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24B-088 (4)
106 INDUSTRIAL DR BP-2019-0874 GIS#: COMMONWEALTH OF MASSACHUSETTS 9W.Block:24B-088 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateuorv'renovation BUILDING PERMIT Permit# BP-2019-0874 Project# JS-2019-001459 Est.Cost: $184000.00 Fee $1288.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PIONEER CONTRACTORS 017890 Lot Size(sp. 11): 87250.66 Owner. DIPWELL COMPANY INC Zonine:GIH00/ Applicant. PIONEER CONTRACTORS AT. 106 INDUSTRIAL DR Applicant Address: Phone: Insurance: PO Box 1145 (413) 586-5491 Workers Compensation NORTHAMPTON MA01061 ISSUED ON2/14/2019 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT A MODULAR CLEAN ROOM WITHIN EXISTING 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: OI: 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 2/14/70190:00:00 $1288.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0874 APPLICANT/CONTACT PERSON PIONEER CONTRACTORS ADDRESS/PHONE PO Box 1145 NORTHAMPTON (413)586-5491 PROPERTY LOCATION 106 INDUSTRIAL DR MAP 24B PARCEL 088 001 ZONE GI(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST E SED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid TvraeofConstruction: CONSTRUCT A MOD AN ROOM WITHIN EXISTING BUILDING New Construction Non Structural interior renovations Addition m Existing Accessory Structure Building Plans Included Owner/Statement or License 017890 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: ✓Approved 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 Perri[ 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 Delays �f 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. �+C Versionl.7 Commercial BuildingPermit May 15,2000 RECEt Ci y of Northampton Status of Pemait ®nt use only B ilding Department Curb OINDrNeway;Permit 12 Main Street SewxfSeptic Avallepi6ty _ 7 ?019 Room 100 wagrOOILAvaiWn* �Nort ampton, MA 01060 TWO Of SeucWral Plane _phone,03-5 7-1240 Fax 413-587-1272 PI P�116' Dow Specdy_ 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 7.1 Property Atltlrass: This section to be comgple ett teed by office 1D6 Industrial Dnve Map o2y,g Lot Li O Unit Zone Overlay District Elm SL District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED-4GENT 2.1 Owner of Record: Dipwell Co. 106 Industrial Drive, Northampton, MA 01060 Name(Print) Current Mailing Address: 413-587-4673 Signature �"' " a Telephone 2.2 Authorized Aaent: Pioneer Contractors P.O. Box 1145, Northampton, MA 01061 Name(Print) Current Mailing Address: 413-586-5491 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Oficial Use Only completed by permitapplicant 1. Building 150,000.00 (a)Building Permit Fee 2. Electrical 16,000.00 (b) Estimated Total Cost of Construction from 8 3. Plumbing N/A Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection Mach: 18,000.00 1 aoC O .00- 6. Total=(1 +2+3+4+5) 1 , VW'Ix/ 1 Check Number q b17 This Section For Official Use Only Building Permit Number Dale Issued Signature: Building Commiasionerllnspeetor of Buildings Date PS Orv&y- Coma c4© �oo O Y� 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 ❑' Existing Wall Signs ❑ Demolition Repairs Additions Accessory Building Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing Change of Use❑ Other❑ Brief Description Enter a brief description here. Of Proposed Work: Construct modular clean room within existing building per plans attached. SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly1:1A-1 ❑ A-2 ❑ A-3 El 1A A-4 ❑ 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 134 ❑ 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. Business Proposed Use Group: Business Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA OFFICE USE ONLY BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Floor Area per Floor(sl) ill 1. 2"" 2n° 3' 3m '.. 4m : Total Area(sl) Total Proposed New Construction(sl) Total Height(it) 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 [j Zone Outside Flood ZoneO Municipal ❑+ On site disposal system[] Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning Phis column m be filled in by Building Depanmeut Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&pavN arkin k of Parking Spaces Fill: wlume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW Q YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW O YES O IF YES: enter Book Page and/or Document k'. B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW Q 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 0 part of a common plan that will disturb over 1 acre? YES O NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Ver ionl.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): Michael P. Bruns Go Truman Young &Assoc. Structural Name Area of Responsibility 4225 Molsbary Rd. Cincinati, OH Structural Address Registration Number 513-861-5655 49632 Signature Telephone Expiration Dale Name Area of Responsibility Address Registration Number Signature Telephone Expiration Dale Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Dale 9.3 General Contractor Pioneer Contractors Not Applicable ❑ Company Name: David Claxton Responsible In Charge of Construction P.O. Box 1145 Northampton, MA 01061 Address I /1 / J 413.626.7267 Signature I Telephone Version1.7 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 O SECTION it -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT DlpWell Co. as Owner of the subject property hereby authorize Pioneer Contractors to act on my—b�ehalfI,�i,n all matters relative to work authorized by this building permit application. A 0_ i A rL- rr 4 Feb., 2019 Signature of Owner N` ff Date Pioneer Contractors/David Claxton as Giiiiivn/Authonzed 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. Pnnt Name V Y Signatureof C�Agenl Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Hader David Claxton CS 017890 License Number P.O. Boz 1145 Northampton, MA 01061 1/19/2020 Address Expiration Date 4a 1 413.626.7267 Signature �, Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C16)) 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 Q 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: i 6h The debris will be transported by: -i�)� saati 'rue d The debris will be received by: 1/J4 r, waa Building permit number: Name of Permit Applicant plz�' zl y��al & Date Signature of Permit Applicant The Commonwealth ofMassaehusetts Department of Industrial Accidents y I Congress Street,Suite 100 Boston, MA 02H4-2017 www.massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbem TO BE FILED WITH ONE PERMITTING AUTHORITY. Applicant Information Please Print Lestibly Name (Bu iness/organizarionnndividual): t e�dr- -1,.v 1 P,Address: C • 0- Q),,Y- 114e , City/State/Zip: q V 14iA ' MPt, bl ( Phone#: 1-113' Are you an employer?Chock the appropn nbox: Type of project(required): lilamaemployerwilh ?✓ employees(full and/or fart-timet.' 7, ❑ ew Construction 2.❑I am a sole proprietor or partnership and have no employees working f s any m g, emodeling any capacity.[No workers'comp.insurance required.] 3.M I am a homeowner doing all work myself[No worked'comp.moor ee rehars!11 9. E]Demolition 4 n an ahomeowaerand will behoingeontradorsto conductall wank on my promr,. Twill 10❑ Building addition ure India wntnctors either have workers'cmnpensathonlmerence or aremlo I1.[]Electrical repairs Or additions proprietors with[no employees. 12.[]Plumbing repairs or additions 5 1 am a geneml contractor and I have hired the sub-co usctors listed on the attached sheet. 13.[:]Roof repairs These,n1v. tmvlam have employees and have workers'comp.manatee 6.❑we we a earn ..tion and its officer have m emised their right ofexemplion per MGL c 14.❑Other 152.Q1(4),and we have an employes.[No workers'comp.announce mi,mocd] "Any applicant flat checks box#1 must also fill out the seamn below showing their workers emn, cation policy information. t Homeowners who submit this affidavit mdivating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check fins box most attached an additional sheet showing Ne name of the subcontractors and state whether or not Nose ermines have employees. If Ne subconnnsuma have employees,Nry must provide Neir workers'eomp.polity number. I am on employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance CompanyName: Policy#or Self-ins.Lia#:��(, 9s(,p 55.5 7Of I S Expiration Date: 6 I 11y4,,� Job Site Address: 1(J(o .�'-�.(. ffG,X n ` City/State/Zip: Y r` Attach a copy of the workers'compensation policy declaration page(showing the policy number and elipiration 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 certify r the 'es ofperjury than the informadon provided above is hue and correct. Signature: 7 Date' Ph #: 4(; - S� ' SZ4q) Oficial 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 N; Associated Employers Insurance Company Insured: 5005957 Producer: 03019-001-044 Pi Con Inc King & Cushman Inc P O Box 1145 P O Box 447 Northampton, MA 01061 Northampton, MA 01060 Insured FEIN: "'1984 Issue Date: 05/31/2018 Policy Number: WCC-500-5005957-2018A Endorsement Effective Date: 06/30/2018 Policy Period: 06/30/2018-06/30/2019 Endorsement Number: ENDORSEMENTSCHEDULE The forms listed below are included in this policy: Form No. Form Description Applicable States Policy Effective Date WC 00 00 00 C Policy Conditions 06/30/2018 WC 00 03 11 A Voluntary Compensation and Employers Liability 06/30/2018 WC 00 04 04 Pending Rate Change End. MA 06/30/2018 WC 00 04 14 Notification of Change in Ownership 06/30/2018 WC 00 04 22 B Terrorism Risk Endorsement 06/30/2018 WC 00 04 25 Experience Rating Modication Factor Revision 06/30/2018 WC 20 03 01 MA Limits of Liability Endorsement MA 06/30/2018 WC 20 03 02 A MA Assessment Charge MA 06/30/2018 WC 20 03 03 D MA Notice to Policy Holder Endorsement MA 06/30/2018 WC 20 03 06 B MA Limited Other States Insurance Endorsement MA 06/30/2018 WC 20 04 05 MA Premium Due Date Endorsement MA 06/30/2018 WC 20 06 01 A MA Cancellation Endorsement MA 06/30/2018 WC 20 06 04 MA Policy Definition Endorsement MA 06/30/2018 En .reemvMSoh(04111) Certificate of Compliance FM This certificate is issued for the following: SE60,SM60,ST60,ETP60,LF,and LM PANELS Prepared for: APPROVED Dagard SA to Route de sde Boussaac,Crease 23600,France FM Approvals Class: 4880 Approval Identification: 3031799 Approval Granted: March 5,2009 To verify the availability of the Approved product, please refer to www.AoorovalGuide.com. Said Approval is subject to satisfactory field performance,continuing Surveillance Audits,and strict conformity to the constructions as shown [ wn in the Approval Guide,an online resource of PM Approvals. ` / Cynthia E. Frank Group Manager,A.V.P. FM Approvals 1151 Boston-Providence Turnpike Norwood,MA 02062 FM Approvals® ,%hndar fdm FU Chdial Gn„<, 9 'II First class modular GMP cleanroom systems Pharmaceutical Biotechnology �� Healthcare Medical device Biocontainment High Tech kYA dagard Cleanroom i l I They trust us ABBOTT, ALLERGAN, ASTRA ZENECA, BAXTER, BRISTOL MYERS SQUIBB, CEA, CITY OF HOPE, ELI LILLY, GENZYME, GLOBAL DATA CENTER, GRIFOLS, GSK, INTERXION, INSERM, INSTITUT PASTEUR, PFIZER, MERIAL, MERCK, NOVARTIS, ROCHE, SAGEM, SANOFI, THALES, VIDRL, WYETH _ s 5 8 E Corporate: x Phone:+33(0(.555.824.000 z info@dagard.com o Route du stade-23600 BOUSSAC- France E Subsidiary North America: Phone:+1(212)920.4027 ^ L contact-usa@dagard.com 5 Dagard USA Corp 1253ay.oftheAmericas,3"Floor-NewYork,10020,NY-USA dagard www.dagard.com C lean roo rn ThanM02d 9'� 7-0 P.6 BOX 1145 Northampton, MA. 01061 Voice 413-586-5491 Fax 413-527-5099 E-Mail pioneerconirac�lvahoa com Cell 413.626.7267 To: Louis HasbroucklBidg.Cornm. Front David Claxton Faze Pages: 27 PlWrrm 413.587.1240 Date: 4Feb.,2019 Re: 106 Industrial DR. CC: ❑Urgent X For Review 0 please Comment ❑please Ropy ❑please Recycle e Comments: Construct Modular Cleary Room Panel system whin Existing Su6dinn Attached please find the following: -Stamped Plans--Mechanical&Structural -Factory Mutual Panel Approval&Manufacturer Information -Building Permit Application&Permit Fee Check -Workmen's Compensation Insurance Affidavit&Insurance Policy Declaration Page -Solid Waste Disposal Affidavit Thank you for your consideration. Respectfully David Claxton Pioneer Contractors