31B-004 (23) GAWITH HALL-46 ROUND HILL RD BP-2016-1233
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map-Block: 3 1 B-004 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: demolition BUILDING PERMIT
Permit# BP-2016-1233
Project# JS-2016-002121
Est. Cost: $220000.00
Fee: $1540.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 3 110 18.4 0 Owner: 1924 LLC
Zoning: URC(100) Applicant: 1924 LLC
AT: GAWITH HALL -46 ROUND HILL RD
Applicant Address: Phone: Insurance:
333 Elm St.
WEST SPRINGFIELDMA01089 ISSUED ON:4/21/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.-INTERIOR DEMOLITION
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 4/21/2016 0:00:00 $1540.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Versionl.7 Commercial Building Permit May 15, 2000
Department use only
JNrthampton,
ity of Northampton Status of Permit:'
} uilding Department Curb Cut/Driveway Permit -
f APR 2 1 2016 212 Main Street Sewer/Septic Availability
L Room 100 Water/Well Availability
DE t r >as MA 01060 Two Sets of Structural Plans587-1240 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
vAL.J/%/t/ �(s i<J/�✓� Map , Lot
Q� Unit
.l
Zone Overlay District
NO-ILTNAMr'T0 j AA�j
_. ........... _....._..... __.. _.. ..... Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
f`ly-LCC:
-/
Name
/yjl 4/ 5
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
com feted by permit applicant
........... ---------
1.
_._1. Building v®� (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 o �J
6. Total=(1 +2+3+4+5) 40001, 06 Check Number
This-Section-For-Official-Use-Only
Building Permit Number Date
Issued
Signature:
BuilTing Commissioner/Inspector of Buildings Date �� i
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 'Enter a brief description here.
Of Proposed Work:i -/
--44//1l 1/t /1-i 0,/L 0(/ 1Jfl111'
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 Tg 2A ❑
E Educational ❑ 2B I ❑
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(sf)
1S 00�. 1Sc
_ 2nd
2nd � Ql/l/ _.
r
3rd
d /
3 U_ _...
.......__ 4th
4th _ ..._... .. ..... .. . ._..._..;
.............._._._._.............................._..__......................_..__-.....................
..;
Total Area (sf) ppC) �Q/—% Total Proposed New Construction(sf)
r
Total Height(ft) V
Total Height ft
7.Water upply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewa a Disposal System:
Public Private ❑ Zone Outside Flood Zone Municipal On site disposal system[]
i
I
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 µ'
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 DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
..
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO CEJ 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 fX) NO
IF YES, describe size, type and location: �u������ LOC471ow S/�w
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
►F-YES,—describe-size,—fype and-locafion:
- - -- _
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 ,
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
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:
Q �V&L As Not Applicable .. _
Name(Registrant).
„� Registration Number
�t,E�sAN7 �_ N . . �z_, M. . ...
Address
Tat411 Expiration Date t
Signure v I /` D 7 Telephone s b
9.2 Registered Professional Engineer(s):
.,.
NameArea of Responsibility
Address Registration Number
Signature Telephone Expiration Date
............. . ..........
NameArea of Responsibility
__....... ... _..._ _ ......
Address Registration Number
Signature Telephone Expiration Date
__....__.._ .... ... _.. __ . . ... .._... ..._........ .. ..__......... _...._.... _..._...._..... _._..._..... _.. ........
Name Area of Responsibility
Address Registration Number
........ .._...........
Signature Telephone Expiration Date
NameArea of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable
--Company-Name: —
Responsible In Charge of Construction
......... _...._...
Address
Signature Telephone
i
i
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 0 No
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
.......
as Owner of the subject property
hereby authorize . ........._.... _ _ .. .. .....
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.perlury.
__ ......... _. .. _.__ . __.. .......
Print Name
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable
c.. ..'/ ...... _ _
Name of License Holder:
License Number
Address TGA Expiration Date
lG x)
Signature Tele hone
S N 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
a •.; The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington 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): a?41 e _
Address: 333 ZC M
City/State/Zip:(d,SA/4LQ/ . AA D/de� Phone#: 73 9- 12,3'/
Are you an employer? Check the appropriate bog: Type of project(required):
1.3�I am a employer with J 4. [] I am a general contractor and I 6. ❑New construction
employees (full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. E] Remodeling
ship and have no employees These sub-contractors have g. 'Demolition
working for me in any capacity. employees and have workers' 9 E]Building addition
[No workers' comp.insurance comp. insurance.$
required.] 5. � We are a corporation and its 10.❑ Electrical repairs or additions
�.❑ 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
employees. [No workers' 13.❑ Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
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 die 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: .0C(_C m II.lc-dA( 1 r i%ltl an�cr .
Policy#or Self-ins.Lic.#: 111"2,3 Expiration Date: 03 / /
Job Site Address: Tp 120� #/a City/State/Zip: Af0 0/4)66
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 tip 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 certify under the pains and penalties ofperjury that the information provided above is true and correct.
Signator . 0 GC Date: - Z
Phone#• -,_ 7d
Of 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#:
i
NOTICE OF ASSIGNMENT
EMPLOYER: _ COMBO I.D. STATUS OF EMPLOYER
1924 LLC 000182641 Limited Liability Comp
333 ELM STREET
WEST SPRINGFIELD, MA 01089 COVERAGE GROUP
1115683
Coverage under this assignment
The Waiver of Our Right to applies to Massachusetts
Recover from Others Endorsement operations only. For coverage
is available on Pool policies. outside of Massachusetts, contact
Contact your agent for details. the appropriate Pool or Plan for
that state.
INSURANCE COMPANY:
AGENT T P DALEY INSURANCE AGENCY INC ACE AMERICAN INSURANCE CO
OR KATHLEEN DALEY Jonathan Scharnherg
PRODUCER: P 0 BOX 1150 P O BOX 3556
WEST SPRINGFIELD, MA 01090 ORLANDO, FL 32802-3556
(800) 453-9843
AGENCY FEIN: 042672704
CLASSIFICATION OF OPERATION CLASS ESTIMATED RATE ESTIMATED
CODE TOTAL ANNUAL PREMIUM
REMUNERATION
CARPENTRY NOC 5403 $60,000 9.86 $5,916
EMPLOYERS LIABILITY 1000/1000/1000 9812 $118
MOD FACTOR 9898 .92 $-483
STANDARD PREMIUM $5,551
ALL RISK ADJUSTMENT PROGRAM 0277 1.00
EXPENSE CONSTANT 0900 $338
TERRORISM CHARGE 9740 $18
TOTAL POLICY MINIMUM PREMIUM $575
TOTAL ESTIMATED PREMIUM $5,907
DIA ASSESS. 5.75% $313
TOTAL EST. PREMIUM PLUS ASSESSMENT $6,220
INSTALLMENT BASIS: Annual DEPOSIT PREMIUM: $6,220
THIS 13 NOT A BILL
COMMENTS
Coverage effective 12:01 AM on 04/01/16.
Subject to 10/12 Anniversary Rate Date.
Coverage under this Notice of Assignment applies to the captioned entity only. If
coverage is required for an additional entity, the employer must submit an application,
check, and an ERM to the Pool for the additional entity.
DATE OF NOTICE: 04/05/16 PREPARED BY: Evelyn Cobb
EXT 522
The Workers'Compensation Rating and Inspection Bureau of Massachusetts
101 Arch Street•Boston,MA 02110
(617)439-9030 •FAX(617)439-6055 •www.wcribma.org
Bk: 12246 Pg: 84
II�Illllli� III I� IIII II II���I�II�II�I�II�IIII�
10
Bk: 12248Pg:84 Page:1 of 44
Preservation Restriction Agreement Recorded: 04/15/2016 01:43 PM
between the City of Northampton and
Historic Round Hill Summit,LLC and 1924,LLC
l
1 The undersigned,Historic Round Hill Summit,LLC,a Massachusetts limited liability company
with its office at 1776 Main Street, Springfield, Massachusetts 01102, its successors and assigns
("HRHS")and 1924,LLC, a Massachusetts limited liability company with its office at 333 Elm
Street, West Springfield,Massachusetts 01089("1924")(HRHS and 1924 are individually and
collectively referred to as "Grantor"),acting pursuant to M.G.L. Chapter 184, Sections 31,32 and
a 33,
c Hereby grants to the City of Northampton,("Grantee","City")a Massachusetts municipal
corporation with a principal place of business at 210 Main Street,Northampton,Massachusetts
01060,acting through its Historical Commission(See Exhibit A for City Council authority);
0
Z a Historic Preservation Restriction,as described below:
b
0
WHEREAS, 1924 is the owner in fee simple of certain real property located on approximately 8.074
x acres of land on Round Hill Road,Northampton,Massachusetts and more particularly shown as Parcel 1 on a
Plan entitled ALTA/ASCM Land Title Survey of Land in Northampton,Massachusetts Surveyed for Doucet
&Associates,Inc.dated February 17,2012 and recorded in the Hampshire County Registry of Deeds in
e Book 229,Page 50;said parcel also being described in a Deed dated March 24,2016 and recorded in the
Hampshire County Registry of Deeds in Book 12227,Page 273;and in Exhibit B,attached hereto and
2 incorporated herein by reference;and
WHEREAS,HRHS is the owner in fee simple of certain real property located on approximately
3.670 acres of land on Round Hill Road,Northampton,Massachusetts and more particularly shown as Parcel
2 on a Plan entitled Plan of Land in Northampton,Massachusetts Surveyed for The Clarke School for the
o Deaf dated April 12,2012 and recorded in the Hampshire County Registry of Deeds in Book 229,Page 52;
said parcel also being described in a Deed dated April 25,2013 and recorded in the Hampshire County
Registry of Deeds in Book 11295,Page 142,and in Exhibit B,attached hereto and incorporated herein by
reference;and
'f Q
WHEREAS,Parcel 1 and Parcel 2 are hereinafter collectively referred to as the"Premises".
WHEREAS,a condition of the zoning used and the site plan approval for redeveloping this site
requires a Historic Preservation Restriction approved by the Planning Board and,the restriction is to be
held by the City by the City Council;and
WHEREAS,the Grantor wishes to impose certain restrictions,obligations and duties upon it,as they
1 relate to their respective portions of the Premises,as the owner of the respective portions of the Premises and
1 on their successors to their right,title and interest therein,with respect to maintenance,protection,and
preservation of the respective portions of the Premises in order to protect the architectural,archaeological
and historical integrity thereof;and
WHEREAS,the preservation of the Premises is important to the public for the enjoyment and
appreciation of its architectural,archaeological and historical heritage and will serve the public interest in a
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