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32C-109 (3) Ratil J.D. Rivet & Co., Inc. ROOFING • SHEETMETAL 1635 PAGE BOULEVARD SPRINGFIELD, MA P.O. BOX 51068 INDIAN ORCHARD, MA 01151 TEL. (413) 543 -5660 January 17, 2012 FAX (413) 543 -3373 Service Properties ARLISL - P.O. Box 60522 Florence, MA 01062 -0522 Carlisle SynTec Attn: Jack Fortier AUTHORIZED RE: Former Stevens Test Facility — 78 Conz St. — Rear APPLICATOR Northampton, MA — Approximately 3,250 Sq. Ft. Scope of Work: 1. Remove and properly dispose of the existing membrane rooting down to the insulation. Replace (2) sheets of insulation where damaged. 2. Furnish and install Carlisle .080mil TPO mechanically attached roofing system complete with all associated flashings. 3. Furnish and install new .040" painted aluminum edge metal in accordance with ler s requirements. 4. Furnish and install new .032" painted aluminum K -Style machine gutter complete with ram leaders and appropriate attachments. 5. Clean jobsite of all roofing debris. 6. Furnish owner with a 15 year Carlisle labor and material warranty. PRICE = 814,7.50.00 (Fourteen Thousand Seven Hundred Fifty Dollars) ames� } ask, President Acceptance of Proposal — The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment terms are net 30 days unless otherwise agreed in writing. All material is guaranteed to be as specified. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire and other necessary insurance. Owner responsible for all building permit fees. All accounts not paid within 30 days are subject to a late charge of I ''/211 per month on the unpaid balance. In the event that legal action is instituted to collect any sums due under this agreement, the undersigned agrees to pay all costs incurred including reasonable attorney's fees. I'AYNIENT TERMS: 25■. DUE UPON PROPOSAL ACCEPTANCE, 25% DUE UPON MATERIAL DELIVER, BALANCE (50%) DUE UPON COMPLETION. NOTE: THIS PROPOSAL MAY BE WITHDRAWN BY US IF NOT ACCEPTED WITHIN 60 DAYS. Signature: l 4.• Date: / / !v 6 / ice 4960 R„:„.,) Bflildin. 1Z4.‘ ;Intl !:)1;;Iit1;irik Construction Supervisor License icense.: CS 50230 ,T.H JAN N DREYER r- 44 LAKESIDE: DR Aft. MONSON, MA 01057 1454 Eir aion 7/212012 1■1111111 T 29504 aC°R°® CERTIFICATE OF LIABILITY INSURANCE DATE O /Y 0 05/02//02/ 2011 1 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 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). PRODUCER 1 - 630 - 773 - 3800 CONTACT Christopher Mowery NAME: P ry Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX (A/C, No. Extl: 312803 - (A/c, No): Two Pierce Place E -MAIL Chi Certificates @AJG,com ADDRESS: Itasca, IL 60143 INSURER(S) AFFORDING COVERAGE NAIC# Christopher Mowery INSURER A: ARCH INS CO 11150 INSURED INSURERS: NATIONAL UNION FIRE INS CO OF PITTS 19445 J.D. Rivet Sc Co., Inc. INSURER C : 1635 Page Blvd. INSURERD: Springfield, MA 01104 -1752 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 20987545 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. IN TR TYPE OF INSURANCE POLICY NUMBER ADDL SUBR POLICY EFF POLICY EXP LIMITS INSR WVD (MM /DD/YYYY) (MM /DONYYY) A GENERAL LIABILITY 1 ZAGLB9131200 05/01/11 05/01/12 EACH OCCURRENCE $ 1,000,000 X l COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300 000 PREMISES (Ea occurrence) , CLAIMS -MADE X OCCUR { MED EXP (Any one person) $ 10,000 X 5,000,000 All Projects 1000,000 PERSONAL & ADV INJURY $ • GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 9 X PRO- RO- LOC J RO- A AUTOMOBILE LIABILITY ZACAT9115300 05 /01 /11 05/01/12 COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED r SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) _ Physical Damage $ 1,000 Comp/Coll B X UMBRELLALIAB X OCCUR I 9788956 05/01/11 05/01/12 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5,000,000 DED X RETENTION $ 10 , 0 00 $ A WORKERS COMPENSATION ZAWCI9235300 WCSTATU- OTH- ANDEMPLOYERS'LIABILITY YIN OS /O1 /1 05/01/12 X TORY' NITS ER ANY PROPRIETOR /PARTNER/EXECUTIVE E.L. EACH ACCIDENT l $ 1,000,000 OFFICER /MEMBER EXCLUDED? N N i A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Coverage THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD chrismow 20987545 The Commonwealth of Massachusetts Print h. _ Department of Industrial.=iccidents Office of Investigations 600 Washington Street �T= ; Boston, MA 02111 _ = www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders /Contractors /Electricians /Plumbers Applicant Information Please Print Leo Name ( Business /Oreanization /Individual): J.D. Rivet & Co . , Inc. Address: 1635 Page Boulevard City /State /Zip: _ Springfield, MA 01104 Phone, 413- 543 -5660 Are you -an employer? Check the appropriate box: Type of project (required): 1.)Kj I am a employer with 50 4. -- 11 am a general contractor and I ] employees (full and/or part- time).* have hired the sub - contractors 6. 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 8. Demolition working for me in any capacity. employees and have workers' q ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. [ We are a corporation and its 10.T1 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.1 I Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 Y<oof repairs insurance required.] t c. 152, §l(4), and we have no employees. [No workers' 13.111 Other comp. insurance required.] *Any applicant that chocks box 41 must also fill out the section below showing their workers' compensation policy information. T homeowners who submit this affidavit indicating they are 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 n I am an employer that is providing workers' compensation insurance for my employees. below is the policy and job site information. Insurance Company Name: Arch Insurance Company ZAWCI9235300 5 - 1 - 12 Policy # or Self -ins. Lic. #: _ Expiration Date: Job Site Address:x _ 0_ Q ( \ Z . - 3 C & 90. r ) City /State /Zip: OC 1(1 h INY14 01066 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 51,500.00 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 D1A for insurance coverage verification. I do hereby certif' under the ,' ins an( - au ;ies of perjury that the information provided above is true and correct. Sisnature: i deo Date: / >< Z- Phone -543 -5660 Official use only. Do not t'rite in this area, to be completed by city or town official • Cite or Town: Permit /License # Issuing Authority (circle one): •1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone #: e> 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 0 No SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT S ' a that f irOpefT(e , as Owner of the subject property hereby authorize Sp. e.,0.. G_, to act on my behalf, in all matters relative to work authorized by this building permit application. Pftast a1 ttk J �' 06v1-Ira.G -I- d/(! Signature of Owner Date J•t 9-A Cb y1f�C� , as 9wrrcr /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. • etc Print Name 4111111F / A / la- Signature of Gwrfl'Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : ,.SCXY\ L scv €.Y [ 1 3 5oa30 11 License Number — '',r- 1.Aesae biNq Na sor ix\Pt 0105`1 c7( /a l fgo 1 2 Address Expiration Date �EL3 _sy �56( 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 b ing permit. Signed Affidavit Attached Yes No O __ s 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: ,^ 1 Not Applicable Pr Name (Regis rant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): n/P- 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 Co Not Applicable ❑ Company Name: _0 Responsible In Cha rge f Construction ` c • '� • •1 •_t• I•.• ♦ �• • V r . \ Address ..G11,r - -� x//3.541 -5 0 Signature Telephone Versionl.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 L: R: L: R: Rear Building Height (O, \_ t � C Lf‘Ie Bldg. Square Footage 3 Q 5 01 1 . 1- % STAIA,LQ-41/11.- Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO S DONT KNOW O YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW el YES O IF YES: enter Book Page 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 0 , Date Issued: C. Do any signs exist on the property? YES O NO ec 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 g 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 (;) IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE ,_,/ Interior Alterations El Existing Wall Signs ❑ Demolition ❑ Repairs t!1 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: Rome_ dise5raL bioi,Voko, tnen4rakt.Q C \ 1 /�30 Op Au ITCH flit r'& SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A 1 ❑ Er ❑ A -5 ❑ 1B ❑ B Business E 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 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 I ❑ 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: COMM- +CCAOQ Proposed Use Group: N,W`J 0(* 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) 1s 1st 2nd 2 nd 3rd 3 rd 4 th 4 th Total Area (sf) Total Proposed New Construction (sf) Total Height (ft) 10 1 \� � Total Height ft ,fric 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 1 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ I Municipal ❑ On site disposal system❑ RECEIVED Versionl .7 Commercial Building Permit May 15, 2000 Department use only JAN ti 1 2012 CI y of Northampton Status of Permit: B !ding Department Curb Cut/Driveway Permit pE�r Ov BthwINGrNSPectt• 12 Main Street Sewer /Septic Availability tao �TON 01p60 Room 100 Water/Well 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 Property Address: This section to be completed by office 1 g Corz 41 C���� Map Lot Unit I ` Zone Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Print) SecvicQ_ Trp ?er. ve.S Current Mailing Address: P. o. 'o( G0519) 'otcA4e l \, � te Signature Set alzdted & rtLe Telephone ({'13 - aaa -cp�53 2.2 Authorized Agent: CJ CeM Name (Print) 3 �r e�{,Y �' Current Mailing Address: Q O �X 3 10G 7, ereb6tr 1 • � 1M�! O \ \5 Signature Telephone t4(, -51 -_3_15 SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 114. 756 . (a) Building Permit Fee 2. Electrical T o (b) Estimated Total Cost of Construction from (6) 3. Plumbing O Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection y 6. Total = (1 + 2 + 3 + 4 + 5) ,� a,-p Check Number J 7 (� Vd ! A90 This Section For Official Use Oniy Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2012 -0662 APPLICANT /CONTACT PERSON J D RIVET & CO INC ADDRESS/PHONE P 0 BOX 51068 INDIAN ORCHARD (413) 543 -5660 PROPERTY LOCATION 78 CONZ ST (REAR) MAP 32C PARCEL 109 001 ZONE GB(100) //WP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out c3 9 �,D Fee Paid 3 0'90 Typeof Construction: INSTALL NEW MEMBRANE ROOF New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 050230 3 sets of Plans / Plot Plan THE FOLL NG 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 o r 10, :, elay v.., , Zj/Z V -Z- 1------- : ------------------ A /(—/ Signature of B 'Ming fficial 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. 78 CONZ ST (REAR) BP- 2012 -0662 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C - 109 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit # BP- 2012 -0662 Project # JS- 2012 - 001141 Est. Cost: $14750.00 Fee: $90.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: J D RIVET & CO INC 050230 Lot Size(sq. ft.): 18164.52 Owner: SERVICE PROPERTIES INC Zoning: GB(100) //WP Applicant: J D RIVET & CO INC AT: 78 CONZ ST (REAR) Applicant Address: Phone: Insurance: P 0 BOX 51068 (413) 543 -5660 Workers Compensation INDIAN ORCHARDMA01151 ISSUED ON :1/19/2012 0 :00 :00 TO PERFORM THE FOLLOWING WORK: INSTALL NEW MEMBRANE 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: 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 1/19/2012 0:00:00 $90.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner