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25A-179 (26)
BP-2022-0415 29INDUSTRIAL DR - COMMONWEALTH OF MASSACHUSETTS EAST Map:Block:Lot: CITY OF NORTHAMPTON 25A-I 79-001 Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0415 PERMISSION IS HEREBY GRANTED TO: Project# 2022 RENO Contractor: License: Est. Cost: 1000000 MOR SERVICES INC 108603 Const.Class: Exp.Date:04/24/2023 Use Group: Owner: LLP 29 INDUSTRIAL DRIVE EAST Lot Size (sq.ft.) Zoning: GI Applicant: MOR SERVICES INC Applicant Address Phone: Insurance: 380 WESTFIELD ST (413)363-2863 6S62UB-0G297226 WEST SPRINGFIELD, MA 01089 ISSUED ON:05/02/2022 TO PERFORM THE FOLLOWING WORK: INTERIOR RENOVATION 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fees Paid: $7,000.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner i AIR 20 Commonwealth of Massachusetts *V� 2iThel Office of Public Safety and Inspections , �3. i1 , Massachusetts State Building Code(780 CMR) BuildingPermit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number: 2 O1Ji5—Date Applied: Building Official: SECTION 1:LOCATION 0a9 /41l Kfr,t!/3L 2i244/1 f.fi No,Qa6liji77a41 ,y.¢ 46?/clec9 No.and Street City/Town Zip Code Name of Building(if applicable) Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below Existing Building dEl- Repair 0 Alteration ®— Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No 0 Brief Description of Proposed Work: fA/O✓-Y D../ 0 F cx't r ilic. celk - S7bA7 "fa c2i•✓G To J41GL.6/ f ,v wlD.t, ritkr.ciKrt4,0C-. L.1A11LS ?f? /`7..o-.J 274d r SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0 Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) i pad 41 I .22 y J. Total Area(sq.ft.)and Total Height(ft.) al87 9' 2 0 f J cL J SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 13. E: Educational 0 F: Factory F-1 I] F2❑ H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4❑ S: Storage S-1❑ S-2 0 U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA IB ❑ IIA ❑ IIBit MA CI IIIB ❑ IV VA VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Trench Permit: Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal:Public w- Check if outside Flood Zone ja. Indicate municipal El- Licensed- A trench will not beDisposalSiteiril Private 0 or indentify Zone: or on site system Elre permit i for trench or specify: is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable P21-. Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No Id_ Yes 0 No 0 SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner 69iS a9kv rR,t4 >Qi-4c 3s cs, R sate, e‘te/e_oi f ,A/ - 0943 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: �1 r h✓ 40/3,4/5o,J y, J2C 9 Sze - ,Prioep-ir.,t1s,4 .(o-y Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here a. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control (the professional coordinating document submittals) Rom` ToC Z ILO y/3-62Y( - y 6o 9 RIoe zK of'II/1/eCAl i f e;.r.Q4. (o-41 574,74 Name(Registrant) Telephone No. e-mail address Registration Number 4 e ct-tr To.4 41 1,10¢ Watt%{er Street Address City/Town State Zip Discipline p ation Date 10.2 General Contractor W1O/L 5 4-4 vtcc s / Company Name FfcA'/-71 CR52444.4k- C- "10-86.0 3 Name of Person Responsible for Construction License No. and Type if Applicable 3Y ,,/4s5sl4 i, s£er 572 rt�f I?d pi7g I Street Address City/Town State Zip 9i5 -Z;- -36 3 Lit; ? 3 ter' !4 s J Y rims-awe-fspic cow Telephone No.(business) Telephone No. (cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yes D No CI SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ a SD, oOo.o-9' Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ appropriate m ' 'pal factor)=$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee= / ntact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ /, 64-1)QD (contact municipality)and write check number here I 57/ SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the b y knowledge and understanding. / J/2' DAs z4,`9� - �7do,�s�' %— /it/_ -21'- 3 3 5' 7 . Please print and sign name Title Telephone No. Date 3 2To iicsl-Fi 5—/J c-Wssrs /. i _ Dim Y'7 ,iq aiiecciwi'fritir, c Street Address City/Town State Zip Email Address A - Municipal Inspector to fill out this section upon application approval: �"'Uv'`�'`, � � " ) ` � a Name Date initial Construction Control Document 90Iw /1 To be submitted with the building permit application by a Le,,1j Registered Design Professional : for work per the 9th edition of the _ S. Massachusetts State Building Code, 780 CMR, Section 107 Project Title: 29 INDUSTRIAL DRIVE EAST Date: April 12,2022 Property Address: 29 INDUSTRIAL DRIVE EAST,NORTHAMPTON,MA 01060 Project: Check(x)one or both as applicable:_New Construction_X Existing Construction Project description: Renovation of existing single story industrial building for a cannabis processing facility, I, Rafal Toczko,MA Registration Number: 51076 Expiration date: 08/31/2022,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 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. 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. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I will 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 will submit to the building official a`Final Construction Control Document'. ...<EiIED A: Q 4,17oce`JYY�f, `� CH 5f07g ti �BELWF:Ta yy, ,- MA ) q(� svP v ,,, do Enter in the space to the right a"wet"or electronic signature and seal: Phone number: 413-241-4600 Email: rtoczko@rt-architecture.com Building Official 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. 14, The Commonwealth of Alassachuselts '' Department of industrial:incidents ' =e it I (on res_s Street.Suite 100 =rsz. : Boston, M.A 02114-2017 ,4., wow ntass.gov'/dia 11 in kers' Compensation Insurance.%Did at it:BuildersiContractorsiElectricians;Plu in tiers. 10 HE FILED'%I'll I HE PIKSII'rrl\(:Art Applicant Information Please Print Legibly Name(Husiness+Organization Individual): 1 a0/l S4/t t/IC£f i r C. Address: 3 eo tt14s-Ices L_ fins£ r City/State/Zip: /JC S e 5 (L i"Al,F/Si_ nig Phone#: y/7 -?I 12 A q Are you an employer?Cheek the appropriate tact: Type of project(required): hens a ottplo er with _J employees I lull Junior part-tins:0 7. 0 New construction =ri I am a mile peupnctur or partnership and have rut employees working for mein 8. Q Remodeling any capacity.[No workers'comp.insurance required.] fx� 9. ❑ Demolition mro 30 I am a huwner doing all work myself.[Nu winters'cutup.rrvuranee required_)' O 0 Building addition ^t.Q I ant a homeowner and will be hiring L+untraL9urs to conduct all work un my property. I will ensun:that all contraction either lase workers'compensation insurance or are sole I 11:1 Electrical repairs or additions prupnetors with nu employees. 12.0 Plumbing repairs or additions SO I am a general contractor and I have hired the sub-contractors listed on the attadietl sheet_ Thesesub-contractors lase employees and hale workers'comp.insuce. 13.❑Roof repat[S ran 6.0 We are a coipruatiun and its officers have excn ixed their nght of exemption per MGL c. 14.❑Other 152,y I(4(.and we base no employees.[No workers'comp.insurance required.] 'Any applicant that checks buy'I must almi fill out the section be:luw showing their workers''compensation pulley information. +Homeowners who submit this affulas rt indicating;they are doing all work and then hire outside contractors mast submit a new atlulat it indicaing such. :Contractors that cheek this box must attached an additional sheet show ing the name of the sub-ei ntml:tor.and stale whether or not those entities have tnpluyces. lithe sub-contractors lase ctrplu}ens.they must pros ire their workers'comp.policy number. 1 am an emplover that is providing worAers'compensation insurance for mi,employees. Below is the policy and job site information. Insurance Company Name: C1' /.i/S i N<c-tg,i-Ai_f co . — Policy#or Self ins. Lic. #: 6 SG 2.- i i i2 — 0 t o d ci 7 2 2 C Expiration Date: ///27 2 L lob Site Address: o)9 /nl2'4, S%!1 �9 -.,2R!✓f A/M,R%/ld,s,WM City StatelZip: 12/OC Attach a copy of the workers'compensation policy declaration page(showing the policy number sad expiration date). Failure to secure coverage as required under MGL c. 152.§25A is a criminal violation punishable by a tine up to S1,500.00 a dlor one-year imprisonment,as well as civil penalties in the term of a STOP WORK ORDER and a tine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coreragc>rriticattort. 1 do hereby certifytr • the pains and penalties of perjury that the irlforrruuio,I protided iibove i.. true unit correct. St mature: 1"1:•.i. 2: Z Z Phone;: -(r/ g ' 36'3 -2./16 3 Official Ilse only. Dr+not write in this eu-cu. to he completed by city or town official. ( its or Posen: Pernril.license r Issuing.tuthurits (circle ono: I. Board of Health 2. Building Department 3.('its Town Clerk 4. Electrical Inspector 5. Plumbing Inspector (i.Other Contact Person: Phone AC'CPREP DATE(MMIDD/WYY) CERTIFICATE OF LIABILITY INSURANCE 04/13/2022 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). PRODUCER CONTACT David R Jarry Neill&Neill Insurance Agency Inc PHONE (413)732-4137 FAX 413 731-6629 662 Riverdale Street (arc.No.Eat): (AIC,No):( ) West Springfield, MA 01089 ADDRESS: dj(d3neillandneill.com INSURERS)AFFORDING COVERAGE NAIC 0 INSURERA: Atlantic Casualty Insurance Co 42846 INSURED MOR Services Inc INSURERS: Chubb Insurance Co 22667 PO Box 977 West Springfield,MA 01090 INSURER C: INSURER D: 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. 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 POUCY EFF POUCY EXP LIR TYPE OF INSURANCE INBD WVD POLICY NUMBER (MMIDD/YYYY) IMM/DD/YYYY1, LIMITS A ✓COMMERCIAL GENERAL LIABILITY M261001615 01/23/2022 01/23/2023 EACH OCCURRENCE S 1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) _$ 5,000 PERSONAL SADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE S 2,000,000 VIPOLICY JEa LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: S AUTOMOBILELWBILITY COMBINED SINGLE LIMIT s (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA LIAR _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 6S62UB-0G297226 11/27/2021 11/27/2022 V SPER TATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT a 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 212 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Northampton, MA 01060 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD City of Northampton �c Massachusetts �4., x. '<< DEPARTMENT OF BUILDING INSPECTIONS y. 41, 212 Main Street • Municipal Building A. Q. Northampton, MA 01060 rAsp:- .• ';,�a CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: _ The debris will be transported by: Name of Hauler: A 17-1 is l / 5" 5' 1Ci S Signature of Applicant: ,.-----`' Date: Y 2�' 2 Z