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39-041 BP-2023-0255 15 ATWOOD DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 39-041-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0255 PERMISSION IS HEREBY GRANTED TO: Project# EGRESS COURT 2023 Contractor: License: Est. Cost: 9000 DEVELOPMENT ASSOCIATES 075752 Const.Class: Exp.Date: 05/19/2023 Use Group: Owner: LLC NORTHWOOD DEVELOPMENT Lot Size (sq.ft.) Zoning: GB/WP Applicant: DEVELOPMENT ASSOCIATES Applicant Address Phone: Insurance: P O BOX 528 (413)789-3720 WC113001806 AGAWAM, MA 01001 ISSUED ON: 03/03/2023 TO PERFORM THE FOLLOWING WORK: CREATE EMERGENCY EGRESS 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: 411 Fees Paid: $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner RECEI V ivy 1_ ) I i I litAR - 2 2023 The Commonwealth of MassaGhuse tts Office of Public Safety and Inspecti ns I I i r1[PT.OF BUILDING IN5PFCTION� Massachusetts State Building Code(780 ) m. NORTHAMPTC�N, AA01060 Building Permit Application for any Building other than a O --or Two-FamilyDwelting�` (This Section For Official Use Only) Building Permit Number: .?3 - .2$$ Date Applied: Building Official: SECTION 1:LOCATION 15 Atwood Drive Northampton,MA 01060 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 9th If New Construction check here 0 or check all that apply in the two rows below Existing Building 0 Repair❑ Alteration se 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 111 No ❑ Is an Independent Structural Engineering Peer Review required? Yes 0 No 15/ Brief Description of Proposed Work:Create emergency egress for Hampshire Probate Court 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.) Total Area(sq.ft.)and Total Height(ft.) 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 ® E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1 0 I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0 S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA CI IB ❑ HA CI IIB Ii MA CI IIIB ❑ IV 0 VA 0 VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public 0 Check if outside Flood Zone 0 Indicate municipal 0 A trench will not be Licensed Disposal Site 0 required 0 or trench or specify: Private 0 or indentify Zone: or on site system❑ permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable 0 Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0 SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: 9th Use Group(s): 11 B Type of Construction: Does the building contain an Sprinkler System?: Yes Special Stipulations: Design Occupant Load per Floor and Assembly space: N/A SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Northw000d Development,LLC 200 Silver Street, Suite 201 Agawam MA 01001 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Travis P.Ward,as agent for owner 413 -789 - 3720 413-335 -7168 tward@devassociates.com Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Travis P Ward 200 Silver Street. Suite 201 Agawam MA 01001 _ 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 O. 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) 1�57131'7 aiPq.oconnory� `m f en Q' • ant _ �rphonq N mail a ess ���0 g i Registr do Lmmbe �� T In� I� - -f- Za Street Ad ess City/Town State Zip Discipline Expiration Date 10.2 General Contractor Development Associates Company Name Travis P. Ward CS-075752 Name of Person Responsible for Construction License No. and Type if Applicable 200 Silver Street, Suite 201 Agawam MA 01001 Street Address City/Town State Zip 413-IBi3-3720 413- 335-7168 tward©devassociates.com 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❑ No CI SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 9.000.00 1.Building $9,000.00 Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ appropriate municipal factor)=$ . 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum f =$100.00 c ct municipality) 5.Mechanical (Other) $ Enclose check payable t 6.Total Cost $9,000.00 (contact municipality)and write check number here 2. O pIL g SECT :SIGNATURE OF BUILDING PERMIT APPLICANT By ent ' my name below,I reby attes under the pains and penalties of perjury that all of the information contained in this application to the be of my knowledge and understanding. - . Operations Manager 413-789- 3720 2128/23 Please print and sign name Travis P.Ward,as agent for owner Title Telephone No. Date 200 Silver Street, Suite 201 Agawam MA 01001 tward@devassociates.com Street Address City/Town State Zip r Email Address 1� ✓ Municipal Inspector to fill out this section upon application approval: W.97 3/3/a3 Name V(/ Eke The Commonwealth of Massachusetts 1 i Department of Industrial Accidents �f,. —likiri .1 I Congress Street,Suite 100 4 - Boston, MA 02114-2017 't;_ '` wwwmass.gov/dla - 11orkers'Compensation Insurance Affidavit:BuildersIContractors/Electriciansll'lumhers. '10 HE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibh Name(Busincsv rga.nizatiotulndividuaI): Development Associates Address: 200 Silver Street, Suite 201 City/State/Zip: Agawam, MA 01001 Phone##: 413-789-3720 Are yew an entployee Clerk the appropriate lax: -1)pe of project(required): 1.�I ant a employer with Li employ:e,t lull andior part.time).• 7. 0 New construction 20 I am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling any capacity.[No worker.'comp.insurance mortal] 301 am a homeowner doing all work myself.No We:tits'camp.imorance required.]' 9. ID Demolition 4.01 am a homeowner and will be hiring cimtrattursto conduct all work on my property_ I will 10 CI Building addition ensure that all ern tractors either have workers`L41mpensatit n mauranct oe are sole 1 l.o Electrical repairs or additions proprietors with nu employees_ 12.0 Plumbing repairs or additions 4.11 am a general contractor and 1 love hired the subcontractors bawd on the attached sheet. These sub-contractors have employees and have workers'camp.irtsunarke. l3.❑Roof repairs 6.0 We are a corporation and iLL officers have exercised their right of exemption per MGL c. 14.0 Other IS2,11(4l.and we have no employees.[No workers'comp.insurance requiter!.] *Any applicant that ehcxks lux n I must also till out the section below showing their workers compensation pokey information. t It nneuwrars who submit tins affidavit indicalrne they are doing all work and then hire outside corm-actors must submit a new affidav it nxdica7ng 4ueh. iCuntraeturs that cheek this b:,t must attached an additiunal skeet showing the n:une of the sub-contractors and state whether ur not those..nines bale employees. If the sub-cutrtractora have errgtloyces.the',must provide their workers"cretin.policy number. l runt on employer that is providing workers'compensation insurance,fair my employees. Below is the polity and job site information. Insurance Company Name: Great American Alliance Insurance Com an Policy#or Self-ins.Lie.#:WC 113001806 Expiration Date: Job Site Address: 15 Atwood Drive City/State/ZipNortham ton,MA 0106 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiratio date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to S I, .00 and/or one-year imprisonment,as well as civil penalties in the forth of a STOP WORK ORDER and a fine of up to S2 0.00 a day against the violator.A copy of this sea ent may be forwarded to the Office of Investigations of the DIA for insu once coverage verification. I do hereby c I y and• th. .'.,s and, allies of perjury that the information provide a6 ►'e is true and correct. a Signature: / i !Date: 1 i ci---1 Phone#: 413-789-3720 1 1 Official use only. Do not rt'rite in this urea,to Le completed by 4.44.or town official. City or Town: PermitiLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other IContact Person: Phone#: _. TE ACCPREP CERTIFICATE OF LIABILITY INSURANCE ©A 3/1/2023WY) 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 CONTACT The Dowd Agencies, LLC PHONE Debbie Mac Neal FAX 14 Bobala Road to/C.No,Extl:413-538-7444 (Nc,No):413-536-6020 Holyoke MA 01040 ADDRESS: dmacneal@dowd.com PRODUCER DEVASSO-01 CUSTOMER ID N: INSURER(S)AFFORDING COVERAGE NAIC f/ INSURED INSURER A:Great American Ins Co of NY 22136 Dev Associates LLC a/ka/Development Associates P. O. Box 528 INSURER B: Agawam MA 01001 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:952958259 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DDNYYY) (MM/DDNYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PR TORENTED PREMISES((Eaaoccurrence) $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 7 POLICY JEo- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE _ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION WC 1130018 06 4/13/2022 4/13/2023 X VbC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $.1 000_040 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Job: 15 Atwood Drive,Northampton MA 01060 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 Street Northampton MA 01060 A THORIZED REPRESENTATIVE I ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Initial Construction Control Document ii �,j l, To be submitted with the building permit application by a tl § Registered Design Professional 'J. for work per the ninth edition of .0� Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Atwood III Court-New Egress .Date: February 20,2023 Property Address: 15 Atwood Drive, North Hampston,MA Project: Check (x) one or both as applicable: New construction XX Existing Construction Project description:New Egress I, Gregory J. O'Connor, MA Registration Number: 7914 Expiration date: 8/31/23 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning1: 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 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 Constc 44 igontrol Document'. Enter in the space to the right a"wet" or electronic signature and seal: f t .n,;A '° Phone number:508-757-1377 Email : greg.oconnor@gjoassociatds '` 0 JJ '":4,,Y .�1-. Building Official Use Only Building Official Name: Permit No.: Date: Version 01 01 2018 City of Northampton SI\� Massachusetts DEPARTMENT OF BUILDING INSPECTIONS w r,- `� 212 Main Street • Municipal Building Northampton, MA 01060 ssygrDN\`\° 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: 15 Mullen Road, Enfield,CT 06082 The debris will be transported by: Name of Hauler: USA Waste&Recycling, Inc Signature of Applicant: / Date: 3- 1 -a-1 Appendix 1 Construction Documents are required for structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where applicable No. Item Submitted Incomplete Not Required 1 Architectural 2 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing(include local connections) 9 Gas(Natural,Propane,Medical or other) 10 Surveyed Site Plan(Utilities,Wetland,etc.) 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review(521 CMR) 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction. Registered Professional Contact Information 61 • 17,C ( (oy OY 503 51-- 13 gf4.O(onno✓Le,gja zoo cs.Gg `) 114-- amei(Re trant) Telephone No. e-mail address') Re tstration Number 3 J°I rat Q,in S-f' Ida rct 54-ck- F-- 01(,0 g l� Street Address City/Town State Zip Discipline Expi atibn Date - - Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Please follow this link for construction control forms to be used by Registered Design Professionals. Commonwealth of Massachusetts Division of Professional Licensure .a jd of Building Regulations and Stan. Construgt cin Su ards pQrvisor CS-Q.Za?52 _ TRAVIS P WARD � EXpires:0z/19/2023 r 227 PINE ROAD 3 lug P.O. BOX 331_r s :r EAST OTIS MA-Q102g � > Commissioner c.,•IacwZ �' ' a