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24C-043 (7)
354 ELM ST BP-2021-1406 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24C-043 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-2021-1406 Project# JS-2021-001628 Est.Cost: $123000.00 Fee: $961.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: NIKOLAY GERASIMCHUK 063630 Lot Size(sq. ft.): 47044.80 Owner: SOUTHERN NEW ENGLAND CONFERENCE Zoning: URB(100)/ Applicant: NIKOLAY GERASIMCHUK AT: 354 ELM ST Applicant Address: Phone: Insurance: 322 FRANK SMITH RD WC LONGMEADOWMA01106 ISSUED ON:6/1/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:INTERIOR ONLY RENOVATION OF CHURCH 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. + i y . cY i J . 2 Certificate of Occupancy signatn I : FeeType: Date Paid: Amount: Building 6/1/2021 0:00:00 $961.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner (_() IRC1 ozetiaj L_ y The Com onwealth oMa.sachusetts �1 / © tie? , Fir.4 blic Sa; ty 4'•�' r Massachu 8 * m 80 CMR) Building Permit Application for any Bui o %an a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number: &-.?I -- I`'Gate Applied: Building Official: SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) 354 Elm Street Northampton, MA 01060 Seventh Day Adventist Church No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Code used 9th If New Construction check here 0 or check all that apply in the two rows below Existing Building® Repair 0 Alteration ® Addition 0 Demolition 0 (Please fill out and submit Appendix 1) Change of Use 0 Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes M No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No Brief Description of Proposed Work: Refurbishing of church (A-3 Use) under new ownership Work includes mold remediation, moisture control mitigation, improved accessibility,and fO reduction of maintenance measures. Improved amenities and new finishes in lower level of t1)D(2�L approx. 5,300 sq.ft. . Sanctuary of approx. 5,440 sq.ft. and choir mezzanine of 900 sq.ft. will —� receive new finishes. New HVAC. plumbing. elertricpl .anrl_T,ife Safety %terns are bein. „widres_sed. Historical Review pending on exterior modifications. FxiERL'li3 SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR wh131o4 CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0 ON I'f Existing Use Group(s): A-3 Proposed Use Group(s):_ A-3 COMM SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)Sr Area Per Floor(sq.ft.) Mez zus 5,330 change change Total Area(sq.ft.)and Total Height(ft.) 10,770 53'0" change change SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 ® A-4 0 A-5 0 B: Business 0 E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1❑ H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1 0 I-2❑ I-3 0 I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0 S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA CI IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ® IV 0 VA CI VB SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit Debris Removal: Public® Check if outside Flood Zone M Indicate municipal CDA trench will not be Licensed Disposal Site 0 Private 0 or indentify Zone: or on site system 0 required®or trench or specify: permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable® Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No® Yes 0 No SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: 9th Use Group(s): A-3 Type of Construction: IIIB Occupant Load per Floor: 160 Does the building contain an Sprinkler System?: NO Special Stipulations: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner $0g.thutoNewEns&viol PO 8or. /149 Caul-h Loy-0c&s¢c& A2/7 ois6/ Name(Print)). f SDR No.and Street City/Town Zip Property Owner Contact Information: 341 f- eih71 it w a.;It. R er Rely Am.4 R 978-365 'SS/ 978_So 2 y8 97 3-1-1.hfti wiz;/ s/ opGire ov itle Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) (If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here❑and skip Section 10.1) 10.1 Registered Professional Responsible for Construction Control Lawrence Tuttle 413-283 - 2553 admin®architectural-insights.com 7141 Name(Registrant) Telephone No. e-mail address Registration Number 3 Converse Street Palmer MA 01069 ARCH 8/21 Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor �, Co any Name .a i. ,c CS- 6 3 .6 3 Name of Pe on Responsib for Construction License No. and Type if Applicable ZZ Ar4�. ,C- 97,r/-IJ 4h .."-il.,2‘A.-) ./'tip 4=1,0-: >� Street Address %/Town State Zip 43-7a le3z - - c(. .4s er:::•i. 7e.FM-.e(ICC. ,s,cv.,„� �.,, / Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes 0 No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ ti O 0 0 Building Permit Fee=Total Construction C x (In there 2.Electrical $ 3 5) O 0 C appropriate municipal factor)= 11 3.Plumbing $ YR, pop 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ 0 3/ 000 (contact municipality)and write check number here /7 3 . . SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Please print and sign name Title Telephone No. Date Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: li i1%''i 1 IL Name Date it Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional th for work per the 9 edition of the �J�4 Massachusetts State Building Code, 780 CMR,Section 107 Project Title: Seventh Day Adventist Church Date: 5/13/21 Property Address: 354 Elm Street Northampton, MA 01060 Project: Check one or both as applicable: ❑ New construction ® Existing Construction Project description: Refurbishing of existing church (A-3 Use) including mold remediation and finish replacement or repair throughout lower level and sanctuary (approx. 10,770 sq.ft.) New HVAC, mechanical, and plumbing. Improved accessibility and Life Safety Systems. Site and exterior changes to improve the maintenance and safety of users. Exterior modifications are pending per Historical Review. 1 Lawrence Tuttle MA Registration Number: 7141 ARCH Expiration date: 8/21 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations, and specifications concerning: [x] Architectural [] Structural [] Mechanical [] Fire Protection [] Electrical [] Other for the above named project and that to the best of my knowledge, information,and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept,shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, I shall submit field/progress reports (see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a 'Final Construction Control Document'. Enter in the space to the right a "wet" or electronic signature and seal: Phone number: 413-283-2553 Email: admin@architectural-insights.com Building Official Use Only Building Official Name: Permit No.: Date: Version 06 I 1 2013 revised Appendix 1 For the demolition of structures the building permit applicant shall attest that utility and other service connections are properly addressed to ensure for public safety. Please fill in the information below and submit this appendix with the building permit application. The building permit applicant attests under the pains and penalties of perjury that the following is true and accurate. Property Location (Please indicate Block # and Lot# for locations for which a street address is not available)S9 E S1 /el2 �T oI1V � © 06o S D Ch AA.izc, t No. and Street City/Town Zip Name of Building(if applicable) For the above described property the following action was taken: Water Shut Off? Yes 0 No 2J Provider notified and Release obtained? Yes 0 No 0 Gas Shut Off? Yes 0 No ®' Provider notified and Release obtained? Yes 0 No 0 Electricity Shut Off? Yes 0 No Et/ Provider notified and Release obtained? Yes 0 No 0 Yes 0 No 0 Provider notified and Release obtained? Yes 0 No 0 Other (if applicable) Yes 0 No 0 Provider notified and Release obtained? Yes ❑ No 0 Other (if applicable) Appendix 2 Construction Documents are required for structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required for this. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where applicable No. Item Submitted Incomplete Not Required 1 Architectural 2 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing(include local connections) 9 Gas(Natural,Propane,Medical or other) 10 Surveyed Site Plan(Utilities,Wetland,etc.) 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review(521 CMR) 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction.Work started prior to approval may be subjected to triple the original permit fee. Registered Professional Contact Information Lawrence Tuttle 413-283 - 2553 adminearchitectural-insights.com 7141 Name(Registrant) Telephone No. e-mail address Registration Number 3 Converse Street Palmer MA 01069 ARCH 8/21 Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date -", The Commonwealth of Massachusetts , :- -4.---- --1-1,,,'Ll'i jor Department of industrial Accident L s 1 Congress Street,Suite 100 ,.....4 Boston, _VA 02114-2017 www.mass.gor/dia vt,(a kers'Compensation Insurance Affidavit:Buiklers/ContractursiElectriciansTlumberv. It)iti.l I I.F.D V1 It II 1 Ift.PERMITTING AUTHORITY. Annlicant Information Pleat Print Lettiblv Name i Bus incss Orgammtion Indtv iduair INN,t/v'S CC/.'t S4 4-e4 e ebt,c'42 <S3,52-eY-. e, Address: X G ••-- t/t)(si City/State/Zip: i cA d/0 tAl W. ,4, sP.-4. Phone ft: ( 4(3) 22_6 - .3 2 sire Nam an VITiplit,er?Clock the apprupriait box: I.Ape of project(required): an a employ m with_ _ eirmloyees WI and?or port-tirrie i• 7. fJ New. etsttstriaCil0/1 .....D I int a sok'proprietor or partnership aixt have no employees working for ore in 8. 9/Rd:tttode I mg alo,cagatcaty_[No workers'amp.torurance required] 9. Demolition I it71 a homeowner doing aii mak myself.[No worker•s"comp_irouraime required]. 10 E3 Building addition I ant a hont,eownor and ss Ai itoe hiring entritructors to L-onduet ad work on my property. I will ensure that all Lona:m.10ot eitiki have workerk-courprmvation rsounince ot are wit 111:1 Electrical repairs or additions prorate- v.ills no cartployees. 12.0 Plumbing repairs or additions .$ a stsmcral contractor and I have hired the aub-cuntractors lobed on the attached%heel. l I 3.r1 Roof repairs These sub-contractors have employees and ase workers'comp Insurance.; 14.0 Other h 0 wa a..corporation and ift otlitin have tktort iNed their ilk&or c.mmoon per Wit_e_ I 52.111(4).and we have rio elm:doyen.No worken'comp.insurance required.) :tort IL ant that cheek%beat It omit also fill out the.s.-ction helou silo*ing then*,mien'coutpen,ation policy artformatien ib'fillM,IS-1,Vr ill)submit this lidEd&Vil indicating they ftreekrms all A ork and then hire roaid contracted mutat aubtant a rim%artida%it 213.114:atinig sock 't oraractors that dick.k iha box must attached an additional sheet%haw log the name oldie sub-contrtor and state V.hether or not those cmtnid hire cmpIesec: It the sub-confrJetora has<errtpltn ets.the's,mum pros.ide their *corker,'comp.poitc:s number I am an employer that is providing workers'compensation Mita rance for my employees,. Below is the policy and fob site information. Insurance Company Name L ; b e,lci--y bil cdu a 1 7 in C 0 poi,,y#or Sell-ins. L3c.#:.(A)e"2 -' 3 I — 6/a..s- 9.1 - 0).0 Expiration Date: i i/?/..Z/ Job Site Address: 3.5-Y EI 0-7 -s71 /00i1h a wi`ID)" /4 11- citytstateizip: 0/ 0 6 0 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to SI.500.00 ardor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a day against the violator.A copy of this statement may be fonvarded to the Office of Investigations of the [MA for insurance eo%eragc verification. 1 do hereby certif.,.j.under i e and , lli -ilni.that the information provided above is true and correct. Sienature: 7-.‘ ' Date SI-2 ..c-- -',..--) e Phone .(4(3) 7eg Official use duty. Do not write in this area, to be completed by city or town official, ( ity or Town: Permit/License Issuing:Authority (circle one): I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.other Contact Person: Phone a.: m DATE(MM/DDlYYYY) AC C)R.i� CERTIFICATE OF LIABILITY INSURANCE 4114..----- 05/25/21 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 have ADDITIONAL INSURED provisions or 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 CON I ACT NAME: Linda M.Hill,CSR Rejean J.Remillard Ins Agency,Inc. (PAHCNr o,Eat): 413-789-3070 (NC,FAX No): 413-786-0193 1040 Springfield Street E-MAIL Feeding Hills,MA 01030 ADDRESS: Linda@rejeanremillard.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Main Street American Assurance INSURED INSURER B: Liberty Mutual Ins Co Anatolie Balaur INSURER C: Allstates Construction INSURER D: 25 Brainard Rd. Wilbraham,MA 01095-1401 INSURER E: INSURER F: 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 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, ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD//YYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A Y Y MPT9213G 01/11/21 01/11/22 _PERSONAL&ADV INJURY $ 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 X POLICY JET LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA LIAB - OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY X. STATUTE ER B OFFICER/MEMBEERANY /EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE N/A WC2-31S-618592-020 11/07/20 11/07/21 E.L.EACH ACCIDENT $ 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached 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 City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main St Northampton,MA 01060 AUTHORIZED REPR9ENTATN) .11 ' Y (1 ...z.eferg: / i ©19 8-2015 ACORD CO PORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD