31B-230 64 Gothic Ramp 31B-230 (7)64 GOTHIC ST BP -2016-1513
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 313 - 230 CITY OF NORTHAMPTON
Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Cateaury HANDICAP RAMP BUILDING PERMIT
Permit# BP -2016-1513
Proiect 9 JS -2016-002559
Esc Cost: $70000.00
Fee, ,4$ 9000 PERMISSION IS HEREBY GRANTED TO. -
Const. Class: Contractor., License:
Use Group: BAYSTATE WINDOW & DOOR 089485
Lot Size(sq. ft.): Owner: GOTHIC REALTY TRUST -BENJAMIN BARNES & ED ETHEREDGE
TRUSTEES
Zodnc CBn00)/ Applicant. BAYSTATE WINDOW & DOOR
AT.- 64 GOTHIC ST
Applicant Address: Phone: Insurance:
87 SHATTUCK RD (413) 549-6824
HADLEYMA01035 ISSUED ON. 6117/2016 0:00:00
TO PERFORM THE FOLLOWING WORK. -NEW WALK, WALL AND RAMP
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing
Inspector of Wiring
D.P.W.
Building Inspector
Underground:
Service:
Meter:
Smoke:
Final:
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:
FeeTvpe: Date Paid: Amount:
Building 6/17/2016 0:00:00 $490.00
212 Main Street, Phone (413) 587-1240, Fax: (413) 587-1272
Louis Hasbrouck— Building Commissioner
J
Version lJ Commercial Buildm
Permit May 15, 2000
/v/A' ..L
b L� bo'� J/ •-... _. -.
Map Lot
Unit
Department use only
Zone Overlay District
City of Northampton
Status of PermitBuilding
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
Department
Curb Cuvonveway Permit212
"11
Main Street
Sewer/Septic AvailabilityROOm
100
Water/WellAvailabilityrthampton,
Name (Pnnh Current Mailing Addrese.
MA 01060
Two Sets ofStructural Plans
-587-1240 Fax 413-587-1272
PIousite Plans
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 1 -SITE INFORMATION
1.1 P rooertress
tltl
This section to be completed by office
/v/A' ..L
b L� bo'� J/ •-... _. -.
Map Lot
Unit
Zone Overlay District
- -- - -- --- -- -
Elm St. District CS District
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name (Pnnh Current Mailing Addrese.
Signature Telephone
2.2 Authorized!gent
Name lPrmry T� Current Malling Address
l
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollars) to be
Official Use Only
completed her ermit applicant
1. Building
t �IQ OCXJ . 00
.!I
(a) Building Permit Fee
2. Electrical
(b) Estimated Total Cost of
Construction from fi)
3. Plumbing
Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
E. Total=(1+2+3+4+5)
Check Number
This Section For Official Use Only
Building Permit Number
Date
Issuetl
Signature: I
I
Date
Bu[dlEi...rer/l,spector of Bul Jings
Versfonl7 Commercial Building Permit May 15, 2000
SECTION 4 -CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wail Signs ❑ Demolition Repairs El Additions
❑ Accessory Building El
Exterior Alterafion ❑ Existing Ground Sign ❑ New Signs ❑ Roofing❑ Change of Use ❑ Other W
Brief Description Enter a brief description here.
Of Proposed Work
G,wl k
c%u
SECTION 5 � USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable)
CONSTRUCTION
TYPE
A AssemblyF-1A-i
1`7A-2 ElA-3111A
11
A4 ❑ A-5 ❑
1B
❑
B eusioess ❑
2A
2B
2C
❑
❑
❑
E Educational ❑
F Factory ❑
F-1 ❑ F-2 ❑
H High Hazard ❑
3A
3B
❑
❑
I InstituJanel E3
1-1 ❑ 1-2 ❑ 1-3 ❑
M Mercantile ❑
4
❑
R Residential ❑
R-1 ❑ R-2 ❑ R-3 ❑
5A
5B
❑
❑
S Storage ❑
S-1 ❑ S-2 ❑
U Utility ❑
Specify
Specify
M Mixetl Use ❑
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 Roar (at)
__.
1st
tsi
__... __ ..
2ne
3 rd
�.
_. ...
4"
Total Area (sf)
Total Proposed New Constructtion (sf)
Total Height (ft)
_
Total Height fit
i
7. Water Supply (M.G.L. c. 40, § 54)
7.1 Flood Zone Information:
7.3 Sewage Disposal System:
Public ❑ Private ❑
Zone Outside Flood Zone❑
Municipal ❑ On site tlisposal system❑
Version l.7 Commercial Building Permit May 15, 2000
S. NORTHAMPTONZONING
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q YES 0
IF YES: enter Book Page. and/or Document N
B. Does the site contain a brook, body of water or wetlands? NO O(/i DONT KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO g
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
IF YES, describe size, type and location:
E WII the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part aid common plan
that will disturb over 1 acre? YES 0 NO g
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Existing
Proposed
Required by Zoning
'chis column to be filled in by
Building De0ari
Lot Size
Frontage
Setbacks Front
Side
Rear
L .. R:_._.._
L: ,. R
Building Height
BldgSquare Footaee
-
Open Space Footage
(Lotarea m'niu bldg&paved
earkin,l
%
_
_
of parking Spaces
—
-----
Fill..
(volume&Laod.ou)
—
--
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q YES 0
IF YES: enter Book Page. and/or Document N
B. Does the site contain a brook, body of water or wetlands? NO O(/i DONT KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO g
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
IF YES, describe size, type and location:
E WII the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part aid common plan
that will disturb over 1 acre? YES 0 NO g
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Versionl 7 Corrunercfat 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
-
6prahon Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name
Area of Responsibility
Address
Registration Number
Signature
TelepM1one
Expiation Date
Name
Area of Responsibility
Address
_
Registration Number
Signature
Telephone
Expiration Date
name
Areeof Responsibility
ACCress
Reg strahon Number
Signature
Telephone
Expiration Date
Name
Area of Responsibility
Address
Regis Number
Signature
Telephone
Expraton Date
9.3 General Contractor
yG �� ("WfC� — J _'_'C -
_.._ _... __:
Not Applicable❑
C.�ompany Na e.
Responsible In Charge of Constructlei
(16 /Kidd/r .S/
ACCress
Signature ?el.phom,
Version L7 Commercial Building Pernot May 15, 2000
SECTION 10 -STRUCTURAL PEER REVIEW (780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
C1/4A-+44f
I. /?-Yf;J l/.n cy, k T'd a�liGnzT— as -Owner of the subject property
nerebyauthonze. YJSCa< C'(✓.Yl�C+ _. to
act an my behalf, in all matters relative to work authorized by this building permit application _
Sgnature of Ownera.
as Owner/Authorized
thatthe statements antl information on the foregoing application are true and accurate, to the best ofmy knowledge
s andpenalties of pe0ury
FNam.
Sgnature of Owner/Agent Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor:
Name of License Holder:
Not Applicable ❑
L cense Number
Address^
Expiration Date
5 Telephone
SECTION 13 -WORKERS' COM ENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6))
W prkars Compensation Insurance ffdevit must be completed and submitted with this application, Failure to provide this affidavit will result
in the denial ofthe issuance ofine building permit
Signed Affidavit Attached Yes 0 No O
_ The Commonwealth qj Massachusetts
Department of bidusti ial Accidents
_c "
Office oflnvesgations
600 n ashing:on Street
_ — Boston, MA 02111
www.mass., die
Workers' Compensation Insurance Aludavit: Builders/Contractors/Electlicians/Plumbers
Applicant Information Please Print LeeiblV
Name (Business/Organi ation/Individual):
Are you an employer? Check the appr
I am a employer with --2
employees (full and/or part -tune).*
2. ❑ 1 am a sole proprietor or partner-
ship and have no employees
worlcog for me in any capacity.
[No workers' comp. insurance
required]
3. ❑ I am a homeowever doing all work
myself [No workers' comp,
insurance required.] t
Crlorle
plate bas:
4. ❑ I am a general contractor and I
have hired the sub -contractors
listed on the attached sheet.
These sub -contractors have
employees and have workers'
comp. insurance i
5. ❑ We are a corporation and its
offices have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees- [No workers'
comp. insurance required.]
T)'pe of project (required).
6. ❑ New ...incise.
,. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
11. ❑ Plumbing repairs or additions
12.❑ Rocf repairs
13, F-1 Other
"4ny son I, can! that checks box RI must also fill out the section below s%ovlog tner workers' compensanon policy mto;manon.
T Homeowners who submit this atodavit indicating they are doing all work and then hire doddiCe contractors must submit anew a6idevit indicating such
SConexctors that check this box trust attached an addin onal sheet shoat, the wane of the sub -contractors and stale whether ono! those gropes have
ert¢loyet, If the ob-con.ubT, have employees,they must provide thefr workers' comppolicy amber.
I am an employer that is providing workers' compensation insurance for my employees. Below is the poll y and job site
informa4an / T
Insurance Company Name: e�- G �elloc k Ti)b&I/o u
Policy n or Self -ins. Lin le: V W C, — /00 —
Job Site Address: 6 / 6,",c &i, City/State/Zip: A/'14e.,Qfan jl(A-Gie6ci
Attach a copy of the workers' compensation policy declaration page (showing the policy number and ezpirafion date).
Failure to secure coverage as required under Section 25A of MGL c. 152 oast lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or ane -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. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DLA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Official ase oupl. Do not Brite in this area, to be completed by city or town official
City or Town: Perant/License st
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact
Phone
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 q (�•� cF,
The debris will be transported by: —Tr �c
The debris will be received by: Meeh-' &-elci /Cows �n
Building permit number:
Name of Permit Applicant
Date Signature of Permit Applicant
05/25/2016 10:19 4132568354
PAGE 03/03
CERTIFICATE OF LIABILITY INSURANCE sizsizDi6
THIS CERTIFICATE IS ISSUED AS A MATTER OF INrr TCMTICN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEC ITIVELY 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: N the ceTUNwte holder's an ADDITIONAL INSURED, the pollcy(les) must be endomed. N SUBROGATION IS WAIVED, Subject to
Na terms and condMors of the policy, certain policies may require an endorsement. A statement on this cer likale does not confer rights W the
certigrata holder In IS. of such endorsemen s .
PRODUCER fAxT°GT Dean Paddock
vMISM
Paddook msaranca Agency PMouE (413)253-5555 uvu5E-eav
20 GEKULatehouse Rued EMILddock@oarhanagenc3ea.com
AoeREss�
LN7 SoX 49 INSURERwsI aPPOROINO COVERAGE _ _ xalee
Amhacet HA 01004-0048 BSURERA:T.a1Nz. insurance_ Coa@en 36137
INSum. IWume.a:COID6_ e. Insurance _ _34.754
Hadley Conometes Sar iaae LLC IrySURERc:
35 hliddle St
Hadley Nm 01035 NEUESRF
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 MY CONTRACT OR OTHER DOCUMENT PATH RESPECT TO 'WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
mLfsW IYPE OF INSURANCE
L'
'
c N
' POUCY EPf PDUCY QP
uuns
X COMMERCIAL GExERAL UJBun
EACH OLGURRExCE
E 1, OOO,fIOfl
A CUNSMADE [j] OCCUR
PREMISES Ee rcavrtrcc 5 300,000
iJ
fiBGe4°03°A9
ID/9/2015 10!9/2016
MEO E[P 'S 5,OOD
GERSONIdS AOV INJURY s IFOOD,Ooo
GENEnm-.GUMEGATE E P, DOD, 000
GENLAGGREGATE LIMTL PLIES PSR
II POLICY l PPO.
l
J JECT LOC
_
PRODUCTS-COMpQpAqq b x.000,000
n101 S
OTHER
OMOBas WNIITY
LDLIBINEO91NOl£LIMn E
BANY
AUTO
9001LV INJURY IPe DRewl 4 50,000
pxu,l
ALL OvmFO v SCHEDULED
AUTOS AUTOS
SslnO
°/10/x015
a/10/2m4
e001LnNJURY Er mWearvll S 100.000
f
X NONONMEO
ROEER1YONdAGE
MIRED °IJ:pS AUTOS
�lPw E SCO, ODO
E
UMapFLLA ILe OCCUR
EACH OCCURRENCE E
AG�NBIIATBS
Q[ESSLIAB CLOMSANOEI
InEn
S
TEITOx
SCOMPENYTWN
PEP DTX-
may.ma
ANO EMILOYEpS'LLIBILIYY YIN
i
,NY
E_,L_ FACE ACCIDENT S
EARTNEIo'1
OFFPF.E.TOPNARTryFRIEAECUPv= L
RIA
__..__ _.. _ _
IMxIdANWaIn
IKs, memm.,.m.EL
DISEASE -EA EMPLOYE f
0E R n u F
E. L DISEASE. E000Y LIMIT
S
NOSCMPTON OF OPERATORS / LOCAPONS I YENICIES IACOAO IM, AEOklmul pmmnrte 9CM6W4 TAY Ee aaeWE N em, l MC, X m,mdl
SHOULD ANY OF THE ABOVE DESCRIBED POLIGES BE CANCELLED BEFORE
City of NOx tEDea pton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
125 LD.Rt St. ACCORDANCE WITH THE POLICY PROVISIONS.
Northampton, PIA. 01060
AUTMORIS90REPREBENTATNE
DNa% Paddock/DOSS
®1988-2014 ACORD CORPORATION. All Rehts reserved.
- r ,Ire Mwnu name ono mga are registered marks at ACORD
IN5026tmuD1l