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18D-060 (12) Versionl.7 Commercial Building Permit May 15, 2000 _ Department use only City of Northampton Status of Permit: D - -_...V� gilding Department Curb Cut/Driveway Permit NOV 7212 Main Street Sewer/Septic Availability 201 / Room 100 Water/Well Availability 9 N rthampton, MA 01060 Two Sets of Structural Plans DEPT phone 41 -5Other Specify 87-1240 Fax 413-587-1272 Plot/Site Plans N� 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 This section to be completed by office 1.1 Property Address: f ...-Ptat')Gt=`tZ �/At1EY tom. ooKS Map t f� Lot t✓O Unit 16SA =NDV!&T21NL '012(VdE' 1Vai2�ff/iA7PTorU , o�o(B Zone Overlay District MA Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: I-II C—T--C-- c (~ Name(Print) i Current Mailing Address: (�, i G�- S.,D�,,,�1��c''-�•�— M p�_..09 oto_?-�� SignatureTelephone 5 (o9 7 2.2 Authorized Agent: Name(Print) r Current Mailing Address: - Y 3__.- 815- Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS –7 Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building oOd (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of �R,oa c' Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) �.�� ..... _ 5. Fire Protection - - d 6. Total = (1 + 2+3+4+ 5) Check Number ✓ O�/ This Section For Official Use Only Building Permit Number Date {�,�•� �� Issued Signatu e: Date Buildin Commissioner/Inspector of Buildi / 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 Enter a brief description here. Of N Proposed Work: P 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 ❑ 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: Q�T�CC 54-11_ 4S' Cv4dl►-r M Mixed Use Specify: � � SG l c c< , C t JUA_17 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): i 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 1 st _ 2nd 2nd ...�,..._ 3rd _.. _ 3rd 4th 4th Total Area (sf) Total Proposed New Construction s 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 0 Zone L_ 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 Frontage Setbacks Front Side L•= R:= L•= R Rear - Building Height Bldg. Square Footage % Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW 0 YES 0 IF YES, date issued: E-1.1-1—J IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW © YES Q IF YES: enter BookE ~ Paged~ and/or Document#! B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained O , Date Issued: C. Do any signs exist on the property? YES NO Q IF YES, describe size, type and location: Sfy a' 6�--tST.N6 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 © 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 / l�...... v t 6�,ey—S Not Applicable ❑ Company Name: Oc rr^y R1 dy--ocu Responsible In Charge of Construction Address Signature Telephone 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 0 No SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT fG = reel ro ec eS L as Owner of the subject property hereby authorize AIRrr�Z ,-Rt d.eoJ to act on m alf, in all mcVers relativ work auth rized by this building permit application. f 1i I � ISI Signatur f O e Date l olr ' e otJ $7f3 f4 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„un ,r the pains and penalties of perjury. Print Name Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: lair A% /��`d License Number l 7„_...�..APo&-. dier- Zvi Il 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. tize Signed Affidavit Attached Yes 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: /Ss.qL 1 �Vo" i'h 0r6�� The debris will be transported by: Akwher The debris will be received by: Building permit number: Name of Permit Applicant r d edJ Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia NVorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information ��tdP1lease Print Leeiibly Name (Business/Organization/Individual): Law-V-� A Wide-,--)T---)T- / D oOt 1C poOf-Eut 1�ey-s Address: 1-2 ?o eu e r- VVI t G j City/State/Zip: 0p7)Phone#: 4113 80 5-0_8?-6 Are you an employer?Check the appropriate box: Type of project(required): 1.®I am a employer with I 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.,aRemodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.0 I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10E] Building addition 4.❑1 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.E]Plumbing repairs or additions 5.M 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.t 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 arc 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: 1 >e�e too r W 1�na rcrs�r -7-vt C Policy#or Self-ins.Lic.#: W C 1(O /��-9 9th Expiration Date: Job Site Address: /a5A-T4o)crnf'r 1 a a City/State/Zip: 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 the pains and penalties of perjury that the information provided above is true and correct. Signature Date: ! / - !6 — e�3! Phone#• /3 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#: A�" CERTIFICATE OF LIABILITY INSURANCE DATE(YWDD/YYYI� 1 v12/2o1 s 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 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). CONTACT PRODUCER NAME: Stacle Breck _ ALEXANDER W BORAWSKI INC PHONE 413 586-5011 FAX No): _ E-MAIL sbreck@borawskiinsurance.com 88 KING STREET SUITE A ----,-,---INSURER(S)AFFORDING COVERAGE NA1C8 NORTHAMPTON MA 01060 INSURER A: ATLANTIC CHARTER INS CO 44326 INSURED INSURER B: LARRY RIDEOUT INSURERC: RIDEOUT BUILDERS INSURER D: POB 290 INSURER E: SOUTHWICK MA 01077 INSURER F: COVERAGES CERTIFICATE NUMBER: 471857 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER M M COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE f CLAIMS-MADE El OCCUR - PREMISES(Ea occurrencef MED EXP(Any one person) f N/A PERSONAL d ADV INJURY f GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE f POLICY1:1 JECT PRO- LOC PRODUCTS-COMPIOP AGG f f OTHER: COMBINED AUTOMOBILE LIABILITY EasocideISINGLE LIMIT f BODILY INJURY(Per person) f ANY AUTO ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) f AUTOS AUTOS SED PROPERTY DAMAGE f NON-OWNPer accident HIREDAUTOS AUTOS f UMBRELLA UAB OCCUR EACH OCCURRENCE f EXCESS LIAR CLAIMS-MADE N/A AGGREGATE f f DED RETENTIONS WORKERS COMPENSATION X I P7ATVTE I !RH- AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOPJPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICERIMEMBEREXCLUDED? WA WA WA WCV01399001 03/14/2019 03/14/2020 E.L.DISEASE-EA EMPLOYEE S 100.000 (Mandatory in NH) If yes describe under E.L.DISEASE-POLICY LIMIT 1 f 500,000 DESCRIPTION OF OPERATIONS below N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Sctwdule,may be attached H mon space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.niass.gov/twd/workers-compensationTinvesbgations/. Sole proprietor has not elected coverage. 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. Pioneer Valley Educational 155 Industrial Dr AUTHORIZED REPRESENTATIVE -� { I y, Northampton MA 0 1060Daniel M.Cro4y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD SCOPE RIDEOUT BUILDERS 17 POWDER MILL RD. SOUTHWICK, MA 01077 413-885-2876 larry.rideout@comcast.net CS-011635 Pioneer Valley Books 11-12-2019 155 Industrial Drive Northampton, MA 01060 Scope of Work: 1. Remove existing floor 2. Prepare Concrete for new floor 3. Install new vinyl glue down strip floor 4. Remove Ceiling tile to facilitate sub trade work. 5. Cut grid where necessary for new walls 6. Repair grid at wall removals and light changes. 7. Frame Insulate and drywall new office walls. 8. New fire door installed at new corridor 9. Remove and patch existing fire doors. 10. Witch equipment to cut three new window openings 11. Aluminum Glass walls, Doors, and Exterior Windows 12. Paint 13. Vinyl Baseboard 14. Reinstall Ceiling Tile adding new where necessary. 15. Final Cleaning Add Alternate: Change double door into warehouse to single door Larr Rideout Rideout Builders Md '20'd now I T 3 Ize•_m• '4` 5 30'-0- 3a-0ad 0-0 _. -. _ - b -3 A C x r STOOP n , 4 I b ; I o COR►IREMCF NOTE: b REas aPna RODR I j I WE Sim PLAN FCR - X16T R AND EXTEroOR E 61�i _� ird 1p b F xlerW.cR.epee v rd t'd s-0•T _ ad ^,rJ• I I I 8PEGIFIGATIONe PEP' I T I j OFFMW _I u 10T I i I I s O I I b'GONG.BLAB W/bXb•7.9X1.9 6I111;1. g e'OOMPACTrO FILL TO 951L DRY 3000•SOIL BEARMG CAP.MN b b JJ�I Tb R I � IFILLD 6"�O 9X= lBOLU® DOARECARrrp.OF e7 10 n l 10i 1 I j C _____________ Ef I � 1 --� I_ 1n b r • W o ` _ GENE OFFICE 1'd b - ME1j�OILET I e'_0• � I 106 Q' AI�DFRN'IE `_____________ b 1 ,�.0. b 1 111 ER MR '� L'o 1; - b I i Z I I O r b l/7•IIEGEBBED 6 B ® O J b• SLAB N' = aia lie --- F — a I I dIN WALL PANEL b ; N '1 tti 116�_ 1®•-m• . I I COPPER b 4'd opm % 36 _ OILET ROOM •JANROR ~ - 6 6ailm ® 5•LONG. r___—______!I e-0 'ROOM b M 8'-0• T-0• 1 BM LETWORKIXC 4 PRF PR AREA I � 6 ® ' OL CEILMG !l b OFFICE © EQUIPMENT I GENERAL W7IM -- _I ADeM/ /tO ►R NO I AREA I ______ 0 -- - f•PI111CRAMNo t - I D.F _ �u I. al II _--_ •CLE'°'R p i "' II -� I j ® ---- i 101 T-r "`D- /ORIEDOR 3 W I �® - -- - -- ® - I E --- • `------------ o F _ 1 - - - - - Ir� 4 DISPLAY WALL O I — B•-1• 14'•2' Il•-10• --_ 17'•b• _ ___________ b I \ i 10'd I 19'd 1a-0" , , r-0' ___ n i?i i 8ALE8 b '-10' 1'-1 I 1I Ir _ YAMUIGER RECEPTIO SS CWMWARMIQAREA ONFERENCE ROOMq PRF AREA 26 cr- 1�-b• I B'-d' IS P 1W ' i tte ( I Px L S lo'd trd ir•7 lyd b i to-1P trd - ,/FmDULE I I I . �. I 1 I LEVELER .. 101 ... ORAPNRG IEAl1AWR I I 9 I 1 ,{..:�T; I (FFG.TO BE SELECTED Lel BT OLLNER) 5 B 0 _ _ ' F.o a .� I 36 36 -r s'a' r-a i•d �•a rd u 'i--4;11i•J• rd a' e•-c r-o• �. .. _.. _. _... .. .. � - - - — I Ir x r mow s'-m tad 3a-0' 2rd 241d 23'-3• 37.7 2+'s - OF E �_- __ - .- -O � B'-6' 4'-0' !'-4• 4'.0• 1t4' 6'-4• 'EJ'_ -_Yj*_�___ =li y_4. L J BSd 9V-V 16ad h b -- ii 155 INDUSTRIAL DR BP-2020-0660 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18D-060 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category: renovation BUILDING PERMIT Permit# BP-2020-0660 Proiect# JS-2020-001118 Est.Cost: $96000.00 Fee: $672.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: LARRY RIDEOUT 11635 Lot Size(sq. ft.): 104108.40 Owner. FIREFLY PROPERTIES Zoning:GI(100)/ Applicant: LARRY RIDEOUT AT. 155 INDUSTRIAL DR Applicant Address: Phone: Insurance: 17 POWDER MILL RD (413) 885-2876 WC SOUTHWICKMA01077 ISSUED ON.1112512019 0:00:00 TO PERFORM THE FOLLOWING WORK.-NEW OFFICE PARTITIONS 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 11/25/2019 0:00:00 $672.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner