Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
39-041 (23)
15 ATWOOD DR BP-2020-0932 GIS#: COMMONWEALTH OF MASSACHUSETTS MW: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-2020-0932 Proiect# JS-2020-001584 Est.Cost: $500000.00 Fee: $400.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: DEVELOPMENT ASSOCIATES 075752 Lot Size(sct. ft.): 217800.00 Owner: NORTHWOOD DEVELOPMENT LLC Zoning:GB Applicant: DEVELOPMENT ASSOCIATES AT: 15 ATWOOD DR Applicant Address: Phone: Insurance: P O BOX 528 (413) 789-3720 WC AGAWAMMA01001 ISSUED ON:3/30/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.FIT OUT 3RD FLOOR - BLUE ROCK 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 3/30/2020 0:00:00 $400.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Versionl.7 Commercial Building Permit MaX 15,2000 Department use only � City of Northar> pton - Q�E- t of P+mit: Building Departmen Curb ut/Dr veway Permit - 212 Main Street FEB a ywer Septi Availability ROOM 100 1 Water ell Ivailability Northampton, MA 01060 s of Structural Plans �Tnr� iS phone 413-587-1240 Fax 413 2y>P loV$ite Plans bfher 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 1.1 Property Address: This section to be completed by office 15 Atwood Drive Map Lot Unit Northampton, MA �,�,(� (� � Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Northwood Development, LLC P. O. Box 528,Agawam, MA 01001 Name(Print) Current Mailing Address: 413-789-3720 Signature _ _________________ Telephone 2.2 Authorized Agent: Travis P. Ward,as agent for owner P. O. Box 528,Agawam, MA 0 100 1 Name(Print) Current Mailing Address: 413-789-3720 Signature ___X, _____________________----------- Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 500,000.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) EE 3. Plumbing Building Permit Fee y- 4. Mechanical (HVAC) i 5. Fire Protection 6. Total = (1 +2+3+4+5) Check Number !� This Section For Official Use Only Building Permit Number Date 60- s Issued Signature: 1� Building Commissioner/Inspector of Buildings Date 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 of professional office space in 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 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 36 ❑ 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 i 1 St 2nd 2nd 3rd 3`d 4th 4th , Total Area (sf) �_ Total Proposed New Construction (sf) Total Height(ft) L 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[-] Version 1.7 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 ® DON'T KNOW ® YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO () DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO U DON'T KNOW ® YES 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 IF YES, describe size, type and location: Existing and previously approved D. Are there any proposed changes to or additions of signs intended for the property? YES 0 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 0 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) 9.1 Registered Architect: Charles W. Roberts Not Applicable ❑ 10107 Name(Registrant): 28 Amity Street, Suite 213, Amherst, MA 01002 Registration Number Address August 31, 2020 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 Development Associates Not Applicable ❑ Company Name: Travis P.Ward Responsible In Charge of Construction 200 Silver St., Suite 201,P. x 528,Agawam, MA 01001 Address 413-789-3720 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 Northwood Development, LLC as Owner of the subject property Travis P. Ward hereby authorize to act on my beh If all m to relative o ork authorized by this building permit application. February 12,2020 Signature a Ow Date Travis P. Ward 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 perjury. Travis P. Ward,as agent ow er Print Name February 12,2020 Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Travis P. Ward CS-075752 Name of License Holder: License Number 32 Columbia Drive,Fe 'n Hills, MA 01030 05/19/21 Address Expiration Date 413-789-3720 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 G) 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 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 February 12, 2020 Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents d 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 Legibly 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.❑✓ 1 am a employer with 5 __employees(full and/or part-time).* 7. ✓❑New construction 2.[:]1 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.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.] 10E] Building addition d.❑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.❑ p Roof repairs These sub-contractors have employees and have workers'comp.insurance$ b.❑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: Great American Insurance Company of NY Policy#or Self-ins.Lic. #: WC113001803 Expiration Date: 04/13/20 Job Site Address: 15 Atwood Drive City/State/Zip: Northampton,MA 01060 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 ertify under the ns d penalties of perjury that the information provided above is true and correct. Si nature: Date- /� Phone#• qO)7409-3-7ala 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#: To: City of Northampton Page 3 of 3 2020-02-24 15:34:41 (GMT) 14138955978 From: Rejean J Remillard InSUrance AC"R" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) �. 02/24/2020 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 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). PRODUCF_R CONTACT NAME: REJEAN J REMILLARD INSURANCE AGENCY PHONE FAX 1040 Springfield Street (A/C,E-MAIL Feeding Hills, MA 01030 ADDRESS: INSURERS AFFORDING COVERAGE NAIL tt INSURER A: AmGUARD Insurance Company 42390 INSURED INSURERS SERGEY KULYAK LIVINGSTONE HEATING&COOLING INSURER C _. . 6 LIVINGSTONE AVENUE INSURER D. _— WESTFIELD, MA 01085 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, NOTVVITHSTANDING 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 AD DLISUBR POLICY EFF POLICY EXP LTR I POLICYNUMBER MMIDD/YYYY) IMM/DDffYYYI LIMITS GOMMERCIALGENERAL LIABILITY EACH OCCURRENCE $ 0 CLAIMS-MADE DAMAGE TO RENTED 0 i EI OCCUR FR MI_CG(C?.omcurrence)..,-_S MED EXP(Anyone person) S 0 _ PERSONAL 8 ADV INJURY $ 0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE I$ 0 I POLICY I _]P�7 LOC PRODUCTS-COMP/OP AGG S 0 —'OTHER. 5 AUTOMOBILE LIABILITY COMBI NED SINGLE LIMIT (-a accident) ANY AUTO j BODILY NLURY(Per person) $ OWNED '.SCHEDULED AUTOS ONLY AUTOS BODILi'N_vRY(Pere I—t) S HIRED I NON-OWNED i PROPER-,-Y DAMAGE AUTOS ONLY ........I AUTOS ONLY (Per accicen:) I S UMBRELLALIAB OCCUR EACH OCCURRENCE $_ EXCESS LIAR CLAIMS-M.ADZ' I j AGGREGATE I - DEC) RETENTION$ WORKERS COMPENSATION iX !STATl1TE OCRH AND EMPLOYERS LIABILITY A 'CFFCER/MEMBEREXCLUDEID?ECU7IVE � NIA R2WC071174 09/10/2019 109/10/2020 !.E.L.EACH ACCIDENT S100,000 (Mandatory in NH) !, EL DISEASE-EA EMPLOYEE S 100,000 If yes,describe under DESC.:RIPI ION OF OPERATIONS below E L DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required( Employees: Full Time: 0; Part Time; 0 Governing Class Description: SHEET METAL WORK NOC& DRIVERS Exclusions: SERGEY KULYAK, HEATING&AIR CONDITIONING; CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main St Northampton, MA 01060 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD