35-029 (17) 1010 RYAN RD BP-2019-1513
GIs#, COMMONWEALTH OF MASSACHUSETTS
M=Block:35-029 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:demolition BUILDING PERMIT
Permit# BP-2019-1513
Project It JS-2019-002448
Es[ Cost;$64000.00
Fee:S700.00 PERMISSION IS HEREBY GRANTED TO:
const.Class. Contractor. License:
Use Group, CHARLIE ARMENT TRUCKING INC 017764
Lot Size(w.R.): 1720620.00 Owner: GGB MASSACHUSETTS LAND LLC
Zoning: Applicant: CHARLIE ARMENT TRUCKING INC
AT: 1010 RYAN RD
Applicant Address: Phone. Insurance:
47 WAREHOUSE ST (413) 739-8431 Liability
SPRINGFIELDMA01118 ISSUED ON:71112019 0:00:00
TO PERFORM THE FOLLOWING WORK:DEMO AND REMOVE ALL STRUCTURES
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 7/120190:00:00 $700.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File N BP•2019-1513
APPLICANT/CONTACT PERSON CHARLIE ARMENT TRUCKING INC
ADDRESS/PHONE 47 WAREHOUSE ST SPRINGFIELD (413)739-8431
PROPERTY LOCATION 1010 RYAN RD
MAP 35 PARCEL 029 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT .Il
Fee Paid Z n
Building Permit Filled out
Fee Paid
Tvoeof Construction: DEMO AND REMOVE ALL STRUCTURES
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 017764
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF"MATION 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 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 Q
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.
r
Vcn icnl.7 Commercial Building Permit May 15. '_000
RECEIVEDDepartment use only
C' of Northampton Status of Permit:
B ilding Department Curb Cut/Driveway Permit
12 Main Street SewerlSeptic Availability
JUN 2 8 2019
Room 100 WaterWell Availability
0 ampton, MA 01060 Two Sets of Stwctural Plans
DEPT OF BUILDING Irppeal�lg 1-5 7-1240 Fax 413-587-1272 Plot/Site Plans
NOPTHAMPTON,MA010a0 Other Speafy
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 Prooerlv Atldni ss: �TsectionNl
6
This section to be Completed by oee
/0
1O_ .(jrAqdG_e 1 Map 3 Lot S 9' Unit
Zone Overlay District
--- Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Name(Pring Current Mailing Address:
0/1 4/3,1/5
Signature Telephone
2.2 Authorized Agent:
Name(Pnnu Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CON TALTION
Item Estimated Cost(Dollars)to be Oficial Use Only
completed by permit a licant
1. Building (a)Building Permit Fes
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3.4.5) Check Number a
This Section For Official Use Only
Building Permit Number Date
Issued
Signature'.
Building CommissonerAmpector of Buildings Dots
5
Vcmionl.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 V Demolition❑ Repairs El Additions ❑ Accessory Building
Exterior Alteration ❑ Existing Ground Sign❑ New Signa❑ Roofing[] Change of Use❑ Other❑
Brief Description Enter a brief description here.
Of Proposed Work:
. ,,w 6hJ srl
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 1:1A-2 ❑ A-3 ❑ 1A 11
A4 ❑ A-5 ❑ is ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ I-3 ❑ 3B
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 156 ❑
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(s0
lei
1'"
2n0 2-
3
m3' P _..
4s 4e
Total Area(sf) Total Proposed New Construction(sf)
Total Height(8)
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 ❑ Zone Outside Flood Zone[] 1 Municipal 0 On site disposal system❑
Versionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZORNG
Existing Proposed Required by Zoning
This column b In fined w by
Building De mt
Lot Sim __._..... _—.
Frontage
Setbacks Front
Side L R:__ L R:
Rear
Building Height
Bldg.Square Footage
Open Space Footage _..._.._..
(Lot utcn minus bldg&pnrcd
4 of Parking Spaces
Fill:
mlumc&I.«etiml
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document#'..
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O 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 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.
Veraionl.T Cotnnu rcud Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 118(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant)
Registration Number
Address
Expiration Dale
Signature Telephone
9.2 Registered Prolesslonel Engineer(s);
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Dale
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Dale
Name Area of Responsibility
Morass Registration Number
Signature Teti!phone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expirabon Date
9.3 General Corrbactor
Not Applicable ❑
Company Name:
Responsible In Charge of Construction
Address
Signature Telephone
VersionlJ 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 0-
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETEDWHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
L as Owner of the subject property
hereby authorize to
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, ,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. _
Print Name
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Conshructillp Supervis
se No/tt��Applicablel��❑1
Name of LicenHolder lr Q0%'l
f license Number
Addre 6i Date
Sign ure Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.152,1 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 ofthe buil ing permit.
Signed Affidavit Attached Yes Nob
City of Northampton 212 Main Street,Northampton, MA 01 060
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: /d/0 IK.� Qat
The debris will be transported by: Q'1'e w TnEAr�lt c
The debris will be received by: �Mc Lau c�rfad-c/
Building permit number:
Name of Permit Applicant (�nnkr/ir 4
"0 /
Date Signature of 4rmit Applicant
The Commonwealth of Massachusetts
Department oflndustrialAccidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Wil.rken'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Le ibly
Name(Business/Or,moratioNlndividualg Arzat
Address: �') Lhlk.—Cd-.
City/State/Zip: S�e Phone#:
Me you an employee Criers he appropriate hoc:
Type of project(required):
IQ Iam aemployer wih_1Jemployeei(fisll atWor part-time),* 7. []New construction
3❑1 am a sok pmprirmror Immcrship and have no employers working frame m 8. ❑Remodeling
any capacity.[No woken'romp.on. .'eired] 9. ep uII-11,.5emolition
;
3.❑lame homeowner doing all work myself IN.workers'comp.insurance required.!'
4.111 am a hon:mwver and will be hums wmmctors to conduct all work on my Proper,, I will 10 E]Building addition
sure that all conoacmrs alba have Workers'compematiw imwence or are sok 11.❑Electrical repairs or additions
,mmetors wih no employm. 12.❑Plumbing repairs or additions
5.[]1 am a general conuamor and!I have hued he suhconrmamm luted on the atmched sheet
Th13.oRoof repairs
Theo sub-cuntrmrs
uhave employees and have wurka%comp.imurance.
6.❑Wrmeacmporaaen and its oRersbsereaemiubheirright cal cxemption per MGL c 14.130ther
152,31(4).and we lave w employes.Mo worium comp.insurance required.]
*Any applicant hat checks box#1 must also fill motion section below showing their worker%compemaYan policy inPommtion.
I Homeowners who submit thn affidavit indicating they an,doing all work and then him outride contractors must submit o new affidavit indicators such.
:ConM1actors that check his box man attached m additional sheet showing the rum,of de,sub-covnacmrs and some whether or not hose emine,have
employttes. If he sub....have rroployees,any must provide her work..row,policy manber.
I am an employer that is providing workers'compensation insurance for my employees. Below tv the policy and job site
information. /1
Insurance Company Name:,/�'.
Policy#or Self-ins.Lie.#;
p
JS WTIP??A Eapimtion Date:
Job Site Address: IUfU Q—�ic�j &Y City/State/Zip:J�FFyll / •�
Attach a copy of the workers'coulpemation policy a
ey declaration page(showing the policy number nd ea Lion 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 venfic n.
Ido hereby c under ts andpe dies ofperjmy that the information provided above is true and correct
Sign Date: ojO
Phone#: — -n
Ojrcfd use only. Do our write in the area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City?own 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,p25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of 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 my 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 your situation and,if
necessary,supply sub-commetor(s)name(s),addresses)and phone number(s)along with their cenificate(s)of
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 polity is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Alm be sure to sign and dam the affidavit. The affidavit should
be maimed to the city or town that the application for the pernit 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 in 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 bum leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
l Congress Street, Suite 100
Boston, MA 02114-2017
Tel.#617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
Client#:17303 CHAARI
ACORD. CERTIFICATE OF LIABILITY INSURANCE DATEPIMODryyrYJ
3292019
THIS CERTIFICATE IS ISSUED AS A MATFt 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:It the certificate holder is an ADDITIONAL INSURED,the pollcy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement.A statement as this cerdNeMe does not carrier rights to the
certificate holder In lieu of such endorsement(s),
PRODUCERKathy
T.P.Daley Insurance Agcy,Inc P,aN,D"N .413788-0971 E=x.:413739-2645
1381 Westfield1150 St.
P.D.BOX 115D Acca s; kathkwWaley®tpdeleylnsuraace.WM
MSURG MFORMW W VEMDE NMC.
West Springfield,MA 01090 MBuRas A:
IX..so Wilma I B:ruwW:I F.
Charlie Arment Trucking,Inc.
47 Warehouse Street InauRER e:NxNI..,..aa,ap
Springfield,MA 01118 INSURER O:
#SURER.:
INumeR F'
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE MR ME POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAIN' BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TIE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
eM .
LT RR TYPEWIWURAXLE AODL UBR PO IEXP
Not WVD P0.ICY NUMBER is Uers
A Om""WEILOY CPS3191687 1/31/2019 Ol/I EACH 00oURHENCE $7000000
X CDE4ERCMLOENEMLLMBILITY B B5 A NTFm 6100000
GWM&MADE OOCCUR MEDEXPI mer—a 5
X BIBPD Dad$5M PERSONLL&ADVINJURY $1000000
OENERILAGGREGAIE 52000000
GENLAGGREGATEUMn APPUESFER: NoxwoTS CMANOP Am 52000000
X POUI Lac f
C AUTOMOM... 5055801 1/311 01/31M2CE;MFIINLIJ a--I- n 1,000000
BOOILYINJUFYPwBaWas f
ALLONNED SCHEDULEDAol X ALTERILLY INJURY IPq eWMMll a
N-y—
HIRED AUNTS X churs"W�UTDO PERtt DA f
$
A UXBRFUALIAe X OCMJR XL30108992 )1/3111 OU3140EAGHOLLURRENCE f5000DDO
MUSUAD CLAMe.MAGE AGGREGATE 55000ODO
DED I X1 RETEm.1110000 f
B WORNERa COMPENSATION 6HUB4951P33A19 1212019 01131/202C X WCSTATUOEMANO EMPLOYER&'LIABILITY
µY PROPRIETORPAHMETHOECUTNEYIN ELL EACH ACCIDENT $1000000
OFFICEWMEMBEP EXCLUOE01 O NIA
"memory In NH) E.L09EASE-BASSAN E $1000000
NYncnoaumar
DE'aeCNIPTNVOFOPEHATwxSe ELDMEASE-wL UMn $1000000
DEBCRIPTONOFOPERAMNSI OC nM./VEHIMMIM®N RO101,ACONbn•IRemarMScl:edulg IImoreapace Isr uln I
General Certillcate
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
019MM10 ACORD CORPORATION.All rights reserved.
ACORD 25(2016#5) 1 Off The ACORD memo and logo are repistared marks of ACORD
#815074BIN1150247 KJD