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37-056 (2)
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I \ , i \,•,.. .1 • • r 1 � ` a.. is tat ` , i 7 - „' . f► r d . t "'' N A °R CERTIFICATE OF LIABILITY INSURANCE 3i2i� YY) 2 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 CONTACT Shannon Sperrazza NAME: P Risk Strategies Company f Am N N m _ (781)986 -4400 (FAX w y N (781)963-4420 15 Pacella Park Drive ADDR I ESS : ssperrazza @risk- strategies.com Suite 240 INSURER(S) AFFORDING COVERAGE NAIC # Randolph MA 02368 INSURER A A1nGuard 42390 INSURED INSURER B : Diversified Construction Service LLC INSURER C: PO Box 168 INSURER D : INSURER E : Belchertown MA 01007 INSURER F : COVERAGES CERTIFICATE NUMBER:cL1111241936 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTR INSR VD M/ POLICY NUMBER (MDD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ POLICY JE T LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS _ AUTOS NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE _ $ EXCESS LIAB CLAIMS -MADE AGGREGATE _ $ DED 1 RETENTION $ $ A WORKERS COMPENSATION Partners Excluded WC STATU- OTH- AND EMPLOYERS' LIABILITY x TORY LIMITS FR Y/ N ANY PROPRIETOR /PARTNER /EXECUTIVE from coverage E.L. EACH ACCIDENT $ 500,000 OFFICER /MEMBER EXCLUDED? Y N/A (Mandatory in NH) DIWC122619 10/28/2011 10/28/2012 E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPT1ON OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Issued as evidence of insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Smith Vocational and Agricultural ACCORDANCE WITH THE POLICY PROVISIONS. High Schools City of Northhampton AUTHORIZED REPRESENTATIVE Northhampton, MA 01060 Michael Christian /SMS y i t C ■ ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. IN9419S (7ninnsl ni Tha ACAQII name *nrl Irwin ores ranicforarl morke of Af AQr) c. Version1.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes ® No 0 SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, Pr I'yoS(0 LOU , as Owner of the subject property hereby authorize 1/ lak sir ' C0 Ki2. i,o// A t' "(•) YY►4vt -L.0\A to act on my behalf, in all matters relative to work authorized by this bulding permit application. Sig ture ner Date 3. h 9 J�t.s cvncT� I, ��q,L�/ l v ��t� , 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. .S. An Knorr Name Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable Name of License Holder : License Number Address Expiration Date 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 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: Not Applicable ❑ Name (Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): �c! Ve AA VA L Cl \IAA- Name Area of Responsibility lLosi rZ hn l Lt-I O1c : ' l"1 Address Registration Number 92, gle.c146.41— Li Sgtt 6 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 Co7N PrnAn. ■ 5 (AZ3 r Luc. Not Applicable ❑ Company Name: Responsible In Charge of Construction WO h1 l \/tfi2Svic 1>TIAA/Vt 0 111 A , o2rriA 01001- Address „ 44+ - 5 41 -7-cob Signature / Telephone Version 1.7 Commercial Building Permit May 15, 2000 S. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front tt Z ve Side L: R: L: L1'uOR: �oO Rear 0 O 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 tj YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T 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 Q DON'T KNOW 0 YES Q 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 Q 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 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 NO 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 Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing Change of Use ❑ Other ❑ Enter a brief description here. Brief Description ti Of Proposed Work: 5 ( 12/0 , N b a N t ' o L1 ' A SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A 1 ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B 1 ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B [] M Mercantile ❑ 4 0 R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B [ ❑ U Utility Specify: S++w■z.. 1 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: 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) 1 1 st St 2nd 2 nd 3rd 3 rd 4 4 Total Area (sf) Total Proposed New Construction (sf) t �® Total Height (ft) Total Height ft 1 3 I 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private Zone Outside Flood Zone[. Municipal ❑ On site disposal system, lee) (1 ("I .K,› Versionl .7 Commercial Building Permit May 15, 200 F w. __ Department use only r -- 1 City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability NORTHAMPTON MA n A 0 "s orthampton, 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 S0%t: w - TO - 1 - tsrv+ - 2 P 62tt,ut4 vet =t 1-t ii1V -'1"S Pa ('2 0/419 PoL,C 3 Map 37 Lot a 51, Unit 00 ' ` .nn4 r ` 1 - Zone Overlay District C G cz. C ' t-t i` L' 5(5.'S ) Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: <' ,N,, ..,‘ ..i (0 C. 4-r to) A/ at.. `c P-c ox , c. _f►,. 0'214-1` t -t S. Name (Print) JyV tk d „0L.O() Current Mailing Address: }jC Lot. VI S 1- �T� tP u� .� nt f S c_ YpoT oni rL 10,: -"vt r ' '413 �.' ; Wr . vl p �b nJ Signature PA. s... AIL Telephone "5 551— 1 `{. Ili 2.2 Authorized Agent: S ?a/') 01,44-Y0.411 Name (Print) D. %p S ` r , c) Cr c.n S` r2,rc ' t c ”„ Current Mailing Address: t cSU ` ti r s 1 l - "1A..4 -t &. c' I V‘ .1 Of c o 7- / / ' Signature /' , -' ' ' '-\\''.. Telephone yl3 c•-1- A Z q cro SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant . 1. Building ! 2, 50 0 (a) Building Permit Fee 2. Electrical t (b) Estimated Total Cost of Z Ga Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) /f� rg 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2012 -0945 tta"CiC 6a APPLICANT /CONTACT PERSON DIVERSIFIED CONSTRUCTION SERVICES - p0 �'• ADDRESS /PHONE 100 UNIVERSITY DR AMHERST (413) 549 -2900 O Q� PROPERTY LOCATION BURTS PIT RD POLE 30 MAP 37 PARCEL 056 001 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: INSTALL SOLAR ARRAY New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 030787 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9AM' 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 Demolition Delay SH/ 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. BURTS PIT RD POLE 30 BP- 2012 -0945 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 37 - 056 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: SOLAR PANELS BUILDING PERMIT Permit # BP- 2012 -0945 Project # JS- 2012 - 001644 Est. Cost: $25000.00 Fee: $0.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: DIVERSIFIED CONSTRUCTION SERVICES 030787 Lot Size(sq. ft.): 4741941.60 Owner: Smith Vocational & Agricultural High School Zoning: Applicant: DIVERSIFIED CONSTRUCTION SERVICES AT: BURTS PIT RD POLE 30 Applicant Address: Phone: Insurance: 100 UNIVERSITY DR (413) 549 -2900 () WC AM H E RSTMA01002 ISSUED ON: 5/16/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: INSTALL SOLAR ARRAY 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 5/16/2012 0:00:00 $0.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner