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39-041 (18) 15 ATWOOD DR-SUITE 303 BP-2020-0718 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) Catego : renovation ny ovation BUILDING PERMIT. Permit# BP-2020-0718 Proiect# JS-2020-001223 Est.Cost:$140000.00 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 - SUITE 303 Applicant Address: Phone: Insurance: P O BOX 528 (413) 789-3720 WC AGAWAMMA01001 ISSUED ON.1211112019 0:00:00 TO PERFORM THE FOLLOWING WORK.-FIT OUT FOR SUITE 303 - CERT PA POST THIS CARD SO IT IS (VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Bt ildim-, Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoker 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 12 1 12019 0:00:00 $400.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner IL C Versionl.7 Commercial Building Permit Muv 15,2000 Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit - i 212 Main Street Sewer/Septic Availability ROOM 100 Water/Well Availability F NnRTH6UIlDiNGtNSPFGTIONS Northampton, MA 01060 Two Sets of Structural Plans DFPT.O nnPTON M°'„$iefT€413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify 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 7 1.1 Property Address: This section to be completed by office Atwood rive Northampton, MA 01060 Map Lot 0 y/ Unit ar P ,Q Zone / Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Northwood eve opmen , ox gawam, Name(Print) Current Mailing Address: 41-3-739-37 Signature Telephone 2.2 Authorized Agent: A44Z ravesF. ward, as agent or owner ox 528,Agawam, MA 0 100 1 Name(Print) Current Mailing Address: Signature Telephone SECTION 3- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 140,000.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of n Construction from 6 3. Plumbing l Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 +2 + 3+4+ 5) Check Number This Section For Official Use Only Building Permit Number Date Issued Signat e: Buildinq Commissioner/Inspector of Buil i s Date Version 1.7 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 13LI11(jolit ot protessional othee 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 ❑ 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: C 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: I 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) i st 15� i 2nd 2nd aro 3`d 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: 7.3 Sewage Disposal System: Public 0 Private ❑ I Zone Outside Flood Zone❑ Municipal ❑ On site disposal system❑ Versionl.7 Commercial Building Permit May 1_S,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage r Setbacks Front Side L:t—=1 R:= L:=R:= Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&L.ocation)A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW O YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DON'T KNOW O YES O IF YES: enter Book Page and/or Document#i B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW © YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O 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 O NO O IF YES, describe size, type and location: L 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 Q 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) 9.1 Registered Architect: Charles W. Roberts Not Applicable ❑ 10107 Name(Registrant): 28 Amity Street, Suite 2B, Amherst, MA 01002 Registration Number Address August 31, 2019 �- 413-259-1630 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 eve opment Associates Not Applicable ❑ Company Name: ravts F. Ward Responsible In Charge of Construction t ver ree , ut e ox529, .,awam, 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 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 b If, in all rs relatie�o work authorized by this building permit application. ecem er 4,2019 Signatu ner Date Travis 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. Signed under the pains and penalties of i)eriury. ravis F. Ward,as agent tor owner Print Name l ecem er 4,2019 Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ ravts Ward - Name of License Holder License Number .52 Columbia rive, Feeding Hills,MA 0!030 19/21 Address Expiration Date 411-189-11210 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 O No 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 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 December 4,2019 Date Signa ure of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents a d 1 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 Leeibly Hanle (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.[D I am a employer with 5 employees(full and/or part-time).* 7. ]New construction 2.n I am a sole proprietor or partnership and have no employees working for me in 8. E] Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.E]1 am a homeowner doing all work myself [No workers'comp.insurance required.]t 10E] Building addition 4.n 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.EJ Plumbing repairs or additions 5.M 1 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? 6.R 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 41 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. Great American Insurance Company Insurance Company Name: Policy#or Self-ins. Lic.#:WC 1130018-03 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 " penalties of perjury that the information provided above is true and correct. 7Z!� Si nature: Date: 5 Phone#:413-789-3 20 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#: Initial Construction Control Document H To be submitted with the building permit application by a Registered Design Professional for work per the ninth edition of the �G Jew Massachusetts State Building Code, 780 CMR, Section 107 Project Title:OnaWay Suite#303 Date: 12/ 05/19 Property Address: 15 Atwood Drive Project: Check(x) one or both as applicable:X New construction Existing Construction Project description:This project is a 2,100 SF fit-out of existing open space on the second floor of a recently constructed and occupied building. The project will include new doors and partition walls as well as new floor,wall,and ceiling finishes. New HVAC work,as well as modifications to the existing sprinkler system will be part of this work. (MEP/FP drawings,specifications,and code compliance documents are to be submitted under separate cover). The new office space,and the entire building,will be fully sprinklered. I Charles W.Roberts MA Registration Number:10107 Expiration date:08/31/19 ,am a registered design professional,and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': X Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge,information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services in accordance with the Professional Standard of Care,and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept,shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents.Such review shall not diminsish or relieve the Contractor of its submittal and other responsibilities. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code.The contractor shall be responsible for performing the work in accordance with the contract documents and shall be exclusively responsible for its construction means,methods, sequences and procedures,and for construction safety. 4. The performance of the services shall not require any special testing or inspections unless specifically stated in the Code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a'Final Construction Control Documeni AED S W.R°y/TSO Enter in the space to the right a"wet" or 0 NO 0107 aFP ERSS electronic signature and seal: a Phone number: (413) 259-1630 Email: Croberts@kuhnriddle.com ' Building Official tial Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an'x'project design plans,computations and specifications that you prepared or directly supervised.If'other'is chosen,provide a description. Version 01 01 2018