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17C-229 (21) 28 NORTH MAPLE ST-SALMON STUDIOS BP-2020-0452 GIs#: COMMONWEALTH OF MASSACHUSETTS MU-Block: 17C-229 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2020-0452 Proiect# JS-2020-000769 Est.Cost:$58440.00 Fee:$409.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: YOUNG ROOFING CO INC 011878 Lot Size(sq.ft.): 16422.12 Owner: OSTROFF SAMUEL Zoning: SI(100)/ Applicant: YOUNG ROOFING CO INC AT. 28 NORTH MAPLE ST - SALMON STUDIOS Applicant Address: Phone: Insurance: P O Box 60056 (413) 584-1367 WC FLORENCEMA01062 ISSUED ON.101912019 0:00.00 TO PERFORM THE FOLLOWING WORK.REMOVE EXISTING ROOF SYSTEM, INSTALL NEW CDX AND NEW EPDM ROOF SYSTEM 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 10/9/2019 0:00:00 $409.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Z� 2�Z51 Versionl.7 Commercial Building Pcrmit May 15,2000 Department use only City of NorThpto Status of Permit: Building Dert -QC1/ Driveway Permit 212 Maine V r/Sep is Availability Room nn Wat r/We Availability Northampton106'�O�T — 7 2019 Tw Sets f Structural Plans phone 413-587-1240 13-587-1272 PI Site lans FaT n�r ul O er S ecify APPLICATION TO CONSTRUCT, REPAIR, RENOVAT L: ,WE)OR OC UPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO-F� ELLING SECTION 1 -SITE INFORMATION �v 1.1 Property Address: This section to be completed by office Salmon Studios Map 6 -7 C Lot �� ` Unit 28 North Maple Street Florence MA 01062 Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Sam Ostroff 28 North Maple Street Florence MA 01062 Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: Young Roofing Co., Inc. PO Box 60056 Florence MA 01062 Name(Print) Current Mailing Address: (413)584-1367 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $58,440.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) o9 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number Date Issued Sign tures Builg Commissioner/Inspector of Build Date e to Q J)q 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 ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration 0 Existing Ground Sign❑ New Signs❑ Roofing El Change of Use❑ Other ❑ Brief Description Remove the existing roof system, install new CDX and new EPDM roof system. Of Proposed Work: 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 ❑ 113 ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory 0 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 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(sf) 1 St 15c 2nd 2nd d 3rd 3r 4m 4m Total Area(sf) 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: F7�.73Sewjage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municial ❑ On site disposal system[:] Versionl.7 Commercial Building Permit May 15,2000 S. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L:=R: Rear Building Height Bldg. Square Footage r Open Space Footage % (Lot area minus bldg&paved �� E parking) #of Parking Spaces Fill: volume&Location _ A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW Q YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained © Date Issued: C. Do any signs exist on the property? YES © NO IF YES, describe size, type and location: E7 _...�....a..._._.�_..___�___.��_...... D. Are there any proposed changes to or additions of signs intended for the property? YES © NO Q IF YES, describe size, type and location: LL— E. Will the construction activity disturb(Gearing, grading, excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version 1.7 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) tect: Not Applicable ❑ Name(Registrant): Registration Number Address Expiration Date Signature Telephone rawarew essional Engineer(s): Name Area of Responsibility Address Registration Number 4 Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number 4 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 Vensionl.7 C;orarnercial Building Permit May 15,20(X) SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) independent Structural Engineering Structural peer Peview Required Yes No 9WECTION 11 -OWNER AUTHORIZAT ON-TO BE COMPLETED WHEN NERS AGENT OR CONTRACT APPILM FOR BLNLDMG PERMrT I, as Owner of the subject property i hereby authorize, � �1�.` ` _r l.�`1...� L���_ _ to { act on my behalf, in all matters relative to work authorized by this building permit application. I i Signature of Owner Date 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 perjur Print Name Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Su2ervia2r: Not Applicable Q Name of License Holder -t i'�r� w... _., .a { < )' License Number Address Expiration Date Signature Telephone Vice Prosident SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) -7 Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit wilt result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes C No 0 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: �1. Q . �C�PYlC4 M' r C)16�a The debris will be transported by: > The debris will be received by: Building permit number: Name of Permit Applicant1 y Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lecibh Name (Business/Organization/Individual): Young Roofing Co., Inc. Address: PO Box 60056 City/State/Zip: Florence, MA 01062 Phone#: (413)584-1367 Are you an employer?Check the appropriate box: Type of project(required): 1.[D I am a employer with 6 employees(full and/or part-time).' 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.oRoof repairs These sub-contractors have employees and have workers'comp.insurance) 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'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: EMC Insurance Companies Policy#or Self-ins.Lic.#: WC231 S618239-019 Expiration Date: 1/1/2020 Job Site Address: 28 North Maple Street City/State/Zip: Florence, MA 01062 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration 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. Ido hereby certify under the pains and penalties of perjury that the information provided above is true and Correct. Signature: Date: Phone#: (413)584-1367 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#: YOUNROO-01 CHRISTINE ACORO" CERTIFICATE OF LIABILITY INSURANCE DATDIYYYY) 10/1/2/1/2o1s 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 CONTACT Christine Sullivan NAMF- Phillips Insurance Agency,Inc. PHONE FAx 97 Center Street AIC,No, Ext): 413 594-5984 ac,No:(413)592-8499 Chicopee,MA 01013 Ep AIL .christine@phillipsinsurance.com INSURERS)AFFORDING COVERAGE NAIC0 INSURER A:EMC Insurance Companies 21415 INSURED INSURER B:Libeft Mutual Fire Ins Co Young Roofing Co.,Inc. INSURERC: PO Box 60056 INSURER D: Florence,MA 01062 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 SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMBS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE OCCUR X X 5D97242 12/31/2018 12/31/2019 DAMAGE TO RENTED 500,000 MED EXP(Any one rson 10,000 PERSONALS ADV INJURY 1'000'000 GEN'LAGGREGATE pLIMIT�APPLIES PER: GENERAL AGGREGATE 2,000,000 POLICY 191spa7 LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 ANY AUTO 5297242 12/31/2018 12/31/2019 BODILY INJURY Per person) OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY p BODILY INJURY Per accident X AUTOS ONLY X OWN PRorr aeadant AMAGE UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAS CLAIMS-MADE AGGREGATE DED RETENTIONS B WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY A FR ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WC231S618239-019 1/1/2019 1/1/2020 E.L.EACH ACCIDENT 500'000 FICER/MEMBER EXCLUDED? NIA andatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,descr be under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Blanket Additional Insured included with respect to General Liability when required 6y written contract. Blanket Waiver of Subrogation Included CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Salmon Studios ACCORDANCE WITH THE POLICY PROVISIONS. 28 North Maple Street 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 Page No. � of z Young Roofing Co., Inc. Date: October 1, 2019 Mailing Address To: Sam Ostroff, 28 North Maple Street, Florence MA o1o62 P.O. Box 60056 Florence,MA.01062 PHONE r a 413-584-1367 Job Location: Salmon Studios 28 North Maple Street, Florence MA o1o62 P 413-586-9167 cell phone 413-522-7287 Specifications: FAX 413-585-0226 EMAIL �. OPen0x 32' section of roof for carpenter's skylight project. Shovelbrianyoun roofing 2 Cdgmail.com youngrl.com coinc stone away from 26'x38' section of roof.) C@gmail.com 2. Work with carpentry team installing temporary weather proofing to new Contr.Supervisors "skylight box." Lic No.-011878 3. Install box frame curbs for Velux Dynamic Skylights. (Four (4) total in this section.) 4. Install two (2) layers of 2" polyisocyanurate insulation to the raised 20'x32' section. 5. Install Carlisle's .oho reinforced mechanically attached roof system to the raised 20'x32' section. 6. Remove the existing ballast stone and dispose. 7. Remove the existing membrane and insulation and dispose. 8. Install %" CDX to the complete roof area. (Approximately 9,76o SF) Attach with ring shank nails. 9. Install two (2) layers of 2" polyisocyanurate insulation to the complete roof area. 10. Install box frame curbs for Velux Dynamic Skylights (Eight (8) total for main roof/twelve (12) total for project) From: To: Louis Hasbrouck Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 The Massachusetts Building Code, section 107.1 allows for an exclusion from requirements for construction control in certain situations. In accordance with code section 104.10, 1 request that you grant a modification to waive the requirement for construction control of the project at � � ✓'fir /1'��1� S� �l�:�t� because the work is of a minor nature, will not affect structural elements, health, accessibility, life or fire safety, and will be done in accordance with the prescriptive requirements of the code. Thank you for your consideration. Respectfully, E L,4* bey r i