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38B-006 (83)
• t BP-2006-1258 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category BUILDING PERMIT Permit# BP-2006-1258 Project# JS-2006-1864 Est. Cost: $30000.00 Fee: $150.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: M J MORAN INC 087728 Lot Size(sq. ft.): 9365.40 Owner: Smith College Zoning: SI Applicant: M J MORAN INC AT: 126 WEST ST Applicant Address: Phone: Insurance: 4 SOUTH MAIN ST (413) 268-7251 Workers Compensation HAYDENVILLEMA01039 ISSUED ON.512512006 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 8 X 20 STEEL DROP BOX - TEMP BOILER FOR SUMMER USE 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 5/25/2006 0:00:00 $150.0090689 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2006-1258 APPLICANT/CONTACT PERSON M J MORAN INC ADDRESS/PHONE 4 SOUTH MAIN ST HAYDENVILLE (413)268-7251 PROPERTY LOCATION 126 WEST ST MAP 38B PARCEL 006 001 ZONE SI THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building,Permit Filled out Fee Paid Typeof Construction: CONSTRUCT 8 X 20 STEEL DROP BOX-TEMP BOILER FOR SUMMER USE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 087728 3 sets of Plans/Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO,YNATION 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 Co ion 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. Versionl.7 Commercial Buildin Permit May 15,2000 1360 rtment use only City of Northampton status of Permit Building Department Curb Cut/Drivig"y Permit _ 212 Main Street Sewer/Septic Availability. Room 100 Water/Well Availability Northampton, MA 01060 To bets of structural Plans , phone 413-58�-1240 Fax 413-587-1272 F tfltt Ply � C3ther�PE�� 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 1.1 Property Address: This section to be completed by office 5m"k" C'>Ike -"130,ler pIA-n-t Map Lot Unit 5trttt �oC-k�ntm�r�1 MPS V 1 ub O Zone Overlay District Elm St.District CB District SECTION 2.PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: b .. Srr'�tln Colle la4 S�t.rLt<-t, Name(Print) Current Mailing Address: tlar*nzr•pr1a-M, ,� _ o talo o Signature Telephone S — p O 2.2 Authorized Aaent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com leted by permit applicant 1. Building $ a`o� 00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of 11 4 p0. O t7 Construction from 6 3. Plumbing ' Soo I o� Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 21 to 0 V 6. Total=(1 +2+3+4+5) 430, 000 . 00 Check NumberAP � This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/inspector of Buildings Date 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 Fotf slb!C4f def tdsjgyp0li f I/! OLMSt o G Of Proposed Work: S' X IV Sittl 1J9up rooyc — ?tIke 4-S Sum"w, USG. 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 ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional 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: b� TCmp�� S,�w,rrre.� bo�Icr 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) 1 sc 1 Sc 2nd 2nd 3`d 3`d 4t' 4"! Total Area(sf) Total Proposed New Construction(sf) Total Height(ft) Total Height It 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Q5 Private ❑ Zone Outside Flood Zone[] Municipal On site disposal system[-]— _ Version L7 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 0 DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document# PTX B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained C , 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, 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. Version 1.7 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: 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 h Signature Tele _ g pone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor ,5....tmaiw...__ Y\.C_ _. Not Applicable ❑ Company Name: Responsible In Charge of Construction Addr s ` l Signature Telephone 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 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property hereby authorize (1R-S.. moo-An to act on my behalf, in all matters relative to work authorized by this building permit application. 51aa1 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 _5Jaalo Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: C f\ac) f MOO-U✓yl\ 5 d & a License Number Li Mai rn S+ py 3 S to- a o-O4 Address J 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 lU•JV iInI LLf L✓JYJO 1L• DVI\nWJr\1 111ZD Kr1IYI.L ILL I7V• JUO-(Z'(,� 7fJJUVi I nVL LTJ ACORDM CERTIFICATE OF LIABILITY INSURANCE D0ATE(NIMIDWYM 5/22/2 6' PRODUCER (413)586-5011 FAX (413)586-7973 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Alexander W. Borawski, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 88 King Street, Suite B HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Northampton, MA 01060-3257 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED MJ Moran Inc INSURER A: Hanover Insurance Companies Z2292 Orchard Valley Technology Inc INSURERB: Mass Bay Ins Co. 2306 4 S. Main St. INSURERc: AIM Mutual Haydenville, MA 01039 INSURER D: NSURER E: EA COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITH ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY ZHN6671222 10/31/2005 10/31/2006 EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300 00 CLAIMSMADE �OCCUR MEDEXPfAnyoneperson) $ rJ 0 A PERSONAL&ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,00( POLICY JEECT X LOC AUTOMOBILE LIABILITY ADN7904817 10/31/2005 10/31/2006 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1000000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per parson) B X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY UHN7917539 10/31/2005 10/31/2006 EACH OCCURRENCE $ 4,000,000 X OCCUR ❑CLAIMS MADE AGGREGATE $ 4,000,000 A $ HDEDUCTIBLE $ X RETENTION $ 10100 $ WORKERS COMPENSATION AND WMZ8002632012005 10/31/2005 10/31/2006 X WCSTATUcOTH- EMPLOYERS'LIABILITY I ER C ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,00( OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,00( If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,00 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS job: Smith College, Boiler Plant. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL --10--DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, The Pike Company, Inc BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY One Circle Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Rochester, NY 14607 AUTHORMED REPRESENTATIVE Robert Borawski/BORIBI ACORD 25(2001!08) FAX: (212)292-5013 ©ACORD CORPORATION 1988