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BP-2019-0934 660 Riverside
660 RIVERSIDE DR BP-2019-0934 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23C-037 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:ZoningPermit BUILDING PERMIT Permit# BP-2019-0934 Project# JS-2019-001146 Est. Cost: Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: LORENZO GARDINER 1132385 Lot Size(sq. ft.): 16465.68 Owner: Jeff,Marney Zoning,:GIO00)/WP(48) Applicant: LORENZO GARDINER AT: 660 RIVERSIDE DR Applicant Address: Phone: Insurance: 5 SHIRLEY ST WC WILBRAHAMMA01095 ISSUED ON:3/4/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONCRETE ALLYWAY, DOORS, FLOORS, IRON BARS ON WINDOWS, CHAIN LINK GATE, 3 BAY SINK 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 3/4/2019 0:00:00 $100.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0934 APPLICANT/CONTACT PERSON LORENZO GARDINER ADDRESS/PHONE 5 SHIRLEY ST WILBRAHAM PROPERTY LOCATION 660 RIVERSIDE DR MAP 23C PARCEL 037 001 ZONE GI(100)/WP(48)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: CONCRETE ALLYWAY DOORS FLOORS IRON BARS ON WINDOWS CHAIN LINK GATE 3 BAY SINK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• - Owner/Statement or License 1132385 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: jZApproved 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 ,00, 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. t ■ DocuSign Envelope ID:8F5C7782-58E3-4FC7-BF03-AAE45225A25B Version 1.7 Commercial Building Permit May 15,2000 E1 V E f'1 Department use only "MAR4 � JCi of Northampton status of Pem,it:Buil ing Department Curb Cut9Drivevisy Permit2 2 Main Street iSewer/Septic AvailabiliRoom 100 Water.Well Availability rth mpton, MA 01060 Two Sets of Structural Plans -5 7-1240 Fax 413-587-1272 Plot/Site Plans NORTHAMPTON.MA 010B0 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 Promrty Address: This section to be completed by office Map �C, Lot 037 unit F 10 f*�LrlCf"A 01062- Zone Overlay District -w Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Jeff Marne y 175 Main St, Leeds, MA 01053 Name(Print) Current Mailing Address: I�Doc asignedby: 413 584-0737 Y`_.._. . . Signature Telephone 2.2 Authorized Agent: EEI8BFAE928841 F_ - 7aimie Fallon 79 King St, Northampton MA 01060 Name(Print) Docusigned by: Current Mailing Address: F84G44E 7\ _ 413 262-1050 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building ; ..x (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of 660 Construction from 6 3. Plumbing 000_ Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 12-7 6. Total=(1 +2+3+4+5) ) ' Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date Version 1.7 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(O Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other N Brief Description Enter a brief description here. Of Proposed Work: , I 'i rvn 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 ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 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 r v , Existing Use Group: tt��li—�'(a��?; r;.�.:t�u++d Proposed Use Group: �ur1) itiltj��fJL1fi�'1� '(vi��1r, _. _ v. iJ 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) 1 St m_ 2nd 2nd 3rd _ 3rd 4" 4m .- _—_- Total Area(sf) 5, � j „ 4 �m Total Proposed New Construction(sf) 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: Public IN 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 filled in by Building Department Lot Size t315hu¢s - Ibl`1rC,�t/FY Frontage �t Setbacks Front fL II .. Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces tJ Fill: (volume&Location A. Has a Special. Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW Q YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T KNOW Q YES Q IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW Q YES Q 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 Q NO Q IF YES, describe size, type and location: N iza- �(Q4 A 0 tw D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO 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 Q NO 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 ❑ 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 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 DocuSign Envelope ID:2009F797-3310-4B34-B1C6-FE7884148FB9 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 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETEDWHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Jeff Marney as Owner of the subject property hereby authorize Lorenzo Gardner r-_., - �r act on my behalf,in all a2d@h&ffibyo work authorized by this building permit application. Yff NA" 2/27/2019 Signature of Owner EE188FAE928841F_ Deft Jaimie Fallon 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., u� Jaimie Fal on Print Name DocuSigned ny m f 2/27/2019 Signature of Owne e1e14E5B020A4De.. Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder.L--,<<-< f'moA 2 License Number Address Expiration Date ... . 1-1-65 Signatu Telephone - S 2,0 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 No O MR FIX IT license Handyman & Remodeling HIC#176019 34 Front Street Box 51475 CSL#112385 Indian Orchard, Ma. 0115 413-219-6528 cell 413-279-1530 office www.mrfixitspfld.com February 14, 2019 Commissioner Hasbrouck Subject: Request for Waiver I request that you grant a modification to waive the requirement for control construction for the Bodelle's Edibles, LLC project at 660 Riverside Drive in Northampton 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.All work will be completed within the prescriptive requirements of 780 CMR.Thank you for your consideration. "Mass Amendments, sections 107.1 allows for an exclusion from control construction for this project" Respectfully, Lorenzo M Gardner Mr. Fix It Handyman & Remodeling 34 Front Street Indian Orchard, MA 01151 a The Commonwealth of Massachusetts Department of Industrial Accidents _�- Office of Investigations 600 Washington Street f Boston, MA 02111 4 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/OrggaanizatiorAndividual): L 0 r e,naz2 oiM art - Address: -1 JF(ID tlt S� City/State/Zip: bf Uj� Phone q ) S 2-9 Are you an employer?Check the appropriate box: Type of project(required): 1.91 am a employer with__�> 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.F_1 I am a sole proprietor or partner- listed on the attached sheet. 7. [V'Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. E] Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11. Plumbing 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: T 1 ' 1 -1Y-\ U F 0 n(v_ - t Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address:�D �D b 1 V t _ on City/State/Zip: NO•fltilW041 n/ 10A, 61 6YP a.- 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$250.00 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 hereby certify under the pains a penal ies of perjury that the information provided above is true and correct. Si nature: Date: - 1 t Phone#: 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#: 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,oral 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 a joint 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 our situation and, if necessary,supply sub-contractors names address es and hone numbers along with their certificate(s)of pP Y O O> O P O g 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 permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax# 617-727-7749 www.mass.gov/dia ^� MRFIXIT-01 MINA ,acorn CERTIFICATE OF LIABILITY INSURANCE DAT/11/2D/YYYY) `..►-�" 2/11/2019 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(ies)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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONE:TACT Nina Kublan NAM Phillips Insurance Agency,Inc. PHONE 413 5945984 FAX 413 592-8499 97 Center Street (A/C,No,Ext):( ) (A/c,No):(413) Chicopee,MA 01013 EDS&ss:nina@phillipsinsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Atlantic Casualty Insurance Co INSURED INSURER B:The Hartford 29459 Lorenzo Gardner DBA Mr.Fix It Handyman INSURER C: 34 Front St INSURER D: Indian Orchard,MA 01151 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 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY ExP LIMITS LTRD M/DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR L261002105-1 1/12/2019 1/12/2020 DAMAGE TO RENTED 100,000 PREMISES Fa occurrence $ _ MED EXP(Any one arson $ 5,000 PERSONAL&ADV INJURY $ 1,000'000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑J CT D LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LU161LrrY COMBINED SINGLE LIMIT accident $ ANY AUTO BODILY INJURY Perperson) $ OWNED f SCHEDULED __- AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED Per PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ I $ B WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE 6S60UB-7H88582-7-18 1/31/2019 1/31/2020 100,000 Y NIA EACH ACCIDENT $ E.L. OFFICER/MEMBER EXCLUDED? (Mandatory in NH) 100 000 E.L.DISEASE-EA EMPLOYEE $ if yes,describe under 500 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Bodelles Edibles LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 660 Riverside a ACCORDANCE WITH THE POLICY PROVISIONS. Florence, MA 01062 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I