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23A-068 (13) 100 MAIN ST-FLORENCE BP-2017-0802 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23A-068 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-2017-0802 Project it JS-2017-001337 Est. Cost:$115247.00 Fee: $400.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: CROCKER BUILDING CO INC 067805 Lot Size(sq. ft.): 20865.24 Owner: OM BHAVYA INC Zoning:GB(I00)/ Applicant: CROCKER BUILDING CO INC AT: 100 MAIN ST - FLORENCE Applicant Address: Phone: Insurance: 186 STAFFORD ST (413)737-7803 Workers Compensation SPRI NG FI ELDMA01104 ISSUED ON:12/21/2016 0:00:00 TO PERFORM THE FOLLOWING WORK TENANT FIT OUT OF HALF THE 1ST FLOOR 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 12/21/2016 0:00:00 $400.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner , , . •. sy 001 ofil File#BP-2017-0802 0 I /.:> �tk APPLICANT/CONTACT PERSON CROCKER BUILDING CO INC 0(C ADDRESS/PHONE 186 STAFFORD ST SPRINGFIELD (413)737-7803 PROPERTY LOCATION 100 MAIN ST-FLORENCE MAP 23A PARCEL 068 001 ZONE GB(1001/ T}i1S SECTION FOR OFFICIAL SE ONLY: PERMIT APPLICATION C - t (ST Ey LOSED REQUIRED DATE FORM FILED OUT Fee Paid c Building Permit Filled out (( Fee Paid TvneofConstruction: TENANT FIT OUT OF HALF THE 1ST FLOOR New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 067805 3 seis of Plans t Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: pproved 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 2(Z/16 Signature o 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 40k Contact Office of Planning& Development for more information. )3A n Co11 Version!.7 Commercial Building Permit May 15,2000 _�. . .. ,—_ Department use onry City of Northampton Stains of Permit _ Building Department Curb Cut/Driveway Permit I DEC 2 I { 212 Main Street Sewer/Septic Availability L_ JI Room 100 _ Northampton, MA 01060 Two Sets of Swclural Plans --_ "-- phone 413-587-1240 Fax 413-587-1272 PIoVSIte 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 DWELLLLINGr - SECTIONI -SITE INFORMATION o"" . " pl ns 1.1 Property Address: This section to be completed by office J /yyh r J Map Lot Unit Floyeara.,w44 v1 e62 Zane Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ,r g//HV/,f Ire. 99 Aso le s f,F/ren« rM/1 64062 Name(Print) Current Mailing Address'. Y/3-566-066- Signature Telephone 2.2 Authorized Anent: Name(Print) Current Mailing Address:. Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. BuildingcUrY7.60 (a)Building Permit Fee 2. Electrical 1( q�/ (b)Estimated Total Cost of 7 z(160Q.OV Construction from(6) 3. PlumbingA' Building Permit Fee 4. Mechanical(HVAC) 6' - -- 5. Fire Protection 4 Da 660-(2 yy - - 6. Total=(1 +2+3+4+5) I4/S:2y9.Po Check Number p3 k IOC This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date Cailia(AI oawd �Vlu Es cip31 &L tese Gf-oCiteb4t' , com Version1.7 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 0 Demolition 0 Repairs 0 Additions X Accessory Building 0 Exterior Alteration ❑ Existing Ground Sign 0 New Signs 0 Roofing Change of Use❑ Other❑ Brief Description iiiragrasbubisraMBIHipMerrisberst. I / I� Ixt, (� Of Proposed Work: 9 i nc..J .yl'*-o.,i tYt H4 }.. ✓� a ] I s� cv(. SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 0 A-2 0 A-3 0 IA 1 0 NN[5 A-4 ❑ A-5 El 1B ❑ ip B Business 2A ❑ E Educational 0 2B 1 if F Factory ❑ F-1 0 F-2 0 2C ❑ H High Hazard ❑ 3A El I Institutional 0 1-1 0 1-2 0 1-3 0 3B ❑ M Mercantile 0 4 0 R Residential 0 R-1 ❑ R-2 0 R-3 ❑ SA g, 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) / i' 4 771,se 1 st 2nd 1.11y5 2a 9' 311 4th 4th Total Area(sf) 3 iv/ Total Propose. ew Const ction(sf) Total Height(ft) :`' Total Hecht ft / 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: *�// 7.3 Sewage Disposal System: Public" Private 0 Zone Outside Flood ZonellCl Municipal iCl On site disposal system Versiont?Commercial Building Permit May 35,2000 8. NORTHAMPTON ZONING allaillaill Required by Zoning This column m be tilled in by BundlnredDepartment Min®® eIMIMIIIIIIIIIIIIIIIMIMIIIIIII Setbacks Front Side 11111111111111 Rear Building Height -®® Open Space Footage -®--_ (Lot area minus bldg&paved arkinr _ MIIMMMIIIIIOIIIIM IIMIMIIIII IIMMIIIMIIIIMIIIMIIIIIIMIIIIMIMIIIIII EIIIIPIIMIIIIIMIIIIMIIIMIIIIIIIIIMIIII A. Has a Special Permit/Variance/Finding ever been issued for/on the site? y' NO Q DONT KNOW 0 YES lsl.r IF YES, date issued: J IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES Q IF YES: enter Book . Page and/or Document it B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES 45 NO Q IF YES, describe size, type and location: on /jy,ld as D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,ex vation,or filling)over 1 acre oris it part of a common plan that will disturb over 1 acre? YES Q 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:`J 1 a,' _ N�Apphca le ❑ rC <r< ox . _. Name(Registrant): Or Th. //e' 08.4 1 C7 /eml/ ,j /` lr. A JN Ih 3S,`, Registration Number Address "1?' Expiration Date Y/3sa�-1"rat 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 Expiration Date 9.3 General Contractor Crs<t-. Balks (,rp 9 Not Applicable 0 Company Name: Responsible In Charge of Construction CS-- I6 $$141,1LJ, %,hst�p r/d tt4 J.1. : 1,4/2as- Address Q Y/3-737-75k3 Signature Telephone Version 1.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes O No OA SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT�GOR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, " `a u Ira- /V 5 Pc " IE"L - _ , as Owner of the subject property • hereby authorize C(,DF7ei plv/� i0Fhn to act on a y behalf, in all ma =r Jature2 rk authorized by this building permit application. big a ure o wner Date I, - ,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 penury. Print Name Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Constructioni /2ra C«k.. ' Supervisor: ,• Not Applicable 0 N'/ Name of License Holder: T/ C5-JL7kor License Number Address Expiration Date -reG 5n *s / W,1bFd4 . PI� o/oss '/ainD2 � /' W3-7s? 7?'3. Signature Telephone SECTION 17-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.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 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: Jao ,. h 5 i l7.rw... di don The debris will be transported by: A/yb.,,al.K, f leexaks KtsG,,; 1/43-sb9-Yws The debris will be received by: Building permit number: Name of Permit Applicant OF1 (i{/f} 1//Yi 4 t. /19//‘ Date �- Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents I —_-= I 1,- Office of Investigations =' _ 1 Congress Street, Suite 100 «= Boston, MA 02114-2017 "COSI www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /, rr�� Please Print Legibly Name (Business/Organizatioon/Individual):_eree/ct, t3o.'/(.// en Address: /8 /�y 5A L2r J 5k- City/State/Zjp: K i rl o//o9 Phone #: 9/3-737-Jea, Are on an employer? Check the appropriate box: Type of project(required): I. Jt I am a employer with .-.04. ❑ I am a general contractor and I T employees (full and/or part-time).' have hired the sub-contractors 6. ❑ New construction listed on the attached sheet. 7. [' Remodeling 2.❑ lam a sole proprietor or partner- ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in anycapacity. employees and have workers' a ty [ 9. [' Building addition [No workers' comp. insurance comp. insurance. required.] 5. 5 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 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' 13.0 Other 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 him outside contractors must submit a new affidavit indicating such. tContractors 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: Avg. w}/y i i K 7i-Sq.,cs hie t- avant Policy#or Self-ins. Lic. #: OS i4 FA cit 11,11B Expiration Date: 3I3)/l7 Job Site Address: lao Iiet, , City/State/Zip: •Fora 44) 61o42 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 certif . ,der the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: ).7f1Y/1I Phone#: 5r/3— 737-7bv) 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): • 1.Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ---'1 CROCK-1 OP ID:AD ACRO' CERTIFICATE OF LIABILITY INSURANCE DAIEIM"re°"`"n 12/14/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND 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 policy(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 mt 97 CENTER STREET PHILLIPSINSURANCE AGENCY INC ie CONTACT€Angela 3-594'59845tino- -_ 1 Mi NPI:413592-8499 CHICOPEE,MA 01013 EMAIL -- Chris Rivers ADDRESS:Angele2phillipsinsurance.com - INSURERISI AFFORDING COVERAGE _ NAICM NSURER A:The Hartford 129459 INSURED Crocker Building Company Inc NSURER SI 186 Stafford St _- --- — — Springfield,MA 01104 NSURER C: - NSURERD: NSURER E: NSURERF: - . _ _.. . COVERAGES CERTIFICATE NUMBER: 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. INSWOOL SUSR O - -- rPOLICY EFF POLICY EXP -- "-- LTR TYPE OF INSURANCE ALSO Mei POLICY NUMBER (MMIOM'YYYI I MmNYYYVI LIMITS A I X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 __ CLAIMS-MADE OCCUR X :08UUAQT9436 04/01/2016/:04/01/2017•vA sE5( $ 300,000 EXP{Any one person) $ 5,000 rPERSONAL a I ADM INJURY s 1,000,000I _ G REGATELIMIT APPLIES PER. IrC LAGGREGATE 3 2,000,000 ' ]wcv X' ECLoc IP c •wmProPAcc S 2,000,000 I _ aOTHER: AUTOMOBLE LIABILITY : I I COMBINED SINGLE LIMITA X a (Ea accident) ° 1,000,000 vAUTO III 08UENOT9437 04)01/2015:04/01/2017 I BODILY INJURY(Per parson) S ALL OWNED SCHEDULEDI ' - - - AUTOS AUTOWNED BODINJURYIP^,amtlenllI •HIRED AUTOS AUTOS PRO DAMAGE(Per acaden1) ISE E X UMBRELLA LMB I X ''occUR EACH OCCURRENCE IS 10,000,000 A I EXCESS LIAO 1 uIMSMADE'I 1100RHAQT9439 104/01)2016 04)01)2017.AGGREGATE I$ 10,000,000 DE I X RETENTIONS q 100001 I I E AND EMPLOYERS' YERS LIABILITYlit %TION ; ST I ER I R A NEREXE unVE YIN OBWEAQT9430 04/01/2016104/01/2017;E Enc comENT E _ 500,000 :OFFIIIMoodeoMEMBER EXCLUDED? N IxIAI CT INCL AS 3A STATE aenbem I I ISL.DISEASE-EA EMPLOYEES 500,000 DESCRIPTION OF OPERATIONS below I I I EL.DISEASE.POLICY OMIT I S 500,000 A Rented/Leased Equi 1 000UAQT9436 04)01)2016104/01(2017':Rented Eq 200,000 A CT Auto 000EAAY2066 04/01)2016104/0112017 CSL 1,000,000 DESCRIPTOR OFOPERAToNs I LOCATIONS I VEHICLES(ACORD 101,Additional Romano Schedule,,Payne attached Mmmn spats Is required) RE:100 Main Street-First Floor Fit-Out The City of Northampton is Included as Additional Insured on the General Liability policy where required due to written contract. CERTIFICATE HOLDER CANCELLATION CITVNOR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS, Building Department 212 Main St AUTHORIZED REPRESENTATIVE Northampton,MA 01060 aT/©- 'L M ORL / - J ®11988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety l -� Board of Building Regulations and Standards License: CS-06ESOE Construction Supervisor WILLIAM D CROCKER,JR 38 SPRINGFIELD ST y WILBRARAM MA 01686 r "^� .rns l� Expftation. Commissioner 04118/$018 Initial Construction Control Document lick)�1 To be submitted with the building permit application by a l� V Registered Design Professional V�"f : q for work per the ft'"edition of the_� err e Massachusetts State Building Code, 780 CMR, Section 107 Project Title: :ge—/� Yk 6x_f_ Date: ___.-_`____ Property Address: _.ja2 J�i&2/0% .. :447. a .zr A la de-__ Project: Check one or both as applicable: New construction 1J,1 Existing Construction ,. �.7y/ Project description: Q-_.11AL.6 d�-'-aiC , s.2/L-fl e u.2—_-caeC -�.sr-" 1 6a,citsre.Y4 MA Registration Number. 6 31 Expiration date. f: 17 , am a legister eddesign professional, and I have prepared or directly supervised the preparation of all desigi plat computations and specifications concerning: Architectural [ ] Structural [ 3 Mechanical I Fire Protection [ ] Electrical [ ] Other for the above named project and that to the best of my knowledge,in forumtion, and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts Slate 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 and be present on the construction site on a regular and periodic basis to: I. Review, for conformance to this code and the design concept,shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perforin 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. 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 hem 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall subm' official a 'Final Construction Control Document'. Enter n the space natu to the right a "we-" so D � electronic signature and sent', ` �,� Tor. Phone number: - >. / Bann W• 4 fficial Use Only Building Official N -. . Permii No RUC: Version 06_11 7013