32C-024 (9) i
i
OAT"vv'mD••TTTT1
CERTIFICATE.QF LIABILITY INSURA CE
s/i7/36ia
TNT$ CERTIFICATM I$ IS411ED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTWICATE,HOLDER_TH15:
CERTWJCATrc DOES NOT AFFIRMAIWELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
9E1.,OW.'THIS GEt IJFICATE 0 INSURANCE L7M NOT CONSTITUTE A CONTRACT,seTWEENt:r ISSUING INSURER(8), AUTHORIZED
REPRESENTATIVE OR PRODUCER AND T14E CERTIMATE FIOLCIFR
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�Fo4: HJ Garr. parking..Lot 1
CER71191CATE FOLDER GANCEU ATION
SHQi,3LD ANY C3P THEABOV•E DESCRIBED POtJe�9 BE 1:ANC*�iZ'D81!FOXE
THE. EXPIRATION DATE TI{BRECF; NOTICE WILL Be:.D6LaVERED IN:
Giky o£ Nrarttlalanton
ACCORDANCE VWTHTR9MUCYPRO"IONS.
C�ltral Sorvicrza
Maaaorial I{all. nvi►loxueafa�rleesEti°rnrlr:
240 Maisa Str"t
Et4xa,c3 13osA;Ittr:a�JJO ,rr: -':""`
ACORp?S/,ZOit1105J IDt0RS-nIQACORD CORPORATION. A1)rtgtzata nawtvad.
Ir1S07S(2M07610I -rho ACORD.Hama Qnd Logo Ara ragi atered musks of ACORD
_ I
�t The Cotnmonweafth of Afassachzlseias
Department oflindustrial Accizents
O Dice of Investio aliens
60(I j3'ashin 'on,Street `r
Sosfan,MA 02111
����=��'` wwYv.tnasx.gav/da
WorkeW Compensation Insurance idavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leei/bl
Name(Business/Organizs icr>flndividualj:
Address:
Glty/State/zi / Phone : '� . ;��25r57
Are .t as emplover?'Cbeckc he appropriate boa: Type pf pralect(requires]):
1. T am a employer with. C3 d- Q I am a general contractor and I
6- ❑. v construction
erngltiyces(fill and/or pant-time)." have hired the sub=contractors
listed en the attached sheet. Rcmode Q
Q'I o-m a sole proprietor or.:parmer- l
- ship and"have no emp?oyccs These sub-�vntractors)save 8. Q Demolition
workinb for me in aay ca achy. employees and have workers' }
p t 9. ❑Blinding addition,!
[No workers'comp.insurance corsp.rnSt>i�IICZ,= �
rcquire3] �..Q We are a corporation and its I0.❑E]ecnic3l repair or addition 1
o$cers ha�re exczcised their ii
3.❑ I am a homeowner doing all work I1-[ Plutnbirg repairs or additions i.
-rayseLf. [No workers' cozen tiglar of exenptioa per 1vIGL 12.E Roof re�ai-rs
insurance requi cd.]t c. 152, 1(4),and we have no
13.M Other
[1\l
err pIoyees. o workers' {
comp,insurance Mr-t ircd-.] !
'Any applimnt that checks boX##1 rraist also fill ourdte section below showing tneirworke•,s'eatrtp-rim on policy informa"d n,
t Harnenwners who submit this afidaYit iridi6iting they ate doing ate work and Then hizc outside ebrstricton tswst Si bf it a rtN.affidavit indica:ink such,'
+Contactors.that Cheek this box mascattached an addidonal sheet showing t9c nznv of the sub-contractors and smte whether or not these entities have
cripiorms, If the sub-eann actor leave a ployees,they must provide Their workers'calm:policy numbc-
`l air an eneplgyer lhcr is roviding workers coat ensadon insurance orm 'em to ee& Below is the uli ..and'ab site
P b ' P � 3 P y P �}` I
urformatinn, . ,: ,
Insurar!ce Company Name: ,t Q<x
Policy f or Sal`-ins.Lic.ff: ( Jl� '��1 Expiration Date:
O I�lD{Qt7D �CJr4la
Job Site Address: 22 �/ �3—�1, Ct;}rState/Zip:
Attach a copy of the workers!compensation policy decl;L anon page'(show(showing the peeler}number and;ezpiratinn date).
_.
Failure to secure coverage as squired tinder Section 25A of MGL c.152`ca_ri lead to the imposiriou of c:izti real penalties of a
fire lip to 51,504.00 and/or one-yeai i>PM, onment,as well as civil penalties in the form of a STOP WORK OFFER and a fine
of up to 52501.100'E.-day against the violator. Be advised that a copy of diis sWemcut maybe forwarded to the Office of
Investigations of the DIA`for ii:sumncc coyerage'vrtification.
l do hereby certify under the pains vii `that iJ4e farmatioripravr".dGd above is true and norree4
Si ate:
one : ..
Official use ooh'. D,o not write in this area,to be completed by eiiy ar town:dffieiar
"`City or Town, PerinitfL]cense N
J
Is Ulna Authority(cif Cie one);
I -1.Board of Health 2_Building Department 3. Cityr'own Clerk a,Electrical Inspector S.Pltimbing Inspector
6.Other_
'ContaEt Per#on: Plionc
i
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-,STRUCTURAL PEER REVIEW(780 CMR 110.11)
i
Q
independent Structural Engineering Str uctural Peer Review Re aired Yes No
SECTION 11.-OWNER AUTHORIZATION TO BE COMPLETED:WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
�� ww . l�l(2 ,C,'Cb rL GCS-IYRA l
as Omer of the subject prop" .
h eby authorize
�tUJt tt� *� GCS X04 k, 'ebtLO t03S 14(—. to
a beh I in afters relativetoworic authorized by this'bui(ding permit application.
S a re Owner Date
I
1, rtV 12--- N� s Authorized
Ag thereby:declare that the statements and information on the foregoing application are true and accurate;to the of my knowledge
and lief.
Sign d der the ains d penalb of perjury.
Print .e
Signatu of a ent Date
SECTIO 2 CONSTRU I N SERVICES
10.1 Llcens d Canstruction aervieor:
Not Applicable :p
Name of License Holder:
License Number
3S� � t�irc� ,moo zamG G o.6 /y 2o1f
Expiration Date
/3s3S"/sao
Signature 7etephone
SECTION 13-WORKERS'.COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c.152,§25C(6))
Workers Compensation insurance affida4 must be completed and submitted with this application.f=ailure to provide this affidavit will result
in the denial of the issuance of the bull ' g permit
Signed Affidavit Attached Yes No
Version1.7 Commercial Build'►ng.PermitMay 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR 8ULLDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) �
9.i Registered Architect;
Not,Applicable E]
Name(Registrant):
Regisfrellan Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Englneer(s)c
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 Expiration Date
Name; Area of Responsibility
Address Registrdtlan Number
Signature. Telephone Expiration Date
9.3 General C tractor
Not Applicable❑
C. ny Na e: /.
V 1
Responsible In Chalge of onst o
061 06
Address
Vr
/IV
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
i
Lot Size
Frontage
Setbacks. Front
Side L:' R: L_! R
i
Rear
Building Height
Bldg,Square Footage
Open Space Footage o/Q
(Lot area minus bldg&paved
-kin
j
#of Parking Spaces
Fill:
Volume&Location)
A. Has aSpecial Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW' Q YES
IF YES.date issued:
IF YES: . Was the permit recorded at the Registry of Deeds?
NO Q DON T KNOW O YES
iF YES: enter Book:' Page and/or Document#
B. Does the site contain a brook, body of water or wetlands?. NO DON r KNOW Q YES
IF YES,has a permit beert'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 a NO
IF YES,:describe size, type and location.'
p' Are there any proposed changes to or additions.of signs intended for the property? YES Q NO
IF YES,describe size, type and location:
E. Will the construction activity disturb(clearing,grading, excavation,or filling)ever 1.acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO Q
IF YES,then a Northampton Storm Water Management Perrrlit from the DPW is required.
.._ --- - -------------
Versionl.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 El Additions ❑ Accessory Buildin
Exterior Alteration D Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other
Brief Description Enter a brief description here:,
Of Proposed Work: 0�
�-a-,Q�P �?Yl v r o
SECTION S.-,USE GROUP AND CONSTRUCTION TYPE
USE:GROUP Check as applicable). CONSTRUCTION TYi'E
A Assembly, A4 E] A-2 ❑ A-3 ❑ 1A ❑
❑ A-4 ❑ A-5 }] 18 ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ❑.
F Factory
F-1 CI F-2 ❑ 2c
H High Hazard:, ❑ 3A
I Instituti onal ❑'< 1-1 Q I-2 ❑ .1-3 Q 38 .
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ SA. ❑
S.Storage ❑, 5 1 ❑ S-2 ❑ 58 []
U Utility ❑ Specify:
M Mixed Use. Specify:
I
S Special Use Specify:
i
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;(sf)
1 a�
i
n0 2rta
2
3a
3ra
40 4m
Total Area(sf) Total Proposed New Construction 0f)
Total Height(ft)
Total Height ft
7.Water Supply(M:G.L.c:40,§54) 7.1 Flood Zone Information-. �7�3 Sew age Disposal System:Public❑ Private [ Zone Outside Flood Zoned icipal On site disposal system[]
�4 2 5 201Q Versionl,7 Commercial Building Permit May I5,2000 i
p� Department use on
inspect1OC�l of Northampton Status of Permit:
P!b-'f.0ng 01060
iect<«, n+cn VIA uilding Department Curb.CutlDriveway Permit
�ortrm
212 Main Street sewer/septic Availability
Room 100 Water/Well Avallabllity
Northampton, MA01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413.-587-1272 Plot/Site Plans
Other Specify
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: 2 This section to be completed by office
E. J. Map v Lot Unit
gS /Y1f'�T?/V !/c�
toneOverlay District
O�ThAjiW7—d
Elm St District CB District
SECTION.2 PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
Name(Print) Current Mailing Address:
Signature Telephone
2.2 Authorized Agent: f�v
lie V1 7
Name(Print} ... Current Mailing Address;
S gnature Telephone
SECTION A-ESTI ATED CO TRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by rmit applicant
1. Building (a)Building Permit Fee
�so-000
2: Electrical'. (b)Estimated Total Cost of
Construction from 6
3..Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6.'Total=(t +2+3+4+5) Check Number
This Section For Official Use Only
Building Permit Number. Date
Issued
Signature: /
� A r
6U ding ommisaionerllnspedor of Buildings Date
ARMORY ST-PARKING GARAGE BP-2015-0230
GIs#: COMMONWEALTH OF MASSACHUSETTS
MW:Block: 32C-024 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-2015-0230
Project# JS-2015-000429
Est. Cost: $150000.00
Fee: $0.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: GARDNER CONSTRUCTION & INDUSTRIAL SERVICES INC
050623
Lot Size(sq. ft.): 127195.20 Owner: NORTHAMPTON CITY OF PARKING GARAGE
Zoning: CB(100)/ Applicant. GARDNER CONSTRUCTION & INDUSTRIAL SERVICES
INC
AT. ARMORY ST - PARKING GARAGE
Applicant Address: Phone: Insurance:
47 OLIVINE ST (413) 535-1500 WC
CHICOPEEMA01013 ISSUED ON.•812612014 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE PARKING ACCESS & REVENUE
EQUIPMENT
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:
Feel e: Datc Paid: Amount:
"a
212 ain S reet,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner