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32A-166 BP-2023-0892 62A HAWLEY ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32A-166-003 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-2023-0892 PERMISSION IS HEREBY GRANTED TO: Project# RENO 2023 Contractor: License: NOVA VC CONSTRUCTION and Est. Cost: 12616 CLEANING INC 110457 Const.Class: Exp.Date: 07/18/2024 Use Group: Owner: PRIOR, MAXWELL & DESERRES, DANIELLE Lot Size (sq.ft.) Zoning: URC Applicant: NOVA VC CONSTRUCTION Applicant Address Phone: Insurance: 41 SULLIVAN ST 857-312-9860 WCMA 000162501 CHICOPEE, MA 01020 ISSUED ON: 07/10/2023 TO PERFORM THE FOLLOWING WORK: INTERIOR RENOVATIONS 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: cF, • 1' • >2 • • Fees Paid: $84.50 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner , RECEIVED i , The Commonwealth of Massachusetts Board of Building Regulations and Stands s Massachusetts State Building Code, 7 30 CMR J U L 02� M'JNT FORC PALITY USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwellin4, DEPT.OF BUILDING INSPEOTIONS NORTHAMPTON,MA 01000 This Section For Official Ust,Only Building Pe it Number: go-)-3. g9L Date Applied: Pe `Z, ill 7-la ZOZ3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION ���pertS Address: 1.2 Assessors Map&Parcel Numbers tt PfAia y 5 N04hartipvn-MA 1.la Is this an accepted street?yes X no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) 1 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 Private 0 — Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: WIX.Wdi P2xorz NorA-kcArAP n— t-'lA oto>o Name(Print) City,State,ZIP 62A 6w1e9 St t4OrkittuyvkA C11(3)320•O330 iv,spc- Oca -71•covv, No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Et Owner-Occupied 61 Repairs(s) ® Alteration(s) 0 Addition ❑ Demolition S Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: DOM° t&'L1.1( tkwe f n /. •.vY\k 1Wty Ltif l y'b 111-1- d -file Pit;s4 r' baih raom i , shrek rock. i vs4c.(L ore t ' • me on t nte(cy( walls i n by, rio ruler 2- rt};n1 t• , 4l,- t6p� t s•4a41 v�CW shelve Yt ete 'v*' . vc, t_au.v trti conheatov. b SECTION 4:ESTIMATED ClOiNSTRUCtION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ sz plc aQ 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fees: $ PI, Check No. )‘ 3,35Check Amount: Cash Amount: 6.Total Project Cost: $ ,i 616.00 gPaid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 4)10467 1 g t206' CS Gt I fmcv coczka., License Number Expiration ate Name of CSL Holder T(ay to r sG List CSL Type(see below) 1J No.and Street Tie Description N A.(�ram.( _ O t 16-7 Unrestricted(Buildings up to 35,000 Cu.ft.) 1111� (,1 t1 R Restricted 1&2 Family Dwelling City/Town,State,ZTP M Masonry RC Roofing Covering WS indow and Siding SF S lid Fuel Burning Appliances 51 Z 860 NOVA VC.0 ONsfru rleioi'Mo:f.c, I ation Telephone Email address D molition 5.2 Registered Home Improvement Contractor(HIC) 14OVA� VC- CANS�ruca-in ke.iC4 i nig.Jtic. E 4r36n oaf 23(nDLs HIC egisttatio Number Expiration Date H C Company Name or HIC Registrant Name 41 sal i Ictr' s't Nov yr c ont+r t thi on e ho+++ua:l ca wi No.and Street Email address cnpee,_ M( 010W ( 1)312 •AIB60 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 this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes l" No 0 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 authorize CA'ATVroc. '1\ �( C,43-,4i ^c- to act on my behalf,in all matters relative to work authorized by this building permit application. itita-Cv itk ?r1 r 6 -7-3 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 perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. r'Lxa.ret\ Pr`, 6-8 ) 3 Print Owner's 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 ownr 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 Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number 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" T 4'-8 1/2" 1�-: /4 4'-8 1/2" C - Bath (old) 10 c N ; _ (ID °' 43.13 ft2 N - N3ath (new) $ co co it t). T i‘ _ ;--1 . 53.60 ft2 - 0 c\- i En k z ,_ A 3 ta a7 v 2 ,� ► ' .s N 4'-8 1/2" .4. t gat c 4" 0 gm' antry (old) ( ' n) —1' = 'za.51 1' = ' _' - 'a, ( ` _.; it • f 6'-5 1/4" Tr 0? 3'-7 3/4" ` ' 3" N N9.68 ft2 \. N 0 _ City of Northampton oat N,,M pp. �5 `..S, -�"`, Massachusetts aAtS k. .c cc w � �. .' DEPARTMENT OF BUILDING INSPECTIONS • \ 3 ` 212 Main Street • Municipal Building 0 ,Ca l!"' {l Northampton, MA 01060 SNly, i‘ 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: v 1ro e+'`, o • 4 The debris will be transported by: O\i p, UC_ ..0 riO`n 1 C-A2.av\6A9 . Jv\G. Name of Hauler: Vim' M• wZ E Mai e. vk Signature of Applicant: ( Date: 0 611 a-I alr)?-3 • The Commonwealth of Massachusetts J;�h Department of Industrial Accidents A k_. 1‘....4.,, I Congress Street.Suite 100 Boston.MA 02114-2017 ti*,' www.ntass.gor/dia 11 uokers'('ompensatiun Insurance Atltdas it:Builders ContractorwrElectrricians Plumbers. TO HI:FILED N 11 It I Ili. PERMITi'IM ;AI!THORI'fl. Applicant Information I�,, , _ I Please Print Lett his Name titusin ss Organization Individual): _ NOVA VG C.Ot s}"``Vv VCl ot'N GAB Avgv tnq . .VsC-, Address: A' SvAt etc S- City,fState/Zip:---C,11\t c op.e,..t.. i-tpr C LO W Phone#: (: l 5(a 'Se,0 r. .5rr yarn an eraplagter?Check the appropriate Met: Ty pr of project(required): I.®i am a esrpioyer with 7 enq+h,yee.,iftdt ted'ot part4iinet.' 7. ❑ Nets construction 201 am a sole propetewr or p;rrtnenhrp and hair no pioy ties wodonit tin nr in N. Remodeling any rapacity.[`o wont!":estop.insurantr mimed.I 9. D Demolition 3❑I am a hoax-miner doing all work myself.(No wuhon;comp.urwr ure ripurd.I" l0 a Building addition 4.0 I am.a hoar nos i and w ell be hint contractors to conduit all weak on my property. I N ill ensure that all contractors either has.:Mothers'compensation insurance w are sole I I a Electrical repairs or additions proprietors+rah no employees. 12.0 Plumbing repairs or additions 50 I am a general contra:tot and I Fume hired the sub-een %t trackurs trrd in the attached sheet. L 13.0 Root repairs se The sub-c.ntrmc►or r base employees and lease workers'romp amurance' 60 V1 e arc a immolation and its officer.lime eirt:erscd them right of exemption per M(iL c_ 1'S-O()the' esmp I y't,It 4).and we has a no employees.[Nu isorkers'comp insurance required" •Ans applicant that chocks bus al rust also till out the section treiow sbmeing them Nurkers eumpenaatsm policy mfumutios. *Ilonrvwtiers who suhenN this affuklsit endsJtrng they are doing all Ntrrk aril then here outside ci*iraeklfs must stibutut J new athdas it milic'trn_n"such :(ontractors that else►this beau must attached an additional sheet showing the name eat the sups urkartori and state'Mhether ow not Those entities!laic employees.. If the sub-erntraetun!laic employees.they must!carte their wr.rrkers`comp.policy number. I um an employer that is providing worAers"compensation insurance for my employees. Below is the policy and job site information. ^f l insurance Company Name: DMA j Wit .. � O al' S Policy#or Srlt=ins.Lie.#: WCGM Pf 00016 z 501 _ Expiration Date: OR t 111 7-02,3 Job Site Address: 6 Z A tTVILt t)(et.( `J+t _t ityStateiZip:.Nor Gt,r4p406r f-t A 01060 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Mt iI_c 152,r;25A as a criminal N.tulation punishable by a tine up to Si.S0).00 and or one-year imprisonment.as well as civil penalties in the time 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 timsttrdcd hi the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify'under the pains and rrnalties of perjury that the information prorided above is true and correct. Signature: ( [)ate: 6_ l 2. ZO 2- Phone ti: ( 57) 3(2 Pg6,'0 Official use only. Do not write in this area,to be completed hr city or town official ('its or'Town: Permitrl_icense it Issuing Authority (circle one): I. Board of Health 2.Building Drparlinent 3.('it:i Joss n Clerk -l.Electrical Inspector 5. Plumbing inspector t►.Other Contact Person: Phone#: • a ACCPRE) DATE IMMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 06/12/2023 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 CONTNAME:ACT Jeffrey Brochu Brochu Insurance Agency Inc (A/c°.No.ExU: (413)536-3311 u//a,Nol: (413)536-0900 725 Grattan Street EMAIL eff m C�brochuinsuranoe.CO ADDRESS: f INSURER(S)AFFORDING COVERAGE NAIC S Chicopee MA 01020 INSURER : Western World Insurance Company INSURED INSURER B: PMA Insurance Omarks Nova VC Construction&Cleaning Inc INSURER C: Progressive Casualty Insurance Company 41 Sullivan St INSURERD: INSURER E: Chicopee MA 01020 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. IN8R TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITSLIR, INen Win POLICY NUMBER IMM/DO/YYYIIrI (MMIDD/YYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500.000 DAMAGE TO REM tU CLAIMS-MADE Xi OCCUR PREMISES(Ea occurrence) $ 100.000 MED EXP(Any one person) $ 5.000 NPP8877348 05/03/2023 05/03/2024 PERSONAL BADVINJURY $ 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1.000.000 25 - POUCY JECT LOC PRODUCTS-COMP/OP AGG $ 1.000.000 OTHER: $ AUTOMOBLE UABIU1V COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 100000 OWNED X SCHEDULED AUTOS ONLY AUTOS 004892160 05282023 05/28/2024 BODILY INJURY(Per accident) $ 300000 _ HIRED NON-OWNED PROPERTY DAMAGE $ 100000 AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER °TH- AW)EMPLOYERS'LIABILITY STATUTE X ER ANY PROPRIETOR:PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000.000 OFFICER/MEMBER EXCLUDED? N N/A WCMA000162501 09/17/20 2 09l172023 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000.000 Eyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 8 1,000.000 it DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule.may be attached if more space is required) Janitorial Service-Cleaning.Carpentry. Painting&Drywall CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Maxwell Prior ACCORDANCE WITH THE POLICY PROVISIONS. 62A Hawley St AUTHORIZED REPRESENTATIVE Northampton MA 01060 Fax: Email: ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS g Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: Office of Consumer Affairs and Business Regulation TYPE:Corporation 1000 Washington Street -Suite 710 Registration Expiration 194365 03/23/2025 Boston,MA 02118 l NOVA VC CONSTRUCTION&CLEANING INC ALMIR DIAS 41 SULLIVAN ST trseta O01020ry Not ' without signature ma- Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-110457 Expires. 07/18/2024 Y4' GILMAR COSTA 8 TAYLOR STREET z«y` ` - MILFORD MA 01757 4 ' Commissioner `"",r.,..., / ., _ i i I, r- j f