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J.D. Rivet & Co., Inc.
ROOFING•SHEETMETAL {
i
1635 PAGE BOULEVARD
SPRINGFIELD,MA
P.O.BOX 51068 I
INDIAN ORCHARD,MA 01151 t
TEL.(413)543-5660
FAX(413)543-3373
December 1,2014
®p Kohl Construction
31 Campus Plaza Rd.
Hadley,MA 01035
Attn:Ted Parker
f
RE: Fitzwilly's,23 Main Street,Northampton,MA
Scope of work:Make temporary por3ry roof repairs to front canopy over sidewalk to prevent water �
from entering canopy structure. {
s
1. Provide truck mounted crane with man basket to gain access to canopy over side walk,
2. Seal west side of metal edge of canopy(approx.50')using asphalt flashing cement and
fabric or self-adhering EPDM tape.(see attached photo#1,2,3&4)
3. Seal leak area on east side of canopy. !
4. Seal crack between top of parapet wall roof.(see attached photo#5)
Jan Dreyer,Operations Manager
Acceptance of Proposal—The above prices,specifications and coruditions are satisfactory and are hereby accepted. You are
authorized to do the wort as specified. Payment tams are net 30 days unless otherwise agreed in writing.All material is guaranteed
to be as specified. Any alteration or deviation from above specifications involving extra costs will be executed only upon written
orders,and will become an extra charge over and above the estimate.All agreements contmgcot upon strArcs,aceidads our delays
beyond our control.Owner to carry fire and other ncocssary iosuurdooe.All accounts not paid within 30 days are subject to a fate
charge of 1 Y25A Per month on the unpaid balanm In the event that legal action is instituted to collect any sums due under this
agreement,the undersigned agrees to pay all costs incurred including reasonable attorney's fees.
NOTE:THIS PROPOSAL MAY BE WnMRAWN BY US IF NOT ACCEPTED WITHIN 60 DAYS.
Acceptance of proposal:
Signature: Date:
&6 -,x� Ji,;tcc -IS6'01
__ N
Chamisa Corporation
■ ■ ■ ® ■ ■ ■
31 Campus Plaza Road, Hadley, MA 01035 p 413 256 0321 f 413 256 0130
Louis Hasbrouck,
Building Commissioner
City of Northampton
Nothampton, MA, 01060
Dear Mr. Hasbrouck -
Based on the Massachusetts State Building Code, section 104.10, I
request that you grant a code modification to waive the requirement for
construction control of the project at 25 Main Street because the work is of a
minor nature, will not affect health, accessibility, life and fire safety, or
structural requirements and the cost of construction control is impractical
when compared to the cost of the proposed work.
The scope of work proposed is to make minor waterproofing repairs to the
existing cornice and parapet wall at 25 Main Street.
Thank you for your consideration.
Respectfully,
Richard D. Lloyd
Building Manager
25 Main Street
The Commonwealth of Massachusetts
Department of Industrial Accidents
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/Organization/Individual): Kohl Construction, Inc.
Address: 31 Campus Plaza Road, Suite 3
City/State/Zip: Hadley, MA 01035 Phone#: 256-0321
Are you an employer?Check the appropriate box: Type of project(required):
1. ✓❑ I am a employer with 10 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. ❑� Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition
[No workers' comp.insurance 5. ❑ We are a corporation and its 10. ✓❑Electrical repairs or additions
required.] officers have exercised their
3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs
insurance required.]t employees. [No workers' 13.0 Other
comp.insurance required.]
*Any applicant that checks box#I 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 their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: AIM Mutual Insurance Company
Policy#or Self-ins.Lic.#: WMZ 800287201 2010 Expiration Date: 02/10/14
Job Site Address: 25 Main Street City/State/Zip: Northampton,MA,01060
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 ofperjury that the information provided above is true and correct.
Si nature: Date:
Phone#: 413-256-0321
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) 1 Z
Independent Structural Engineering Structural Peer Review Required Yes 0 No
SECTION 11-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
94 AACC 9- , NO GEt,o VA S A C-09-P
as Owner of the subject property
hereby authorize ... .._. . ... ._._._ � „.....�-._-.--
act on my behalf, in all m r�to work authorized by this building permit application.
Signature of Owner Date
(2.tGHA2� LWY�
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,,nains and_penalties of
R lGlrto 2 �. V V OY
Print Name
12- 3
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
.
Name of License Holder. R-�LK''.v._,. 2 C 0+S_,.3).
License Number
.6V ... t �..........v �.�s.`{' 1. .... _._..... m._...._ ___
Address Expiration Date
Si nature Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6))
Workers Compensation Insurance affi vit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the b ding permit.
Signed Affidavit Attached Yes No 0
- --
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTUP,4S SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENC OSED SPACE)
9.1 Registered Architect:
Not Applicable
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
..._._---
1
_._... .., _...__.. . ......_
Name Area of Responsibility
i
_..,.,,,
Address Registration Number
Signature Telephone Expiration Date
.
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
i
Address Registration Number
Signature Telephone Expiration Date
i
Name Area of Responsibility
. �... ........__ ._.. .._..._
i
Address _ .,,,.,,,,,
Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
y (,!;;A, ,,,. jc_ _. Not Applicable ❑
Company Name:
Responsible In Charge of Construction
ILE
Address
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
IEx�ST i Building Department
Lot Size -------j
Frontage -....__. ...
Setbacks Front F _i ...._
Side U R. L....—:.:..__, R.=,., 3
Rear _
Building Height
Bldg.Square Footage % "'""
_ ..
Open Space Footage _ %
(Lot area minus bldg&paved
,... 1_
Parking)
#of Parking Spaces
Fill: ....�....�_....,.....
volume&Location ...._. _._ .. ..,...,,,, _._ ......,,,. ___ ._-----„- ;,__- ,.. ...._ _.._. _.
A. Has a Speelial Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW Q YES Q
IF YES: enter Book Pager and/or Document#11
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES
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 NO Q
IF YES, describe size, type and location: 0+4 VAIN S-T. 'FoR ft cS-T&A AA�JTS
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,jation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
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 iding❑ NO 14 E
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other NO WE
Brief Description =Enter a brief description here. To 1LEp,c1 1t-,, W T1E P—• pR,ovrrl Nk A-,— Fx:k5TiNh
Of Proposed Work:`
VIN-c., e-O R.N jc e Qkj D dA 2 Q PET
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 ❑ 113
❑
B Business M 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A Ed
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility El Specify
M Mixed Use S❑ Specify:
P
S Special Use ❑ Specify
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: 815-(►1€SS ._.....,., m€ Proposed Use Group: t0 .L Q, E._.___ BV1 Sln/ESS
--------
Existing Hazard Index 780 CMR 34):1-, Proposed Hazard Index 780 CM 34) ...,.._.._
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
"c> C-44OKlae
st
1st
1 E � _
_ �,.._.., v 2nd
s
2nd
......r.__ .,,— ..,,...._ .. .. _. ..., ._a
............ _.
.,._..._. - ._.._..-- ,. 3rd
3rd
t
4
Total Area(sf) Total Proposed New Construction(sf)
_.-
Total Height(ft)
Total Height ft
7.Water upply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage isposal System:
Public Private ❑ Zone• Outside Flood Zon Municipal On site disposal system[:]
N N
-- Versionl.7 Commercial Building Permit May 15,2000
Departe
y of Northampton
ilding Department ��
t �
it DEC 4 ? 14 12 Main Streeteptf �ty
Room 100
� , �tail�o11r1��
mpton, MA 01060 nom,'IPt
Electr'c, P.un ring&Gss irs � �
Norih� r p�r. 1A 01060
- 7-1240 Fax 413-587-1272
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
25 W1/A114 SZak.;Z? ;Map Lot Unit
Iv o 2.'C'ITt•�w•� -I:'b�
MA
Zone Overlay District
...... Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
c�{EO 00(46 1 , PA R(cam R-- Si COvt�P L1S pL�}�A RdAO tAp t.E Wld
Name(Print) V.P . C.E.{/Z IM S A CO R P Current Mailing Address: 0(O
0
zs6 32.1
Signature Telephone
2.2 Authorized Agent: % K a}{C. CO tit ST 0-(A CT'10 N /Q C-.
F
31 CA�PL4S PC.A�a SAO A{AOIX'r I'u
......... ..._ ._._._, __.�.. ...._
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 / i Building Permit Fee
4. Mechanical(HVAC) _ _„ ,_.._,-----
5.Fire Protection
6. Total=(1 +2+3+4+5) s06 Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/inspector of Buildings Date
File#BP-2015-0631
APPLICANT/CONTACT PERSON KOHL CONSTRUCTION
ADDRESS/PHONE 31 Campus Plaza Rd HADLEY (413)256-0321
PROPERTY LOCATION 25 MAIN ST
MAP 32A PARCEL 138 000 ZONE CB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out to 2 it
Fee Paid
Typeof Construction: REPAIR WATER PROOFING AT BUILDING CORNICE&PARAPET
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 073313
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
Pen-nit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
Signature of BA ding 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.
25 MAIN ST BP-2015-0631
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A- 138 CITY OF NORTHAMPTON
Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2015-0631
Project# JS-2015-001212
Est.Cost: $4500.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin KOHL CONSTRUCTION 073313
Lot Size(sq. ft.): Owner: CHAMISA CORPORATION TO:HAMPSHIRE PROPERTY GROUP
Zoning: CB(100)/ Applicant: KOHL CONSTRUCTION
AT. 25 MAIN ST
Applicant Address: Phone: Insurance:
31 Campus Plaza Rd (413)256-0321 Workers Compensation
HADLEYMA01035 ISSUED ON:1211212014 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPAIR WATER PROOFING AT BUILDING
CORNICE & PARAPET
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 Occupant Signature:
FeeType• Date Paid: Amount:
Building 12/12/2014 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner