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24B-079 ) c ' A - an Name: DAVID W CORREIRA . ender vi er Name: 1 n .4 s ;6 • enTation ddress 96 GRAPE STREET REAR ddress 2: ity: Chicopee Mate: MA ipcode: 01013 o n U "fed tates �_. • rata is ` License No CS- 072783 License Type: Construction Supervisor `rofession: Building Licenses Date of Last Renewal: 1/27/2012 Issue Date: 2/312010 Expiration Date: 1/6/2014 tense Status: Active Today's Date: 7/20/2012 N.econdary License: going Business As: � ., tus Chan • e: 18 : ',, o . No Prere uisite Information .._ :. b .. _._..� .. _ o Discipline Irtf rs we oetirriAi - ; .q ' ' . - i :; J ''. ; j ' . ',!: . - , j ' '''-j ,s j'Jj i s - . , . • , ., . • - -J :J.', • (c..) .-:, •,,, c) ) ) •U 6 1' U •,' .-' 1 . I (..,? r ',.)') . ''''' HI ( .1. - - (i) b 0 P, .i.;) ( ( - .'::.•:,.:::::H.......,.: ? '..'.. ', - ....,,, a. ) nti cN.,' :i- (:) ;.:.!. (,',',) .1 (2) \ ( ;•„\\ 'ed f,':1 co I c.) , c. (.-':., --: L..) 1 I 1 <.) 9 \ \ u ,., . .. ,,,, 1)) (..) `:.'.4'''-: a ) , -... , .-`l ) X .-.'; r I io ' ,... ; ,.... 6) t: : C' "C 2 ,'P t '' ,,:, ,- ■,),J )_.7.1 ,',,,'": r - - \ '1,3 1 ,: . ;• "-.: co 1 ::; ) (? .:3 H v (.1 ,..-.' ;?? 0 , ..„. i.. ...:.... ,.., .,,..{tH...,:! t.., p•.) . ..,‘n J—JJ 7...JJJ t, .,J J , 4.:,:; t-1 , ,,,L`AHL111 '-', 1,, i c\:, rf'1, c■.) i;11,, ' :,, ...::Tl1 ' LiThHi; ,''.:' , ':. ! , ,.r - , :i.: " 9 f ) '-`'-: cc :1/1` o ',!..• t‘', c ..: o .... - ',', ' ;HiW ; ',",'), e-, J :::; 'r< 6 ,, / ., • 1. 0 !':;-.: ■--, (-11 , i r' .---•-. - -'",,•;H:HiJj 1;:!! J `•7',. , , ‘....,1 J c: - • J J J .•-. _ -- j ,, • -,, J',.c.,:i f\) JJJ ;, J -• I I- * Cetl ,,, c..1: ■r. 1 i G '-'''' -::' : 1, C..) (1 - --A ''??, ''' -••:' IA (0 1(. u.) tl>,, :- y, c.) I 1 r -- I SI) 2 , . .. . . 2 (.1(.■ ,..:, (0 ,,:) u --, is.) tin ---•:,., r. • i' :-.-., i i F : C s l:::: ' Ni C.) 01 f,''' . {''i 'r 1 : •-■ 1, .., 1) : e, r.t. , v, o . ., Owner shall have sole control of any data breach notification required by applicable law. At the Owner's request, the Contractor shall investigate and remediate any data breach caused by the Contractor or the Contractor's agents, all at the Contractor's sole expense. 7. This contract embodies all of the representations, rights, duties, and obligations of the parties hereto. and any prior oral or written agreement not embodied herein shall not be binding upon or endure to the benefit of any of the parties. 8. Sections D and E shall survive the termination of this Agreement. 9. Any waiver by the Owner of a breach of any provision of this Agreement shall not operate or be construed as a w aiver of any subsequent breach of such provision or any other provision hereof. 10. The Contractor hereby agrees that each provision herein shall be treated as a separate and independent clause, and the unenforceability of any one clause shall in no way impair the enforceability of any of the other clauses herein. Moreover, if one or more of the provisions contained in this Agreement shall for any reason be held to be excessively broad as to scope, activity, subject or otherwise so as to be unenforceable al law, such provision or provisions shall be construed by the appropriate judicial body by limiting or reducing it or them, so as to be enforceable to the maximum extent compatible with the applicable law as it shall then appear. 11. The Owner shall have the right to assign this Agreement to its successors and assigns, and this Agreement shall inure to the benefit of and be enforceable by said successors or assigns. The Contractor may not assign this Agreement or any rights or obligations hereunder without the prior written consent of the Owner's President, and this Agreement shall be binding upon the Contractor's heirs, executors, administrators and legal representatives. 12. This Agreement and all aspects of the relationship between the parties hereto shall be construed and enforced in accordance with and governed by the internal laws of the (circle one: Massachusetts or Maine) without regard to its conflict of laws provisions. The Contractor further agrees that any claims or legal actions by one party against the other arising out of the relationship between the parties contemplated herein (whether or not arising under this Agreement) shall be commenced and maintained in any state or federal court located in (circle one: Massachusetts or Maine), and the Contractor hereby submits to the jurisdiction and venue of any such court. This c ntract and all le is and conditions contained herein are approved and accepted as of the date first above writ -n ..., (Owner) (Colattacto . A test; ' Attest Lf ski f ♦ _. ` By: - � — ..._ .. Witness 441 ess toe —�� Page 5 of 5 owner contracts 7 re , C t 500/500'd 6179# 6ti:ll Z10i; /l£ /50 :woJj Owner shall first notify the Contractor of the existence of such violation and provide the Contractor ten (10) days in which to remedy the violation at the Contractor's expense. F. GENERAL PROVISIONS: 1. The Contractor agrees to perform all contract work as specified, and the Owner agrees that neither he, his tenants, agents, nor his employees will hinder the Contractor or his work. 2. Ville Contractor is a corporation or a limited liability company, the Contractor warrants, represents, covenants, and agrees that it is duly organized, validly existing and in good standing under the laws of the state of its incorporation or organization and is duly authorized and in good standing to conduct business in the State of (circle one: Massachusetts or Maine), that it has all necessary power and has received all necessary approvals to execute and deliver the Agreement, and the individual executing the Agreement on behalf of the Contractor has been duly authorized to act for and bind the Contractor. 3. In the event of any breach of this contract by the Contractor, the Owner may, at his option, engage the services of another contractor to complete the work and deduct the cost of such completion from any amount due the Contractor. The Contractor further agrees that any breach of this Agreement by him will cause irreparable damage to the Owner and that in the event of such breach the Owner shall have, in addition to any and all remedies at law, the right to an injunction, specific performance or other equitable relief to prevent the Contractor from violating his obligations hereunder. 4. The Owner may request that progress reports be provided by the Contractor. 5. The Owner and the Contractor expressly agree and understand that the Contractor is an independent contractor and nothing in this Agreement nor the services rendered hereunder is meant, or shall he construed in any way or manner, to create between them a relationship of employer and employee, principal and agent, partners or any other relationship other than that of independent parties contracting with each other solely for the purpose of carrying out the provisions of this Agreement. The Contractor is not the agent of the Owner and is not authorized and shall not have the power or authority to bind the Owner or incur any liability or obligation, or act on behalf of the Owner. At no time shall the Contractor represent that he is an agent of the Owner, or that any of the views, advice, statements and /or information that may be provided while performing the Services are those of the Owner. While the Owner is entitled to provide the Contractor with general guidance to assist the Contractor in completing the scope of work to the Owner's satisfaction, the Contractor is ultimately responsible for directing and controlling the performance of the task and the scope of work, in accordance with the terns and conditions of this Agreement. The Contractor shall use his best efforts. energy and skill in his own name and in such manner as he sees fit. 6. The Contractor shall implement reasonable and appropriate administrative, physical and technical safeguards to protect the security of Personal Information that is collected, transmitted, or maintained by the Contractor on the Owner's behalf. Such safeguards shall be sufficient to comply with the requirements set forth in 201 C.M.R. 17.00 and other federal and state law applicable to the Owner, bn the effective date of this Agreement and annually thereafter, the Contractor shall certify the Contractor's compliance with such requirements, in writing. The Contractor shall notify the Owner within one (I) business day of the Contractor's becoming aware of a possible security breach with respect to such Personal Info mation. The Contrac agrees that the Page 4 of 5 owner contrac 'r / -7 (r57) 5OO /1700'd €b9# 6t:ll ZIOZIIC /50 :uoJ. � 4 services, inventions, designs, methods, formulas, drafts of publications, research, know -how, techniques, systems, databases, processes, software programs or code, developments or experimental work, works of authorship, customer lists and /or customer information, business plans, marketing plans, financial information, sales techniques, projects, the Owner's personnel information, and all other plans and proposals. (b) The Contractor acknowledges that the Confidential or Proprietary Information and/or Trade Secrets are the Owner's sole, exclusive and extremely valuable property. Accordingly, the Contractor agrees not to reproduce any such information without the Owner's prior written consent, not to use such Information except in the performance of this Agreement, and not to divulge all or any part of such Information in any form to any third party, either during or after the term of this Agreement, except to the Owner's employees and the Contractor's employees, if any, who need to know such Information in order to perfom the Services. Upon termination or expiration of this Agreement for any reason, the Contractor agrees to cease using and to return to the Owner all whole and partial copies. (c) The Contractor warrants that his performance of all the terms of this Agreement does not and will not breach any agreement entered into by the Contractor with any other party, and the Contractor agrees not to enter into any agreement, oral or written, in conflict herewith. E. INDEMNIFICATION /RELEASE: (a) The Contractor agrees to take all necessary precautions to prevent injury to any persons (including employees of the Owner) or damage to property (including the Owner's property) during the term of this Agreement. and shall indemnify, defend and hold harmless the Owner, its officers, directors, shareholders, employees, representatives and/or agents from any claim, liability, Toss, cost, damage, judgment, settlement or expense (including attorneys' fees) resulting from or arising in any way out of injury (including death) to any person or damage to property arising in any way out of any act. error, omission or negligence on the part of the Contractor, any Contractor employee or any sub - contractor in the performance or failure to fulfill any Services or obligations under this Agreement; (b) To the extent the Contractor retains any employee in furtherance of the services the Contractoris to provide in accordance with the terms of this Agreement, the Contractor shall require each such employee to execute a Waiver, in the form attached, providing'that a claim for Workers' Compensation benefits shall be the employee's sole remedy whenever and to the full extent available. Further, the Contractor shall require a Waiver in similar form be executed by any subcontractor and the employees of any subcontractor. (c) The Contractor agrees to indemnify and hold the Owner harmless from and against any and all claims, losses, demands, liabilities, damages, costs, or expenses (including, without limitation, attorneys' fees, back wages, liquidated damages, penalties or interest) resulting from any violation of any federal, state or local law, regulation, or ordinance by the Contractor, any Contractor employee or any sub- contractor, including, without limitation, the Contractor's failure to collect, withhold, or pay any and all federal or state taxes required to be withheld or paid by employers or employees, including, without limitation, any and all income tax, social security, and FUTA taxes; (d) The Contractor further agrees to indemnify, defend and hold harmless the Owner, its officers, directors, shareholders. employees, representatives and /or agents from the costs to the Owner of remedying any violation or breach of this Agreement by the Contractor or any sub - contractor and /or from the costs to the Owner resulting from a breach by the Contractor to a third party during the performance of the Services under this Agreement. In remedying any violation of this Agreement by thentractor, the Page 3 of 5 owner contrac -� 500 /£00'd C 9# Bb :tl ZIOZ /L£ /50 :woad 10. Guarantee the work performed for a period of twelve (12) months from the date of final acceptance of all work required by this contract. Furthermore, furnish the Owner and the Grantee with all manufacturers' and suppliers' written guarantees and warranties covering materials and equipment fumished under this contract. 11. Furnish the Owner, upon completion of the work and upon final payment by the Owner, a Release of Lien Form certifying that all charges for materials, labor, and/or any other expenses incurred by the Contractor pertaining to the execution of this contract have been paid in full. 12. The Contractor will comply with all employment laws including, but not limited to, State and Federal Wage and Hour, And - Discrimination. and workplace safety (OSHA) laws. Further, neither the Contractor nor his employees will engage in any conduct that violates any rights of any of the Owner's employees. Moreover, the Contractor, directly or through his employees, will not violate any established employment policy of the Owner including, but not limited to, its Sexual Harassment, General Harassment, Drug -Free Workplace, Workplace Violence and Information Security Policies. The Contractor shall take any and all steps necessary to inform his employees of these and any other policies provided to him by the Owner. 13. The Contractor shall incorporate the requirements of paragraph A(11) of this Section in any and all subcontracts. B. THE OWNER SHALL: 1. Advise the Contractor of any changes to the description of the work to be performed. 2. Permit the Contractor to use existing utilities such as lights. heat, power and water as necessary to carry out and complete the work as specified. C. METHOD OF COMPENSATION: Unless otherwise agreed to in writing by the Owner and the Contractor, payment for the work performed shall be made in one lump sum and shall be paid to the Contractor within twenty (20) days after the latter of: (1) the completion of the work; or (2) the Owner has received the Contractor's Final Invoice and a satisfactory release of liens, or claims for liens, by subcontractors, laborers and material supplierr for completed work Qr installed materials. C TracTtsC S1 i1 pc-Q(2 Wt. ',2C u dr- "- ' ° ` .t- it /0 000 a ec e(est 0-1E job cvrcrc c7 F,r.r� w, Li NN I. C eS s of lf'S( cri° a -F, l a ! b) o, rep d.(' • The Contractor shall be liable for and shall pay to the Owner the sum of $ © as fixed, agreed and liquidated damages for each calendar day of delay from the above stipulated completion date (Section A, Paragraph 3) or as modified by a properly executed Change Order until such work is satisfactorily completed and accepted by the Owner. D. NONDISCLOSURE: (a) The Contractor understands that, in connection with his engagement with the Owner, he may receive, produce, or otherwise be exposed to the Owner's Confidential and Proprietary Information. which is defined as any information concerning the organization, business or finances of the Owner or of any third party which the Owner is under an obligation to keep confidential or propriety d that is Page 2 of 6 owner _ contra oc�f r_ . - U 50O/ OO d Eti9# eti it elOaI1EI50 :woJ3 SPEAR MANAGEMENT GROUP, INC. Simple Bid /Contract Agreement THIS AGREEMENT, made and entered into on 5/507 L (Date) by and between -orv, RO. MaaELINC , hereinafter called the "Contractor" and HR'734 oFR) MS L.. t°. . hereinafter called the "Owner ". In consideration of the mutual premises and agreements contained herein. the undersigned Contractor and Owner agree as follows: A. THE CONTRACTOR SHALL: 1. Furnish all labor, materials. tools, machinery, supervision and services necessary to perform all of the work in accordance with the description of work consisting of all work write -ups, specifications and supplemental contract } docum�en �tjon dated 5�E-P 7 5E2 0 11 on the properties located at 'T5 9aadzCc'f'f tbT "'r for the sum of $ 1 a _ All work write -ups shall be made part hereof by reference. 2. Perform all work timely and diligently in a good and workmanlike manner using approved or equal materials as specified by the Grantee. 3. Begin work by: Jur/E ! 010)R and complete the work by: Tal''1 t ( a l a unless change order request for any extension in writing is submitted and is agreed by both the Contractor and the Owner. 4. Carry Workers' Compensation and Em.lo er's Liability Insurance in accordance with the laws of the State (circle one: Maine or - j -1 for all persons engaged in work at the site; and carry Contractors' Public Liability an. Property Damage Insurance and Comprehensive Automobile Liability Insurance. All said policies shall be in amounts and with insurers reasonably acceptable to the Owner, and the Owner shall be listed as an additional named insured and/or as an additional loss - payee under such policies. 5. Furnish, before beginning the work, a Certificate of Insurance showing compliance with the provisions of Section A, Paragraph 4 above. Such Certificate(s) shall indicate that the policies will not be changed or terminated without at least ten (10) days' prior written notice to the Owner, and shall also indicate that the insurer has waived its subrogation rights against the Owner. 6. Obtain and pay for all permits and licenses for the execution and completion of the work and labor to be performed under this contract. 7. The Contractor will maintain employees who are properly trained and experienced personnel to ensure satisfactory performance under this contract and the Contractor agrees that all persons connected with the Contractor directly in charge of the work are duly registered and /or Licensed under all applicable federal, state and local laws, regulations and ordinances 8. Keep the premises clean and orderly during the work and upon substantial completion of the contract. remove all rubbish, tools, scaffolding, and surplus materials from and about the site(s) and leave the work and premises consistent with prior appearance or equivalent. Material and equipment that have been removed and replaced as part of the work shall belong to the contractor. 9. Not assign the contract without written consent from the Owner. --^. Page 1 of 6 owner contrator.%.„ - - --- 900 /l00'd Cl/9# 9ti:11. et0E /LE /50 :tuoJj ACCPRO CERTIFICATE OF LIABILITY INSURANCE DATE i�u2o T ) 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 P 617- 924 -1100 Fax 617 - 926 2162 NAME Bradley S. Michels Insurance a .E:t,: P 617 -924 -1100 FAX WC, Fax 617-926-21d 19 Main Street E-MAIL DSS: Watertown, MA 02472 INSURERS AFFORDING COVERAGE NAIC # Robert Tuttle INSURER A : Arbella Insurance Company INSURED INSURERS : AIM Mutual., Inc. J & C Home Remodeling INSURER C 997 Tinkham Road INSURER D: Wilbraham, MA 01095 INSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER: 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 INER S yUyD POLICY NUMBER POLICY EFF POLICY EXP UNITS GENERAL UABIUTY EACH OCCURRENCE $ 1.000,000 DAMAGE TO RED A / COMMERCIAL GENERAL UABILITY PREMISES (Ea o $ 100,000 CLAIMS -MADE OCCUR TBD2012 06/21/2012 06/2112013 MED EXP (Any one person) $ 55 000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2.000.000 GEN'L AGGREGATE OMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY Q I LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY (Per person) $ AL OOWNED SCHEDULED BODILY INJURY (Per accident) $ NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per acdden0 _ $ UMBRELLA A LIAR OCCUR EACH OCCURRENCE _ $ EXCESS UAB CLAIMS -MADE AGGREGATE _ $ DED 1 j RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' UABIUTY Y /N.. TORY1 MITR FR ANY B OFFICEER/MEMBERPEXCLUDED? ECUTNE1 N NSA TBD2012 06/21/2012 06/21/2013 E.L. EACH ACCIDENT $ 100.000 (Mandatory in NH) EL. DISEASE - EA EMPLOYEE $ 100,000 &ascribe under it DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY UNIT _ $ 500.000 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, M more space is required) For operations to be performed at Hathaway Farms, 73 Barrett Street, Northampton, MA 01501. Spear Management Group, Inc. 319 Southbridge, Auburn, MA / Hathaway Farms Townhomes of 73 Barrett Street, Northampton, MA / Hathaway Farms Townhomes Limited Partnership, 319 Southbridge Street, Auburn, MA / Spear Hathaway LLC, 319 Southbridge Street, Aubum, MA are listed as additional insured for liability. This is based on $1,000,000 per occurance/ location limit. CERTIFICATE HOLDER CANCELLATION Spear Management Group, Inc. SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE EREOF, A Massachusetts Corp ACCORDANCE W THE POLICY PROVISIONSE WILL BE DELIVERED IN 319 Southbridge Street Auburn, MA 01501 AUTHORIZED REPRESENTA 03198 20 i COR I CO ' • O - - ION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACO The Commonwealth of Massachusetts Department of Industrial Accidents 4, Office of Investigations e , = aa. 600 Washington Street Boston, MA 02111 r ~4 ' www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians /Plumbers Applicant Information Please Print Lea,ibly Name ( Business /Organization/Individual): Z =Y c_ ` .` --Yr Address: 9 q. ,-1 \ City /State /Zip: CL, Yv4. r.�1c42S Phone #: 4 ( - Are you an employer? Check the appropriate box: Type of project (required): 1. 54. I am a employer with (y 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part- time).* have hired the sub - contractors listed on the attached sheet. 7. ❑ Remodeling 2., I am a sole proprietor or partner- ship and have no employees These sub contractors have g. ❑ Demolition for me in any capacity. employees and have workers' working 9 g y p ty ❑ Building addition [No workers' comp. insurance ' comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions officers have their Plumbing repairs or additions 3. ❑ I am a homeowner doing all work ave exerc r 11. ❑ myself. [No workers' comp. right of exemption per MGL 12.154 Roof repairs insurance required.] t c. 152, § 1(4), and we have no 13.❑ Other employees. [No workers' 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' cornp. 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: 1 1 Y`^ I (0..9 _ *• . Policy # or Self- -ins. Lic. #: i 0 c} C�' r1� Expiration Date: L- r 1 — Job Site Address: ` ' 1 3 'MA- r r ,y, . R<_, City/State /Zip: N rim 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 und,gr the pains and penalties of perjury that the information provided above is true and correct. Signature: < C—,i Date: la Phone #: '1 - i Lcf 3 c 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 #: 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 0 _ No c SECTION 11 OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, . m �. , as Owner of the subject property hereby authorize _ ,.._ _.......w_, _�,..,.,.., _ _ _ ._ - to act on my behalf, in all matters relative to work authorized by this building permit application._____ _ _ _. Signature of Owner .-- -..._. _..._ - Date , 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 er'ury , ._— Print Name �... . m. _ . Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable El Name of License Holder . f P� � 1fll ' �^. , m 1 a f .rt_.._ , ,. ....._. _ .__ .......... . License Number Address c,s Expiration Date Si tune ---, Telephone i f& SECTION 13 - WORKERS' COMPENSATION INSURANCE AFFIDAVIT (MG.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 N No (e\ ( POL , Version1.7 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 1;16 (CONTAINING MORE THAN 35,000 C.F. OF E■,LOSE© SPACE) . 9.1 Registered Architect: Not Applicable CI Name (Registrant): - _ _._..__.____...._ , _.. _ .., a - - _ _� _ ._�w. _. Registration Number Address _______ . 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 R tti Number egisraon _ ._ Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name _ �_�" "� �� " "`_ � --- " "' ____��...� Area of Responsibility Address Registration Number Si c nature Telephone Expiration Date eneral Contractor J C 7nc,-e_r.v� u• ..._....__.. _...._ �- ___..� _� ..._. Not Applicable ❑ Company Name: Responsible In Charge of Construction °t`( .. 1i '''X.1r_.‘- .ar- -. _ (Zcya r _) a s` -4-w. t ..., .,...Q.1 5 Ad res Signature Telephone • Version1.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column M re filled in by Building Department Lot Size ___.. " _o _, ' __ _ Frontage Setbacks Front Side . L Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) w... # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW ® YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 1f YES IF YES: enter Book Page and /or Document #. B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 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 6 NO IF YES, describe size, type and location: Q f } 3' X 5' c & . ��, � i` =t,N- e, ,aa D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 N O j IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, - xcavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ( 3 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. .•r Version1.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE lt Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofin • :.. Change of Use ❑ Other ❑ Brief Description Enter a brief description here. y,rnz; -..e C.,;. , - .r°�'Sw.().es 1z y ay.1, l,5 Of Proposed Work e..... f 'Rti�as SECTION 5 - USE GROUP AND CONSTRUCTION TYPE- . USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1A 1 0 A-4 ❑ ` A -5 ❑ B Business ❑ 2A ❑ E Educational ❑ 2B A r ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C 0 H High Hazard ❑ - 3A 0 1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential i , e , 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 ..__m_________ _ , Proposed Use Group: _ _____ ____ .. Existing Hazard Index 780 CMR 34): ,, _ __ µ____ _ . 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 .... _ �-_, 2nd 2" d 3rd v - 3rd _. , 4 Total Area (sf) Total Proposed New Construction (sf)__ Total Height (ft) Total Height ft e:.:.:w: ___ s, .,......, 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 Zone❑ Municipal On site disposal system • .. Version1.7 Commercial Building Permit May 15, 2000 _ City o Northampton ::t::I n JUL $ uilding Department e 21 M ain Stree Sew /Septttvatrabtl P ECTIC Room 100at8felal�a�lty a v' � 2 i OF BU� E 1 AOb0SO e N oRTw�MF - �° 1`Torthampton, MA 01060 T iifSel o t cturakPfens , > � ,w ,, phone 413- 587 -1240 Fax 413 587 -1272 Pl P ra n s Other'S ec! , 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 This section to be completed by office 1.1 Property Address: k-AeL (i`∎5 \- c cc._ 1 'siv. -5 i h . ` Map Lot Unit n, `c r c_k,•, , / Zone Overlay District - - - a - � - - -a =• --e- - �---• / El 'St. District CB District - SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: , ) (`. n� �e.iht �` A 1'r 4— cs.. '.."-"r t ".fiV ..cs.•k iv-e- .j_ Name (Print) Current Mailing Address: ,_ ) Signature Telephone ' . 1 3 5SSL..- i `(c 2.2 Authorized Agent: Name (Print) Q ;i ._ •, j ..vu —„ c tt.J Current Mailing Address Signature Telephone 4 t 3 -- F1), - �€.3 c SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building Lt la v�� _ (a) Building Permit Fee 2. Electrical : ----- _ ------- (b) Estimated Total Cost of Construction from (6) _. _ ____ . _ ._..._ , . 3. Plumbing ...._. ..__.,. .... ---- . _ _ Building Permit Fee 4. Mechanical (HVAC) - ____w °__ _ _ " _ 5. Fire Protection 6. Total= (1 +2 +3 +4 +5) Check Number / * ' c9 2 3 id This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0074 APPLICANT /CONTACT PERSON J & C HOME REMODELING ADDRESS/PHONE 997 TINKHAM RD WILBRAHAM (413) 324 -6930 PROPERTY LOCATION 73 BARRETT ST - HATHAWAY FARMS MAP 24B PARCEL 079 001 ZONE URB(100) /WP(7)/ 7 THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ��, �� Fee Paid J Tvpeof Construction: STRIP & SHINGLE ROOF - UNITS1,7,8,13,25 & 26 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 INFO ATION PRESENTED: (pproved 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 ( i 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. 73 BARRETT ST - HATHAWAY FARMS BP- 2013 -0074 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24B - 079 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit # BP- 2013 -0074 Project # JS- 2013- 000104 Est. Cost: $47222.00 Fee: $283.20 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: J & C HOME REMODELING_ Lot Size(sq. ft.): 785822.40 Owner: HATHAWAY FARMS TOWNHOMES LIMITED PARTNERSHIP C/O SPEAR MANAGEMENT Zoning: URB(100) /WP(7)/ Applicant: J & C HOME REMODELING AT: 73 BARRETT ST - HATHAWAY FARMS Applicant Address: Phone: Insurance: 997 TINKHAM RD (413) 324 -6930 WC W I LB RAHAM MA01095 ISSUED ON: 7/24/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF - UNITS1,7,8,13,25 & 26 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 7/24/2012 0:00:00 $283.20 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner