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31B-081 (4) 131 KING ST- SERVICENET BP-2017-0551 cis : COMMONWEALTH OF MASSACHUSETTS Mao:Block: 31B- 081 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) catecorv: window replaced BUILDING PERMIT Permit= BP-2017-0551 Proieet= JS-2017-000$91 En. Cost: $500¢0 Fee:S100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: THOMAS GROSS_ 059093 Lot Size(sq. ft.): 24480.72 Owner: Servicenet Inc yning ly),0 L Applicant THOMAS GROSS AT: 131 KING ST - SERVICENET Applicant Address: Phone: Insurance: 237 Plumtree Rd (4131665-8235 Workers Compensation SU NDERLANDMA01375 ISSUED ON:1O12112016 O:OO:OO TO PERFORM THE FOLLOWING WORK:REPLACE 5 WINDOWS ON RIGHT SIDE BACK OF BUILDING 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: FeeTvpe: Date Paid: Amount: Building 1021/20160:00:00 S100.00 212 Main Street,Phone(413)587-1140,Fax:(413)587-I272 Louis Hasbrouck—Building Commissioner File#BP-2017-0551 APPLICANT/CONTACT PERSON THOMAS GROSS ADDRESS/PHONE 237 Plumtree Rd SUNDERLAND (413)665-S235 PROPERTY LOCATION 131 KING ST-SERVICENET [MAP 3IB PARCEL 081 001 GONE GB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildine Permit Filled out Fee Paid Tvpt^of Construction: RELA E 5 WINDOWS ON RIGHT RIGHT SID ACK OF DING New GN Structural m Non Structural interior renovatipns 4111V Addition to re Accessory Structure Building Plans Included: Owner/Statement or License 059093 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOy,RMATLON PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UN PERT' 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 10- volition D- y Sig' tore of Buil litg ifficial 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, 21. _ Version 1.7 Commercial Building Permit May 15,2000 "Q /,A -/ 1 Department use only �� / City of Northampton Status of Permit '11 7 '• -/ Building Department Curb CutaDrtvewey Permit - 212 Main Street Sewer/Septic Availability fi c Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 PbUSite 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 �_ Map Lot Unit / 3 / AO s/ Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Ser✓7To /Vrei /A., C. /1/ k/A/� r Pint 1 9 �✓c r12%�.�N.,...✓ Name (t ) Current Marling�Sd°es�`.-' it arxr+i//v-71 Crz,sl _5:r 4-' e-0 '//7- frs- /so0 Signature 4 Gs' / 'r. Telephone 2.2 Authori ed Agent: �/ -IA pr7/ Cj 'faJj /3/ /A c 21 Name(PnCurrentMailing n C .entAddress: 5 / r`t`/ef R�q%o-a_ /{tORM c, `le 65-r-1-) `i/1 -cc`7S• f'9- 0Y3 7 / Signature Telephone e-ma ro5S �'_Strsir CL 4e p SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant _ 1. Building P S— 01 Cm (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 _ / v 6. Total=(1 +2+3+4+5) 'KIP O Check Number / 7 Gi300.4 "9,70.0 This Section For Official Use Only Building Permit Number Date Issued I Signature: Building Commissionerllnspector of Buildings Date ServiceNet Integrated Human Services 129 King Street • Northampton, MA 01060 • 413.585.1300 • Fax 413 5824252 • wwwservicenetorg • Susan L. Stubbs, C.E.O. anWar.[ Version 1.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations 0 Existing Wall Signs ❑ Demolition Repairs Additions 0 Accessory Building 0 Exterior Alteration ❑ Existing Ground Sign❑ New Signs�} ❑ Roofing❑ Chang,of Use 0 Other ❑ Brief Description Enter a brief desedptio jxay here. ' — S W/r-s`""-t' 0"V- rt yl Jr c1 1D Of Proposed Work: „x4i c- 4v{ �2/ SECTION 5)USE GROUP AND CONSTRUCTIONTYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 0 A-2 0 A-3 0 1A I 0 A-4 0 A-5 0 is 0 B Business (. 2A 0 E Educational 0 . 213 0 F Factory 0 F-1 0 F-2 0 2C ❑ El High Hazard ❑ 3A 0 I Institutional 0 1-1 0 1-2 0 L3 0 36 P M Mercantile 0 7 4 0 R Residential 0 R-1 0 R-2 0 R-3 0 5A 0 S Storage ❑ s-1 0 5-2 0 5B 0 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(st) 1 s 1F it 3" 4 4m Tota Area(sf) Total Proposed New Construction tsfl 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 0 Private 0 Zone Outside Flood Zane❑ Municipal 0 On site disposal system ServiceNet Integrated Human Services 129 King Street • Northampton, MA 01060 • 413.585.1300 • Fax 413.582 4252 • u•wwservtcene&org • Susan L. Stubbs, C.E.O. m:as Version I.7 Commercial Building Permit May 15.2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning PVA column be Iiihai in by Building Dcpeument Lot Size Frontage Setbacks Front Side L Rear Building Height Open Square Footage 4a Open Space Footageid8& parkin)mime:bJn'�&paved parkina) if of Parking Spaces Fill: bcaume&tocanooc A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES a IF YES,date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES d IF YES: enter Book Page and/or Document B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained O , Date Issued: C. Do any signs exist on the property? YES (J NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O 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 Q NO 0 1F YES,then a Northampton Storm Water Management Permit from the DPW is required_ ServiceNet Integrated Human Services 129 King Street • Northampton, MA 01060 • 413.585.1300 • Fax 413.582.4252 • www.servicenet.mg • 59san L. Sntbhs, CEO. rater Azn,v Version)7 Commercial Building Permit May 15, 2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 790 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 9.2 Registered Professional Engineer{s): Name Area of Responsibiftty 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 Expiration Date 9.3 General Contractor Not Applicable 0 Company Name. Responsible In Charge of Construction Address Signature Telephone ServiceNet Integrated Human Services 129 King Street • Northampton, MA 01060 • 413 585.1300 • Fax 413 582.4252 • www_servicenetorg • Susan L. Stubbs, C.E.O. U t.e w.,: Version1.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.1} independent Structural Engineering Structural Peer Review Required Yes 0 No ev. SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR� w� APPLIES FOR BUILDING PERMIT I, Sr per'r5Ar c f /Arc s Owner of the subject property hereby authorize'ail Cr(>/ p Si to act on r - a in all matters relative to work authorized by this building permit application. Signet i Owner Date I, ti 67_c_f ,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 u .r the pains and penalties 000fffo airy. Print me —f / .nn z /J U /z CI / a/Y/i4. Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 1 10.1 Licensed Construction Supervisor: / w Not Applicable ❑l 7 Name of License Holder io /Y Ctrs J C5 0 J90 vJ License Number 237 PL✓pnil YC 2l 5I,Ir I .2JFT *1 V ? Address / Expiration ^ 1_ANte,- _�. 41ir -J'7S-cYI7 Signature Telephone �'I 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 tot provide this affidavit wdl result in the denial of the issuance of the building permit. Signed Affidavit Attached Yens' No 0 ServiceNet Integrated Human Services 129 King Street • Northampton, MA 01060 • 413 585.1300 • Fax 413.582.4252 • wwwservicenet.org • Susan L. Stubbs, C.E.O. uunsermm unr u. 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: / / 4, s The debris will be transported by: _iFn,., Ci—c-; ) The debris will be received by: , K 1, „f' Building permit number: Name of Permit Applicant c i I 1 Date Signature of Permit Applicant (07A ServiceNet Integrated Human Services 129 King Street • Northampton,MA 01060 • 413585.1300 • Fax 413.582.4252 • wwwserviceneLorg • Susan L. Stubbs, C.E.O. V The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations > 1 Congress Street, Suite 100 Boston, MA 02114-2017 ,y' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly -- N81rie (Business/OrgmnizetioNlndividue[): / l.r,'_/11C/ //yr. _ Address: / t City/State/Zip: -r 7jrD l.r✓ Z•2 - Phone #: Y/1 �S-71-,.041.77. Are you an employer? Check the appropriate box: Type of project(required): 1.K I am a employer with 4. E I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. R.Rcmodeling , ship and have no employees These sub-contractors have g, Q Demolition working for me in any capacity. employees and have workers' 9. Ej Building addition [No workers' comp. insurance comp. insurance/ required.] 5. fl We are a corporation and its 10.0 Electrical repairs or additions 3.E I am a homeowner doing all work officers have exorcised their I I.❑ Plumbing repairs or additions myself [No workers comp. right of exemption per MGI. 120 Roof repairs insurance required.] ' e. 152, §1(4), and we have no employees. [No workers' 13.E Other comp. insurance required.] _„ *Any applicant that cheeks box n I must also nil ow the section below showinh their.cot-kers'compensation policy information. `Homeowners who submit his affidavit indicuf g they are doing all work and then hire outside contractors must submit a new affidavit- tcating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and s rare whether or not those entities hare employees. If the sub-contractors have employees,they must provide their workers'comppolicy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the polity and job.site information. /'� / Insurance Company Name: /Yrs /J X e r 74 Cri fi Policy#or Self-iris. Lie. 4:_,0/01603 f 0170 0 9//4. Expiration Date: / /*/Jy7..0/ 7 Job Site Address: /LI 9 .Y City/State/Zip:, /V V enc-' - 0/c Ca Attach a copy of the workers' co enation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A ofMGL c, 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a line of up to 5250.00 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 of perjury that the information provided above is true and correct Si_tature: 4/...:�_. /'/ _ .i7 Date. / V/C Phone#: 41 Z3 575 - e"9.'37 .. 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#: _ ServieeNet Integrated Human Services 129 King Street • Northampton, MA 01060 • 413,585.1300 • Fax 413.582.4252 • wwwservicenet org • Susan L. Stubbs. CEO. 1 A 8 CERTIFICATE OF LIABILITY INSURANCE DATE I T/T/2o16 1 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS ICERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFOROED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED I REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IIMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to I the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the i certificate holder in lieu of such endorsement s). I0C PR00ER cos C Sandi Zagenlaoz !Webber b Grinnell I,y>CNNLmu, (413)586-0111 mac At Ian)S86-6481 '8 North Icing Street I VrtIless szegan ecaBwebberandgrannell.com 1 INSUR£RISI AEYOROMG COVEPAOE NN[a Northampton MA 01060 (INsuP A:Philadelphia Indemnity/PA Ins. NATO INSURED I INSURER BMA Healthcare Group/Co-eRiak ' 1 ServiceRet, Inc. !USURER C: Attn: Kathy Lorenz INSURER 0• 129 King StreetNSURERE. I Nrgr orthaton MA 01060 INS REEF: COVERAGES CERTIFICATE NUMBER:Exp. 1/2017 REVISION NUMBER: i THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO 1HE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 10 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED 9Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, i EXCLUSIONS LIMITS SHOWN MAY HAVE BE NREDUCEDBYPAIDCLAIMS- COM ERPELF I ERLOR�Ln SUCH POLICIES POLICY NUMBER IMFAIFcy EFF POi+CYC%P Lm ca QMTY 1/NON EXP HMOS AL EAC .o CUPRENCE E 1,000,000 t hAtE X OCCUR vP_.FMB ZE O ec 100,000 A 2_ OLE . - sc. : PHVa1436033 : 1/1/0016 S/1/101Ot+e-' %P' -.es�.-. - 5,000 a , PERSENAA b AEAIvsily S 1,000,000 I_GENI.AG R GA'S''JM.TAPP!EB?ER: CP FGA GGREG F $ 3,000,000 X "CLCY PRO LOO ,AR021.055,.COMP CP AGO 5 3,000,000 OIfiER. S AUTOMOBILE LIABILITY D,ru 0RT. E ..M1 I. 5 1,000,000 A X nAurc EU dna. 5 ALL NMEL CHEOOLAO PBOB143B033 1/1/2016 1/1/2017 ROD, N 4 .ec �$ A04'05 , AUTOS VON.OINNEO PROP EMCEE K imisi.UZOS K Au-as 5,50 CA, PVYMRNTS 'S 5,000 UMBRELLA LAB :000Oy EACH OCCURRENCE 5,000,000 e RCGATE a 5,000,000 A '.x EKEssuAOCiAMS,d596 A up '' 1L,RETENTIONS 10,000 PW19404465 1/1/4016 1/1/2011 MACRE COMPENSATION x a WOm E eA AND£MPI 9UARIETY % Ah RU ETO W1% T E T. NIF C P CC 0 RT 500.000 F CER/ME NH uoE N 019003100004116 1/1/2016 1/+/2017 - 500,000 N 'OF CE ry NH} _ ' DESCRIPTION RP. OPERA ENSAAA. vI I/GRASPPOE cYl s 500,000 A 'PROFESSIONAL PRUB1438033 1/1/2016 1/1/2017 PEP AC,C_NT 1,000,000 SGC' A-E 3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES RIGOR°101.AE01ebnel Remarks SMatlule.may be attached it more apace Is nOUNedl --aapw CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES RE CANCELLED BEFORE FOR INSURANCE VERIFICATION THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I , AUTHORIZED REPRESENTATIVE i; _ L--)(<4' 1,G1L . s. Pe_.._ ©IS88-2014 ACORD CORPORATION. Alt rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ($5025;TAM. ServiceNet Integrated Hunan Services 129 King Street • Northampton, MA 01060 • 413.585.1300 • Fax 413.5824252 • www.servicenet org • Susan L. Stubbs. C.E.O. OMS Veit 0002 lc or Tim!ertj d ct avalla Ith and cin, NORTHAMPTON ARMORY F gs e_ to charge. SERVICE NET Oirate t;caber.2PDM6F7 A 2hitect utal Project Nun'net: LINE ITEM QUOTES The fototving is a scheduleo he windows and doors for this nroect. For additional mut n to s,pease see Li-e Item Quotes, Additionalcharges,tax or Terms and Conditions of ay apply. Detail pricing is par unit. Line Pt I Marx Unit'1 VPf A Net Price:: Qty-5 ce: 893 00 -fNF1NTTY` .. - ex 'SEI'-re: PSD 446e00 MAPVIN Hindu upper sash wiu stationary. Sa..t LS Hrair ho ar m Egress es'i Eginformation Performance Infotc` ia Story 0 25 V F CvmG t tight' - r5c Condertation Mrs 'a L b- MAN 244 Hari r.HOOT PetorPert mence ranuc SES Grade . .a)6H2rf Project Subtotal Net Pdce:USE; 4,466.00 6.250%Sales Tax: USE, 279.12 Proiact Total Net Price: USD 4,745.12 < 0 ir '. „d ,. of ServiceNet Integrated Human Services 129 King Street Northampton, MA 01060 • 413.5851300 - Fax 413.582.4252 • wnwscrvirenetorg • Susan L.Stubbs. CEO. myr P.m-}mo service rims innovative mental health and human services October 20, 2016 I request that you grant a modification to waive the requirement for control construction for the replacement of 5 windows at 131 King Street in Northampton because the work is of a minor nature,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. "Mass Amendments,sections 107.1 allows for an exclusion from control construction for this project" Respectfully,g/ Thomas H. Gross Facilities Supervisor Human Resources 296 NonOtUCs Street • Florence. MA 01062 Phone 415 3871105 • -ax 417 582 0367 ...... ._rvicenetora iir