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18D-058 (42) 01/12/2016 4135620407 ELM ELECTRICAL PAGE 01/02 Weaffield,MA 01085 CLM FAX COVER Tel, 413.568.0905 Fax:41:3.562.0407 E wvvvf.elmelec,rom POWERING PRODUCTIVITY SHEE T Building Inspector Livia Scrivener 77M 1/12/2016 413-587-1272 2 J71✓E PERMIT APPLICATION FOR ST.GOSAIN g gggpw E�ft �EA EMOM 'Imp Attached is a letter from the subcontractor performing the sprinkler work located at.,:34. Gobain 175 Industrial Dr. Thank you, Elm Flax Cover Sheet Rev 01 01/12/2016 11:03 4135620407 ELM ELECTRICAL PAGE 02/02 507 Southampton Rd 11 Westfield, NIA 01085 0 Tele:413.642.3267 Fax: 413-642-3792 www.hampshirefrrellc.cam January g,2016 Northampton Building Department 212 Main Street Northampton,MA 01060 Attn: Building Inspector RE: St.Gobain—175 Industrial Drive-Fire Sprinkler Modifications Dear Building Inspector, As per our fire department permit application our intent is to extend the existing overhead fire sprinkler protection into the new"Jet Mill'room that is being constructed. The new room measures 14'-10"X 11'. The existing fire sprinkler system is a hydraulically calculated system. We will match the existing pipe sizing,head type and style. No new hydraulic calculations will be performed. All new work will be performed in accordance with NFPA i3 (2013 ED.). No new calculations will be required as per NFPA 13,(2013 ED.) Section 23.4.4.5.4—"Where sprinklers are installed above and below a ceiling or in a case where more than two areas are supplied from a common set of branch lines,the branch lines and supplies sha'I be calculated to supply the largest water demand". We will provide a"as-build" sketch of the new sprinkler work we are performing at the completion of this project. Sincerely, Brad Viola Service f Inspection Manager AWAFARr 507 Southampton rod. jo,ad viola Wesfflefd,MA 010$6 ServlcMnspection Tel: 413.642:8287 Manager r ax: 41$.642,3792 Cell.413.579.1160 bvlo;O*hampshlrafrrellc.00m MAUausc105360 www.hampshlreffmflavom CT L10 F11499 Mcs L!41c� n�t ` Page cif :., Made by k-&e soci tes Computation Sheet - Consulting Structural Engineers Date Subject J Checked by Date / m ., a V, W � � { i S f a ,� °€e i R1 �t l n � r 4 ,{ l n.K,3Mhite Page I _of MO associates Computation Sheet Made by , Consutting Structural Engineers Date Subject J C-+ i 0� g'i f,.\) � Checked by [date — p f ..— A J k` rt i gr A i F I { X � 3 d 4 1 ; s � 4 _w fr F t � ° Ini#*al Construction Control Document H DEF t F o beub fitted with the building permit application by a N Registered Design Professional for work per the 8t'edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: J-� ,r Date: Property Address: �—y�—�.�j--l—r—�'. '" Project: Check one or both as applicable: �C few construction 6rxisting Construction Project description: ti MA Registration Number: JOCA,�C., Expiration date: a i , am a registered design professional, and I have prepared or directly supervised the preparation of all design pans, computations and specifications concerning: ,,Architectural [ ] 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 f M Re ee item 3.)together with pertinent comments,in a form acceptable to the building officia. Q�' \ P"� Upon completion of the work, I shall submit to the b o ' 0 in 1 struction.Control Document'. p p � M Enter in the space to the right a"wet"or �r electronic signature and seal: q; o IFS P Phone number: E ail: tam ac"? Building Official Use Only Building Official Name: Permit No.: Date: Version 06 1l 2013 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street UV. Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0bly Name (Business/Organization/Individual): Elm Electrical, Inc. /One Development&Construcrion Address: 68 UNION STREET City/State/Zip: WESTFIELD, MA 01085 Phone #: 413-568-0905 Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 130 4. ❑ I am a general contractor and I 6. ® New construction employees(full and/or part-time).* have hired the sub-contractors 2.E-1 I am a sole proprietor or partner- listed on the attached sheet. + E] 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 required.] officers have exercised their 10.© Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ 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' comp. insurance required.] 13.F1 Other *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 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: MASSACHUSETTS EMPLOYERS INSURANCE COMPANY Policy#or Self-ins. Lic.#: MCC20020000842014A Expiration Date: 7/1/2016 Job Site Address: ALL JOBS IN City/State/Zip: 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 ce fy under the pains and penalties of perjury that the information provided above is true and correct. Si nature: Date: 7 /5 Phone#: 413-568-0905 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 th 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 No SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property Ronald Hannah hereby authorize L. ...... _.,.. _.._ to act on my behalf, in all matters relative to work authorized by this building permit application. L 11/18/2015 Signature of O er Date �. Ronald Hannah 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_pams and„penalties of perjury. _ . Ronald Hannah Pri ame Signatu N of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder. Ronald Hannah 096240 License Number ,68 Union Street Westfield, Ma 04/03/2016 dres Expiration Date (413) 485-4056 Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) -T 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 E Name(Registrant): Registration Number Address . ...... .e Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): .Richard White =Structural Name Area of Responsibility 50 Railroad Avenue, Southington Ct 46792 Address Registration Number ;,(860) 276-9100 06/30/2016 Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number I Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date .m.ee. a. u.... ...P_..._ . .. ... Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor One Development& Construction ..= Not Applicable ❑ Company Name: Ronald Hannah Responsible In C I rge Construction 68 Union Stre We tfield, Ma Zde 1(413) 485-4056 Telephone Versionl.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 E 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 DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES IF YES: enter Book = Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 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 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, excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES NO kv 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❑ Brief Description ;Construction of 14'x 11'x 12' interior CMU room with light storage floor on top with safety Of Proposed Work: Trails. (1) Overhead Door/(1)Mandoor 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 I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 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: �..a.. 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 St 1 St e _., 2nd _ . ._,_ �. eem .. ...� a .b .., u�_�. 2nd v 3rd 3rd , .,, .... K. ...®a. �,.. ..6 ,. .�mqw: 4th ; 4th _.. Total Area(so _ Total Proposed New Construction(sf) . ........ 154 Total Height(ft) ........ Total Height ft „„ „ 12 7.Water Supply(M.G.L. c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private E] Zone Outside Flood Zone❑ Municipal ❑✓ On site disposal system E] Version 1.7 Commercial Building Permit May 15,2000 r�aprtlefi'�� -a �-� ity of Northampton Status of Par � _. Rr - - - --� uilding Department I u—rb y P" off-00 212 Main Street Sewrf6eptrc Av01100ty Nov 18 2n Room 100 ellAv lIftltt+ s. Northampton, MA 01060 Two S�r Str[act�lral°°Dana r — -- _- phone X13- 87-1240 Fax 413-587-1272 Pl t/Sit plate L 21 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 This section to be completed by office 1.1 Property Address: ......... ,,. _.. .. 175 Industrial Drive Map Lot Unit Northampton, Ma 01060 zone Overlay District ___..... _..... Elm St.District'' CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: :Saint-Gobain =same .., __ .. . Name(Print) Current Mailin g Address: (413) 586-8167 Signature Telephone 2.2 Authorized Anent: :Ronald Hannah 168 Union Street Westfield, Ma ��. a_ ..��. .... ®_._ ..... ... ..... _ �. . Name(Print) Current Mailing Address ,(413) 485-4056 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant ............... _ 1. Building $40,000.00' (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 14 Uac) This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2016-0700 APPLICANT/CONTACT PERSON ONE CONSTRUCTION&DEVELOPMENT ADDRESS/PHONE 68 UNION ST WESTFIELD01085 (413)485-4056 PROPERTY LOCATION 175 INDUSTRIAL DR MAP 18D PARCEL 058 001 ZONE GI(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 vtee Typeof Construction: CONSTRUCT ROOM W/LIGHT STORAGE FLOOR WITH SAFETY RA S OVERHEAD DOOR&MANDOOR �S New Construction le2 S' Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 096240 3 sets of Plans/Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN ATION 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 De n Signat uil mg Officlial 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. 175 INDUSTRIAL DR BP-2016-0700 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18D-058 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category: renovation BUILDING PERMIT Permit# BP-2016-0700 Project# JS-2016-001173 Est.Cost: $40000.00 Fee: $280.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ONE CONSTRUCTION & DEVELOPMENT 096240 Lot Size(sq. ft.): 160300.80 Owner: SAINT-GOBAIN INDUSTRIAL CERAMICS zoning: GI(100)/ Applicant: ONE CONSTRUCTION & DEVELOPMENT AT. 175 INDUSTRIAL DR Applicant Address: Phone: Insurance: 68 UNION ST (413) 485-4056 WC WESTFIELDMA01085 ISSUED ON.111312016 0:00:00 TO PERFORM THE FOLLOWING WORK.CONSTRUCT ROOM W/LIGHT STORAGE FLOOR WITH SAFETY RAILS, OVERHEAD DOOR & MANDOOR 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 1/13/2016 0:00:00 $280.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner