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23A-146 (23) BP-2024-0523 130 PINE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23A-146-001 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-2024-0523 PERMISSION IS HEREBY GRANTED TO: Project# FIRE SUPP 2024 Contractor: License: Est.Cost: 105000 JOSE ROSARIO Const.Class: Exp.Date: Use Group: Owner: FLORENCE CONGREGATIONAL CHURCH Lot Size (sq.ft.) Zoning: URB Applicant: FLORENCE CONGREGATIONAL CHURCH Applicant Address Phone: Insurance: 130 PINE ST 413-586-1106 FLORENCE, MA 01062 ISSUED ON: 05/07/2024 TO PERFORM THE FOLLOWING WORK: NEW FIRE SUPPRESSION SYSTEM IN SANCTUARY INCLUDING THE GREEN ROOM,BATHROOMS, OFFICE ,FOYER AND ORGAN CHAMBER POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Build ink 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: /72. Fees Paid: $735.00 212 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 m (This Section For Official Use Only) O O 1 , ` D T `^' Building Permit Numb y-SA 3 Date Applied: Building Official: y C SECTION 1:LOCATION 4's Z n' 1 Z � No.and Street City 130 Pine St. /Town Florence Zip Code 01027 Name of Building(if applicable) Bombyx Dom CD rri o Assessors Map#23A-146 Block#and/or Lot#001 i SECTION 2:PROPOSED WORK N t Edition of MA State Code used_9_If New Construction check here 0 or check all that apply in the two rows below Existing Building Repair 0 Alteration*0 Addition❑ Demolition 0(Please fill out and submit Appendix 2) *0 Change of Use❑ Change of Occupancy 0 Other•0 Specify: fire Suppression 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:_New fie suppression system in sanctuary section of building.Including the green room,bathrooms,office,foyer and organ chamber. See attached letter from Brian Hellwig with submitted 4/16.24 with drawings_showing attic trusses ability to support sprinkler piping_. SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDMON, 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):_A- A-3 2 SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) 3 4590, 4590,132 0 Total Area(sq.ft.)and Total Height(ft.) 20' SECTION 5:USE GROUP(Check as applicable) A:Assembly A-1 0 A-2.0 Nightclub 0 A-3 U A-4 0 A-5 0 B:Business•0 E:Educational u F:Factory F-1 0 F2 0 H:High Hazard H-1 O H-2 O H-3 U H-4 0 H-5 0 I:Institutional 1-1 0 I-2 0 I-3 0 14 0 M:Mercantile❑ R:Residential R-10 R-2 U R-3❑R-4❑ S:Storage S-1 0 S-2 0 U:Utility 0 Special Use❑and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA❑IB❑ IIA❑IIB❑ MA❑IIIB❑ IV VA❑VB•❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Flood Zone Information: Sewage Disposal: Trench Permit Debris Removal: Supply: Check if outside Flood Indicate municipal A trench will not Licensed Disposal Public•❑ Zone 0 or indentify '❑ or on site be required ❑or Site ❑ or Private C Zone: system 0 trench permit is specify:_valley enclosed❑ Recycling Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Not Applicable*0 Is Structure within airport approach Pmcesc Is their review completed? or Consent to Build enclosed❑ area?Yes❑or No*0 Yes❑No*0 SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code:_9 Use Group(s):_B Type of Construction:_V-B_ Does the building contain an Sprinkler System?: NO Special Stipulations: 300 Design Occupant Load per Floor and Assembly space: SECTION 9:PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Florence Congregational Church _Marissa Egerstrom 130 Pine St.Florence Ma 01062 Name(Print)No.and Street City/Town Zip Property Owner Contact Information: Pastor 413 - 584 - 1325 415-710 - 2574 e offic Ofccnorthampton.org -— — - — Title Telephone No.(business)Telephone No.(cell)e-mail address If applicable,the property owner hereby authorizes: _Bombyx 130 Pine St.Florence Ma.01062 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) John Losito _413__330_-_2179 Name(Registrant)Telephone No.e-mail address Registration Number John@bombyx.live _130 Pine St. _01027_Street Address Discipline City/Town State Zip Florence Expiration Date 10.2 General Contractor AA Fire Protection Company Name lose Rosario Name of Person Responsible for Construction License No.and Type if Applicable _34 Barbara Lane Feeding Hills Ma.01030 Street Address City/Town State Zip _413_-_250=_9983 as firegroksoutlook.corn 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❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs: Total Construction Cost(from Item 6)_$_105,000 (Labor and Materials) Building Permit Fee=Total Construction Cost x (Insert here appropriate municipal factor)_$_700 1.Building $ Note:Minimum fee=$ (contact municipality) 2.Electrical $ Enclose check payable to 3.Plumbing $ (contact municipality)and write check number here 4.Mechanical(HVAC) $ r, Q� �f.-Q/1 5.Mechanical(Other) $105,000 7 / , 0 6.Total Cost $ c- 6P-al �( 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. John Losito _413_-_330=_2179 Please print and sign name Title Telephone No.Date 130 Pine St. _Florence .John@Bombyx.live _ Street Address City/Town State Zip Emailil Address Municipal Inspector to fill out this section upon application approval: /I/ Z 5- / Z Zt Name Date CITY OF NORTHAMPTON SETBACK PLAN MAP: 23A LOT: 146 LOT SIZE:_71,761 SF REAR LOT DIMENSION: 41,258 REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton Tr Massachusetts " 14, 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: Valley Recycling The debris will be transported by: Name of Hauler: Bombyx Signature of Applicant:_John Losito Date: 4/29/2024 Appendix 1 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.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 x 2 Foundation 3 Structural x 4 Fire Suppression x 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.) II Specifications 12 Structural Peer Review Structural Tests&Inspections Program ACC0 RO® CERTIFICATE OF LIABILITY INSURANCE DATE T ( MAD/4Y) 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 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 Laura Monsalve, Ext 122 NAME: Foley Insurance Group Inc. PHONE o.Ext1; (413)214-7474 FAic,No): (413)214-7447 37 Elm Street E-MAIL lmonsalve@foleyinsurancegroup.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# West Springfield MA 01089-2703 INSURER A:Hudson Excess Insurance Co. INSURED INSURER B:NGM Insurance Co. 14788 AA Fire Protection LLC INSURERc:Associated Employers Insurance Co c/o Jose Rosario INSURER D: 34 Barbara Lane INSURER E Feeding Hills MA 01030 INSURER F: COVERAGES CERTIFICATE NUMBER:CL2431818201 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. INSR TYPE OF INSURANCE IADDL SUBR POLICY EFF POLICY EXP LIMITS LTR p Wvp POLICY NUMBER (MMIDDIYYYY) ,(MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X OCCUR DAMAGE TO RENTED 100,000 PREMISES (Ea occurrence) $ FSL00052204 5/1/2023 5/1/2024 MED EXP(Any one person) $ 5,000 X ERRORS & OMISSIONS PERSONAL &ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO I ILOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED M1T6163M 2/3/2024 2/3/2025 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) $ Waiver of collision deductible $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ^ E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? I I N/A C (Mandatory in NH) WCC50050268062029A 3/31/2024 3/31/2025 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The certificate holder named below is included as an additional insured for General Liability coverage for ongoing and completed operations if required by written contract, permit, or agreement executed prior to a loss. CERTIFICATE HOLDER CANCELLATION kcarson@northamptonma.gov SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Northampton Building Department THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 212 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Northampton, MA 01060 AUTHORIZED REPRESENTATIVE Brian Foley/LAURA ^'-rf ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)