25A-190 (43) 54 INDUSTRIAL DR BP-2016-1151
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25A- 190 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-2016-1151
Project# JS-2016-001980
Est. Cost: $601650.00
Fee: $4214.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MDM ENGINEERING INC 102656
Lot Size(sq. ft.): 98010.00 Owner: PIONEER VALLEY TRANSIT AUTHORITY
Zoning: GI(111)/ Applicant: MDM ENGINEERING INC
AT.- 54 INDUSTRIALDR
Applicant Address: Phone: Insurance:
51 SAWMILL RD (774) 230-0734 WC
DUDLEYMA01571 ISSUED ON.4/5/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.STRIP ROOF TO METAL DECK,VAPOR
BARRIER,ISO & PVC FULLY ADHERED
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:
TIIIS 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 4/5/2016 0:00:00 $4214.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File# BP-2016-1151
APPLICANT/CONTACT PERSON MDM ENGINEERING INC
ADDRESS/PHONE 51 SAWMILL RD DUDLEY01571 (774)230-0734
PROPERTY LOCATION 54 INDUSTRIAL DR
MAP 25A PARCEL 190 001 ZONE GI(111)/
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: STRIP ROOF TO METAL DECK VAPOR BARRIER ISO&PVC FULLY ADHERED
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildinu Plans Included:
Owner/Statement or License 102656
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
proved 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
Delay
ure of Building bfficioal 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.
i
Version 1.7 Commercial Building Pcrmit Mn IS 2004
-L-0', f -Departritent use only
- iCity of Northampton Status of Permit:
Building Department Curb CutlDdveway P.etmit
0 d�Gl 212 Main street Sewer/Septic,Availaollity 1,7
Room 100 Watedwell Aitaitablfltioty,
DE{'i tr r
rthampton, MA 01060 Two Sets of Structural -
-587-1240 Fax 413-587-1272 Piotlsite Plank �
--�.-. other.Spw�,-
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
54 industrial Drive,Northampton,MA 01060 Map Lot Unit
Zone Overlay District
� 3
_ Elm st District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORiZED AGENT
X2.1 Owner of Record:
:Pioneer Valley Transit Authorit ` . � `�"NJ�808 Main Street,Springfield,MA 01107
Name(Print) s1 Current Mailing Address:
,(413)732-6248 _
Slgnst TNephone
2.2 Authors ed{-A990:
Damian Mroc `190 South Quin sigamond-Ave,-Unit 105 0
Name(Print] Current Mailing Address:
'(774)230-0734
Signature Telephone
SECTION 3- qTtoN cT
Item Estimated Cost(Dollars)to be Official Use Only
own eted b permit applicant
1. Building ' (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
6-Fire Protection
6. Total= i+2+3+A+5} 00 1, 51d Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
BultdkV CommiaslonedInspector of WAdinp Date
Version 1.7 Commercial Building Permit May 15,2000
qggjQ&4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE I
Interior Alterations El Existing Wall Signs 0 Demolition 0 Repairs[I Additions El Accessory Building 0
Exterior Alteration 171 Existing Ground Sign El New Signs 171 RooflngEl Change of Use[I Other[I
Brief Description Strip down to metal deck, vapor barrier, iso fully adhered, pvc fully adhered
Of Proposed Work:
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly F1 A-1 0 A-2 F1 A-3 F-1 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
8 Business El 2A 0
E Educational 171 2B n
.F Factory 11 F-1 ❑ F-2 E] 2C ❑
H High Hazard 0 3A ❑
I Institutional 11 1-1 0 1-2 E] 38
M Mercantile 13 4 ❑
-R Residential n R-1 El R-2 0 0 5A ❑
S Storage El S-1 [3 S-2 Fl 5B ❑
U utility El Specify:
M Mixed Use ❑ Speaty:
S Special Use n Specify
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGklt"�G RE VATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: ropse,,Us 'Group:
I_
Existing Hazard Index 780 CMR 34): \Propos Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(st)
1s
2""
gra
3"j 3
4th 41"
Total Area(so 150.000 Total Proposed New Construction(so
Total Height(ft) 14
Total Height It
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public Zone Outside Flood Zoneo Municipal 0 On site disposal system❑
Prwate 0 leo
vooiool7Commercial Building Permit May lj.2o00
8. NORTHAMPTON ZONING
Existing Proposed Required by Zonino
This column to be filled if)hv
Budding Deparinient
Lot Size
Frontage
Setbacks Front
Rear
Building Height
Bldg.Square Footage
Open Space Footage
4 of Parking Spaces
Fill* if
A. Has uSpecial Permit/Variance/Finding ever been issued forlon the site?
NO ���� DON7KN0N YES ����
|FYES, date issued:
IF YES: Was the permit recorded atthe Registry ofDeeds?
NO ��/�\ DONT KNOW /�\ YES /—���
��
IF YES: enter Book Page and/or Document
B. Does the site contain abrook, body nfwater nrwetlands? NO /—\ DONT KNOW (j) YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs tobcobtained �_/�`\ Obtained /—\ Date v_� ` '
C. Doany d ��signs YES \`/ NO
IF YES, describe size, type and location:
Q. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO /i\
|FYES, describe size, type and location:
E. Will the construction activity disturb( mQ.qrading'oxswadon.nr@hng)ovrz1aunm`aitpnuofacmmmunp}an
that will disturb over 1acre? YES ��/—� ��
N0 �)
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 Commercial Building Permit May 15,2000
5ECTIQN 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 0
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone t
-9.2 Registered Professional Engineer(s)-
Professimal Roneer
Jon F. TMjtff8
Name Area of Responsibility
163 labbey PadUAUY, W-y th,'M 02189 32173
Address Registration Number
3/28/2016 6/30/2016
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 i Telephone Expiration Date
9.3 General Contractor
M.D-M. Engineering Company, Inc, Not Applicable 0
Company Name:
Damian Mrqprka
Responsible Charge of Construction
190 So th Xtinsigan-lond Av�WTjnit 105, Shrewsbury, Ma 01X445
Addtv3 (774)230-0734
Telephone
Version 13 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Inde endent Structural Engineering Structural Peer Review Required Yes O No •
SECTION 11-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the sutged property
hereby authorize to
act on aif,in all matters reiakvve to work authorized by this building permit application
k"
Signature of er 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 bellet
Signed under th ` s and,penalties of erlury.,
ADM I col
Print Name
Signature of ant Date
SECTION 12-CONSTRUCTION S CES
10.1 Licensedono uotlon S Not Applicable [3
dam.a(ucarua itoldar•7Damia roczka CS- 102656
License Number
190 S th uinsigaa/nd Ave,Unit 105,Shrewsbury,Ma 01545 i03103l2017
AddressW Expiration Date
(774)230-0734
Signature Telephone
SECTION 13 RKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162, 25C(6))
Workers.Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit vAl result
In the denial of the Issuance of the buildspermit.
Signed Affidavit Attached Yes No 0
The Commonwealth of Massachusetts
. _ Department of IndustrialAecidents
Office of Investigations
x ice} l Congress Street,Suite 100
Boston,MA 02.114.2017
a www.mass.govldiu
Workers'Coinpensationl Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le ibiv
Name(Business/£organization/Ittdividttal); M.D.M. Engineering Company, Inc.
Address:51 Sawmill Road
City/State/Gip.Dudley,Ma, 01571 .Phone#:774-230-0734
Are you an employer?Check the appropriate box: _ Type of project(required):
1.Q I am a employer with 9 4. [] I am a general contractor and 1
employees (full and/or part-time).* have hired the sub-contractors 6. F]New construction
2.❑ l am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees "These sub-contractors have 8, C]Demolition
working t for me in an capacity. employees and have workers'
Y P 9. MBuilding addition
[No workers' comp. insurance comp.insurance.•
required.] S. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officer-,have exercised their I t.❑Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs
insurance required.] c- 152,§1(4),and we have no
employees. [No workers' 13,V Other Re-Roaangfcarpentrylstc light
comp. insurance required-
lily applicant that checks box#1 must also till out the section below showing their workers'compensation policy information,
tlomeowmcrs who submit this affidavit indicating they are doing all work and theta hire outside contractors must submit a new affidavit indicating such,
tC'ontractors that check this box nurst attached an additional sheet showing the name of the sub-contractors and state whether of riot those entities have
canployces. If the sub-contractors have employees,thcy must provide their workcrs'comp.policy number.
I am an employer that is providing workers'compensation insurance for my empkvees. Below is the policy and joh site
information.
IriSUranee Company Name:AmGuard Insurance Company
Policy#or Self-ins. Lic.#:R2Wc641289 Expiration Date:08104/2016
Job Site Address: 54 Industrial Drive City/stale/zip:Northampton, Ma 01060
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 h19 . 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or o -yea imprisonmentas we civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 a day a tst the olator. Be advis at a atpy of this statement may be forwarded to the Office of
Investigations of the D for insVrance coverag5oenhfication.
I do hereby certify Ve 'th ains and pe ties of perjuYy that the information provided above is true and correct.
r 3/24/16
l
Phone a 7742300734 �
Oficial use only. Do nor. rion this area,to he completed by citir or town official.
l f,}
City or Town: � Permit/License#
Issuing Authority(circle one):
1. Hoard of health 2.Building Department 3.City/Town Clerk 4. Electrical inspector 5.Plumbing Inspector
h.Other
Contact Person: Phone#:
City of Northampton 212 Main Street, Northampton, MA 01050
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 b :
p
The debris will be received by:
Building permit number: 0 TT
Name of Permit Applicant
- t .
Date ignature of P it
pplicant
1,
Initial Construction Control Document
= W
To be submitted with the building permit application by a
d Registered Design Professional
for work per the 8th edition of the
a
ye�'w Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Pioneer Valley Transit Authority Northampton Operations Facility Date: March 16, 2016
Property Address: 54 Industrial Drive,Northampton, MA
Project: Check(x) one or both as applicable: New construction X Existing Construction
Project description: Roof Replacement and Associated Work
I Jon F. Lindberg, MA Registration Number: 32173 Expiration date: 6/30/16, am a registered design professional, and I
have prepared or directly supervised the preparation of all design plans, computations and specifications concerning':
Architectural Structural Mechanical
Fire Protection Electrical Other: Roof Replacement
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 in accordance with the Professional Standard of Care 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 for general conformance with the requirements of the construction documents. Such review shall not
diminish or relieve the Contractor of its submittal and other responsibilities.
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. The contractor shall be responsible for performing the work in accordance
with the contract documents and shall be exclusively responsible for its construction means, methods, sequences
and procedures, and for construction safety.
4. The performance of the services shall not require any special testing or inspections unless specifically stated in the
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 Co of Document'.
�� ssq�ti
Enter in the space to the right a"wet"or LI ON
a
electronic signature and seal: No. 173
Phone number: 781-335-6465 Email:jfl@gaine.com
0 l
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
z
:40
-P
January 14, 2016
Pioneer Valley Transit Authority, Springfield, MA
The PVTA announces ADDENDUM #1 to IFB 15-013, ROOF REPLACEMENT &
ASSOCIATED WORK
This Addendum#1 provides notice of the following changes made to the subject IFB.
Item 1: Pre-bid Walkthrough
Please note that the time as presented in the local advertisement and the
Central Register differ due to a scheduling conflict.
The pre-bid walkthrough shall take place on Wednesday, January 20, 2016 at
11:OOam at the 54 Industrial Drive,Northampton Site.
Item 2: DCAMM Certification
As indicated in the specification documents, the skylight work has been
designated as a filed sub-bid under"Metal Windows", due to the size and
complexity of the units. Division of Capital Asset Management and
Maintenance (DCAMM) Certification for the field sub-bidder will be
required with the submission.
As the majority of remainder of the work is roofing related, DCAMM
Certification for the general contractor shall be in the category of Roofing.
Bob Johnson, Procurement Officer
PVTA
bjohnson@pvta.com
CELES=Arra-46 0 YEARS Gale Associates, Inc.
CALE
163 Libbey Parkway I P.O. Box 890189 1 Weymouth MA 02189-0004
<s P 781.335.6465 F 781.335.6467 www.galeassociates.com
Engineers and Planners
To: Mr. Damian Mroczka Date: March 16, 2016 .lob No. 829700
MDM Engineering Re: PVTA—Northampton
190 South Quinsigamond Avenue
Unit 105
Shrewsbury, MA 01545
U) Tel: 508-949-1616 Del: Federal Express 2-Day Standard
C
Item Copies Date No. Description
1 2 1.13.16 Stamped/Signed Specifications
2 2 1.13.16 Stamped/Signed Full Size Drawings
3 1 3.16.16 Initial Construction Control Affidavit
Remarks:
Enclosed please find the above referenced documents for permitting.
Please contact Chris Musorofiti of this office should you have any questions. Thank you.
cc: Signed: t'a4-��- -�2- LJs4
Ce-
Patricia M. Whalen
Administrative Professional
If enclosures are not as noted,please notify us at once.
I:\829700\04 Construction\permits\MDM Permit Set Affidavit Trans 2016 0316.docx