32A-152 (26) BP-2024-0494
5 STRONG AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32A-152-001 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-2024-0494 PERMISSION IS HEREBY GRANTED TO:
Project# CEILING 2024 Contractor: License:
Est. Cost: 7500 DAVID CLAXTON 017890
Const.Class: Exp.Date: 01/19/2026
Use Group: Owner: CORP TRIDENT REALTY
Lot Size (sq.ft.)
Zoning: CB Applicant: PIONEER CONTRACTORS
Applicant Address Phone: Insurance:
PO BOX 1145 4136267267 WCC500500957
NORTHAMPTON, MA 01061
ISSUED ON: 04/24/2024
TO PERFORM THE FOLLOWING WORK:
INSTALL SUSPENDED CEILING IN KITCHEN
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: /2.
Fees Paid: $100.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
0114 4)
APR 2 3 The Commonwealth of Massachusetts
2024 Office of Public Safety and Inspections
Massachusetts State Building Code(780 CMR)
`~ �k c L'ernut Application for any Building other than a One-or Two-Family Dwelling
().7';10N3 (This Section For Official Use Only)
Building Permit Number„,74 7 9 Date Applied: -WM/2-4 Building Official:
SECTION 1:LOCATION
No.and Street City/Town Zip Code Name of Building(if applicable)
15-t-f2o►-�lv �T l.Jp�-ria6J-11�r�1 J�1-dA . 'text,O
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used cC If New Construction check here 0 or check all that apply in the two rows below
Existing Building Repair 0 Alteration IV Addition 0 Demolition 0 (Please fill out and submit Appendix 2)
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 0 No 0
Is an Independent Structural Engineering Peer Review required? Yes 0 No 0
Brief Description of Proposed Work: I11.1�. T.L1L.L.- .C)uS Co II L
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
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.)
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 EiK 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 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 El IB ❑ IIA ❑ IIB 0 IILAQ IIIB ❑ IV CI VA CI VB
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Trench Permit Debris Removal:
Water Supply: Flood Zone Information: Sewage Disposal: Licensed Dis osal Site
Public Check if outside Flood Zone g Indicate municipal A trench w'll not be P
Private 0 or indentify Zone: or on site system 0 requiredEli
or trench or specify:
permit is enclosed 0 UN YG1.4 MLA
Railroad right-of-w Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable Is Structure within airport approach area? Is their review compl ted?
or Consent to Build enclosed 0 Yes 0 or No' Yes 0 No la
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
R- -rY 15 c,i 4.64r_.1zT. +fix-lQr a►._t , LAA .o IcC o
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
jZ1C l -t7 1--I4-.12aw 1 T Z - - -4 Z.59_ '7&66 r r c h c pare-A/P"'c t t�•t��'L
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
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 C.
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)
/WA — -
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
Ala►- �� GC-aT12a�s
Company Name
1:7LS.,v I 1:7 4 . «- c I l 8c1
Name of Person Responsible for Construction License No. and Type if Applicable
3?0.2C I)4-S I--t4='1"0t3 1- . d Icy 1
Street Address City/Town State Zip
- - -d 0.42‘,- ''72.107 p Icy eP,r G€ ' -i f ram se..644z).cam.
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 is uance of the building permit.
Is a signed Affidavit submitted with this application? Yes 0- No 0
SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE
Estimated Costs:(Labor
Item and Materials) Total Construction Cost(from Item 6)_$ 7,6enz5•op
1.Building $ 'e>o Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ 1,5ex=,•cam appropriate municipal factor)=$
3.Plumbing $ Z ct:::+f,•o p
4.Mechanical (HVAC) $ Note:Minimum fee=$lam'`° (contact municipality)
5.Mechanical (Other) $ Enclose check payable to G(' "* u1 rim!-2utt�1►J�o'S��IPT
6.Total Cost $ ?, 0O (contact municipality)and write check number here 2-l89 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.
74..V17:7 //�tGt�4 - 0 -"e - 7267 -/ /z4
Please prin d s' rXne✓ Title Telephone No. Date
Street Address City/Town State Zip Email Address
t?o. j! I I• 1—F2-71-I-AY-•(pf"C'4-1 l jj C'l'lc I I ta'1�►"'Go✓1 N�3 C.c�Yd .co'
Municipal Inspector to fill out this section upon application approval: / ' ' Zy-2ZZy
Name Date
2S ' The Commonwealth of Massachusetts
•
1 k� Department of Industrial Accidents
_ =k�
I Congress Street,Suite 100
• v.: Boston, MA 02114-2017
`,.w•
ww)+:mass.gov/dia
- 1lrukers' Compensation Insurance Affidasit:Builders/('ontr'atton(Ekctticians/Plumber..
It)HI.1.11.1.1)N 1111 1 III. P1.R'N11'I Itit AIITHORII'l.
sonlica ut Information Please Print Leeibls
Name 4Husincss Organization Indntduall:
Address: 145
b10�
City/State/Zip: 1.,127r4 -Ipw' 'Je l�l d.. I Phone#: -mil 13-IPZ Co- '724='7
Art you as coven,er?Chock the appnrprrate tw,s:
�l
�Iv pc of project(required).
I.�I am a cmplos-sT with e- eurplosses 1 lull arid.or part-time 1• 7 ®�/\t w eunstric11u11
20 I am a wile proprietor
or partnership and have no employees witting tun me in S. `—a RemudeImg
e u emir u ee any aprty (No workers'er uuran npam ) •J
9. 0 Demolition
a a I am a homeowner doing all wart myselt I!iu workers'comp unmans.n.qurnsl
10 Q Building addition
t❑I am a hurravwnrr and*ill be hiring ctrntrxtunto conduct all work on rats properly I will
cmun that all contractors either lase wurh.en'compensation insurance or are wile I 1 a Electrical Repam or additions
proprietors with no employees.
12.0 Plumping repairs tit additions
L'rl I am a general contractor and I has c hind the sub-contractors listed on the atiafa'.1-.heel 13.0 Root repairs
[hest nib-contractor,hasa emplusec,and tease workers'comp rmurmce
6.0 Vie are a corporation and its officers thaw exercised their nght of ctempt:on par 1NCaL e. 14.❑ ---
IS:.s4114I.and we have no etriplences.Ion workers'comp insurance requtred.l
aAny applicant that checks inn.a I must also till out the section bckrw showing then s utt.r,'eompcns ikon poll:. information
t Homeowners who animal this;Aidase indicating they are doing alt work and clam hue outside conitractor>nubs submit a new aiidas it missing such
:Contractor(that check this he, must anaehed an additional%him ahow,ng the name of the sub•:amtraclun and state whether or not those entities!lase
einplusces It dxc mute-contractors tease ernpluscc,.tins must pn"slde their wingers'..nip rvhes numhrr
I am an employer that is providing n'orAers'compensation insurance Or my employees. Below is the polies and job site
information.
Insurance Company Siam.. )--IUTU(1.1—
Policy x or Self-ins.Lie. r: 57Z0Z3A Expiration Date: <%/2-'4
Job Site Address: '1 �- � City�SLtte zip:we,lerru-a6.t--thral l t►-td. cxocl
Attach a copy or 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 tine up to SI,5(K).(X)
and'or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.(K)a
day against the s iolator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coserage senlicaIion.
I do hereby certify an e pat s and nail that the in%urmatian provided above is true and correct.
Signature ' V j Date
Phone=.-d 13—C.ZCO— '72Co 7
Official use only. Do not write in this area,to be completed bt'city or town official
( its or I own: 1'rrmit:License#
Issuing.‘uthorits (circle one):
I. Board of Health 2. Building Department 3.City 11own Clerk 4. Electrical Inspector S. Plumbing Inspector
6.Other
("intact Person: Phone#:
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
INFORMATION PAGE
Associated Employers Insurance Company
54 Third Avenue, Burlington, Massachusetts 01803-0970
(800) 876-2765 NCCI NO 40959
POLICY NO. WCC-500-5005957-2023A
PRIOR NO. WCC-500-5005957-2022A
•
ITEM
1. The Insured: Pi Con Inc
DBA: Pioneer Contractors
Mailing address: P O Box 1145 FEIN:**-***1984
Northampton, MA 01061
Legal Entity Type: Corporation
Other workplaces not shown above: See Location
2. The policy period is from 06/30/2023 to 06/30/2024 12:01 a.m.standard time at the insured's mailing address.
3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the
states 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 liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident
Bodily Injury by Disease $ 500,000 policy limit
Bodily Injury by Disease $ 500,000 each employee
C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B
D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE
4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans.
All information required below is subject to verification and change by audit.
Classifications Premium Basis Rates
Code Estimated Per$100 Estimated
No. Total Annual Of Annual
Remuneration Remuneration Premium
INTRA 000063757
INTER SEE CLASS CODE SCHEDU_E
Minimum Premium $377 Total Estimated Annual Premium $1,923
GOV GOV Deposit Premium $497
STATE CLASS
MA 5437 State Assessments/Surcharges
$1,507.00 x 4.1800% $63
This policy, including all endorsements,is hereby countersigned by JJ— ----'c - 05/30/2023
Authorized ignature . Date
Service Office: King&Cushman Inc
54 Third Avenue P 0 Box 447
Burlington MA 01803 Northampton, MA 01060
WC 00 00 01 A(7-11)
Includes copyrighted material of the National Council on Compensation Insurance,
used with its permission.
City of Northampton
atH M
u `S . .'si
i "g " Massachusetts ��NI • c'i. !
F.
1 ( , DEPARTMENT OF BUILDING INSPECTIONS
R j1 1 212 Main Street • Municipal Building y`)b ���
Northampton, MA 01060 �Sb,y .1,�0��
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: 1/�-------,c- p---G�e-t—i LLB
The debris will be transported by:
Name of Hauler: 1--lic- (-t5'lsk z /1C '
G�%CI : -4/ /�-
Signature of Applicant: Date
CONSTRUCTION CONTROL WAIVER
From:
���/I d
Li OAP TY-1-a-ti-•l t'TOL.I b (0 /
To:
Jonathan Flagg
Building Commissioner
City of Northampton
212 Main Street
Northampton, MA 01060
The Massachusetts Building Code, section 107.1 allows for an exclusion from requirements for
construction control in certain situations. In accordance with code section 104.10, I request that you
grant a modification to waive the requirement for construction control of the project at
7 .e -fl 'L1c.. Itt14,F l 1�b1�1 I. 4.ti.
because the work is of a minor nafure, will not affect structural elements, health, accessibility, life or fire
safety, and will be done in accordance with the prescriptive requirements of the code.
Thank you for your consideration.
Respectfully,