18D-060 (7) Top View
K Em 2x4 metal stud wall
with 5/8" drywall
8" block wall (non-
y _ structural fascia)
=Double 2x10 PT header Elevation View(not to scale), Exterior wall is 120'+/- L x 10'+/- H
?� Existing _ Existing = y Existing
rTr Txz� Existing
•.- •' T
extended s zr � r
"'�r'-71iA-..Y. »T�I --•.
7
L L �•J-=�}`Y r u.�T,Z,.y^.1.:rT .,.��.
Z'°, 7_�L
down
w Tr... T�, ,�s��s�,. _.� .�'T'`T•�- ,1'- �_,y,-�—�r� �= "'�-T= T- ''�`z
- T � „� . - fir_ �-�=. t-' x� .��•`-�"Z
T r 1 T4 A
.:.T. _ T ;.�.��;:�. ..,c;-r` LZ7 S. r STT1�. �=xl��+-•i-r" -'I 'S`d
.�=�`. ���� �z�,�����i =�,-�,��'� - ''Trr'T�—�-�*-�ry�_,-�-r`.� C� Z't:*���r���.��°`�z'���_�r �='°� �".L`'-,�'•� �'�,°-,_�r='�: �".�
i Existing window, 48"
x 30".
�f.
Existing steel purlins on steel piers
Opening increased to - --- Existing 2x4 insulated
64" down from top ; metal stud wall;
(32"+ inside sill). Metal Structure __-Butler building. Within metal butler
building
Windows are YKK Metal .
store front frames with"to 8" block wall (non- ------ Pioneer Valley Books
code" lowE glass. structural fascia) 155A Industrial Drive
Northampton, MA
For Excel Builders
_S
Scope of project is to increase the window size of three existing openings from 48W x 30"D to 64"D, using existing upper openings; and add
a fourth opening 48" x 64". Header to be installed is a double 2"x10" PT spanning opening and attaching to existing 30" H 2x4 partition wall
over block. These are to match existing 64" windows located on the same exterior wall. Interior sill height at 32"+; exterior at 42" or higher.
Cutting ofexterior block fascia wall and interior stud wall, header new opening, install frames and glass. Finish interior openings with 5/8"
firecode drywall, exterior: fill any block cavities with 5000psi cement, grind finish; caulk frame/wall seams.
11/05/2014 WED 10:45 FAX Q001/001
11/5/200�1--4----6:23:05 AM PST (GMT-8) YHOM: 100005-'IV: 14135849322 Page: 2 of 2
C4J2 CERTIFICATE OF LIABILITY INSURANCE D`IE;/1N2
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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
the temps 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 endors s.
PRODS KING AND CUSHMAN INC E
176 KING ST PNONE FAX
BA
PO BOX 447 R ftfi,
NORTHAMPTON,MA 01060 s:
a19UR S AFFORDItROCOVERAGE TlkiCif
INSURERA: Liberly Mutual Fim insurance 23035
INSURED EXCEL BUILDERS CO LLC RRER e
60 CHMURA ROAD NsuR�RC`
HADLEY MA 01035 N&URERD:
"SURER E:
rrs F:
COVERAGES CERTIFICATE NUMBER: 22226793 REVISION NUMBER:
THIS iS TO CERTIFY THAT THE PCLICIES 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 DESCREED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
e�R TYPE OF INSURANCE INSD PORJCY NUMBER (M�EFF UFAMO YYYY
LT1t
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLArASMADE "OCCUR anobi
MED EXP jAny we person) i
PERSONAL&ADV INJURY S
GEN'L AGGREGATE UN11T APPLIES PER; GENERALAGGREGATE $
POLICY❑,RO- F LOC PRODUCTS-COMPfOPAGO S
OTHER s
AUTOa1oaLE LIABLrfY f
ANY AUTO BODILY INJURY(Par parson) is
ALL OWNED SCHEDULED BODILY INJURY(Per ecddenq $
AUTOS NNOO"WNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS
i
LNBIRELLA LIAR OCCUR EACH OCCURRENCE S
ExcessLWB CLAUS-MADE AGGREGATE $
DED I I RETENTION s $
A wORKE"cONPENSATmN WC2-31S-60 066-013 11/21/2013 11!2112014 PRE S n
AND EMPLOYERS'LLABRAY
ANY PROTORMARTNEMID(ECUTIYE YIN El.EACH ACCIDENT $ 100000
OFFICEPMEMSM EXCLUOM? ®N/A
(Mende"in NR) EL.DISEASE-EA EMPLOYEE S � 100000
WN6serDeunder
PTION OF OPERATIONS hebw E.L.DISEASE-POLICY OMIT $ 500000
DESCRvnw OF OPERATIONS!LOCAMONS f VEN;ti(ACORD 101,AddMonal Re anrks Schedule,nay be aRached if more upaceis required)
Workers Compensation insurance coverage applies only to the workers Compensation laws of the state of MA.
This Certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage.
CERTIFICATE BOLDER CANCELLATION
CITY OF NORTHAMPTON SHOULD C ANY OF THE ABOVE DES MDED POLICIES BE CANCELLED BEFORE
212 MAIN STREET AACCCOROAt�ENTHDTHEPOLILICYY�vISI�ONSS. WILL BE oELiv6itED IN
NORTHAMPTON MA 01060
AUTNORIZED REPRESENTATIVE AA-�
Libedy Mutual Fire insurance
®1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
CERT NO.: 22226793 CLEE4T CODE: 1726091 Anne Chandler 1113/201.4 9:20:09 An (ESTJ Page 1 of 1
< The Commonwealth ofMassachitsetts
x -- Department of Industrial Accidents
r,�s�, -
Office of Investigations
r r 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: Phone#:
F Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4- ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7: ❑Remodeling
ship and have no employees These sub-contractors have g- ❑Demolition
working for me in any capacity. employees and have workers'
9. EJ Building addition
[No workers' comp.insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
1❑ 1 am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs
,1521(4),
insurance required.] t c. § and we have no li.❑ Other
employees. [No workers'
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 isproviding workers'compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic. #: Expiration Date:
Job Site Address: City/State/Zip:
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-
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Sienature: Date:
Phone#:
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
L Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector
6. Other
Contact Person: Phone#:
• Versionl.7 Commercial Building Permit May 15,2000
.8
f
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 1110.11)
Independent Structural Engineering Structural Peer Review Required Yes No 0
SECTION 11 OWNER AUTHORIZATION-TQZE COMPLETED:WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
l _ ,........_ as Owner of the subject property
hereby authorize:... _ ..._. . .
act on my behalf, in all matters relative to work authorized by this building permit
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 tha.._p ins ,. �_.. ... .._ . .
Av a k[
_....Print Name _..__.... ..._,..- _...
Signature of Owner/Arent Date
SECTION 12-CONSTRUCTION.SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
k4 5 / 3
Name of License Holder
IPA _.w .. .,,..,__......_ .. �.+/..... _.
License N tuber
Cow, -
Address 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
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:
r_,.. ._... .,.._..._ _.._ ..__._r,. .._w_._. _..._. ___..___.___... .__..__............._. Not Applicable ❑
Name(Registrant) _._._ _..
_,...__., .. ....�._.,_ .__.m,, ,_. .__,W.�.. _ .. ._ . ..._.._..
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 w Registration Number
...._..
I
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
_...... .. ...,.........._._.._...... _ ._.._.._._. . ......
. . . ..
Name Area of Responsibility
Address Registration Number
Signature Telephone I Expiration Date
9.3 General Contractor
Not Applicable ❑
Company Name:
Responsible In Charge of Construction
Address_
Signature Telephone
Version 1.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to
filled in by
Building Department
LotSize _ __.. __._.,........ ,.._."_. i ,...__,.. _..
Frontage
Setbacks Front ,._
R Side L _.,. ._.t R:� ......
Rear
Building Height _,.
Bldg. Square Footage % _..._.._.
Open Space Footage °
-- - (Lot area minus bldg&paved t
parking)
#of Parking Spaces
Fill:
(volume&Location) _•....._..., _. ., .._r._,_. .._.._. _.. _._. ... _.. _ ._,.."
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 0,... YES 0......._
IF YES: enter Book " Page and/or Document#,
B. Does the site contain a brook, body of water or wetlands? NO �A) DONT KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:_....
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, cavation, 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.
Version 1.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 I x,14
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing.Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑
Brief Description ;Enter a brief description here. Reelace 3 wIN06LJS w�+ 7444C-A- tX.7"4Ar1D zNb
Of Proposed Work: rJr)yuN1UA-2D '
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 El A-5 ❑ 1 g El Business 2A ❑
E Educational ❑ 28 Ifi, ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 36 ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 513 ❑
U Utility ❑ Specify:
w _ _ _. _..w... - ._.._A..........._ .
M Mixed Use ❑ Specify i
S Special Use E-1 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)
4
St
,..._..._ ...,,,.., .._. ..�-. _.,___,w_ _.,, 2nd
2nd
3rd .
4m
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 Zone❑ Municipal ❑ On site disposal system❑
Versionl.7 Commercial Building_Permit May 15,2000
! Departme t use,only
r ` `City of Northampton status of Permit
JAN 14 2015 'Building Department curb cut/Driveway Perrn[t" "
t
212 Main Street Sewer/SepttcAvaclabiGty
Room 100 Water/Wrell Availability
r)flE�
D Northampton, MA 01060 Two Sets of>Structural Rlans -
phone 413-587-1240 Fax 413-587-1272 Plot/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
This section to be completed by office
1.1 Property Address:
-... _..............
...,. _
�55A- 2'NVV6ftf14q-L Z>Rt t�!°_ Map Lot Unit
Zone Overlay District
-- — Elm St:District CB District`
SECTION 2-:PROPERTY OWNERS HIP/AUTH'ORIZE.D AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address
1
Signature Telephone
2 2 Authorized Agent
L
01035
Name(Print) Current Mailing Address
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be _. Official Use Only
completed by ermit applicant
1. Building OO 0 (a)Building Permit Fee
2. Electrical C l (b)Estimated Total Cost of
SO l Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) _ _._
5. Fire Protection
6. Total=(1 +2+3+4+5) a- .Check Number
This Section For.Official Use Only
Building Permit Number Date
Issued
Signature:.
Building Commissioner/Inspector of Buildings Date
File#BP-2015-0728
APPLICANT/CONTACT PERSON ANDREW KLEPACKI
ADDRESSIPHONE P O BOX 604 HADLEY (413)214-2338
PROPERTY LOCATION 155A INDUSTRIAL DR
MAP I 8 PARCEL 060 001 ZONE GI(100V
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out Jal t? 4dwy
Fee Paid
Typeof Construction: INSTALL 3 REPLACEMENT WINDOWS W/LARGER&ADD 4TH IN EXISTING
BLOCK FASCIA
New Construction
Non Structural interior renovations
Addition to Existin
Accessory Structure
Building Plans Included:
Owner/Statement or License 091132
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOY,MATION 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
De fi ' ay
/—/�/—/S
Si e Building ffic' 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.
155A INDUSTRIAL DR BP-2015-0728
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map-.Block: 18D-060 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-2015-0728
Project# JS-2015-000998
Est.Cost: $12350.00
Fee: $73.00 PERMISSION IS HEREBY GRANTED TO
Const. Class: Contractor: License:
Use Groin ANDREW KLEPACKI 091132
Lot Size(sq. ft.): 104108.40 Owner: SHAFII REAL ESTATE LLC C/O HAVOC LLC
Zoning: GI(100)/ Applicant: ANDREW KLEPACKI
AT. 155A INDUSTRIAL DR
Applicant Address: Phone: Insurance:
P O BOX 604 (413) 214-2338
HADLEYMA01035 ISSUED ON.1/1 512 015 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 3 REPLACEMENT WINDOWS
W/LARGER &ADD 4TH IN EXISTING BLOCK FASCIA
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 siinature:
FeeType: Date Paid: Amount:
Building 1/15/2015 0:00:00 $73.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
now