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38B-075 (10) BP-2024-0760 215 SOUTH ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-075-001 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-2024-0760 PERMISSION IS HEREBY GRANTED TO: Project# BATH RENOS 2024 Contractor: License: Est. Cost: 78929 CHRISTOPHER JACOBS 60475 Const.Class: Exp.Date: 11/10/2024 Use Group: Owner: LATHROP HOME Lot Size (sq.ft.) Zoning: URB Applicant: BARRON &JACOBS Applicant Address Phone: Insurance:, 420 NORTH MAIN ST 413-586-8998 WMZ80080063652022A LEEDS, MA 01053 ISSUED ON: 06/12/2024 TO PERFORM THE FOLLOWING WORK: RENO 2 FULL BATHS 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: 7 0 Fees Paid: $553.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner RECEIVED JUa 1 1 2024 The Commonwealth of Massatihus�etts t r• Office of Public Safety and Inspections GFPT OF�UICf)N �.• Massachusetts State Building Code(780 CiMR) J �,�.�,s, ,, IN„ PF TION S Building Permit Application for any Building other than a One-or T* Family-lhve tg (This Section For Official Use Only) Building Permit Number..'/` '70e Date Applied: Building Official: SECTION 1:LOCATION 2-15 Soo•i'v, St• t l^v•(}A'A"m,p2on b\00, rhPi No.and Street City/Town Zip Code Name of Building(if applicable) -208 (3-O -001 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 Repair 0 Alteration 24 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 Oil No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No Brief Description of Proposed Work pcl..\e., 10 (bx'‘S vOohev%S ,hS� n�.lvW 7\Jr 00 '^I �CO(Avre-S &"-A- r\AAJ 21tc kricr �'T 4 foor 644%, k\- 1ne:o�1 r� \1 lac. (L 1v%Ou tzL - ".0 t r L L..wng S -14 frt��r �Iar1 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)&Area Per Floor(sq.ft) Total Area(sq.ft.)and Total Height(ft.) y(-051 Sf 4O '\h3 SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2❑ 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 0 I-23i I-3❑ I-4 0 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 0 IBO IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV 0 VA 0 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 1,4 Check if outside Flood Zone pi Indicate municipal VI A trench will not be Licensed Disposal Site la Private 0 or indentify Zone: or on site system 0 required$)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&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 Lam} --\-btNn¢- 245 Si $t. 0:Yek nsil,.. 0111)100 Name(Print) No.and Street City/Town Zip Perty Owner Contact Information: i t i:,!'n*V-- '01>58'i- 71'4nt - Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: e.-AfW 5&-C-30 !51V(V9 .rS %2Z N i \r• St (, s 010 3 Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Company Name C,\nc.‘ tC S - o 'OI-V Name of Person'Responsible for Construction License No. and Type if Applicable "\10 k . tAAkr. St• l..a-e- A N\la Q DS3 Street Address City/Town State Zip 0)- - rVt'S tit s -290- b f' i h e, bao/Y0 v- J cvaobs cam' Telephone No.(business) Telephone No. (cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes 0 No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ �(el ZP\ 1.Building $ CIO)`ki Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ (0, 'AOC appropriate municipal factor)=$5`b 3.Plumbing $ l 2 Q 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ TT.F\'1-41\ (contact municipality)and write check number here ')- 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 owledge and understanding. C..^{.‘S *SA(. 106 �j' ?res;d4A-A- k°1`t� Please print and sign name Title Telephone No. Date -2' N• NA v (WC- o1o9) w o ba voivb(Jac.o bS.c Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: /r�///- Gj/z zq Name Date SIGNATURES No work can begin prior to the signing of the contract,and the owner receiving a copy of the contract. By signing below,you agree to items A, B and C. A. Alternative Dispute Settlement(Arbitration Clause):The Seller and the Buyer hereby mutually agree,in advance,that in the event of a dispute concerning this Agreement,the parties shall submit such dispute to a professional,state-approved arbitration service(cost,if any,to be paid by the submitter)prior to either party proceeding to legal action in the courts. B. By signing this agreement,you,as the owner of record,are hereby authorizing Barron&Jacobs Associates Inc.to act as your authorized agent in all matters pertaining to the building permit application. C. This is a binding Agreement. You may not cancel it except as stated. This Agreement covers and supersedes all conversations,statements and agreements,expressed or implied,between the parties,their agents or representatives. DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES. You,the Buyer,may cancel this transaction Buyer Date at any time prior to midnight of the third business day after the date of this transaction. See the attached notice of cancellation form Buyer Date for an explanation of this right. Seller retains an equal right to cancel. 9( / , Barron&Jacobs Representative Dat ********************************************************************************************* Contact Information Office Manager: Sandy Scavotto Office:413-586-8998. x102 © Chris Jacobs,President CT HIS#0554397 Cell phone:413-250-6677 Office phone ext: 100 Home phone:413-665-91 13 0 Iesha Gomillion,Senior Designer Cell phone:413-923-7003 Office phone ext: 104 MA Construction Supervisor License 060475 MA Home Improvement Contractor 100809 CT Home Improvement Contractor 518617 Purchase Agreement Page 24 of 24 DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit was issued with the condition that all debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L c. 111, s. 150A. The debris will be disposed of in: JName Of Waste-f'acility Address of Waste Facility 111.5 Debris: As a condition of issuing a permit for the demolition, renovation, rehabilitation or other alteration of a building or structure. M G.L c 40 s. 54 requires that the debris resulting therefrom shall be disposed of in a properly licensed solid waste disposal facility as defined by M G L.c. Ill s. 150 A Signature of the permit applicant, date and number of the building permit to be issued shall he indicated on a form provided by the Building Department and attached to the office copy of the building permit retained by the Building Department. If the debris will not be disposed of as indicated, the holder of the permit shall notify the building official, in writing,as to the location where the debris will be disposed. 780 CMR—6th Edition Signature of Permit Applicant 61-5f Date The Commonwealth of Massachusetts t!l. Department of Industrial Accidents _wed= 1 Congress Street,Suite 100 e Boston,MA 02114-2017 av www mass.gov/dia � Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information nn Please Print Legibly Name(Business/Organization/Individual): 1Ay'y'.v-, pw-�c{ '!ll��)� �CS�i,�1` Address: te\ ct City/State/Zip: L12- .a PM' 01o`:3') Phone #: ►-t�?�-S$'C� ���1� Are you an employer?Check the appropriate box: Type of project(required): 1.®1 am a employer with kO employees(fiill and/or part-time).• 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ®Remodeling any capacity.[No workers'comp.insurance required.] 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]' 9. El Demolition 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.VI Electrical repairs or additions proprietors with no employees. 12.Ui Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.: 13.❑Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.QOther 152,§1(4),and we have no employees.[No workers'comp.insurance required] *Any applicant that checks box k1 must also fill out the section below showing their workers'compensation policy information. *Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. /y Insurance Company Name: /� , MukJ \ Policy#or Self-ins.Lic.#: V�1'V�� -VD(a-1) Expiration Date: -7j t 12-0 2-'3 _ lob Site Address: 2i5 50,J\ City/State/Zip: Np(-k- 111 V- MPc Attach a copy of the workers'compensation policy declaration page(showing the policy number and ezpira 'ou date). O lOhO Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or 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 DIA for insurance coverage verification. I do hereby certify under the pains nalties of perjury that the information provided above is true and correct. Signature: Date: (D( >t J--is 1 Phone#: -77 - l°1 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACC P RLY CERTIFICATE OF LIABILITY INSURANCE DATEIM'a,DD,YYYYI 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 Adina Edgett,CISR NAME: Alera Group.Inc IAICNvo Est): 586-0111 FAX �): (413)586-6481 Webber&Grinnell Division E-MAIL aedgett@webberandgrinnell.com ADDRESS: 8 North King Street INSURER(S)AFFORDING COVERAGE NAIC H Northampton MA 01060 INSURERA: Main StreetAmerica/MSA 29939 INSURED INSURER B: NGM/MSA Barron&Jacobs Assoc Inc INSURER C: A I M Mutual/A.I.M. 33758 420 N Main Street INSURER D INSURER E: Leeds MA 01053 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 03/24 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 ADOLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDOIYYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000.000 DAMAGE rCLAIMS-MADE X OCCUR PREMISESO c (Ea occurrence) S 500.000 MED EXP(Any one person) S 10,000 A MPT8049D 03/09/2023 03/09/2024 PERSONAL BADVINJURY $ 1,000,000 03/09/2024 03/09/2025 3,000,000 GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S POLICY Fl JPROT pi LOC 30000l OTHER EPLI S 10,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 1,000,000 B OWNED X SCHEDULED M1 T8049D 03/09/2023 03/09/2024 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED 03/09/2024 03/09/2025 PROPERTY DAMAGE S X AUTOS ONLY X AUTOS ONLY (Per accident) Medical payments S 5,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE S B EXCESS LIAR CLAIMS-MADE CUT8049D 03/09/2023 03/09/2024 AGGREGATE S DED X RETENTION S 10,000 03/09/2024 03/09/2025 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDENT S 500,000 OFFICER/MEMBER EXCLUDED') n NIA WMZ80080063652023A 03/01/2023 03/01/2024 (Mandatory In NH) 03/01/2024 03/01/2025 E L DISFAAF-EA EMPLOYEE S 500,000 If yes descnbe under 500.000 DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is reawred)� CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE .11 C 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Jam/ Barron & Jacobs DESIGN . BUILD . REMODEL Dear Code Official, Enclosed please find an application and supporting documentation for a requested building permit. I have enclosed a self-addressed, stamped envelope for your convenience. Please mail the building permit to our office. Thank you. Sincerely, Chris Jacobs A Tradition of Building Satisfaction,Since 1986 420 North Main Street, Leeds, Massachusetts 01053 413.586.8998 barronandjacobs.com > 8'-1 1 /4" x X 1'-1 3/4" > < 5'-1 1 /2" x 1 '-2 1 /8" 3'- 1 /8" x 3'-2" >< I5/8" 1 q/16" 6 q/16" + q <>< 2'-q" - - 2'-q" > 3249DH — _ - - 0.111WIMIIIIII. 294001-1= =294017H= r 1 al'cn 1 - - - r-1 �- � SLOPED 1c324R) I 1gg ' , 4,-q„ / ,-� ) CEILING t. - - _ � 1 266� �c N `� i� Itiii L 1 l� tNI- iN Nil � �� .)3 11sl � 0 j � I � o I v4S 1 x � �'o� fl > E/ I Ir -2868 — \ / L2868 —fie 8'-4„ ,SECOND FLUOR BATH THIRD FLOOR BATH EXISTING CONDITIONS EXISTING CONDITIONS SCALE - 3/8" = 1'-0" SCALE - 3/8" = l'-0' SCALE:AS STATED DRA\WING TYPE: PROJECT: CLIENT INFO: i I I DRAWING PHASE: SHEET: LATIIROP -IOM E PRFI.I'.1IINARI' Barron & Jacobs BATHROOM REMODEL - DESIGN . BUILD . REMODEL 215 SOUTH ST D:1'I'IE:.,8/1I 420 NORTH MAIN STREET.LEEDS MA 01053 NORTHAMPTON PTOi�' MA 01060 i 1 DRAWN BY:CBE ALL DRAWINGS,PLANS,& DESIGNS ARE PROPERTY OF BARRON&JACOBS,INC. _ i