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30B-022 • Property Address: I l p si. . .. SEP 1 6 2010 , Contractor - ., Name: Address: Aet C.‘„.14-4.. City, State: _ . ... ' , ' \ h. 0 tcl Phone: '"" {; 641 Property Owner 1 Name: *ti . �. . 4Z31h■ _____a_4 w Address:, - __.. 1 ! Jr. t City, State: AQ C 6CD 6 0-411;Zarlb-N6 '4/ 1, „ , , 4 � NIL itiPontrattor) attestand affirm that the building I intend to insulate does not have any open air (knob aid tube) wring in the spaces to be insulated and that I have provided the property owner with a cops of this effir1enit Contractor signature ........sie Date (NV c % a uld- ' 0 +1 .}...zis . 411/*ImniSe■tt, i G Q. ehme.. '-' 1 ■ • tip. ~� From:Syndi Friberg, CISR FaxID: Page 1 of 1 Date:8/31/2010 10:55 AM Page:1 of 1 R CERTIFICATE OF LIABILITY INSURANCE OP ID SF CAPII50 08/31/10 PRODUCER • THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION IRM Insurance Agency, Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Barry M. Stephens , CPCU HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 75 North Main St . -P 0 Box 564 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. East Longmeadow MA 01028 Phone:413- 759 -0010 Fax:413- 759 -0017 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A. Central Insurance Companies 20230 Colony Insulation of INSURER B. West Springfield Inc. dba Capital Insulation INSURER C 103 Wayside Avenue INSURER D: West Springfield MA 01089 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. INSK AUL/ L - — POLICY - EFFECTIVE POLICY tXPIHAt1UITU LTR NSRC TYPE OF INSURANCE POLICY NUMBER DATE (MM/DDIYYYY) DATE (MMIDD/YY1'Y) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY CLP8606135 01/01/10 01/01/11 PREMISES (Ea occurence) $ 300000 CLAIMS MADE I X I OCCUR MED EXP (Any one person) $ 5000 PERSONAL &ADV INJURY $ 1000000 X GL Plus Endo Appl GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ 2000000 POLICY X PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 A ANY AUTO BAP8606134 01 /01 /10 01 /01 /11 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ 1000000 A X I OCCUR I J CLAIMS MADE CXS8626973 01/01/10 01/01/11 AGGREGATE $ 1000000 DEDUCTIBLE $ X RETENTION $ 0 WORKERS COMPENSATION X I TORY LIMITS I ( AND EMPLOYERS' LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE IY i WC860613612 01/01/10 01/01/11 E.L. EACH ACCIDENT $ 500000 OFFICER /MEMBER EXCLUDED? (Mandatory In NH) N E.L. DISEASE - EA EMPLOYEE $ 500000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500000 • OTHER A Equipment - Sched'd CLP8606135 01 /01 /10 01/01/11 Limit 71000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITYOFN 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 City of Northampton IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR Building Dept. 212 Main Street REPRESENTATIVES. Northampton MA 01060 AUTHORIZED REPRESENTATIVE P IRM Insurance Agency Inc. 1 - ACORD 25 (2009/01) ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD , City of Northampton E r, Massachusetts .4' 1-- %{ c .A i.:—.5.: y 3{r L DEPAR2MEPT OF BUILDING INSPECTIONS ?+ i •�� �.,. .� 4 ' 212 Main Street • Municipal Suilduig v�:. r i ' ' Northampton. MA 01060 �Sh k _NSPECTOR Louis Hasbrouck Fax: 413 - 587 -1272 Building Commissioner Phone: 413- 587 -1240 Assistant Commissioner SECONDARY CONSTRUCTION CONTROL DOCUMENT (For professional EngineerstArchitects responsible for a portion of a controlled project) Project Title: !�J_(( t 1 i g D1? +M T� P � f. �` Date: $1 Project Location:541 -1;W , *KCAL" hi wrt f6, k. Map: Parcel: Zone: Scope of Project: kbitil 1.14 PATIO IRSOL kci,CN In accordance with the sixth edition Massachusetts State Building Code, 780 CMR Section 116.0: I. 1-d f5 7 '5. 4N .S Mass. Registration # 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: [ ] Fire Protection (✓architectural [ ] Structural [ ] Mechanical [ ] 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, alt acceptable engineering practices and all applicable Laws for the proposed project. Furthermore, I understand and AGREE that I shall perform the necessary professional services to determine that the above mentioned portions of the work proceed in accordance with the documents approved for the building permit. Upon completion of the work, t shall submit to the building official a final report as to the satisfactory Completion of the above mentioned work. S re and Seal if Registered Professional `S,topED ARch Day of t i S. r ,Ce it rr 20 t D ' ; @ 40 � Q ' t 1-4L - .. i . a No. 9039 0 w ��, .;,11, PALMER, , ° t om MISS. i n'' - ,1, T 0 t 14C '�F A r c h i t e c t u r a l == = E.. == = Submittal Architects Planners Interiors Reject ENIEIRGYIMPROVIZIENTPROJECTS Stiirihi: lisulSSfeSPFberGass Blowing knoblike City of Northampton Data 8 - 19 Revision NA APPROVED FABRICATION /INSTALLATION MAY BE UNDERTAKEN. APPROVAL DOES NOT AUTHORIZE CHANGES IN THE CONTRACT SUM OR CONTRACT TIME UNLESS STATED BY APPROVED AS NOTED CHANGE ORDER OR CONSTRUCTION CHANGE DIRECTIVE. APPROVED PENDING SUBMISSION OF MISSING ITEMS (SEE CCMVIENTS) REVISE AND RESUBMIT FABRICATION/ INSTALLATION MAY NOT BE UNDERTAKEN. IN RESUBMITTING, LIMIT CORRECTIONS TO THE ITEMS REJECTED MARKED REVIEW AND APPROVAL ARE ONLY FOR CONFORMANCE WITH THE INFORMATION GIVEN AND THE DESIGN CONCEPT OF THE PROJECT AS EXPRESSED IN THE CONTRACT DOCUMENTS. REVIEW AND APPRO AL OF SUBMITTALS ARE NOT CONDUCTED FOR THE PURPOSE OF DETERMINING THE ACCURACY AND COMPLETENESS OF OTHER DETAILS, SUCH AS DIMENSION AND QUANTITIES, OR, FOR SUBSTANTIATING INSTRUCTIONS FOR INSTALLATION, OR, PERFORMANCE OF EQUIPMENT OR SYSTEMS, ALL OF WHICH REMAIN THE RESPONSIBILITY OF THE CONTRACTOR AS REQUIRED BY THE CONTRACT DOCUMENTS. THE ARCHITECT'S REVIEW AND APPROVAL OF THE CONTRACTOR'S SUBMITTALS SHALL NOT RELIEVE THE CONTRACTOR FROM ANY OBLIGATION CONTAINED IN THE CONTRACT DOCUMENTS. THE ARCHITECT'S REVIEW AND APPROVAL SHALL NOT CONSTITUTE APPROVAL OF ANY CONSTRUCTION MEANS, METHODS, TECHNIQUES, SEQUENCES, OR ANY SAFETY PRECAUTIONS OR PROCEDURES. THE ARCHITECT'S APPROVAL OF A SPECIFIC ITEM SHALL NOT INDICATE APPROVAL OF AN ASSEMBLY OF WHICH THE ITEM IS A COMPONENT. ARCVIILLAUKAL IN Ib4IJ, irvL,. ✓` o5 S. 3Eaeuetea 8 -25 -10 BY: DATE: Review Comments: Sample(s) required? (NO) Supplied? (NA) Certificate(s) required? (NO) Supplied? (NA) Wananty(s) required? (NO) Supplied? (NA) Notes: Please be sure to maintain ventilation pathways from the eave soffit vents. (If there are existing recessed light fixtures attention should be given to allow for ventilation around light fixture housing unless the fixture is rated and made to allow insulation placed directly around the fixture. 3 Converse Street Suite 201 Palmer, Massachusetts 01069 PH 413 -283 -2553 FX 413 - 289 -8993 I: \10 \1066 Energy Improvemets - Northampton \ConstrAdmin\Shop Drwgs \Blown Insulation.docx 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 Q SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN . OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, p01\" as Owner of the subject property h: -by authorize ` r'a � � clA\ to a i half, al matters relative to work authorized by this building permit application. Sign.ii-.�1: Ow :r , Date 13 " liti I, �' �__ "` , as Owner /Authorized Age , hereby de : re that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and . ief. Signe . fi- " pains and penalties of perjury. Print N. Signature o • ner/ • ! • Date SECTION 12 - CONSTRUCTION SERVICES I j 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder . �, A _ - 1 O2. 8 C> License Number I 6 2,7 i 1 A• sass Expirationbbate 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 0 No 0 ` __~_-_' - PROFESSIONAL DESIGN AND . CONSTRUCTION CONTROL PURSUANT TO (CONTAINING MORE THAN z5,wmn E) Registered - - ) �� C] r -- - - -' . L , � �_� -----�-� ---'--=} 41:3 .. - aFf/QESExpiration Dale Signature Te4 , hone ___.�_____ ________ _________ � !__ _____. _____. �_ ___� _ Area of ���--����- u�espvnsixm? _ _ ' ' ! 1 ..- ._ -_. / _�____-� � - _ . i--- _ ___- ___ ---_- uw, remponn� � ' - -- |� ---- -- - - -- ------ -- -- -----'- !'-- '-'---'- ' -''-----, _ ' | AddreSe ' ` - -- - ' �n»*m� �___��_ Telephone Expiration ---. _ ��_-- ' _ � '. ' . ! | - - '' . [ -_-- _' �_ _ -- ' --_ ___-__- __- ____ *dd*rss __ m ' . Signature ' Telephone Eviration -- ` -`' ` ` - - _ - - _'_ . .__ ---- Registration � ' � -' � _ _ -_ _ Signature Telephone Expiration Date -� _ ________ Company Name: . �'~_� � - '`~ "^.1 `_&- k - ' v~-`'r ^~ k b. ^ -_-_-- Ohs ^ I, - k �^v,~ v '' � \ ��` ' r. A rum--. ^�� �� — � - � x^on=w U � • * � � ' - �'- ' T� �� � ' '� v.�-_� - ^_" ^ . ~- Alum Telephone . _ IF r 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 ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ e of U g Sign Signs Roofing ❑ Change ❑ Other Exterior Alteration ❑ Existing Ground Si n ❑ New Si ❑ R __... Brief Description Enter a brief description here. ' ' "Vd Of Proposed Work: SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑ A-4 ❑ A -5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational Iiii4 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 ❑ 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 l BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1st 1r zo 1 2"d 2�c 3i° 3ro 4 Total Area (sf) G,6® Total Proposed New Construction (sf) Total Height (ft) la , Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood ZoneD Municipal ❑ On site disposal system❑ Versionl.7 Commercial Buildineermit May 15, 2000 Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit - S E P 1 5 2010 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability jNort ampton, MA 01060 Two Sets of.Structural Plans phone.y413 -5 7 -1240 Fax 413- 587 -1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office 1.1 eof'_ . Q Map Lot Unit > %' Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: ado Kn • Name (Print) Current fling Ad : 1 alisfacs Signature Telephone 2.2 Authon • • : nt: Name (Print Current Mailing Address: X Signature a , Telephone SECTION 3 = s I NSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 5u tw� r1 t tai 10 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 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- 2011 -0235 APPLICANT /CONTACT PERSON CAPITAL INSULATION ADDRESS /PHONE 2 BURLINGTON WOODS BURLINGTON (781) 203 -2706 PROPERTY LOCATION 221 RIVERSIDE DR MAP 30B PARCEL 022 001 ZONE URB(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 Typeof Construction: INSTALL ATTIC SULATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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 /7 P/6/ /6 Signature of Building fficial Date g g 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. 221 RIVERSIDE DR BP-2011-0235 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30B - 022 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 -0235 Project # JS- 2011- 000398 Est. Cost: $12600.00 Fee: $0.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CAPITAL INSULATION Lot Size(sq. ft.): 45302.40 Owner: NORTHAMPTON CITY OF FEIKER SCHOOL Zoning: URB(100)/ Applicant: CAPITAL INSULATION AT: 221 RIVERSIDE DR Applicant Address: Phone: Insurance: 2 BURLINGTON WOODS (781) 203 -2706 WC B URLINGTON MAO 1803 ISSUED ON: 9/17/2010 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL ATTIC INSULATION 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 9/17/2010 0:00:00 $0.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner