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31C-046 (8)
General Laws: CHAPTER 112, Section 8 1 R https:Hmalegislature.gov/Laws/GeneralLaws/PartUTitleXVi/ChapterI... to the jurisdiction of the department of public utilities or the department of telecommunications and cable which work and services are performed as part of their employment and for the benefit of such person, firm, or corporation; or (m) the performance of engineering work and services by employees of the Massachusetts Bay Transportation Authority which work and services are performed as part of their employment and for the benefit of the said authority. 3 of 3 6/23/2015 8:51 AM General Laws: CHAPTER 112, Section 81R https://malegislature.gov/Laws/GeneralL.aws/Partf/TitleXWChapterI... under clause (b) or (c) of this section; (e) the practice of officers and employees of the government of the United States while engaged within the commonwealth in the practice of engineering or land surveying for said government; (f) the practice of engineering or land surveying in the commonwealth by a firm, co-partnership, corporation or joint stock association; provided, that the person in charge of such practice by such firm, co-partnership, corporation or joint stock association is a professional engineer or land surveyor, holding a certificate of registration under said sections; (g) the performance of engineering work or services by employees of a corporation engaged in manufacturing, research or development operations, which work or services are performed in connection with the research or development activities of, or the manufacture, sale, installation, maintenance, repair or service of the products of, such corporation, or of its parents, affiliates or subsidiaries; provided, that such research or development activities which are not related to the manufacture, sale, installation, maintenance, repair or service of the products of such corporation, or of its parents, affiliates or subsidiaries, are not primarily in connection with the construction of fixed works which are to be made available for use by the general public; (h) the practice of landscape architects, city planners and regional planners, in so far as their work consists in the consultations and preparation of master plans of parks, land areas, sites, organized groups of buildings or communities, or the preparation of detailed plans and the supervision of planting, grading, paving, and such structural features as fences, steps, walls, minor pools, garden structures and minor utilities normally included as part of their work; (i) sales personnel from recommending applications to specific uses of products for which they act as sales representatives; Q) the performance of engineering work or services by any person employed by an insurance company or by its agents, its affiliates or subsidiaries, or the performance of engineering work or services for insurance inspection and actuarial bureaus, provided such work or services in either case are incidental to the operation of an insurance company; (k) the work of an owner or managing agent of a building or any employee of such owner or agent making alterations or repairs to such building or supervising the same, or of a person engaged by such owner or agent to perform work of any other legally recognized trade exempted under clause (a) of this section; (1) the performance of engineering work and services by a person, firm or corporation subject 2 of 3 6/23/2015 8:51 AM 11 1 General Laws: CHAPTER 112, Section 8 1 R https://malegisIature.gov/Laws/GeneralLaws/PartFTitleXWChapterI... t Print PART I ADMINISTRATION OF THE GOVERNMENT TITLE XVI PUBLIC HEALTH CHAPTER 112 REGISTRATION OF CERTAIN PROFESSIONS AND OCCUPATIONS Section 81R Construction Section 81 R. Nothing in said sections shall be construed to prevent or to affect:— (a) the practice of any other legally recognized profession including the practice of architecture as defined in this chapter and the practice of any trade, including, in connection with the practice of the electrical, plumbing, heating, ventilating, air conditioning, refrigeration and all other trades, the preparation of plans, specifications or shop drawings by any person, firm, partnership, corporation or association practicing any such trade, for work to be installed or being installed by the same person, firm, partnership, corporation or association preparing such plans, specifications or shop drawings; (b) a person not a resident of and having no established place of business in the commonwealth from practicing or offering to practice therein the profession of engineering or land surveying, when such practice does not exceed in the aggregate more than thirty days in any calendar year; provided, such person is legally qualified by registration to practice the said profession in his own state or country in which the requirements and qualifications for obtaining a certificate of registration are not lower than those specified in said sections; (c) a person not a resident of and having no established place of business in the commonwealth or who has recently become a resident thereof, from practicing or offering to practice engineering or land surveying therein for more than thirty days in any calendar year, if he shall have filed with the board an application for a certificate of registration and shall have paid the fee required by said sections; provided, that such person is legally qualified by registration to practice engineering or land surveying in his own state or country in which the requirements and qualifications for obtaining a certificate of registration are not lower than those specified in said sections. Such practice shall continue only for such time as the board requires for the consideration of the application for registration; (d) the work of an employee or a subordinate of a person holding a certificate of registration under said sections, an employee of a person practicing lawfully under clause (b) or (c) of this section, or an employee of a firm, co-partnership, corporation or joint stock association engaging lawfully under clause (f) of this section; provided, such work does not include final designs or decisions and is done under the direct responsibility, checking and supervision of a person holding a certificate of registration under said sections or a person practicing lawfully 1 of 3 6/23/2015 8:51 AM y." V1W�iia{rr d. �._s v WWft.t+J MA 4 r ,r OO,,* l ® DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12/23/2014 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). CONT PRODUCER NAMEACT Renee Skillings THE ROWLEY AGENCY INC. PHONE (603)224-2562 Fax (603)224-8012 139 Loudon Road EMAIIESS:rskillings @rowleyagency.com P.O. BOX 511 INSURERS AFFORDING COVERAGE NAIC# Concord NH 03302-0511 INSURER AAmTrust Intl Underwriters Ltd 0010 INSURED INSURER BAllmerica Financial Benefits 41840 Hampshire Fire Protection, LLC INSURERCA.I.M. Mutual Insurance Co. 507 Southampton Rd. INSURERD:Hanover Insurance Co. 22292 INSURER E:Wesco Insurance Co. Westfield MA 01085 INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 Master 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 NUMBER MM/OCDYlYYYY MM/DD1YYYY LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED 100,000 PREMISES Ea occurrence) $ A =1 CLAIMS-MADE ❑X OCCUR PAL104190802 1/1/2015 1/1/2016 MED EXP(Any one person) $ 51000 X Contractual per CG0001 PERSONAL&ADV INJURY $ 1,000,000 X $2,500 BI/PD Ded - OCC GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 ri POLICY X PRO $ LOC AUTOMOBILE LIABILITY (Ea accideDtSINGLE LIMIT 11000,000 X ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED ILWV 9412142 03 1/1/2015 1/1/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS N 1 $ AUTOS Per accident X UMBRELLA LIAR I X OCCUR EACH OCCURRENCE $ 5,000,000 E EXCESS LIAB CLAIMS-MADE UMB01012015 1/1/2015 1/1/2016 AGGREGATE $ 5,000,000 DED I X I RETENTION 10,00 $ C WORKERS COMPENSATION X WC STATUS OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRI ETOR/PARTNER/EXECUTIVE❑ C01012015 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A 3A: MA/CT 1/1/2015 1/1/2016 E.L.DISEASE-EA EMPLOYE $ 1,000,000 (Mandatory in NH) If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 D LEASED/RENTED EQUIPMENT HV 9412144 03 1/1/2015 1/1/2016 LIMIT 50,000 INSTALLATION FLOATER LIMIT 50,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) 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. For Permit purposes only AUTHORIZED REPRESENTATIVE1 C Holman, CPCU, CIC/H ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 romnn,�m Tho AR(1Rr1 name and Innn aro ronictoraH marirc of arr)p 1 i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �'' Please Print Lesibly Name (Business/Organization/Individual): H A yU1 a5(-�►A6 F t m C& i 101J L L Address: �✓0'T So-vTI-1►°rVv�t�TaJ �fl City/State/Zip: 6- T FICA2tQ Phone #: (3 (QC/2 • 32-8"7 Are you an employer?Check the appropriate box: Type of project(required): 1.[ I am a employer with_ JU _ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I 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. ❑Building addition [No workers'comp. insurance comp. insurance.# required.] 5. ❑ We are a corporation and its 10.E)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.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 1311 Other comp. insurance required.] *Any applicant that checks box#I 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: A h4ur u A L. S Policy#or Self-ins.Lic.#: 666- A`t KcM E )C.�•Z Expiration Date: Job Site Address: = d City/State/Zip: A_) 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 tdy a pains and en ies of er7 ry that the information provided above is true a d correct. Sian ature: Date: P > Phone#• � -3 - l�q 2 • 32-tQ� Official use only. Do not write in this area,to be completed by city or town official City or Town: PITTSFIELD Permit/License# Issuing Authority: Building Department Contact Person: Phone#: (413)499-9440 Version 1.7 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 0 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 William J. Rhodes 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 belie)de Signed and penal f erlu Print N 1,Jwk Signat of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number 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 0 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: Kuhn Riddle Not Applicable ❑ Name(Registrant): Kuhn Riddle Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Hampshire Fire Protection LLC Name Area of Responsibility William J Rhodes Address Registration Number (413) 642-3287 Signat 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 Wright Builders Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone Versionl.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 Frontage Setbacks Front Side L: R L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ® DON'T KNOW YES C) IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO C) DON'T 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 0 DON'T KNOW (�) YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 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 0 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 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.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 ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other ❑ Brief Description Installation of an NFPA 13R fire sprinkler system as per HFP drawing FP 1, dated 6/11/15 Of Proposed Work: 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 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H Hi h Hazard ❑ 3A ❑ Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ✓❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B 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) 15t 1 St 2nd 2nd 3 rd 3rd 4th 4th 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 Department use only Citw of Northampton Status of Permit: I! Building Department Curb Cut/Driveway Permit - L f JUN 23 201 12 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Etectnc F u ,,k; ampton, MA 01060 Two Sets of Structural Plans I- � ✓.-, ,100 p 7-1240 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: I- 4EII Unit ap Lot Village Hill M �7 '1�`� Building B Zone Overlay District GC -- IsJt��� v,lders. Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: unknown Name(Print) Current Mailing Address: Signature Te_gphone 2.2 Authorized Agent: � William J. odes p 507 Southampton Rd Westfield, MAO 1085 Name(Print) Current Mailing Address: (413) 642-3287 Signature Telephone F L/ 3� SECTION 3'-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) $22,500.00 5. Fire Protection 6. Total =0 +2+3+4+ 5) Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2015-1349 APPLICANT/CONTACT PERSON HAMPSHIRE FIRE PROTECTION LLC ADDRESS/PHONE 507 SOUTHAMPTON RD WESTFIELD01085 (413)642-3287 PROPERTY LOCATION LLAGE HILLPPER RIDGE,VILLAGE HILL PHASE III/ MAP 31 C PARCEL 046 001 ZONE PV / ��� THIS SECTION FOR OFFICIAL USE ONLY: /e/ / PERMIT APPLICATION CHECKLIST !Q'� 11�� ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: INSTALL NFPA 13R FIRE SPRINKLER SYS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan 4 4! 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 D oliti n D y Z_00�7L� Si o uiIding O f fi gal 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. 29 MOSER ST BP-2015-1349 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 3 1 C-046 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:New townhouses BUILDING PERMIT Permit# BP-2015-1349 Project# JS-2015-002087 Est. Cost: $22500.00 Fee: $135.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: WRIGHT BUILDERS Lot Size(sq ft.): Owner: WRIGHT BUILDERS Zoning: PV Applicant: HAMPSHIRE FIRE PROTECTION LLC AT. 29 MOSER ST Applicant Address: Phone: Insurance: 507 SOUTHAMPTON RD (413) 642-3287 WESTFIELDMA01085 ISSUED ON.612912015 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL NFPA 13R FIRE SPRINKLER SYS 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 6/29/2015 0:00:00 $135.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner