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24D-185 (7) \ Z o_ a � N w a > O N 0 w W w W Z O_ O_ Z y� ? O IN 0 o oCL CL "g Z L o m o V)i ? Z O Z Z 3 Ws W Z r _ x �� � W e� W W W H Q . \ \� \\ \\ w \ F LL. I WQ � N \\ \\ \ \ \ o (L Z o � zQa � m EL \ ry (� w Q J Z L W L'i�- JZ CD� Z ❑ ~O Q Z O O Ll- _ W U O� Y CD Z w O Z U m a M U Ljj O :2 O C L Q N Y w O U (n C) J m CL • O i 1! II rn 4vJ _ / V+ V) u Ld 4 � Q 0 o � � § 0 » w U7 mo o uj z � 0 g ,z \ b 2 o Uvi Z z V Z k � e q �7cE 0 w u _ wR � 2� � § — � : � LL- ± � E � ƒ / z w c k 0KR 0 � 2 � CLd / / / ix / 3 / � LE $ �e ® Q 7 / / 2w \ \ \ / 0 Q \ / / \ 7 0 cL � � o / / / a s 0 En rn U)■ ■ � w AC"R" CERTIFICATE OF LIABILITY INSURANCE F DATE 4/14/2014 Y) 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) 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 CONTACT Christine Sullivan NAME: Aquadro & Associates PHONE (413)586-7373 FAX No),(413)584-0859 355 Bridge St., P. 0. Box 357 E AI -ML INSURERS AFFORDING COVERAGE NAIC# Northampton MA 01061 INSURERA:Main Street America Insurance 29939 INSURED INSURER B: COOLIDGE NORTHAMPTON LLC INSURERC: PO BOX 310 INSURER 0: J INSURER E: WHITE PLAINS NY 10605-0310 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1441405466 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 ADDLSUBR TYPE OF INSURANCE POLICY NUMBER POLICY F IC X LTR D/YYY POLICY M/ /Y Y LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED- X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 500,000 A CLAIMS-MADE a OCCUR BPF3111Y 12/21/2013 12/21/2014 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE $ NON-OWNED ED Per accident HIRED AUTOS AUTOS $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAR HCLAIMS-MADE AGGREGATE $ 3,000,000 DED I X I RETENTION$ 10,000 CUP3111Y 12/21/2013 12/21/2014 $ A WORKERS COMPENSATION WC STATU• X OTH- AND EMPLOYERS'LIABILITY D ER ANY PROPRIETORIPARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBEREXCLUDED? N/A CF3111Y 12/21/2013 12/21/2014 (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 FOR INFORMATION ONLY ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD Coolidge Northampton,LLC Delaurentis Management 43A Greenridge Avenue White Plains, NY 10605 April 24, 2014 Louis Hasbrouck Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 1 request that you grant a modification to waive the requirement for construction control of the project at 243 King Street, Suite 246, Northampton, MA, because the work is of a minor nature, it will not affect health, accessibility, life, and fire safety, or structural requirements and is impractical in that the cost of the control construction is considerable when compared to the cost of the proposed work. Thank you for your consideration. Re7Lard ully, aValley Managing Agent for DeLaurentis Management The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Izvestigatiorns 600 Washington Street Boston,MA 02111 www.mass.govI Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Legibly I A Name (Business/Organization/Individual): C�D o !' / ( � �o� - �Ensp ,40 Address: L n City/State/Zip: f� gone#: ��9�� ' 5 Y / -3 V Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a.employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. E]New construction 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.1 ❑ required.] 5. ❑ We are a corporation and its 10.[1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am are employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self--ins.Lic.#: Expiration Date: Job Site Address: �j 1 , City/State/Zip: 1 v Qrf Attach a copy of the workers' compensation policy declaration page(showing the policy number and expilition 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 hereb certify nder the pains a en ties of perjury that the information provided above is true and correct. Signatur • Date: y Phone#: F e only. Do not write in this area,to be completed by city or town offeciaL wn: - _ Permit/License# g thority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Version 1.7 Commercial Building Permit May 15,2000 :777 SECTION 10-STRUCTURAL PEER REVIEW1780.CMR110.11);' Independent Structural Engineering Structural Peer Review Required Yes - No SECTION 11 -OWNER AUTHORIZATION!-TO BE COMPLETED.WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property herebyauthorize! ..__ ........._ .,w ___.._ _ _.__. ..._. _.. _,___...._.:.._.w ___ __-__.._.. .._.. ._.,.. __ ___.to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 77 R1 C.. OX A___ al_._._. _ __._ _...__. .._..___. 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 me Signs ure of Owner/Agent Date SECTION 12-CONSTRUCTION:SERVICES 10.1 Licensed Construction Supervisor: - Not Applicable ❑ Name of License Holder 'Lit G✓h a _.w�G1.�l e . �'S y Z y 3 _ .. License Number u 28 ZOI (o Address 2-7 Noru-xx)d S t Expiration Date (�cec ld t-1P� v 130 1 4 i3 326... `lam CE_�.�. Signat (e / Telephone 1 fib/ SECTION 13,-WORKERS.`:COMPENSATION INSU CE;:AFFIDAVIT(M G L c.1'522§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 CONSTRUCTIONK:SERVICES-FOR BUILDINGS AND STRUCTURES.SUBJECT TO CONSTRUCTION CONTROL..PURSUAN.TTO 780 C.MR1.16(CONTAINING G MORE I THAN 35,000 C.F.OF EN SLOSEDSPACE) 9.1 Registered Architect: Not Applicable [I Name(Registrant): Registration Number r 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 7 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 .............. 1 Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON:ZONING Existing Proposed Required by Zoning This column to'lie filled in by Building Department Lot Size J Frontage Setbacks Front ( ' Side L:= R:(_. - L: _ R: Rear Building Height : ._._ Bldg. Square Footage 1 _ Open Space Footage % r - (Lot area minus bldg&paved 'parking) #of Parking Spaces I M Fill: i (volume&Location) -,- _.- -.• -•. -•.— - _ A. Has a Special Permit/Variance/ ding ever been issued for/on the site? NO 0 DONT KNOW YES 0 :IF.YES, date issued: IF YES: Was the permit recorded a e Registry of Deeds? NO 0 DONT KNOW YES IF YES: enter Book Page; and/or Do ument# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued:_. I 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,gradin , excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 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 PRO_ JECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE == Y Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Addition'sig Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description 'Enter a brief description here. p' Of Proposed Work T ka-r\ �, geV(5r�e Ui1�t i56 �lltf SECTION 5-USE GROUP AND CONSTRUCTION TYPE � �T� 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 ❑ 26 r ❑ 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 ❑ 513 ❑ U Utility El Specify: M Mixed Use El Specify:; SSpecial Use ❑ Specify:_...-. .....�.....a.....u_�_..,�,,...a.�.n....o...�...�.�,........-...�_..-..-._,....,,�-,_.._..�,�.......,...u-....�._..�.._..-_..._M� COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING.RENOVATIONS,ADDI-TIONSAND/OR CHANGE]NUSE 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) 15l ; _._... _., 15l ..._.._ __...____....__,�_..__....__._...�_�.._,........_..�.i .. 3`� _ 3,d th 4th Total Area(sf) Total Proposed New Construction s ._ ...._ _.__ .. __:_._......_..._.._...._,._..._....._...,..__............................ Total Height(ft) --- - --- _ Total Height ft .. 7. ater Supply(M.G.L.c.40,§54) 7.1'Flood Zone Information. 7.3 Sev�ge Disposal System: Public Private ❑ Zone Outside Flood Zone[] Municipal] On site disposal system[] i - _ Version 1.7 Commercial Building,Permit May 15,2000 I n F- +. 71 �?� �) Departure t E1Se�Onl�/ City of Northampton status af'Pem�Et y i ;5 AI'k 2 Q 2Q14 Building Department Curb Cuf/Dnvewa�f Permitx " ,x 212 Main Street Sewer/SepficAvatCabt[rt}r echo+ : ROOM 100 Water/WeII Availability pBCtric,Plumbing P f r� ,r _—Northampton, MA 01060 ' Northarrrton Twa£Seis of Structural PI,an phone 413-587-1240 Fax 413-587-1272 Plaf/Site Plans Other specify x 3 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 KI S L!. 4,—t Z y z :Map Lot Unit v rrk 1�- a►z� Zone Overlay District ----- N 0 r44,ka.xr.� i x, M!A O 1 ob 4 Elm St:District CB District SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: all the Name(Print) Current Mailing Address. Signature `" '� Telephone 91q- 2.2 Authorized Agent: 1Z�C4►au±d Name(Print) Current Mailing Address _ a7 vor4.bad St- (yre-cnbe, / 0/ 0 J Signature 'D v Telephone y13- 2b- j 9 SD - L 1/ SECTION 3-:ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be Officia6 Use Qnly completed by ermit applicant 1. Building vo (a)Building Permit Fee 2. Electrical SUO. �� (b)Estimated Total Cost of Construction from(6) _..............._...__ 3. Plumbing 4-1Uo 00 i Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection m. 6. Total=0 +2+3+4+5) OO , Check Number This.Section For Official Use Only Building Permit Number Date Issued _,Signature: Building Commissioner/Inspector of Buildings Date File 4 BP-2014-1110 APPLICANT/CONTACT PERSON RICHARD LAVALLEY ADDRESS/PHONE 27 NORWOOD ST GREENFIELD (413)326-1950 Q PROPERTY LOCATION 243 KING ST-SUITE 246 MAP 24D PARCEL 185 001 ZONE HB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: SUITE 246-REVISE UNIT FOOTPRINT SEPARATE BATHS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildine Plans Included: Owner/Statement or License 054203 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOR 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 Demolition Delay Signature of Building Wicial 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. 243 KING ST-SUITE 246 BP-2014-1110 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24D- 185 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-2014-1110 Project# JS-2014-001889 Est.Cost: $14900.00 Fee: $165.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RICHARD LAVALLEY 054203 Lot Size(sq. ft.): 86248.80 Owner: COOLIDGE NORTHAMPTON LLC Zoning: HB Applicant: RICHARD LAVALLEY AT. 243 KING ST - SUITE 246 Applicant Address: Phone: Insurance: 27 NORWOOD ST (413) 326-1950 O Workers Compensation GREENFIELDMA01301 ISSUED ON:412412014 0:00:00 TO PERFORM THE FOLLOWING WORK.-SUITE 246 - REVISE UNIT FOOTPRINT, SEPARATE BATHS 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: FeeTvpe: Date Paid: Amount: Building 4/24/2014 0:00:00 $165.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner