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31B-201 BP Phased Demo-Prep AGENCY CUSTOMER ID: 570000036474 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of AGCY NA D aJSt) ED Aon Risk Services Northeast, Inc. ConsigHi Construction Co., Inc. POLICY NUMBER See Certificate Number: 570048604257 CARRI :R Nam coos See Certificate Number: 570048604257 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES Ifs policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. POLICY POLICY INSIt TYPE OF INSURANCE !NNSDR SUER POLICY NUMBER EFFECTIVE EXPIRATION LIMITS DATE DATE IMM/DDIYYYYI (MM1DI3I YYY) EXCESS LIABILITY C 11Y12EXC7698991V 12/30/2012 12/3012013 Aggregate SS,000,000 Each S5,000,000 occurrence ACOR0101 (2008101) 0/2008 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks or ACORO 1 DATENHAIDONYYY) CERTIFICATE OF LIABILITY INSURANCE 12,4262012 THIS CERTIFICATE 15 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 8 certificate holder in lieu of such endorsement(s). c sa PRODUCER CONTACT y8 Aan Risk Services Northeast, Inc. Boston MA Office py0, Ne. imp OM 283 - 7122 ` N (8473 953 -5390 One Federal Street Boston MA 02110 USA A *$ x w5URER(S) AFFORDING COVERAGE NAIC 2 INSURED INSURER k. Old Republic General Ins Corp 24139 Consigli Construction co. , Inc. R,EINRIERB; Starr indemnity 8. Liability Company 38318 72 Sumner street Milford MA 01757 USA INSURER*: Navigators insurance Co 42307 INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570048604257 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUC)ES 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 W)TH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Unite shown are As requested R TYP$ OF eNSVRAlICE " AODL SUER R POUCT tot 1� a LTR A aENERAtLwamm A2DG96831 NUMBER /1 203 012 12,/3012013 EW.MOCCURRENCE $1.000,000 Q COMMERCIAL GENERAL Lamm. DAMAGE E a R 5100,000 ■ ctAims.mAne 0 occuR MEO ExP (Any one perms) 510,000 III PERSONAL it ADV INJURY 51.000,000 p ■ GENERAL AGGREGATE 52,000,000 GENt AGGREGATE LmdiTAPPLIES PER PRODUCTS COMPIOP AGO 52,000,000 POLICY n I LOC " A AUTOMOBI.EUML1tY A2CA96841203 12/30 /201212/30/2013 COMMNEDERNGLELRMHT 61,000,000 A05 IES ecd0eM1 A © A N Y A U T O A2CA96831203 12/30/2012 12/30/2013 BOO2.Y INJURY ( PIN Palm* q . ALL OVNNED SCHEDULED MA BODILY INJURY (Per eeddent) z AUTOS AUTOS ■ $)RED AUTOS A NON O A S WI D DAMAGE B © UMBRELLA LIpp x ' OCCUR SISCCCL01697212 12/30/2012 12/30/2013 EACHOCCURRENCE 55,000,000 (7 ExCESSLAS CLAIMS.NADE AGGREGATE 55.000,000 DED [ lRETENnON A WORKERS COMPENSATION AND A21746831203 12/30/2012 12/30/2013 X I go LI r 8gT� A I f oR EMPLOYERS' LIABILITY ANY PROPRIETOR! PARTNERRI ExECUnVE Y E.L. EACH ACCIDENT S1,000,000 OFFICER/MEMBER EXCLUDED? N 1 A iiflMyyesenmd wry in ME E.L. 0(SEASE'EA EMPLOYEE 51, 000,000 PESCRIP IO O OPERATIONS Oeaw E.L. OLSEASE.POLICY UNIT 51, 000, 000 Ili DESCRIPTION Of OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Addimonal Remarks Schedule, 2 more space Is renvind) fiM, For Evidence of Insurance M CERTIFICATE HOLDER CANCELLATION SHOULD ANY Of THE ABOVE DESCRWED POUCES BE CANCELLED BEFORE THE EXPIRATIOROVISIONSN DATE THEREOF. NOTICE NN.(. BE OELNERED IN ACCORDANCE WITH TIM MOUCY P. Consigli Construction Co., Inc. AUTHORIZED REPRESENTATIVE 72 Sumner Street Milford MA 01757 USA a C�tJ 4 tifo -s'l ,, 01988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD €t R ;S A l i3 't , �: T ON • o:` �itits ti* (a ` fi>iitet O tt ai t1iii 's gMtory sf.t e .. .hc P# i i .: otttra tot' . • 8 it of a prtisli ctt -'iii ttic'ili ` itit fl ry � • • : 3r •a orl st atoiy of : . ' :: : rN t}ie;Siib ti r tor. 'at . e40.. Ctc : '.. • i t iit rota ry e : 1, a °ir� . f j :- : ' l - ,Y ..}'... ^1 . T /' " o.y .. t+` „ - prime= or sub �•µ ' r 'c4 . � : ' fr � rt' .-.: ; j.r : any ;; .. :OId Repubi e . ry y� : . • ;!:-.-:::::f . '.�[a ? A . te r'• '•' = i; �iti[+ t tt#�<t�s1it1'; Ga t � ' j�at e ; of. 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' . < •ai:' . { h Xf 1s',or' Sub -Cot rf iil i ottypluntary inssu rat„: mark A ,• sox as t} a W' i - &•, 3 ` tr�fpit rough_. d,,; . : isoo. > t . s'r ( r,'. ✓ s A� i c, r ;.rn.ov,vs -• F.•. C ka ii iiita rl-4 i1' qr scjf et d thcy :iii iy:p C t i fi c at c : it u cd a dddi i 0. itlt+ity t c t- g eRty srtiicithoriitsi'' loin ea of c Pri . , or' he 'seib»Gori .. :: . • • • Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub- contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self - insured companies should enter their self - insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit /license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in _(city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114 -2017 Tel. # 617- 727 -4900 ext 406 or 1- 877 - MASSAFE Fax # 617- 727 -7749 Revised 7 - 2010 www.mass.gov /dia The Commonwealth of Massachusetts l Print Form 1 Department of Industrial Accidents ''? �' Office of Investigations ,7 x 1 Congress Street, Suite 100 Boston, MA 02114 -2017 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizati on/Individual): Consigli Construction Co. Inc. Address:72 Sumner Street City /State /Zip:Milford MA 01757 Phone #:508 458 0543 Are you an employer? Check the appropriate box: Type of project (required): 1. 0 I am a employer with 350 4. I am a general contractor and 1 employees (full and/or part-time).* have hired the sub contractors 6. ❑ New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub - contractors have 8. © Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10. al Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.0 Other 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: Old Republic General Policy # or Self -ins. L # :A2DW96831203 Expiration Date: 12/30/2013 Job Site Address: Elm Street City /State /Zip:Northampton, MA 01603 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby c ' ti under he pa' and penalties of perjury that the information provided above is true and correct. Signature:I U Date Phone #: SD 0 f 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 #: Versionl.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (T80 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 Na Q SECTION 11 •OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date , 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. Print Name Signature of Owner/Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name qt License Holder : Michael Caputo ( Z... License Number 72 Sumner Street Milford MA 01757 4 l (o 1 2 o l Address pct sq. Expiration Date (508) 458-3 Signatur 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 0 No Veoion1.7 Commercial BuiNiim Permit May 15, 2000 I SECTION .9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO ! ..f CONSTRUCTION CUNT/ROL FURSUA.NT TO 780 CNIR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 1 Expiration Date l 1 Marl: Wakh-Cooke Mechanical i h.iti me Area of Responsibility 955 Ma.ssachusetts A.).enue. Cambridge NIA 02139 ' 49296 Registration Numbei (617) 864-2987 06/30/2014 - telephone. Expiration Date I AndIc \\oodxanj Fire Protection -------- ------------- --------- ! Name Area of Rsponsb 955 Massachusetts Areouc 47842 _-_______' _ _-_____-___-__ Addfess Registration Number �^ ^r (617) 864-2987 06/30/2014 _-_-__-___-~ _-___--- .-46..._- Signature Telephone Expiration ____� _ Electrical - ------- Area of Responsibility 955 Massachusetts Avenue, Cambridge MA 02139 45455 Address r ' . Registration Number Signatuce / (617) 864-2987 Oh/3U/20l4 \ ::: • Tr�phone �pkaV on Da F )imm)8u Strutcural _--____ __- _.___ __-________-- I\4-me Area of FesponsibiUty q�5&1u Massachusetts [ nh �d �J/�OZ(}9 41770 ssu _ u/ o �c |-----------==-�-�'---`�---==----'----------------------------- � -- ----------' Auoreo -_ Registration Number / 617 864-2987 06/30/20/3 • / Date _ _-_______-_ _ ____- _�_ 9,zson�w,|oon�ammr _-__- _____-___'___-_-__-____.____'-_ _ Not Applicable LJ Company Name: e'sponOmE /nc^a/geurCm,yoct/on ������������`���������� ��� .Auumo5 --__ _ \ | i�y�»� _ --_-_' _____ T��m«»e ___--_ | --___-________''_ Version1.7 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 100650 100650 Frontage 280' +1- 280' +/- Setbacks Front 40 40 Side L: 52 R 96 L 52 R 96 Rear 70 70 Building Height 39.5 39.5 Bldg. Square Footage , - % ( o Open Space Footage (Lot area minus bldg & paved 47.1 44.8 parking) # of Parking Spaces 50 51 Fill: (volume & Location) 0 p 0 A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW Q YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T KNOW Q 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 Q 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 Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q 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 Q NO O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Versionl.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: 1. .115IWK Not Applicable ❑ Name (Registrant): 30578 t� 12. \1 (w',` "t t '�- S n L i W oc TD 1 f A oz ` Registration Number Address `" t 08131/2013 ' *. 617 406 - 3420 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 ry Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Consigli Construction Co. Inc. Not Applicable ❑ Company Name: Michael Caputo Responsible In Charge of Construction 72 Sumner Street Milford MA 01757 Addre 046 �- �%� (508) 458„9'53' Signature Telephone Version1.7 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 0 Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Enter a brief description here. t� • Re s I ' w, R b E(6VAt' R.. Of Proposed Work: ME atloe , 1 S( -CcIRK IC U J 1"1 VAC- G1.`I4�0N3 P r ' 13.A3C1' N'± SECTION 5 - USE GROUP AND CONSTRUCTION TYPE I"EvE' L USE GROUP (Check as applicable) I CONSTRUCTION TYPE A Assembly 0 A -1 El A-2 ❑ A -3 © 1A 1 0 A -4 ❑ A -5 ❑ 1B 0 B Business ❑ 2A ❑ E Educational ❑ 2B 1 IN F Factory ❑ F -1 ❑ F -2 0 2C ❑ H High Hazard ❑ 3A i ❑ 1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B 0 M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage o S -1 ❑ S -2 r4 _ 5B I ❑ U Utility ❑ Specify: L M Mixed Use igi Specify: Non - separated p 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) 1st Vca"IWiI 11,003 1s actl,tek 11,003 2 "d 19,401 2nd 19,939 3` 17,274 3 rd 17,274 4 17,274 4 `h 17,274 Total Area (sf) 64,952 Total Proposed New Construction (sf) 65,490 Total Height (ft) 40 Total Height ft 40 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone information: 7.3 Sewage Disposal System: Public p Private ❑ Zone Outside Flood Zone Municipal p On site disposal system phase IA Versionl.7 Commercial Building Permit May 15, 2000 Department use only City of Northampton Status of Permit Building Department Curb Cut/Driveway Permit - FEB 2 U 2013 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability DEPT. OF BUILDING INSPECTIONS Northampton, MA 01060 Two Sets of Structural Plans NORTHAMPTON, MA: • • '- 587 -1240 Fax 413-587-1272 Piot/Site Plans 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 , 1.1 Property Address: This section to be completed by office 79 Elm Street ' I Map 3 I Lot (Db ) Unit Northampton, MA 01063 Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Smith College 126 West Street Name (Print) Current Mailing Address: (413) 585-2424 Signature Telephone 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 1. Building $1,692,578.00 (a) Building Permit Fee 2. Electrical $1,342,224.00 (b) Eatf Construction stimted To from al Cost (6) o 3. Plumbing $693,800.00 Building Permit Fee a S5 ao 4. Mechanical (HVAC) ' / 0O 3 S 5. Fire Protection $2,233,614.00 //J 6. Total = (1 + 2 + 3 + 4 + 5) $ 5 g t�2,11 kl Check Number c & i'C `? 0 5s7 This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0772 APPLICANT /CONTACT PERSON CONSIGLI CONSTRUCTION CO INC ADDRESS/PHONE 72 SUMMER ST MILFORD (508) 458 -0487 PROPERTY LOCATION 79 ELM ST - ZISKIND /CUTTER MAP 31B PARCEL 201 001 ZONE EU(100)/URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 3 SS Fee Paid Typeof Construction: MECHANICAL,ELECTRICAL,HVAC RENOVATIONS& ELEVATOR PITS BASEMENT LEVEL - New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFI) OMATION PRESENTED: p S p,�OV 61 — / ND 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 (9Z-- ~ 2,z. '3 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. 79 ELM ST - ZISKIND /CUTTER B P- 2013 -0772 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31B - 201 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- 2013 -0772 Project # JS- 2013- 001320 Est. Cost: $5963216.00 Fee: $35557.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CONSIGLI CONSTRUCTION CO INC Lot Size(sq. ft.): Owner: Smith College Zoning: EU(100)/URC(100)/ Applicant: CONSIGLI CONSTRUCTION CO INC AT: 79 ELM ST - ZISKIND /CUTTER Applicant Address: Phone: Insurance: 72 SUMMER ST (508) 458 -0487 WC MILFORDCT01757 ISSUED ON:2/22/2013 0:00:00 TO PERFORM THE FOLLOWING WORK: MECHANICAL,ELECTRICAL,HVAC RENOVATIONS& ELEVATOR PITS BASEMENT LEVEL. Phased approval for demo and prep work 2/22/13 pending plan review 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 2/22/2013 0:00:00 $35557.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner