Loading...
17C-207 (7) 69 MAIN ST-FIRE STATION BP-2018-0112 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C-207 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2018-0112 Project# JS-2018-000186 Est.Cost: $110620.00 Fee: $0.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: INDEPENDENT ROOFING CO INC 017759 Lot Size(sq. ft.): 9321.84 Owner: CITY OF NORTHAMPTON Zoning: GB(100)/ Applicant: INDEPENDENT ROOFING CO INC AT: 69 MAIN ST - FIRE STATION Applicant Address: Phone: Insurance: P O BOX 1446 (413) 568-9405 WC WESTFIELDMA01086 ISSUED ON:7/31/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF 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 7/31/2017 0:00:00 $0.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Co,T o- CoN ST CaCi • Versionl.7 Commercial Building Permit May 15,2000 �' , f3epartr�ent use only City of Northampton StatusofPermtt ` Building Department Curb E01*.twj r Perrritt 212 Main Street Sewed/,S tricA atlabiiiy" ! ' Room 100 Water%, ( I!Availabiii j 0 �..` Northampton, MA 01060 Two Sets of Structu a1 e.ans phone 413-587-1240 Fax 413-587-1272 PtotlBite kPlans '} Other Specify -r (CATION 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 g( — I `11 Z 1.1 Property Address: This section to be completed by office 69 MAIN ST. (FLORENCE FIRE STATION) Map j ! Lot 20'7 Unit FLORENCE, MA 01062 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 O\N er of Record: C ity of Northampton-David Pomerantz • 240 MAIN ST. NORTHAMPTON, MA 01060 Name(Pr' t \ Current Mailing Address: j� 413-587-1260 . ature E.) (jV• Telephone 2.2 Auth• ized • ,ent: DA • Pe MERA T .ir- tor of Central Services 240 MAIN ST. NORTHAMPTON, MA 01060 Name(Pri Current Mailing Address: y�1 y 413-587-1260 ignature 1 '1. 8.t1 Telephone SECTION -E' IMAT:D •NSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Buildinga 110,620.00 Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) U 5, Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: /4.✓� f /'7 Building Commissioner/inspector of Buildings Date ; C j / , 24 ; CDt Ge`31— 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 0 Existing Wall Signs 0 Demolition 0 Repairs 0 Additions 0 Accessory Building 0 Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Roofing LX Change of Use 0 Other 0 Brief Description REMOVE EXISTING ROOF AND INSTALL Of Proposed Work: NEW ROOF. 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 1A I 0 A-4 0 A-5 0 lB Li B Business 0 2A 0 E Educational 0 2B F Factory 0 F-1 0 F-2 0 2C H High Hazard 0 3A 0 I Institutional 0 1-1 El 1-2 0 1-3 0 3B M Mercantile Li 4 R Residential El R-1 0 R-2 0 R-3 1:3 5A 0 S Storage 0 S-1 El S-2 1:1 5B U Utility Specify: M Mixed Use o Specify: S Special UseKIX Specify: : FLORENCE FIRE STATION 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) 1st 1st 2nd 25d 3rd 3rd 4tb 4th Total Area(sf) Total Proposed New Construction(sf) 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 E] Zone Outside Flood Zone 0 Municipal El On site disposal systemp Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be tilled 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&paved • 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 Cg YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW ® YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO 13 DONT KNOW Q YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained ® , Date Issued: C. Do any signs exist on the property? YES ® NO IF YES, describe size, type and location: N/A D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO O IF YES, describe size, type and location: N/A 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 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: ROY S. BROWN ARCHITECT'S Not Applicable 0 Name(Registrant): 85 C.HILSON RD, WILBRAHAM, MA 01.095 Registration Number Address 413-596-2360 Expiration Date 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 INDEPENDENT ROOFING CO., INC Not Applicable 0 Company Name: PETER A. RUSZALA_ Responsible In Charge of Construction 294 UNION ST.-WESTFIELD, MA 01085 Address --- 413-568-9405 Signature VVV((( 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 O No SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT _DAVIDPOMERANTZ DIRECTOR OF CENTRAL SERVICES , as Owner of the subject property her-�authorize._____INDEPENDENT ROOFING CO., INC. -PETER RUSZALA to act• •-half,i all , atters relative to work authorized by this building permit application. r ° 7-28-17 ._._ Sign ture of ewner ak Date PR RU A , 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. PETER RUSZALA Print Name '' lp 7-2 8-17 Signature o Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder.. PETER RUSZALA 17759 License Number 294._U. ON ST-..WESTFIELD, MA.0.1085 9-19-17_ Address Expiration Date / 413 568-9405 Signatur Telephone 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 to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ® No 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: 69 MAPLE ST- FLORENCE, MA 01062 The debris will be transported by: COMPLETE DISPOSAL The debris will be received by: COMPLETE DISPOSAL Building permit number: Name of Permit Applicant INDEPENDE ROOFING CO., INC. - PETER RUSZALA l'aR° 9-,./141, a. K„,),/,, Date Signature of Permit Applicant The Commonwealth of Massachusetts �fl Department of Industrial Accidents Mawr' 1 Congress Street,Suite 100 (`I Boston,MA 02114-2017 www.mass, ov di � E • g / a Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Independent Roofing Co., Inc. Address: 294 Union Street City/State/Zip: Westfield, MA 01085 Phone#: 413-568-9405 Are you an employer?Check the appropriate box: Type of project(required): Lig'am a employer with 15 employees(full and/or part-time).* 7. 0 New construction 2.0 I am is sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp,insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.0 1 am 10 homeowner and will be hiring contractors to conduct all work on my property. I will 10 []Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.11 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 152,§1(4),and we have no employees.[No workers'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. tCoutractors 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: CNA Insurance Policy#or Self-ins.Lic.#: wc130699444 Expiration Date: 5-1-18 Job Site Address: 555 North King 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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer •y under the pain d penalties of perjuty that the information provided above is true and correct Peter JO?Ruszala _ � Signature: � Date: �, ill Phone#: 413-568-9405 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#: Client#: 12556 INDRO ACORDT. DATE(MM/DD/YYYY) , CERTIFICATE OF LIABILITY INSURANCE 7/05M/DD/ 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 CONTACT Tina Genza NAME: T.P. Daley Insurance Agcy, Inc PHONE FAX (A/C,No,Ext):413 788-0971 (PJC,No): 413 739-2645 1381 Westfield St. E-MAIL tina t dale insurance.com ADDRESS: genzaPY P.O.Box 1150 INSURER(S)AFFORDING COVERAGE NAIC# West Springfield,MA 01090 INSURERA:CNA Insurance Companies INSURED INSURER B: Independent Roofing Company, Inc INSURER C: P.O.Box 1446 INSURER D: Westfield, MA 01086 — — INSURER E: INSURER F: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP WLIMITS LTR INSR VD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) A GENERAL LIABILITY C1030699430 05/01/2017 05/01/2018 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES TO occcu ante) $100,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $15,000 X PD Ded:1,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 7 POLICY PRO- LOC $ JECT A AUTOMOBILE LIABILITY 2075657847 05/01/2017 05/01/2018 (EOa aacideDtSINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ _ _$ X HIRED AUTOS X AUTOS ED (Peri accident)ROPERTY AMAGE A x UMBRELLA LIAB X OCCUR C1030699458 05/01/2017 05/01/2018 EACH OCCURRENCE $2 O00 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 DED X RETENTION$10000 $ A WORKERS COMPENSATION WC130699444 05/01/2017 05/01/2018 T/OCRYTLIMITs ERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) The Replacement of Roofing at the Florence Fire Station,Florence,MA. CERTIFICATE HOLDER CANCELLATION City of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 210 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Northampton, MA 01060 AUTHORIZED REPRESENTATIVE I _ ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S140893/M136382 TMG Initial Construction Control Document 1.1 1"o he submitted with the building permit application by a xl 1 Registered Design Professional for work per the 8`h edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Replacement of Roofing at the Florence Fire Station, Florence, MA Date: 07/28/2017 Property Address: 69 Maple Street, Florence, MA 01062 Project: Check(x) one or both as applicable: New construction XX Existing Construction Project description: All labor and materials necessary for the replacement of roofing as detailed in the construction documents. I, Roy S. Brown, MA Registration Number: 4293 Expiration date: 08/31/2017 am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': XX Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that l (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. Perform the duties for registered design professionals in 780 CMR Chapter 17. as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, I shall submit field/progress reports (see item 3.) together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a 'Final Construction Control Document'. Enter in the space to the right a "wet" or electronic signature and seal: .zoittt fr •i. ir5 sem,"';'; M. .`E 114 Phone number: (413)596-2360 Email: rsba85(&yahoo.com Building Official Use Only Building Official Name: Permit No.: Date: Note I. Indicate with an`x' project design plans,computations and specifications that you prepared or directly supervised. If'other' is chosen, provide a description. Version 06 112013