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32C-013 (3) \ 5y-N1 100 Main Street, Northampton, MA Thomas Douglas Architects Inc Code Review 196 Pleasant Street Northampton, MA 413 -585 -0641 EQUIPMENT There will be a new printing press installed in the new tenant space. HVAC Existing ductwork will be extended into the newly created space. TOILETS This is an expansion of the Guild art space. No new toilets are required. HANDICAPPED ACCESSIBILITY: The project will be less than $100,000 and less than 30% of the assessed value of the tenant space. All new construction will be built to AAB standards. PARKING No new parking is required SIGNAGE To be filed under a separate permit 2 of 2 100 Main Street, Northampton, MA Thomas Douglas Architects Inc Code Review 196 Pleasant Street Northampton, MA 413 -585 -0641 CODE REVIEW January 16, 2012 100 Main Street, Lower level at rear exit Tenant: Guild Art Store Chip Smith, Building Owner Northampton, Ma Applicable Building Code: MA 780 CMR Seventh Addition ZONING DISTRICT: Central Business PROPOSED RENOVATIONS: PROJECT DESCRIPTION: • Remove existing closet adjacent to the existing egress stair. • Build a new enclosed room over the existing egress stairs and connect to the former closet. This room will be used by The Guild Art Store as a room for a printing press. • Retain the existing ramped exit. USE GROUP No Changes to existing occupancy which is B business. OCCUPANCY Less than 50 occupants. Proposed maximum occupancy: approximately 3 employee occupants. MEANS OF EGRESS The existing ramp egress will be maintained. There is 60 inches of clear space for the ramp. This exit only serves the lower level of the guild and the adjacent pottery studio. There is an existing 36 -inch door at the end of the ramp which will be maintained. The existing ramp dimensions will exceed the code minimum of 44 inches clear. The stairs, which will be removed, are not required to meet the exit requirements for this floor of the building. FIRE SEPARATION The proposed tenant use is B. The new construction materials will be the same as exists for the tenants on that floor. FIRE ALARM SYSTEM There is an existing fire alarm system with horn strobes and pull stations. These devices will be relocated to work within the new space layout. SPRINKLERS The building is fully sprinklered. Existing sprinkler heads will be relocated to work with the new space layout. 1 of 2 3 \ortt '54 araD GI-VAll o -1,d\\' ) , G 9 100 Main Street, Nortli4 , ` Thomas Douglas Architects Inc Code Review 196 Pleasant Street Northampton, MA 413 -585 -0641 EQUIPMENT There will be a new printing press installed in the new tenant space. HVAC Existing ductwork will be extended into the newly created space. TOILETS This is an expansion of the Guild art space. No new toilets are required. HANDICAPPED ACCESSIBILITY: The project will be less than $100,000 and less than 30% of the assessed value of the tenant space. All new construction will be built to AAB standards. PARKING No new parking is required SIGNAGE To be filed under a separate permit -it, . 2 2 of 2 II 100 Main Street, Northampton, MA Thomas Douglas Architects Inc Code Review 196 Pleasant Street Northampton, MA 413 -585 -0641 CODE REVIEW January 16, 2012 100 Main Street, Lower level at rear exit Tenant: Guild Art Store Chip Smith, Building Owner Northampton, Ma Applicable Building Code: MA 780 CMR Seventh Addition ZONING DISTRICT: Central Business PROPOSED RENOVATIONS: PROJECT DESCRIPTION: • Remove existing closet adjacent to the existing egress stair. • Build a new enclosed room over the existing egress stairs and connect to the former closet. This room will be used by The Guild Art Store as a room for a printing press. • Retain the existing ramped exit. USE GROUP No Changes to existing occupancy which is B business. OCCUPANCY Less than 50 occupants. Proposed maximum occupancy: approximately 3 employee occupants. MEANS OF EGRESS The existing ramp egress will be maintained. There is 60 inches of clear space for the ramp. This exit only serves the lower level of the guild and the adjacent pottery studio. There is an existing 36 -inch door at the end of the ramp which will be maintained. The existing ramp dimensions will exceed the code minimum of 44 inches clear. The stairs, which will be removed, are not required to meet the exit requirements for this floor of the building. FIRE SEPARATION The proposed tenant use is B. The new construction materials will be the same as exists for the tenants on that floor. FIRE ALARM SYSTEM There is an existing fire alarm system with horn strobq,and pull stations. These devices will be relocated to work within the new space layout. SPRINKLERS The building is fully sprinklered. Existing sprinkler heads will be relocated to work with the new space layout. 1 of 2 .3 `3 Pioneer Contractors Pi Con, Inc. • 4. ►.. t r RECEIVED P.O Box 1145 Northampton, MA. 01061 LD 'I 1 2012 Voice 413-586-5491 Fax 413-527-5099 E alanseeatatalsokshosafai of r. OF BUILDING INSPECTIONS Gei 413.626.7267 NORTHAMPTON MA 01060 1b: Louis Hasbrook- Prone David Claxton Northampton Building Commissioner Pain 413 5871272 Page: 1 Phonon 413 5871240 Date: 2121112 Roc Building Permit CC! 100 Mast Strut- Basement 104 Maas Street-e Floor O Urgent X For Review ❑ Please Comment 0 Please Reply ❑ Please Recycle • Comments: ents: Louis, As per our conversation of this marring, we would Mao to reveler the Building Permit for the above as our contact with the Owner has been terminated. We request refund of the hermit Fee. Please call with any questions Thanks, David Claxton Pioneer Contractors tors T `d 66OS -L S -CTir XLLd 13rN3Sd1 dH Wd12 :2I 2100 Ta clad Thomas Douglas Architects Inc PROPOSED RENOVATIONS OCCUPANCY: Floor Area Area per person, gross Number of Occupants (code requirements) (actual) Table 1004.1.1 2 ° 1159 100 12 occupants MEANS OF EGRESS: Exits Required Exits Exits Exit Width stair Exit Width other 1015 required provided .3" per components occupant .2" per occupant 2nd Floor Tenant 1 1 NA 36" min Space Section 1015 We are allowed one egress from this space because the conditions below are met. 1. The occupant load of the space does not exceed 49 2. The common path of travel (does not apply to spaces with 1 exit) and is not more than 100 feet (business use). (There is a sprinkler system) 3. Sections 1015.3, 1015.4, 1015.5, 1015.6, and 1015.6.1 are not applicable. Travel Distance With NO sprinkler With sprinkler Proposed max travel distance (1016.1) system system B use 300' 93 feet • Exit signs and emergency lighting will be relocated as necessary in these spaces. New Emergency lights will be installed on each landing of the existing fire escape. HANDICAPPED ACCESSIBILITY: There is an existing elevator in the tenant space. There is one existing toilet which will be renovated to meet Accessible standards. PARKING No new parking is required in the CB district because no new areas are being added to the building and there are no changes of use. TOILETS: There is one existing toilet which will be renovated to meet Accessible standards. There will be a new employee -only shower which will not be accessible because of the curb at the floor pan. We are allowed to have a single unisex toilet for this space because it is less than 1,200 square feet. 3 of 3 Thomas Douglas Architects Inc g. Modify HVAC duct system. h. Install new devices and modify existing fire alarm systems FIRE PROTECTION AND BUILDING CLASSIFICATION: Since there is no change in use and the renovation is not a substantial alteration or renovation, chapter 3404 of the building code is in effect. This allows us to maintain or improve the performance of the building with same or like materials. We will maintain the existing fire separations including the sheet rock ceiling and walls. FIRE RESISTANCE RATINGS OF STRUCTURAL ELEMENTS Fire Resistive Required Types of Building Element Type 3B Construction, Table 601 Primary Structural 0 Frame Bearing walls: Exterior 2 Interior 0 Nonbearing walls and 0 see table 602 partitions, exterior Nonbearing walls and 0 partitions, interior Floor construction and 0 secondary members Roof construction and 0 secondary members FIRE SUPRESSION AND PROTECTION SYSTEMS: • There is an existing fire alarm control panel next to the first floor front exit to the sidewalk. There is a Knox box, a red strobe and a pull station at this exit as well. • The existing building fire alarm system will be maintained in its current configuration. • Modifications will be made to the system on the 2 floor • New smoke detectors, pull stations, strobes and horn strobes will be added and connected to the existing fire alarm system. 2 of 3 RECEIVE Thomas Douglas Architects Inc / 2012 CODE REVIEW _ February3, 2012 BUIL DING INS PECnO 104 Main Street � 01060 NB Second floor tenant space (access is from 104 Main) Northampton, MA Applicable Building Code: MA 780 CMR Eighth Addition IBC, IEBC International EXISTING Building Code, 2009 ZONING DISTRICT: CB EXISTING BUILDING Floor Use Area Construction Fire Protective Signaling Systems Sq.Ft. Type 1" M use on ls` 3B Exterior New Fire alarm signaling systems floor walls are exist and will be modified to meet masonry with code. See plans for details 2nd B, Business 1159 sq. some wood Tenant use. ft. framing; The entire building is equipped Space interior walls throughout with an automatic B, Business are of any sprinkler system, which needs use. approved. minor work and reconfiguration. 3rd Structure is B, Business unprotected use. Base ment B, Business use. Sub - B ase ment PROPOSED RENOVATIONS: PROJECT DESCRIPTION: • Renovate existing office unit on the 2n floor. • There is no change of use. It will remain B Business. • There is no expansion of the existing tenant space. • Renovations of the space will include 1. 2nd Floor: a. Remove non -fire rated acoustic tile ceiling and lighting, and almost all of the framed walls. Install new sheetrock walls and ceilings throughout. Sheetrock will be 5/8" type X rated. b. Examine structure of existing ceiling joists. A ; ,tk nt c. Install new paint, finish flooring, millwork d. Install new kitchenette e. Install new electrical distribution. Panel to remain. f. Modify plumbing in toilet room 1 of 3 i $ N(1rtI it 6� n E md gl asaaci[nsrtiti € ' DEPARTMENT OF BUILDING INSPECTIONS �= • 212 Main Street Municipal Building -� Northampton, Mass. 01060 "' WOR ER'S COMPENSATION INSURANCE Alel. wAVIT Pioneer Contractors • (licensee/permittee) with a principal place of business/residence at: • P.O. Box 1 1 4 , Nnrthampton, MA 01061 (phone0 586 5491 (dtrc t/city /staldzip) do hereby certify, under the pains and penalties of perjury, that. (0" 1 am an employer providing the following worker's compensation coverage for my employees worrlg on This job: • Wcc 50059570120Cti �� Assnri atpd Employers Insurance--Co - - -- - (lnsurance Company) (Policy Number) ,-piraaon Date.) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) •r (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) • (Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale) • (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional shed ifneccrsaary to include information pertaining to n11 cooAvdon) ( ) I am a sole proprietor and have no one worli.ng for me. ( ) I am a home owner performing all the work myself. NOTE: please bc aware that wile homeowners who employ persons to do maimenanec, construction or repair work on a dwelling of not max than three unite in which the homoowoa- resides cc on the grounds appurtenant thereto arc not generally 000ridcrod to bc employers under the wt rker'Y oempcasation Art (GL152,a 1(5)), application by a homeowner for a license or permit may evidence the I ear stahaa of co employe( uoder the Woric es Compomdion Act [ uctdcrsixad thit a. copy of this =tomcat may bo for wardod to tbo Deportment of Industrial Ao idcace Offioo of in ursoco for rho coverage vcrification and that failure to secure coverngo tinder saxion 2SA of MOL 152 can lead to the imposition of criminal penalties consisting of a fine of up to S1,500.00 tmdlor im[ttisoomcnt of up to one year nod civil penalties in the form of a Stop Work Onic and a fins of 5100.00 a day against inc For dcputmrril tut only t Pcrmit Number I a Ik L Maps Lot # r` Situ here o.f Licensee/Pcrmi • - to 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 Bally Bunion LLC. _.. m__ as Owner of the subject property Pioneer Contractors hereby authorize ;m_ N_" �u. " to act on my behalf, in II matters r9 ive work authorized by this building permit application. 02/10/2012 Signature of O r Date David Claxton - Pioneer Contractors , 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. Print Name 02/10/2012 Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of license Holder : , David Claxton 17890 License Number P.O. Box 1145 Northampton, MA. 01061 01/19/2014 Address -1 , ‘4 — Expiration Date ' p / (413) 586 -5491 Signatu e 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 C) No Versionl.7 Commercial Building Permit May 15, 2000 t . 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: Thomas Douglas Not Applicable ID Name (Registrant): Thomas Douglas Registration Number Address (413) 585-0641 a 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 Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Pioneer Contractors Not Applicable ❑ Company Name: David Claxton Responsible In Charge of Construction P.O. Box 1145 Northampton, MA. 01061 Address rL -5°- (413) 586 -5491 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 �m Setbacks Front Side L: . R: Rear Building Height Bldg. Square Footage 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 0 DON'T KNOW Q YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW 0 YES IF YES: enter Book ` Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES 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: No change D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 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 Q 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 FEET OF ENCLOSED SPACE 1 Interior Alterations p Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing E] Change of Use ❑ Other ❑ p Ente a brief description here. Per Plans Attached . Brief Description P i . , , Of Proposed Work: ' Basement -- Interior Partitions " 2nd F1.-- Bathroom Alteration,Closet etc. SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ED A -1 ❑ A -2 ❑ A -3 ❑ 1A 1 ❑ A -4 ❑ A - ❑ 1B ❑ B Business p 2A ❑ E Educational ❑ 2B 1 ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A p 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 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: Business Proposed Use Group:Business 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) 15t 1 St 2nd 2nd 3rd 3r 4th 4th Total Area (sf) Total Proposed New Construction (sf) 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 p Private ❑ Zone Outside Flood Zone p Municipal 151 On site disposal system ❑ Versionl.7 Commercial Buildin: Permit May 15, 2000 T > � � ✓ ✓, five t i '' Mi , a �, %iv '" -- ' City of Northampton ; •flPe9 it „v Building Department P t� r� tf #i „, A 1-to 212 Main Street Sewte e • ° 4 . ' 6 6 2012 Room 100 1 11' , m��, ,� 4 t v r "Igior�* orthampton, MA 01060 ` t~r� l;; v ,p t"= � OS s if d ; #g � %b s -a �� f itt. ri x t� le,» /i� r a3br rr i r,,c e ixMu� ; i - °Feun- DINGINsPE.i-: • e ' 13- 587 -1240 Fax 413 - 587 -1272 f it ns ; �� > �1',' ...•.ill • N MA 01.. , k ,at r 11 a P4 , d ,✓H r i E ,, r u , %I iii r � �/ r � � i � d .other e 3 /� 3Rri 3�eri6 3 v ` 33 a .✓ u, 3',333333,333.N3-,3333/3003/ 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 P� _. r .._. Address: , _. 100 main St- Basement Map Lot Unit ;104 Main St. -2nd Floor Zone Overlay District _�. ,. �a _ __ __ _.w, Elm St. District CB District SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Bally Bunion LLC. P.O. Box 342 Feeding Hills, MA. 01030 Name (Print) Current Mailing Address: (413) 562 -6611 Signature ii ` Telephone 2.2 Authorized A nt: .,Pioneer Contractors "P.O. Box 1145 Northampton, MA 01061 Name (Print) Current Mailing Address: (413) 586 -5491 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building $46,800 00 (a) Building Permit Fee 2. Electrical $5,200.00 (b) Estimated T from Cost (6) 3. Plumbing $3,650.00 = . Building Permit Fee 4. Mechanical (HVAC) • • - $5,405 00i . ,m tie _ .....w, 5. Fire Protection _ .. _ „. .. $' 6. Total = (1 + 2 + 3 + 4 + 5) (, 1 , C; 5 5 , or,' Check 9 Check Number � This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date d File # BP- 2012 -0717 APPLICANT /CONTACT PERSON PIONEER CONTRACTORS ADDRESS/PHONE PO Box 1145 NORTHAMPTON (413) 586 -5491 PROPERTY LOCATION 100 - 108 MAIN ST MAP 32C PARCEL 013 001 ZONE CB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out i Q6 43.2d- Cons Fee Paid O' 77 Typeof truction: INTERIOR PARTITIONS IN BASEMENT & 2ND FLR BATHROOM NO & CLOSET O 611 New Construction '\ ( j ' Non Structural interior renovations /►rl (/ � Addition to Existing ' l Accesso Structure A /I J I i ' Building Plans Included: — 11 Owner/ Statement or License 017890 1 , 3 sets of Plans / Plot Plan / V ( THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 Demolition Delay 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. City of Northampton Massachusetts A - �' , , . .{gi�p (f¢ � � N. ,, �{ i , C" 4 & t 4& a } ' ^ ,. DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building a - Northampton, MA 01060 f'iy .. - )\- e as INSPECTOR Thomas Douglas Architects March 1, 2012 196 Pleasant Street Northampton, MA 01060 Subject Location: 104 Main Street Map Block: 32C - 014 Dear Mr. Douglas, There is a change of contractors underway as we review these plans. Pioneer Contractors have completed demolition and ceiling joist reinforcement at 104 Main Street. We have required that the new contractor get your signature so you can establish a level of comfort with him. I'm not sure if you intended to provide additional information, but here are a few items I'm looking for. Additional information required: 1. Sheet A -102 figure 2 correct labeling. 2. U -Value of new window. 3. Elevation of 1 floor partitions indicating glazing locations for hazardous location review. 4. Copy of the final plan electronically. Feel free to call if you have any questions. My telephone number is 587 -1240 and office hours are Monday through Friday, 8:30 am to 4:30 pm, excepting we close for walk -ins at 12:00 noon on Wednesdays. My email address is: cmillerc northamptonma.gov Thank yo o� r cooperation on these matters. L uck Miller City of Northampton Assistant Commissioner and Zoning Enforcement ,..L.. c / ,./ 3 / i fr . b76 11( r f70 '' f , fi :, 02/27/2012 15:28 4135686708 ROGER BUTLERINS PAGE 01/01 Airc a CERTIFICATE OF LIABILITY INSURANCE sell (MIMI l 0 THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOE i�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 PROpUCBR, AND THE CERTIFICATE HOLDER. IMPORTANT: If the cerM84ate holder is an ADDITIONAL INSURED, the policy(ass) oust be endorsed. ff SUBROGATION IS WAIVED, subject to the terms and Conditions of the policy, certain polici may require an O2)dorsenfent. A Statement On this certificate does not confer rights to the certificate holder In lI.0 Of such entitle: Wheats). . PRODUCER Phone: (413)1 2304 Faz (413) Bes-e7D1 • CON ?Aar ROGER BUTLER INSURANCE R ar Butler Insurance Inc. RANCE AGENCY, INC. PHONE _ "' --• -' F - . ow. (413) X8 "2304 _ -- .. WC: Na):•_ „ (413) 588 - 67 WESTFIELD MA 01086 FEB 2 7 2012 118.. -_ .. A CORaes• I nfo rogorbut 5 COURT STREET 1 P O BOX 896 PROIxICCR _._...__ _. .. - :: cueromBuR__ 3 .. . __.�_..--- --�._...._ ACOncyLica:1710920 WILMER'S) AFFORDING COVERAGE DEVINE CONSTRUCTION, INC I , been A : ATLANTIC CASUALTY 20 HARTLAND HOLLOW . INSURF,R o ARBEI,LA PROTECTION 41360 GRANVILLE MA 01034 'want : - INEUNNR E : _ INSURER F ; COVERAGES CERTIFICATE NUMBER: 1 REVISION NUMBER: THIS IS TO • : THAT THE POUCIES OF INSURAN . D BELOW HAVE BE N ISSUED TO TH ' .t - : ED NAMED ABOVE • R THE POLICY ' ` • • INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUE0 OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 'NO AODLI MAIM - mum EFF POLICY SAP 1 .... TYPE OF IN?"1!mca .... ..,....�._._..e+sa IIY4/D ._._.._PnucYNyrtt�R , tN111Y1�I • DIYY,'f,'Q tMMYDD .. LIMITS A GENERAL LUISILIrr L081000795 04/07/11 04107/12 EACH OCCURRENCE $ 1,000.000 • X • I CDMMGRCIAL C3ENERAL warm). ! ” -- � CLAIMS -MADE I X I o0CUR M D_ EA '9no ?°Mon) 9 _ _ _.- _.__.._ 5,000 PERSONAL & ADY INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 f$EN'L AGGREGATE LIMIT APPLIES PER; PRO- RODUCTS - COM A 0 PIOP GG $ 2,000,00 POLICY _ $ 0 B I AUTOMOaILE upenm ILOC I 55537400004 I 02/2" 8112 . - 02 12f1 1s 1 COmei S I N GL E mart s 1,000,000 ANY AUTO I ... eoaaonq .. _ . BODILY INJURY (Per person) 5 ALL OWNED AUTOS e0DILY INJURY (Pareeeideol) a . .... .._ ._........ X SCHEOLLEDAUTOS PR aoEATYDAMAGE 5 X • HIRED ALTOS (Per modem . , • X NoN -ONED AUTOS I . $ W a UMtfRtl N s Lips OCCUR 1 EACH OCCURRENCE + '$ . MEW LIAR • CLAIMS -MADE I • AGGREGATE ........ . MEW DEDUCTIBLE _ _ .. __$ . .. _ _ RETENTION 8 __ _— _.... ... __- .._ —... -._ . S INC L� Ar - CTFt __ WORKERS DOMPEN6Arf4q .... T TORY uiu rs __ t' AND EMPLOYERS' LIABILITY YIN ANY PROPR _ . ... • erWUPANTNI EEOUTWE EL.2ACHAGCIDENT ., . . S _�. _.. ...... . OFFICER NEMNER EXCLUDED? 1.......... 1 N r A - A� yes. nitl EL DISEASE-EA EMPLOYEE $ OI CRIPr10N OP O ENATIONEI bear E L DISEASE.POLICY LIMIT $ DESCRIPTION Or OPERATIONS, LOCATIONS 1 VEHICLE!) (AMIRah ACORD 151, Additional Remark, Scpequla, W mere apace 1e toquhhad) 1 4 E HOLDER . CANCELLATION . CITY OF NORTHAMPTON 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CIT CI T MAIN O THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 212 ACCORDANCE WITH THE POLICY PROVISIONS. NORTHAMPTON MA 01060 ■ AUTHORIZED nestItaDowrive Atglntion: VIA FAX 587.1272 1 :r -7 ( - ACORD 26 (2009/09) 01988 -2000 ACORD cORPORATION. AI) rights reserved. The ACORD tame and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washin Street 7- Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumbers Applicant Information Please Print Leg Name ( Business /Organization/Individual): Address: 2o 1444 1-(d 6(0,A, City /State /Zip: Grevw, /(e ou d ( 0 3Y Phone #: y( 3 2l y' s Are you an employer? Check the appropriate box: Type of project (required): 1.X I am a employer with 4. I am a general contractor and I * have hired the sub - contractors 6. 11] New construction employees (ful and/or part- time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [WRemodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' g Y P h'• 9. ❑ Building addition [No workers' comp. insurance comp: insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions ❑ officers have exercised their 11. 3. I am a homeowner doing all work f h id h ❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL m Y P 12.0 Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box #1 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 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: - Zpy 0R ker Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: /o'( pul 20 °( City /State /Zip: (0%0 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 co py of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify nder the , • ' s and penalties of perjury that the information provided above is true and correct. Si • nature: __ ___ Date: Z Z 1 Phone #: L( 1 3 21 S-C 2 ? 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 #: Version 1.7 Commercial Building Permit May 15, 2000 , SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) k Independent Structural Engineering Structural Peer Review Required . Yes 0 w No 0 SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED! WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT it I, ..t . a ..._d,a_ ...,_ , as Owner of the subject property hereby authorize . _m _._ ._ _ to act on my behalf, in all I. ers r- a ' . ,,. - authorized by this building permit application. Signature of 0 , "r Date I, _ __ _ ..___..__.' , 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 per lug. _ _ _ ,_„_ , ,_ _ Print Name _. _,. _ __ _ __......__ Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder . +_.. ,...ei .v -e .5�.�� ...... ._.�..__.n.., e...�.... _.n. .—.n _ a. License Number _leo_ _41 its__ AR _SYQ3q .__ ' .qi 77 __ _ __. „ ,. ress Expiration Date :_T1. 2 .16_?. .. __ 7(7 f Z 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 No b %' Version1.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION:.SERVICES -FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION 780 CONTROL PURSUANT TO CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF E ILOSED SPACE) 9.1 Registered Architect: Q _ . t No Applicable ❑ _. ot Applicable Name (Registrant): - �° - - -° ____ . 1 c / s .pjea NO ` / c_ vY C) Registratio Number Address /� [_,�_ �+QO7 ' ... 41. 1 .. 1 / /1 / I /� % � �` � Signature Telephone . Expiration Date �/ v fit!! �y 12 ) . 1 ^ � (/ 9.2 Registered Professional Engineer(s): Name Area of Responsibility i 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 i Name Area of Responsibility _ Address _.._ _. __ _. ____ Registration Number ....�. —. _._..� _._..._. _ I Signature Telephone Expiration Date 9.3 General Contractor P eVi ..e. -- ��`t__.�.A,�C,` _ Not Applicable ❑ Company Name: Orr- _- - - e111/ _ __. Responsible In Charge of Construction 7.-0 floc � ..1h o .. _.... uall _., C � ' •.. >s ..-. ONO& 1111‘ Signat e Telephone Version1.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to Tie filled in by Building Department Lot Size ___ _ _ _. Frontage Setbacks Front Side L.: ` R. _ L:i __' R. :'_ _ t_ Rear Building Height Bldg. Square Footage Open Space Footage % (Lot area minus bldg & paved parking) .,.....�..�.� �...,....�,� ,....�..�.. , # of Parking Spaces Fi]1: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF. YES, date issued: „ IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 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 0 NO /1 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Version1.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE '!:` `,, -ti Interior Alterations I] Existing Wall Signs ❑ Demolitions Repairs, Additions ❑ Accessory Buildin' 6 S 1 Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other p Brief Description : Enter a brief description here. J. �. Of Proposed Work SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) I CONSTRUCTION TYPE A Assembly A -1 ❑ A -2 ❑ A -3 ❑ i IA 1 ❑ ❑ A-4 ❑ A -5 ❑ 1B ❑ B Business ® I 2A ❑ E Educational ❑ i 2B - r ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ j 3A ❑ 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 ❑ j 5B 1 ❑ U Utility ❑ Specify: _. M Mixed Use Specify: i _ 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) i 1St _. 1300 m_.__.......,._ 2`� _........ _ _. ,____._.____. ...._.__ 2 nd 3rd 3 b __ 4 4 h .___-_ _ _ _ —___,. Total Area (sf) Total Proposed N Construction s 1300 ew on . p _._. (sfL ... 1..0 - Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood, ZonelInformation: 7.3 Sewage Disposal System: Public Private ❑ Zone ______ _ Outside Flood ZoneQ, Municipal i;iii On site disposal system Version1.7 Commercial Building Permit May 15, 2000 Departrnet:useopkyX RECEIVED y� Ci of No ton °- 0 � t tY p� n l?e� ►tsk� fi�"; uilding Department p Ct Dnrre�P�itii.0i ,�� itz,, 212 Main Street Sevier!S'eppp t t tS - e �' a F fee 2 8 U itl f ell atra s £ a - - 4- N rthampton, MA 01060 Tv e �T trr�cttxr lartsM � A , , _ a ',En. OF BOWING rd : 413 587 -1240 Fax 413- 587 -1272 P l a t/Sit P r ns . % :i t NORTHAMPTON • 01060 .t. ;Other Speeity 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 10 M1..J C-k' Ma Lot Unit 0i. • Q A i Zone Overlay District D CB District SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED :AGENT 2.1 Owner of Record: ekt,Oi. i(2IV LLC A Name (Print) Current Mailing Address: m FED fNE,; Ff1 11.5 _ 5 .0 I ? Signatu - _.i Telephone 413 701 7 1 2.2 Authorize; • en : Name (Print) Current Mailing Address_ „_ _...,_.__._.. Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building p6 (a) Buildin g Permit Fee : 2. Electrical vo ' (b) Estimated Total Cost of (� 1 Construction from (6) ... ._.._ __..___.. . „. „.. 3. Plumbing 6-- oo l Building Permit Fee 4. Mechanical (HVAC) — —._ 5. Fire Protection so so `, . 6. Total = (1 + 2 + 3 + 4 + 5) Check Number 9 35 0353 ` This Section For Official Use Only Building Permit Number Date . Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2012 -0754 APPLICANT /CONTACT PERSON FORREST DEVINE ADDRESS /PHONE 20 HARTLAND HOLLOW RD GRANVILLE (413) 214 -8629 PROPERTY LOCATION 100 - 108 MAIN ST MAP 32C PARCEL 013 001 ZONE CB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 7 y4o Typeof Construction: CONSTRUCT 2ND FLR BATHROOM & KITCHENETTE - 104 MAIN New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 95779 3 sets of Plans / Plot Plan THE FO OWING 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 7,01 Dela : gnature 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. 104 MAIN ST BP- 2012 -0754 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C - 013 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit # BP- 2012 -0754 Project # JS- 2012- 001168 Est. Cost: $50500.00 Fee: $303.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: FORREST DEVINE 95779 Lot Size(sq. ft.): 1742.40 Owner: BALLY BUNION REALTY LLC Zoning: CB(100)/ Applicant: FORREST DEVINE AT: 100 - 108 MAIN ST Applicant Address: Phone: Insurance: 20 HARTLAND HOLLOW RD (413) 214 -8629 GRANVILLEMA01034 ISSUED ON:3/7/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: CONSTRUCT 2ND FLR BATHROOM & KITCHENETTE - 104 MAIN 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 3/7/2012 0:00:00 $303.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner