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39-060 (12)
NOTICE N W NOTICE TO a TO EMPLOYEES EMPLOYEES y �W � V 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-8771 W83-7-1 3) 04-13-13 TO 04-13-14 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 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 what the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS ,05 W20P1G02 TO BE POSTED BY EMPLOYER ACORV CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/18/2013 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 PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. AORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 NAME: Debbie Mac Neal James J. Dowd and Sons Insurance Agency Inc. PHONE FAX 14 Bobala Road A/c No Ext: — — A/C No: — — Holyoke MA 01040 ADDRESS: dmacneal @dowd.com PRODUCER CUSTOMER ID#:KENNPVI-01 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:Travelers Indemnity Company of Conn 25682 Kenneth P. Vincunas & E. J. O'Leary, DBA Developme INSURER B P. O. BOX 528 Agawam MA 01001 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:347327360 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 POLICY EFF POLICY EXP LIMITS LTR IN SR WVD POLICY NUMBER MWDD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENT D COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE F-1 OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION UB8771W837 4/13/2013 4/13/2014 X WCSTAT OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Northampton Building Department 212 Main Street Northampton MA 01060 AUTHORIZED REPRESENTATIVE Rd6cu-tv �- ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Massachusetts - Department of Public Safety �f Board of Building Regulations and Standards Construction SuperNisur License: CS-075752 TRAVIS WARD 32 COLUMBIA DRIVE,, � FEEDING HILLS MA Expiration Commissioner 05/19/2015 Version 1.7 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 Edward J. O'Leary as Owner of the subject property hereby authorize Travis P. Ward to act on my bell 1f, in all matters yelat, t work authorized by this building permit application. 12/19/13 Sign to o ner Date I, Edward J. O'Leary 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. Print Name `f 12/19/13 Signature Owner/Agent Date SECTION 12-CON R ION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Travis P. Ward CS-075752 License Number 630 Silver Street, P. O. Box 528, Agawam, MA 01001 5/19/15 Address_. Expiration Date ( 413 ) 789-3720 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 n No 0 i i Version 1.7 Commercial Building Permit May 13,2000 S=iON 0-PROFg881ONAL DESIGN AND CONSTRUC71014 SERVICES FOR BUILDINGS AND STRUCTURES SUBJECT TO 00I48T RUCT10H.CONTROL PURSUANT TO 780 CUR 118{CMAINl O MORE THAN 38,OW C.F.OF ENCLOSED SPACE} 6.1 Re 9ftlered Architect: John A Ferrem Jr Not AppGcabte fl i Name(Ragls#tantr 20364 517 Rolgsione.Road-Fitchburg,MA 01420 Registration Number Addroas .09-31-1.4 978.407-884$ Explrattan Rate 3 Sign to Telephone 9.3 Registered Professional En Inee a): Robt. W. Ha11 .Consulting Engineers, Inc. Ji.m. Sullivan Electrical Arse of Rasponslbpi:y J6 I 540 Meadow St. Ext, Aaawam, MA 01001 $ 9 5 - Registration Number 14-13? 739-0960 4 natriro Telephone Expiration Data Robt, W. Hall Consulting Engineers, Inc. Rnharf• f+ Tri fi.t'h's-, PE HVAC:, Name Area of Responsibility 540 Pjdow St. E , A awam MA 01001 f Address tag tra'eon.Ni Abet . 1 3) 709— Q rT---- a Slgnirt Telephone Expiration Date: Robt F.W. Ha alifConsu ting n Engieers, Inc, fiths, PE Plumbinq Name Area 61 RespansbNttyy 540 M dow St. Ext,, Agawam, MA 01,001 Address Registration Number R 4137 709-09.60 Stgnai Tatephone Expiration Date. Ito t. W. H gineers, Inc. Robert 'F:. Griffiths, 'PE Fire Protection Nahm Area Responsibility 540 Wgidow St. Ex . Ag to MA 01001 Aditn Rag tration Number° t t 1 } 789-0960 �1i!�,��1'tP�' 5 rtes Te hone Expiration Dsle } 9 :Car Igo Contrscicr D '416prit nt Associates NatAppilrabie E3 comp4ny Name: Travis F. Ward 7 Re�ponsf6la.0 Charge of Cansauc9cn 630 S: 3ver PQ Box 528, Agawam, MA 01001 addrs�s �Rg_T=0 Sigrtatura . Telephone `. r t s t 1 Version 1.7 Commercial Building Permit May 15,2000 8 I�IURTH .MP' tJN Z0 11T�iG Existing Proposed Required by Zoning This column to be filled in by N/A N/A Building Department Lot Size Frontage Setbacks Front Side L; R: L: R: Rear Building Height 45 ' 45' Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Ucation) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ® DON'T KNOW 0 YES Q 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 0 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 NO Q IF YES, describe size, type and location: Tenant sign at entry for driveway 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 0 NO X IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version 1.7 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❑ New Signs❑ Roofing❑ Change of Use❑ Other ❑ Enter a brief description here. Brief Description Interior buildout of medical office space ( 40,495 sf) in Of Proposed Work: existing shell building recently completed. Finishes to be on all 3 floors SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business 2A ❑ E Educational ❑ 213 F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I 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: 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 a n� Floor Area per Floor(sf) �" sa b Y® St 1bt 1 13, 500 ," g 2nd 2nd 13, 500 N/A �. 3rd 3rd 13, 500 x ., 4th — 4th r Total Area(sf) Total Proposed New Construction (sf) ` 40, 495 sf � Total Height(ft) #y> Total Height ft N/A 7.Water Supply(M.G.L. c.40, §54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ® Private ❑ I Zone Outside Flood Zone[] Municipal ® On site disposal system[:] 1 Versionl.7 Commercial Building Permit Ma 15,2000 yg City of Northampton uilding Department Main Street \212 Room 100 am pton, MA 01060 t, pfrhe 413-587-1240 Fax 413-587-1272 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 aT I$se tlon to be completed by r flog, r 1.1 Property Address:' t Y Unih 22 Atwood Drive _ p Northampton, MA torte, Qyerta Y It"Ilk „r EIrrt.St:,District ��lstrl " SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Oxbow Professional Park, LLC Name(Print) Edward J. O'Leary Current Mailing Address: 6 3 0 S i lver S t. , PO Box 5 2 8 General Pa net Agawam, MA 01001 Signature Telephone ( 41 3) 789-3720 2.2 Authorized A en Name(Print) Travis P ard, as agent for Current Mailing Address: 630 Silver St. , PO Box528 owner Agawam, MA 01001 Signature Telephone ( 41 3 ) 789-3720 SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building $1 , 770, 000 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of 600, 000 Construction from 6 3. Plumbing 500, 000 Building Permit Fee 4. Mechanical (HVAC) 850, 000 5. Fire Protection 80, 000 6. Total=(1 +2+3+4+5) 3 f i U a., 0130 Check Number '�v•� This Section For Official Use Only Building Permit Number Date Issued; Signature: Building Commissioner/inspector of Buildings Date L L A0 4 �vcrL) File#BP-2014-0749 APPLICANT/CONTACT PERSON DEVELOPMENT ASSOCIATES ADDRESSIPHONE P O BOX 528 AGAWAM (413)789-3720 PROPERTY LOCATION 22 ATWOOD DR MAP 39 PARCEL 060 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid e" Building Permit Filled out Fee Paid Typeof Construction: INTERIOR BUILDOUTOF MEDICAL OFFICE SPACE(40,495 SQ FT)ALL 3 FLOORS 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 INFO 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 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 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. 22 ATWOOD DR BP-2014-0749 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 39-060 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-2014-0749 Project# JS-2014-001286 Est. Cost: $3800000.00 Fee: $400.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: DEVELOPMENT ASSOCIATES 20404 Lot Size(sq. ft.): 194756.76 Owner: Oxbow Professional Park LLC ZoninjZ: Applicant: DEVELOPMENT ASSOCIATES AT. 22 ATWOOD DR Applicant Address: Phone: Insurance: P O BOX 528 (413) 789-3720 WC AGAWAMMA01001 ISSUED ON.112412014 0:00:00 TO PERFORM THE FOLLOWING WORK.-INTERIOR BUILDOUTOF MEDICAL OFFICE SPACE (40,495 SQ FT) ALL 3 FLOORS 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 1/24/2014 0:00:00 $400.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner