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22B-109 (8) 199 PINE ST-PIONEER VALLEY BOOK BP-2020-0941 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:22B- 109 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-2020-0941 Project# JS-2020-001603 Est.Cost: $68000.00 Fee:$476.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: LARRY RIDEOUT 11635 Lot Size(sg.ft.): 203425.20 Owner: MATT&NICK LLC Zoning: SI(92)/WP(73)/URA(19)/URB(2)/ Applicant: LARRY RIDEOUT AT. 199 PINE ST - PIONEER VALLEY BOOK Applicant Address: Phone: Insurance: 17 POWDER MILL RD (413) 885-2876 WC SOUTHWICKMA01077 ISSUED ON:2/24/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-MODIFY 1 ST FLOOR BREAKROOM AND BATHROOMS, FINISH 2ND FLOOR 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 Sip-nature: FeeType: Date Paid: Amount: Building 2/24/2020 0:00:00 $476.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Vcrsionl.7`�IFm(rai lAiffgf nit May 15,2000 Department use only City of Northampton Sta us of�Permit: Building Department E8 0 2026 Cu b Cut�Driveway Permit - { 212 Main Street Se er/Sgptic Availability Room 100 RFPT nF r3un nING,INSPF Wgtpr/Well Availability Northampton, MA 01 d6�1'.T"'�'' -W MAO, Two Sets of Structural Plans phone 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 9 1.1 Property Address: This section to be completed by office 7"IOn�G eY' �q llYy �C GC r hors-� q Map da IS Lot l�/ Unit l99 -V/►7,-C 5t '�' Zone Overlay District F l o rrepw-C k?ex o t o C a' r - - Elm St.District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Aaent: Act Name(Print) Current Mailing Address: Af/3- ea6- a87 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 5y g� (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of ,a�O I Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) ....... ..��,.....,.,....... ���., 5. Fire Protection 6. Total = 0 + 2+3+4 + 5) 6y 000 _ Check Number This Section For Official Use Only Building Permit Number /� �a 0 q(* Dat ed Signature: "�Y\,,, t,,A- Buildi Commissioner/Inspector of Buildihbs Date RC1 _' �°t r•r mCQ s* ,n let 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 ❑ Demolitions Repairs❑ Additions gr Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs ❑ Roofing❑ Change of Use❑ Other ❑ Brief Description Enter a brief description here. /Yloo�,-� �iel �0�, �t'�a�d ►'t l-,l efi mo � _._. Of Proposed Work: 1Ces.s-pl+eC,&-C) t 60mi- © 41ceS +cc 1�►^Y�a�G/� C'��ln.� s 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 ❑ 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: 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 at 2nd 2"d 3rd ... 3rd 4`h Total Area (sf) Total Proposed New Construction sof 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 i 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 L— ---- ---- 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 Q DON'T KNOW YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW YES 0 IF YES: enter Book Page and/or Document#, B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location. E_ D. Are there any proposed changes to or additions of signs intended for the property ? YES Q 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 Q NO 19 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 El Name(_Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number r t � 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 R t..q�ea'c-.�v V ( ev-S Not Applicable ❑ Company Name: Responsible In Charge of Construction ? Awd ec All Address �-3-885- 876 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 © No SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize Ru. (( �,r5 •• 'to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner ate 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. ���_ 40crr y PNa rintm za��Dlb �2_- 19-aa�o Signature of wner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: tY'f- ,- ("d ...... License Number o �. i`�►� c P� �_ � w� il �s1,8/ ago Address Expiration Date Signa re 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 0 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: / `I `% �;tif S5i The debris will be transported by: EnsT The debris will be received by: V" f��� ✓c�����/�� , �3�{ ��sn�.� ��� Building permit number: Name of Permit Applicant N7�Ti {stic�'p, v /L, �f Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents a 1 Congress Street, Suite 100 Boston,MA 02114-2017 r www mass.gov/dia NVorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): A CO Zt�S OL I�P t/t:z Address: ( 7 F CA)de r City/State/Zip: 55n, &i,c4;,.C k n?q Phone#: V i3 _e� -aS .>6 Are you an employer?Check the appropriate box: Type of project(required): 1.011'.a employer with 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 $,]A Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3f�I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 E]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 I L❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.M I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E:] p Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.F�We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I 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: ( t ,C r Etl.c,1S r Z✓+C Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: `e /i/,!f City/State/Zip: O/0 6 ;�— 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 andpenalties ofperjury that the information provided above is true and correct Signature: Date: Phone#: 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#: l ® DATE(MM/DD/YYYY) AC"R" CERTIFICATE OF LIABILITY INSURANCE 02/19/2020 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). PRODUCER NAME: Stacie Brack ALEXANDER W BORAWSKI INC PHONE 413 586 5011 FAX Nor t�.JE ( ) E-MAIL ADDRESS: sbreck@borawskiinsurance.com 88 KING STREET SUITE A INSURERS AFFORDING COVER AGE NAICff NORTHAMPTON _ MA 01060 INSURER A: ATLANTIC CHARTER INS CO 44326 INSURED INSURER B: LARRY RIDEOUT INSURERC: RIDEOUT BUILDERS INSURERD: POB 290 INSURER E__ SOUTHWICK MA 01077 INSURER F: COVERAGES CERTIFICATE NUMBER: 507055 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. ADDL SUBR POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERALLIABILITY EACH OCCURRENCE $ DAMAGE T REN O CLAIMS-MADE El OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ PRO [—] LOC PRODUCTS-COMP/OP AGG $ JECT $ OTHER: AUTOMOBILE LIABILITY Ea accc accident) LIMIT $ BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS -PROPER DAMAGE NON-OWNED Per accident $ HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ EROTH_ $ WORKERS COMPENSATION X I STATUTE ER _. AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 _ 0 03/14/2021 A OFFICERWEMBEREXCLUDED? NIA NIA NIA WCV01399002 03/14/202E.L.DISEASE-EA EMPLOYEE $ 100,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more 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.mass.gov/lwd/workers-compensation/investigations/. 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. City of Northampton 210 Main St AUTHORIZED REPRESENTATIVE fl Northampton MA 01060 '....{. C.4 P Daniel M.Crown y,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 From: Larry Rideout Rideout Builders 17Powder Mill Rd� Southwick KAAO1O77 To: Louis Hasbrouck Building Commissioner City ofNorthampton 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 _199 Pine. Florence M 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, /t A' 2n vr\ r�U SCOPE RIDEOUT BUILDERS 17 POWDER MILL RD. SOUTHWICK, MA 01077 413-885-2876 1arry.rideout@comcast.net CS-011635 Pioneer Valley Books 2-19-2020 155 Industrial Drive Northampton, MA 01060 Scope of Work: FIRST FLOOR 1. Patch and finish new openings at bathroom ends of bunker. 2. Frame new entries at Men's and Women's Room. 3. Install new doors and hardware at new entries. 4. Add a second door opening and door and hardware at Women's Room. 5. Add a Door at the Break Room. 6. Cut and opening and add a header in the Break room to enlarge area into the next space. 7. Remove and patch existing IT room. 8. Add a new closet with doors to the space. 9. Paint walls and patch floors at renovated areas. SECOND FLOOR 1. Prepare existing Framing for drywall. 2. Insulate common walls. 3. Drywall and tape all walls. 4. Paint entire space. S. Install new suspended ceiling with 2x2 tile. 6. Install hollow metal doors and jambs at each office with vision lite. 7. Install 3 other vision lites as indicated on the drawings; 8. Install 4 new vinyl 4'x4' windows to replace existing higher metal ones. 9. Demolition of masonry is required to increase the window openings 10. New 12 x 12 VCT floor tile with vinyl base. 11. Construction Coordination 12. Permit 13. Final Cleaning