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31B-253 (5) Final Construction Control Document girt To be submitted at completion of construction by a Registered Design Professional tk ' i for work per the 8th edition of the Massachusetts State Building Code, 780 CMR., Section 107.6.4 Project Title: Baldwin House Date:July30, 2013. Permit No. Property Address: 15 Bedford Terrace,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. - may{.=6,:AAA.,- �,°,°, O F /41qu" Enter in the space to the right a"wet"or w'" E f�� CHARLES ,� electronic signature and seal: i P. u'`�.tf4 co 0 SHARFLES i 028940 c 0 fi 7, f /' Phone number: (413)732-4336 Email: eshatples@lindgrensharples.com ! 1 Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an'x'project design plans,computations and specifications that you prepared or directly supervised..If'other'is chosen, provide a description. Trial Version 10 09 2012 .....-■•■N ACCORD". CERTIFICATE OF LIABILITY INSURANCE DATE ONIVODNYYY) filwww.*•-• 5/16/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OP INFORMATION ONLY AHD CORPUS NO RIGHTS UPON THE CERTIFICATE HOLDER.This CERTIFICATE DOES NOT AFIWUAATWELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. MIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: It too seideasto holder Is an ADDITIONAL BMW,Dm PIMINYONO me be 6050nled. If fROWOWATION W WAIVED."IOW to the terms and conditions of the policy,certain peados may esquire an endorsement A etelement on this certMcnie does not confer HMS*to the certificate WOK in Neu of such endorsesnent(s). mama — '• ..- Ma C James J. Dowd & Sons Ins ry Conroy 1 FAX 24 Bobala Road .. Erik A 1 3-53 R-7 9 4 4 1 WC.Hot 91 3- 3 6-6 0 2 0 Pr , Holyoke MA 01040 _BURCSIIIMILIINELL, __ INSURERS)AFFORDING COVERAGE NAIC a mom= WftRERA:NorthlAnd Insurance Company Energia, LLC 242 Suffolk Street ossomme:Commerce Insurance Company 34754 Holyoke MA 01040 ammusc:Guard Insurance Group wommD:Torua $Pcciety Insurance company INSuINUI E: INSURER F: COVERAGES CERTIFICATE WEBER:77 3382656 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF I LISTED HAVE WEN ISSUED TO THE INSURED NAMED ARMS FOR THE POLICY PERIOD INDICATED. NOIWITHSTMEWNG ANY , OR COWDITiOR OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PENTAIR.THE MENALANCE By THE POLICIES DESCRINED', RW IS SUBJECT TO AU.THE TERNS,EXCLUSIONS AND CONDITIONS OF SUCH POLICES.LOOTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS itigt TYPE OP INIMEANCE lAri2V71.11Twairk, POLICY Nunn* ANIANWmINIAWn; UNITS A searenm.urasurr ,Y WS096521 2/17/2012 i2/17/2013 EACH OCCURRENCE $1,000,000 'DAMAGE To REFRED / !COMMERCIAL GENERAL LIABILITY malanteaccoasnom i$100,coo / CLA4MS-Aim* 1 ,OCCUR ' MED EXP(Any one parson) 1 S5,000 k------I. ' x '500 Deductlble PERSONAL&AOV INJURY $1,000,000 ----/ GENERAL AGGREGATE 31,000,000 -,- GEN'L AGGREGATE UMIT APPLIES PER , PRODUCTS-COMPIOP AGG 'sl,000,000 I I POUCY r ,Tg , Lac i 5 , B ,AUTOMOBILE ummrty , BEOIC I' 42,,„,20i2 2/17,2013 CONSINEDSINGLELIMIT S1,000,coo (Ea. d1) , ■ " ANY AUTO ' -, t BODILY INJURY(Per poison) $ L._I ALL OWNED AUTOS ,---- — _ BODILY INJURY(Pw sconsno S I/ i SCHEDULED AUTOS 'PROPERTY DAMAGE $ 4 HIRED AUTOS '(Per nntlent) I 'I !X i NON-OWED AUTOS $ $ D I x 1 UNSRELLA LIAO I i OCCUR 70074cii0ALI 9/14/2011 9/14/2012 EACH OCCURRENCE $1,000,000 EXCESS MO I CLAIMS-MACE , AGGREGATE 1$2,000,000 , DEDUCTMLE , ■ $ t X 1 1190,0N $10,000 , $ C COMPENSATION I • AN LOMIE UMMUTY YIN ENV1C319433 12116/2012 2/16/201.3 1-x I ARCITITILts' ILRI4' D INIFM ' ANY PROPRIETOROPARTWEIVERECuTtvE Fi ,,,i , El.EACH ACCIDENT $1,000,000 _ .„ OFFICERNOMER EXCLuDED? EINAMINly In NII) 1 EL.DISEASE•El1 EMPLOYEE$1,000.000 ItOrSCRIarbs4ON OF OPERATIONS bola* 1 E,L DISEASE-POLICY UNIT Si,000,000 T ' , T 1 , OESCRIPTION OF OPERATIONS/LOCATIONS I VENICUIS(AWNS ACORD1411,AliMenel ftemirks Iktodlois,V moce egoine Is requivd) CERTIFICATE HOLDER CANCELLATION SIBBAD ANY p.. ,_11,18 ABOVE ONSCRINIM mums BE CANCELLED won THE fiCIII DATE THEIMOF NOTICE WILL BE DELIVERED - IN ACCORDANCE WITH TINE POLICY PROVISOS& AuTrIORRIDREPISISENTA1WS TAW,A f iltfj, ' —- 0 19115.2009 ACORD CORPORATION. All shifts reserved. ACORD 25(2009109) The ACORD name and logo are registered masts of ACORD 'il.iwchus tt. - Brioartru4•nl 0i Pohl'', '..ict1 Board of /tinkling Regulations one! stantlarii. Construction Supervisor License I;..-n..r C S 9254C THOMAS S ROSSMASSLER 100 MAIN STREET HATFIELD, MA 0103E1 _ E ifuetl..n 5/212013 •It1.111•%3,f113■3 N- Office o oassaterr A irs seas Regulation License or registration x;titd for individul use ooh .. HOME PROVEMI:MT CONTRACTOR before the expiration date. If found return to 4 .,V Office of(onxaatrr Affairs and Business Regulation a s - 765169 Type a t,,,:,• Expiration: 1111/2014 It)Parr Plaza-Suite 5170 ').": Roston. M.tr 02116 Et IA L...0 THOMAS ROSSMASSLER f t 242 SUFFOLK STREET i 10LYOKF MA 01040 1 adersecreur. Nut .akd without signature .. The Commonwealth of Massachusetts `.= Department of Industrial Accidents 1 '1rt-:=7:7.r/ Office of Investigations _ 600 Washington Street Boston, MA 02111 :�'' 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/Zi•: Holyoke, MA 01040 Phone #: 413-322-3111 Are you an employer?Check the appropriate box: Type of project(required): 1.® 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. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ 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 l0.0 Electrical repairs or additions 3.0 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 13 Other Insulation employees. [No workers' comp. insurance required.] 'Any applicant that checks box#1 rnust also till 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 ha'.e employees. If the sub-contractors have employees,they must provide their workers'comp.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:_ Guard Insurance Group Policy#or Self-ins. Lic. #: ENWC319433 Expiration Date: 2/16/13 Job Site Address:1\3 -Begotd 1. e- `r C'ityiState/7,ip:M 44, 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 nder the pains and penalties of perjury that the information provided/above is true and correct. Si*nature: / Date: G 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 Clirliri. 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 • • CONTRACTOR APPLIES FOR BUILDING PERMIT I, _ w r ® O,& a dis r:J as Owner of the subject property hereby authorize --2 e.-.5 to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, AP a SS/-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 a nalties of perjury. omas oss MASS_Ie Print N - /2 .20 i2. Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: 1k arvt-&6 ' OS V&& 5 I e c ci 2.,`. a D License Number -'- S w- 61 k S-t-- IA o 0 Ve )41C- _o ���1 u 9 i 2 I 1 3 Address ( Expiration ate (3- 322-%,t1 _ Si.nature 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 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: 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 Versionl.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 Q DON'T KNOW Q YES C) IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained Q , Date Issued: C. Do any signs exist on the property? YES ( 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 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. 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 El Exterior Alteration El Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other iiseMid, Brief Description Enter a brief description here. j1fS6J/a/ /.4h - /c $ 4,es / Of Proposed Work: _ je //GK Ce/%4SG SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 1:1 A-2 ❑ A-3 ❑ 1A I ❑ A-4 ❑ A-5 El 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 El 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 El R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 El 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 BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 151 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 El On site disposal system Ok Ta fles i u ('VeTftrc /a-ao la c---- Version1.7 Commercial Building Permit May 15,2000 Department use only I - :: ' 1 City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit, j E 212 Main Street Sewer/Septc' Availability 1 Room 100 Water/ Il Availability, riEF.of �i_ tag orthampton, MA 01060 Two Sets of structural Plans NORTHAMPTON,MA Ji np�1 587 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:��,,//ue� This section to be completed by office /5 23 e4 cd 7er'l' Map /j ``3 Lot O$3 Unit i/ _#,-/' i 1,4 Zone Overlay District �/_ Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: c.S,I(/T" c.&4,6- /2a )V ,. .M A lli l/i Name(Print) Current Mailing Address: Signature Lull - v FA 14 1 714 Telephone 2.2 Authoriz-•4Li : �7 1 I/ Lr 0 ' 43 v5511ta e r" 2 i(2 St/W a i k s-�, rid(t1pg2r ,/►'111 Name(Print) Current Mailing Address: ` 13- 22- ii ( Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building )/� �� n- , /d (a) Building Permit Fee 2. Electrical f (/ (b)Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection Q 6. Total= (1 +2+3+4+5) y �5lid• w Check Number / L9 ? f <1 / This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2013-0676 APPLICANT/CONTACT PERSON ENERGIA LLC ADDRESS/PHONE 242 SUFFOLK ST HOLYOKE (413)322-3111 PROPERTY LOCATION 15 BEDFORD TER BALDWIN HOUSE MAP 31B PARCEL 253 001 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 / 93 6 d5961 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 FOLLO ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO TION 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 em. tion Del. / Signature or i u •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.