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24B-066 (17) 241 KING ST-SUITE 114 BP-2016-1028 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24B -066 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category: renovation BUILDING PERMIT Permit# BP-2016-1028 Project# JS-2016-001735 Est. Cost: $3900.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RICHARD LAVALLEY 054203 Lot Size(sq. ft.): 182342.16 Owner: Coolidge Northampton,LLC Zoning: HB(98)/GI(2)/ .Applicant: RICHARQ LAVALLEY AT: 241 KING ST -'iSUITE 114 Applicant Address: Phone: Insurance: 27 NORWOOD ST (413) 326-1950 O Workers Compensation GREEN FIELDMA01301 ISSUED ON:2/18/2016 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMOVE INTERIOR PARTITIONS 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 CITP OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount:'. Building 2/18/2016 0:00:00 $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File# BP-2016-1028 APPLICANT/CONTACT PERSON RICHARD LAVALLEY ADDRESS/PHONE 27 NORWOOD ST GREENFIELD0001 (413)326-1950 Q PROPERTY LOCATION 241 KING ST-SUITE 114 MAP 24B PARCEL 066 001 ZONE HB(98)/GI(2)/ THIS SECTION FOR OFFIiCIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: REMOVE INTERIOR PARTITIONS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildine Plans Included• Owner/Statement or License 054203 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: Leo'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 m . n oe- Signature of Buil ing Of ial Date Note: Issuance of a Zoning permit does not relieve a appliant'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. I * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. i t / Version 1.7 Commercial Building Permit May 15,2000 Department use only '�, ��,� C ty of Northampton Status of Permit:: ----EIVE=--I B ilding Department Curb Cut/Driveway Permit FEB 1 I ,ifs 212 Main Street Sewer/Septic Availability Room 100 WaterM/ell Availability `�No hampton, MA 01060 Two Sets of Structural Plans of Fsu' NUR, ANI PTON`' % It n�5413 87-1240 Fax 413-587-1272 Plot/Site Plans , �� �� Other Specify APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THt 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: aN _3 Ix 1 �.' Map Lot Unit Zone Overlay District Elm St.District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address Signature Telephone 2.2 Authorized Agent: Name(Print) Current Mailing Address 13 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION CO,4S Item Estimated Cost(Dollars)to be Official Use Only -completed by permit applicant 1. Building '] (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 ......:... 3. Plumbing F J Building Permit Fee 4. Mechanical(HVAC) �� 0 5. Fire ProtectionAli - 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date i a Versionl.7 Conunercial 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 ;Enter a brief description here. q 3 77 Of Proposed Work: ' mve C / �� ..✓ �� �/ Jjrl .fr'�� SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A AssemblyF-1A-1 F-1A-2 11A-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 ❑ 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(sf) 151 ... 1 5t 2nd 2nd 3rd 3rd . ..... .. th 4th __...._............................................... .................___......_..........__...._.......: 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 ❑ On site disposal system[:] I Versionl.7 Commercial B4iilding Permit May 15,2000 S. NORTHAMPTON ZONING j 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 /o 0 Open Space Footage (Lot area minus bldg&paved parking) ..................._..... #of Parking Spaces L'F lume&Location) _ _.... A. Has a Special Permit/Variance/Finding ever been issued for/on the site? XN NO 0 DON'T KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW KIN YES. 0 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 0 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 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,gradin"q,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 4 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 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 I Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone i i I I Versionl.7 Commercial Bulilding Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No 0 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 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. ii .... __... . _ .. .. ...... Pn e Signature of Owner/Agent ' Date SECTION 12-CONSTRUCTION SE ICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number e_7J7 . �j i^a a 033rJ Add es r� �- 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 � No 0 1 4 The Comnionwealth of Massachusetts Department o f Industrial Accidents - - Office of Investigations =! 600 97ashington Street ' Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): — Address: City/State/Zip: Phone#: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 7 I am a general contractor and I * have hired the sub-contractors 6 New construction ❑ employees (full and/or part-time). Remodeling listed on the attached sheet. 7• � g 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g. E] Demolition working for me in any capacity. employees and have workers'comp. 7 Building addition [No workers' comp.insurance comp. insurance.$ 5. 7 We are a corporation and its 10.7 Electrical repairs or additions 3.❑ required.]I am a homeowner doing all work officers have exercised their 11.0 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 13.7 Other employees. [No workers' 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. lain an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: — Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: 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 doh ereby certify under the pains and penalties of peijuty that the information provided above is true and correct. Si nature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# I 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#: i �I i Coolidge Northampton DeLaurentis Management Corp. 43A Greenridge Avenue White Plains, NY 10605 June 25, 2014 Louis Hasbrouck Building Commissioner City of Northampton 212 Main Street Northampton, MA I request that you grant a modification to waive the requirement for construction control of the project at 241 King Street, Suite 114, Northampton, Massachusetts because the work is of a minor nature, it 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. Respectfully, Richard LaValley Manager for Coolidge Northampton 1 , l ® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 2/11/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, XTEND 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 pplicy(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 ;ENT Christine Sullivan AME: PHONE FAX Aquadro & Associates . ( AIC No,: (413)584-0859 355 Bridge St. , P. O. Box 357 "MAIL INSURERS AFFORDING COVERAGE NAIC# Northampton MA 01061 INSURERAMain Street America Insurance 29939 INSURED -INSURER B: COOLIDGE NORTHAMPTON LLC INSURERC: PO BOX 310 -INSURER D: INSURER E: WHITE PLAINS NY 10605-0310 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1441405466 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. INSR ADDL UBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMA E T R WED 500 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ r A CLAIMS-MADE Fx_] OCCUR BPF3111Y 12/21/2015 12/21/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ __. ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,000 DED I X I RETENTION$ 10,000 CUF3111Y 12/21/201512/21/2016 $ A WORKERS COMPENSATION WC'RYSTATU- I X OTHER - AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A CF3111Y 12/21/201512/21/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEq $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) 241-243 KING ST NORTHAMPTON MA 01060 225 KING ST NORTHAMPTON MA 01060 CERTIFICATE HOLDER PANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THE CITY OF NORTHAMPTON BUILDING DEPT NORTHAMPTON, MA 01060 gUTHO ED REPRESENT IV �✓� -�'IrC V Ili�(^%, ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005)01 The ACORD name and logo are registered marks of ACORD i "i uuiuu rioor- Potpourri Piaza - 241. King Street Nortit ai�aiatta�� MA Redesign Version 3 Scale Appioxiinately 1/4" = V-0" '—' Scale may distort depending on how Adobprr)Acrobats adjusts the image --� for your printer. L 1 '— -7-- Assure Assure your printer is set to print in original size. PRINT ON LEGAL_PAPER / r 822 sq.ft.internal Area = 855 sq.ft.Usable Area ivEreonnsaandrrdsi 'F N i 4 I f_ CITY OF NORTHAMPTON BUILDING DEPARTMENT Floor plan provided by Another away Reame Estate, a These pIans ha},, ea e� mv!eWed Although significant effort was made approved '� to accurately represent this property, Ant{(`� {(ap� no warranties are made as to the accuracy o ve d�, of any dimension or area shown or implied. All dimensions should be _ considered approximate. 00 Dater I,- Co Signatur �1. JL z t Utility,7 Ll c� _Y Sprinkler System and Water Main OJO for �? Building 1 4'-3" Suite 114 - Ground Floor - Potpourri Plaza - 241 (Ling Street Nortliantptgl) MA Scale Approximately 1/4" = V-0" Scale may distort depending on how Arlohen Acrohat'7 adjusts the image for your printer. N Assure your printer is set to print in original size. PRINT ON LEGAL PAPER 322 sq.ft.Internal Area 355 sq.ft.Usable Area(rer(Y)MAS1-lord,) Fl D-F l w II l l Floor plan provided by Another Way Real Estate,CTC l Although significant effort was made I to accurately represent this property, k no warranties are made as to the accuracy ' — of any dimension or area shown or implied. I All dimensions should be f — considered approximate. 01 Ll T�--j Sprinkler t LiJ System and - Water It Main for Building 1