25A-185 (29) MCCLURE INSURANCE Fax 41373185d8 _ Mar 10 2009 03:29pm P001/001
ACORD. CERTIFICATE OF LIABILITY INSURANCE 0311012"9
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
McClure Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
103 Van Deena Avenue HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.0.Box 339
West Springfield,MA 01090-0339 INSURERS AFFORDING COVERAGE NAIC 6
""REV INSURER A. The Hanover Insurance Company
Thermal Structures Inc INSURE R& Amer.Internat.Co.
P.O.BOX 44 INSURER C.
East Longmeadow,MA 01028 INSURER D:
INSURER I`:
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 15 SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITION$OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED 8Y PAID CLAIMS.
TYPO OF INSURANCES POLICY NUMBER PO MYMFFE M0 DATE IY Y P RATION L�
A GENERAL LIABILITY ZDN616892308 11/01108 11/01109 EACH OCCURRENCE $1000000
X COMMERCIAL GENERAL LIABILITY DAMM E TO RENTED $100,000
CLAIMS MADE L—1 OCCUR MED EXP(Any One person) $5,000
PERSONAL&ADV INJURY s1 000 000
GENERAL,AGGREGATE $2,000,000
GEMLAGGREGATE LIMIT APPLIES PER, PROCWCT3-COMPIOPAOG $2000000
POLICY PRO- LOC
A AUTOMOBILE LINNUTY AMN626374108 11/01/08 11/01!09 COMBINED SINGLE LIMIT $1,000,000
ANY AUTO (Ea ecdDeM}
ALL OWNED AUTOS BODILY INJURY $
X SCHEDULED AUTOS (Pqr p9mon)
X HIRED AUTOS BODILY INJURY S
X NON-OMED AUTOS (Per aoadaW
PROPERTY DAMAGE $
(Par accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGO S
A EXCESSlUMBRPLLA UABXITY UHNS27200706 11/01/08 11/01/09 EAC1400CURRENCE SZ 000 000
X OCCUR F CLAIMS MADE AGGREGATE s2.000.000
b
R DEDUCTIBLE $
X RETENTION $10000 $
S W Ey ORKERS CO MSATION AND WC005597889 11/01/08 11/01/09 WC STATU
oTH-
RMPLOYFRS'LL4WLM E.L.EACH ACCIDENT $1,000 000
ANY OFFICER NIeMBBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1 000,000
dygg dessaiieundgt E.L.DISEASE-POLICYLIMff s1 OOO,OOO
SPECIAL PR 1n IONS below
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED 13Y ENDORSEMENT I SPECIAL PROVISIONS
Coca Cola 45 Industrial Drive Northampton MA has been named as additional
Insured.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED EVoRE THE EXPIRATM
Coca Cola DATE THERE,OP,THE ISSUING INSURER WILL ENDEAVOKTO MAIL 30_ DAYS WRITTEN
45 Industrial Drive NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEF BUT FAILURE TO DO SO SHALL
Northampton,MA 01060 IMPOSE;NO OBLIGATION OR LIABILITY OF ANY riMD UPON THE ENSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED P pTI1K'
7r
ACORD 25(2001108)1 of 2 ffS41458IM41228 DMB A ACORD CORPORATION 1988
STEIGER ENGINEERING INC.
9 Moody Rd, Suite 15,Enfield,CT 06082 Tel. (860)698-9626
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The Commonwealth of Massachusetts
- Department of Industrial Accidents
a.� 7
Office of Investigations
600 Washington Street
-— Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians!Plumbers
Applicant Information Please Print Legibly
Name (Business/Organizarion/Individual): ?�� /�/7 /c�i�C �_6114e
Address: / AZI CI
City/State/Zip: L' Lair( hone#: / r
Are you an employer'Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
have hired the sub-contractors 6. ❑New construction
employees (full and/or part-time).* Remodeling
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑
ship and have no employees These sub-contractors have g, Demolition
for me in any capacity. employees and have workers' 9 ❑Building addition
[No workers' comp. insurance comp. insurance.$
5. We are a corporation and its 10T-1 Electrical repairs or additions
required.]
3.❑ I am a homeowner doing all work officers have exercised their 11.El Plumbing repairs or additions
right
myself. [No workers' comp. , exemption per MGL
12.0 Roof repairs
insurance required.]t c. 152, §1(4),and we have no 1�. i
employees. [No workers' ^ �Other �oCn�
comp.insurance required.] T�C&CM,t2_
*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.
�Contraetors 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 an 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.#: C2 Expiration Date:
Job Site Address: �/S��Li die/�/t' ,�f' City/State/Zip: ® � 1-*'1�-.-
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 certi un r the pains and penalties of perjury that the information provided above is true and correct.
Sim natur Date- 3,
Phone#:
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#:
.► 1
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 O No
SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,
C;1 Yy as Owner of the subject property
hereby authorize _ /h eYn- , . 1 fyvGfvf CS to
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature o� Date
I, 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 perju_ry.,
Print Name
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
� License Number
Address Expiration Date
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 X 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
Addre � -
/,/�� � q Expiration Date
Signature// Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
eyo
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 I Expiration Date
9.3 General Contractor
TL4�=.iLr�w?L S T2UL-voXES .C.!C,.. .. Not Applicable ❑
Com ny Name:
Responsible In Charge of Construction
Address
r�3 gas y�ys`
Signature Telephone
f.
Versionl.7 Commercial Building Permit May 15,2000
S. 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) _ ...,. _, ....._. ...... ,,. ...... ._,.m,.
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT^KNOW 0 YES Q /
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT 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 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission? x
Needs to be obtained 0 Obtained 0 , 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 x`
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 cf a common plan
that will disturb over 1 acre? YES 0 NO 0 "//4
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[g
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑
Brief Description Enter a brief description here. 11<1-e- T
Of Proposed Work:
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 ❑ 2B ❑
F Factory F-1 ❑ F-2 2C
H High Hazard ❑ 3A ❑
1 Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 El S-2 F-1 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(so
St
St
_ .. ... . 2nd
2nd
3rd
3rd
_-----. 4
4m th
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 Sewa a Disposal System:
Public Private ❑ Zone _ Outside Flood Zon Municipal On site disposal system❑
• Version l.7 Commercial Building Permit May 15,2000
Department use only
aty of Northampton Status of Permit:
'Building Department Curb-Cut/Driveway Permit -
212 Main Street Sewer/Septic Availability
Room 100 Water/W611 Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
'i Other Specify
APPLICATION TO CONSTRUGr,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
C.-0C A CO& Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address. Kla k j{,y�rq�.�T�j�C/�
` /3 _. _ `_� 57-F 3
Signature Telephone
2.2 Authorized Agent:
Name(Print) Current Mailing Address.
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (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
6. Total=(1 +2+3+4+5) Check Number p�
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2009-0744 J
APPLICANT/CONTACT PERSON SIEGFRIED PORTH
ADDRESS/PHONE 116 PLEASANT ST SUITE 3404 EASTHAMPTON (413)529-9434
PROPERTY LOCATION 45 INDUSTRIAL DR
MAP 25A PARCEL 185 001 ZONE GI(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: INSTALL STEEL STRUCTURE FOR 1800 SF ENVIRONMENTAL CONTROL ROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accesses Structure
Building Plans Included• -
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN_FQ M'ATION 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
44-"-J 011 1106..
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-2009-0744
GIs#: COMMONWEALTH OF MASSACHUSETTS
zsz= l as CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2009-0744
Project# JS-2009-001108
Est. Cost: $17000.00
Fee: $102.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: THERMAL STRUCTURES INC
Lot Size(sq. ft.): 948344.76 Owner: COCA COLA COMPANY THE C/O GORDON JENKINS TAX DEPT
Zoning_G1000)/ Applicant: THERMAL STRUCTURES INC
AT. 45 INDUSTRIAL DR
Applicant Address: Phone: Insurance:
31 BENTON DR (413) 525-4795 WC
EAST LONGMEADOWMA01028 ISSUED ON:41712009 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL STEEL STRUCTURE FOR 1800 SF
ENVIRONMENTAL CONTROL ROOM
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 4/7/2009 0:00:00 $102.0091278
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo