31B-004 (35) 46 ROUND HILL RD-BOILER HOUSE 13P-2019-0113
CIS ft: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: 31B-004 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildino DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Category:demolition BUILDING PERMIT
Permit# BP-2019-0113
Project# JS-2019-000188
Est. Cost:$20000.00
Fee: $140.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: WESTERN MASS DEMOLITION CORP 106022
Lot Size(sn.ft.): 311018.40 Owner: MAX HEBERT
Zonine:URC000 Applicant. WESTERN MASS DEMOLITION CORP
AT. 46 ROUND HILL RD - BOILER HOUSE
Applicant Address: Phone: Insurance:
30 SUNSET DR (413) 574-5254 WC
WESTFIELDMA01085 ISSUED ON:7/27/2018 0:00:00
TO PERFORM THE FOLLOWING WORK removal of block fill windows and all interior
mechanicals
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: [louse ft 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 Occuoancv Signature:
FeeTvoe: Date Paid: Amount:
Building 7/27/20180:00:00 $140.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Versiond.7 Commercial Building Permit May 15,2000
City of Northampton
"X
Building Department
212 Main Street
Room 100
Northampton, MA 01060
phone 413-587-1240 Fax 413-587-1272 Pl*bggsa Pl'
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 I -SITE INFORMATION
1.1 Promr-tvAddress This section to be completed by offics
LA,, Wi\� R,) Map �71 j% Lot 00y Unit
Zom Overlay Dievict
-_---------- Elm
- -------
El.SL Disbild CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
,i�n ----------
-- -------- --------
--
Name(Pant) 9,&ANib OIL(, RZ Cureut'Maulirg Address:
Signature Telephone
2.2 Authorized Agent,
Name(Part) Cument'Makril Mine..
Signature Telephone L(%-:g;, S—IeA,— $Zj��k
SECTION 3-ESTIMATED CONSTRUCTION COLTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit a Pliczint
-—------------
1. Building (a)Building Plamitt Fee
2. Electrical (b)Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 -2+3+4+5) Check Number fLjO.80
This Section For Official Use Only
Building Permit Number Date
Issued
Signature: -71Z oil
Bulkling Comathisionerilaspector of Buildings V Date
VersienL7 Commercial Building Permit May l5,2000
SECTION 4 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition El Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑
Brief Description 'IEn r a brief descripption here.
Of Proposed Work: \ r,I-
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
5 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(so
3b ._.. 3rd .......
Total Area(so Total Proposed New.Construction fsf,-
Total Height(R)
Total Height it
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public El Private 0 Zone Outside Flood Zone❑ Municipal ❑ On site disposal system❑
Versiori Commercial Building Permit May 15,2000
B. NORTHAMPTON 7.5NTN7G
Existing Proposed Required by Zoning
This c.i.m be filled in by
Buildwg Depmma,t
Lot Size
Fronto a __._ '..__ __
Setbacks Front
Side L R:.___. L:- R
Rear
Building Heigh[ -
Bldg.Square Footage % ----
Open Space Footage % _..
(Lot area minus bug&roved _........ ___. .___ ._ ..._.___ _...
piulunio
4 ofParking Spaces - --
Fill: _...... ,__..... _.___ ._.
.mine&t atsn) ___— ...._L____
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location: '..
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 O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Versiou1.7 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:
Not Applicable ❑
Name(Registrant)'.
Registration Number
Address
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 Respensibihty
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable ❑
Company Name.
Responsible In Charge of Construction
Address
Signature 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
I• - ----- ------ as Owner of the subject property
hereby authorize -.
to
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner 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 pe0ury .....
_
Pnnt Name
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Q� Not Applicable EJName of Lii Holder '.Jra-� Uxy�at "'�( CSSL- /()W72-7
License Number
t`t.....
Address \ Expiration Date
u,1 �w �r as UJe �:e\a 413 s iy-_szs�
Signature Telephone
SECTION 13-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 bui ng 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: % � 1n �� bokc(- Vtar,,_
The debris will be transported by: W e4Wv, . M—%5 �e
The debris will be received by: Cc-bL�h —ioo
Building permit number:
Name of Permit Applicant a �lwxlasr
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department oirIndustrial Accidents
7 Congress Street,Suite 700
Boston,MA 02714-2077
www.mass.gov/dia
Workers Compensation Insurance Affidavit:General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Informadon Please Print Lecibly
Business/Organization Name: e_b.re[✓� b r
Address:
City/State/Zip: 6kk 6t Phone#:
Are yonan employer?Check the appropriate box: Business Type(required):
1.Lj I am a employer with In employees(full and/ 5. ❑Retail
or part-time)." 6. ❑RestaurantBar/Eating Establishment
2.❑ I am a sole proprietor or partnership and have no 7, ❑Office and/or Sales(incl. real estate,auto,etc.)
employees working for me in any capacity.
[No workers'comp. insurance required] 8. ❑Non-profit
3.❑ We we a corporation and its officers have exercised 9. ❑Entertainment
their right of exemption per c. 152,§1(4),end we have I0.❑Manufacturing
no employees. [No workers'comp.insurance required]* 11.❑Health Care
4.❑ We are a non-profit organization,staffed by volunteers,
with no employees. [No workers'comp.insurance req.] 12.0 Other
*Any applicant abut checks box#1 mast also In out the section below showing nee workers'compensation policy iafmmatiou.
"If the cors raw officers have exempted themselves,but the cot ombon bas othtt employees,a workers'compmsubon policy is required and such an
organ.,.n should check box aI,
I am an employer that is providinng`orkers'compensation insurance for my employees. Below is the policy information.
Insurance Company Name: 1� t 3
Insurer's Address: 1,�.,1',Xu� y_
City/State/Zip: awAo
Policy#or Self-ins.Lia# Expiration Date: z
Attach a copy of the workers'compensation policy declaration page(showing the policy number oil 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 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 hercertify,under the pains and penalties ofperjury that the information provided above is true and correct.
Signature' Q Date,
�'Z.-1• I
Phone#:
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Pm mit/Liceuse#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
www_mass-goddia
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,and or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However,the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply your insurance company's name,address and phone number along with a certificate of insurance.
Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members
or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy
is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of
insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town
that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you
have any questions regarding the law or if you are required to obtain a workers'compensation policy,please call the
Department at the number listed below. Self-insured companies should enter their self-insurance license number on the
appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number.In addition,an applicant that
must submit multiple penvit'license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary). A copy of the affidavit that has been officially stamped or marked by the city or town
may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit
must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business
or commercial venture(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this
affidavit.
The Department's address,telephone and fax number.
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-N ASSAFE
Fax# 617-727-7749
www.mass.gov/dia
Fom aevised02-23-15
CSSL-106022
s70 �.•: nweaie- -
7-3075 am RmarrF
DALE W UNSDERFER
-30 SUNSET DR - -
P1` WESTFIELD MA 01089, E:
o a„yam,. 0511112018 r
WESIFEIQ NR OIOA51]}5 - _.. . .ay._ -
a »i
of Nass„:^demo
t” cut _'Vir" �n _ +rtn mef poblio Safety`
License: HE-116280
AsbestOs,Supervlsor ll Hoisting Engineer _
DALE UNSDERFER ! -
R ,u sv DALE W EEER
Efl 0
�piStl SUNSET
OORR
Exp. 04MM6 f',': ! WEST IELD MA 01085 TM n
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s mot alC ON.E6
5PR -. S1vft�E1+t II II11
���������I�������������I�����11�� �d /�'✓ -w � ;r�� Expiration:
Cog nnissi00er 05/1112019
OSHA . - 091657898
�aa��5�lnr,b>�na,�mlry�oa
Dale Dnedezfer
MS ucca64uAyWiIIDIeM161U1t1/AL1AOm�1$aIM'Aa�HeeM '".
i2nir9 Cour"�I:n.�'p-p��p -
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\ ry �c�ie �pryrsaira� -rae>l �i a�C� ccc�2tatP,�l,''
Office of Consume'Affairs and B mess Regulation
10 Pa 1"Pl&.&a - Suite 5 170
. R 07116
Home�Improv mentCcf�1(Th.gtorRegistration-
rr- Registration: 178435
�1 Type: Corporatio
. r _ 1'.G Expiration: 4/16/2018 Tre 419291
WESTERN MASS DEMOLITION �
DALE UNSDERFER
30 SUNSET DR. '� l�
WESTFIELD, MA 01085
\a !eix Update Addressandreturn card.Mark reason for change.
scnr ti 2..r n -t Address D Renewal Q Employment n Lost Card.
Nb > r
rf5re it Alm, SU tt<gli .n License or re5atiation valid for ineih4dul use only
fi qr,
A ,OE INIFI OVFM ENT 701,11 RACTOR before the expiration Lute. If found return to:
�x fryiatratlon 370a35 Type: 010ce of Consumer Affais and Basiness Reputation
Expicador: 4 a@612, Corporation 10 Para Plaza-Suite 5170
Baxter,MA 02116
ESTEkN MASB D�MOf,f' ON Ct•)'f1P.
fI
'DALE UNSDERFER 1 �f
00 SUNSET
WE.STFIFI D,MA 01085 0 a nccrewrYNot h ;oi na[nrc
a.n rn,�iW etniteotthecorrmon.fthof MassamuwM
Consumer Affairs and Business Regulation
Division of Professional Licensure
Office of Public Safety and Inspections
License Home Page Application Submitted
Logout Your application has been submitted and all fees have been applied to your credit
card. Please print this page as your proof of submission and receipt of payment.
Application Information
Date Submitted: Wednesday, July 25, 2018
Applicant Name: Dale W Unsderfer
License Number: CSSL-106022
Agency: MADPS
Process: Renew License process
Payment Information
Authorization Code: 015282
Received Date: 7/25/2018 11:28:33 AM
Received Amount: S100.00
_Print Receipt
2
dale@wmdemocorp.com
From: Max Hebert <maxchebert@gmail.com>
Sent: Thursday,July 26, 2018 2:32 PM
To: dale@wmdemocorp.com
Subject: Re:Revised
Attachments: Boiler-WMD interior.pdf
Proposal attached. Per our conversation, please pull necessary demolition permit with the City of Northampton,and notify Building Commissioner Louis
Hasbrouck prior to work start.
Thank you,
Max
From:<dale@wmdemocorp.com>
Date: Monday,July 23, 2018 at 11:30 AM
To: 'Max Hebert'<maxchebert@gmail.com>
Subject: Revised
Max
Good afternoon attached is our revised proposal.Just keep me in the loop as far as the back fill of that hole and we can work together to get a start date.
Thanks
DALE UNSDERFER,
WESTERN MASS DEMOLITION CORPORATION
50 Medeiros Way, Westfield, MA 01085
Office (413)579-5254
dale(owmdemocorp.com
J
jaid =4
L iT " , ` am]
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2
Wedan MmDemdldon CapmMon
50 Medeiros Way
Westfield, MA 01085
(413) 579-5254
info@wmdemocorp.com
www.wmdemocotp.com
ADDRESS '
Max
46 Round hill Road, MA ,
Max 413-896-3019
TE 07/19,2018
maxchebert@gmail.com
DATE ACTIVITY AMOUNT
07/19/2018 S3vlaes 20,000.00
Western Mass Demo Corp is pleased to provide service for the below
scope of work.
WMDC
>46 Round hill Road,Northampton mechanical building selective demo.
>Based on site visit and scope sheet provided.
>Proposal is for a building with a clean bill of health.
>All man power, supplies, equipment, and debris disposal related to demo
scope sheet provided.
>Based on regular working hrs. 7-4 Mon-Fri
>W ill supply our own temp power supply should power not be available.
>3 line item extras included
>Once demo begins all scrap, salvage, and recycling rights belong to
WMDC.
>Not to be held accountable for any damage to landscape, grass, side
walks, or road ways from weight of equipment and or trucks.Any
unknown underground utilities not marked out by DIG SAFE shall become
the owners responsibility.
Max/G.C.
>Permitting and related fees to demo scope of work.
>Site security and temp fencing if required.
>Utility disconnections.
>Providing access to interior work via large overhead door way
>Weather proofing, patching, sealing, and all repair work related to the
project. Including concrete floor patch and repair work.
_ >Large door way header left in place.
07/19/2018 Optional night and/or weekend crew additional $800 to cover over time
and/or night differential pay
Y.I III 11
Any balance that becomes overdue for any reason will be charred a service charge of 1.5%per month,18%annually.If i1 should become necessary
to turn this account over to collections,the billed party agrees to pay all collection cost plus attorney fees.
Accepted By Accepted Date
Max Hebert 07-26-2018
yT �
Any balance that becomes overdue for any reason will be charged a service charge of 1.5%par month,18%normally.If it should become necessary
to turn this account over to collections,the billed pant,agrees to pay all collection cost plus aLLomcy fees