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42-089 (18) 6/20/2014 Cityof Northampton Mail-Shed at the landfill Shed at the landfill Louis Hasbrouck <Iasbrouck @northamptonma.gov> Fri, Jun 20, 2014 at 2:22 PM To: Ned Huntley <nhuntley @northamptonma.gov>, James Laurila <jlaurila @northamptonma.gov>, David Veleta <dveleta @northamptonma.gov>, David Pomerantz <dpomerantz @northamptonma.gov> To all, Here's the permit application I got for renovations to the shed at the landfill. I didn't realize that it wasn't signed by someone from the city, and I'd asked for a (very) brief review of the structure. I got a call today from some volunteers today asking if they could start tomorrow. I'll tell them no. What should we do to work this out? Who could sign for the city on this building? What about liability waivers for the wlunteers? I know we're able to work that out for some other projects. I realize Ned's away until Tuesday. Let me know what you all think. Thanks. Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg (413) 587-1240 office (413) 587-1272 fax https://mail.g oog le.conVmai I/ca/u/0/?ui=2&i I-ec5fl9a57e&\ie\&=pt&search=sent&th=146ba841 cde4fdbd&si ml=146ba841 cde4fdbd 1/1 ------------------------------------................ ....... ................ ........................ ................................... EXHIBIT I RECREATIONAL AND VOLUNTEERS ACTIVITIES RELEASE FORM 1,the undersigned(insert name),do hereby consent to my participation in voluntary or recreation programs of the Town/City of (insert name of municipality). I also agree to forever release the Town/City and all their employees,agents,board members,volunteers and any and all individuals and organizations assisting or participating in any voluntary or recreation programs of the Town/City("the Releasees")from any and all claims,rights of action and causes of action that may have arisen in the past,or may arise in the future,directly or indixe6tly,from personal injuries to myself or property damage resulting from my participation in the Town/City of voluntary activities or recreation programs. I also promise,io indemnify,defend,and hold harmless the Releasees against any and all legal claims and proceedings of any description that may have been asserted in the past,or may be asserted in the future, directly or indirectly,arising from personal injuries to myself or property damage resulting from participation in the Town/City of voluntary activities or recreation programs. I further affirm that I have read this Consent and Release Form and that I understand the contents of this Form.I understand that my participation is voluntary and that I am free to choose not to participate in said programs.By signing this Form,I affirm that I have decided to participate in the Town/City as a volunteer or in its recreation programs with full knowledge that the Releasees wi tf not be liable to anyone for personal injuries and property damage that I may suffer in voluntary activities Town/City or recreation programs. Participant Signature: Date: MIJA Risk Management Procedures Manual Page 21 The Commonwealth of Massachusetts Departmernt of Industrial Accidents Office of Investigations , 600 Washington Street Boston, MA 02111 www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): _ Address: City/State/Zip: Phone#: 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. 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 10.0 Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions �.❑ I am a homeowner doing all work ❑ myself. [No workers'comp. right of exemption per MGL 12.7 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 an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self--ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: 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 the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: Of use only. Do not write in this area, to be completed by city or town official - - - —Cit y_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 SECTION 10-STRUCTURAL.,PEER,13REVIEW,(780:CMR11 0.11.). 777] Independent Structural Engineering Structural Peer Review Required Yes No SECTION 11 -OWNER:AUTHORIZATION-..TO.BEI COMPLETED:.::WHEN;I: OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ............................... ........... as Owner of the subject property hereby authorize€..._. . ........................... act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date --—-—- 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 . .......... .......... 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',COMPENSATIONI.INSURANCE AFFIDAVIT r .. 1 M I L.c.152:-§.25C(8)) 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 0 No 0 Version 1.7 Commercial Building Permit May 15,2000 SE('.TIOfi1..90-: T_RUCTUE::P1=Ef3"�lZEfl�1=� Independent Structural Enginedring Structural Peer Review Required Yes No SECT[ON 11r OWNER�AU P,TIQtt 0E3�` MR1? T�T3 OWNERS ACEN.T'OR'CONTf�A=CTOR`AP:i?LIES:: QR 13l}II:DJftt as Owner of the subject property hereby authorize !_..�G_../�/3?� act on my behalf,in all matters•retative to work authorized by this bullding perfrilf application. :- ' Signature wrier -. Date • ' I - - as Owner/Authorized Agent hereby declare that the'statements and information on the foregoing'appiication are true and accurate,to the best of my knowledge and'belief: SI fgned under the pains anA penaltles&p u Pont Name e Signature of Owner/Agent Date SECTION;12-CONSSTRUi:110&S.ERVICDES' '10.111 ensed Construction Supervisor: . .• Not Applicable -Name of License Holder:�� -- - � ��------• - - - •--� L€cense Number Addressor Expiration Date Signature Telephone • - - - c7 .j{,,r�?4 =�.;di y,:4':.z;-.r•'q".f n. -.._�.. .�,, >µF`..'.,,.,:+"'. _ .... ,j CPU, aArFF a.U4 i ii}f-r v"k SZ r ' 2 SECTIO1113-Vb P,K".Es 'C T40 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 ''Q' 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(C'ONTAINING MORE THAN 35;000 C.F,OF EN LOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Na_me(Registrant): Registration Number Addr Expiration Date 5_$6... --77 Signa re Telephone 9:2 red Professional Engineer(s): i Name Area of Responsibility .............._..... _. _,.__. __._ _..,_.,. .... __....... ._.. ._._._...._.. .. Address Registration Number t Signature Telephone Expiration Date I 2 S Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date ....... ._ ..d_... .....__. Name Area of Responsibility Address Registration Number _.._ _...... _._... .., ....... _ _....... . ...._... Signature Telephone Expiration Date _._........ .. _.__ , _..., .._.._ .._.._. w _..� t_.,--_------- ...__... _. -....... ..__ ...._..... ._.._ Name Area of Responsibility Address Registration Number Signature Telephone I Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Address j 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 €..... .._._. . ,._..._..:_ _.._..,. _ . _ .._...__._... .. ` ....... ...._._._W _..._. - Setbacks Front Side L Rear Building Height Bldg. Square Footage % Open Space Footage % —, (Lot area minus bldg&paved #of Parking Spaces -- — Fill: ....._.. . _. _........ ... _.., (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES 0 �IF,YES, date issued: .�._...__....._.�...�.._� IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page= and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW C) YES C 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 r NO 0 IF YES, describe size, type and location: L+k-7 zA i-,L w G•1�r� �}�� ......._1.1-1.1- ...... .._..- .. _... .. _.__ ........ D. Are there any proposed changes to or additions of signs intended for the property? YES 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 (J IF YES,then a Northampton Storm Water Management Permit from the DPW is required. V.brsionl.7 Conunercial Bailding.Permit May 15,2000 ity of Northampton D vilding Department 212 Main Street JUN 1 2Qt4 t Room 100 No hamptan,:MA 01:060 Plumbing& ts 87-'1240 Fax 413-587-1272 - E1eclri ortharnpton.fi ni 0 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,-SI'rEJNFQftIVrATION`• r - •~ 'This.-se�,ti�n.to:'be complet¢d�q�'office ' 1.9 Property Address: �/ n. L.ot Shq Wilt 1 ! lJ / " � �oire=' ' :Oye�la}(t]•it;.triet --•--. -�'-_ .._._._..._..._. - - --- ��,(¢li�'5L'`gt-sCrFc:. -. _. =;ca olsi�ict°• . '... i SECTION 2 PFtOPI Y}rfY'01fVNEE25F1I 13lAU�CfO.i��L�,Aw/�GEt�� ': *�_� r " I 2.1 Owner of Record: Name(Print) Current Mailing Address: -t 15-70 �t Signature / Telephone j 2.2 Authorized A-gent: mil. ' �-�_ C�� h► �..•��--�-A_...._.t Name(Prin�t)C Current Mailing Address__ Signature Telephone ' 'SEETIdI�'3•�: ,tti_TE�k,GE11s(SsTFif1:G.�fOW�G4ST5'`,;`,'.`� Item Estimated Cost(Dollars)to be 'completed by ermit a licant „°' _" t'- !: tCdi� 1. Building . _ - �,:-- 2. Electrical i'� rl `Esfited' afa0ost of j nsluctiort-from-'6: 3_ Plumbing ";Hrtil liq zP rtriIt- ee -- 4. Mechanical(HVAC) 5.Fire Protection Total=(1•+.2+3+4+5) ,ffieclC_NurpbQr _- This.Sectiarf+Fof°Officlaf Us'po6j Building Permit Number. • :�,Issued' , 8u11dibg Commissioner/inspeetor'ot Buildings Date Version 1.7 Commercial Building Permit May 15,2000 9 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[:1 Roofing❑ Change of Use❑ Other❑ Brief Description 'Enter a brief description here. Of Proposed Wor { Ile- 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 ❑ Institutional E] 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:} SSpecial Use ❑ Specify:� �_..�.....,.r�..w_�-..•..�.��...........-..u.,,,.,�..�,.� «..._.-...,..,�m�... _.r....r...a�._�.... ,W,._,.� ..,__ COMPLETE THIS SECTION IF.EXISTING'BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE m 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 5� nd nd 2 2 _...._. , 3rd 3rd __...._ ---______m_..______. .,_ __. v 4 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 Sewage Disposal System: Public ❑ Private ❑ Zone,"'"" one Outside Flood Zone[7f Municipal ❑ On site disposal system E] C Version 1.7 Commercial Building.Permit May 15,2000 --- � Departure t use,only ity of Northampton status of Permit ` 3 uilding Department curb Cufi/Dnveway Perinrt,� 212 Main Street Sewer, epticAvailabilrty JUN r 1 ��i4 ;J Room 100 Water NVell Availabuity ENO hampton, MA 01060 Two Sets of Structural Plans t Electric F�urr pt1c7?tL-4*LfS5 87-1240 Fax 413-587-1272 Plot/Site Plans' Norther r. Other Specifyr '� t 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 fq��/G�►�{Cc8 IVlap � . Lot �l�� Unit -L � f'lo t 6LIti UUU Zoner Overlay District ''Elm St.District CB District" SECTION 2 PROPERTY OWNERSHIP/AUTH'ORIZED AGENT . 2.1 Owner of Record: Name(Print) Current Mailing Address: Signature Telephone __....._...,__....,__. _.,__„__._.__._...__.... _....._.._._..._.__....�,.., 2.2 Authorized Agent: Name(Print) Current Mailing Address Signature Telephone SECTION 3- ATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building f by v i (a) Building Permit Fee i 2. Electrical j (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee I 4. Mechanical(HVAC) 5. Fire Protection ........ ........ _. _6. Total=(1 +2+3+4+5) Check Number This.Section.ForOfficial Use 0nl Building Permit Number Date Issued Signature:__ Building Commissioner/Inspector.of Buildings Date File#BP-2014-1335 APPLICANT/CONTACT PERSON TRISTAM W METCALFE ADDRESS/PHONE 142 Main St NORTHAMPTON (413)586-5775 OK PROPERTY LOCATION 170 GLENDALE RD MAP 42 PARCEL 089 001 ZONE d�C LI?,ffl,iT�f WTI THIS ONLY: APPLICATION CHECKLIST MAIL Td N Ted too Al PERMIT ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT �c'F4j 10 �1'�I 5 Fee Paid Building Permit Filled out arl 0C Fee Paid Tvpeof Construction: TRANSFER STATION IN RIOR DEMOLITION New Construction Non Structural interior renovations Addition to Existing AccessoU 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 INFORMATION 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. 170 GLENDALE RD BP-2014-1335 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 42-089 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INTERIOR DEMOLITION BUILDING PERMIT Permit# BP-2014-1335 Project# JS-2014-002234 Est. Cost: $0.00 Fee: $0.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TRISTAM W METCALFE Lot Size(sq. ft.): 2265120.00 Owner: NORTHAMPTON CITY OF LEACHATE TREATMENT FACILITY Zoning: Applicant: TRISTAM W METCALFE AT. 170 GLENDALE RD Applicant Address: Phone: Insurance: 142 Main St (413) 586-5775 N O RTHAM PTO N MA01060 ISSUED ON:6/25/2014 0:00:00 TO PERFORM THE FOLLOWING WORK:TRANSFER STATION INTERIOR DEMOLITION 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 6/25/2014 0:00:00 $0.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner