18D-066 (3) Client#: 18589 SIFIN
ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMfOD/YYYY)
11/09/09
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Alton E. Woodford, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
10 North Main Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
West Hartford, CT 06107
860 236 - 5861 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Peerless Insurance Co.
Sifco, Inc INSURER B: S.N. Smith & Co Inc
2643 Day Hill Rd
INSURER C:
P.O. Box 787
INSURER 0:
Windsor, CT 06095
INSURER E:
COVERAGES
I THE POLICIES OF INSURANCE USTED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADD'C TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMBS
LTR r1SRt DATE IMMIDD/YY) DATE fMMIDDIYYI
A GENERAL LIABILITY CCP8007507 02101/09 02/01/10 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES rFn eminence) $50,000
CLAIMS MADE n OCCUR MED EXP (Any one person) $5000
XCU INCLUDED PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE s2,000000
GENT. AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 •
POLICY n EC n LOC
A AUTOMOBILE LIABILITY BA8055465 02/01/09 02101/10 COMBINED SINGLE LIMIT
X ANY AUTO (Ea accident) $1,000,000
ALL OWNED AUTOS
BODILY INJURY $
_ SCHEDULED AUTOS (Por person)
X HIRED AUTOS
BODILY INJURY $
X NON -OWNED AUTOS (Per accident)
X Drive Other Car `
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A EXCESSIUMBRELLA LIABILITY CU8009807 02101/09 02101/10 EACH OCCURRENCE $10,000,000
,) OCCUR n CLAIMS MADE AGGREGATE $10,000,000
DEDUCTIBLE $
RETENTION $ 10000 $
A WORKERS COMPENSATION AND WC9936420 02/01/09 02/01/10 X STATLL {1 ItOTH-
EMPLOYERS' LIABILITY I TORY LIMBS I f ER
ANY PROPRIETORIPARTNER!EXECUTIVE E.L EACH ACCIDENT S500,000
OFFICERIMEMBER EXCLUDED? E.L. DISEASE . EA EMPLOYEE $500,000
If yes describe under
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $500,000
B OTHER POLUTION 09CPL00510 , 05/14/09 05114110 $1,000,000 OCC.
LIABILITY $1,000,000 AGG.
DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
•
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ 3A DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZSDAEPRESEN TIVE ar,
{' -
ACORD 25 !2001/081 of 7 012681 CMF 0 ACORD CORPORATION 1988
•
✓fie anvntrnurieala er ,gz.ac�rwella
Board of Building Rcgulatio s and Standards
Construction Supervisor License
License: CS 15825
Expiration: 3/4/2010 Tr# 17697
ll Restriction: 00
RICHARD E ZAPERT
11 COOK RD
SOUTHAMPTON, MA 01073 Commissioner
•
(
' I . 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 0 No Q
SECTION 11 OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
( I, 6!ne v' eve t,0' t I Cs , as Owner of the subject property
hereby authorize , AP1 c ._ 5 w" ei c10 - T to
act on my be If, in all matters relat e to ' "w irk by this building permit application.
,, / `.2i -ice 1 c'tti e / - t; ifs / _— /. �� is
Signature o wner Date
y a, c , 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
/o vi J S ay C 4 if
Print Name'`
X 0/2 /0
Signatur of Owner /Age 7 7--""<-
! / Date
SECTION 12 - CONSTRUCT SERVICES
10.1 Licensed Construction Supervisor: Not Ap I=1 Name of License Holder : 4/ a i C, 7 Gi/'";'/z_T J `J
l License Num er
c ---c/L- '44 ei-N-r V ) '1 Al 3iii to
dress . Expiration Date
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 No 0
� &(/ a l I e 0 A/ce fp,' ,,, -de ,,,e ,,,
i
S , -I G Dr, c .
L
\j 5ay � r SI`l�'�t• ►7�> P b 7
, "I^ ' . -e L T 0612)'
'
Versionl.7 Commercial Building Permit May 15, 2000 k
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
Name (Registrant): ,
Registration Number
Address
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
J I t CU J Vic . Not Applicable ❑
Company Name:
:Tok .5 a
Responsible In Charge of Const ction
n�
6c x 7 11 7 A )) v7 GS 11 C_ r e6 o9�
Address
/'.7. � - , (O.) ( 647-3'33
Signatur y,,,,,,,,,,----.--,
Telephone
(6-(l1)06) ?7/ 70
0'
t 1 Versionl.7 Commercial Building Permit May 15, 2000
8. NORTHAMPTON ZONING
Existing Pxoposed R 'red by Zoning
1 J
+ L a � column to be filled m by
�� �� ( ding Department
Lot Size
Frontage
Setbacks Front
Side L:'' R. L R:
Rear
Building Height 7y
Bldg. Square Footage % x
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
F ill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DON'T KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW YES Q
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 YES 0
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 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES l NO q)
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.
Versionl.7 Commercial Building Permit May 15, 2 •
R
SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ad Existing Wall Signs ❑ Demolition 4,Ikepairs.0 Additions ❑ Accessory Building ❑
Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ R g [3 Change of Use ❑ Other ❑
Brief Description Enter a brief description here. Coves In ' 11 C i ..1 " ''' ( 'y/C
Of Proposed Work: A 4,1 rt 0 64' c P s J Jci c e
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1A 1 ❑
A -4 ❑ A -5 ❑ 1B ❑
B Business )4 2A ❑
E Educational ❑ _ 2B 1 ❑
F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B
I S
M Mercantile ❑ 4 ❑
R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑
S Storage ❑ S -1 ,A S -2 ❑ 5B I ❑
-
[
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)
151 151
2nd 2 nd
3 d 3rd
4 th
4
Total Area (sf) Total Proposed New Construction (sf)
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 Outside Flood Zone0 Municipal ❑ On site disposal system El
t
A
Versionl.7 Commerc ; Permit Ma 15, 2000
Department use only
City of Northampton \) , - atu , Permit:
Building Department , ' , Driveway Perm -
JAN 212 Main Street ./ r� epticAvailability
�� R oom 100 ` ` Wate Ava
Northampton, M 1 . /. Two Sets of Structural Plans
� phone - 413 - 587 - 1240 .FeX, - 4. ' . - 5872 Plot/Site Plans
J r Other Specify
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE; C4ANGE 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
1
d . 9 / U, /6,-)i) ` ,31- Map Lot Unit
A v)-N ' ./14:1'1 ,4 Zone Overlay District
_ T Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Ownef of Record:
Lei 1e. ,%I e v l w 'i ( 1 I t'r . 3) Cie 4 S C.it I l i), - I6+-i../1( 479 OJ)
Name (Print) - Curre t Ma iling Address:
` 1r 3) .�yt7 - 5.560
Signature ,9� /.� ` fi / J �eTelephone
2.2 Auth Agent:
Name (Print) - Current Mailing Address:
Signature , •- - Telephon t (i) ( �' 3 1t /'3 ,G) �/ -C�LY7 r
SECTION 3 -'ES7 , ATED CONS TRUQTI0N COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building 4 (a) Building Permit Fee
2. Electrical 4 ) Uo47 c 4 % (b) Estimated Total Cost of
Construction from (6)
3. Plumbing /9 `'`-J Building Permit Fee
4. Mechanical (HVAC) �U G i � '
5. Fire Protection ( P-1/4) ' iL
6. Total = (1 + 2 + 3 + 4 + 5) 7 1 v�cJ rte, ~ ^ Check Number w) U i 0
Building Permit Number
This Se ction For Official Use Only
Date
Issued
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2011 -0621
APPLICANT /CONTACT PERSON SIFCO INC
ADDRESS /PHONE P 0 BOX 787 WINDSOR (860) 688 -3331
PROPERTY LOCATION 24 NORTH KING ST
MAP 18D PARCEL 066 000 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 7 �c �1 L� n
Fee Paid W�
Typeof Construction: CONSTRUCT NEW OFFICES & H/C RESTROOM - ENTERPRISE RENT -A -CAR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 15825
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission _ Permit DPW Storm Water Management
Demolition Delay
2 --/i 0
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
24 NORTH KING ST BP-2011-0621
GIS #: - COMMONWEALTH OF MASSACHUSETTS
18D -066 CITY OF NORTHAMPTON
Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit # BP- 2011 -0621
Project # JS- 2011- 000957
Est. Cost: $35000.00
Fee: $210.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SIFCO INC 15825
Lot Size(sq. ft.): Owner: WICKLES EDWARD J & GENEVIEVE F CIO WICKLES FAMILY TRUST
Zoning: Applicant: SIFCO INC
AT: 24 NORTH KING ST
Applicant Address: Phone: I nsurance:
P 0 BOX 787 (860) 688 -3331 WC
WINDSORCT06095 ISSUED ON:1/13/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT NEW OFFICES & H/C
RESTROOM - ENTERPRISE RENT -A -CAR
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 1/13/2011 0:00:00 $210.00
212 Main Street, Phone (413) 587 - 1240, Fax: (413) 587 - 1272
Louis Hasbrouck — Building Commissioner