -2553 p 00:10. 04'00' Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility 38130 Address Registration Number 06/30/2012 Signature Telephone Expiration Date Name Area of Responsibility Address Re istration 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 New England Glass Not Applicable ❑ Company Name: Tim Ha ling Responsible In Charge of Construction 31 Connecticut Ave t4orwich CT 06/6 Address ;1� 64� (860) 887 -1640 Signature Telephone ' Version 1.7 Commercial Building Permit May 15, 2000 Independent Structural Engineering Structural Peer Review Required Yes O No 0 SEC �1QN 11 O1�I! ER H ©R1�TiO�I,� TO �OMPt1:TE13 1MEN OWNERS GENT O NT i M ►PPLIE RB1�ILE � 1� S�� E �': [39 C€ ] 6 P fi .. . E 9 PPP 3 f fiEf g David Pomerantz as Owner of the subject property her kautho Tom Haling of New England Glass to act lf, 1'K all matters relative to work authorized by this building permit application. 4"�� I .0 Signat o wner Date l Tom Haling of England Glass 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 Pedury. Tom Haling of New England Glass Print Name Signature of Owner/ ent Date SEGT K 12 CQN$TftiUGT1fJN SI2VICES .. ::: ... f.,..... :. .; ....: 3 :: .::... ..:, 10.1 Licensed Construction Supervisor Not Applicable p Name of License Holder License Number Address Expiration Date Signature Telephone SECTION 13 : WORKERS' COMPENSATIQI INSLIF A [ S FElI �l1i� M �1 � X52, ? 5 6 :'i .:. ..... .......:..... a ..:...c... '::. .. .... :.. S 3 .. 3..... :.,:...I. .. .... ,., 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 building permit. Signed Affidavit Attached Yes Q No 0 RECE! l x _._ gag 2tull a �o )EPT. OF BUILDING i' NORTHAMPTON �00 Z Q C Vl J < S p C U _ LILI !- d Z Z�c w c z a 000 CD o O CO � C � X � N � Cb O cc C a••' c E 'c c� d• = 8 u') w co c o c : a Cc L-7 Co C* M c °o CO 3 C CC= - .,..� �..r I —IN co G1 +�+ o � N .0 I� j 'p N Co to An ,co C c Q m V CO 0 O O Cl) O O O Ln CO) C •a to N C C Z i .r The M -85 Series M � kp The Cam-offeseremoicehr New Consume" and powetieo r y , R i t M i �.Y .r. ...:" •� Lb.a'G tklLldeCC�lfit:MleKt]ItC mnnxmemmwsibhmdy h.eauq hovh. horns. _ manidunoamc uivms shs perhmr.r rsq..sanms. (w r.s ., seowmaaJ o sir s.t. 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AA61A 1%"iU G.L I.a..a1v6'e.g J,.,..arfr kuL �I B{ookB4W.1o6na+.nM11TwMr6R Tt �fi' o yy^^ �'€r '�' ;` ;s.r..bp.�. rrr e,rry ,Ed.w.', ilnall N. OtaeYA el6rpYYra..MM.wN £ �� A 'w. ��,.,,�""+��. F p ' 116r <e {fie. M{.an R I..p Me.aa. eedBMaarowYr..aa . d6 '� NMryN.®r.WMew brMa.vrNl.NSw ,xP>3 rv�'�..�t yr" '�a� ENiItlM IWn YIO.tY ..MO yy � aim 7r/ B(.N6.Ia6.trel.IMO. .I.aYYWwfiry.11N ❑ i n 8 �/ t�� an. bdift 1. glow 4T BNyMa..uuY bar3wnaa..rt} No S.1. uYNraw..w(a.q awq - !1 ?Be.. M 6 LL�r� Nuabsrw6g .. j � tAarlsra6. AlieldpeA7A BIBJq&t. Fi.1e/Jr.la. uerlt..MMIBMw10M - Ea ... {N6�W2- Bite %Fe{�TfSO:17'A �� McAgY BSii uYr gl.np r. YrYr.urYaY.r aa.M Y W ,�,;�,,,, 1P -- - + ,.. neBriw,xsx; Fe.eth tract aYa( «tR. r www.wojon.4om GII7IAUR N.tr.BtsuWq. yg{.r.Fy DD/YYYY) ATE (MM ACORD CERTIFICATE OF LIABILITY INSURANCE DATE PRODUCER 860.482.5591 FAX 860.496.9713 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Burns, Brooks & McNeil ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR www.burnsbrooksmcneil.com ALTER THE COVERA AFFO RDED BY THE POLICIES BELOW. 69 Water Street P.O. Box 717 Torrington, CT 06790 INSURERS AFFORDING COVERAGE NAIC # INSURED 385 Central Glass & Mirror Inc. INSURERA: Peerless Insurance Company 24198 DBA New England Glass & Mirror Co., Inc INSURERB: Excelsior Insurance Co. 11045 31 Connecticut Avenue INSURRc: The Netherlands Insurance Co. 24171 Norwich, CT 06360 INSURER D: INSURR 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. I LTR N R TYPE OF INSURANCE POLICY NUMBER DATECMMIDDCTIVE POLICY M/DD/YY YY LIMITS GENERAL LIABILITY CBP8567494 01/01/2011 01/01/2012 EACH OCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY PREMISES Ea ocairrence $ 100,000 CLAIMS MADE I OCCUR MED EXP (Anyone person) $ 51000 A PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,00 POLICY X JE PRO- CT LOC AUTOMOBILE LIABILITY BA8829778 01/01/2011 01/01/2012 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ B HIRED AUTOS BODILY INJURY NON -OWNED AUTOS (Per acddent) $ PROPERTY DAMAGE $ (Per acddent) GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTOONLY: AGG $ EXCESS / UMBRELLA LIABILITY CU9505453 01/01/2011 01/01/2012 EACH OCCURRENCE $ 10, 000, 00 X OCCUR EI CLAIMS MADE AGGREGATE $ 10, 000, 00 A $ DEDUCTIBLE $ X RETENTION $ 10,00 $ WORKERS COMPENSATION WC9549793 01/01/2011 01/01/2012 X I TORYLIMrrs ER AND EMPLOYERS' LIABILITY C OFFIC R/MEMBEREXC UDED?ECUINEY Y E. L. EACH ACCIDENT $ 1,000,000 (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under SPECIAL PROVISIONS below I E.L. DISEASE -POLICY LIMIT 1 $ 1,000,00 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Re: Northampton. onEdison Solutions and the Property Owner are included as an additional insured if required by ritten contract or agreement, subject to the terms and conditions of the insurance policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Consolidated Edison Solutions, Inc. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 100 Summit Lake Drive, Ste 410 REPRESENTATIVES. Valhalla, NY 10595 AUTHORIZED REPRESENTATIVE Patricia Tedesco, CIC ACORD 25 (2009/01) ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I k The Commonwealtlt of Mrts.vac/ttrsetis Department of 1ndrstrial Accidents Office of Investigations 644 Washing on Street Y, Boston, M 42111 www.mass MI Workers' Compensation Insurance Affidavit: builders /Contractors/Electricians /Plumbers Applicant Information Please Print Legibly Nanle ( Business/organization /Individual): A A,4, yv 64,f S5 Address: City /State /Zip: P §§ One #: Are you an employer? Check the appropriate box: Tyne of project (required): 1. Z I am a employer with f(-, 4• ❑ l am a general;contractar and t employees (full and/or part-time) have hired the sub- contractors G_ ❑ New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling These sub - contractors have ship and have no employees 3 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' camp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ 1 ant a homeowner doing all work officers have exercised their I l .❑ Plumbing repairs or additions [ myself. No workers' corn p. right of exemption per MGL Y p 1(4), and we have no 12.[] Roof repairs insurance required.] c. 152, � employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box #1 must also (ill out the section below showing thei{ workers' compensation policy information. I i lomcowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a nc%v affidavit indicating such. :Contractors that check this box must attached an additional slice( showing the nantrr of the sub- contractors and state whether or not those entities have employees. lithe sub•contrictors have employ they►nust provide their work comp. policy number. 1 am an employer that is providing workers' compensation tnsurd nce for ity eniplgltees. Below Ps the policy and job site information. Insurance Company Name: Policy # or Self ins. Lic. # 14)6 < , q 79 - 3 Expiration Date: t ZI , 2_01 Job Site Address: City /State / Zip: lhVV9r L / * O/CI,CO Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required tinder 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 civilE' penalties in the form of a STOP WORK ORDER and a fine Of tip 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 gin a d p rattles of perjury that the information provided above is trn aild correct. Si gnatttre: Date. 5, Phone #: 9 Official use only. Do not write in this area, to be completer) bv`city or toivn official City or Town: Per M' Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City /Town Clerk A. Electrical Inspector 5. Plumbing Inspector G. Other Contact Person: Phone #: P.O. Box 95 - 217 Stover Road _ Charlevoix, MI 49720 0 Phone: (231) 547 -2931 t�,PQ 1AT10 (8M) 63 M7 Fox. (231) 547.4237 1� 2011 DEPT. OF GUILD;VG INSPECTIONS NORTHAMPTON, MA 070 PPG Industries a orm Iculator Calculated CwW -rat Gless Thermal and Cpticai Properties Based on NFRC 100 -2001 Environmental Design Conditions f Dods tot'Ooabb Giving as SpecMed Quiroor .Ghana Us 1X (3rnM) 0esr GM N* oarsnaion 1W (13rlun) Gee r`li! 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