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31B-311 (2) r , v GARLAND CONSTRUCTION CORP. --- GENERAL CONTRACTOR 40 OLD JAMES ST. CHICOPEE, MA 01020 (413) 533 -7699 FAX (413) 532 -6046 MICHAEL AVIS Cell (413) 885 -5239 Project Manager Mavisla @aol.com • • v _ `� The Commonwealth of Massachusetts N l � : c r= Department of Industrial Accidents ( - �, , . Office of Investigations _`° -17 600 Washington Street, 7 Floor Boston, Mass. 02111 Workers' Compensation Insurance Affidavit: Building/Plumbing /Electrical Contractors Applicant information: Please PRINT legibly name: Garland Construction Corporation address: 40 Old James Street c ity Chicopee, Ma. 01020 state: zip: phone Al3 533 7699 work site location (full address): 42 Gothic Street Northampton, Ma. 01 060 ❑ I am a homeowner performing all work myself. Project Type: ❑ New Construction Remodel ❑ I am a sole proprietor and have no one working in any capacity. ❑ Building Addition x Handicap kl I am an employer providing workers' compensation for my employees working on this job. Ramp company name: Garland Construction Corporation address: 40 Old James Street city: Chicopee, Ma. 01020 phone #:413 533 7699 insurance co. Acadia Insurance Co. policv# WCA 004290820 ® I am a sole proprietor, general contractor, or homeowner , p p ' g meowner (circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: Owens' General Contractor, Inc. address: 142 Jarvis Avenue city: Holyoke, Ma. 01040 phone #: 413 533 9635 insurance co. A.I.M. Mutual In Co policy# 7015273012008 company name: address: city: phone #: n insurance co. policy # Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of MGL. 152 cai lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of In9idtigatious of the DIA for coverage verification. 3 r° I do hereby certify under the pail and penalt of �th the information provided above is true and correct. Signature .r'_/�.�- y!dfi' ' Date 11/3/09 Printnameward L. Orwat, President Phone 413 533 7699 i official use only do not write in this area to be completed by city or town official 3 i r-- city or town: permit /license # ❑ Building Department i ❑Licensing Board ' j ' ❑ check if immediate response required ❑Selectmen's Office ; P onse is re 9 ',,,'1 ❑Health Department contact person: phone #; ❑Other ' t (revised Sept 2003) I Page 11 12/10/2008 3:25:04 PM 8975 ® 02/02 % %a % 1 % %t., 95 % aaz;e'ra% %x% , % % % % % %a % % %.a a'r %3 "syi5zrz % '149'iz itr "z:��� nz9t hsn ; °. x %.,.:r4ry ±:i�s; %ts. , zt,5'V "; ;s t"i., .ztri , s';zsi's'zzs2 <,xs24M1izrrzysocr . s 1 .Y t rviz.. c31yz;7c •.. ..; :�4t: •un. rx,Y: ", izz;.. , .;, .s Y, s'';;h,. �, 6 "snt .:zs % .n:,y%,s.,,,, sY.;r °tit 5f'zi)X "is�zcs'i. "i. �" �}; )Ir sli Woe e U'. 1�# { sti �" , t` P' r 4 t � i fi I 1 l �. ovvo r „0 �' . ,I , > Y ,� ' Mtt t5 I r IS SUE DATE 12/10/2008 W:�.•i?' 1l5 J ti om , Y%� a '� ,� ac t r W:,,, ,' . "�. t . -*t ,:4' ' , v' 0 .. t 44,A 44006V, 44 400$ PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND A J Pijar Insurance Inc CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 1793 Northampton Street DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Holyoke, M k 01040 COMPANIES AFFORDING COVERAGE INSURED Owens General Contractor Inc 142 Jarvis Avenue COMPANY A A.I.M. Mutual Insurance Co Holyoke, MA 01040 LETTER +` X1 %1 of a t T .. .ox H t % q';' x T r 1i .. t� . [ 4' � , 1te t ` v i�' . l 1 % 4 � x d 0 �r raa S % t .z t x V. �3;.Sza.Ni, It: :d -4P, ti i ., V. et?, -. � 5` Air' � }',4,: r'... .4K r M t�,t yav 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. CO ryPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM /DD /YY) DATE(MMIDD /YY) GENERAL LIABILITY GENERAL AGGREGATE • PRODUCTS - COMP /OP AGG. • I I CO NMERCIAL GENERAL LIABILITY PERSONAL &ADV INJURY I I E CLAIMS MADE (OCCUR EACH OCCURRENCE I I OT NER'S & CONTRACTORS PROT. FIRE DAMAGE (Anyone tire) • I MED EXPENSE (Anyone person) • AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT , I AN Y AUTO BODILY INJURY A L O W N E D A U T O S (Per person) SCI IEDULED AUTOS HIF ED AUTOS NON -OWNED AUTOS BODILY INJURY GARAGE LIABILITY (Per accident) PROPERTY DAMAGE EXCESS LIABILITY EACH OCCURRENCE — 1 UM SRELLA FORM AGGREGATE k j 00 t �� u 4 '' , ✓ y i n I OT ER THAN UMBRELLA FORM A t , ;: u , 4" ` Y . ( - ' `fi g. 6« r � ). A q , t' WORKERS COMPENSATION AND +TAT LIMITS STATE •THER EMPLOYERS LIABILITY t MA THE PROPRIETOR/ EL EACH ACCIDENT x 1,000,000 A PARNERS\ EXECUTIVE OFFICIER: ARE 7015273012008 11/26/2008 11/26/2009 EL DISEASE -- POLICY LIMIT r 1,000,000 II JCL ® EXCL EL DISEASE - -EACH 1,000,000 EMPLOYEE COMMENTS/ DESCRIPTION OF OPERATIONS OR LOCATIONS: PETER J WINDOLOSKI, IS NOT COVERED BY THE WORKERS' COMPENSATION POLICY ANN M ROBLINSON, IS NOT COVERED BY THE WORKERS' COMPENSATION POLICY F n } ? ,. s 49rtr� : s ,,.fs. p V �; * .; t .a 'C P"a.',� • f , m Y o urea ary . HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE GARLAND CONSTRUCTION CORP HEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL JWRTTEN NOTICE TO THE CERTIFICATE I OLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION • R LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. 40 OLD JAMES ST ---- — I CHICOPEE, MA 01020 • UTHORIZED REPRESENTATIVE 9409 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD /YYYY) 10/30/2009 PRODUCER Phone: 413- 538 -7444 Fax: 413 -536 -6020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION James J. Dowd & Sons Ins ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 14 Bobala Road HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 10300 ' Holyoke MA 01041 INSURERS AFFORDING COVERAGE NAIC # INSURED INsuRERA:Acadia Insurance Company 31325 ___ Garland Construction Corporation INSURER B: 40 Old James Street — , Chicopee MA 01020 INSURER C. INSURER D: . • INSURER E:'1 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. INSR ADD'L POLICY NUMBER DATE POLICY I M /DD! EFFECTIVE 1 DA IMMIDD!YYIN � ; LTR LIMITS INSRD TYPE OF INSURANCE DATE (MMIDDIYYI � DATE (MMIDD(YYI � A GENERAL LIABILITY CPA005404919 7/18/2009 , ,7/18/2010 ` EACH OCCURRENCE I $ 1, 000, 000 X COMMERCIAL GENERAL LIABILITY I DAMAGE TO RENTED PREMISES (Ea occurence) 1$250,000 CLAIMS MADE X I OCCUR I !_ MED EXP (Any one person) $ 5, 000 • PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP /OPAGG $ 2,000,000 -- I POLICY r I PRO- r I LOC A AUTOMOBILE LIABILITY MAA004293121 7/18/2009 '',7/18/2010 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS '' BODILY INJURY X NON -OWNED AUTOS , (Per accident) $ ___._ _ -___.. _. _. ____— _ PROPERTY DAMAGE $ I � (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN • AUTO ONLY: AGG $ A EXCESS /UMBRELLA LIABILITY CUA0 0 4 2 9 2 819 7/18/2009 1, '7/18/2010 , EACH OCCURRENCE $2,000,000 }{ ] OCCUR CLAIMS MADE j I AGGREGATE $2,000,000 DEDUCTIBLE '� '.. $ I RETENTION $ I $ WC STATU- OTH- A WORKERS COMPENSATION AND pCA004290820 7/18/2009 7/18/2010 X TORYLIMITS, ER EMPLOYERS' LIABILITY ! E.L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR /PARTNER /EXECUTIVE - --- - -- - - -- OFFICER /MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE'. $ 1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT i $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 10 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER City of Northampton WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE 210 Main Street CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO Northampton MA 01060 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE""' /} ACORD 25 (2001108) ff ©ACORD CORPORATION 1988 . ._ I 1. ards { . i L i mo s @ • 1 iz . ;'N 1 = Tr# 961 f i „ I v,.".irt WI' 1 40 O1 �1 S' ST -1- ' - I, • TA C we# 4 H J4t Detioptour44 p 54 G I ! { O. A440444 ROOM 1301 . .. $axe., me4444164014 0210$ -1615 P1044 (61» 2' -3200 Fea (1)) 727 - 5732 CONSTRUCTION CONTROL DOCUMENT Project Title: James House Ramp Date: 1 0 /29 / 09 Project Location: 42 Gothic Street Northampton, Ma. 01060 Scope of Project: Remove and reinstall (rebuild) Accessible Ramp with new railings and stairs. In accordance with SECTION 116.0- 116.4.2 of the ath edition of the Massachusetts State Building Code : I, Vi l \.&.t A AA . 63A ✓t..Y1,1I Mass. Registration Number 361 C l ( 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: [ ] Entire Project [ ] Architectural 14 Structural [ ] Mechanical [ ] Fire Protection [ ] Electrical [ 1 Other (specify) 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 acceptable engineering practices and all applicable laws for the proposed project. Furthermore, I understand and AGREE that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved by the building permit and shall be responsible for the following as specified in section 116.2.2: 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction contract 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 offict• I ;. report aS o the satisfactory completion and readiness of the project for occupancy s Th • • W/PA -/ YAII Signature and Seal of registers professi itARIty. P' . ; - 01196 Page 9 Tit Cisosoms444viiiig 4 1 ,,, , 4444eidivgat 1 �I 54.tely `I { tz' Ng fi4' R6004301 $a w•, M as s i 02109-1619 Nom (617) 727 -3200 fea (617) 727 -5732 CONSTRUCTION CONTROL DOCUMENT Project Title: James House Ramp Date: 10/29/09 Project Location: 42 Gothic Street Northampton, Ma. 01060 Scope of Project: Remove and reinstall (rebuild) Accessible Ramp with new railings and stairs. In accordance with SECTION 116.0- 116.4.2 of the 7th edition of the Massachusetts State Building Code : I, -E-R--' L. li 1 Z. Mass. Registration Number 52,(0 A- 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: [ ] Entire Project [K] Architectural [ ] Structural [ ] Mechanical [ ] Fire Protection [ ] Electrical [ ] Other (specify) 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 acceptable engineering practices and all applicable laws for the proposed project. Furthermore, I understand and AGREE that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved by 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 contract 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. a ' . lk „■ S - 49 Signature and Seal of registered professional: ` Q �. e L. Q y / 2�` 0 tli p No. 5264 � � .7:• .. Springfield, °' i . MASS. / z 0 9 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 a) SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT -•- -- - -- - - . - _ '' as Owner of the subject property hereby authorize _ __ -... _ —_ -__-_.-_-_.._ ._.__..-_._-_.._.._._- __._____ act on my behalf, in all matters relative to work authorized by this building permit application. F Signature of Owner Date 1 David Pomerantz , 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. Si. ed under the pains and penalties ofperjurv. _- ______ Dad,. • Omerant2_,—D±re.ctor Cpnt 1 SQrvi ces -Depa r-tment Pnn '71,111 Avi MIA Sig at , tf - r • • - nt Date SE I TION 2 C• S RUCTION SERVICES 10.1 icen -ed Con- ction Su.ervisor: Not Applicable ❑ I l Name ense Holder: E dward L .; License Number 40 p d es_ z' ee- ••a -'_ _e e- -_, — __a_ e I / Address Expiration Date r . �1 L5 3 3 — 7 6.9_9,___. 5 re 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 0 . . V:rsioplJCommerual Rai bUog Permit May lj.2O0V SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 180 CK0m11e (CONTAINING MORE THAN 35,V0oC.F.OP ENCLOSED SPACE) 9.1 Registered Architect: --- ---- -----------'----------- ------------- Not Applicable Cl Kerry L. Dietz / Name (aeumtrant):___ ____.______ __________ —7 Registration iPJ.�,'_Y$a.- �� �����--- ----� ^.-. ' ���� Expiration Date 2� ` ...�-.._`...^... - o•'t rau�xono - .2 'eW/ edPr�����o|�mg�nu*4m>� Name Area rResponsibility �ao � i � 5 . \-[ k- � ��� �� �� �� _ [~ � �N�� ' � �»� ����c���] �___ � Signature NN Telephone Expiration Date ' ~w ! | --------------- -____ ---_-__ ^ ' --_ _______ pame ��� -__ ___ -___ ____'__ ___� _�_-______ � _ | Address wuauv Number | i | / Signature Telephone Expiration Date | ! i --' ---- � ---- ----- ---�---- _____ _� -_ J Name Area of Responsibility F -------'-------'--------'---�------ ----'�--------------- ! ----------------------- - 1 Address Registration Number � - l ---- --1 | �_-_-_- __ j Si gnature Telephone Expiration Date - — ---� � — ----- - | I L - _-___-_J wume Areaw/Responsibility { ---- ---------- --'----- L - r -'------------------------ 7 ______ ____________ / Address Registration Number | --'--- F ---'---------'-1 / ] / --_'-_____--__ _ / Signature Telephone Expiration Date 9.3 General Contractor |� -- --- --- | u Not Applicable D Company Name: 'Michael &n'i-- -------- --------- s - Responsible In Charge of Construction ! --- -- - \ 4U 0 higope ] Address Al � �� �3J��6�S_1 o���u 7 � mmm~� Telephone , � � ' . Version] .7 Commercial Building Permit May 15, 2000 8NOltrtliA.10TONION11■16.;.:4 Existing Proposed Required by Zoning No Work in Existing Building This column to be tilled in by Building Department Lot Size L ----- - J r 1 r , ! Frontage I 1 F. _ 1 I ...._.____, Setbacks Front L ] Side L:r7-7- R: L:i R:L. T. 1 1 , ! i I Rear 1.77._._1 L _ .J L__ i Building Height i 1 ' Bldg. Square Footage r r % 1 Open Space Footage % 1 i (Lot area minus bldg & p 1 j F aved 1 I t _ parking) _ # of Parking Spaces I — 1 ...... F - I --- Fill: I I I 11 I (volume & Location) . L._ 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: l IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 1 IF YES: enter Book i I i Pagel 1 and/or Document tt 1 1 i 1 B. Does the site contain a brook, body of water or wetlands? NO (;) DONT 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 0 , Date Issued: 1 C. Do any signs exist on the property? YES e NO 0 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 (g) IF YES, describe size, type and location: r : E. Will the construction activity disturb (clearing, grading, excavation, or tilling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. , Version 1.7 Commercial Building Permit May 15, 2000 SE CTION'4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 85,000 CUBIC;FEE OF ` ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Bu ilding ❑ Exterior Alter Exist Ground Sign ❑ New 5fgn ❑ Rooting ❑ Cha te ramp nge of Use ❑ Other ❑ I Brief Description En ter a brief descrip here. Remove existing concre and Of Proposed Work: ins tall n ew ramp with new footings and walls, to include rai SECTION 5 -USE GROU AND CONS TRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A 2 ❑ A -3 ❑ 1A ❑ A 4 1=1 A -5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 28 ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I institutional ❑ I -1 El ❑ 1-3 El ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R- 1 ❑ R -2 El R -3 0 5A ❑ S Storage ❑ S 1 ❑ 5-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use spec DaY care, educationa auxiliar use -- ij S Special Use ❑ Specify: i COMPLET THIS SECTION IF EXISTING BUI L D ING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHAN IN USE Existi Use Group: Proposed Use Group: ' _ - - — —I Existing Hazard index 780 CMR 34): Proposed Hazard Index 780 CMR 34): _.._._. _ I • SECTEON6BUILDING- HEIGHTANDAREA A il work is outside existing; building BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (BO sc I ..._._..� . 1st i - r _ . _ .. __ - - - - - -- -- - -- I 2nd 2" 4 ' 4 _ _....._..._. - t 33 — Total Area (st) NA Total Proposed N w Construction (sf)_ _ Total Height (ft) CN — j - � Total Height ft [ - -- _.� :' __. . 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Dispos System: Public Private ❑ Zone Outside Flood Zone Municipal On site disposal sys Version1.7 Commercial Building_ Per y mit May ay 15, 2000 f i i Jf i 9 I r,11 ' �� ` ialiDe , I�Il .t k a1 . y +`.i l 1 City of Northampton �i la}iitii ' i ll ;+ti t li „ H,:fliil 6 i�'t y ,,. S t sQ , i of � 1 Al l 11 t ' 1 , 1S � D , i 1 i 11:111 e ' h-n , 1,: xi i l 1.f I4't u r f 0,-91 f fY ”' ` l Building Department Cu' t n i7e i j ay , ° I if I � i t > f wil 14111.4 r l j l f f j _ 4l d' f''�'�,l librolt, i it , 1 ili:3f 1 ryl i t ' L ' 1 t: t i . 1 It !!f a i g l i! q iig 212 Main Street tNIII.Ilil Q ,� I t y , ,. z1 i 1 It � , i i l , Se+�ver�Se ftc i Yaiiab it S f i I, uI f ,4 a � , � I li Ii 1 till (f l :' f 3 i t r l 1 S11 h 1, iirl i�flil F f •ry r �'1 ;,1' 1 : lS i , 1 t 1 Room 1 OQ q erN Avavl m ab iitty , li !1 ortithiiirii fl83r i� fly , f 11 111�3I0 t'' rtf of +alu 1 t1II ,t "til " ,' `! ? Northampton, MA 01060 Tura 5'etslof StNctu ilPlarsr :'1f 14 :1; i li r + , i f l 117 1, t 11 ni" i&gl�f' r ' 1 1 n ,011 ;It ni� - tif 1 1 , r , phone 413-587-1240 Fax 413 -587 -1272 �lo l tis Riansl t, l ifal 112..0uqq il.� ; f i t;,ii; :, 1 1 x 1 , v tl iii li i- l I t 1 Nt 11 S t i gE ecr Y/ l ,f'I f f 1 u lxt `i--4 l f „ 0 wr 1 l , 1 il 14il ! i { r f11 L.f a l.f�il fl „�.. I'vn. .w�ul.l :,.� 1� f >• l,tl.,S. -:..._ APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCU = C'F, s e MOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWEi.LII , , C "s��t C j `SECTION 1 • -SITE. INFORMATION 1.1 Property Address: This section to be completedi y office 42 Gothic Street -Map fat !� Umt" iNorthampton, Ma. 01060 =Zone, ” OverlayDlatrrct, • I -- ;`Elm St:` D istrict ' CB District ` " SECTION ':2 PROPERTY OWNERSHIP /AUTHORIZED - AGENT 2.1 Owner of Record: Lei ty_ Of NorthamRto 1 L.2 1 0 Ma.i.n Str_ee_t. - - -- — Name (Print) Current Mailing Address: ___ _ _ 1413 587 12 49 Signature Telephone « 2.2 Authorized Agent: S r -- __ l - vi d- -Pemez ant z - - -- -- -• - - -- 2-4 -0— Mai n -- Scree -t , - -S -u te— #- 3--- _...- ... - - - Name (Print) Current Marling Address: [4:1_3.......5.8.7_1_2 - _ ':. Signature Telephone SECTION 3 ESTIMATED: CONSTRUCTION COSTS . Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant t 1. Building � I : (a) Building Permit Fee – I 1 4 8, 6 2 3.0 0 _ I .- _._. _..- _ _ 2. Electrical Estimated Total Cost of F l 1 (b) :.Construction from (6) ...._,.... 3. Plumbing —__ i Building Permit Fee 4. Mechanical (HVAC) I 5. Fire Protection i __._ 6. Total =(1 +2 +3 +4 + $4R 62R on Check Number This Section For Official [Ise Only Building :Permit Number Date . Issued • Signature; Building Commissionerllnspector of Buildings Date File # BP- 2010 -0505 APPLICANT /CONTACT PERSON GARLAND CONSTRUCTION CORP ADDRESS /PHONE 40 Old James St CHICOPEE (413) 533 -7699 PROPERTY LOCATION 42 GOTHIC ST MAP 3113 PARCEL 311 001 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 1 V - Fee Paid Typeof Construction: REMOVE RAMP & INSTALL NEW RAMP W /FOOTINGS, WALLS & RAILA New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans / Plot Plan 7/0 a it 24 -44 ( THE FOL WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOR ATION PRESENTED: proved 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 Buil. ing 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. t r 42 GOTHIC ST BP- 2010 -0505 GIS #: COMMONWEALTH OF MASSACHUSETTS Map :Block: 31B - 311 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- 2010 -0505 Project # JS- 2010 - 000698 Est. Cost: $48623.00 Fee: $0.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: GARLAND CONSTRUCTION CORP Lot Size(sq. ft.): 16814.16 Owner: NORTHAMPTON CITY OF CITY PROPERTY Zoning: CB(100)/ Applicant: GARLAND CONSTRUCTION CORP AT: 42 GOTHIC ST Applicant Address: Phone: Insurance: 40 Old James St (413) 533 -7699 Workers Compensation CH ICOPEEMA01020 ISSUED ON:11/13/2009 0:00:00 TO PERFORM THE FOLLOWING WORK: REMOVE RAMP & INSTALL NEW RAMP W /FOOTINGS, WALLS & RAILA 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 11/13/2009 0:00:00 $0.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo The Commonwealth of Massachusetts Department of Public Safety Docket Number d _* �$ Architectural Access Board One Ashburton Place, Room 1310 (Office Use Only) YT Y Boston Massachusetts 02108 -1618 Phone: 617- 727 -0660 Fax: 617- 727 -0665 www.mass. gov/ dps REQUEST FOR AD. UDICATORY HEARING RE: Name and address of building as appearing on application for variance I, , do hereby request that the Architectural Access Board conduct an informal Adjudicatory Hearing in accordance with the provisions of 801 CMR Rule 1.02 et. seq. as I am aggrieved by the decision of the Board with respect to Section(s) of the Rules and Regulations of the Architectural Access Board, 521 CMR. I understand that I may request such a hearing within thirty (30) days of receipt of the Notice of Action. Date: Signature PLEASE PRINT: Name Address City /Town State Zip Code E -mail Telephone PLEASE NOTE: This form must be received by the Board within thirty (30) days after receipt of the Notice of Action. Rev, 01/10 0~ d ( .9 .1 � a7 4, I I f es#60eaded4140..s944, attiob /Eve D@val L Patricia 'e ei/e eo GRV4rRRr ga er :/ teffer t�f �• ii*Pg- Timothy P. Murray 64itiil4iSAW Liciutcin®nt Gnvamor S o r- 7, - exo y �TiktAii r� SitS Mary Plinciheth W®Hcirncin Pic&cit9r Scicir®tery G NOTICE OF ACTION DOCKET #: 10 — 207 RE: James House, 42 Gothic Street , Northampton 1. A request for a variance was filed with the Board by David Pomerantz- Director (Applicant) on November 12, 2010. The applicant has requested variances from the following sections of the 06 Rules and Regulations of the Board: Section: Description: 25.1 Petitioner seeks relief from having to provide. access for persons with disabilities to the main entrance which has been recognized by the Mass Historic Commission. 27.2 Treads and risers 27.3 Nosings 27.4 Handrails 2. The application was heard by the Board as an incoming case on Monday, November 29, 2010 3. After reviewing all materials submitted to the Board, the Board voted as follows: GRANT: the variance to Section 25.1 as proposed for the reason that impracticability (see definitions of impracticability in Section 5 of 521 CMR) has been proven in this case on the condition that signage is placed at the front entry indicating the location of the accessible entrance in accordance with 521 CMR Section 25.6 GRANT: the variances to Sections 27.2, 27.3, and 27.4 as proposed for the stair case located at the foyer of the main entry for the reason that impracticability (see definitions of impracticability in Section 5 of 521 CMR) has been proven in this case and on the condition that a wall side compliant handrail is provided at that stair. Photos of the installed compliant handrail are required to be submitted to the Board once the handrail has been installed. • PLEASE NOTE: All documentation (written and visual) verifying that the conditions of the variance have been met must be submitted to the AAB Office as soon as the required work is completed. Any person aggrieved by the above decision may request an adjudicatory hearing before the Board within 30 days of • receipt of this decision by filing the attached request for an adjudicatory hearing. If after 30 days, a request for an adjudicatory hearing is not received, the above decision becomes a final decision and the appeal.process is through Superior Court. Date: November 30, 2010 cc: Local Disability Commission Chairperson Local Building Inspector ARCHITECTURAL A ESS BOARD Independent Living Center f - ____:____-t __ erh -6:01Mevitel vf-/gadoeteitaetaf. 3/13-311 1.. * :. `Q, / �` �Q/j Ind � • � ..41€,* 4 �d///��� _ l 4G��� r 11 ' af.../ t. .. e ® @■al 6, Petrie# getielt, ,� dS rr/ iadidG ,",�1d 8 ,r/6 1G'/e 9 ®yarn ®r s 4 eXVIAeffo6' Atts & i4ii4, Tlmethy P, Murray 691K 4A15S Lleut @n®nt 9®vI§rn ®r L 6'7-9. 7eff!5' ift.i9.4ittiliatitsw Mary II r ry non l�I R TO: Local Building Inspector Variance Number: 10 207 Local Disability Commission Independent Living Center FROM: ARCHITECTURAL ACCESS BOARD RE: James House 4Ja0 42 Gothic Street `-`' .._ Northampton Date: 11/30/2010 Enclosed please find the following material regarding the above location: r Application for Variance \/ Decision of the Board Notice of Hearing Correspondence Letter of Meeting The purpose of this memo is to advise you of action taken or to be taken by this Board. If you have any information which may assist the Board in reaching a decision in this case, you may call this office or you may submit comments in writing.