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24D-134 (2) a� CERTIFICATE OF LIABILITY INSURANCE X30/ ' 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: it the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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 endomement(s). PRODUCER 1-312-704-0100 CONTACT Certificate Issuance Team Arthur J. Gallagher Risk Management Services, Inc. PHONE I FAX 312-803-7443 A/C No 300 South Riverside Plaza A%tg&SS: Chi Certi.ficateaBAJG.Con Suite 1900 INSURERS AFFORDING COVERAGE NAIL/ Chicago, IL 60606 INSURER A: ARCH INS CO 11150 INSURED INSURER B: AXIS SURPLUS INS CO 26620 J.D. Rivet & Co., Inc. INSURER C 1635 Page Blvd. INSURER D: INSURER E: Springfield, MA 01104-1752 MIStKtER F COVERAGES CERTIFICATE NUMBER: 39509284 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. IR TYPE OF INSURANCE ADDL POLICY NUMBER POLICY EFF POLICY EXP LMIRS LTR A GENERAL LIABILITY ZAGLE9185900 05/01/1 05/01/15 EACH OCCURRENCE $1,000,000 X AMA O R N $300,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP(My one person) $10,000 X 5,000,000 All Projects PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/0P AGG $2,000,000 1-1 POLICY X PRO- LOC $ A AUTOMOBILE LIABILITY 2ACAT9210000 0 15 (Ea accident)SINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per aasdent Physical $1,000 lPhysical Damage $1,000 Comp/Col B X UMBRELLA LIAB X OCCUR EAU773723/01/2014 05/01/1 05/01/15 EACH OCCURRENCE $ 51000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTION$10,000 $ A WORKERS COMPENSATION ZANCI9324700 05/01/1 05/01/15 X WCSTATU- ER AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN N E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? N❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEO$ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,I more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Master 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(2010/05) The ACORD name and logo are registered marks of ACORD chrismow 39509284 list 4 / _. A GS-M230 JAN V DtREYER 44 LAKESIDE DR Monson MA 011157 47/21/2046 Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(99 i m')of enclosed space. Failure to possess a current edition of the Massachusem State Ruifding Code is cage for revocation of this license For QPS Licensing kr4ornaton visit: www.GUMass.GcvrjM 000.3,1 Bracing tot—a;nrcinforced masonry hearing�Nal1 jMraPels. l hi �,t'.Ct+�_lli doc; nc''t i!lz-lll dicrc Fitt no parllpc-tz, 606.3.2 t Di phraoftia resaSting ivind loads in high 1'61i(L Roof his secOon doe not Fit 111 he'lt3u'+i the l',adc d Wd speeds cl*,mk:Ows "ah the kwaiion of thij i•}Iiddli `-' & , i vii '�� r f l i h. ti'tinl.LLt.{1i1..1 TJr ait .41nC_Sl4'. i?l L`ic f:S1��371i_" �t?E?�ll"tL iTtC� C'yEoI2nu: 11+tili�Lll;l1T1 tC>I`lri :�?1S I'i?i)t J1 501;11. �:,';R1I:1fine "here'To C''1]`_,t!ii4'_ mire ll ji?i)1 do k llt.';ii's tti on We -iii'-() 1mg `!,abi c'ljd .tall k)t Li)nnecllo n's that I n1a haw missed. it you ako ;'i)me to The calncltt-;i w that this e`iii€1`_`.incliil deck (7t2llr, lipo11 till ?<3i111 end `fall`. �hcf III(! there are no 'Colincc iow, 3t'.?i1:13111 .dw eximhg nwin l deck t0 Me ST Ale 1Willt`, ma-1110 Wii.ti. Wt ld deli _. C;il l7lCet i lonu 1 lon MatiC1nq sl'iv"`; at 12-on ct'11 or thr'C?igh Me 31`Iil3 diietal do-,J, €t the +,ililnneis that hear lirecdV l poll '.i t: t:_`-_itiiing 111au1nrI ball jedge mIli into li1``Rm o dw exislinl, 12.. Fil?C}ti n,fiSOniG tii'i1il. n't all the ile\t I1Iasoln-\ �Crc ' Pcr thl !nllnlal`actF c` !nstril+_(ions. Prol ltic !l 2'., illiiiiilttlill (i1!c distance 1roill dit: inside nt'th4 it€all. It�Oti du UiSC0\Cr additional connections That 1 I1azt !niswed ih al contact me :31i-! 1 ".\ill re:z icn th.° } iticil 9000 1i]1llh KK s f 1 . � ro ( JACOB SMITH ENGINEERING & DESIGN Ro,ci ;1h ra hal?? NLA, t1 Cf1la In p;,t'1 1 L 182 KAY Vow Vwhan4van NO } ff ;� Ai NllC't;in5u r ti'fi:d the h u A d W1 9 .ir 1.... 1 iCl•.f1Css in Cii': : _r CIT,:c. isli 1y ?c lls. i?c �!f �(lC f1Ct:? .� ,f f (jocjCjn, at '. e W,t f,.�?� �ai.�( ,)? ,132Lrots112o ox<7 k, S ht t)# fT'�fl.e t : uds i?�7iirr?' wi rii 5 U) \[s_;,; .i?itt �ie : i?�1`..-�sC'r",t{{,tl t iti;i�ft.t..,:•.,�i i-�ll�� )E ,�C6is`i�? 'it.' �C1S,SS7tiF:ll? 1 Ss-, "c . i ){ t ( f i?C. ) t iilai ( i )k -xis r , it ,tsc i 1?l. i • ','4 °i ti;.€ls ' yS,s f srt` e'mC9l,y "OH'amNi" i'1 t)!'dli ar) „llf ?ved ._ 1hib, i?II-,C ro"IS 11i ad flw,C 6?ii 1 n �.:fSCiii FiSa a{ i_ 35 Frid'_ C? ,Rr"3f'f �+ �97t'iSi i«4 t. t,t io J(.5C1� ` etl;i(tatL 5}3?ti ff 211 -�' c ,�) ., e._5 <"t�f 3-i ??C�`€�i 4L'�S' connected:P_>✓tCC+�S iT11 f'� � l ar �"? 11rs near �)�t 1 `a r `s"fC�Ci },: t , - , r [ +,:c'I Ei L lai�Il llt'i � l:„W f1 a imin �d�?s_ and C�<fi�� Eft 11uf .dpp eft ,�, ..t �i1I;?��k�� :�? to ..shin natal '�w crack. i h Iloo is a :dab- Seedon 05062 - Addhio i or rephrea nt of rest Ung or rep a ein ia'i of equipine is F! i ,i3sl f2Sl(` t ;tis1 ?! tt : f and ; ? i{ ; l'i Nhail 0, (cii,S .tf C:, li3 jo tile ?a) z r i� id , iyfh . id Anti! a , _ .60 &1 f pi D ",lf ounnNanc ..jf he bl i"rkkA. !he _ie" !V of tPhttfttlho Sect 1on NN dl a ild loais­ S.. TO secl w sh,_fi es that if mor,z WN 25"y M a t'Ul t urw in "imn" .4Cadr:,1 ti;':IW1 I Y fa hill% #'Wl . Ij f,. b"-' 3 r rI?e:i ,f�G" tavll, ;Ita J! SI�1:I1;a�� r?,, iE�',f�.��,31ii5iF�:f .�C'-i! �tiCi;tis7' d C�iC 5,�=1 itia.. __ 9`4,;,�f11':.;.dF1C:Ct.S MR 11'11i 1%,i W Biala Code Out ;wWric inces if (tf.r' We P'+_\Wed thl onARAw a, A '.!i'1,Fks 41 dAs svucure, t'l, 'alis al-Q lii:•? L;: iEt, 1,.,1:11 tl tt_'• i€ll#'"`,flit` 3 t i,;s roof-deck, i hk in «cond7 ion thm i �f i need R! 't foe lop O F,i:. e ?q mac' 12_ chick C'11nV ft',na;,n y 1il?li_ txaf_". ii�4_. a solid fS( ul 13t„12'al w the metal i::`R. 1L eL l ficrc is a 'f :S'lic ..10f t.9 ned i,..o Thu wT t>s (f e C:ii„W a'tii.nrC t+„ss-"; if:,41 f;ii: �AlSilit",tilcta ll decking bears iquin. Nea e 1nA 1CA t , Fun- m l -v - tCs Ft 12-on cover 1 11ugh the l ai deck at tic chamois duo h"r dwwd nor; dw W {t'r_ .S OPQ "R 1 rCi''t_ i I into W 10P Of if:,_ l<.k#a�. ill E,d h4 no" m . ti �: 7, .. #i�la °(lP�b Si.i.".t`; ''1rLEilfi�-' 7{ ,iiltit:3i:?.. :._ lYiFt),_�, fstYli�f:-21' � tf75..-,'lc von We �n:>idc of %r,; 8 CoocTfs AvE.t uE:Sow i j DEIRFULD.MA Ci j s7 3 jacob @jacobsmithengineering.com VS:IECt 413.3W-3443 FAX 4)3-665-1142 , i , 4 Z i : y o Q : i + _ I : ! REFER TO S ECS DETAILS, SYSTEM LAP SPLICE J.D.Rivet & Co., Inc. Date: i S ° -®D Z wAUCwAY, 1635 Page Boulevard Springfield, MA 01 104 Project: © U W.0 ® CURB, P.O. Box 51068 Indian Orchard, MA 01 151 N S W� # DRAIN. (413)543-5660 Fax (413j543-3373 N glii� TON �� _j 5 -#« SCUPPER, O PIPE, ■ POURABLE SELLER POCKET, i J.D. Rivet & Co , Inc. ROOFING.,SHEETMETAL 1635 PAGE BOULEVARD SPRINGFIELD,MA November 4,2014 P.O.BOX 51088 INDIAN OHCHARD,MA01151 TEL, 543-5600 Wilbr liamTire and Auto Service FAX( 13)'543--3373 2694 Boston Road Wilbrahaln,MA 01095 Attu: Kurt Zimmerman RE; REROOFING OF NORTHAMPTON TIRE -182 KING STREET,NowrHAMPT'ON MA 1. Remove and properly dispose of the existing roofing down to the metal deck. 2. Furnish and install 4.3" polyisocyanurate insulation(R 25.4) over the metal deck. 3. Furnish and install tapered insulation crickets between roof drains. 4. Furnish and install Johns Manville 60 mil TPO mechanically attached roofing system complete with all associated fhshings. 5. Furnish and install new pressure treated wood nailers with height to match thickness of the new insulation.. 6. Furnish and install new.040"painted aluminum edge metal. 7. Furnish and install new expansion collar drain inserts at existing locations. 8. Clean jobsit,e of all roofing debris. 9. Furnish owner with a 20 year Johns Manville labor and material warranty. PRICE=$49,800 (FORTY NINE TuouSAND EIGHT HUNDRED DoLLARS) ALL COSTS RELATED TO OBTAINING A BUILDING PERMIT AKE,EXCLUDED FROM THIS PROPOSAL an Dreyer,Operations Manager Acceptance of proposal,The above prices,specifications and conditions are satisfactory and ere hereby accepted. You are authorized to do the work as specified. Payment temp are net 30 days unless otherwise agreed in writing.All material is guaranteed to be as specified. Any alteration or deviation Qom above specifications involving extra costs wj l be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strtkos,accidents or detaya beyond our control. owner to carry fire and other necessary insurance. All accounts not paid within 30 days are subject to a late charge of I'/.%per mouth on the unpaid balance_ In the event thst Ic9a1 action is mstitittsd to collect any sums due under the agreement,the undersigned agrees to pay all costs incurred including reasonable Btorney'e foci Nom-Tms PROPOSAL.MAY B&WLTHDIiA.WN.BY US IF T40T ACCEFTJED'v nmN 66 DAYS. Signature. Date: ,66 Caw cos wi xa rice x,960 City of Northampton 212 Main Street,Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: (g 2- KIA J(-=I S T The debris will be transported by: 1>k5E� The debris will be received by: 'VtN�`� f PJPl L- CL f Aj C7 Building permit number: Name of Permit Applicant JAA) Df e kl�'ET CO Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 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): j.D.Riyet & Co., Inc. Address: 1635 Page Boulevard City/State/Zip: Springfield, MA 01104 Phone#: (413)543-5660 Are you an employer?Check the appropriate box: Type of project(required): 1.[ I am a employer with 50 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. ?. ❑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.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 131-1 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Arch Insurance Company _ Policy#or Self-ins. Lic. #: ZAWCI9295000 Expiration Date: 05/01/2015 Job Site Address: VA N(I ST_ N©P---TH---A<FAPT()/ `y City/State/Zip: tAA ®k o �j 0 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 unde the po an enalties of perjury that the information provided above is true and correct. Signature: — Date: h� Phone#: r3 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#: Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes No 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT • ZIMM L('�M M�� O St�1 FF -1L S �—, : as Owner of the subject property hereby authorize— ..1 © •• to act on my behalf, 'natters relative to work authorized by this building permit application. . Signature of Own 6r Date I, as>er/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 Name Signature of>mk/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: l\Ii"`�/`4 �'` o6o 23c) License Number L- K Sf Dom._b-9J\;& mo FAA 0 l Q -71,2-1 -2-0 k6 Address Expiration Date Signatur 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 lo ilding permit. Signed Affidavit Attached Yes 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 El Name(Registrant): Registration Number 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 Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor • �..... y �r ._..�.'.7 We%......... Not Applicable ❑ Company Name: Responsible In Charge of Construction I(03-5 f>-'OE f't-yb) 5pP"c-IiFteL-t� All R- Ulio Address Signat Telephone Vcmion}7 Commercial 8uUdinQPoonbMuylj.28U0 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved 4 of Parking Spaces (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? �� �� NO �~��� DON7KNOVV �_� YES �~/ |F YES, date issued: � IF YES: Was the permit recorded a1 the Registry ofDeeds? NO K ] DON'T VY KNO YES~-� ~=c-_ �------------ —1 �� | IF YES: enter Book | Page ' and/or Document#, | ' L__-_____� �------------� �� �� �� B. Does the site contain a brook, body of water orvvetiands7 NO �~� DON'T KNOW �_� YES «�� IF YES, has permit been or need to be obtained from the Conservation Commission? Needs tobeobtaned x�� Obtained �-\ Date' �-� �~� ' ' L__---____--� C. Do any signs exist on the property? YES �_��/ NO �~�� � IF YES, describe size, type and Location: | f D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb ng.grading,excavation,or filling)over 1 acre orisd part ofa common plan that will disturb ovor1aore? YES 0 NO 0 IF YES,then a Northampton Storm Water Management Permit 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❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ RoofingX_ Change of Use❑ Other❑ Brief Description � � X`�T►� 't-'J TO p K-• 1MSTA<t.(_ /vl tA) Of Proposed Work: 'Z i/�St,�L J�TI O f.1 � �7v M iL `T '� 0✓11k� P— t✓C�-�� �V1�TP�L—. 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: _. 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) St 1 St 2nd 2nd .. _.. 3rd . 3rd 4th 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 Outside Flood Zone❑ Municipal ❑ On site disposal system[] Version 1.7 Commercial Building Permit May 15,2000 Department use only City of Northampton Status of Permit: Building Department 'Curb Cut(Driveway Permit iu�4 212 Main Street Sewer/Septic Availability ` NOV 9 Room 100 Watertyl/ell Ava labilitv in�pe orthampton, MA 01060 Two,Sets of StructuraP Plans Electri N PihamiP on MA -587-1240 Fax 413-587-1272 PlottSite 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: This section to be completed by office le-IN- S'T( T Map Lot Unit Zone Overlay District: __. _......... .. Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: .514FFOLle- ST 2E�AL EsTA7E Tl ,1ST�t_L� 266f4 6oSToly � WIL_5g2A p A Name(Print) Current Mailing Address: M,�b f ®q-S 3 S�--t ( 42;l0 1 Signature fti/ 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 1110 19 (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) goo Check Number Y3 I 754!�v This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2015-0582 APPLICANT/CONTACT PERSON J D RIVET&CO INC ADDRESS/PHONE P O BOX 51068 INDIAN ORCHARD (413)543-5660 PROPERTY LOCATION 182 KING ST MAP 24D PARCEL 134 001 ZONE EB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out tz Fee Paid Tvpeof Construction: REPLACE ROOF New Construction Non Structural interior renovations Addition to Existing Accessoty Structure Buildine Plans Included: Owner/Statement or License 050230 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9?MATION 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 lay Sig ure of Building cial 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. 182 KING ST BP-2015-0582 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24D- 134 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cate_oorv: ROOF BUILDING PERMIT Permit# BP-2015-0582 Project# JS-2015-001113 Est. Cost: $49800.00 Fee: $300.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: J D RIVET & CO INC 050230 Lot Size(sq. ft.): 18730.80 Owner: SUFFOLK ST REAL ESTATE TRUST LLC Zoning: EB Applicant: J D RIVET & CO INC AT. 182 KING ST Applicant Address: Phone: Insurance: P O BOX 51068 (413) 543-5660 Workers Compensation INDIAN ORCHARDMA01151 ISSUED ON:1112012014 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE ROOF 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 11/20/2014 0:00:00 $300.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner