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31B-222 (6) how' ' filx,c•ia1h, Hool'ing 111c. July 29, 2015 To:Northampton Building Department 212 Main St Northampton MA.01060 € request that you grant a modification to waive the requirement for control construction for the Lamont House project at 17 Prospect St.Smith College 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, C Specialty Roofing Inc Donald Wurster President 50 Valley View Dr. Westfield Ma. 01085 Phone 413-642-3842 Fax 413-642-3955 PURCHASE ORDER Vp SMITH COLLEGE Page PURCHASING DEPARTMENT 126 WEST STREET PO Number: NORTHAMPTON,MA 01063 P8008837 Issue Date: 07116/15 Delivery Date: 08/22/15 991173950 vendor: MMC Specialty Roofing Inc Bill Smith Coll p e A � 9 Smith College 50 Valley View Dr ,lay Lucey Westfield MA 01085 126 West St Northampton MA 01063 Buyer Phone/Fax Terms Lynn Peiland P:(413)585-2240 Net 30 Days F: (413)585-2089 NO Description Quantity Unit Cast Total Cost minorities and females, qualified veterans, and qualified individuals with disabilities. 1 . Lamont - Skate roof work per attached 1.00LOT 64,000.0000 64,000.00 SOB: FOB Destination TOTAL: 64,000.00 Not valid without the terns and conditions on the reverse,which are an integral part hereof. ignature: ��Q Date; -7h /'j JDEX FUND ORGN ACCT PROG ACTV LOCN AMOUNT 881507 2691 77502 7600 64,000.00 Details Page 1 of 1 t` s ensee Details . graph c ull ame: CLIFTON FROST ender. er Name: dress: ddress 2: ity: Brimfield tate: MA ipcode: 01010 o nt : U 'ted tates icense o: GS-076497 License Type: Construction Supervisor rofession: Building Licenses Date of Last Renewal: 6/13/2015 Issue Date: Expiration Date: 617/2017 icense Status: Active Today's Date: 7/9/2015 econdary License: oing Business As: atus Chan e: Lic se Renew I Prerequisite Information No Prerequisite Information ine No Discipline Information ocumen um t Close Window ©2011 Commonwealth of Massachusetts Site Policies Contact Us http://elicense.chs.state.ma.us/Verification/Details.aspx?agency_id=1&license id=265362& 7/9/2015 a massachusetss-Departrneiit nlf=�ji}iic Sate Berard of Suitding Regulations and Standards Cowitauction SuPM'150r License:CS-076497 CLIFTON F[tOST= r 89 MARSKHI .TD = Brimfield MA'01 10 ' Expiration -'� 0610712015 cornimissioner MMCSP-1 OP ID:CG CERTIFICATE OF LIABILITY INSURANCE °A0/' ' 0611 112015 'HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS :ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES IELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED IEPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. 41PORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. if SUBROGATION IS WANED,subject to he terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the ;ertificate holder in lieu of such endorsement(s). ILLIPS INSURANCE AGENCY INC NCAAME Chrystal Greenleaf ^ENTER STREET arc°NN .413-5945984 Ne;413-592-8499 [COPEE MA 01013 E-MAIL Ieph Philips ADDREss:chrystal@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Associated industries ins Co. URED MMC Specialty Roofing Inc INSURERS:National Union Fire Ins Co. 19445 50 Valley View Drive Westfield,MA 01085 INsuRERc:A.1.M.Mutual Ins.Co. 33758 INSURER D; INSURER E INSURER F: IVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 'HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD 4DICATED. 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, XXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY POLICY POLICY NUMBER M M LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0 CLAIMS MADE OCCUR X X 1G06CO03368-00 06/02/2015 06/02/2016 PREMISES IEa eaaurerxe $ 100,00 DAMAGE T(3 RENTE MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIESPER GENERAL AGGREGATE $ 2,000,00 POLICY a PRO- LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SI LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIREDAUTOS NAOUTOSWNED PRRrOPPET DAMAGE $ X UMBRELLA UAB OCCUR EACH OCCURRENCE $ 1,000,00 EXCESS UAB CLAIMS-MADE X X BE032114065 01/16/2015 0111512016 AGGREGATE $ 1,000,00 DED I I RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X STATUTE X ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN AWC-400-7030594-2014A 06107/2015 0610712016 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? a N i A If yes,d my in under DISEASE-EA EMPLOYE S 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 CRIPTiON OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) :tificate holder is included as additional insured on a primary/ non- ttributory basis with waiver of subrogation included. RTIFICATE HOLDER CANCELLATION WESTNEC 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 th A � 01988-2014 ACORD CORPORATION. All rights reserved. ORD 25(2014101) The ACORD name and logo are registered marks of ACORD i The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations I Congress Street, Suite 100 Boston,MA 02114-2017 N www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): IV\vy\C_-� eC_I Address: '�)0 �1 y I -e ,.,/ � City/State/Zip: Y' .5 {? Ik MA G1 hone#: L03 Vf2f3 dr2-- Are you an employer?Check the appropriate box: Type of project(required): 1� I am a employer with� 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. 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.t 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 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 11❑Other comp. insurance required.] *Any applicant that checks box 41 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. ► � M1- v"�� �..�5t �'�y`C�„ C_ Policy#or Self-ins. Lic.#: `7 0 305 -�c>I expiration Date: Job Site Address: e�A `b City/State/Zip:) Attach a copy of the workers' compensation policy declaration page(showing the policy number and expira 'on 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 hereVerd unde r th ains and penalties of perjury that the information provided above is true and correcit Si ature Date: j 2 11s Phone#: q 1 3 4 23 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 O 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 I, 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, Print Name Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: - License Number Address Expiration Date 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 0 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 M C_ Not Applicable ❑ Company Name: f Responsible In Charge of Construction 6 L---,)le V► Addr ss 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 Q YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW ® YES Q 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 ® Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® 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 O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 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❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ RoofingIN Change of Use❑ Other❑ Brief Description Enter a brief description here. Q 1-114 (G^\ R-K- v-VR —1�7 -3 L> Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE --� USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly E] A-1 ❑ A-2 El A-3 El 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ I-1 ❑ 1-2 Cl 1-3 ❑ 3B ❑ M Mercantile ❑ 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(sf) 1 St 1 Sr 2nd 2nd 3rd 3rd 4�h 4 m 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 E].3 site disposal system[] Version 1.7 Commercial Building Permit May 15,2000 Department use only f City of Northampton Status of Permit: - I� � Building Department Curb Cut/Driveway Permit 212 Main Street Sewer]SepdCAvallability 3 0 Room 100 wateriwen Availability i orthampton, MA 01060 Two Sets of Structural Plans ` Elecirnc, P;u; ,t nq -R �� 3-587-1240 Fax 413-587-1272 Plot/Site Plans Northampton,f 9A 0 4 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 VOW, Map 3 Lot d Unit c-,'1 d&l-, Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: .5,M �-�1� ��J l lle— , 121 Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: ms s ` G-C) v 1y' 1 Name(Print) Current Mailing Address: g-13 Ib4Z 3 � Signature � Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 1ZSU (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) 3 Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2016-0119 APPLICANT/CONTACT PERSON MMC SPECIALTY ROOFING INC ADDRESS/PHONE 50 VALLEY VIEW RD WESTFIELD01085 PROPERTY LOCATION 17 PROSPECT ST-LAMONT HOUSE MAP_31B PARCEL 222 001 ZONE EU(100)/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 Typeof Construction: PARTIAL SLATE_REROOF(3,000 SQ FT) New Construction Non Structural interior renovations Addition to Existiniz 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: _LZApproved 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 O ficial 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. 17 PROSPECT ST-LAMONT HOUSE BP-2016-0119 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 3 1 B-222 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-2016-0119 Project# JS-2016-000208 Est.Cost: $63000.00 Fee: $441.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MMC SPECIALTY ROOFING INC 076497 Lot Size(sq. ft.): 87555.60 Owner: SMITH COLLEGE OFFICE OF TREASURER Zoning: EU(100)/URC(100)/ Applicant.• MMC SPECIALTY ROOFING INC AT: 17 PROSPECT ST - LAMONT HOUSE Applicant Address: Phone: Insurance: 50 VALLEY VIEW RD WC WESTFIELDMA01085 ISSUED ON.713012015 0:00:00 TO PERFORM THE FOLLOWING WORK.-PARTIAL SLATE REROOF (3,000 SQ FT) 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 Siiznature: FeeType• Date Paid: Amount: Building 7/30/2015 0:00:00 $441.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner