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32C-001 (56) 150 MAIN ST-REBEKAH BROOKS BP-2017-0728 GIS a: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C-001 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 Permax BP-2017-0728 Project# JS-2017-001204 Est.Cost:$5215.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const,Class: Contractor: License: Use Group: MARK SMITH 104325 Lot Size(sq. ft.): 16683.48 Owner: THORNES MARKETPLACE LLC C/O HPMG Zoning:CBIl00)/ Applicant: MARK SMITH AT: 150 MAIN ST - REBEKAH BROOKS Applicant Address: Phone: Insurance: 5 ANNA ST (413) 531-7342 WAREMA01082 ISSUED ON:11/30/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:SOUNDPROOF 2 - 8X8 WALLS. BUILD 8X8 WOOD CEILING 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 q 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 11/30/2016 0:00:00 $100.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0728 APPLICANT/CONTACT PERSON MARK SMITH ADDRESS/PHONE 5 ANNA ST WARE (413)531-7342 PROPERTY LOCATION 150 MAIN ST-REBEKAH BROOKS MAP 32C PARCEL 001 001 ZONE CB(I00)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST CLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid ` Building Permit Filled out Fee Paid TvpeofConstruction: SOUNDPROOF 2-8 ' • LS.BUILD 8X8 WOOD CEILING New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owned Statement or License 104325 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: 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 ire i //-3d/7 Sig . rre of Bu"ding •`ficial 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. Versionl.7 Commercial Bulletin Permit May 15,2000 nBPerbnerlts_t ?..Y h4," City of Northampton *tun of Pernik y;5" c, afe ..L Building Department 212 Main Street Se t - _ ,tr Room 100 Northampton, MA 01060 Tr -Sets phone 413-587-1240 Fax 413-587-1272 PIotSta oho,. 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 Properly Address: This section to be completed by office Rebekah Brooks Map Lot Unit 150 Main Street Suite 17 Zone Overlay District Northampton, MA 01060 - -- - - -- Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Thornes Marketplace LLC 150 Main Street Suite 6 Northampton MA 01060 Name(Print) Current Mailing Address 0rJ , ^ (413) 5829970 Signature Telephone 2.2 Authorized Anent: Mark Smith Name(Print) Current Mailing Address 5Ma/.w.A�t�S. (AN rM4 Cron— Signature ron Signature 1/1/4-1‘11461.1' Ltr� Telephone 2]- Sat-73'LZ SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $3,500.00'. (a)Building Pem tt Fee 2. Electrical - $850.00 (b)Estimated Total Cost of Construction from(6) --. 3. Plumbing -� - $0.00. Building Permit Fee 4. Mechanical(HVAC) - _-- 5. Fire Protection $865.00 6. Total=(1 +2+3+4+5) `7 SZ( S . CCD . . . Check Number 4-/a3 /re7 This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date 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 0 Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description Enter a brief description here. Of Proposed Work: �`U mb9cooF 2. - $x0p 144 5 '0,4.uu fizz Woof cc,( H SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) ICONSTRUCTION TYPE A Assembly A-1 ❑ A-2 ❑ A-3 ❑ 1A I ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business g 2A ❑ E Educational ❑ 28 I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A t�.❑, I Institutional 1-1 011-2 ❑ 1-3 ❑ 3B 1� M Mercantile 4 0 R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A 1--I S Storage ❑ S-1 ❑ S-2 ❑ 58 as U Utility ❑ Spedfy: •• 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) gig 1" ICXg • - 3itl 3m Total Area(sf) Total Proposed New Construction(sfj_-__ Total Height(ft) _ --- _ ____. . Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood ZAn4Jnfonnation: 7.3 Sewage Disposal System: Public 0 Private ❑ Zone __- Outside Flood Zone❑ Municipal 0 On site disposal system❑ Li Version1.7 Commercial Building Permit May IS,2000 SECTION 10.STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION II -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, J0(V -VV--c--Ge—e," Rt C'Ti as Owner ofthe sublea property hereby authorize .- lt"-SU- illt-__ _______._.._— MY`Yf^1 u1 GOMChJk�ri &ie- ito act on my behalf,in al a%=rs relati , to work authorized by this building permit application. On ,�/__ Signature of ODate I, 44-.S.731-_-____._.- -- -_ 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 h airs d • s f_pgripry. • Prim Name _""` NArk. Sum (( (701f(. �__ _ Signature of Owner/Agent ate SECTION 12•CONSTRUCTION SERVICES 10.1 Licensed Construction�Supervisor� _ Not Applicable ❑ Name of License Holder __7TtAL.k,k im•rl _ ___._ _ �.......J �{ CS -_to-F 3Z-5" _ License Number • 5_AnNA _ W ill.L ___oto$2— 1711i i i2l(3 [20r1 _ Address Expiration Date lout Signature Telephone ) SECTION 13 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§25C(61) 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 y�{ m Signed Affidavit Attached Yes �7 No 0 ! .1 s E I 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. R. ___ ____ -...._ Rear __-__- _ ._ ---- Building Height Bldg.Square Footage - % --- _-- • Open Space Footage __ % _ -. ----- (Lot area minus bldg&pave] ------ parking) #of Parking Spaces - -- """- - _ -- Fill: • (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW 0 YES O IF YES: enter Book Pagel i and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained 0 , Date Issued: • C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0 IF YES, describe size, type and Location: E. WII the construction activity disturb(clearing,grading,exczn(ation,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. Version1.7 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 95,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: -9Al1\!_ C5 Not Applicable C Name(R strant) K Aja- Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number • i I 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 ApplicableC Company Name: Responsible In Charge of Constmctlon Address Signature Telephone 4 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: 15) MAul S{. The debris will be transported by: INOODNACI1t5 'I ' c� t The debris will be received by: Ti CA ' r I K.ccyu i a; l Building permit number: Name of Permit Applicant MPt{C- Mi tT Date Signature of Permit Applicant 1 l . \ The Commonwealth of Massachusetts =,.,=.r.... Department of Industrial Accidents r=.. 1l ilUO ce of Investigations =x/r= l: 1 Congress Street, Suite 100 =1YIEI ' Boston,MA 02114-2017 •� www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ( c- Please Print Leeibly M Name (Business/Organzationdividual): Wel0b5Y4l,(x(Sj P44I,.Ic. �. ACD-1 Address: 5 AAJf-'A- CJI City/State/Zip: VP.'e, NIA C 2-'Phone#: `'[(3.5-3 -7312-- „ Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.1 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' n P ty 9. ❑ Building addition [No workers' comp. insurance comp. insurance.; required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 9 1 3.❑ I am a homeowner doing all work officers have exercised their 11.p Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 ❑ Roof repairs insurance required.] ' c. 152, §I(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 hire outside contractors must submit a new affidavit indicating such. 1 tcontractors that check this box must attached an additional sheet showing the name of the subcontractors 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: a%rt Co.41.P”/4 Policy#or Self-ins. Lic. #:�'rV(�,YnJ, OIL* I LO?j3- 10 Expiration Date:, IrOr `L �" [�7 atq,t _ i lob Site Address: t 0 I`I MPJ UT• City/State/Zip: 'bpd{ 110.49 n'J 1' A- I Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 3 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 l 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 9 Investigations of the NA for insurance coverage verification. 4 Ido hereby cert' under the p�g'iiyn�t ,{ kand penalties of perjury that the information provided above is true and correct 1. Signature: `+"" ---- Date: ii(21 flip • Phone#: 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 3 6.Other Contact Person: Phone 4: 4 / 1/7 rot, "sr liA\/ O;ty of P14"ttamPinn Building Department Iv, Plan Review EXISTING TIN CEILING.TO 212 Main Street REMAIN. NOTE'NO Northampton,MA 01060 STORAGE ON EXISTING HEIGHT CEILING OF WALL TO REMAIN NEW SPRINKLER HEAD ,� CONNECTED TO EXISTING ( 2 D �` SYSTEM. LOCATION TO BE `'7' CONFIRMED BY INSTALLER. i4Mt `V AN\5M/Vi .!!I WW. tit/V . li . . 11 I 1 E — 2X6'S 24"O.C. ±7-11 It7 1 FABRIC COVERED ACOUSTIC Il PANELS. SEE I MANUFACTERER'S � •4: INSTALLATION REQUIREMENTS. El s to, DTD GWB , 1 z (+ BASEBOARD AND CARPET r�;. TO BE SELECTED BY OWNER II 3 PARTIAL BUILDING SECTION �..,....,,/ Scale: 1/2" = 1'4Y -- V THORNES gli MARKETPLACE REBEKAH BROOKS MARKELACE EMILY ESTES iso Main west Nonnampbn,MA 10/25/16 PERMIT SET "RCXe"R1flH'""""LC p> f liWprng111111 MAIIIIrinmP,mnn!rt t?fA;MMIMnmr W WALL TO WALL CARPET Y TO BE SELECTED BY __ T-1111/2" OWNER 2X4 FABRI (COVERED SEE MANUFACTERER'S N ACOUSTIC AI FI INSTALLATION GUIDE \ I CEILING MOUNTED LIGHT C O FIXTURE TO BE SELECTED C W BY OWNER } RELOCATED SPRINKLER C I HEAD DROP BELOW NEW C I CEILING 2X4 FABRIC(COVE'ED N ACOUSTIC PANEL WI S T iX "INNLI EXISTING TO REMAIN EXISTING TO REMAIN 0REBEKAH BROOKS OFFICE FLOOR PLAN 1/2" _ 1 -0. EXISTING GWBREMAIN f//// EXISTING WOODOOD 2X42X4'S TO REMAIN (16"O.C.ASSUMED) 1/ 1 NEW BATT INSULATION,MINIMUM •1111 l Iff I 1! ft R13 -1111 iii;;;;;;;;;;;;;;;;;;;;;;;; ;;;;;;iiiiiiiiiiviiiioli 1/2 440 SOUND BARRIER ` HOMASOTE.SEE MANUFACTERER INSTALLMENT REQUIREMENTS. 5/8"GWB 7-2 WALL ASSEMBLY DETAIL J Scale: 1 1/2" = 1'-0"HORS C MARKETPLACE REBEKAH BROOKS _ C EMILY ESTES 150 Main Slreel,Nodhampton,MA 10/25/16 PERMIT SET --------.............. � / tII , r • -I ;�1 � _- X11 , ir_77,---_,t MEI ME 1SII AREA OF WORK r SI II 111 Ili*Ili MAIN STREET FIRST FLOOR PLAN 1 1/32•= 1'-0" Iiii ARKETS MREBEKAH BROOKS MARKETPLACE EMILY ESTES 150 Main Street,Northampton,MA 10/25/16 PERMIT SET 'o'RmCRIU•DUNK LLC Code Review ESTES Architecture+Design,LLC Rebekah Brooks Northampton,MA 01060 Thomes Marketplace 413.320.6199 Northampton,MA 01060 CODE REVIEW October 25, 2016 Thornes Marketplace Rebekah Brooks-Acoustic Improvements 150 Main Street Northampton, MA Applicable Building Code:MA 780 CMR Eighth Addition IBC, IEBC International EXISTING Building Code, 2009 ZONING DISTRICT: CB Proposed Renovations: Project Description: • Improve acoustic performance between 2 tenant spaces by altering existing partition wall and addition of new ceiling. Use Groups • No change to use groups. Private office to support M (Mercantile) Use Group. Construction Type • 3B, Brick exterior walls, combustible framing. Valuation of Project: • This project's construction costs are: $9,000 • The assessed value of the building is:$3,854,400 • The cost of the project is 0.2%of the assessed valuation. Areas • The total building area is 76,876 square feet. • The proposed renovated work area is: story, 6o square feet • 0.78%of total area 704 Fire Protection:The building is fully sprinkled. Existing distribution will be modified with new ceiling location. According to the IEBC this renovation is being reviewed as: Work Area Method, Chapter 4.Applicable Sections are: Chapter 6-Alterations Level 1- New finishes and fixtures Chapter 7-Alterations Level z-New construction. Work Area Method Calculations I of 4 Code Review ESTES Architecture+Design,LLC Rebekah Brooks Northampton,MA 01060 Thornes Marketplace 413.320.6199 Northampton,MA 01060 The total building area is 76,786 square feet. The existing renovated space is 1 story, 6o square feet The work area is less than 0.01%of the aggregate area of the building. The work area comprises less than 5o% of aggregate area of the building;therefore this is not a level 3-alteration project. IEBC section 405) The work area includes reconfiguration of the space and the reconfiguration of systems (sprinklers, electrical). Most of this project will be classified as a level 1 project.The alterations will follow level r guidelines. Level 1 work requirements: The removal and replacement or the covering of existing materials, elements, equipment or fixtures using new materials, elements, equipment or fixtures that serves the same purpose This Project will have new interior walls, ceiling, finishes, and lighting. 602.1 Interior finishes:All newly installed wall and ceiling finishes shall comply with the IBC. 603 Fire Protection:Alterations shall be done in a manner that maintains the level of fire protection provided. This project will not affect the level of fire protection that is currently provided. Corridors throughout Thrones are non-rated tenant separations. Fire Resistive Required Types of Building Element Type 3B Construction,Table 6m:IBC Primary Structural o Frame Bearing walls, Exterior 2 Bearing walls, Interior o Nonbearing walls and o partitions, exterior Nonbearing walls o and partitions, interior Floor construction and o secondary members Roof construction and o secondary members 2 of 4 Code Review ESTES Architecture+Design,LLC Rebekah Brooks Northampton,MA 01060 Thornes Marketplace 413.320.6199 Northampton,MA 01060 704.2,912.2.1 Automatic sprinkler systems Automatic sprinkler systems will be upgraded in the work area as needed. 704.4 Fire alarm and detection: • The building has a fire alarm system in all areas. It will be maintained. No new devices are required in this project. 705 Means of Egress There will not be a reduction of means of egress in any part of the building. IBC Table ior6a Exit Access Travel Distance: For M use and sprinklers:ego ft maximum allowable travel distance. The travel distance is 64'-8"feet from the most remote space in the space to the nearest exit door. IBC ior4.3 Common path of egress travel: For M use and sprinklers:75 ft maximum allowable common path of travel. The common path of travel from the most remote corner of the private office to a point where there are 2 choices of exit routes is 25'-8". 711 and 607 Energy Conservation: Level t alterations are permitted without requiring the entire building to comply with the International Energy Conservation Code.Alterations (new construction)shall comply with the International Energy Conservation Code. Where there are reconfigurations of the space or new doors or windows, any such new element is required to meet the International Energy Conservation Code. Elements within the building that are not being affected do not need to be evaluated and do not need to comply with the energy provisions. Essentially the entire building is not required to meet the energy provisions;only a degree of possible improvement in the energy performance of the building is intended to be achieved by making the new elements meet the IECC. In certain cases where the reconfiguration of the space might have resulted in the creation of new spaces the newly created space should be evaluated as a whole for compliance with the energy provisions even though some of the element within the space might actually not have been altered. Likewise, in a case where an existing mechanical system is being extended to other areas or new ductwork is being installed to reconfigure and reroute the ducts to various spaces, it is only required to have the new elements meet the energy provisions and not the entire system. 3 of 4 Code Review ESTES Architecture+ Design,LLC Rebekah Brooks Northampton,MA 01060 Thornes Marketplace 4133204199 Northampton,MA 01060 thou Structural: There is no structural work. 2700 Electrial New electrical equipment will comply. End of Document 4 of 4 WOODSMITHS C/O MARK SMITH 5 ANNA STREET WARE, MA 01082 1413-531-7342(BUSINESS CELL) Nov, 30 2016 To the Northampton Building Deportment, I request that you grant a modification to waive the requirement for control construction for the Rebekah Brooks project at 150 Main St Northampton because the work is of 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. The scope of this proposed project is the removal of existing drywall from 2 8'x8' walls, the framing of an 8x8 wood framed ceiling, then soundproof and drywall these 3 surfaces. Thank you in advance for your consideration. Mass Amendments, sections 107.1 allows for an exclusion from control construction for this project. Respectfully Mark Smith WOODSMITHS 5 Anna St Ware, MA 01082 1 .41 3.531 .7342 VersionI.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 [1y� SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT// OR CONTRACTOR APPLIES FOR BUILDING PERMIT __ t4c._ h" •:� r „NAL F CF I, i s.c' T;;-zr) cF 4.1C.S s .''N Q z ,as Owner of the subject properly LLC' hereby authorize �.�-i �<.� r'J.o.�c25 to act on my behalf, in all matters relative to work au0tonzed by this building permit application. x- / ¢t :nos eF !�- -v�:r✓ PET e c� -i- /Dale Signature o'o s 11.1111111111111111111111111r— I� /[ p / Dale Ef� y /�wl 'c.( AG> N^Y , 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. ams G�ts,L President,KM (! } S /( c, Signature of Owner/Agent Dale SECTOR 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor:' ' Not Applicable Name of License Holder: )Sc a -y-y ( S — f O d 1 I 1— License Number 5- oke. i S -1- rietwt,c4, A.A4- 6�Ar? tl R A s Expiratlo Dale ess President,Kill 5 b+L LJ Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MAL 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 buil rdq permit. Signed Affidavit Attached Yes 9 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 Budding Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MOL c 111, S 150A Address of the work: 14 Green Street The debris will be transported by: Keifer Builders, Inc. The debris will be received by: vaiiey Recycling Building permit number: Name of Permit Applicant Keifer Builder, Inc 09.27.16 , &t . ti � Proidcw.«r, Date Signature of Permit Applicant lije Common wealth of Massachusetts Department ofIndustrial Accidents i=t,.._" Office of Investigations L�,F R- 1 Congress Street,Suite 100 € 3' — Boston,MA 02114-2017 '. ' ' www.ntass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 1 Please Print Legibly Name (Business/Organization/Individual): (e4_11n A tt,r— _ Address: _ _...._vu.Pa,ln ---....---.....- --.�..... ....... City/State/Zip: p/ (.ete.rn c.§„ AAA Phone ii: SIG rix ' Are you an employer? Check the appropriate box: Type of project (required): L 0 I am a employer with 42t) 4. 0 I am a general contractor and 1 . employees(full and/orpart-time}.' have hired the sub-contractors 6. ®Nen construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. (I Remodeling ship and have no employees These sub-contractors have g. 0 Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers' comp. insurance comp.insurance.: 5. Wecorporation and its 10.0 Electrical repairs or additions required.] ❑ are a 3.El a homeowner doing all hark officers have exercised their 11.0 Plumbing repairs or additions myself [No workers right of exemption per MGI, Y comp. 12.0 Roof repairs insurance rcquired.J ' c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required] `Any applicant hat checks hots dl must also till out Ilse section below showing their workers'compensationpolicy information. I Honnv,eners 11110 submit this nllidavil indicating the,are doing all work and Ilion hire outside contractors must submit a new mdat II indicating such. :Contractors that check this box must attached an additional sham slowing the name of fie sub-contractors and slaw+dulhee car run(hlne entities hare anpkisees. if the sash-contractors have eopk,)yess the+must prosilk their wnekers comp.policy numkr. I am an employer that is providing workers'cnnrpensatioa insurance for my employees. Below is the policy and job site information. Q� / Insurance Company Name:_. rr 44,2114`-- lit/ __ Policy k or Self-ins. Linc/. d: /_/f 2- tin 6 [ ) — Expiration Date: Fj it, /t '4- Job Site Address: I (... 6i•-CAtn.- S4 City/State/Zip:7V (1Pt.. A/C1 de dd )- Attach a copy of the workers' compensation policy declaration page(shoving 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 tine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the forth of a STOP WORK ORDER and a line 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 rtify under the pains and penalties of perjury that the information provided above is true and correct. Sienature:?"/'Yr President,KW Date: Lt /4)--t/4 C, Phone b: 57-6 ` ` Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License N - 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 e: ACORD CERTIFICATE OF LIABILITY INSURANCE6O DATE IM/RW n 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 poIcylies)must be endorsed, It 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 eNnO TAcr Cynthia Henderson, CSR Webber & Grinnell "OPE (413)586-0111 EAX 1 (A(C Ess:c _. ., igi;.No131566-6461 B North King Street Pe16411 hendersen@webborandgrinnell.com IHVRERISJ AFFORDING COVERAGE NAIL' Northampton MA „01060. IlN6UREAA Athena Protection 43360 4.15E0E0 .HOWERa •._ I Reiter Builders, Inc. INSURER Attn: Scott Reiter INSURER b: 35 wain Street - - -- Florence HA 01062 j,WsuRER G. COVERAGES CERTIFICATE NUMBERsaster Exp 2017 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 LITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBES) HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE SEEN REDUCED EY PAID CLAIMS. miR' TYPE O[INSVRAHCE -ADD SUBP' _. _ --. POLICY E[4 POLICY ESP -_.._... m6f WV.. POUCV NUMBER . in.yon YYtLE4LOO ; WAITS X COMMERCIAL GENERAL.LIAStITY EACH OCOCRREUCE $ 1,000,000 Cu;MS.MAGE X OMR M1 G'MinATET PET YEI}. A . ...�—".. „PSESL w,�nrq__ S 100,000 :norms 396 6/1/2016 6/1/2017 MEDE P y eP.tlmcnl S 5,000 _.... _.._.. rCCCSONAL anov NvnY $ 1.000,0000 X IP2GaTE LIMIT RiP4:Pi5 GEA ifGRQGcid I 3,000,009 POUC LOG : PRODUCTS LOIMgPrGG4 2,000,000 IDMEN I .1 AUTOMOBILE WRntry I 'COM EO SENGt€UMC $ 1,000,000 LEaa t A µ AUTO BODILYINJURY( mum) 5 (MINED 71 BCrCOULEU '-- .. 100$ I_X )AUTOS 103003936101 611/2016 6/112011 •OCOP N RYAP ecclev i • in PROP Rtn NANA&c S XIflEU AUTOS :� Xt _ Sawa AUTOS I . rer y ` .c0.aloayven Ie S 5,000 M X UMBRELLA UAE 000u : ' EACH OCCURRENCE 1e,0✓0 000 A EAOE96 LAB CLAIMS-MADE . . AOCREOATE $ $,000 000 1 CEO X AETENTION$ 10,000 ,9600060)99 6/1/2016 6/112013 $ WORREPSCWFENSATMm GEp .^1rv. AND EMPLOYEPS'LIABILITY vHi 1S )UTE X F,4.. •ANY PNRMNETORIPFRT XECFVEEI EAC L !DENT S S000`000 A IOFfdEINEMSER EXCW0E0t NN/A :Iyyen6selryInNH) -—_ 912)640616 : 6/11/2016 6/1112017 'EL G5 SE EA EMPLOYEES 1 000,000 01019109 Under . AESCP Pt ON OF OPERATIONS e01100. 1 El. OIS€?SE-POLY!Nn I s 1 000,000 DESCRIPTION Or OPERATIONS/LOCATIONS/VEHICLES IACORD 101,Adnlllonii Remark.5eheclu,t mAy be attached Il mon,spate I.worn) CERTIFICATE HOLDER CANCELLATION 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Informational Purposes THE EXPIRATION GATE THEREOF, NOTICE WILL SE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZE0 REPRESENTATN£ I IC Henderson, [ISR/CIN •ir' V- ' '^•/6-Nara-" 1888-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I6.1SO25nnvm, �� Initial Construction Control Document v i It ( � i i n be auhntiucd ,sigh the hdldu:g ['tumid application ha a t { 1't I Registered Design Professional rl J 1kt I ruudperih Cs dition . t the -_> / Ma ichusens Staid Buildtug Code. ?WI ( MR. Section I0 pr..-Cc: : ,tie. 14 Green St Repairs oat; 's \..,nab:: francs, Addres.'. 14 Cereal el AAnirr • 14.n. At Ihr I ir 1 tF.rs s ,s i one or Nob as tpphcan.e- _v.ichu: A Eaisonq C umtriUiun I. I It is KC tin-man. Al A. MA Ker Iratrn Nunn-ter, 1O4 S I spiration eatte. e -. am a r::tttit,e✓d.,:;yt i rs u' and I have prepared or d.tc::1. su pen i scd the pr p ret e r:. ni ail design plans.conhpuwuons and sixcifiicattons concerning': Arc hitcctu ral For the allot (maned project and that to the hot of my Anoss nrciae. [Warmanon. and he. e:such plans. contpatati.•n, sin. ',set inc an. meet the dppt:C.Inte pros , en.Ti the M.bubeibi,itit. Sane Roil ii1 t-tidal-Nn('t{R1. Ind A.e entr.seerrni nrs,:ndes for the proposed pr reC i t teui.'.lid and ann., than l I e r sr, Lie,:-t s II II'. ntarlenn _,_roc; ,n _. ,:a I scrcn r, ces and he tse t on the n n4' on hi rc ,'h.ernh ,: gulat arid 1, d sr hasII I. R.,i<,s. Im eontiumarree r :ins code and the acs iey e>ncept_shop dr ass ure-, za'l d rab;r ihIrc to-i, 'tr. IL Lontra:IIT in aces.rdnnc' s 'th-thcrmi 'mania nt 'hc centnueiton L: cunsene.-. _. f'erlorm ihe dutiesr r is toted dean p .r.._I, in'Xn(l9R( hapter IP.Li,appri..d-l-a. 3 Re presrm at itilenais appropriam to the Niece LII cpnsua:ttun to tItcrOrtrIltt hu crru: 'sin ii. roc r'h I ,t a.,•:.. in..: quality piths,.orA and to determine:t the sore s bels,performed eta manner oil it es ICI: the ,IIIIthr._. eotufructiou inkLan timl:Uhl than cede. I 4. h t. 11'as d ct a en,r urn, 11 e _ 1t:zt r i .:�rC>�.o1 I d s re�r'd• :rrr:"r_ , of -X I t AI R I 'at hs required b-the hutIdiots ohAzia,, 1 stall submit :idd prostress reports' ee item ; liinethr n a turnrt.-ut ewumcnts. III.I limn : ssailable to the building ofllcial. II pill cotnplelou.P1 the xor4,I all submit toinc h ;i ..cn^.s i:eai a F inai t oh nstructioo t t Jr):reurne fnt.r l n:kir +pace t. ihr ri:,ht a "sen nr r*' _ ee..,,ni: . :^ ere'and seal 1 Yr f ` m 1't rn irhsr i I Ah Yr-:r.'<, r .^ 171. ftnidn:._0I11..&r. c n_ it Teri"l '... 1h:, t;nrrn r+ '1 rh I'