39-063 (5) NOTICE t ..=.10Ak= I NOTICE
TO — °�� TO
EMPLOYEES EMPLOYEES
7 �W
V
QOM r %%
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
600 Washington Street, Boston, Massachusetts 02111
617 - 727 -4900 — http: / /www.mass.gov /dia
As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that
I (we) have provided for payment to our injured employees under the above mentioned chapter by
insuring with:
THE TRAVELERS INSURANCE COMPANIES
NAME OF INSURANCE COMPANY
P.O. BOX 1450
MIDDLEBORO, MA 02344 -1450
ADDRESS OF INSURANCE COMPANY
(IEUB- 8771W83 -7 -12) 04 -13 -12 TO 04 -13 -13
POLICY NUMBER EFFECTIVE DATES
JAMES J DOWD & SONS INC 14 BOBALA RD
HOLYOKE MA 010402879
NAME OF INSURANCE AGENT ADDRESS PHONE #
DEVELOPMENT ASSOCIATES 630 SILVER STREET, UNIT 3C
AGAWAM
MA 01 001
EMPLOYER ADDRESS
EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE
MEDICAL TREATMENT
The above named insurer is required in cases of personal injuries arising out of and in the course of
- employment to furnish adequate and reasonable hospital and medical services in accordance with the
provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the
°� injured employee. The employee may select his or her own physician. The reasonable cost of the services
a - provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably
connected to the work related injury. In cases requiring hospital attention, employees are hereby notified
that the insurer has arranged for`such attention at the
NAME OF HOSPITAL ADDRESS
000003 W20P1G02 TO BE POSTED BY EMPLOYER
• •
Massachusetts - Department of Public Safety
• Board of Building Regulations and Standards
Construction Supcn isur
License: CS -020404
■
TERRENCE L RIP�
PS
60 SILVER LAID. DR:
AGAWAM 114A 01001
Expiration
Commissioner 12/15/2013
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
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I , CGw ?' 0 1./ , as Owner of the subject property
�f
hereby authorize 170 l ( QIKi 4S4 So LGc to
act on my behalf, in all matters relative o ork authorized by this building permit application.
g104%X.41 19-7 7 /Z /tot 2..
Signature of Owner Date
I, i(g/v/ F Tq v lwcc) N'4,s , 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.
*AiAte + V i4& t'.4S
Print Name
/24/ (R
Signature of ner /Agent Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
r License Number
Ji Li ke QQi! vg 4j4 1 ) • d1CV/ Logo '
A dress � Expiration Date
4 /
,Z�'cv yr.3 392 ri ' % � -~ l 5
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
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 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
�j Not Applicable
Name (Registrant): / 1 �
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
TBD
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
4,E1/. 4Y 4 /74 17 tiSc 'C //9 ,S Not Applicable ❑
Comp n Name:
Responsible I harge of C s uction
Address
c ud 2.oyDi�
113 368.770f
Signatu a Telephone
Versionl .7 Commercial Building Permit May 15, 2000
14 141 (1 . li +
i P tli iR '; {r i III piim�''- :0 1 1, i .
re 11iNli i, a. rt € dkNi ilihuiP fitter hi 014td 1 . 1 1 11,
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DON'T KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® DON'T KNOW 0 YES Q
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW ® YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO
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 0
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 Q NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Versionl .7 Commercial Building Permit May 15, 2000
SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolitio ,%J Repairs ❑ Additions ❑ Accessory Building ❑
Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑
Enter a brief rt0' here. " ��
Of Proposed Work: �wl�IaM�/�
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 2Ai
E Educational ❑ 2B I .0,
F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ I -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 l ❑
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 .
((( V II I OFFICE U E O L
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION I0 , 3, :1 1 I h 41 If�1 Il :1 [, 5 "I, 1,1,,1 1 11
n r 1, I m k1 all I � I I r y 7 u ay tl 1, 1
,111 i 1I pl 1 I II I , I I IG Nh 10 4
„^ . h F a I lu 4h1 , Itl,1P11111111�114111 0 :, 1 1
per ' +II)II,I 1 1 . 1411 � 1 �.>,_.,ull ° Il�lllfil�l
Floor Area l
p (sf) I III 1,1
IlPl hl 1 I� I ,,i » y
t ,I Irt� sr 1 I
1 11
: 11111 fi ll s - , l 1 i 1 V
1 1, 1 :I 1 I 1
st 11 1 11
1 St Il X11 I ,l' ul I -ijV o .. l t lI 1 ° II 1 9111 1 I 1
�4 I I I I ! I I I I
� m ,,I,III,11,,j1 '€ 1l I i „ U r
2 nd
; 1111 I ,re ��
2 ,= , I I 1 �r III , 0 1 livillp I � ,u r o ,' � - x 2 nd „ II l n � , 1 1 11 1 11 1 1 1 1 a x P ! 11 11 d � l II II' II r 11 N lu 11,1 �I 1 I�,�� �tlmll 1 tlI IN �I��I� 1111 �i VII,(11,11,Illxr fd l I lli 11 I hI I PING I Ij 1 1 1 11 1,1 1 I I 10 p 1
3 rd 3 „!1 h III DIlir 1 401 I 1 111 1 1 I I I I (I I I I 1 IV I I III iV
3 1 a 1�11IN111k11 4s 1! ..01, a Ill16I 1 I III:h11111,j1111
" 1 h f�k r 1111111 1� 1, „ *.
hill,! II V 1 7 k Y u I 1 1 1 fir' ll 111 1 1V11Vh, � l
4 th ry111Ij o11 ` 1 III 1
1 h
4 th ` a 1 , �""'M' u1' iy } r,"a t�` a I
7 I 1..
st, s 1 w '?,SuvrR sti x d t ma ,� l .t4 rn
„ ,r. I I I , ( , 11 „ ' tt k. . b � "
{ I r ys h � t -h. 1 1 1 , i ll
1 7, I IIiI l II I 111 1 N9 „ .0'0 s 1411 illll
Total Area (sf) Total Proposed New Construction (sf) 11 111 111 1 1 , 1{IIII � 11,1I1 " 1 r ' A
' 1 IIIII1 h1r m 14, 1 1 1 111N r ISiE t i111I1111 U t 1111
a 711111 h1V t II I I 44rl l,l 4 IIIIh I (111
II N t 1 lI '�,, l �l y I � II I Vhf N lh 1 p II � 1 �� � �I
1, 1 , 1 I �I,I�P,1119, a 7
t 0 '.I h 1 1 W, hI11111111 1 11111 t11a1 i4 Jn i
a r� s i ht � , IIU4 j I 111 1 h 1 41" I i +I ,
Total Height (ft) S
Il 1111111 +ir i, 1,11 I I I
1mu1NI, Ii r, u,+'� 1
11 1 11 111,111 11 INIIIIupI@Nh1 ,uI ,k ,1
1u , ar III,„ 1 1
Total Height ft P10:::
u �i� jfi 11 �,� � f lu 411,, 1 1 1 I I
g 11 11111 } i I N, I �, :7.N' � 1 u I I 4 t I G I l i
mm I �IIIU�II 4 h 111 III III 1„ 11 t
: 1:i, I,11,1'IIII s � 1 V p i 4149I� 1 0111111 1,1 l"x. . . of 11 h1 1111 1 111
7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage posal System:
Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal O n site disposal system❑
Versionl .7 Commercial Buildin_ Permit Ma 15, 2000 I
I tyro II I 1 re l,n � 1I
� p 1 Il .41r.,$'11 s�
1 V III }c,1:,,,,I, i iti yr �
'
ECEIVED •ity of Northampton i . „,4i,1 , I I
ilding Department ,4�i, n . 'III I,l I,
SEP 2 6 2012 212 Main Street� °1 ° 91 '`
Room
i✓ u �I 1 Vw�. l V .
00 100 ,I N 1
.
DEP7 BUILDING INSPECTIONS No hampton, MA 01060
NORTHAMPTON ' 587 -1240 Fax 413-587-1272 '1 1 II
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
II I 1 u Thfs section to be c om p let e d I I
1.1 Property Address: ) by off e : a 1, ,1 ,1 °� z 1 ;, 11111111, I; ,11111 0401111101,
""�� I II N ulll
8 Atwood Drive — 1 a1 �II INr�I 111
,1
MA v 1011,11111 ' U I t
M : , »� € I II I i I1 t
ll d I a 6`, jIII II -- ,I I u i �d �II II I'
Z one Overlay Districtill 1111
h, 'I I Ill 11 1 ! , III IIII 1 111 Ili ,1 s, "1111111 I l I}I fl III IIIII
'1111,1111111 I I n , a
, '` 1 II II a '''''''''''.111111 II
Elml -..,,'''t li ,HCBID ct: I
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT zu,r p V "T , SoCJyQ?S
2.1 Owner of Record: / � „ g o � 4 C .
,
6 3 0 4"Z,"EC Sri.' AG BOX
Name (Print) Current Mailing Address: /a6 ,QlvA n) niA, olc,
Signature Telephone 1)3 - 7g9-3 J 2 D
2.2 Authorized Agent:
t. / .A j1/ yn,',,, A s - rz 43o s, E2 S ?, p. o.BokS --7'
Name (Print) Current Mailing Address.
/ �� / I47 t 'Ar))'1J,4 . a/a)/
Signature % �/.�1� • /_..*. Telephone .57/,3 3' {w U � 99 ( °J"�
SECTION 3 - ESTIMATED CONSTRU ON COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
8
5. Fire Protection 00.00 /1j,/ '
6. Total - ( 3 + 4 + 5) Check Number
- 1 + 2 +
This Section For Official Use Only
Building Perm Num Date
Issued
Signature:
Building Commissioner /inspector of Buildings Date
File # BP- 2013 -0344
APPLICANT /CONTACT PERSON DEVELOPMENT ASSOCIATES
ADDRESS/PHONE P 0 BOX 528 AGAWAM (413) 789 -3720
PROPERTY LOCATION 8 ATWOOD DR
MAP 39 PARCEL 063 001 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 / ? �7 / $sf"
Typeof Construction: REMOVE NON CONNECTED PLUMBING UNDERGROUND - 1ST FLR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 20404
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFWCIATION 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
).:of,DeL
/ r - P9-
Signature of Building i fficial 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.
8 ATWOOD DR BP- 2013 -0344
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 39 - 063 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit # BP- 2013 -0344
Project # JS- 2013- 000552
Est. Cost: $8000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: DEVELOPMENT ASSOCIATES 20404
Lot Size(sq. ft.): 64381.68 Owner: Oxbow Professional Park LLC
Zoning: Applicant: DEVELOPMENT ASSOCIATES
AT: 8 ATWOOD DR
Applicant Address: Phone: Insurance:
P O BOX 528 (413) 789 -3720 WC
AGAWAMMA01001 ISSUED ON:10/1/2012 0:00:00
TO PERFORM THE FOLLOWING WORK: REMOVE NON CONNECTED PLUMBING
UNDERGROUND - 1ST FLR
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 10/1/2012 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner