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23B-014 (25) BP-2006-0055 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Bui!dinm Category:roofing BUILDING PERMIT Permit# BP-2006-0055 Project# JS-2006-0072 Est. Cost: $219690.00 Fee: $0.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: INDEPENDENT ROOFING CO INC 017759 Lot Size(sq.ft.): 493534.80 Owner: NORTHAMPTON CITY OF Zoning: SI Applicant: INDEPENDENT ROOFING CO INC AT: 125 LOCUST ST Applicant Address: Phone: Insurance: P O BOX 1446 (413) 568-9405 WC W ESTFIELDMA01086 ISSUED ON:7/18/05 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE BARN ROOF 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: j 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 7/18/05 0:00:00 $0.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo iE' -�'�e r `1 Versionl.7 Commercial Building Permit May 15 2000 • C' (— v �—' �� - � '- - ?. Department use only �. f Northampton Status of Permit • 1 • '1` $ ZC.J Bu"ilding Department Curb CutlDnveway Permit: - i \\..%\ J� 212 Main Street Sewer/Septic availability - Of BUIl0 G1 p►OI�nS F�oom 100 Water/Well Availaoility ��,ifi haripton, MA 01060 Two Sets of Structural Plans .. BAN R'' p one 413-587-1240 Fax 413-587-1272 Plot Site Mars 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 r- _This section to be completed by office ---1 t-Protperty-Addresc: CITY OF NORTHAMPTON—DEPT. PUBLIC WORKS Map Lot Unit BARN ROOF REPLACEMENT — DPW 125 LOCUST STREET Zone Overlay District ,- NORTHAMPTON, MA. 010)50 Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record• ,sr/ C G6'1/1,•� I Name(Print) CIT OF NORTHAMPTON—CENTRAL SERV'S Current Mailing Address: 240 MAIN ST. , NORTHAMPTON, MA. 240 MAIN STR ET— NORTHAMPTON_. MA. 01060 Signature Telephone (413) 5F7-1238 FAX (.413)444-4442 lr. lir tt Jacobus—Director 2.2 Authorized Agent• 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 `ter ' - a- 1. Building ROOF i (a)Building Permit Fee REPLACEMENT 219,690.00 2. Electrical (b)Estimated Total Cost of • }}' ' Construction from(6) i, 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) I 5. Fire Protection 6. Total=(1 +2+3+4+5) $219,690.00 Check Number ' This Section For Official Use Only Building Perrnd lumber` Date Issued ,- Signature: Building Commissioner/Inspector of Buildings Date 4 • Version1.7 Commercial Building Permit May 15,2000 SECTION4 CONSTRUCTION SERVICES,FO PROJEC13 ESS THAN 35,000 CUBIC FEETOFENCLOSEDSP.ACE - Interior Alterations ❑ Existing Wall Signs 0 Demolition❑ Repairs 0 Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description Enter a brief desc ' on here. Of Proposed Work: 1 i :'SECTION 5-USE-GROUP AI D CONSTRUCTIONTYPE. - ROOF REPLACEMENT DPW '7 125 LOCUST ST. , N'HMPTON USE GROUP(Check as applicable) CONSTRUCTION TYPE A AssemblyCI Al- ❑ A-2 ❑ A-3 ❑ A 1 I El_ A-4 ❑ A-5 ❑ B Business ❑ 2A 0 E Educational ❑ 2B I ❑ F Factory El F-1 ❑ F-2 ❑ 2C 0 H High Hazard ❑ 3A ❑ I Institutional ❑ 1-1 0 1-2 ❑ 1-3 ❑ 3B 0 M Mercantile ❑ 4 0 R Residential 0 R-1 ❑ R-2 0 R-3 ❑ 5A ❑ S Storage ❑ S-1 0 S-2 ❑ 5B l ❑ U Utility ❑ Specify:I M Mixed Use 0 Specify:I S Special Use 0 Specify: COMPLETETHIS;SECTIONfTE EXIST1NG BUILDING UNDERGOING RENOVATIONS..ADDITIONS-:AND/OR-CHANGE IN USE I Existing Use Group: � ProposedUse Group: Existing Hazard Index 780 CMR 34):. I Proposed Hazard Index 780 CMR 34): I -SECTION`6BUILDING-HEIGHT=AND:AREA- - BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION ` -- -,t- .`s.L ' -..^a-" I 4Floor Area per Floor(sf) ram'v if - -: -. 4 Y• ' ,-sue :a. m.r� q't.-. 1stI -v.- ��" ` ',,,,,S St > ra A - - 2nd 1 --,: ,' g Fri s-a°*c -; i ' `` ue 3rd1 g • 4- s ,-.c1. ` a i 4 M" t ..- -> - - 4o '.� � ?ROOF REPLACEMENT e y ' Total Area(sf) I Total Proposed New Construction(sf) x �z* � 21.300 sq ft i -0- 1 aet �Yr. . � �. ` '�" , Total Height(ft) I � � Total Height ft ' �' k I a��y 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ® Private 0 Zone i I Outside Flood Zone❑ Municipal 0 On site disposal system • • Versionl.7 Commercial Building Permit May 15,2000 i 1)1E 1s7k.T ,t,. N/A Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size 1 Frontage Setbacks Front I I , Side L: 1 R 'r J R: T �—i Rear i 1 -Building Height ,• --, Bldg.Square Footage °a - ) f Open Space Footage % � � �— (Lot area minus bldg&paved �! i t__1 pig) 7-7 #of Parking Spaces r Fill: ' j I i (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW (l YES IF YES: enter Book 1 Page' ; and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW (4 YES Q 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 Q NO IF YES, describe size, type and location: j 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: 1 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 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version1.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION-SERVICES-FOR BUILDINGS.AND STRUCTURES SUBJECTTO CONSTRUCTION CONTROL;PURSUANT'TO 780-CMR 116(CONTAINING MORE THAN.35,D00,C.F.OF-ENCLOSED SPACE) 9.1 Registered Architect Not Applicable ❑ j Mr. William V. Gillen—FORD GILLEN ARCHITECTS, INC. Name(Registrant): 409 MAIN ST. . AMHER ST, MA_ Registration Number Mr. William V. Gillen + Address09 Main St. , Amherst, MA. 01002 i 41'3-253-2528i Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): • Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date � 4 Name Area of Responsibility Address Registration Number s I Signature Telephone Expiration Date I Name Area of Responsibility i I Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number I I Signature Telephone Expiration Date 9.3 General Contractor INDEPENDENT ROOFING COMPANY INCORPORATED Not Applicable❑ Company Name: I.R.C. , INC. , PETER A. RUSZALA — OWNER/PRESIDENT Responsible In Charge of Construction 294 UNION ST. , P.O. BOX 1446 — WEST 'IELD, MA.01086-1446 Address 413-568-94(A Signature A. RUSZALA — RESIDENT Telephone m s -c1 tA.,f pi., f- O0. O (rii of Northampton sl mpton R+ � }�E laz• rhncre• - — 1-z- o^ DEPNJ4EOP BUILDING INSPECTIONS �jT—. . 212 Main Street - Municipal building Northampton, Mass. 01050 rr WORKER'S COMPENSATION a?SURAN'C r. AVM:DAVIT I, /1/../..) ioiS i VG) A- 7-- 4,,,-,„,, 6-,. /,,,, . _, --- (1i ocnsxlpermi ttec) .1>_6rt,_a nn 1 ce of busin.-s irtsidencc at: a 9 �,� �,p G �/ .vee�i `!/2sT�/EL�1Irq (phone=) /3 �[v0 — �7Q� (srrt/city/sla c.'tw p) do hereby certify, under the pains and penalties of perjury, that (lam an employer providing the following tti.orker's compensation coverage for my 0 employees working on this job` G./V,19 • //c 43.&_ 9y5VX j/-.qoo • u-an n � (Ins c Com -ry) (Policy Number) (Expiration Date) ( ) I-am a sole proprietor, general contractor or homeowner (bide one) and have hired the contractors listed below who have the following worker's compensation policies: asiame of Contactor) (Insurance-. Coiaoany/PoUc- Number) (ExplrJt?on Date). (Name of Contractor) (1ns,>i-acne; Company/Policy Number) (E.vDir,:tion Date) (Name of Connamo;) (insurance Company/Policy NuJrbe.r) (Expiration Date) . 1 (Name of Contractor) (Lnsurancc Comcauy/Policy Number) - (Expiration Date) . (nat.th:.cidi ic.,J,6,--c if 000ea..y to clew&ioforma ion pertaining to.1J 000na-nCo ) . 3 ( ) I am a sole proprietor and have no one worldng for me. ' ( ) I am.a home owner performing all the work myself. NOTE:pie c bc abeam IL.,1•+it.le bo¢ro.�aezz who employ pezom to do c^•:n(-,gym or.--.;eJoo a repair Work on.ds..Ui g of not more then ` oc 1.Milr in u'sieh the homeowner rnirjo or co the grouncla appurtcn:rt them t_-t no(gca-ally oecrd to bc employes.+K'.e the..a-u ec,.r,r-- •on Act(GLI S2,s I(5)),npplintion by o bom.aaazer fel c LJr�x or permit raoy evideoec the . legal ct a u of ea eployet wader rho Wocko,.Conapom,.Lioa Act I uodcsiaod tha a copy of this mt®off m.y bo forxurd.ed to tbo Doponmmt of lo�wiJ Acodaatz'Moo of tox.r•oco for th. oavcr.Sc vcriEctioa and th t L•s)th-a to senor)coverage under section 25A of NCH_152 can lead to the ii-Crn+tion of eiminsl pcaoltio onazixiug of a tine of up to S 1300.00 and/or i=prizoamat of up to one ytor end civil per.luo in&form of a Stop Work Ordcr nod• ram of S 100.00 1 city.p.inA Q . For doj rn."1 u.c only Permit Numb= Si �t-.4 A'tap::__ Lot ' of Licensee/Pc •ucc Lflte J Versionl.7 Commercial Building Permit May 15,2000 • SECTION 10-STRUCTURAL PEER REVIEW'(780%CMR 110 411{ Independent Structural Engineering Structural Peer Review Required Yes © No A SECTION 14 -OWNER AUTHORIZATION-'TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING'PERMIT j I, I as Owner of the subject property j i hereby authorize; !to act on my behalf,in all m relative to work authorized by this building permit application. i _' , rl i ,ii �r il"Pior/A1Pr' 1 Signs re of Owner Date i I,I 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 er the pai.s - • ,enalties of perjury. Print Name Signature of Owner/Agent Date ,SECTION12'-CONSTRUCTJON SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder:, PETER A. RUSZALA ! 1 License Number 1230 WESTERN AVENUE — WESTFIELD, I.A. 01085 Address Expiration Date (413) 562-0570 Signa e Peter A. Ruszala NSTRUCTION SUPERVIhone 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. ATTACHED Signed Affidavit Attached Yes ® No 0 r i ' PHONE:(413)568-9405 • FAx: (413)562-5906 IRC INDEPENDENT Roofing Company, Inc. COMMERCIAL• INDUSTRIAL• RESIDENTIAL ONE PLY ROOFS• SLATE FULL INSURED* BONDED P.O.Box 1446 PETER RUSZALA 294 UNION STREET PRESIDENT WESTFIELD,MA 01086 itk-: =�� Board of Building egulations One Ashburton Place, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 09/19/1951 • Number: CS 017759 Expires:09/19/2005 Restricted To: 00 • PETER A RUSZALA 1, • 230 WESTERN AVE WESTFIELD, MA 01085 Tr.no: 6268 - Keep top for receipt and change of address notification. < 1 rl ,,�/�aaaac� ------- _f y I y 1 00-35,000 cf enclosed space BOARD OF BWILQING REGLII A $ } (MGL C.112 SsoL) LIc$nBe .CONSTR CTION SUPE VI$ 1A-Masonry only I ' 1 G-1 8,2 Family Homes Nur>{bet. C� O17759 r. Failure to possess a current edition of the Fj I Birth)tlate:)09/19/1, 51 J Massaohugelts State Building Code �r _ � is cause for revocation of this license.Cdiru .-¢9/19/2005 Tr.no: 6268 Restr'Isteds'00 PETER A RUSZALA 7 230 WESTERN AVE WESTFIELtt MA 01085 Administrator DIG SAFE CALL CENTER: ( ) 44 888 3 7233 ` '^ r..w....�—��� - v (. .•..+!:"���^"! !^="•1.,,�.+.e�T �.... _-""sa....�*--ram.--�-�_-a.._ -a.. . y . Client#: 12556 INDRO ACORD,,, CERTIFICATE OF LIABILITY INSURANCE DATE(05D"Y) 06/08/ PRODUCER ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION T.P. Daley Insurance Agcy, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1381 Westfield St. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 1150 West Springfield, MA 01090 INSURERS AFFORDING COVERAGE INSURED INSURER A: CNA Insurance Companies Independent Roofing Company, Inc INSURER B: 294 Union Street ' INSURER C: P.O. Box 1446 INSURER D: Westfield, MA 01085 INSURERE: COVERAGES 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 .1AY 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMN LTR DATE IMMIDD/YYl DATE(MM/DD/YY) A GENERAL UABILITY C1030699430 05/01/05 05/01/06 EACH OCCURRENCE S1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $100,000 CLAIMS MADE X OCCUR MED EXP(Any one person) $5,000 X PD Ded:1,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIM IT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY n JEc n LOC A AUTOMOBILE LIABILITY 5657847 05/01/05 05/01/06 (COMBINEDEa i1) $1000SINGLE LIMIT ,000 ANY AUTO ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS - BODILY INJURY S X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per acddent) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS LIABILITY C1030699458 05/01/05 05/01/06 EACH OCCURRENCE $1,000,000 X I OCCUR CLAIMS MADE AGGREGATE $1,000,000 $ DEDUCTIBLE $ X RETENTION $10000 $ A WORKERS COMPENSATION AND WC130699444 05/01/05 05/01/06 WCSTATU- OTH• EMPLOYERS'LIABILITY TORY LIMITS ER E.L.EACH ACCIDENT $1,000,000 E.L.DISEASE-EA EMPLOYEE $1,000,000 E.L.DISEASE-POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Department of Public Works Barn Roof Replacement, 125 Locust Street, Northampton, MA CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED EFORE THE EXPIRATION City of Northampton DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAI30_-_DAYS WRITTEN 240 Main Street NOTICETOTHE CERTIFICATE HOLDER NAMED T,BUT FAILURE TO DO SO SHALL Northampton, MA 01060 IMPOSE LIGATION OR LI OF ANY KIND UPON THE INSURER,ITS AGE NTS OR RESENTATIVES. AUTHORIZED REPRESENTATI ACORD 25-S(7/97)1 of 2 #546882/M46121 TMG © ACORD RPORATION 1988