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44-056 (9)
BP-202 1-2207 376 EASTHAMPTON RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 44-056-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2021-2207 PERMISSION IS HEREBY GRANTED TO: Project# BEM-2021-000194 Contractor: License: Est. Cost: 20000 STEPHEN ALBERTSON 81426 Const.Class: Exp.Date:01/21/2022 Use Group: Owner: FOURNIER FRANK N III TRUSTEE Lot Size (sq.ft.) Zoning: GI Applicant: STEPHEN ALBERTSON Applicant Address Phone: Insurance: 95 CRONIN HILL RD (413)522-3158 AWC-400-7030930 HATFIELD, MA 01038 ISSUED ON:11/30/2021 TO PERFORM THE FOLLOWING WORK: BUILD STORAGE ROOM WITHIN A GARAGE BAY 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. Signature: Q 3-1,, �, so Fees Paid: $140.00 • 212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner The Commonwealth of Massachusetts Office of Public Safety and Inspections Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number:.i",?c 07 Date Applied: Building Official SECTION 1:LOCATION 311(4, �4-s4-1la..w.-p4.r ed•/t-\o+'!'4,t..i 01040 No.and Street City/Town Zip Code Name of Building(if applicable) Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below Existing Building at Repair 0 Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other X Specify: See.°itg STD&.1r r Are building plans and/or construction documents being supplied as part of this permit application? Yes g No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No p Brief Description of Proposed Work: So t t..bt N& 0. S Ec u/i.L ST1D R.46-6 'lZa'aM. w:t-k ti o- 50.+e�• loam - Rice sm .i A.L L Q S4 4.ds,n er6f-t cipm, 4 Shae e.c.k. SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0 NA Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft) NfAk Total Area(sq.ft.)and Total Height(ft) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0 F: Factory F-1❑ F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1 0 I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0 S: Storage S-1 S-2 0 U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA IB ❑ IIA ❑ IIB ❑ MA IIIB ❑ IV Cl VA CI VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: A trench will not be Licensed Disposal Site N/kr Public 0 Check if outside Flood Zone 0 Indicate municipal 0 required 0 or trench or specify: Private 0 or indentify Zone: or on site system 0 permit is enclosed 0 Railroad right-of-way. Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable fir- Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No IX Yes 0 No WI SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: City of Northampton Massachusetts ' ,, y R. t DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building $'M " - Northampton, MA 01060 I CO i I\ Z PROCE URE FOR OBTAINING A BUILDING PERMIT FOR COMMERCIAL & TI-FAMILY NEW CONSTRUCTION/ADDITIONS/ALTERATIONS 1. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specification of proposed work(digital and hard copy). 3. Site Plan with location of proposed structure(s)and setbacks. 4. Construction Debris Affidavit filled out and signed by applicant. 5. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 6. Contractors must supply a copy CSL and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate(if applicable). 8. Note any Conservation and/or Special Permit requirements (if applicable). 9. Driveway Permit(if applicable). 10. Proof of Water and Sewer entry fees paid(if applicable). 11. Trench Permit(if applicable). 12. Initial Construction Control Documents filled out and signed by the Registered Design Professional in responsible charge. 4 t SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Fraak r,n tEL.. 17 4.1llr L&i At/. /6J/ r' .i'i+ o/O Name(Print) No.and Street City/Town Zip Property Owner Contact Information: 41_3_-53s 7o 93 = - Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: S A-L BEp7s J cALarv.✓p4 // /w. c/.1 ovp 3,g Name Street Address City/Town State Zip to apply for and 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 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here❑. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor S'tep t & Ace- p7 o) , 7,13 r_ S. B. Al-Bc6z 40' 1 Company Name S'iE 10441 trtsrahrfr e S - 0 g (4?-6 - 1 JLi I Name of Person Responsible for Construction /, License No. and Type App cable qs" piteNiN M!,//Ad /Yi Elm(, /hf- 0/e 3e Street Address City/Town State Zip - - �¢13- f2? 3/S�o a.t bar-/-seN sit 6,, enA,/ ce Telephone No.(business) Telephone No. (cell) e-mail ad ress 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 No 0 SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs:(Labor Item and Materials) Total Construction Cost(from Item 6)=$ Z O, owl' 1.Building $ // err)D Building Permit Fee=Total Construction Co rt here 2.Electrical $ 4,,c p appropriate municipal factor) /'9'O - 3.Plumbing $ 4.Mechanical (HVAC) $ ,4,r Szn7 Note:Minimum fee=$ /'v (contact m cipality) 5.Mechanical (Other) $ Enclose check payable to r ` O r� 6.Total Cost $ Z 0,trt)O (contact municipality)and write check number here I I g(O 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 m knowledge and understanding. sTEp+ J Augripticitiv � mac- 4is Czz 3'58 //44 Please print and sign name e I �(' Title Telephone No. Date heI/ 4d /A/L..'� Q'/0 3( .._allueisALs1LeS inst w�•COri^ Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: : ''ANC (� D�al Name Date CITY OF NORTHAMPTON N 4 SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton i r = -- Massachusetts t ti r t, DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building '. ., Northampton, MA 01060 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 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, S 150A. The debris will be disposed of in: Location of Facility: \lai(t1 cycA„-,5, , 254 C#-54-441._yIvriza )46 f� � 'Ik c' b The debris will be transported by: Name of Hauler: S,-, }-cfg D") Signature of Applicant: Date: f/ /7/7--/ 1.7\\ The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 . • Boston,MA 02114-2017 WWW.mass.gov/dia Wotiterf Compensation Insurance Affidavit: Builders/ContractorsiElectricians/Plumbers. TO RE FILED,tt ITN TIIE P .R. 1l ITING AUTHORITI. ADDliCallt Intnrination Please Print Le2iblt Name olusiThessorgummtitinandividuaty S re-P46,..) ArtiSeittptp-) , 17-3A- S ti(- E./2-450") Address: Cite // ,e-c/ city/StateiZip:_1(4-1-fa 41._ (5' ,3g Phone 4/3 5-2-2 Are most an employee Clievk the ppropriatie Type of project(required): 142F am a employes with erripitv,ves andlor part-iitnej.* 7. 0New construction 24:1I I ant a sale proprietor or partnership and have no employees working for nte 8_ c3 Remodeling any eamicity.[Nu workers'comp.insuranoe reptimdl 9. Demolition 3.0 arn a homeowner doing all work myself[No 146tiLetS'eon .imiantrwe mooned]' to El-Building addition 401 am a horistownez and will be hrenn oaten-actors to conduct alt*eek on city property.. I will ensure that all comm.-tors either hate workers'4.-onspkitsatton neurance or are sole JI.fl Elutrical repaiis or additions pre with no employee, 2E3 Plumbing repairs or A,Ltitions SC:1 I am a general contractor and 1 have hued the tobocuratractors lasted on the auadied sheet teota f s Thme intstractors base employeta and hasst,workers'c1.71141. 1 3.E3Roo repair 14_0 Other 6.0 We are a oorpuratiota and Its officers have exercised then right nt exemption per MC11._e. 152.Ito),and we luive 170.3 employers.(Nsa workers comp.insurance repo-All appi want that clucks bus 41 must also till out the section N.lo 're.1 nifurniation. Hien' nowners utio Aiimnit this att'ida..srindieatinie they are doing:tit*otk and then hoe tostsele..amtratators must sultana(a new affoiliw it indicaing such. %Connectors that check this bus iris,'at tsalsad tn addmona3 sheet h."tow the name-arils.sub-contractrirs and gate whether or not those ensues hat omp I o c,• f the sub-eurttractor, pm,.hie their sot oxen,puik?numtvt I am an employer that is pryviilinz workers'compensation insurance for my employees_ Below is the policy and job site infarrndaion, Insurance Company Name: itLi't.Alloill?Att, Policy#or Self-ins.Lie.#: A 40 c 400 '?O3O' 3O-tOlffA Expiration Date: Srl/S Job Site Address: -316 6ito-lel lee/ J. City!Stateqip:N #_14- e;4c> Attach a copy of the workers'conipensa ion 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$1,500.00 ander 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 DEA for insurance coverage verification. /do hereby certify mod ii p41//13 UndpentlittO,I,/ cry r) Mc!the prortifed oho l'e is true and correct. Sismature. Date: 11/1/2-ei Phone#: 413 5-2-7 --- 3/ 5-10 Official nse only. Do nor write in this urea,to he completed by city or town official City or Town: Permit/License# Issuing Autkoriq(circle one): I.Board or Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: ....... A COR CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD"Y"Y) 11/18/2021 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 CONTACT MSA Service Center NAME: Berkshire Insurance Group CLSC (A/CO,No,Ext): (866)400-6343 FAX No): (866)332-4776 MSA Service Center E-MAIL servicecenter@msagroup.com ADDRESS: PO Box 2006 INSURER(S)AFFORDING COVERAGE NAIC N Keene NH 03431 INSURER A: Main Street America Assurance 29939 INSURED INSURER B: Stephen B Albertson INSURER C: 95 Cronin Hill Road INSURER D INSURER E: Hatfield MA 01038 INSURER F: COVERAGES CERTIFICATE NUMBER: 21-22 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. LTRINSR IA SD DDL�WVD POLICY NUMBER UBR POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE (MMIDDIYYYY) {MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO CLAIMS-MADE X OCCUR PREMISES(EaENTED occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A MPT9340S 08/06/2021 08/06/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PE0 LOC PRODUCTS-COMP/OPAGG $ 2.000,000 X POLICY 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 Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 Street AUTHORIZED REPRESENTATIVE Northampton MA 01060 �t sw „/C dtS I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD _ . -- ' ' 0 .,. A. , , ti, ...4-4) c , LA • 11 . g 44 to : Vf itP. o 4,_.1 I T, i f. 41 I- -(1-4-j> '"',--_,...1,1„, 0_74" tio 0 ci Ty . g. 4,.. -is 0 ., 1 „r, , 12' \-\\I t cs ' '' .t , .1.16,.. tig, 1 ',1„- i Y, 0 _,,..P n 0 t'O'.* 8- 3 --4:•;N 4 ,#.' t.,, -,0, g r. *. til ti 1 gs, 1.-i. T4 tit 0 ti c .. r f,,,, MMM TRANSPORT LAYOUT: INTERIOR DIMENSIONS ♦ ♦ 255" Alk � I r►rrrrr rrr�rrrrrrrrrr' *i�ii�i+i�r�i�i�i�i�i�i�i�i 13 7/8" " ♦ ♦ * i 43" 160" f 12„ + (INSIDE CEILING) ♦ i "" DOOR 1/8" 80 A 82 1/8" 75" I 71" i 2" _ - * I t 43" • + i * 43 ♦ j-16"_-► * MMM TRANSPORT LAYOUT: EXTERIOR DIMENSIONS 48" + 68.5" 4 43" 168 ♦12„ (OUTSIDE CEILING) '41 78.5" 75" + * * 43" . ♦ -16"--► * ♦ 159" * 48,E ♦