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24D-329 (8)
203 KING ST BP-2019-1016 GIs*: COMMONWEALTH OF MASSACHUSETTS Map,Binok:24D-329 CITY OF NORTHAMPTON Lm:.001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) CAt&gorv'renoya0on BUILDING PERMIT Permit# BP-2019-1016 Project# JS-2019-001668 Est.Cost:575000.00 Fee:$525.00 PERMISSION IS HEREBY GRANTED TO: Const.class: Contractor: License: Use Grouo� JORDON JONES - GLOBAL CONSTRUCTION STRATEGIES 113108 Lot sizelsu.B.): 22520.52 Owner: AFC BRANDS Zonine' HB(100)/ Applicant., JORDON JONES - GLOBAL CONSTRUCTION STRATEGIES AT. 203 KING ST Applicant Address: Phone: Insurance: 4802 LENA RD#106 (941) 745-1144 WC BRADENTON FL34211 ISSUED OK3/1912019 0:00:00 TO PERFORM THE FOLLOWING WORK:RENOVATION TO THE FRONT PORTION OF RESTAURANT POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wirtng D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House k Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: moke: 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 3119/20190:00:00 $525.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Version 1.7 Commercial Building Permit May 15,2000 qorthampton Vi,rfi Department Mpg 4 PO 21 ain treet ont 100 a a I ton, MA 01060 1*4 - 1 40 Fax 413-587-1272 APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING -------7 SECTION I -SITE INFORMATION This section to be completed by office 1.1 Property Address 203 KING ST Map 1;?`40 Lot �.Af Unit NORTHAMPTON, MA 01060 Zone Overlay District Elm St.District CIS District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: AFC BRANDS 3379 PEACHTREE RD STE 360, ATLANTA, C Name(Print) Current Mailing Address Signature Telephone 2.2 Authorized Agent, Eric Renegar 2572 WEST STATE ROAD 426 SUITE 2064, a Name(Print) Current Mailing Address (321) 244-0402 Signature Telephone SECTION 3.ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com leted b ermit a licant 1. Building $75,000.00 (a)Building Permit Fee 2, Electrical $0.00 del Estimated Total Cost of Construction from(6) 3, Plumbing $0.001. Building Permit Fee 4, Mechanical(HVAC) 5 Fire Protection 6. Total-(1 +2 1 3+4 5) Check Number This Section For Official Use Only Building Permit Number Date Issued Signature -3 /a�__ 1 Building dingN Commissionerfinspeclor of Buildings Date 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 0 Existing Wall Signs ❑ Demolition❑ Repair❑ Additions ❑ Accessory Building El Exterior Alteration ❑ Existing Ground Sign❑ New Signs Ej Roofing❑ Change of Use❑ Other!71 Brief Description THIS PROJECT CONSISTS OF AN INTERIOR YRONTOF HOVSL REVOIATION 01 [HE P DINING ARLA FOR AN EXISII\-O KFC/LAC OBl RRSTACRANr THE RIT('HEN A\D DRIVE THROUGH ARF AS Of Proposed Work: WILL REMAIN IN OPERANO\.DLRI\OTHE RFNIODLLING PROCESS EX I ERIOR IMAGE LPGRADF WILL CONSIST OF NEW EXTERIOR BRANDING&SIGNAGE LLEMFNTS WITH NEW PAINT PINISHLS SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑i A-3 ❑ 1A ❑ A� ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1-1 Cl I-2 ❑ I-3 ❑ 3B M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 513 Q U Ublity 11 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: Restaraunt Proposed Use Group No Change Existing Hazard Index 780 CMR 34): N/A Proposed Hazard Index 780 CMR 34): N/A SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(60 1 ' . . .3,006 to 2a . 2a . . 3,a 4 4m 1, Total Area(so 3,006 Total Proposed New Construction(at). _ Total Height(It) 17 Total Height It 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Private ❑ Zone Outside Flood Zoned Municipal 0 On site disposal system E] VerNmA]Comowciel Building Pmok May 15.2W 1SECTION 10-STMICTMAL PEER REVIEW 4751 CMR 110.111 ^. 1 tn0epndan SingWrN ElMitmpkg Sbu4WR1 PPOrfleview uIW _.—...— Yea_Q_ No O >�EC110N 11• A�.TS9E CSWLETRU IRMN OWNERS AGENT OR CCNIRACTOR APPLIES FOR]RIDING PEPMB hlRb/aWWi➢1�_'f_i�..-_. am Nl mNrtrn{4l.e Wrmlk wNamml by dpa b.k"ppmA RWluW , Eric ReneW ASem hereby dsdm tlrt Ole abtom"and fnbmakon an IM hrepdM appfiu0on aro tma and acurati.100n beN of my knoarbd" and 6874 sgrod wMer 0r pens ane pwefip of emkry. 'Eric M.Renege PmI d/asia,r� � SECTION 12-CONSTFAXIM SERVICES 10,1 Not —TAU fl—. J:pf/ 10 WEIXI-7115-11f4 E>p.1an� 6areb•a TaNplpna i SECTION 154NORKERV COMPENSATION NISVRANCE AFFIOAVR(M.6 e.167.62"1) Wodlas CompareMbn Immanca611aNN1 muR bs o>,rolwd end aunmMed wen mm appMratbn.FNYaO b Dnm1e 0�N e6perawN rowk n 6wdanlN p/tlN 47WN0 of tlM OINd Version 1.7 Commercial Building Permit May IS,2000 8. NORTHAMPTON ZONtNO Existing Proposed Required by Zoning This column robe filled iu by Building Ddl attmenl Lot Size Frontage Setbacks Front Side L. R: L:'.. R:'. Rear Building Height Bldg. Square Footage Open Space Footage I1o1 area minus bldg&paved akin ) 4 o Parking Spaces wlume&Locaoonl A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DON'T KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW © YES IF YES: enter Book Page and/or Document s B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW © YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained © , Date Issued: C. Do any signs exist on the property? YES 0 NO O IF YES, describe size, type and location: See elevation sheets in the plan set 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: Updated for branding, see plans 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 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: ANDY D. MIN - 8845 Tulley Ave. Oak Lawn IL 60453 Not Applicable ❑ 034832 Name(Registrant)'. SANDY D. MIN - 8845 Tulley Ave. Oak Lawn IL 60453 Registration Number Address 11/30/2019 (321)244-0402 Fxpiratlon Data 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 �\ The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.gov/din Wil.cluers'Compentation Insurance Affidavit:Builders/Contmetors/Electricians/Plumbers. 1"0 BE FILED VVI"1'11 THE PERNH ri IN'G At'THORI'1'V. Applicant Information Please Print Leuibbe Name (Dusmesslorgonizationnndividnap: _ Address: City/State/Zip: Phone#: Are you an rmplol<r"Cbnk the apprupriete box: Type of project(required): I.❑lahosmptoyerwith_ employees(full and/o"irenme)" T ❑New construction 2.❑l am a sole proprietor or partnership and have no employees working for me in 8. F9 Remodeling any capacity.[Newark,, comp insurance required.] 9. El Demolition J l am a homeowner doing all work myself [No workers'wmp insurance required 4.❑1 am a homeowner and will be hiring contractors to conduct all work on no property_ I will 10 E] Building addition ensue that an contractors either have,caro,s'compensntion insurance or aro sole I1.❑Electrical repairs or additions propnemn with no employees 12.❑Plumbing repairs or additions 5®I oto a genial comramor and have hired the subcontrmmrs listed on the couched sheer I Three sin-contractors have employees and have workers'comp.ivumnec. 13.❑Roof repairs 5.❑Wearea cotppm tionand in eRecrs have exercised their night ofe-un tion 14.❑Other g technical pu MCLc 152„+q4f and w<naweno employor=.Irvo woAers eomv-insnan� .7 `Any opplicamthat checks box 41 must also fill out the section below showing their workers`compensation policy Information. frocawners who submit this amdav It ind testing they we doing all work and then hire outside contractors most submit a new affidavit indicating such :Comractom that check this box must attached an additional sheet showing the name of the subcontractors and sure whether or not those entities have employees. If the subcontractors have anployecs,they most 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. p Insurance Company Name: S 9�Ow� 9 ��c'—W /I Policy#or Self-ins.Lic.#: W'/Ga � ��3 Expiration Date: g"�`/�� _q Job Site Address: �b� K--INGI �� City/State/Zip: /`t ✓�/0&0 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under NGL 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 at may be forwarded to the Office of Investigations of the DIA for insurance coverage e ' toff. I doheby cer ifyu paths an p ies ofper/ury that the baboons lion pro videddabovee 'Zen e andcorrect. Si azure' Date: J r Phone#: Off+ al use only. Do 1 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#: 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: The debris will be transported by: Noa�a3tn,Z (� 3QAPE� The debris will be received by: Building permit number: R)P-Q7O1q-�0//p Name of Permit Appli I� Date nature of-Pe pplicant AC CERTIFICATE OF LIABILITY INSURANCE D"tel n 226/2019 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 cortificate does not confer rights W the certificate holder in Had,of such elHbnenRnt(s. PRODUCER NAMP ROSanna Castro Brown 8 Brown-Tampa PHONE - FAC P.O. Bax 173086 INC xe Er 813492]020 L o,xD1:813-22&1313 Tampa FL 33672 ARIES E rc str0 bbtam a con USUREWSI AFFORDINGCOVERAGE NAICtl INSURER A-.Anensure Insurance Co _ _ 19468 INSURED GLOBA14 INSURI Global Construction Strategies, Inc -- - 4802 Lena Rd-Suite 106 INSURER, Bradenton FL 34211 INSURE I D _ INSURER E' _ INSURER F: COVERAGES CERTIFICATE NUMBER:471297530 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 WTH 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.LIMITSSHOWNMAYHAVEBEENBEXCEOBYPAIDO MS. INSR DL ROBR - POUCYEFF POLICY ECP LIMITS TYPEC£INSURANCE POLICY HUMREP MMNDM"W MWBDIYWY LA I X i COMMERCWLGENERALUAINUTY GL2104811 411211018 4/192019 EACX OCCURRENCE ai 000,000 x AMAOSTC kENTu CLAIMS MADE J OCCUR PREMISESLcQ nceT _ E 1,000,000 MED EXP1Anyane'rec l $10000 P DNgLXAOV NJURY 51000.000 NE BY ABAL Pini $2,000000 GENLPOA6CIREGXTEJbri gPPLACT �5LOC PROOVCTSGCOMPIOPAGG 92000,000 OTHER E A AM OMOBILEUABIUTY CA2104810 4/1212018 4/12/2019 OMBIN PSTN LE VMIT 51000000 m end ANY X O.EC O e001LV INJURY Per�lSonn —s OWNED SCHEOVLEO BODILY INJURY(Pxdt'1Een1 —I — NY ONLY ALT - X HIRED X NON OWNED � PROPERiY pPMAGE ._AUTOS ONLY AUTOS ONLY Pe..cGeenO _ A X UMBRELLA US. X OCCUR CU2104012 4/12.11 4/12/2019 EACHOCCURRENCE 52000000 Inc n CESS.AB �GIAIMEAIADE AGGREGATE 152.000,000 PEO X RETENTIONS r A WORtERSCOMPENSATON WC2104813 4112/2018 41IV2019 X $TATVTE I ERH AND EMPLOYERS'WBIUW ANYPROPRIETOREARTHERIEXECUTrvE YIN EL EACH ACCIDENT 51,000.000 OFFIOERIMEMBEREXCLUOED? ❑ NIA IM.......nNR EL.DISEASE.Eq EMILOYEEI $1000,000 ey ee:onda xnder DESCRIPTION OF OPERATIONS EeIow EL.DISEASE POLICY LIMIT $1,W0,000 DESCRIPTION OF OPERATIONS LOCATIONS VEMICLES(ACORD 101,Additional Rameha SCbOUN,nuy M McAred Nmore a WCs N essUes) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept. 212 Main Street Aum aBEDREPaeSENTATIVE Northampton MA 01060 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD West State Road 426 Suite 2o64 LETTER OF TRANSMITTAL LISOviedo,FL 32965 j U Tel: (321)244-0402DATE: 03/01/2019 JOB NO: 2015-261 Fax: (321)244-9419 ATTENTION: Building Review RE: KT Northhampton - Remodel KT TO: City of Northampton 203 KING ST Building Department NORTHAMPTON, MA 01060 212 Main Street, Room 100 Northampton MA 01060 WE ARE SENDING YOU Attached Under separate cover via UPS the following items: Shop Drawings Prints Plans X Samples Specifications Copy of Letter Change Order COPIES DATE NO. DESCRIPTION 1 03/01/2019 S/S Plans 1 03/01/2019 Application Remarks: Please let me know if you have any questions. Plan Review Fee Check being sent by owner in separate package. COPY TO: File SIGNED: EPIC Renegar