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39-041 (15) 15 ATWOOD DR-3RD FL BP-2020-0606 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:39-041 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2020-0606 Project# JS-2020-001026 Est.Cost: $110000.00 Fee:$400.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: DEVELOPMENT ASSOCIATES 075752 Lot Size(sg.ft.): 217800.00 Owner: NORTHWOOD DEVELOPMENT LLC Zoning:GB Applicant. DEVELOPMENT ASSOCIATES AT. 15 ATWOOD DR - 3RD FL Applicant Address: Phone: Insurance: P O BOX 528 (413) 789-3720 WC AGAWAMMA01001 ISSUED ON.11/13/2019 0:00:00 TO PERFORM THE FOLLOWING WORK-3RD FLOOR BUILD OUT FOR NEW OFFICE SPACE 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 11/13/2019 0:00:00 $400.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2020-0606 APPLICANT/CONTACT PERSON DEVELOPMENT ASSOCIATES ADDRESS/PHONE P O BOX 528 AGAWAM (413)789-3720 PROPERTY LOCATION 15 ATWOOD DR-3RD FL MAP 39 PARCEL 041 001 ZONE GB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T eof Construction: 3RD FLOOR BUILD OUT FOR N CE New Construction ON Non Structural interior renovations Addition to Existing Accesso Structure Building Plans Included: Owner/Statement or License 075752 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 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 LJL I %f4 )I 73 )q Si ature of Building Official V0 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. 2wWc� Ra.rlA Versio mercial Buildino Permit May 15,2000 Department use only City of North mpt ��1 i tu�of Permit: Building Dep rtm nt V rb Cut/D veway Permit 212 Main tre ^fOV Sew r/Se is Availability Room 00 6 2019 Wa er/W I Availability Northampto MAS p 0 T Set of Structural Plans phone 413-587-1246 Fa.x 9;, 'F5$�/b P Usit Plans TNa''�nroN f�4Anc,Fc / her pecify •- T APPLICATION TO CONSTRUCT, REPAIR, RENOVATE,CHANGE THE O CUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY D ELLINGQ SECTION 1 -SITE INFORMATION 13• 2Z rW/j� 0 1.1 Property Address: This section to be completed by office Atwood rive Map 3-1 Lot 1 ( Unit Northampton, MA 01060 Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: orthwood Development, LLU 11, 0. BoxAgawam, Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: ravts P. wa7l, w x Agawam, MA 0 100 1 Name(Print) Current Mailin Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 110,000.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) h/DD 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number 3 This Section For Official Use Only Building Permit Number Date Issued SignL&2 Buildg Commissioner/Inspector of Buil i gs Date I I 1 T W CCS cue asco��c��� s QA- 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 ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other ❑ Brief Description buildout ot prolessional ottice space to existing building 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 ❑ 1B ❑ B Business 0 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ 11 ❑ 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) 2nd 2nd rd 3rd 4in 4 h �. 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: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system E] 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 Frontage -- - ---- Setbacks Front -) Side L: 77 R:E" L: R:r� Rear -J Building Height u Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parkinR) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW © YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DON'T KNOW 0 YES Q IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO (F) DON'T KNOW © YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained 0 , Date Issued: C. Do any signs exist on the property? YES (�) NO 0 IF YES, describe size, type and location: Existing and previously approve D. Are there any proposed changes to or additions of signs intended for the property? YES © 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 O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version l.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: Charles W. RobertsNot Applicable 0 Name(Registrant): - 10107 28 Amity Street, Suite 2B, Amherst, MA 01002 Registration Number F Address ----- ---— --- 08/31/20 —� C 413-259-1630 Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name _ l Area of Responsibility Address _ _ Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address (Registration Number Signature Telephone Expiration Date I i Name Area of Responsibility Address Registration Number Signature Telephone I Expiration Date Name _ Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Development Associates Not Applicable ❑ Company Name: Travis P.Ward — Responsible In Charge of Construction 200 Silver Street,Suite 201,P. 528,Agawam,MA 01001 — — Address--- ddress _ _ 413-789-3720 — Signature Telephone Version 1.7 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 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Northwood Development, LLC I, , as Owner of the subject property ravts ar hereby authorize to act on my f, in all s relati work authorized by this building permit application. November , Signat re o er Date ravts P.War 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. Si ned under the Dains and Denalties of er'u . ravts P.Ward,as age r owner Print Na /j ovem er ,2019 Signature f Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ ravts Ward - Name of License Holder-I I License Number o um to Drive, I-eening Hills,MA 0!030 717� Address Expiration Date Signature Telephone 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 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: 15 Atwood Drive,Northampton,MA 01060 The debris will be transported by: USA Hauling The debris will be received by: USA Hauling Building permit number: Name of Permit Applicant Northwood Development,LLC November 5,2019 � . Date Signature of Permit Applicant The Commonwealth of Massachusetts W Department of IndustrialAccidents 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. Ayplicant Information Please Print Leeibly Name (Business/Organization/Individual): Development Associates Address:200 Silver Street, Suite 201, P. O. Box 528 City/State/Zip:Agawam, MA 01001 Phone#:413-789-3720 Are you an employer?Check the appropriate box: Type of project(required): 1.E✓ I am a employer with 5 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. Demolition 3 01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t ❑ 10 E] Building addition 4.O 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.C]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance? p 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. tContractors 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. Great American Insurance Company Insurance Company Name: Policy#or Self-ins.Lic.#:WC1130018-03 Expiration Date:04/31/20 Job Site Address:15 Atwood Drive City/State/Zip:Northampton, MA 0106 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. I do hereby certify under th ns a d penalties of perjury that the information provided above is true and correct. Signature: Date: Novernber 5,2019 Phone#: 413-789-3720 Official use only. Do not write in this area,to be comple ted 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#: