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31A-065 (7)
28 KENSINGTON AVE-WILSON/MORROW BP-2019-0163 GIS u: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31A-065 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 9 BP-2019-0163 Proiectk JS-2019-000274 Est.Cost: $48000.00 Fee:$336.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MMC SPECIALTY ROOFING INC 076497 Lot Size(sq.ft.): 20603.88 Owner. SMITH COLLEGE OFFICE OF TREASURER Zonine:EU(100)/URC(100)/ Applicant. MMC SPECIALTY ROOFING INC AT. 28 KENSINGTON AVE -WILSON/MORROW ApplicantAddress: Phone: Insurance: 50 VALLEY VIEW RD (413)642-3842 0 WC WESTFIELDMA01085 ISSUED ON.81912018 0:00:00 TO PERFORM THE FOLLOWING WORK.•REROOFING OF 3,650 SQ FT ROOFING ADDING 5.2 IN INSULATION EPDM ROOFING 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 sienature: FeeType: Date Paid: Amount: Building 8/9/2018 0:00:00 $336.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner -vv I ?-00 F Version l.7 Commercial Building Permit Ma 15,2000 -T-I Department use DfNy $ City of Northampton 9tataFgf Permik s° M Building Department G16p ' Pama 7 -1 212 Main Street Sax%at> It;t�Al w m Room 100 y�l sgdv'8�a66ftK Northampton, MA 01060 'IW6" �Pkim" . o p 413-587-1240 Fax413-587-1272 m Orw 91* , AP LUCT,REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address z /This section to be completed by office LISP ✓f Lot (Ju'�; Unit zw r Jt Zone Overlay District -- -- - Elm St.District CB Distrkt SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Name(Pant) Current Mailing Address _ e113 �i.G . Signature Telephone 2.2 Authorized Agent: \ Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit a licant 1. Building 4� tA'V (a)Building Permit Fee t 2. Electrical - (b)Estimated Total Cost of Construction from 6 3. Plumbing ',, Building Permit Fee 4. Mechanical(HVAC) - - 3 5. Fire Protection 6. Total=(1 +2+3+4+5) tT^ Check Number -7� I This Section For Official Use Only Building Permit Number Date Issued Sig re: Buil n mmi sio r/Ina f uildings Date f: Version l.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 Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Rocofingly Change ofUse❑ Other❑ 1 n Brief Description .Enter a brief description here. P, wvt-i.- T b\�V S°� ` I`14i Of Proposed Work: A,1J I�j.. 5,2 1 I r 51-.�.��t �R=3�uJ 4� SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly 11A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 18 ❑ 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 Utillly ❑ Specify: ' M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS Al 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) ist 1" 2n° 2 n 3 e _ 3rd 4m Total Area(sl) - Total Proposed Nev,Construction(so Total Height(ft) _ Total Height it 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system[] Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be Mod!in by Building Dcpanm sa Lot Size I. Frontage Setbacks Front Side U R:'-- L,.. R:. Rear Building Height Bldg. Square Footage Open Space Footage % (Lot area minus bldg&paved ,.,king) #of Parking Spaces - Fill: (volume&L ,,tim A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O 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 Pages, and/or Document#. B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O 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 IF YES,then a Northampton Storm Water Management Permit from the DPW is required Version 1.7 Cornmercial 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 36,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant) - Registration Number Address 6piration Date Signature Telephone 9.2 Registered Professional Engin"its): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Dale Name Area of Responsibility Address Registration Number Signature Tekphone Expiration Date Name Area of Responsibility Add... Registration Number Signature Telephone Expiration Data Name Area of Responsibility Address Registration Number Signature Tekphone Expimtian Data 9.3 General Contractor Mm Not Applicable [3Company Name: i Responsible In Charge of Construction ryq SDv" � l2 �irwflr ti ;e�ol �� v1oLS5 aye Signature Telephone Version 1.7 Commercial Building Pennit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes O No O SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETEDWHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 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, �'^^1� (�)LtiL^ ,as Owner/Aulhonzed 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 pains and pe Itles_of perjury_ nniN e Signa[u of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ S Name of License Holder C 1 I�+fz� T--"-T--"-5k� . ' C - 1(r,4-\ J License Number (v17I2L'i9 Expiration Date Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§2SC16)) 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 O 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: `6 .'.,"s I 'V, "Vv � C The debris will be transported by: J � The debris will be received by: U- le v Building permit number: Name of Permit Applicant Jv`vv,r Date Signature of Permit Applicant AeCommonwenil ofA uss&chaseur Deparj)Wjg1 OffrfduviriaiAccident, I Congress Street,Suite 100 Boston,AIA 02114-2017 ))$rkers' www•massgop/dia Compensation Insurance Affidavit:Builders/Contractors/Electricians/plumbers. Alicanf Information TO BE FILED WITH THE PERMITTING AUTHORITY. Please P 'nt Le Ill Name(Business/Organ zazioMndividuaq: Mvv\'7 S?�c I v Address:S 0 U ) e\ La City/State/Zip: )nJ cS I P.IA A of c�g Phone#: 4-)3 Are you an employer?Check the appropriate bra' Type of project(required): '9L11 Iamaemployerwith ) u employees(full and/or pattime)e 7. New construction 2.❑I an a sole proprietor or partnership and have a employees working for me in g. ❑ Remodeling any capacity.[No workers'comp.assurance required 1 3.❑I am a homeowner doing all work myself,[No workers'com,insurance required)t 9. El Demolition 4.❑1 am a homeowner and will he hiring10❑Building addition contractors m conduit all work onor p,sole - I will ensure that WI convictors eitherhave cookers'compensation insuranceor are sole IL❑Electrical repairs or additions rn,martnrs with no employees. 12.E]Plumbing repairs or additions sI he ageneral mexadorandIhavesired Neve workttacmrs p in er the attached short 13.®Roofrepairs These sub-convectors have employees and have workers'camp.interstate; 6.❑Weare a calibration and its officers have exercised their right of exemption per MGL c. 14.E]Other 152,§I(4f end we have no employces.INo workers'camp.insurance requirbi *Any applicant that checks box#I most also fill out thesection below showing their workers'compensation policy catamtaran. a Homeowners who submit this affidavit indicating they aro doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box mast attached an additional sheet showing the..a of sub-asymmc[ors and state whether or not those entities have employees. Ifthesub-conhactom Mh employees,Neymmtprovidetheir workers omp.polirynumber. l am an employer thW is providing worker'eompensation insuMUCe for my employees. Below is the policy and job site information I Insurance Company Name: Policy#or Self-ins.Lic.k:{PWC—A3 C�y9et ' Expiration Date:))F' )� Job Site Address: ZSt rSry �L✓� 1�>r� City/State/Zip.:UoA- Attach a copy of the workers'compeastition policy declaration page(showing the policy number and expirilifion date). Failure to see=coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-yearimprisonment,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 ofthis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage v ion. I do he eby cerci ,, qtr red Hanle,ofperjury than the informadon provided)above is nor and correct S'm t ° — F 'Date 1 L iU Phonen 412 b4Z 3842 Qjf1dW use only. Do not write in this area,to be completed by city ortown official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical in 5.Plumbing Inspector 6.Other Contact Person: Phone#: suesnquSsew ld ` s�peiuo�1 sajapod at'5 mopwMasolo uo4euuolW ap.sm jai o ema a asuedil z at MUZ :aled s,Aepol eA!PV 6tottGr9 a#eouogeudx3 G LOZ1 :lemeuaa isel P oleo sesueoll 6uip�ms Joswadng uo 'I'lEt/9 llo MAI asuaarl L6 Lmp sa MMCSPEC-01 KAYLA CERTIFICATE OF LIABILITY INSURANCE °pDS gB'W o Y"1B 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(Sh AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the certlOcaM holder is an ADDITIONAL INSURED,me policy(las)must have ADDITIONAL INSURED provisions or be endorsed. H SUBROGATION IS WANED, subject to the farms and Conditions of the Policy,contain policies may require an endorsement A statement on tris certificate does not corder rights to me cartlTcaM holder in lieu of each endonemar t(s. PawuCER ?UT Kayla Marie DrjnkWine Phillips Insurance Agency,Inc. PIpxE 97 Cam.,Street Dow(413)394-3984 Fpx,xo:(413)592-8499 Chicopee,MA 01011 JtM6.kayla@phillipsinsumnce.com INSU ARORgNOC E g33758 .R.A:First Marc Insurance COINSURED IasueER a:Selective Ins Cc of South Caro MMC Specially Roofing Inc RERc:A.I.M.Mutual Irks.Co. SO Vail,View Drive INSURER o:BerldeV Assurance Company Westfield,MA 01085 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 DOCUMENTPATH RESPECT TO'MfICH 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. IxER TYPE OF IXSDRpXLE M,oL Uasem PoIICYNUMaER POIICYESF PoIICYFSP LIMITS A X LOMMERPAL.EFERAL LIABILITY EgLH OCCURRENCE 5 1'DDD'000 C".SNADE 0 uCCUR -CGL-0OOD07593441 02/21/2018 OW21/2019 DAA11GETORENTED $ 100,00 MEDFXPA a 5000 PEMW La ADV INJURY 1000000 GEN'L AGGREGAIELIMIT APPLIEG PER. GEN RAL AGGII 2,00,OD0 PDucv❑, �LDc FFo000T5-couPlov A. 1 2,000,000 OTTER B AUTOMOBILE LIABILITY COMBIN ,IINcLE 1IM1 1,00.00Q X ANYAUTO A 9105249 07117/2017 07117/2018 SDMLvwARVP OWNED GCNEouLED AU EIDpG ONLY AUpTryO�$µryE1� NgILY WJURY PvanMnl $ ALTOS ONLY AVTpS UXLV FROP�EDAIMOE S Ax ul"a IA LAS % OCCUR E HOCCURRENCE $ 1.000,000 EXCESS ape CIIIMS.DE TX-EXODD0076935-01 02/21/2018 OV2112019 AGGREGATE 5 1,000,000 DED RETExnoNa i DXp D EMPLOVERW LABILT' X PEP OTH- ML{Fy�PROPREIETORIPARTNERIE%ELUTIVE Y❑ WOOD-7030594-201 TA OIV078018 OSIm/2019 EL FACHAc<IOEm S 1,000,000 IWnmlwylaM IEXCLUOEO� NIA 1,000,000 ELDISEASE.EA EMPLOYE $ e w amore max 1,000,000 DESCRIPFION OF OPERATIONS Cekx' E.L.DISEASE POLICY LIMIT D Worker's COMP(CT) TARP303404 01/24/2018 0112CM19 1,000,000 MaCePrONUFOPERATKKISIIMATIXISIVEMCLIS IpCORD 101,MtlMOIxIRmn,b&aa0ula.11xy CsaWCMEammepewln rasuNeai CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Provide Proof of Coverage THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 ACCORDANCE WITH THE POLICY PROWSKKIS. AUTHO�RREDREPRESExfATNE /�.✓Y y��" L"Lr ACORD 25(2018/03) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registeretl marks of ACORD The OlfCiel Website of the Execuilve Office of Puhllo Safety end Sacuny(EOPSS) MBs..G.,HOTP Slele Ag.,.I5 nsee Details tiOR W ame:Name: IFTON FROST gEens%er nm ie d tate: MA ipcode: 01010 o nt : U 'tetl tates (cense a: 97 License Type: Construction Supervisor rofession: Building Licenses Date of Last Renewal: 6/13/2017 ssue Date: Expiration Date: 6/7/2019 icense Status: Active Today's Date: 2111/2018 econdary License Type: in9 Business As: atus Change R as : License R ewaI erequisize in, o rete uisite Information Close Window ©2011 Commonwealth of Massachusetts Site Policies Contact Us 1 fAa3>aeYuseiCs -u's;:actme�7Y c.F.ih0u3afey Board of Building Regulations and Standards G nstru<fion Shper+,rci r �`" License CS-076497 ,r UMT'ONN FROST` ~ 69 MARSL{HILL" Brimfield MA 61610 Expiration Cemmissloner 0616772015 Hvc Fprci.dt) Roofing Inc. August2018 To: City of Northampton MA 212 Main St Northampton MA 01060 1 request that you grant a modification to waive the requirement for control construction the Smith College Wilson- Morrow Dormitory roof replacement, because the work is of a minor nature,will not affect health accessibility, life and fire safety, or structural requirements and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work.Thank you for your consideration." Mass Amendments,section 107.6.1 allows for an exclusion from control construction for the project" ,"Where work is performed by licensed trades people pursuant to M.G.L.c 112-81R,shop drawings or plans and specifications prepared to document that work shall not be required to bear the seal or signature of a registered design professional. 17 ectfully, MM Specialty Roofing Inc Donald Wurster President 50 Valley View Dr. Westfield Ma. 01085 Phone 413-642-3842 Fax 413-642-3955