The URL can be used to link to this page

31A-035 (29) BP-2023-1203 5 FRANKLIN ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31A-035-001 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-2023-1203 PERMISSION IS HEREBY GRANTED TO: Project# RAMP 2023 Contractor: License: Est. Cost: 21000 MASS SURGICAL SUPPLY LLC 087453 Const.Class: Exp.Date: 11/29/2023 Use Group: Owner: CORPORATION RELIANCE HOLDINGS Lot Size (sq.ft.) Zoning: URB Applicant: MASS SURGICAL SUPPLY LLC Applicant Address Phone: Insurance: 249 HIGH ST (413)532-1401 014000500604123 HOLYOKE, MA 01040 ISSUED ON: 09/05/2023 TO PERFORM THE FOLLOWING WORK: INSTALL RAMP 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: 1 + rn,ptit4 „,,„ i.9, I'b I 41 Fees Paid: $147.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner RECEIVED SEP - � �ma� C �kG� 12lClG�/ 2023 The Commonwealth of Massachusetts DE•�r 4`' `DING INSPECTIONS Office of Public Safety and Inspections Iw lllg "•TON.MA 01060 Massachusetts State BuildingCode(780 AF CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number:42.4' /car3 Date Applied: Building Official: SECTION 1:LOCATION 5 Franklin Street Northampton 01060 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 9th If New Construction check here❑or check all that apply in the two rows below Existing Building Z Repair 0 Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other ® Specify:Temporary Handicap Ramp Are building plans and/or construction documents being supplied as part of this permit application? Yes ® No ❑ Is an Independent Structural Engineering Peer Review required? Yes 0 No 181 Brief Description of Proposed Work: Install pre-engineered metal(aluminum)handicap ramp for building access until elevator is returned to service. 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) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)Sr Area Per Floor(sq.ft) 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 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1® 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 Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ® IB ❑ IIA ❑ IIB 0 MA IIIB ❑ IV ❑ 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: Public 0 Check if outside Flood Zone 0 Indicate municipal 0 A trench will not be Licensed Disposal Site 0 Private 0 or indentify Zone: or on site system 0 required 0 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 0 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: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Reliance Holdings Corp. One Reed Avenue Westbrough 01581 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Reliance Holdings Corp. 508.981 _1331 - OneReedAve@gmail.com Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Mass. Surgical Supply, LLC 249 High Street Holyoke MA 01040 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 Wayne Boisvert Company Name Wayne Boisvert CS-087453 "U" Name of Person Responsible for Construction License No. and Type if Applicable 48 Carillon Circle Easthampton MA 01027 Street Address City/Town State Zip 413.539 8003 413.539.8003 4 wayne_boisvert@yahoo.com 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® No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor 21 000.00 and Materials) Total Construction Cost(from Item 6)=$ 1.Building • $ 21,000.00 Building Permit Fee=Total Construction Cost x 7n000 (Insert here 2.Electrical . $ appropriate municipal factor)=$ 147.00 . 3.Plumbing $ 100.00 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to City of Northampton 6.Total Cost , $ 21,000.00 (contact municipality)and write check number here 106478 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. David J. O'Connor Managing Member 413.532.1401 8/23/2023 Please print and sign name Title Telephone No. Date 249 High Street Holyoke MA 01040 djoc@masssurgical.com Street Address City/Town State Zip Email Address 2 Municipal Inspector to fill out this section upon application approval: J�9h4��V-,u�^ ` *t ► i'V s�o�3 Name Date J City of Northampton rr rid,:, .e.- s, Y '' �" Massachusetts 4�? �._ 'f<<`� fit, �, 1~: c+ C �: �j A DEPARTMENT OF BUILDING INSPECTIONS ys „x, .ycr' 212 Main Street • Municipal Building Northampton, MA 01060 SNii;,,- ‘%�c 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: 249 High Street, Holyoke, MA 01040 The debris will be transported by: Name of Hauler: Mass. Surgical Supply, LLC Signature of Applicant: CZ„,..,..,#/;‘,..„,_,,_ Date: 8/23/2023 IMN...® The Cornrnartwealth of Massachusetts i{„� Department of industrial Accidents \' - :,,„.,, ��T 1 Congress Street,Suite 100 �'�,"kBoston,MA 02114-2017 www.rtoss.gov^/dia )l alkers'Compensation Insurance Affidavit:BuiltlersiContractors/Electriclans/Plunibers. TO HE FILED WITH THE PERMITTING AUTHORITY. Annlicant Information Please Print L.ceiblc Name(ausinecsr(3tganiratiotvindividual): Mass. Surgical Supply, LLC Address: 249 High Street City/State/Zip: Holyoke, MA 01040 Phone#: (413).532-1401 Are roe an employer?Cheek the Appruprtate laic Type of project(required): 1. 1 run a employer with___,12._._employers(tilt and/or part-time).* 7. 0 New construction 20 I an a sole proprietor or pntnrrsbip and have no employees,working for nse in $, Q Remodeling any capacity.[No workers'comp.insurance required] ICJ I am a homeowner doing all work myself.[No workers`cone.insurance munins.l_I' 9. ❑Demolition 100 Building addition 4.C:1 1 am a homeowner and will be hiring contractors to currdrn,t all work on my property. I will ensure that all coattra1ara either have workers'aonyetitsation insurance or are sole 110 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 501 am a general contractor and I have hired the sub-contractors listed on the attached sheet_ I3. RUOf repairs These orb-contractors have employers and have workers'camp.insurance.: 6.®We are a corporation and its offccers have exercised their tight of exemption per MCAL c. 14.��i other Temporary Ramp 152,*1(4),and we have no employees.[No workers'comp.insurance require41.1 'Any applicant that chxks box#1 most also fill out the siectiort below showing their worker'etimpensation policy ud'urmatiun_ +I nneuwrhers who submit dui affi4L•nvit urdicatittg they are doing all work and then hire outside contractors must submit a new affid.av it iadiening strr:h. tConrractnn drat check thin box moat attached an additional sheet showing the name of der.ub-contractors and state*heater rye nut dose entities have employees. It'the sub-contractors have employees.they must provide their workers'comp.policy number_ I ant an employer that is providing rrorAers'compensation insurance for my employees. Below is the policy and Job site information. InSUratice Company Name: MA Retail Merchants W.C. Group Inc. Policy#or Self-ins.Lie.#: 014000500604123 Expiration Date: 01/01/2024 Job Site Address: 5 Franklin Street City/state/Zip: Northampton,MA 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 MGL c. 152,§25A is a criminal violation punishable by a fine up to SI,500.00 and.'or one-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up to S250.00 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. I do hereby certl y under the pains and penalties of perjury that the information provided above is true and correct. Signature: _- Date: 8/23/2023 phone (413) 532-1401 Official test.'only. Du not write in this urea,to be completed by city or town official_ (`its it I'uer n: Pertttit+License i I ss Mug;Authority(circle one): I. Board of Health 2.Building Department 3.CitylTo»n Clerk 4.Electrical Inspector 5. Plumbing Inspector (i.Other ('otrtAct Person: Phone#: Cmmonwealth nt Massachusetts Division of Occupational Licensure Board of Building Re ulations and Standards f'onstttrciton S visor CS-087453 $ 6pires: 11/29/2023 WAYNE M BOISVERT ' 48 CARILLON'.CIR EASTHAMPI'b)V MA 01027 Commissioner nee K. 27Cndia. Construction Supervisor Unrestricted -Buildings of any use group whict contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. • • Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license • Call(617)727-3200 or visit ycww.mass.goy/dpl NOTICE , _ NOTICE �.0 7� O _.- ,—• �— TO s EMPLOYEES or F. :; r EMPLOYEES ,1e MID The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS LAFAYETTE CITY CENTER, 2 AVENUE DE LAFAYETTE, BOSTON, MA 02111 (617) 727-4900 — www.mass.gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I (we) have provided for payment to our injured employees under the above-mentioned chapter by insuring with: MA Retail Merchants WC Group Inc. NAME OF INSURANCE COMPANY PO Box 859222-9222, Braintree, MA 02185-0000 ADDRESS OF INSURANCE COMPANY 014000500604123 01/01/2023-01/01/2024 POLICY NUMBER EFFECTIVE DATES HUB NE Association Programs 300 Ballardvale Street,Wilmington, MA 01887 NAME OF INSURANCE AGENT ADDRESS PHONE # Mass. Surgical Supply, LLC 249 High Street, Holyoke, MA 01040 EMPLOYER ADDRESS 01/17/2023 EMPLOYER'S WORKERS' COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the ser- vices provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the Holyoke Medical Center 575 Beech Street, Holyoke,MA 01040 NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER MASS. SURGICAL SUPPLY,LLC Customer: Independent Housing Solutions M S S • 4 Phone: sgh413 275 gmai ti Email: 2077 jakobsghost@gmail.com independenthousingsolutions@gmail.com Contact: Jakob Harris 249 HIGH .5T HO'L- GGK E.. MA 01040 PHONE : (413) 5 32— 140 1 Quote Date: 6/29/2023 FAX : (413) 532- 1128 Product# Qty Description Unit Quote Price Total RAMP 1 RAMP PER DRAWING EA $16,750.51 $ 16.750.51 LABOR 1 LABOR TO INSTALL 1:A $4,000.00 $4,000.00 FREIGHT 1 FREIGHT FROM FACTORY EA $1,222.92 $1,222.92 PERMITS REQUIRED BUILDING PERMITS EA TBD TBD TAX ON RAMP $1,046.91 SUB TOTAL $23,020.34 INDEPENDENT HOUSING SOLUTIONS 5 FRANKLIN STREET NORTHAMPTON,MA 01060 (413)275-2077 *Quotes are valid for 30 days 1 OF 1 AUTHORIZED SIGNATURE: DJ OCONNOR TA 5 Franklin Street, Northampton, MA 01060 Fence Mass. Surgical Supply, LLC PROJECT LAYOUT AND QUOTE (A)tof of 1l1.5g 249 High Street (A) fence 11.5' Holyoke, MA 01040 Project Information _ A (413) 532 — 1401 Surface: SOLID D.J. O'Connor Handrail: GUARDS Parking Lot 4 x 6 SR 4 x 6 —5 X 5 PHDPSSG Ramp Width:48" System Length:41' i--G —4 x 6 Comments Building —4 x 6— �PPrro,Property Owner's Approval 11 Signature: 0`�%"� --1"-) Door Printed Name: Durai Rajasekar - — Date: 08/22/2023 —4 x 6- 5x5 PHDP55G— —4X6— --4 x 5— Corner of building(B)to street 94' Door to corner of ,� _._ _ B building(C)21' 0-- • , e l 1 Electric Meter I 5x6 5x5, PHDP56GT —PHDP55G 1 <— Street Gas Meter Corner of building C (B)to fence 18' • FD Connection C EZ/ CCESSz A DIVISION OF NOMECARE PRODUCTS,INC. yi i Corner of building i (C)to fence 7.5' 1-800-451-1903 I FAX 1-866-528-1498 Fence i