31D-142 (7) 175 MAIN ST-TD BANK BP-2017-0166
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31D- 142 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2017-0166
Project JS-2017-000263
Est. Cost: $123993.00
Fee: $868.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BOSS CONTRACTORS, INC JOHN P GAVIN
Lot Size(sq.ft.): 22389.84 Owner: MAIN ST LLP 0/0 COLEBROOK REALTY SERVICES
Zoning: CB(I00)/ Applicant: BOSS CONTRACTORS, INC
AT: 175 MAIN ST -TD BANK
Applicant Address: Phone: Insurance:
581 Rt. 119 (603) 899-9630 Workers Compensation
RindgeNH03461 ISSUED ON:8/11/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:RENOVATE CUSTOMER/EMPLOYEE AREAS &
RESTROOMS,REPAIR & CLEANUP TO STOREFRONT & NEW FRONT DOOR -front door size &
location as drawn & sign needs separate sign permit
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 8/11/20160:00:00 $868.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0166 • . ite `,
tea%
APPLICANT/CONTACT PERSON BOSS CONTRACTORS,INC s*SO
ADDRESS/PHONE 581 Rt. 119 Rindge03461 (603)899-9630 n t
PROPERTY LOCATION 175 MAIN ST-TD BANK I"
MAP 31D PARCEL 142 001 ZONE CB(100)/ 6
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT p� �J i f/
Fee Paid /3/ 6 Y{ 6
Building Permit Filled out
Fee Paid
T .eofConstruction: RENOVATE CUSTOMER/EMPLOY E AREAS&RESTROOMS REPAIR : CLEANUP ,
TO STOREFRONT& NEW FRONT DOOR A'4-3R'tfwp -- FRDNT poo P 511E A NU tOc iaA AS DRF WN
New Construction
Non Structural interior renovations SIQ,.I NEbbS s%PApATt,
Addition to Existing fE RrAtI
Accessory Structure
Building Plans Included:
Owner/Statem-nt or License JOH P GAVIN
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INE6RMATION PRESENTED:
�t// 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
Demolition Delay
1, gltilt&
Signature of Building Official 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.
• n(5 . G ° Version!.?Commercial Building Permit May 15,2000
.e"
r f Department use only
�, ,1(,j'' City of Northampton Status of Permit
G�i, {�A _1 'wilding Department CmticWDnveway Permit e/� �V�O 12 Main Street Sewer/SepticAvailability
Room 100 Water/Well Availability
•`G N. ha ton, MA 01060 Two:Sets of SWaural Plans
511 ne 41 -.7- P40 Fax 413-587-1272 Plot/Site Plans
11\55 „ ,'•. Other Specify
APPL AT •N To :rn '.CT, REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 - TE INFORMATION
1.1 Property Address: This section to be completed by office
TD Bank Map Lot Unit
175 Main Street Zone Overlay District
Northampton, MA 01060
Elm SL District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
inciteinciteN. 6i Ll_ c/o Cu le arpek vvlc-,r.c}t Ks-.f LI.C+ o
Name(Print) Current Marling Address' 1 t 9 M e q .5:•
_. ._ 5r 'C,'e4 MIA olio,_...
re Signature ”eele,rocst N\c-.cr,�.Y-..1 Lie tar t1a+SF LI-?Telephone 9 t3 `l C• ( 00 bio
2.2 Authorized Anent:
Peter Brissette RJP Consulting Group
Name(Pont) Current40 Address
(267)400-0170
///�
✓ signature Telephone
P
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
/60/
/!3 id t
2 Electrical - - rh (b) Estimated Total Cost of
/(t7 75' - ✓V Construction from (6)
3. Plumbing 7E21 ,
� e� Building Permit Fee
4. Mechanical(HVAC) -/ !
5. Fire Protection IF . G,410d
6. Total= 1 +2+a+4+5) Y /a3� If S , //V Check Number /,367,30 iga
This Section For Official Use Only
Building Permit Number Date
Issued
Signature'.
Building Commissioner/Inspector of Buildings Date
E7na/f. bosscon74-ac �`��s . Coto c— a ^y g ea z ins p1 t4.
e tna%/
Verslonl.7 Commercial Building Permit May 15,2000
CUBIC 4- OF ENCLOSED
SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations 0 Existing Wail Signs ❑ Demolition❑ Repairs 0 Additions 0 Accessory Building 0
Exterior Alteration ❑ Existing Ground Sign 0 New Signs❑ Roofing❑ Change of Us✓❑ Other Q
Brief Description .improvements to interior customer and employee areas and restrooms to include new furniture,ecilfng tiles and lighting,
Of Proposed Wark; carpeting/tiling.repairs and general cleanup to building storefront including new'Dept floor and new sign faces to replace
existing faded sign face
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) •CONSTRUCT 'TYPE
A Assembly ❑ A-1 0 A-2 0 A-3 0 IA resE ❑
A-4 0 AS 0 18 ❑
B Business ❑+ _ 2A 0
E Educational 0 28 0
F Factory 0 F-1 0 F-2 0 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ I-1 0 1-2 0 I-3 0 38 0
M Mercantile ❑ 4 .❑
R Residential 0 R-1 0 R-2 0 R-3 0 SA 0
$ Storage ❑ S-1 0 5-2 0 58 O
•
LI Utility ❑ Specify. ' . __... . __. . _.
M Mixed Use ❑ Specify r _.. _. . ..
S Special Use ❑ Specify
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS ANDtOR CHANGE IN USE
Existing Use Group: B Proposed Use Group. B.
Existing Hazard Index 780 CMR 34): 2 _ ,Proposed Hazard Index 780 CMR 34) 2
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per floor(et)
ta' . 7,760
2na 25c
311
471
Total Area(s0 .7,760 Total Proposed New Construction(sf)
Total Height(tt) 10 ....
Total Height ft
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public 0 Private 0 Zone Outside Flood Zone❑ Municipal ❑i On site disposal system
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.I. R._.. . •
Rear _.
Building Height
Bldg. Square Footage % -
Open Space Footage /
(Lot area minus bldg&paved
•
paddng)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DON'T KNOW O YES 0
IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location: 50sf storefront sign over main entry doorwal
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO 0
IF YES, describe size, type and location: install new sign faces of the same type and nature as
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 O
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Version1.7 Commercial Budding 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 0
Name(Registrant); _.
Registration Number
AddressExpiration Date
Signature Telephone
9,2 Registered Professional Engineers}:
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 Responsibihty __. .
Address Registration Number ,.... __
Signature Telephone Expiration Date _
Name Area of Responsibility _. .
Address _.. _. .. Registration Number
Signature Telephone Expiration Date
9.3 General Contractor 7y1-- ,J7�
N V7�� �QiA�(/MP'� Y/l" "... Not Applicable
Company Name _
381 eV d- R 1/ 47
Responsie In Charge of Con_struct,on, 03 4-6 j
Address , _ fj 9- 10 F131 - 3 6` `39 ,�� 3
Signature JZ Telephone
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 O
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, Kev» +lae:.-.. Dcc P..,,a..4 CJecrc(v_tL.-5Y-Ja,. tn"\t-c 'S.9 Sor res Owner of the subject property
hereby authorize Peter Brissette _ _ to
act on my be If, i all matters relative to work authorized by this building permit application.
���/�� a _ g 2_ ib
Signature er Date
LSC ti"
- - - - - -- .- ,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.
- - 13r195._ J_
Print
r
Signature of Owne!/Ag€nt Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder John P.Gavin _ CS-094810
License Number
46 Woodbury Street Keene,NH 03431 08/26/2016
Address n Expiration Date
0,/ 12. -� / (603)674 5790 1pi1'/ t
Si a re Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(.6)}.
Workers
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 O No 0
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 150k
Address of the work: 175 MAIN STREET NORTHAMPTON, MA
The debris will be transported by:
The debris will be received by:
Building permit number:
Name of Permit Applicant JOHN GAVIN, BOSS CONTRACTORS, INC.
Date Signature of Permit Applicant
L\ 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 Leeibly
Name (Business/OrganizatioNlndividual): Boss Contractors, Inc.
Address: 581 NH Route 119
City/State/Zip: Rindge,NH 03461 Phone #: 603-899-9630
Are you an employer?Check the appropriate box:
contractor and I Type of project(required):
L 18 4.® I am a employer with ❑ I am a general
employees(full and/or part-time).' have hired the sub-contractors 6. ❑ter New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7.'Q Remodeling
shipand have no employees These sub-contractors have 9
❑ Demolition
working for me in any capacity. employees and have workers'
comp. Insurance.i 9. ❑ Building addition
[No workers' comp.insurance
required.] 5. ❑ We are a corporation and its 100 Electrical repairs or additions
3.❑ lam 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' 13.0 Other
comp. insurance required.]
'Any applicant hat 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: Berkshire Hathaway Guard Insurance Company
Policy#or Self-ins.Lie.#: BOWC757933 Expiration Date: 07/01/2017
lob Site Address: 175 Main Street City/State/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 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 cerci r the pains and penalties of perjury that the information provided above is true and correct.
Si nature: /j _. Date: 8/3/2016
Phone 6: 603-'99-9630
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):
I.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: - Phone#:
14' Worker's Compensation and Employer's Liability Policy
'v� AmGUARD Insurance Company - A Stock Co.
Policy Number BOWC757933
�V' Berksh ire Hathaway
G UA RD Compare es Renewal
NCCINo . [21873]
Policy Information Page
[1]Named Insured and Mailing Address Agency
BOSS CONTRACTORS INC CROSS INSURANCE - MANCHESTER
581 NH Route 119 1100 ELM STREET
Rindge, NH 03461 Manchester, NH 03101
Agency Code: MECROS34
Federal Employer's ID 02-0440758 Insured is Corporation
Risk ID Number 911583925
Locations on Policy
(L2) Main Street , Fairport, NY 14450
(07/01/2016 - 07/01/2017)
(L3) Main Street , Montgomery Village, MD 20877
(07/01/2016 - 07/01/2017)
(L4) Main Street , Barnett, VA 24266
(07/01/2016 - 07/01/2017)
[2] Policy Period
From July 1, 2016 to July 1, 2017, 12:01 AM, standard time at the insured's mailing address.
[3J Coverage
A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation
Law of the following states: Connecticut,Florida,Massachusetts,Maryland,Maine,New Hampshire,New
York,Rhode Island,Virginia,Vermont
B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed
in item [3]A. The limits of our liability under Part Two are:
Bodily Injury by Accident - each accident $1,000,000
Bodily Injury by Disease - each employee $1,000,000
Bodily Injury by Disease - policy limit $1,000,000
C. Other States Insurance - Part Three of this policy applies to all states, except any state listed in
item [3]A. and the states of North Dakota, Ohio, Washington, and Wyoming.
D. This policy includes these endorsements and schedules:
See Extension of Information Page - Schedule of Forms
[4] Premium
The Premium Basis and, therefore, the premium will be determined by our Manual of Rules,
Classifications, Rates, and Rating Plans. All required information is subject to verification and change by
audit. (Continued on another page)
Total Estimated Policy Premium $ 34,524
Total Surcharges/Assessments $ 1,245.00
Total Estimated Cost $ 35,769.00
INTERNAL USE XX Page - 1 - Information Page
MGA BOWC757933 WC 000001A
Date : 06/20/2016
MANOTE
Issuing Office: P.O. Box A-H, 16 S. River Street, Wilkes-Barre, PA 18703-0020 • www.guard.com
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: TD BANK 175 MAIN STREET NORTHAMPTON, MA
The debris will be transported by: USA HAULING
FG RECYCLING 3 SHOHAM ROAD EAST WINDSOR, CT
The debris will be received by:
Building permit number:
Name of Permit Applicant JOHN GAVIN, BOSS CONTRACTORS, INC.
e/5/2016 // A 14P-friV
Date Signature of Permit Applicant
The
Colebrook
Group
Real Estate
Brokerage,
Management,
Development
&Consulting
1 Colebrook 110 Main Street
0
01103
413-781-0066
August 2,2016 413-732-8124 fax
Ms.Tina Miraglia
TD Bank,N.A
Enterprise Real Estate
US Lease Administration
17000 Horizon Way
NJ5-005-105
Mt.Laurel,NJ 08054
RE: 175 Main Street,Northampton,MA
Dear Ms. Tina Miraglia:
Please be advised that Main Street LLP has reviewed the proposed renovation/alteration drawings by
Bergmeyer Associates, Inc. dated June 14, 2016 for renovations to your Demised Premises and is providing
their consent to the proposed renovations/alterations.
Consent to these renovations/alterations is predicated on your compliance with all of the following
requirements:
• Prior to the commencement of any work,provide the Landlord with a certificate of insurance from the
general contractor naming Main Street LLP and Colebrook Management LLC as an additional insured.
• The construction area must be secured each day at the completion of activities.
• Disruptive work that interrupts normal operations of adjacent tenants must be done off-hours and
scheduled in advance with the Landlord.
• HVAC alterations must not adversely impact the building system. Any re-balancing of the system or of
your space required after the alterations are complete will be done at your expense.
• No roof penetrations or outside wall penetrations are to be done without prior review by the Landlord.
• Should the contractor adversely impact any common area or building systems during this project the
affected systems will need to be repaired immediately at your expense.
• All Building Code issues or compliance issues of any authority with proper jurisdiction that may arise, as
a result of the alterations will be resolved at your expense.
Also enclosed please find the building permit application which has been signed on behalf of the Landlord,
Main Street LLP.
Should you have any questions please call.
Sincerely,
COLEBROOK MANAGEMENT LLC
As Managing Agent for
Main St LLP
Kevin Morin
Vice President
www.colebrookrealty.com
0:%axoak Reeky
Martha Dimauro serwces rnc,
Property Manager 1441 Main Stint
SprMstiekl,MA01103
413.781-0066 x113
413.732-8124 FAX
41343725F8CEtt
m.am6urooColebroOkfleelty.mn
www.0 isbmokflealty.am
SCteeXock
Kevin Morin The Colebrook
Woe President Group
1441 Main Street
Springbaid,MA 01/03
453.785-0086
413-732-8124 (Fax)
413497-2684 (Cell)
Nevin Morin@CalebrookReefty.com
IC Colebrook