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31B-310 (11)
71 STATE ST BP-2019-0096 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:31 B-310 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2019-0096 Proiect# JS-2019-000155 Est. Cost: $269000.00 Fee: $1883.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Group: J D RIVET & CO INC 050230 Lot Siae(sp.H.): 90735.48 Owner: MICHAEL'S HOUSE LLC Zoning: URC(100)/ Applicant: J D RIVET & CO INC AT: 71 STATE ST ApplicantAddress: Phone: Insurance: PO BOX 51068 (413) 543-5660 Workers Compensation INDIAN ORCHARDMA01151 ISSUED ON:712512018 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE ROOF SYSTEM AND REPLACE WITH NEW ASPHALT SHINGLES, SELF ADHERED MEMBRANE AND PAVER WALKWAY PADS 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 7/25/20180:00:00 $1883.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner 6ho,e Versionl.7 Commercial Buildin Permit Ma 15,2000 ntuseonlyCity of Northampton rinke�rBuilding Department Cwb212 Main Street ".' �Sep6cA„ ce 'tRoom 100 A�orthampton, MA 01060 3-587-1240 Fax 413-587-1272T, REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 6,o— 1.1 Property Address: This section to be completed by office 71 State Streetp Lot 3l() Unit Northampton MA 01060 Zone Overlay District Elm SL District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Michaels House/Appleton Corp [[[ 800 Kelly Way Holyoke MA Name(Print) JCO-A. Cuoent Mating Atltlress ,. Tr{G.S ur L/' 4135401454 Signature IJnA4� Telephone .. 2.2 Authorized Anent: JD Rivet Roofing 1635 Page Blvd Springfield MA 01151 Name(Print) Current Mailing Address: __ . . 4135435660 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed bpermit applicant 1. Building —-- -- $269,000 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) 6 .Z 1i 9004 Check Number 3 This Section For Official Use Only Building Permit Number Date Issued Signal Fu—ii-d m2 caVnr.—.ion.nins ectorof i6s Date Einar/ s�ouvin@ riv27`roa 'n�. corn Version 1.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be fillotin by Building Deparment Lot Size Frontage Setbacks From Side L R:-- L: R __ ... Rear _ Building Height Bldg.Square Footage __ Open Space Footage (bot area mums bldg&paved --- arkiv of Puking Spaces Fill: vomme&t.acatmn A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW Q _YES O IF YES: enter Book Page: and/or Document#� B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O 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 vdll disturb over 1 acre? YES O NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Vemionl.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) Registatlon Number Address Eoatipn Data Signature Telephone 9.2 Registered Professional Engineer(s): Name^ Area of Responsibility Atlress Registration Number g ure Telephone E)qiimfion Date Name Area of Responsibility Registration Number Md... Reg'_ Signature Telephone Expiation 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 D Rivet Roofin_g Not Applicable❑ Company Name: Jan Dreyer Responsible In Charge of ConsWction 1635 Page Blvd Springfield MA 01151 Address f j3yz>rrim i Signatur Telephone V ersionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes © No O SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Steve Fisk as Owner of the subject property hereby authorize Jan Dreyer to act on my beha0, in all matters elative to work authorized by this building permit application _. ZV � � � Signature of Omer ( r Date .Sean Gouvin _... ,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. Sean Gouvin /l -7. /�.�� July 18, 2018 SigS�re of OxnerlAgent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Jan Dreyer CS-050230 License Number 44 Lakeside Drive Monson MA ',7/21/2020 Address Expiration Date 4134278060-......._....... Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.162,§26C(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 Q No 0 City of Northampton 212 Main Street,Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: 7/ Sl; The debris will be transported by: OSA The debris will be received by: Building permit number: Name of Permit Applicant Date Signature of Permit Applicant Tlu CommanwedOn oJMassaehasetts ' DsportYnentoJlnduradalAccfdenzs Offk- 600 Washington Shed Basion,MA 02111 WMVAmsy gmvdta Workers'Compensation lummnce Alstlavlt:BnBdera/Cont ador&MectriduaMl=ben Aunlicantlaformation Pltase]Mntl.eelbh Name0�^mpF J.D.Fivet & Co . , Inc. Address; 1635 Page Blvd. Springfield, MA 01104 phi 413-543-5660 Anyoa to employsrt Chmktheappmprhua boa a): Type ofpnjedVegoka 1.0 Im&employcwhh50 4. ❑Imagwmalombadorandl 6. ❑Newooagargeo employeee(W edlorpottbW hawhudthewbemmuomsa 2.0 find eudmaWehedsheet 7. Rommodeft ddpaodbavemmpkyees 'IDme wbwnildora hav& L [I Demolition vodit forme Is.socapuft employemmdhmwodcm' 9 ❑BuOdmgddiim D4oworkm'c®p.ioanance comp.faemmcot MWINK5.❑Wemeampmetlmand its 10.❑BkNidmpdmwaddl6om 3.0 I homsowomdoioga0wmk offeoemhamom I rd thak ' 11.❑PlwoMog mpdmorsddltions •myrli(Nowodmla'comp. rlgkoYmnwptionpmMOL htmravicerequhed,)t c 157,§1(4),adwe have oo mm Roar em*yea.Din wodcem' 110 Immence AgemawtaaA boss ern We 9a mo aa,rriecb,bm wdmalseehvadrt prmY b sallgykek . iHosmemnhe mednhbeaHwk4emegroywmbauwo3edmmhlsaeefasremommvtrEmdtamwamAeandkWigamL tCemrenematwathkarreteme8,dreamerldeaMbobmma[aemb�eNa®balYrrmetawaatlr Wn eeepbyesa nlb m6retmm,wYrampbyegawampsrlidefr vedmw'erpyolkr oeml¢ Imo mseagdryerdd4proafag markws'ce>epesmHOn6mrmrsfortoy eaplryeas 8efowtrAepo0q aedJobatre injaremdoa. Inst¢mco Coo>QeryNmos American Casualty of Reading PA p.ft#n,Selfaayw0. 5092136486 BWkatimDVIC 5/1/19 yob Sift Mdteer 7f5 fa,� .Sf Attack a rapyof the wodmn'compensation palsy drhoaeom pags(shewingthe poBaynmaberaodesplradondatc). PaBmetoaeemecovmageartegandmdws ,25A9fUMa152mnlediodmhttpodamoratmlealpualtimofa BaetW to S1,5a0A0 wdlorons yartmpd>mmtat,rwe0 m aivdpmagim b,Ihefooa o(a bTOP WORI:ORDBR aadafim ofnp to SM.00&dry asking the vkbtw.BedvLdthmacopy of9us stemmmamry bola wmddto do Ofam of 7avestiadkm of the DYA ftr hmuavco massage ved5rdoo. ydobmaby ra/dfy mdorbe mdpemWe ofperJmyllmthelgfmmatlenpoWdadabow8 mWoonect S. 6�..r1+-/Y�J+t Ome 7/2 ph•-w• N/3 /z 2 0��0 OJpddme poly. De nonm,ieeht Wtr wrgbbeeomptadbydpr erroxa ofJldot Ciyoriowm PortoWLletme0 Itsmes Authority(drde ons): L Beard ofHealth L BoDdingDepniment 3,Ckylrown Clerk 4.PJeetdeallnspector 5.PI®bleghupedor C Other cmueaperson: Phone M. Client#:39066 JDRIV ACORD. CERTIFICATE OF LIABILITY INSURANCE °413 012 01 8 "1 4/3012018 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 ma certiilcate hostler Is an AOpITIONAt,INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED,subjeot to the terms ami corWBions of the policy,certain poUdes may requim an endorsement A statement on this Certificate does not confer any rights to the certificate hostler In lieu of such endorsement(s). PRODUCER N ME Denise Kelley People's United Ins.Agency MA M E eni a Kelle64 —FFA�yv One Monarch Place,10th Floor uu° E.1- �yluc x°: PO Box 4950 A> Ras Denis e.Kelley@peoples.com Springfield,MA 01144 _..._ ....INUM.FFORKHROCOVERAIR NNI _ INauRRaA.R 20893 20443 PO Box 510068 J.D.Rivet Company, Inc. INSURER a:A.-,L.1 aa.. Fr—Ry & .. 20427 1635 Page Blvd. INauRSR o Indian Orchard,MA 01151 m32PER E� IxsuRERF COVERAGES CERTIFICATE NUMBER: 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 CONDIT ION OF MY CONTRACTOR 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 SUCHPOLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. lTA 11toFINWRANCENW I IDL 4 POLICYMYMB_ER P COYME,FYY POB pMny A % COWLERCIAL L..FRAL U-114. 5092136472 51011201805101/201 EROM, AApDP�O,[CCU_RRENCE _$1000000 PREM CWM9.MPDE OX OCCUR ISE ENTEb $SOO ggO Bikt Addti insured sgDEv tAnm.Fa,o„I $15000 WlWfltten C.nI X X PERSONAL n ADV INJURY s1000pDO GE«1 pGGREGArEL10.1rz MPL1ES PER. GENERA-AGGREGAi£ $2_000000 71 PRO PolicyX $ECT ELOc PRODUCTS.COMwoa AGO s2,000000 OTHER: A AUTOMOBILE LKi X X 5092136469 5(B1t201805/B1t20t `a 'Leer 1,000004 X ANY AUTO 9ODILVII(Per"mo, $ 9WNE0 SCHEWLED AUTO9ONlY ALPOS BOCLLY WXIRT{Pn 1,WOs61 $ ^IgEO HONd2 NED X UfOa ONLY X ALTOS ONLY r a'"�OF i X ma Ota CA, $ B XIMIRCULA UAB % OCCUR X X 6012109801 - 510172018051011201 EACH OCCUARENCe 110000000 —..�..._ EXCESS LIAR C, s. AGGREGATE $10._ ,0,000_, 00 �XDEMPLOYERSEENSATO N5I000O i $ DEO - X RETEIJTI C " X 5092136486 5/01/2018 05/01/201 % PER OT"' INTFF O`F.avAEMRCR EXRC WeOI ECurIVEO Y1Ai ex.EACH ACc Nr 51900000 IM•"y1"I.`ax E L.DISEEASE.FA EMPLOYE' $1.000,000 n MrorM°.a. Et. -POucv uwT 11,000,000 osgYPnoN aF,oPERAno«s allo,., as'asE DESCRIPTION OF OPERATION'I LOCATIONS I VEHICLES(ACORD 101,PATI MR.mwrt*9°MEW WIN,M RN4M°X Mmu I k n°Wntll Proof of Insurance CERTIFICATE HOLDER CANCELLATION Proof of Insurance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. A��/�Uyyf,,H��OR��DI�D REPRESEMATIVE l' flGlOhdAtt 01988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2816103) 1 oil The ACORD name and logo are registered marks of ACORD #S946517/M945390 DMK V ersionl.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Attentions ❑ Existing Wall Signs ❑ Demolition❑ Repairs El Additions ❑ Accessory Building❑ Exterior Attention ❑ Existing Ground Sign❑ New Signs❑ Roofing +❑ Change of Use❑ Other❑ _..__ Brief Description Enter a brief descnptiodhere. The Existing Roof System will be removed and replaced with new asphalt shingles,self adhered membrane,and paver walkway pads. Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A AssemblyElA-1 ElA-2 11 A-3 ❑ 1A A-4 ❑ A-5 ❑ 18 ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 13 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ I 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: _ _..._ ._._.. .. _ _ posed Use Group __._. . . Pro m Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34). i-_ _ SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 2nO__ _.___ _____ 2^e 3b 30 Total Area(sf) Total Proposed New Construction(sg- Total Height(ft) _ Total Height ft 7.Water Supply(M.G.L.c.40,§64) 7.1 Flood Zone Irdormation: 7.3 Sewage Disposal System: Public ❑+ Private ❑ Zone's____ Outside Flood Zone[EZ] Municipal ❑+ On site disposal system❑