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38A-061 (2)
f � cORD ' CERTIFICATE OF LIABILITY INSURANCE DATE(IDO/YYYY) L......-- L......-- MNI 1/8/2010 PRODUCER (413) 586 -7373 FAX: (413) 584 -0859 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Aquadro & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR -4 Bridge St . , P . O. Box 357 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Northampton MA 01061 INSURERS AFFORDING COVERAGE I NAIC # INSURED INSURER A: Travelers Insurance Company 0015 Aquadro & Cerruti, Inc. INSURER B : National. Union Fire of Pitts 0005 'Texas Road INSURER C: _ P.0 Box 656 INSURER D: I Northampton MA 01061 I 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. INSRI%. 00'LU POLICY EFFECTIVE POLICY EXPIRATION LTR INSROI TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD /YYYY) DATE (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED �., 1 x C O MMERCIAL GENERAL LIABILITY I PREMISES (Ea occurrence) $ P!' I I CLAIMS MADE I X I OCCUR pT - CO - 8336L914 COF - 1/1/2010 1/1/2011 MED EXP (Any one person) I $ 5,000 FRI. PERSONAL 8 ADV INJURY I $ 1,000,000 ' °A"' �J I I GENERAL AGGREGATE $ 2,000,000 7 GENII AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 I POLICY JECT I 1 I LOC I I AUTOMOBILE LIABILITY 1 ' COMBINED SINGLE LIMIT $ 1,000,000 i ' I ANY AUTO (Ea accident) ' A ALL OWNED AUTOS 2TAO 810 978K7592 COF - 09 1/1/2010 1/1/2011 BODILY INJURY X SCHEDULED AUTOS I (Per person) $ HIRED AUTOS I BODILY INJURY X NON -OWNED AUTOS (Per accident) $ -- PROPERTY DAMAGE I $ (Per accident) 1,000,000 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ = AUTO ONLY: AGG $ I EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ 10,000,000 X I OCCUR L_ J CLAIMS MADE AGGREGATE $ 3: r. . $ (DEDUCTIBLE IDTSM- CUP- 8336L914- TIL -08 1/1/2010 1/1/2011 $ _Si!. X I RETENTION $ 10 , 0001 1 $ `$ WORKERS COMPENSATION ! WC STATU- 0 TH - I AND EMPLOYERS' LIABILITY Y / N li TORY LIMIT NP __ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? I - ' (Mandatory in NH) WC 6518032 12/31/2009 1 12/31/2010 I E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under SPECIAL PROVISIONS below I E.L. DISEASE - POLICY LIMIT I $ 500,000 OTHER I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS • CERTIFICATE HOLDER CANCELLATION ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION" FOR INFO PURPOSES 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 A ' IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENT 1 S. , 1: AUTHORIZED EP ES N TIVE - .0/ eh . ACORD 25 (2009/01) c 1988 -2009 ACORD CORPORATIO . All rights reserved. INS025 (2009011 The ACORD name and logo are registered marks of ACORD -- Version! .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 O SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT , as Owner of the subject property Aquadro & Cerruti Inc. hereby authorize .. to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, RNC.h.S / — 4C3> LA,A,1>2 j t f TC7.4a�A►��Z L1 C �1 , as Owner /A thorized C • ent • - -by declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge ief. ignedu der the pains and •enal ies •f per ry. Print Name Signature of Owner /Agent Date SECTION 12 CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : : Francis J. Aquadro III CS 62357 License Number Ea•t Street, Ha MA 01035 07/04/2011 Address Expiration Date \ (413) 586 -2095 Signature \ Telephone SECTION 13 - WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) I -- 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 0 No 0 Versionl.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: NA Not Applicable ❑ Name (Registrant): ,NA Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): NA �. 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 Aquadro & Cerruti, Inc. Not Applicable ❑ Company Name: Francis J. Aquadro III R > : •onsibl= In Charge of Construction ' O Bo 656, Nort pton, 01060 Addres' (413) 586 -2095 Signature ' - Telephone Version! .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 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 0 DONT KNOW Q YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW O YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES 0 NO C) IF YES, describe size, type and location: Facility Sign w/ street address D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO ©i 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 V 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 IS Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs El Roofing 0 Change of Use ❑ Other 0 Brief Description Rework roof eve and fascia to direct water away from bldg envelope. Re -roof structure once the Of Proposed Work: t framing changes have been completed. SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 ❑ A -2 El A-3 ❑ 1A I ❑ . A-4 ❑ A -5 El 1 B ❑ B Business El 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 o Specify Group S -1 and Group E , U 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) 1st 480; 1s , 480; 2nd 2n 3 r d 3 rd 4 th 4 Total Area (sf) 480 Total Proposed New Construction (sf) 480 Total Height (ft) 13 Total Height ft 13 ! 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public is Private ❑ Zone Outside Flood ZoneD Municipal el On site disposal system 0 Version! .7 Commercial Building Permit May 15, 2000 Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit L ° .'`C 212 Main Street Sewer /Septic Availability 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 Smith College Equestrian Center Map Lo t Unit 178 Rear West Street Northampton, MA 01060 Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: =Trustees of Smith College 126 West Street, Northampton, MA 01060 Name (Print) ' % Current Mailing Address: f-- (413) 585 -2400 Signature Telephone 2.2 Authorize gent: 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 (a) Buil Permit Fee / °" $30,00 -TivootS4,04, 2. Electrical $0.00 (b) Estimated Total Cost of $30,000.00 Construction from (6) 3. Plumbing $0.00 Building Permit Fee 4. Mechanical (HVAC) $0.00 do [.d.0 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number This Section For Official Use Only 77 Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date • File # BP- 2011 -0439 APPLICANT /CONTACT PERSON AQUADRO & ASSOCIATES INSURANCE ADDRESS/PHONE P 0 BOX 357 NORTHAMPTON (413) 586 -7373 PROPERTY LOCATION 178 WEST ST (REAR) - EQUESTRIAN CTR MAP 38A PARCEL 061 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out � � " Fee Paid Typeof Construction: REWORK ROOF EVE & FASCIA, REROOF New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 062357 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFpRMATION PRESENTED: V 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 Offi 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. it 'On WEST ST (REAR) - ' 'EQUESTRIAN CTR BP- 2011 -0439 GIS #: COMMONWEALTH OF MASSACHUSETTS e ..« . ti; 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- 2011 -0439 Project # JS- 2011- 000717 Est. Cost: $30000.00 Fee: $180.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: AQUADRO & CERRUTI INC 062357 Lot Size(sq. ft.): Owner: Smith College Zoning: Applicant: AQUADRO & ASSOCIATES INSURANCE AT: 178 WEST ST (REAR) - EQUESTRIAN CTR Applicant Address: Phone: Insurance: P O BOX 357 (413) 586 -7373 Workers Compensation NORTHAMPTONMA01061 - 0357 ISSUED ON:11 /15/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: REWORK ROOF EVE & FASCIA, REROOF 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 11/15/2010 0:00:00 $180.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner