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24C-181 (2) 218 CRESCENT ST BP-2021-0043 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24C- 181 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category: Bath reno BUILDING PERMIT Permit# BP-2021-0043 Proiect# JS-2021-000059 Est.Cost:$22000.00 Fee: $143.00 PERMISSION IS HEREB Y GRANTED TO: Const.Class: Contractor: License: Use Group: Chagnon Building & Remodeling LLC 060175 Lot Size(sa.ft.): 11848.32 Owner: SIMON PETER Zoning: URB000)/ Applicant. Chagnon Building & Remodeling LLC AT. 218 CRESCENT ST Applicant Address: Phone: Insurance: 91 Stockbridge Rd (413)259-6785 HADLEYMA01035 ISSUED ON.7/14/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-BATH RENO 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 Sig(nature: FeeTyne: Date Paid: Amount: Building 7/14/2020 0:00:00 $143.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner U0(a05 o The Commonwealth of Massachusetts Z Board of Building Regulations and Standards FOR 0 kt. MUNICIPALITY Massachusetts State Building Code, 780 CIMR USE D9 Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mm 2011 o° One-or Two-Fandly Dx;elling This Section For Official Use Only S 'o n Buil permit Number: 76 " Date Applied:FD T o� Z : L"6t�'- TIM& 7 Building Official(Print Name) Signature JU Dke —-------! SECTION 1:SITE INFORMATION 1.1 Property Address: 1 1.2 A sessors Map&Parcel Numbers r1'/ LI a Is this an accepted street?yes_/,�no Map Rumber Parcel Number 1.3 Zonin Information: 1.4 Property Dimensions: (J!2 '5&'Je Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: Outside Flood Zone? Public lL� Private 13Zone: if yes❑ Municipal i 'On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIPt 2.1 Owners of Record: , M4- nle)66 1� Name(Print) L City,State, ZIP d a l ew SC t' S/� � 7 -50 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied Repairs(s) ❑ 1 Alteration(s) &I Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Pr posed Work': [ SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) 1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ f' �� p Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 500 ?: Other F'ees'- S. 4.Mechanical (HVAC) $ / List: 5.Mechanical (Fire $ l Suppression) Total All Fee S Check N JZN Check Amounl�W-3�ash Amount: 6.Total Project Cost: $ dam,doo 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 1 C1a49&yg4-- License Number xpiration Date Name of CSL H der i / List CSL Type(see below) lJ No.and Street V77 Type Description � U Unrestricted Buildings up to 35,000_cu.ft.) j ' (d ©l/0�� R Restricted 1&2 Family Dwelling City/Town,Stated M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances CT,yaA-�,egy��NA13 I Insulation Telephone Email address t D Demolition 5.2 Registered Home Improvement Contractor(AIC) �L/9 75/ CfA1� t3V14PIt4 frZ,"Yo4c� ' GS 1I1C Registration Number Expiration Date HIC Com an Na e orC R istra Narny `�1 tr�g T No; e A�eeC T Email address City/Town State,ZIP Telephone SECTION 6: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 inks arudavit will result in me denial of the issuance of ine building permit. Signed Affidavit Attached? Yes..........!d' No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorized/' X< C,&46 t-F^-J to act on my behalf,in all matters relative to work authorized by t i>building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of petjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. C/7A-101-- Print Owner' or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner-who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Super\,isor License can be found at\x�v.mass.gov/dps 2. When substantial work is planned,provide the information below: i Qi?.i fivOr u"'u!u� �� l��viuuti"'"uau'�i �iat$u�d DuSiaia4aivru�a.5,uiiiii yr"vr�h� Gross Iiving area(sq.ft.) Habitable room count Dumber of fireplaces Number of bedrooms Number of bathrooms 'Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3, "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of Massachusetts Department oflndustrialAccidents - I Congress Street,Suite 100 a Boston,MA 02114-2017 xY ' www massgov/dia 'Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. Anr��nr ,-.rte A V DG r L41vY TVA r A 1 n1-(Grcivir i�.!!'1%--iV'�l!r2L�24!!I. Applicant Information Please Print Lesibly Name(Business/Organization/lndividua[): L/�}�9 r?/�/t �U�L //wl P 421't 7(�1A C Address: /512-6g City/State/Zip: Phone#: Are von an emnlnver°Cherk the annronriale box: �- Type va pruiesi(required): employer with employees(full and/or part-time).* 7. n New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] J71 am a homeowner doing all work myself.[No workers'comp.insurance required_]t 9. ❑Demolition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10[]Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 I.❑Electrical repairs or additions proprietors with no employees. 12.F1,Plumbing repairs or additions 5.Q 1 am a general contractor and i have hired the sub-couvactors listed on the attached sheet. 13 Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL C. 14.0 Other 152,§1(4),and we have no 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 ani an enepioyer tient is providing workers'compensation insurance for ney employees. !Below is the policy and job site information. Insurance Company Name: Policy It or Self-ins.Lic.M �✓'Com` Expiration Date: / Job Site Address: ;71the workers' compensation policy declaration City/State/Zip:�GY�G -on p p y tion page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 15z, §25A is a criminal violation punishable by a tine 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify and the pains and pen eriury that the information provided above is true and correct. Signature: Date: J 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other II Contact Person: Phone#_ �� k�E�►ro>l;,� The City ofAdthampton Building Department 212 Main Street 9�AAIFOS1SStENorthampton, Massachusetts 01060 Phone (413) 587-1240 Fax (413) 551-1272 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLi MION AND RENO-VAT MN d ROjECTS) In accordance with the provisions of MGL c40, s54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, sl 50A, The debris will be disposed of in: Location of Facility o�,3�/ � I�1�1-M/�C� ,� ��'/v( ,� `'TLLv— The debris will be transported by: Name of Hauler Signature of Applicant: Date: o"/ Farm Family Casualty Iii. rr�1� Insurance Company AMERICAN AnAfmd(an?"nonalCampmy NATIONAL. 3"ROUTE 9W I GLENMONT, WNY 12077-2910 ORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE NCCI COMPANY NO. 16721 SEAN P ROONEY POLICY NO. 2001W7205 2341 BOSTON RD EFFECTIVE 11/14/2019 WILBRAHAM MA,01095-1152 TRANSACTION TYPE Endorse FEIN M 20-8363040 413-887-8817 IT# �` INSURED AND MAILING ADDRESS: CHAGNON BUILDING&REMODELING LLC 91 STOCKBRIDGE ST HADLEY,MA 01035-3517 THE INSURED IS LLC Workplaces covered by this policy: ST WP NO. ADDRESS OF WORKPLACE RTG.BUR NO. INTRASTATE NO. MA 1 91 STOCKBRIDGE ST 280784 000280784 HADLEY MA 01035-3517 The polity period is from 11.14-2019 to 11-14-202012:01 A.M.Standard Time at the insured's mailing address. r ., , MIM A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the state listed here: MA B. Employers Liability Insurance:Part Two of the policy applies to work in each state listed in item 3.A.The limits of our liability under Part Two are: Bodily Injury By Accident Bodily Injury By Disease Bodily Injury By Disease $1,000,000 each accident $1,000,000 policy limit $1,000,000 each employee C. Other States Insurance:Part Three of the policy applies to the states,if any,listed here: All states except the states designated in item 3.A.of the information page and ND,OH,WA,and WY D. This policy includes these endorsements and schedules: WCOOOOOIA0319 Copyright 1987 National Council on Compensation Insurance PROCESSED 2020-02-11 WC000001A Edition 03-19 2001 WT205 Ilits111, Its Farm Family Casualty AMERICAN Insurance Company NATIONAL :ua R WE sV' GLFNI0 kir NFW V NRK 12207 2910 SELECT BUSINESS PACKAGE DECLARATION PAGE Policy Number; °y ,',ti Portfolio Number: Account Number Name and Madmig Address of First Named Insured: HAGNON BUILDING & REMODELING LLC 91 STOCKBRIDGE RD i ADLEY. >11A, 01035-3517 Agent: 38,89 SEAL P ROONEY 2341 BOSTON RD b"�"ILBRAHAM MA. 01095-1152 Agent Phone: 413-887-8817 Business Description: GENERAL CONTRACTING Form of Business: Limited Liability Corporation Transaction Type: Renew Policy Period: From 06-23-2020 To 06-23-2021 12:01 A.M. Standard Time at your mailing address shown above IN RETURN FOR THE PAYMENT OF THE PREMIUM.,AND SUBJECT TO ALL THE TERMS OF THE POLICY,WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY PROPERTY COVERAGE TOTAL LIMITS OF INSURANCE Buildings $0 Business Personal Property $10,000 Business Income &Extra Expense Actual Loss Sustained Not Exceeding 12 Months Other Endorsements See Schedules LIABILITY COVERAGE General Aggregate Limit (Other than Products-Completed Ops.) $2,000,000 Products-Completed Operations Aggregate Limit $2,000,000 Personal & Advertising Injury $1,000,000 EACH PERSON/ORGANIZATION Each Occurrence Limit $1,000,000 Medical Expenses $ 5,000 EACH PERSON Other Endorsements See Scheoules PREMIUM Premium shown is payable at inception Total Premium POLICY SUBJECT TO ANNUAL AUDIT: Yes The Declarations, Schedules and Forms and Endorsements Make Up Your Complete Policy. Refer to Schedule Of Forms and Endorsements. Process Date: 05-04-2020 X-3842 0319 Page 1 of 5 1008xczae Commonwealth of Massachusetts Division of Professional Licensure .. Board of Building Regulations and Standards Constroctibn Supervisor CS-06017� Ezp i res: 09/30/2020 GARY J CHAGNON 91 STOCKBRIDGE RD HADLEY MA 01035 Commissioner Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:LLC Registration Expiration 112751 04/21/2021 CHAGNON BUILDING&REMODELING LLC GARY J_CHAGNON 91 STOCKBRIDGE RD (' HADLEY,MA 01035 Undersecretary ffto Owner",to them at: Mark& Mara Sinton 218 C'rescem Street Northampton, KIA 01060 lmail(s): Peter.b.sinxm((Pgntail.com TI:RNIINATI ON 23.0 If the Contractor shall: (a)be adjudged bankrupt. (b)persistently or repeatedly refuse or fail,except in cases where extension of time is provided,to supply enough properly skilled workmen or proper materials to perform the work, (c)persistently disregard laws,ordinances,rules,regulations,conditions of any public authorities ha\ing jurisdiction over the WORK,or (d)be guilty of material violation of this Agreement, then the Owner shall be entitled,upon seven(7)days prior notice,unless the Contractor shall cure such iolation during said seven(7)day period,to terminate this Agreement and take possession of the Site and all materials and equipment thereon and finish the WORK by whatever method Owner may deem expedient. ARTICLE 24 GOVERNING LAW; EFFECT This Contract shall be construed and enforced in accordance with the substantive law of the Commonwealth of Massachusetts without giving effect to the conflicts or choice of law provisions thereof,and shall have the effect of a sealed instrument. This Agreement executed on the day and year first written above. Contractor CHAGNON,3UILDJ*,'G& REMODELING LLC By --- --- It's President Owner(s) r � � Contractor Initial Owners Initials:_ Page.7 of 14 y Copyright 0 2020 Chagnon Building&Remodeling LLC Created on 5/6/2020 7.53 00 PM Semon Bathroom Agreement 050820.doec