31B-216 (2) A�" CERTIFICATE OF LIABILITY INSURANCE 2�26�oil'
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: if the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. if SUBROGATION IS WAIVED, subject 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).
PRODUCER CONTACT Jenne Rodrigue, CISR
Webber & Grinnell PHONE (413)586-0111 FAX (413)586-6481
8 North Ring Street 2i§M6.jrodrigue@webberandgrinnell.com
INSURER(S) AFFORDING COVERAGE NAIC 0
Northampton MA 01060 INSURER ABxcelsior/Liberty 11045
INSURED INSURER B.Liberty Mutual Insurance 24198
Wright Builders Inc INSURERC:Netherlands/Liberty 4171
48 Bates Street INSURERDAdmiral Ins Co REU
INSURER E:
Northam ton MA 01060 INSURER F:
COVERAGES CERTIFICATE NUMBERX3cp 2016 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.
rA TYPE OF INSURANCE POLICY NUMBER PMT n1 MM//DD EXP LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
COMMERCIAL GENERAL LIABILITY occurrence) $ 100,000
7 CLAIMS-MADE F—I OCCUR CBP8616138 /1/2015 /1/2016 MEDEXP(Any one person) $ 51000
X Blanket Add't Insured PERSONAL&ADVINJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,0 0 0,000
X POLICY PRO LOC $
AUTOMOBILE LIABILITY COMBINE SINGLE LIMIT 11000,000
fEs
ANY AUTO BODILY INJURY(Per person) $
A ALL OWNED X SCHEDULED 8615140 /1/2015 /1/2016 BODILY INJURY(Per accident) $
X AUTOS X NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Par.
PIP-Basic $ 81000
X UM13RELLALIAB X OCCUR EACH OCCURRENCE $ 5,000,000
B EXCESS UAB CLAIMS-MADE AGGREGATE $ 5,000,000
DED I X I RETENTION 3-C),000 CUS618241 /1/2015 /1/2016 $
C WORKERS COMPENSATION X I WC STATU- MFR
EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN EL EACH ACCIDENT $ 500,000
OFFICER/MEMBER EXCLUDED? NIA /1/2015 /1/2016
(Msndslory In NH) C8612741 E.L.DISEASE-FA EMPLOYEE $ 500,000
M describe under
DESCRIPTION OF OPERATIONS bebw EL DISEASE-POLICY LIMIT $ 1,000,000
D Pollution Liabili ECC1137202 2/1/2014 2/1/2015 L'mriil $1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Scheduis,N more space Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
J Rodrigue, CISR/JER —
ACORD 25(2010105) m 1988-2010 ACORD CORPORATION. All rights reserved.
INSn25 r9nim,inl The Anr1Rr1 name and Inn^am roniefnroel m%rL m of A(_f)Rr1
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supenisor
License: CS4084280
.r:rI-.S »FA
ROGER S BUZZE
277 SOUTH ST IE s
Bernardston MA all
Expiration
Commissioner 031OW2017
a
3
Addebw
ZAW
WRIGHT
BUILDERS
April 17, 2015
Louis Hasbrouck
Building Commissioner
City of Northampton
212 Main Street
Northampton, MA 01060
RE: Building Permit for:
79 King Street
Northampton, MA 01060
Dear Louis,
We respectfully request that you grant a modification to waive the requirement for
control construction for the project at 79 King Street in Northampton because the work is of a
minor nature,will not affect health,accessibility, life and fire safety,or structural requirements
and is impractical in that the cost of control construction is considerable when compared to the
cost of the proposed work. Thank you for your consideration.
Please let us know if you have any questions or need additional information.
Sincerely,
L - —
da
LinJdreau
Operations Manager
Cc: Roger Buzzell, Project Manager
NEW HOMES+WORKPLACES+DESIGN+RENOVATIONS+ENERGY RETROFITS+CONSTRUCTION MANAGEMENT
48 Bates Street, Northampton,MA01060/413.586.8287/Fax 413.587.9276/www.wright-builders.com
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) 1.
Independent Structural Engineering Structural Peer Review Required Yes No _�
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property
hereby authorize. �.! _.,1��,�� _ ._, _.__. -.._y o
ac my behalf, in all matters relative to work authorized by this building permit application.
Sig ature of Owner Date
W!',qy+ -�S _.. .__ as Owner)Authorizpad
ent 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 perlu".
Print Na
Sig ature of Owner/Agent Date
SECTION 12 CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
3v:�d�rs '. O.
Name of License Holder:
_. _ ._..
License Number
MR ;03/06/ ao+7
A Expiration Date
Ylk
S gnature 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 No
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:
__.. Not Applicable ❑
Name(Registrant):
Registration Number
Address �... ..... . .. ... __:..
W Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
F
Signature Telephone Expiration Date
Name Area of Responsibility
1
_._____ ._...._. .. m .._. .___.... _.
Address Registration Number
Signature Telephone Expiration Date
i
Name Area of Responsibility
i
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
AEI work to be alone i^isa e,osftn� 6M�'Idiy�
Version l.7 Commercial Building Permit May 15,2000
F8. N HAMPTON ZONING
Existing Proposed Required by Zoning
'this column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: W R, . ...
Rear _..
Building Height
Bldg. Square Footage
Open Space Footage °
i
(Lot area minus bldg&paved
parking)
#of Parking Spaces -u
Fill:
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES 0
IF YES, date issued:
IF YES: , Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES 0
IF YES: enter Book '., Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO N DON'T 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
IF YES, describe size, type and location:
D. Are there
an y proposed changes to or additions of signs i ntended for the property ? YES 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading, qxcavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 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 Building❑
Exterior Alteration Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other ❑1.Brief Description Enter a brief description here. Re,,n 0 v zee eX
Of Proposed Work S + nj ;0 i �n a �o ,r1 en t,/
Q � �
e H E s+��e c��F° �tM� gush d,4Vc f1►r.. 44 PIWA s. Re
< ba
SECTION 5-USE GROUP AND CONSTRUCTION TYPE No 5t&W"(t'M r st y .
USE GROUP(Check as applicable) �(� ( CONSTRUCTION TYPE
A Assembly El A-1 E] A-2 ❑ A-3 ❑ 1A El
B Business 2A ❑
E Educational ❑ M 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 ❑
S Storage ❑ S-1 ❑ S-2 ❑ 58 [1�
U Utility ❑ Specify:
M Mixed Use ❑ Specify: ;'''---'-
pecify ,
S Special Use ❑ Specify:.
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: __... . ._._... .__ Proposed Use Group:
. ._,
� inl
Existing Hazard Index 780 CMR 34)::'.. . _..._.__ _.h Proposed Hazard Index 780 CMR 34)
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
AD
Floor Area per Floor(sf)
ext*sh;�
_._._..._ 1st _
ist
2nd 2
;,, 3rd ?"
3rd
to
Total Area(sf) Total Proposed New Construction (sf)
Total Height(ft) i
Total Height ft
7.Water upply(M.G.L.c.40, §54) 7.1 Flood Zone„Information: 7.3 Sewage Disposal System:
Public JN Private ❑ Zone Outside Flood Zone Municipal On site disposal system❑
Versionl.7 Commercial Building Permit May 15,2000
j 'Departrrtenf use only
( ,
� ity of Northampton statusmof Permit
uilding Department Curb Gut/Dnveway Permit - "
212 Main Street SewerTSepttc,Ava►(ability
Gas tnspe�ions Room 100 WatertVVeil Rvilablhty
tor.MA oA06o ampton, MA 01060 Two Sets of Stfuctural Plans
Electric. tramp
one 413-587-1240 Fax 413-587-1272 Plot( te Plans' -
Other:Spec►fy
.
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
7 Map Lot Unit
Ivor-k\ ,T,,,,.f` o,' o 1 0 60 Zone Overlay District
___. .. __..__._ ... Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
-
Name(Print) Current Mailing Address:
Sign u > L't"' Telephone
2.2 Au horized Agent:
t3�+e S}.. N.¢.f��.uM,��a.. . Mk 01,0-60
Name(Print) Current Mailing Address
i
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS .p`�I K = 6 k I a K
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building � Ilss (a)Building Permit Fee
2. Electrical d'%" I�" (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) G.
5. Fire Protection 3, / 3g
6. Total=(1 + +3+4+5) 7 Os Check Number
This Section For Official Use Onl
Building Permit Number :late
ued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2015-0988
APPLICANT/CONTACT PERSON WRIGHT BUILDERS
ADDRESS/PHONE 48 Bates St NORTHAMPTON01060(413)586-8287(116)
PROPERTY LOCATION 79 KING ST
MAP 3 1 B PARCEL 216 001 ZONE CB000)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: DEMO DRIVE THRU&INTERIOR PARTITIONS,&REBUILD PER PLANS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 84280
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF,9RMATION 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.
79 KING ST BP-2015-0988
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31 B-216 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-2015-0988
Project# JS-2015-001901
Est.Cost: $91605.00
Fee: $552.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WRIGHT BUILDERS 84280
Lot Size(sc. ft.): 46173.60 Owner: GOGGINS PATRICK M C/O BANK OF AMERICA ATTN: CORP REAL
ESTATE
Zoning_CB(I0o)/ Applicant: WRIGHT BUILDERS
AT. 79 KING ST
Applicant Address: Phone: Insurance:
48 Bates St (413) 586-8287 (116) Workers Compensation
NORTHAMPTONMA01060 ISSUED ON.51112 01 5 0:00:00
TO PERFORM THE FOLLOWING WORK.DEMO DRIVE THRU & INTERIOR PARTITIONS, &
REBUILD PER PLANS
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 5/1/2015 0:00:00 $552.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner