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38B-081 QUOTE Toshi Kashima 15 Union Street Greenfield MA 01301 Phone & Fax 413-774-5402 Cell 413-522-1713 3/28/15 Peter Pacosa Third floor fire escape for 171 South Street Drawing and permit Install concrete piers according to code Install 4 x 4 landing on ground Install 4 x 4 middle landing Install staircase, 4' outside dimensions From ground to existing third floor deck Install wooden grab bar for both sides of staircase Use P.T. for framing and decking not inlcuding stairs and risers Grab bar material 11/4" douglas fir No paint or stain included in this quote Labor and materials 8000.00 Permit 350.00 TOTAL 8350.00 $5,000.00 downpayment required before drawing starts Specifications and/or price could change according to building inspector requests Owner Date Toshi Kashima Date i _ �, -----:----- r� i i ----- i i i /, � .� 'I r i � I �� ,_ . . __ __ _ . ___._ __ ��.. � _____. __. __ -��- -. _, ---- -- �� , �: �---�. ( _� I �: E __ _ - -.-- =_ _:-1 ----- ---- --- ____ -- _____ __ �� ___ ___ � � _ __, y.`TI I CV f � � � - I � � � ---� _'�.__-�r- -�---- � - i ' -- ___ , ; � --- -- --- i � � .. i l � �� _ � +, �\ ' -� _.._ _�-4. � /� ---. .. -__ .� e- --____._ ___�_ n 1. i. i .c I I i i -t t i I , } I � r i I � Alj �,` � �• � ;- Y it AC"R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) _ 4/1/2015 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). PRODUCER A H RIST INS AGCY INC CO N TACT NAME_ PO BOX 391 PHONE — TURNERS FALLS, MA 01376NQ- tL— _ A/C No: -- ADDRESS: INSURERLSLAFFORDING COVERAGE NAIC# INSURER A:_Liberty Mutual Fire Insurance_ __ 23035 _ INSURED TOSHIHAR.0 KASHIMA INSURER B -- —___— 15 UNION STREET INSURER C: GREENFIELD MA 01301 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 24079529 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE-'OLICY 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. IN—SR ADDL SUER POLICY EFF POLICY EXP -- LTR TYPE OF INSURANCE POLICY NUMBER IMM1DDfYYYYt (MM/DDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR PREMISES � PREMISES Ea occurrenceL 5 I -- MED EXP(Any one person)_ S _ -J PERSONAL 8 ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER POLICY JE C LOC GENERAL AGGREGATE S PRODUCTS-COMP/OP AGG S OTHER. — - -- -- S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED -- AUTOS AUTOS BODILY INJURY(Per accident) S HIRED AUTOS AUUTOS�ED PROPERTY DAMAGE S — Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE _ S EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTIONS S A WORKERS COMPENSATION WC2-31 S-376057-025 3/23/2015 3123/2016 PER OTH- AND EMPLOYERS'LIABILITY Y/N ✓ STATUTE ER _ PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 100000 OFFCER/MEMBER EXCLUDED? N/A ___ (Mandatory in NH) E.L DISEASE-EA EMPLOYE S 100000 If yes,describe under — _ DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S 500000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers compe-isation insurance coverage applies only to the workers compensation laws of the state of MA. THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR TOSHIHARU KASHIMA This certificate cancels and supersedes all previously issued certificates,only as they relate to workers'compensation coverage. CERTIFICATE HOLDER CANCELLATION TOWN OF GREENFIELD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDING INSPECTOR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 14 COURT SQUARE ACCORDANCE WITH THE POLICY PROVISIONS. GREENFIELD MA 01301 AUTHORIZED REPRESENTATIVE 1 /� Liberty Mutual Fire Insurance ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERT NC,: 24079525 Anne Chandler 4/1/2015 11:10:03 AM IEDTI Page 1 of 1 A�°® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/Y 3/31/2015 5 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). PRODUCER CONTACT Tracey Kuklewicz A.H. Rist Insurance Agency, Inc. PHONE (413)863-4373 FAC No (413)663-9658 159 Avenue A E-MAIL P.O. BOX 391 INSURERS AFFORDING COVERAGE NAIC# Turners Falls MA 01376 INSURERA:Phoenix Insurance Company 5623 INSURED INSURER B: Toshiharu Kashima INSURER C: 15 UNION STREET INSURER D; INSURER E: GREENFIELD MA 01301 1 INSURER F COVERAGES_ CERTIFICATE NUMBER:2014-2015 Cert REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR T17E 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. POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE D POLICY NUMBER IMMIDDNYYYI 1MM/DDNYYY1 LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE RENTED PREMISES L occurrence $ 300,000 A CLAIMS-MADE OCCUR 6807042C348 /20/2014 /20/2015 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident)6 ANY AUTO BODILY INJURY(Per person) :6 ALL OWNED SCHEDULED BODILY INJURY Per accident :6 AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS-MADE AGGREGATE DID I I RETENTION$ y; WORKERS COMPENSATION WC STATU- I IOTH- AND EMPLOYERS'LIABILITY RY I YlN ANY PROPRIETOR,PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT 9 (Mandatory in NH) E L.DISEASE.-EA EMPLOYEE$ If yes,describe under — DESCRIPTION OF OPERATIONS below E DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Classification: Carpentry workers comp certificate to issue separately CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Greenfield ACCORDANCE WITH THE POLICY PROVISIONS. Building Inspector 14 Court Square AUTHORIZED REPRESENTATIVE Greenfield, MA 01301 Tracey Kuklewicz/DNP kCORD 25(2010/05) c0 1988-2010 ACORD CORPORATION. All rights reserved. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I 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/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1. 1 am a employer with r 4. 0 1 am a general contractor and 1 6. 0 New construction employees (full and/or part-time).* have hired the sub-contractors 2. 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g. 0 Demolition working for me in any capacity. employees and have workers' 9. ® Building addition [No workers' comp. insurance comp. insurance.'. required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0q ] officers have exercised their 11.0 Plumbing repairs or additions 1 am a homeowner doing all work 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.� 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: — Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: 1 f 7 < ti Y,� 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. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Si gnat C Date: Phone# � l 7 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#: Version l.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 0473� I Area of Responsibility Address 01 Registration Number fG� 616 Si ture Telephone Expiration Date IV 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 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 be filled in by Building Department Lot Size Frontage -�--' Setbacks Front Side L: R: U_g2�R:.l d Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parkin.-Spaces - Fill: volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES O IF YES: enter Book Page and/or Document#! B. Does the site contain a brook, body of water or wetlands? NO O DON'T 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 will disturb over 1 acre? YES O NO O 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 CUBIC FEET OF ENCLOSED SPACE Interior Alterations [I Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration E] Existing Ground Sign❑ New Signs❑ Roofing[] Change of Use❑ Other fJ Brief Description Enter a brief description here. � sccr °U -6-- �v,G C � � Of Proposed Work: r�,� +Y � i� -+ F,-- ' p C Gtin` �J , �L l� bs� 7 d - � r SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly 1:1 A-1 E] A-2 E] A-3 El 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 ❑ I Institutional ❑ 1-1 ❑ 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) 1st 151 2nd 2nd 3rd 3rd 4 th 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❑ Version 1.7 Commercial Building Permit May 15,2000 _.._ Department use"i y Y p of Northampton Status of Permit: L� .1 Q Iding Department Curb Cut/Drtveway Permit APR 1 6 12 Main Street SeWexleptic Availability Room 100 WaterNUet1 Avallabiitty s In ac mpton, MA 01060 TWe Sets of Structural Plans Electric.I'iun A 3- -1240 Fax 413-587-1272 Plot/ Stte Plans'. Noih<;rr{.tc 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 1.1 Property Address: This section to be completed by office f Map Lot Unit MA. d i i)6 o Zone Overlay District Elm St.District CB District; SECTION 2-'PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) �� Go�r Current Mailing,Address 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 ermit applicant 1. Building (N 0 D (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 = 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-2015-0985 \ APPLICANT/CONTACT PERSON TOSHI KASHIMA ADDRESS/PHONE 15 UNION ST GREENFIELD01301 (413)774-5402 F—Q y PROPERTY LOCATION 171 SOUTH ST s'ti Q►J �QU 60 5 � MAP 38B PARCEL 081 001 ZONE URB000)/ �C C 1 5 COYY�� 0)4 OJ R- 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: SCONSTRUCT 3RD FLR FIRE ESCAPE W/LANDING New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 060134 3 sets of Plans/Plot Plan l THE FgLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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 ay ature of Building fficial 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. 171 SOUTH ST BP-2015-0985 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38B-081 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-2015-0985 Project# JS-2015-001892 Est. Cost: $5000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TOSHI KASHIMA 060134 Lot Size(sq. ft.): 17467.56 Owner: PACOSA PETER A Zoning: URB(100)/ Applicant. TOSHI KASHIMA AT. 171 SOUTH ST Applicant Address: Phone: Insurance: 15 UNION ST (413) 774-5402 WC GREENFIELDMA01301 ISSUED ON:412812015 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 3RD FLR FIRE ESCAPE W/LANDING 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 4/28/2015 0:00:00 $55.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner