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32C-268 (11) DIG SAFE SYSTEM, INC. - Dig Location Page 1 of 1 Request Number7l 20061911410 Date 05/12/2006 Time 09:53:35 Start Date 05/18/2006 Start Time 10:30 Location Info. MASSACHUSETTS NORTHAMPTON 30 WILLIAMS ST. F- Member Utility List Code Abbreviation Name MC MASSEL MASS ELECTRIC COMPANY ML MCI MCI SP VERIZN VERIZON TTI COMCAS COMCAST WG BSTGAS BAY STATE GAS ON ONTARG ON TARGET LOCATING RJ VERIZN VERIZON • There may be non member utilities in the area that you need to notify. • Electric and other companies may not mark lines they don't own or maintain. You may want to contact them for more information. • The excavator is responsible to maintain markings placed by member utilities... Create New Create From Existing Return To Menu Return To Home http://digsafeforin.digsafe.com/cgi-bin/DLCGI.exe 05/12/2006 IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer,and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S(2001108) 2 of 2 #S23821/M23660 r + � Client#:27633 ASSBU1 ACORDTM CERTIFICATE OF LIABILITY INSURANCE 05/11/06Dnvvv) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Chittenden Ins Group ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1391 Main Street Suite 500 HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 4950 Springfield, MA 01101-4950 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Steadfast Insurance CO Associated Building Wreckers, INC INSURER B: Maxum Indemnity Company 352 Albany ST INSURER c: American International Springfield, MA 01105 INSURER D: 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. 11 D POLICY EFFECTIVE POLICY EXPIRATION LTR INSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MMIDD/YY LIMITS A GENERAL LIABILITY GPL586686401 03/15/06 03/15/07 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $100,000 CLAIMS MADE N OCCUR MED EXP(Any one person) $5,000 X BI/PD Ded:10000 PERSONAL&ADV INJURY s2,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/CP AGG s2,000,000 POLICY -X] JE° LOC Poll.Liab. 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ B EXCESS/UMBRELLA LIABILITY UMB600431601 04/15/06 03/15/07 EACH OCCURRENCE s5,000,000 X OCCUR EI CLAIMS MADE AGGREGATE $5,000,000 DEDUCTIBLE $ X RETENTION $10000 $ C WORKERS COMPENSATION AND 00895319200 02/01/06 02/01/07 X WC srATU- oTH- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE:Quonset hut,30 Williams ST,Northampton,MA Certificate Holder and the City of Northampton are named as additional insured under general liability as required by written contract for work performed by insured subject to terms and conditions of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION John Gibson DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN 30 Williams ST NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Northampton, MA 01060 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S23821/M23660 MEH © ACORD CORPORATION 1988 JOB INVOICE ��4 "e r 5 ee-Tr r c r l ev vo f- tD Lair�tA c, P2,7 C( . a dG �- 1-1 3_ may_ S-3 DATE ORDERED ORDER TAKEN BY TO PHONE NO. CUSTOMER ORDER# Nt rs ( (3 a t ADDRESS 3 JOB LOCATION JOB PHONE STARTING DATE i,ft'i 'G�s r ATTENTION TERMS • •UNT DESCRIPTION OF • - C_ n t L r- N . MISCELLANEOUS CHARGES WORK ORDERED BY TOTAL LABOR DATE ORDERED TOTAL MATERIALS DATE COMPLETED TOTAL MISCELLANEOUS SUBTOTAL CUSTOMER APPROVA SIGNATURE TAX AUTHORIZED SIG T E_ GRAND TOTAL 7 �ryff MADE IN USA 817 ��1 ` �OB INVOICE The Commonwealth of Massachusetts Department of Industrial Accidents a )z Boston,Office of Investigations 600 Washington Street MA 02111 N www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibl Name (Business/Organization/Individual): 4_�3 OCI CI Z //LIny A f(Aw —[/)C. y Address: 3S) A 1&01 A. City/State/Zip: t/ r<��lrl DII _ Phone#: q0 AV1, u an employer?Check the appropriate box: Type of project(required): 1. am a employer with q 0 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7. YF� emodeling ship and have no employees These sub-contractors have 8. emolition working for me in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10. Electrical repairs or additions required.] officers have exercised their ❑ 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' 13.0 Other 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 their workers'comp.policy information. I am an employer that is providing workers'compensation Insurance for my employees. Below is the policy and Job site information. Insurance Company Name: ry (gaup Policy#or Self-ins.Lic.#: Oy A g53f ,�00 Expiration Date: �3 McOl Job Site Address: � � j City/State/ZipAC//h)/,l A %), h , 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 copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under nthe pains and penalties of perjury that the information provided above is true and correct Si nature: U/ )A Date: V/llei Phone#: �� ✓t Of 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#: Versionl.7 Commercial Building Permit May 15,2000 5ECTItlN 10 =S�RUC 'U�2AL.PEER R�i�l�l�f(7�b�C�j�+IR 11Q 11) Independent Structural Engineering Structural Peer Review Required Yes......❑ No...... �� pr1 + �� a Ml� 'John P as Owner of the subject property hereby authorize� '/C �/ / � `U lrS• lb L (elf��G+�m `�lll� & to act on my behalf, in all matters relative to work a thorized by this building permit application. Signature of Owner Date I, as.&wrrer/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. Print Name - Signature of Gww/Agent Date g F: f 3e, I3 'F' Yp31 tk Ya �'. 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder. �1� r�l��// /� 11N,w License Number AK Ifxrri� Ur�r�r fif'Id, t4q too �i'f�11�7c'c � dress - ` Expiration Date Signature Telephone 1Pei 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 f the building permit. Signed Affidavit Attached Yes....... W No...... ❑ Version 1.7 Commercial Building Permit May 15,2000 Ip ...' Q b ANA NS 1QM1t ER1f10ES FGsBUl1R,fNG hAN[?=S7Ei ;BTUlJBJECT T8 MIN" UW�l { 'T"f � ' �1 6(� f'I# N + W H.A A ' y N S C SPACE) 9.1 Registered Architect: Not Applicable Name(Registrant): Registration Number Address Expiration Date Signature Telephone 92 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 � I1N S 5 )I. 0114 4,14 1./1 0 A ress Signature Telephone Version 1.7 Commercial Building Permit May 15,2000 7.Water Supply(M.G.L. c. 40,§54)Q/A 7.1 Flood Zone Information: 7.3 Sewage Disposal System: kfA Public ❑ Private ❑ Zone: Outside Flood Zone ❑ Municipal ❑ On site disposal system ❑ 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 DON'T KNOW `" YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 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 _ No IF YES, describe size, type and location: Versionl.7 Commercial Building Permit May 15,2000 ip 4 'T HM _ ' lay Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑ ❑ ❑ Exterior Alterations Demolition New Signs [ ] Change of Use [ ] Other [ ] ❑ 6��00/161 i ttt Accessory Building[ ] Repairs [ ] twi _ .Ski.., £ N,.>. 5 � .�r�,.ON.�. >lr!. USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly Io A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 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: ATN , �r� Ya�R AtV�NS Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION , Floor Area per Floor(sf) 15t 1st 2nd 3rd 2nd �y s 4th 3rd 4th s Total Area(sf) Total Proposed New Construction (sf) xJ% .................................... .Jy Total Height(ft) M ` Total Height ft ------------------- r IY Version 1.7 Commercial Building Permit May 15,2000 of Northampton tiding Department 12 Main Street Room 100 2106 ampton, MA 01060 phone 413-587.1240 Fax 413-587-1272 PON'C'�NS�,LCJ IONS PATjftj&ddh&1k1=,kPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING pr-,-- 1.1 Property Address: ll''''I I ill,ill Ill 11',llyl,11 ill!iiiiiiiiiiiiiii, -g 01 90 N p', 2.1 Owner of Record: 104 Off Name(Print) Current Mailing Address: -W 00AI W enlff(ie-4 �m-,5m Signature Telephone 2 Authorized Agent: -A-:F5X/J/ff/1/1(N�/yM(&/ -, �j Ind, t44 74/r//rt1/vL/6:/fi, -:�/W. --) N�e(Print) Current Mailing Address: Signature Telephone R Item Estimated Cost(Dollars)to be completed by ptrmitapplicant 1. Building X, 177 0 2. Electrical ( ) Jft1 eclat ff LN "c imw- "'M X5 3. Plumbing 4. Mechanical (HVAC) 5. Fire Protection A 6. Total =(1 + 2 +737+4+ 5) '!�� :y .., t M�,Issued, z t 77' 15 File#BP-2006-1222 APPLICANT/CONTACT PERSON Associated Building Wreckers Inc ADDRESS/PHONE 352 ALBANY ST SPRINGFIELD (413)732-3179 PROPERTY LOCATION 30 WILLIAMS ST MAP 32C PARCEL 268 001 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out Fee Paid T_ypeof Construction: DEMOLISH QUONSET HUT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 062382 3 sets of Plans/Plot Plan THE PLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON I RMATION 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 Pemut 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 P rmit from EloStreommission l ./6 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. � ?r BP-2006-1222 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category_ BUILDING PERMIT Permit# BP-2006-1222 Project# JS-2006-1815 Est.Cost: $8050.00 Fee: $15.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Associated Building Wreckers Inc 062382 Lot Size(sq. ft.): 57934.80 Owner: GIBSON JOHN S& Zoning: URC Applicant: Associated Building Wreckers Inc AT. 30 WILLIAMS ST Applicant Address: Phone: Insurance: 352 ALBANY ST (413) 732-3179 Workers Compensation SPRINGFIELDMA01105 ISSUED ON:511812006 0:00:00 TO PERFORM THE FOLLOWING WORK.-DEMOLISH QUONSET HUT 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 5/18/2006 0:00:00 $15.0019909 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo