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38B-006 (74)
Details Page 1 of 1 nsee Details ull Name: CLIFTON FROST ender: er Name: dress: ddress 2: ity: Brimfield tate: MA ipcode: 01010 o nt : U dted tates 1cense o: GS-076497 License Type: Construction Supervisor rofession: Building Licenses Date of Last Renewal: 6/13/2015 Issue Date: Expiration Date: 6/7/2017 icense Status: Active Today's Date: 7/912015 econdary License: oing Business As: atus Chan e: Lic se Renew I No Prerequisite Information No Discipline Information ocumen um 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 �P585t2ch setts ifpPa win"" J 'u �t}C 5��°i}{ Board of Building Regulations and standards Construction supervisor License:CS=076497 CLIFTON FAUST 89 MARSH HIL woo s � y RrisnSeicl R'IA"0101Q>� . I ,may 06107!2015 Com,nissioner 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: The debris will be transported The debris will be received by: C �' -5-n1 C-U Building permit number: Name of Permit Applicant KYS.'A Q&LIQ) )5 Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of IndustrialAccidents 6-4 Office of Investigations 1 Congress Street,Suite 100 <W Boston,MA 02114-2017 ^M www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): lM M C-- ct-c I c* 4 �= V C- Address: 5 U U10 ti V v.% -r-)v~,Q— C- City/State/Zip: � � 1 c a� Y OI APh �� one 4: Are you an employer?Check the appropriate box: Type of project(required): L'R I am a employer with 10 4. n I am a general contractor and I * have hired the sub-contractors 6- ❑New construction employees(full and/or part-time). 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. n We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I Ln Plumbing repairs or additions right myself. [No workers' comp. , exemption per MGL 12.0 Roof repairs insurance required.]t C. 152,§1(4),and we have no employees. [No workers' 13.0 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.-T- VV*N MLA t-"`4� Tn S Policy#or Self-ins. Lic.#:AW I-_ 5c)4C _�!u) Expiration Date: I7 2 ] Job Site Address: )Zio ��e. City/State/Zip:N ►v-��. 1` � 1�� 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 erti under�L andpenaldes of perjury that the information provided above is true and correct Si afore: A Date: 9 / 14-115 Phone# 9--1 OV-Z'I rts' 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#• Initial Construction Control Document = W To be submitted with the building permit application by a m d Registered Design Professional for work per the 8t" edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Smith College Facilities Roof Replacement Date:09.02.15 Property Address: 126 West Street,Northampton, MA Project: Check (x) one or both as applicable: New construction X Existing Construction Project description: Roof replacement. I Tim Eagles, of EDM, MA Registration Number: 10283 Expiration date: August 31, 2016, am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': X Architectural X Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official. I shall submit field/progress reports (see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'. Enter in the space to the right a"wet"or electronic signature and seal: N0 ;0233 � CT Phone number: 860-819-3462 Email: teagles @edm-ae.com y c TH Building Official Use Only Building Official Name: Permit No.: Date: Note 1. Indicate with an 'x'project design plans.computations and specifications that you prepared or directly supervised. If`other' is chosen. provide a description. Version 06 11 2013 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 0 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 periury. Print Name Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Clifton Frost CS-076497 License Number 89 Marsh Hill Road Brimfield MA. 01010 06/07/2017 Addre� s Expiration Date (413) 478-6943 Signature Telephone I T- 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: &,A V — ---- ---- —- Not Applicable ❑ Name(Registrant): 45 South Main St.Unionville CT. 06085 Registration Number Address (860) 233-8282 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 MMC Specialty Roofing Inc Not Applicable ❑ Company Name: Donald Wurster Responsible In Charge of Construction 50 V y View Dr. Wesrfield MA. 01085 Ad ress (413) 642-3842 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 30 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 e 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 C) YES Q IF YES: enter Book Page; and/or Document#. 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 Q Obtained O , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q 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 O NO Q 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 Replace roofing on 16,500 Sq, Ft. with 5 inches of insulation and fully adhered EPDM roofing. Of Proposed Work: Structural infill of 1,100 Sq. Ft. 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 ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 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(so 1 St 1 St 2nd 2nd 3rd 3rd 4th 4th 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: 7.3 Sewage Disposal System: Public ❑ Private ❑ I 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: }V/ �- "g Department Curb CuVDdveway Permit 'Main Street Sewer/Septic Availability 4 20IS Boom 100 Water/Well Availability N mpton, MA 01060 Two Sets of Structural Plans Elect 41 -5 -1240 Fax 413-587-1272 Plot/Site Plans Ins J10G) Other Specify APPLICATION TO CONSTRUCT,jMPAIR, 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 Prooerty Address: /� This section to be completed by office 126 West Street Map U Lot 06 j! Unit Northampton MA. 01060 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Smith College 126 West Street Name(Print) Current Mailing Address: (413) 585-2898 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 $274,000.00 (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=0 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2016-0349 APPLICANT/CONTACT PERSON MMC SPECIALTY ROOFING INC ADDRESS/PHONE 50 VALLEY VIEW RD WESTFIELD01085 PROPERTY LOCATION 126 WEST ST-PHYSICAL PLANT MAP 38B PARCEL 006 001 ZONE SI(100)/WP(6)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiny,Permit Filled out Fee Paid Typeof Construction: REPLACE 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 INFO,PMATION 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 r u in ial 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. 126 WEST ST-PHYSICAL PLANT BP-2016-0349 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38B-006 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-2016-0349 Project# JS-2016-000558 Est. Cost: $274000.00 Fee: $1918.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MMC SPECIALTY ROOFING INC 076497 Lot Size(sq. ft.): 9365.40 Owner: SMITH COLLEGE OFFICE OF TREASURER Zoning: SI(100)/WP(6)/ Applicant: MMC SPECIALTY ROOFING INC AT. 126 WEST ST - PHYSICAL PLANT Applicant Address: Phone: Insurance: 50 VALLEY VIEW RD WC WESTFIELDMA01085 ISSUED ON.9/1712015 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 Denartment 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 9/17/2015 0:00:00 $1918.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner