31B-202 (7) Final Construction Control Document
Tr,
To be submitted at completion of construction by a
Registered Design Professional
ez
for work per the 8th edition of the
v v Massachusetts State Building Code, 780 CMR, Section 107.6.4
Project Title: Talbot House Date:July30,2013 Permit No.
Property Address: 25 Prospect Street,Northampton, Massachusetts
Project: Check(x)one or both as applicable: New construction X Existing Construction
Project description: Insulate all rafter bays (including dormers)and roof slopes with either dense pack cellulose insulation
or"celbar"glue based cellulose insulation. Seal all air leaks either visable to the eye or detected using an infrared
camera.
I Charles P. Sharpies, MA Registration Number: 28940 Expiration date: June 30,2014 ,am a registered design
professional, and hereby certify that I have prepared or directly supervised the preparation of all design plans,
computations and specifications concerning':
X Entire Project Architectural Structural Mechanical
Fire Protection Electrical Other:
for the above named project. I certify that I,or my designee,have performed the necessary professional services and was
present at the construction site on a regular and periodic basis to determine that the work proceeded in accordance with
the requirements of 780 CMR and the design documents prepared by me and approved as part of the building permit and
that I or my designee:
1. Have reviewed,for conformance to this code and the design concept, shop drawings, samples and other submittals
by the contractor in accordance with the requirements of the construction documents.
2. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the
progress and quality of the work and to determine if the work was performed in a manner consistent with the
construction documents and this code.
?" Qf , 4h
Enter in the space to the right a"wet"or 1° CHARLES G;�,,
electronic signature and seal: 'SHA
1
\``'),0 Its�lcS
28940
v,
1 +
Phone number: (413)732-4336 Email: csharples a,lindgrensharples.com 4
Building Official Use Only
Building Official Name: Permit No.: Date:
Note I.Indicate with an`s'project design plans,computations and specifications that you prepared or directly supervised.If'other'is chosen,
provide a description.
Trial Version 10_09_2012
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ACCORD" CERTIFICATE OF LIABILITY INSURANCE DARE 00WODNYVY)
4......---- 5/16/2012
THIS CERTIFICATE IS ISSUED AS A MATTER OF*FORMATION ONLY AND COWERS NO*GNU UPON TIE CERTIFICATE HOLDER.MS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THE CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE SWING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. '
IMPORTANT: if the certilicate holier Is so Aparnomu.INSUMID,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,wthieet to
the terms and tonalities of the policy.certain policies may require an endorsement. A etallement on this cardilcate does not confer rights to the
certificate holder ki lieu of such endoreementis).
mower ** "
' - Mary Conroy
James J. Dowd & Sons Ins, 4.4
IFAX
14 Bobala Road .4 -
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Holyoke MA 01040 _.... ...
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_ imams)AFFONIONG COVERAGE MX 11
MA=
WRUNIRA:NOrthlROd Insurance CoMparly
Energia, LLC
242 Suffolk Street lessraM•:Commerce_Insurance Company 34754
Holyoke MA 01040 ,INSURER C:guard InsuLance Grouts ..
mums D:Tprus Scully nsu rance S.omoany
INSURER a:
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COVERAGES CERTIFICATE* ER.773382656 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE PCXXIES OF INSURANCE LISTED MOW HAVE BIRN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
PERIOD INDICATED. NoTIFATNETATENNo ANY RimulIRENENT TERM OR CONDITION OF ANY CONTRACT OP OTHER DOCUMENT vaTH RESPECT TO
wtocki THIS CERTIFICATE MAY BE ISSUED on MAY PERTAIN.THE INSuRANCE AFFORDED BY THE POuOES DESCRIBED HEREIN IS SUBJECT
TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICES.LINTS SNOW MAY HAVE BEEN REDUCED BY PAID CLAIMS
MR r h.11. ■ --
1-Sal. 'NPR OF INSURANCE 141....?'L'A1Vw::.4..TAA UMITII
A SENERALusaurr i V 445096521 2/17/2012 '2/17/2013
I 'EACH OCCURRENCE '$1,000,000
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PROPERTY DAMAGE $
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i X i NON.O4M1NEO AUTOS
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ANC/SIIPLOVERIX UASEJTY ' : '
ANY PROPRIRTOROPARTNEROEXECuTIVE--] EL L EACH ACCIDENT $1,000,000
OFfICERININSER EXCLUDECR V N IA I .,
(11mOstery In NH)
I EL ogsEAsE.EA BARLoyEE$1,000,000
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I0ECR1IT161 ION OF OPERATIONS below :
I EL DISEASE-POLICY WAIT $1,000,000
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DESCRIPTION OF OPERATORS,LOCATORS/VOW=(ANAsSacotio set Addlleald RINIFININ Schoduilkr mon s ta nmper•d)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OP THE ABOVE DESCRIBED POLICES BE CANCELLED
BEFORE THE EGINATION DATIETIMPOOF.NOTICE WILL BE DELIVERED
w ACCORDANCE arm TIE POLICY PflOvillIONS.
,
AUTHOMII2D 1111Par1esTA14V1
•
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0 1968-2009 ACORD CORPORATION. All rights resented.
ACORD 26(2009109) The ACORD name and logo are registered marts of ACORD
III1,14.14s his tt. • IkpArtitknt of Puttli, %acts
Board .4,Building Regulations and Standard.
Construction Supervisor License
Ai, ._
t e,ruse c S 92540
THOMAS 8 RO?SSMAS&ER
100 MAIN STREET
HATFIELD, MA 01038
_.__.. C IL pi!,4114 aft f`�13
■ .111.11 I..,...f.1 .. ,T
Office o onsioner irs seas ear aims License or registration valid for individul use only
•.r HOME NORM/MEW CONTRACTOR before the eapirat on date. If found return to:
4' s'`" '°'Registration: 165169 Type ()trice of(Olisumer 4Rsirs and Business Regulation
a 4
* ' + Expiration: 111112014 ...L:_, 18 Park Plata-Suite 1170
Boston.MA 02116
EaIA L:C
THOMAS ROSSMASSLER t
242 SUFFOLK STREET
HOLYOKE MA 01040 t ndersecrctars Not salid without signature
The Commonwealth of Massachusetts
t �.- + Department of Industrial Accidents
s
W=.l Office of Investigations
_= 600 Washington Street
v Boston, MA 02111
4 •. www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Energia, LLC.
Address: 242 Suffolk Street
City/State/Zip: Holyoke, MA 01040 Phone #: 413-322-3111
Are you an employer?Check the appropriate box: Type of project(required):
1.12 I am a employer with 10 4. ❑ I am a general contractor and 1
employees(full and/or part-time).*
have hired the sub-contractors 6. ❑ New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have S. ❑ Demolition
working for me in any capacity. employees and have workers'
9. ❑ Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
12.0 Roof repairs
insurance required.] t c. 152,§1(4), and we have no
employees. [No workers' 13.►:4 Other Insulation
comp. insurance required.]
Any applicant that checks box#1 must also tilt 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 has e
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:. Guard Insurance Group ____
Policy#or Self-ins. Lic. #:` ENWC319433 Expiration Date: 2/16/13
Job Site Address; f�
2�� u°C! '___ City/State/Zip:,_ � O / //0' .ii
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 tine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certi miler the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:` /2, a_-(9--
Phone#: 413-322-3111
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):
I.Board of Health 2. Building Department 3. City/Town C1�r4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
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 0
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT 0- CONTRACTOR APPLIES FOR BUILDING PERMIT
I, _, ,�. /' 1 t , as Owner of the subject property
•hereby authorize ,E* -. ] I Q to
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, —Moro S 1 ..C.SS mck S 3_I-e...r_
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 pe p 'ties of perjury.
a rn JL0 SS SS I -e r
Print N e
/ 2 -.2a_ - ( 2
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Ofl& .S ' R O ss '&445 I e r q 2514 0
License Number
242 d(k # aiei o/aViO R z a
Address Expiration ate
q/ - 322 3/II
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 0
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):
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
Not Applicable ❑
Company Name:
Responsible In Charge of Construction
Address
Signature Telephone
Version1.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
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 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
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 Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained Q , Date Issued:
C. Do any signs exist on the property? YES NO Q
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q
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 Q
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 El New Signs❑ Roofing❑ Change of Use❑ OtheA fW4
Brief Description Enter a brief description here. j u/47'Q1f 7v f%(G S dpec
Of Proposed Work: ,e//(e ,6 c,t Ce4/asc
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 ❑ A-2 ❑ A-3 El 1A I CI
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 El F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 El R-2 El R-3 ❑ 5A ❑
S Storage ❑ S-1 El S-2 El 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: 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)
1St
1St
2nd 2nd
3rd 3rd
4th
4th
Total Area (sf) Total Proposed New Construction(sf)
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L. c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private El Zone Outside Flood Zone❑ Municipal ❑ On site disposal system❑
OkP�JteerK/VegrJ /c9-94 f/ a...._
Version1.7 Commercial BuildingPermit May 15,2000
Department use only
f;',.,El ,,• , , City of Northampton Status of Permit
Building Department .Cut/Driveway Perm
�� 2 �i 212 Main Street Sewer/Septic Availability
an Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
DEPT.OFBUILDINGINSpECTIIon 413-587-1240 Fax 413-587-1272 Plot/Site Plans
NORTHAMPTON,MA 0'106 .— 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(25 P c d s p e e 7 4 3G/ Map Lot Unit
Zone Overlay District
/ 2t7a/,o/'f! //7/ y
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
&if/7' C4/4 G6 1211 Ve c_SZ. /WQ. //7/,,i,
Name(Print) 1 Current Mailing Address:
/3-32L-3i//
Signature .ail �°'' t �r1'l /� ld Telephone
2.2 Authoriz d A ent: �/ ,�f /0
OmaS �..o S57114.551-e.r 2�.2 � /� ,J44
Name(Print) Current Mailing Address:
7/3-322 -3///
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 12 D Di� 6� (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 ff /9.8 6. Total=(1 +2+ 3+4+5) ( IZ , e' - ad Check Number 7 4t ia0
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2013-0677
APPLICANT/CONTACT PERSON ENERGIA LLC
ADDRESS/PHONE 242 SUFFOLK ST HOLYOKE (413)322-3111
PROPERTY LOCATION 25 PROSPECT ST-TALBOT
MAP 31B PARCEL 202 001 ZONE EU(100)/URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out l? 3! 15/;eo
Fee Paid
Typeof Construction: INSULATE ATTIC SLOPES
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 92540
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INJ9WVIATION 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 Petuiit 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
I- �:;yI n Delay
/ • /6 r/g/-/:
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.