31B-224 (9) PURCHASE ORDER
, ► SMITH COLLEGE Paget
PURCHASING DEPARTMENT ".. "".. .
126 WEST STREET PO Number: P8008757
NORTHAMPTON,MA 01063
Issue Date: ohm i m 5
Delivery Date: 06116115
991173950
Vendor: MMC Specialty Roofing Inc Bill To/Ship To:
50 Valley View Dr Smith College
Westfield MA 01085 Jay Lucey
126 west St
Northampton MA 01063
Buyer Phone/Fax Terms
Lynn Pelixnd P:(413)585-2240 Net 30 Days
Y F:(413)585-2089
Na Description Quantity Unit Cost Total Cost
----------------------------------------------
Send invoices to Smith College "Bill To/Ship To,,
address for payment. invoice must reference PO ##
and vendor #. The vendor # is above the vendor
name on they PO.
The contractor and subcontractor shall abide by
requirements of 41 CPR 60-1.4(a) , 41 CFR 60-300.5
(a) , and 41 CPR 60-741.5(x.) . These regulations
prohibit discrimination against qualified
individuals on the. basis of race, color, religion,
sex, national origin, veteran status, or
disability, and requires affirmative action by
covered prime contractors and subcontractors to
employ and advance in employment qualified
FOB: FOB Destination TOTAL: CONTINUED
Not valid without the terms and conditions on the reverse,which are an integral part hereof.
Signature: Date:
INDEX FUND ORGN ACCT' FROG ACTV LOON AMOUNT
R26021 883090 2692 77502 7200 R26021 B900 27,450.00
�/� PURCHASE ORDER
+� SMITH COLLEGE Page
I
PURCHASING DEPARTMENT
126 w1~s7 STREET PO Number: P8008757
NORTHAMPTON,MA 01463
issue Date: 06111/15
Delivery Date: 06116115
991173950
Bill To/Ship
Vendor: MMC Specialty Roofing Inc Sm ith College
54 Valley View Dr ,lay Lucey
Westfield MA 01485 126 West St
Northampton MA 01063
Buyer Phone/Fax Terms
P:(413)585-2240 Net 30 Days
Lynn Pelland F:(413)585-2089
No Description Quantity Unit Cost Total Cost
minorities and females, qualified veterans, and
qualified individuals with disabilities.
x
Chase Duckett roof over dining room per attached 1.00LOT 27,450.0000 27,450.00
FOB: FOB Destination TOTAL: 27,450.00
Not valid without the terms and conditions on the reverse,which are an integral part hereof.
Signature: '' Date:
INDEX FUND ORGN ACCT PROG ACTV LOCH AMOUNT
826021 883090 6692 77502 72DO R26021 B900 27,450.00
4
Spocialt. Hoofing Inc.
May 26,2015
To: Northampton Building Department
212 Main St
Northampton MA.01060
1 request that you grant a modification to waive the requirement for control construction for the Chase
Dining Hall project at Smith College Bedford Terrace Northampton MA.01060 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."Mass Amendments,section 107.1 allows for an
exclusion from control construction for the project".
Respectfully,
MUC Specialty Roofing Inc
Do UVurster
President
50 Valley View Dr. Westfield Ma. 01085 Phone 413-642-3842 Fax 413-642-3955
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: ` -5 i tvv\,
The debris will be transported by:
The debris will be received by: CU
Building permit number:
Name of Permit Applicant Y`'��� l 1-��, �Z�v vY ►
Date 5 )aL- ) 1 Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
1 Congress Street,Suite 100
Boston,MA 02114-2017
M V' www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information i l Please Print Leizibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: 5 rC 1 e l� MA `J 1 p S5 Phone#: 4-13
Are you an employer?Check the appropriate box: Type of project(required):
f'g] I am a employer with 4. ❑ I am a general contractor and l
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. 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. F1 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 124M Roof repairs
insurance required.] t c. 152,§1(4),and we have no
employees. [No workers' l3.❑ 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: A,—L ,
Policy#or Self-ins. Lic.#: `I�� piration Date:
Job Site Address: f V City/State/Zip: � �^c�w��
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration n 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 hereb certi' under a and penalties of perjury that the information provided above is true and correct.
Signature• "-a--� Date: S��C- 1 1
Phone#Official use 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 1.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes Q No 4
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject property
hereby authorize to
act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
Y 3
� �.,) w' '��-�ti�► c_ -� �tv.1 �- 1 V} '�� 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 pains and penalties of perjury.
MIA )L V
nt Na e
sIZL -S
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction SSuuuervisor. Not Applicable ❑
Name of License Holder: C 1 t ` -b,`'� f r-,�
I License Number
Address Expiration Date
L
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 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):
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 l
: Not Applicable ❑
Company Name:
Responsible In Charge of Construction
ddres
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
Frontage
Setbacks Front
Side L: R L: R:
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 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:
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(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 Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
ow
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[I Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing-fig Change of Use❑ Other❑
Brief Description Enter a brief description here.
Of Proposed Work: _ .1 I t�'
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTIO TYPE
1 '119
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 ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 36 ❑
M Mercantile ❑ 1 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 56 ❑
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(so
1 St 1 St
2nd 2nd
3rd 3 rd
4th
4m
Total Area(so Total Proposed New Construction(so
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: F7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone❑ unicipal ❑ On site disposal system❑
Version 1.7 Commercial Building Permit May 15,2000
Department use only
1 ! ity of Northampton Status of Permit
ilding Department Curb Cut/Driveway Permit
Mp`l 2 12 Main Street Sewer/Septic Availability
&Gas 1nsPecUOns Room 100 Water/Weli Availability
Oump'ng �nA 01p6 ampton, MA 01060 Two Sets of Structural Plans
Etiectri�o�hampton,
p one 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: This section to be completed by office
4 is 1F-.1 w-%. 5—` Map Lot Unit
Molrkv"'A Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
S''44\ Cs.l1e-
Name(Print) Current Mailing Address:
Signature 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 (0 UV\D (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) 2 Ic V"-) Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2015-1176
APPLICANT/CONTACT PERSON MMC SPECIALTY ROOFING INC
ADDRESS/PHONE 50 VALLEY VIEW RD WESTFIELD01085
PROPERTY LOCATION 45 ELM ST-CHASE HOUSE
MAP 31 B PARCEL 224 001 ZONE EUQ 00)/URC(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
Tyneof Construction: INSTALL NEW EPDM ROOF
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 076497
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
proved 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
//
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.
45 ELM ST-CHASE HOUSE BP-2015-1176
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 3 1 B -224 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2015-1176
Project# JS-2015-002205
Est. Cost: $26000.00
Fee: $156.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MMC SPECIALTY ROOFING INC 076497
Lot Size(sq. ft.): 51400.80 Owner: Smith College-Office of Summer Prop-rams
Zoning: EU(100)/URC(100)/ Applicant MMC SPECIALTY ROOFING INC
AT. 45 ELM ST - CHASE HOUSE
Applicant Address: Phone: Insurance:
50 VALLEY VIEW RD WC
WESTFIELDMA01085 ISSUED ON.713012015 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL NEW EPDM 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:
FeeType• Date Paid: Amount:
Building 7/30/2015 0:00:00 $156.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner