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39A-020 (4) Bk: 11670 Pg: 132 i F Planning-Decision City of Northampton Hearing No.: PLN-2014-0049 Date: May 30, 2014 F. Compliance with the following technical performance standards: (1) Curb cuts onto streets shall be minimized and maintained as existing from side streets. (2) Pedestrian,bicycle and vehicular traffic movement on site must be separated,to the extent possible. COULD NOT DEROGATE BECAUSE: t FILING DEADLINE: MOILING DATE: HEARING CONTINUED DATE: DECISION DRAFT BY: APPEAL DATE: 51112014 511512014 51512014 REFERRALS IN DATE: HEARING DEADLINE DATE: HEARING CLOSE DATE: FINAL SIGNING BY: APPEAL DEADLINE: W812014 6/26/2014 5/22/2014 61512014 6119/2014 FIRST ADVERTISING DATE: HEARING DATE: VOTING DATE: DECISION DATE: 5/812014 5/22/2014 5/22/2014 5!3012014 SECOND ADVERTISING DATE: HEARING TIME: OTING DEADLINE DECISION DEADLINE: { 511512014 1 4:30 PM 8/20/2014 8/20/2014 MEMBERS PRESENT: VOTE: William Grinnell votes to Grant f John Lutz votes to Grant Debin Bruce votes to Grant j Ann DeWitt Brooks votes to Grant Mark Sullivan votes to Grant MOTION MADE BY SECONDED BY: VOTE COUNT: DECISION: I Debin Bruce William Grinnell 5 Approved with Conditions { MINUTES OF MEETING: Available In the Office of Planning&Development. s 1,Carolyn Misch,as agent to the Planning Board,certify that this is a true and accurate decision made by the Planning Board and certify that a copy of this and afl plans have been flied with the Board and the City Clerk on the date shown above. I certi that a copy of this ecislort-ltas been mailed to the Owner and Applicant. `� Mac 3 Notice of Appeal An appeal from the decision of the Planning Board may be made by any person aggrieved pursuant to MGL Chapt 40A,Section 17 as amended within twenty(20)days after the date of the filing of the notice of the decision with the City Clerk The date is listed above. Such appeal may be made to the Hampshire Superior Court with a certified copy of the appeal sent to the City Clerk of the City of Northampton. June 20, 2014 3 I, Wendy Mazza, City Clerk of the City of Northampton,hereby certify that the above Decision of the Northampton Planning Board was filed in the Office of the City Clerk on May 30, 2014, that twenty days have elapsed since such filing and that no appeal has been filed in this matter. Attest: } qty lerk City of Northampton i GeoTMS®2014 Des Laurlers Municipal Solutions,Inc. ATTEST: HAMPSHIRE, , REGISTER MARY LBERD Bk: 11670 Pg: 131 Planning-Decision City of Northampton A Nearing No.: PLN-2014-0041 Date: May 30,2014 i APPLICATION TYPE SUBMISSION DATE: PS Intermediate Site Plan 422/2014 Applicant's Name: Owner's Name: I II IN) I NAME: NAME: 1 10 NEW ENGLAND TREATMENT ACCESS GRETNA GREEN DEVELOPMENT CORD Bk: 11670Pg: 131 Page: 1 of 2 ADDRESS: ADDRESS: Recorded: 06/20/2014 09:16 AM 45 ORCHARD RD 210 EXCHANGE ST 3 TOWN: STATE tIPCODE TOWN: STATE ZIP CODE ] SWAMPSCOTT MA 01907 CHICOPEE MA 01013 i PHONE NO.: FAX NO.: PHONE NO.: FAX NO.: i (617J 838-2168 EMAIL ADDRESS: EMAILADDRESS: Site Information: Surveyor's Name: STREET NO.: S[TE ZONING: COMPANY NAME: 118 CONZ ST GB(1001/ TOWN: ACTION TAKEN: ADDRESS: 4 NORTHAMPTON MA 01060 Approved With Conditions MAP: BLOCK: LOT: MAP DATE: SECTION OF BYLAW: 39A 020 001 Chpt.350-11:Site Plan Approval TOWN: STATE: ZIP CODE: } Boric: age: . 1 2012 213 PHONE NO.: FAX NO.: i t EMAIL ADOR I'- i NATURE OF PROPOSED WORK REGISTERED MARIJUANA DISPENSARY HARDSHIP: I� M AY 3 0 2014 l � CONDITION OF APPROVAL: 1) Prior to issuance of a building certificate of occupancy,the applicant.shatl as o eyed m1 a payment_ in lieu of traffic mitigation to the City of$57,680. '•!f+ S -' L FINDINGS: NOF i K:=..i,9F ;�j0 0 Iv;t,1'�'06 The Planning Board approved the site plan for the rouse of an existing building for two tenant spaces,Inc ud s medicinal marijuana dispensary based on the following plans and information submitted with the application: 1).Site Plan for New England Treatment Access by Bohler Engineering,sheets 1,2 dated 411412014.Sheet L 1.1(lighting spec)dated 4-16- 14. i 2)New England Treatment Access floor plan and exterior,by i W64 Architects,Sheet A1.Dated 4114114. The Board granted approval for the usellayout upon finding that the following elements within the zoning had been met. t A)The requested use protects adjoining premises against seriously detrimental uses.If applicable,this shall Include provision for surface water drainage,sound and sight buffers and preservation of views,light and air. The applicant will add an impervious fence to screen the dumpster and parking lot from abutting residential structures. Additional landscaping will be added to the front of the parcel to comply with 10 setback between the sidewalk and the parking area. B. The requested use will promote the convenience and safety of vehicular and pedestrian movement within the site and on adjacent streets. No site changes to access are planned.The main entrance will be from a side street off of Conz/Pleasant. As offered by the applicant off-site traffic mitigation will be addressed through payment-in-lieu of physical improvements in the amount of$57,680. (3)Access by nonmotorized means is being accommodated with existing facilities such as bike racks,sidewalk connections from the building to the street C. The site will function harmoniously in relation to other structures and open spaces to the natural landscape,existing buildings and other community assets in the area as it relates to landscaping,drainage,sight lines,building orientation,massing,egress,and setbacks.No major changes are planned for the she. a D.The requested use w11J not overioad,and will mitigate adverse impacts on,the Clty's resources,including the effect on the City's water supply and distribution system,sanitary and storm sewage collection and treatment systems,fire protection,streets and schools. 1 E. The applicant has met all special criteria for such use including j (1)Building facades and property must be consistent with the character of the neighborhood,Including such items as transparent storefront windows with a view Into the Interior of the building.Security measures must appear from outside of the building to be with the character of the neighborhood. This does not create any restriction or compromise on security measures but does consistent require that such measures be camouflaged to blend into the background. (Z)Buildings must be ventilated with such flhers or scrubbers to ensure that there are no odors fro m marijuana in any place where the public or clients are present and no public exposure to any pesticides,herbicides or other chemicals. (3)No medical marijuana dispensary and/or treatment center shall be located within 200 feet of any elementary school,middle school,or t high school;there are no other buffer limitations. GeOTMS®2014 Des Lauriers Municipal Solutions,Inc. i Transmittal Letter May 1, 2014 Nadeau Corporation Construction Development & Engineering 727 Washinqton St. Attleboro, MA 02703 Phone: 508-399-6776 Fax: 508-399-7270 To: City of Northampton Attention: Building Department 212 Main Street, Room 100 Re: NETA Northampton Northampton, MA 01060 Job Number: 1416 X Attached ❑ Under Separate over via: FedEx the following: ❑ Shop Drawings ❑ Prints X Plans X Other: 1 ❑ Copy of Letter ❑ Change Order ❑ Samples I ❑ Total Quantity ❑ Reproducible ❑ Specification 1 1 Stamped Signed Construction Set 1 Electronic Stamped Signed Construction Set 1 Construction Control Document - Architectural 1 Construction Control Document - Mechanical 1 Construction Control Document - Electrical/Pumbing 1 Workers Comp Insurance Affidavit 1 Permit Application Fee Check $1080.00 ❑ For Approval ❑ Approved as Submitted ❑ Resubmit copies for approval X For Your Use ❑ Approved as Noted ❑ Submit [#] copies for distribution ❑ As Requested ❑ Returned for Corrections ❑ Return [#] corrected prints ❑ For Review and Comment ❑ Revise and Resubmit/Work May Not Proceed ❑ FOR BIDS DUE: ❑ PRINTS ETUR D AFTER LOAN . I f . j I r ) /4 t Client#: 754320 NADEACOR3 DATE(MM/DD/YYYY) ,--A-CORD„ CERTIFICATE OF LIABILITY INSURANCE 1/02/2014 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: I the certl leate holder Its an ADDITR NAIL INDURED,the polloy(les)rnuat be end®reed.if&LIO 00ATION 16 WAIVED,eubject 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). NA TACT PRODUCER NAME: US[Insurance Services LLC C/L PHONE 401 885-5700 F4X 877 484-4772 AIC,No,Ext: A/C,No 5700 Post Road E-MAIL ADDRESS: P.O. Box 1158 INSURER(S)AFFORDING COVERAGE NAIC# East Greenwich, RI 02818 INSURER A:Employer's Mutual Casualty Insu 21415 INSURED INSURER B:Beacon Mutual Insurance Company 24017 Nadeau Corporation -- _ 727 Washington Street INSURER C: INSURER D: South Attleboro,MA 02703 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: jr 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 CONTRACTOR 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 ADDL SUB POLICY EFF POLICY EXP LIMITS LTR _ INSR WVD POLICY NUMBER MMlDD {MM/DDIYYYY A GENERAL LIABILITY X 2X6526414 12/31/2013 12/31/2014 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMIOEa occu ence $100,000 CLAIMS-MADE I J OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X JET LOC $ A AUTOMOBILE LIABILITY X 2X6526414 12/31/2013 12/31/201 COMBINED SINGLE LIMIT 1,000,000 (Ea accdent $ _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE $ NON-OWNED Per accident X HIRED AUTOS X AUTOS A X UMBRELLA LIAB X OCCUR 2X6526414 12/31/2013 12/31/201 EACH OCCURRENCE s5,000.000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$10,000 _ $---- B WORKERS COMPENSATION X 66554 12131!2013 12/31/201 X WC y A�U O�TH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? a NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500 OOO If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$500,000 A Property 2X6526414 12/31/2013 12/31/2014 $85,000 Leased/Rented Equipment 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 Sample Certificate THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S11522923/M11482772 BYPZP Name-Title Signature D Section 5: Post Construction Compliance Statement Record Drawings and Operating and Maintenance Manuals: 1. Construction documents with record drawings and operating and maintenance manuals provided to the owner. Lighting Designer or Contractor Name Signature Date Project Title: NETA NORTHAMPTON Report date:04/28/14 Data filename:Z:\2014120140047 NETA Dispensary Northampton,MA\20140047-COMCheck\20140047 NETA COMCheck-FINAL2.cxl Page 2 of 2 COMcheck Software Version 3.9.3 Interior Lighting and Power Compliance Certificate 2012 IECC Section 1: Project Information Project Type:New Construction Project Title:NETA NORTHAMPTON Construction Site: Owner/Agent: Designer/Contractor: 118 CONZ ST JASON RIOUX NORTHAMPTON,MA 01060 CREATIVE ENVIRONMENT CORP. 50 OFFICE PARKWAY EAST PROVIDENCE,RI 02914 401-438-7733 Additional Efficiency Package:Reduced interior lighting power.Requirements are implicitly enforced within interior lighting allowance calculations. Section 2: Interior Lighting and Power Calculation A B C D Floor Area Allowed Allowed Watts Watts/ft2 Retail 3881 1.3 5045 Total Allowed Watts= 5045 Section 3: Interior Lighting Fixture Schedule A B C D E Fixture ID:Description/Lamp/Wattage Per Lamp/Ballast Lamps/ #of Fixture (C X D) Fixture Fixtures Watt. :Retail(8883 sq r LED 1:A:2 X 4 LED TROFFER:LED Panel 44W: 1 5 44 220 LED 2:B:2 X 2 LED TROFFER:LED Panel 36W: 1 12 35 420 Linear Fluorescent 1:C:8'FLUOR.WRAPAROUND:48"T8 32W:Electronic: 4 3 128 384 Linear Fluorescent 2:D:4'FLUOR.WRAPAROUND:48"T8 32W:Electronic: 2 5 64 320 Compact Fluorescent 1:F:30"DIAMETER PENDANT:Other:Electronic: 3 4 33 132 LED 3:G:TRACK HEAD:Other: 1 40 19 760 Incandescent 1:H:PENDANT:Incandescent 60W: 1 28 60 1680 LED 4:K:6"DOWNLIGHT:Other: 1 4 29 116 LED 5:L:LED PUCK LIGHT:Other: 1 24 4.3 Exempt Exemption:Retail Display Window LED 6:M:LED TAPE:Other: 1 1 300 Exempt Exemption:Retail Display Window LED 7:M1:LED TAPE:Other: 1 24 12 Exempt Exemption:Retail Display Window LED 8:M2:LED TAPE:Other: 1 4 12 Exempt Exemption:Retail Display Window Total Proposed Wafts= 4032 Section 4: Compliance Statement Compliance Statement: The proposed lighting design represented in this document is consistent with the building plans,specifications and other calculations submitted with this permit application.The proposed lighting system has been designed to meet the 2012 IECC requirements in COMcheck Version 3.9.3 and to comply with the mandatory requirements in the Requirements Checklist. Project Title: NETA NORTHAMPTON Report date:04/28/14 Data filename:Z:\2014\20140047 NETA Dispensary Northampton,MA\20140047-COMCheck\20140047 NETA COMCheck-FINAL2.cxl Page 1 of 2 ,� �� ^ .9 Y + ��r. {. � F.� .,q� '� � r �� P ,. � ;�. y, •w.. Rya *�s.«o v� City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS „ 212 Main Street • Municipal Building fp ° ` µms Northampton, MA 01060 " INSPECTOR Louis Hasbrouck Fax: 413-587-1272 Chuck Miller Building Commissioner Phone: 413-587-1240 Assistant Commissioner CONSTRUCTION CONTROL DOCUMENT (For professional Engineers/Architects responsible for Entire Project) Project Title: New England Treatment Access (META) Dispensary Date: April 28; 2014 Project Location: 118 Cora Street: Northampton, MA Map: 39A Parcel: 020 Zone: GB Scope of Project: Interior renovation of existing medical office buiding to a new Registered Medical Marijuana Dispensary In accordance with the Eighth edition Massachusetts State Building Code, 780 CMR Section 107.6: 11 Richard C. Newell Mass. Registration# 45888 Being a registered professional Engineer/Architect hereby CERTIFIES that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: MECHANICAL, PLUMBING YV For the above named project and that to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable Laws for the proposed project. Furthermore, I understand and AGREE that I shall perform the necessary professional services to determine that the above mentioned portions of the work proceed in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 10.7.6.2.2: 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction documents as submitted for the building permit, and approval for the conformance to the design concept. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine, in general, if the work is being performed In a matter consistent with the construction documents. I shall submit periodically, in a form acceptable to the building official, a progress report together with pertinent comments. Upon completion of the work, I shall submit to the building official a final report as to the satisfactory completion and readiness of the project for occupancy. N OF Mq,S`rI ° c"y e an al of Registered Professional HIGtiAFi0 C NEWEja v Mlrl 40CAI No.4A9 88 2b Day of PFJL- 20 1d— �'OF FG/STEP'�\.���Q �SSIONAI EhU (seal) City of Northampton : Massachusetts W," DEPARTMENT OF BUILDING INSPECTIONS ' 212 Main Street • Municipal Building Northampton, MA 01060 DPW INSPECTOR Louis Hasbrouck Fax: 413-587-1272 Chuck Miller Building Commissioner Phone: 413-587-1240 Assistant Commissioner CONSTRUCTION CONTROL DOCUMENT (For professional Engineers/Architects responsible for Entire Project) Project Title: New England Treatment Access (META) Dispensary Date: April 28, 2014 Project Location: 118 Conz Street, Northampton, MA Map: 39A Parcel: 020 Zone: GB Scope of Project: Interior renovation of existing medical office building to a new Registered Medical Marijuana dispensary In accordance with the Eighth edition Massachusetts State Building Code, 780 CMR Section 107.6: I, Steven Costa Mass. Registration# 41728 Being a registered professional Engineer/Architect hereby CERTIFIES that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: ELECTRICAL For the above named project and that to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable Laws for the proposed project. Furthermore, I understand and AGREE that I shall perform the necessary professional services to determine that the above mentioned portions of the work proceed in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 10.7.6.2.2: 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction documents as submitted for the building permit, and approval for the conformance to the design concept. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine, in general, if the work is being performed In a matter consistent with the construction documents. I shall submit periodically, in a form acceptable to the building official, a progress report together with pertinent comments. Upon completion of the work, I shall submit to the building official a final report as to the satisfactory completion and readiness of the project for occupancy. OF M,gssq oy Signature and Seal of Registered Professional STEVEN i, o COSTA - �. �,, ELECTRICAL ti ,A .41728 -* Day of "X rL� 20 14 SSIpSQtE ' City of Northampton �. Otis •� ri< Massachusetts DEPARTMMT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 INSPECTOR Louis Hasbrouck Fax:413-587-1272 Chuck Miller Building Commissioner Phone:413-587-1240 Assistant Commissioner CONSTRUCTION CONTROL DOCUMENT (For professional Engineers/Architects responsible for Entire Project) Project Title: New England Treatment Access (NETA) Dispensary Date: April 28, 2014 Project Location: 118 Conz Street, Northampton, MA Map: 39A Parcel: 020 Zone: GB Scope of Project: interior renovation of existing medical office building to a new Registered Medical Marijuana Dispensary In accordance with the Eighth edition Massachusetts State Building Code, 780 CMR Section 107.6: I, Keith R. Davignon Mass. Registration# 30067 , Being a registered professional Engineer/Architect hereby CERTIFIES that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: N ARCHITECTURE For the above named project and that to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable Laws for the proposed project. Furthermore, I understand and AGREE that I shall perform the necessary professional services to determine that the above mentioned portions of the work proceed in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 10.7.6.22: 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction documents as submitted for the building permit, and approval for the conformance to the design concept. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine, in general, if the work is being performed In a matter consistent with the construction documents. I shall submit periodically, in a form acceptable to the building official, a progress report together with pertinent comments. Upon completion of the work, I shall submit to the building official a final report as to the satisfactory completion and readine of the project for occupancy. �R Signature d a of is ed Professional T �roZ 1 RI y of 20`r OF VA'S (seal) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a a I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): IV AO&TA J Address: -72'7 (/y is fll -Y7 City/State/Zip:���l-�f!'�v�-C> UL�u Phone #: �' � Are you you an employer? Check the appropriate box: Type of project(required): L Lt�'I am a employer with _)_1(D 4. ❑ I am a general contractor and I employees (full and/or part-time). * have hired the sub-contractors 6. ❑ construction 2.❑ 1 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.❑ 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 12.0 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 till 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. lContractors 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: �&,-4 761AI— `G��i�Z•4�VZG C�//�'�/��'^�/ Policy#or Self-ins. Lic. #: 4�1 41 Expiration Date: 2- , Job Site Address: y&_ 1 Z City/State/Zip: �� n�D'`/ � Attach a copy of the workers' compensation policy ration page(showing the policy number and expiration date). Failure to secure coverage as required under ci of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imp ' t, s civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the vi o . ad s t t a copy of this statement may be forwarded to the Office of Investigations of the DIA for ins nce era riff ti . I do hereby certify under t pains d pe ies o rj ry that the information provided above is true and correct. Si nature: Date: Phone#: ���� 3 �` & Official 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#: Version].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 e SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Matt McDonough , as Owner of the subject property hereby auth rize Ernest J. Nadeau to act on my eh f, i all m ers relative to work authorized by this building permit application. s � Signatdfe of OwnWr Date Ernest J. Nadeau as Owner/Authorized Agent hereby declare that the statem s a /nfor o n the foregoing application are true and accurate,to the best of my knowledge and belief.Signed under the pains and pe Iti s rj Ernest J. Nadeau Print Name 05/01/20 14 Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ET��_J.Name of License Holder dea CS-018835 t License Number 727 Washington o. le o 03 01/04/2016 Address Expiration Date (508) 399-6776 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 e No 0 Version 1.7 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 Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Steven Costa Electrical Engineer Name Area of Responsibility Creative Environment Corp.-50 Office Parkway, East Providence, RI 41728 , Address Registration Number • - (401)438-7733 x06/30/2014 Signature Telephone Expiration Date Richard C. Newell Mechanical Engineer Name Area of Responsibility Creative Environment Corp.-50 Office Parkway, East Providence, RI 45888 s -- Registration Number C..., (401)438-7733 06/30/2014 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 Address Signature Telephone 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: Keith R Davignon Not Applicable .. 30067 Name(Registrant): _._.__.. . _ ___ _. ..._. ... 1111 ....._...__ . Keith R Davignon Registration Number _. !08/31/2014 Address 225 Chapman St, Providence, RI 02905 1.. 111....._ f Expiration Date �aiy :(401) 461-7771 Signature 0.11.1 Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number i Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number i Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number l................. ..............1111 .......4 :........... ............ 1111. ..1111.1111 ........ Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number i i111,1_ _........... ....f i.._ _........ .._.._... .. ............. ..........._...i Signature Telephone Expiration Date 9.3 General Contractor Nadeau Corporation Not Applicable Company Name: __.._... .. 1111... ......... 1111,,•. . 1111.. _ .._.. .... ... ...... .. _.-_ ._ _._ Ernest J. . Nadeau . Responsible In Charge of Construction 727 .Washington b. . o.,... MA....0.2 7„0.3 Address j( 508) 399-6716 Signature Telephone Version 1.7 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 34943 34943 Frontage Existing Existing Setbacks Front '`1.3 1.3 Side L:'_l8.6_ R: L: 18.6 R: Rear '9.2 9.2 Building Height 24 24 Bldg. Square Footage 19 ° 6558 19 Open Space Footage % (Lot area minus bldg&paved 71.7 parking) #of Parking Spaces 34_ 35 Fill: volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO kV DON'T KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES Q 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 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained ® , Date Issued: C. Do any signs exist on the property? YES (�) NO 0 IF YES, describe size, type and location: 48 s.f Pedestal and Main Entry D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO G) 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 e 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 ❑ Brief Description Interior renovations per submitted plans and specs. 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 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: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: M Proposed Use Group: M 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) 1St 6,558 1 S 6,558 2nd 2nd 3 rd 3rd _ 4m 4th Total Area (sf) 6,558 Total Proposed New Construction (sf) 6,558' Total Height(ft) _ 24 Total Height ft 24 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑✓ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system[-] Version 1.7 Commercial Building Permit Ma 15,2000 ity of Northampton uilding Departmentrfls � y 212 Main Street i MAY -52011 Room 100 hampton, MA 01060 T�� 13 587-1240 Fax 413-587-1272 Electric, Plumbing& as Inspections 77777 k Northampton, MA 01060 J O"IthJer'"'Sp e1,W 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 118 Conz Street Map Lot Unit Northampton, MA 01060 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Gretna Greep Development Corporation 270 Exchange Street, Chicopee, MA Name(Print) Current Mailing Address: (413) Signature Telephone 2.2 Authorized Agent: Nadeau Corporatio 727 Washington St., So. Attleboro, MA 02703 Name(Print) Current Mailing Address: '(508)399-6776 Signature Telephone SECTION 3-ESTIMATED C TRUCTI COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building $100,000.00 (a)Building Permit Fee 2. Electrical $37,500.00 (b)Estimated Total Cost of Construction from 6 3. Plumbing $25,000.00 Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection $17,000.00 6. Total = (1 +2+3+4+5) $18 0, 0 0 0. 0 0 Check Number 17697 This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2014-1151 HOLr p6ND IN I, APPLICANT/CONTACT PERSON NADEAU CORPORATION 5P "PtUVA-L )KIZI OAMO a ADDRESS/PHONE 727 WASHINGTON ST SOUTH ATTLEBORO (508)399-6776 PROPERTY LOCATION 118 CONZ ST MAP 39A PARCEL 020 001 ZONE GB(100) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T_ypeof Construction: RENOVATIONS FOR DISPENSARY New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 018835 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO,,A ATION 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 7 7 Sig ture of Building fficial 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. 118 CONZ ST BP-2014-1151 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 39A-020 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-2014-1151 Project# JS-2014-001738 Est. Cost: $180000.00 Fee: $1080.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: NADEAU CORPORATION 018835 Lot Size(sq. ft.): 20473.20 Owner: GRETNA GREEN DEVELOPMENT CORP Zoning,: GB(100)/ Applicant: NADEAU CORPORATION AT. 118 CONZ ST Applicant Address: Phone: Insurance: 727 WASHINGTON ST (508) 399-6776 WC SOUTH ATTLEBOROMA02703 ISSUED ON.71712014 0:00:00 TO PERFORM THE FOLLOWING WORK:RENOVATIONS FOR DISPENSARY 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 7/7/2014 0:00:00 $1080.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner