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23B-014 (13) 125 LOCUST ST BP-2019-0247 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23B-014 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: demolition BUILDING PERMIT Permit# BP-2019-0247 Proiect# JS-2019-000396 Est. Cost: $18150.00 Fee: $0.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ASSOCIATED BUILDERS INC 062382 Lot Size(sq. ft.): 730501.20 Owner: NORTHAMPTON CITY OF BOARD OF PUBLIC WORKS Zoning: SI(100) Applicant. ASSOCIATED BUILDERS INC AT. 125 LOCUST ST Applicant Address: Phone: Insurance: 4 Industrial Drive (413) 536-0021 WC SOUTH HADLEYMA01075 ISSUED ON:9/11/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-COMPLETE DEMO AND REMOVAL OF DPW BARN BUILDING 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 9/11/2018 0:00:00 $0.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner D File#BP-2019-0247 SE APPLICANT/CONTACT PERSON ASSOCIATED BUILDERS INC ADDRESS/PHONE 4 Industrial Drive SOUTH HADLEY (413)536.0021 S PROPERTY LOCATION 125 LOCUST ST D K MAP 23B PARCEL 014 001 ZONE SI(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST Fly REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: COMPLETE DEMO AND REMOVAL OF DPW BARN BUILDING New Construction Non Structural interior renovations _ Addition to Existing Accesso Structure Building Plans Included: Owner/Statement or License 062382 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO.JMATION PRESENTED: _AZApproved 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 Signature of 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 40A.Contact Office of Planning&Development for more information. v Versiont.7 Commercial Building Permit May 15. '_000 Z Department use only o rn City of Northampton Status of Permit: n c G' Building Department Curb Cut/Driveway Permit - v Nrn 212 Main Street Sewer/Septic Availability z a) +y Room' 1 Room 100 Water/Well Availability D a, ry C Northampton, MA 01060 Two Sets of Structural Plans m o M hone 413-587-1240 Fax 413-587-1272 Plot/Site Plans o Other Specify APPLICATION TO Cf NSTRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION eP'. ' q''aL 1.1 Property Address: This section to be completed by office 125 Locust Street, DPW Barn Building Map d �j(j Lot 01 Unit Zone Overlay District - - Elm St. District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: City of Northampton 210 Main Street, Northampton, MA Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: Associat d uild g Wreckers, Inc. 352 Albany Street, Springfield, MA Name(Print) Current Mailing Address: (413) 732-3179 __.._ Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $18,150.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) $18,150.00 Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date f,a6 © i ���vre cars i �� �3 � r} -:�.2 Y .. t�► I r - _.� ,,, c� 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 El Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description Demolition and complete removal of the DPW Barn Building Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ 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: 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(so St St 1 2nd 2nd ', _______.._.__._...._.....__...._.._____.. 3rd 3rd 4 4t th Total Area(so Total Proposed New Construction (so 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: None Public ❑ Private ❑ None Zone Outside Flood Zone❑✓ Municipal ❑ On site disposal system[] i Version 1.7 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: Rear Building Height Bldg. Square Footage10 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 DON'T KNOW 0 YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book 08584 Page305 and/or Document# 897 B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES o 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 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 ® NO Q IF YES, describe size, type and location: J 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 ® NO O 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: Not Applicable 0 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 Responsibility Address Registration Number t l Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Associated Building Wreckers, Inc. Not Applicable ❑ Company Name: Andrew Mirkin ResponsibleA Charge of Construction 352 Alb nt Str et, Springfield, MA 01105 Address ;(413) 732-3179 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 Q No E) SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT City of Northampton as Owner of the subject property Associated Building Wreckers, Inc. hereby authorize' to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 'Associated Building Wreckers, Inc. 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. _ Andrew Mirkin, President Print Name Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Andrew Mirkin CS-062382 License Number 299 Tan 1 wood D ive, Longmeadow, MA 10/31/2019 Address Expiration Date (413) 732-3179 Signature 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 Q 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: Its Locust Street The debris will be transported by: Associated Building Wreckers, Inc. The debris will be received by: Casella Waste Systems, Holyoke, MA Building permit number: Name of Permit pllc nt Associated Building Wreckers, Inc. Vv Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeEibly Name (Business/organization/Individual): Associated Building Wreckers, Inc. Address: 352 Albany Street City/State/Zip: Springfield, MA 01105 Phone #: 413 732-3179 Are you an employer? Check the appropriate box: Type of project(required): 1.® 1 am a employer with 32 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ 1 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 an capacity. employees and have workers' Y P tY• 9. ❑ Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.EJPlumbing 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.❑ 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. $Contractors 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: Great Divide Insurance Company Policy#or Self-ins. Lic. #: WCA154516517 Expiration Date: 02/01/2019 .lob Site Address: 125 Locust Street, DPW Barn Building City/State/Zip: Northampton, MA 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. a ay against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations f t e DIA r insurance coverage verification. I do hereby crt' nder e p ins and penalties of perjury that the information provided above is true and correct. Si nature: w Mirkin President Date: Phone#: (413) 732-3179 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#: 27633 ASSBU1 ACORD,r., CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 311512018 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(les)must have ADDITIONAL INSURED provisions or 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Alison Gable People's United Ins.Agency MA PHONEFA ICQ--" --- --" A ,No Eat:413 735-6708 �A/C, m No _________ One Monarch Place, 10th Floor E-MAIL abl on li as . e les ADDRESS: _ g@Peo .comp __— PO Box 4950 I - --------------------- Springfield, MA 01144 INSURER(S)AFFORDING COVERAGE NAIC# _ INSURER A:Nautilus Insurance Company INSURED INSURER B:Westem World Insuranco Company 13196 Associated Building Wreckers, Inc. INSURER C:Uruat Dlvids Insurance company 25224 352 Albany Street INSURER D: Springfield, MA 01105 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 CONTRACTOR 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 ADDLSUER I! POLICYEFF POLICY EXP LTR TYPE OF INSURANCE IN R WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY X X GLP2011149 3/15/2018 03115/201 EpAgCMHq�OECCUR�RENCE__ $1,000,000 CLAIMS-MADE OCCUR PREMISE Eaoccurrrence $100000 Blanket Al prior MED EXP(Any one person) $1_0,000 written contract PERSONAL&ADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 PRO. PRODUCTS-COMP/OP AGO 33000 000 POLICY X JECT LOC , OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ _ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED rPROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY P _accident _ BOUMBRELLA LIAB l OCCUR X X GLX1000340� 3/1512018 03/15/2019 EACH OCCURRENCE -_ $5 OOO,OOO _ X EXCESS LIAB l XX It CLAIMS-MADE AGGREGATE_ _L--_ $5J OO OOO J-----._-.-- DED� RETENTION 1 1 1J $ C WORKERS COMPENSATION X WCA154516517 210112018 02101/2019 X JsTAOTH. TuTE ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N I E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A 1 (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 A Pollution X X CPL2011150 3/1512018 03/15/20191 $5,000,000-Occurance $10,000,000-Aggregate Deductible:$10,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RE: Any and all jobs City of Northampton is listed as additional insured under general liability as required by written contract for work performed by insured subject to terms and conditions of the policy. CERTIFICATE HOLDER CANCELLATION Cit f Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City op THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 210 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Northampton, MA 01060 AUTHORIZED REPRESENTATIVE �Q.�v�e$ C�tv�u�l��hQilLc. til ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) 1 OfIl The ACORD name and logo are registered marks of ACORD #S9276421M927450 DMK .�`� ���12�122(t/7iCUP-�%��i l��✓1��JC1�c�'cJ'-(,��(�lr.�ef� Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Horne Improvement Contractor Registration Type: Corporation Registration: 169969 ASSOCIATED BUILDING WRECKER ', Expiration: 08/24/2019 INC. 352 ALBANY ST. SPRINGFIELD, MA 01056 SCA 1 b 2.0M-05/17 Update Address and return card. .T� �nii�iirr�i�ivaL// i�/. �%�r•i,:¢r�iiaii/rG Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiratio date. If found return to: Registration Expiration Office o nsumer ffairs and Business Regulation 168968 OSi24/2019 10 Par PIa a-Suit 170 Bosto ,MA'02116 ASSOCIATED BUILDING WRECKERS,INC. ANDREW MIRKIN 352 ALBANY ST, SPRINGFIELD, MA 01056 Undersecretary Not valid without signature Construction Supervisor Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpi • Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConstruCtron Supervisor CS-062382 Expires 10/31/2019 ANDREW H MIRKIN 299 TANGLEWOOD DRNE LONGMEADOW MA 01106 Commissioner Certificate No: A047275 THE COMMONWEALTH OF MASSACHUSETTS 0.4 EXECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT {� DEPARTMENT OF LABOR STANDARDS 19 STANIFORD STREET,BOSTON,MASSACHUSETTS 02114 ASBESTOS CONTRACTOR LICENSE ASSOCIATED BUILDING WRECKERS,INC. 352 ALBANY STREET SPRINGFIELD MA 01105 LICENSE: AC000898 EXPIRES: Monday,July 15,2019 IN ACCORDANCE WITH MGL CH. 149 §6B AND 453 CMR 6.04 THIS CERTIFICATE IS ISSUED BY THE DEPARTMENT OF LABOR STANDARDS TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF ENTERING INTO OR ENGAGING IN ASBESTOS WORK. THIS LICENSE IS VALID FOR A PERIOD OF ONE(1)YEAR. WILLIAM D.MCK.>rIrIEY,DIRECTOR Please detach this mailing tab and keep your license certificate in an accessible location.A copy of this license must be maintained at each worksite. ASSOCIATED BUILDING WRECKERS,INC. 352 ALBANY STREET SPRINGFIELD,MA 01105