32A-182 (4) BP-2024-1007
69 BRIDGE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32A-182-001 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-2024-1007 PERMISSION IS HEREBY GRANTED TO:
Project# WTR DAMAGE REPAIRS Contractor: License:
Est. Cost: 200000 M&S DEVELOPMENT LLC 094086
Const.Class: Exp.Date: 06/28/2025
Use Group: Owner: 69 BRIDGE STREET LLC
Lot Size(sq.ft.)
Zoning: URC Applicant: M&S DEVELOPMENT LLC
Applicant Address Phone: Insurance:
270 N MAIN ST SUITE 101 (508)538-8007 WCA5582798-10
MANSFIELD, MA 02048
ISSUED ON: 08/19/2024
TO PERFORM THE FOLLOWING WORK:
REPAIRS DUE TO WATER DAMAGE
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: 1/2-
Fees Paid: S1,500.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
RAC
The Commonwealth of Massach sett' AUG 7 2 202
Office of Public Safety and Inspectio 4
Massachusetts State Building Code(780 CM ) r) Pr OF
Building Permit Application for any Building other than a One-o
°a.kta os IONS
(This Section For Official Use Only)
Building Permit Number:02V1ZW7 Date Applied: I Building Official:
SECTION 1:LOCATION
(0 DGE S`i' 1�107tTii10.AP111J 01O oO NoR11tAMP1bU 1MPtANI 4 Y
No.and Street City/Town Zip Code Name of Building(if appe
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 a Repair a Alteration 0 Addition❑ 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 $i$ No 0
Is an Independent Structural Engineering Peer Review required? Yes ❑ No B
Brief Description of Proposed Work FE PAIR H.00 0 S O c r Of f LOOt2 i 1J Ei , DEV1,d A t.L IR E PA t►� 2'
Whin. cry o 4 PILL tN A
y.totc 1tw IJ g , PPn7 NIA, 101E7.1o& 1NAt.t.S ► IREPt_ft�.E
-nthtvl AS t.teEDED . Rey LALE ALL O tNe-tP ( EOM REGENT 1Ath'fEP- 7AAAAGE
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.) 1-1,o00
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 ® E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4❑ H-5❑
I: Institutional I-1 0 I-2❑ I-3❑ 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❑ U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA D IB0 HA 0 IIB0 IIIA0 IIIB 0 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:
119.
Public 0 Check if outside Flood Zone 0 Indicate municipal ❑ A trench will not be Licensed Disposal Site
Private❑ 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 VA. Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No 0 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
C4tULi4wk-.J VA AA b9 6RlOG'E Sit IWT NoRTHAMP'1ati/ Ol(Mob
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
tmlne . 413 -5 - I1V (#11-$49- o0oo C4.41)L4twA-,...K1M0/Alioo.
Title Telephone No.(business) Telephone No. (cell) e-mail address (oM
If applicable,the property owner hereby authorizes:
MS DSVE1,o1"1.AaT. L.A.C. Tht4 MAIN S-r' SVtTC lot MAIJSI=tEt.D MA 02o4B
Name Street Address City/Town State Zip
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here$.
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)
\gate(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
(4 S bEVOA*M.a kt, u,c, - -
Company Name
MAIL- PtwIt 1ci 6141
Name of Person Responsible for Construction License No. and Type if Applicable
'L'to N MAN ST. Svtrl 1 o I MMJSFIEL( lt/r aOita
Street Address City/Town State Zip
Sob -53L- tool 942) -1)240 - '10.0 M?AVER i MANDS DEVELIPMENT• LAM
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 2 oc�, p 0 O
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ too,o o O Building Permit Fee=Total Construction Cost x_(Insert here
2.Electrical $ appropriate municipal factor)_$ .
3.Plumbing $ & �f
4.Mechanical (HVAC) $ Note:Minimum fee=$ Is (contact municipality)
5.Mechanical (Other) $ Enclose check payable to THE CITY OF Noltitiftet4t7D IJ
6.Total Cost $ 2.00,0 00 (contact municipality)and write check number here e'j 0 O
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 • owledge and understanding.
MKK MitKO- a OWN61<. MIS DE L5�3z(o- 1120 8-5 2y
Please print and sign name Title Telephone No. Date
'Li 0 0 MAIN Si. SvtiE cat Mikti Sft OA 4/A 0Z04 b MPARKE1(&UiMubS DO OPMevr.f,M
Street Address City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval: /J// 8 I7"zoZy
Name Date
f
City of Northampton
7 °" Massachusetts ?
rt�4 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: RFc.' c t,ANG SoWT1oNc. Y J1-tA vA. MA
The debris will be transported by:
Name of Hauler: PAS 1)1,S PoSAL► l,l�G
Signature of Applicant: Date: g -5 -24
The Commonwealth of Massachusetts
Department of Industrial Accidents
—v {l" 1 Congress Street,Suite 100
_
t'• .1;1_" Boston,MA 02114-2017
- w ww mass.gov/dia
a "1 1
Workers'Compensation Insurance Affidavit:BuikiersiContractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
ADDileant Information Please Print Legibly
Name(Business/Organization/Individual): M v Pt't rr 4LC
Address: Z10 Imo) MAIN 4T SJ tTe (O►
City/State/Zip: M RNS F 11✓L.D .MA O2O4 so Phone#: 5orr S38— 8 OO-I
Are yea an employer'Cheek the appr.prtate box: Type of project(required):
l.9.l am a employer with r employees(full and/or part-Limey* 7. �New construction
20 I am a sole proprietor or partnership and have no employees working forme in 8. Remodeling
any capacity.[No workers'comp.insurance required.]
301 am a homeowner doing all work myself[No workers'comp.mini ice required.)' 9. Demolition
4.01 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will I 0 Q Budding addition
ensure that all eoetra►.tors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
5C3 I am a general contractor and I have hired the subcontractors listed on the attached sheet. 3.0 Roof repairs
These subcontractors have employees and have workers'comp.insurance.:
6.0 We are a corporation and its officers have exercised their right ofexemption per A1GL c. 14. Other
152,¢1(4).and we have no employees.[No workers'comp.insurance required.]
'Any applicant that checks box#1 mmt also fill out the section below showing their workers'compensation policy information.
t 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 subcontractors and state whether or not those entities have
employees. If the subcontractors have employees,they must Provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: R CAb i Pt INSo1'ZAN G E ( M Pik-la'(
Policy#or Self-ins.Lic.#: W C A 55 55 21°l " 1 _ Expiration Date: 3--2t4- 25
Job Site Address: 1Dci FAZIDG-E St City/State/Zip:iqtYe.-TiiAMPTbtJ kA41- O1Ot40
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$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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereb r e ns and penalties of perjury that the information provided above is true and correct
Q
Signature: Date: cl.-C;
Phone#: 50$ S 38- s3OC 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):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
�...N M&SDEVE-01 K• 11
AC: RO CERTIFICATE OF LIABILITY INSURANCE DA3r2srzoza TE YI
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
1 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
GAME.
'Keefe Insurance Agency. LLC
51 West Central Street ArC.N o.Eaq (508) 528-3310 FAX
No; (508) 528-3887
Franklin,MA 02038 A❑DRESS MAIL inf keefeins.corn
INSURERjS1 AFFORDING COVERAGE NAIL a
.INSURER A.Acadia Insurance Company 31325
INSURED ' INSURER B.
M&S Development LLC iNSURgRC
270 N Main St,Ste 101 INSURER D
Mansfield,MA 02048
INSURER E
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.
NM ADDI.SUER POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE POLICY NUMBER LIMITS
IN 1MWOolYYYY) (61MiOWYYYYE
A I)( f COMMERCIAL GENERAL LIABILITY 1,000,000
EACH OCCURRENCE • S
I •
CLAIMS-MADE X OCCURDAMAGE TO RENTED 300,000
CPA5582796-10 3/24/2024 3/24/2025 PREMtsES(Ea ox s ence) S
MED ExP An rson $
10,000
I_JL�eL_ 1
PERSONAL B AM/INJURY 1,000,000
GE 'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE ,S 2,000,000
- POLICYJ PRO-
JECT I LOC PRODUC'S•C P P AGG _ 2,000,000
OTHEI.
A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
_IEaacddent
ANY AUTO s !MAA5582797-10 3/24/2024 3/24/2025 BODILY INJURY(Per person)_O
AUT S ONLY x I SCHEDULED BODILY INJURY(Per accdeng $
X AUTOS ONLY X I AUTOS ONLY (PROacctlenERTtDAMAGE S --_
1 — I1
A X UMBRELLA LIAB X ' OCCUR - EACH OCCURRENCE S 1,000,000
EXCESS LIAB CLAWS-MADE CUA5584356-10 3124/2024 3/24/2025 AGGREGATE ,$
, L IiL E\-. rl j f 1,000,000
A WORKERS COMPENSATION PER -OTH•
AND EMPLOYERS'LIABILITY STATUTE ER
ANY PROF RIETORIPART\ER!bXECUTIVE Y/N' WCA5582798-10 3/24/2024 3/24/2025 E.L.EACH ACCIDENT S 100,000
OFFICERIM in BERNIl)EXCLUDED, [ N JA E.L.DISEASE•EA EMPLOYE>F- 100,000
(MandMory in NH) 500,000
It es.descrlDe under
a - rums OF OPERATIONS below j ___- E L.DISEASE-POLICY LIMIT j S
I
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule.may be attached if more space is required)
•
ii
CERTIFICATE HOLDER _CANCELLATION
1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE '
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Cities and Towns in MA for permitting purposes
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
. ag:114141A-.V,A.,1 A-
ACORD 25(2016/03) Cc)1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to:
TYPE:LLC Office of Consumer Affairs and Business Regulation
Registration Expiration 1000 Washington Street -Suite 710
196741 09/19/2025 Boston,MA 02118
M&S DEVELOPMENT LLC
NARK PARKER
270 MAIN ST,SUITE 101
MANSFIELD,MA 02048
Undarseeretary Not valid without signature
A
Iii Commonwealth of Massachusetts
D of aoal L
Board oif Building
Occup RegI rationstin and Standards
Canso bin S ervisoricensure
CS-094086 f 4pires:06128/2025
MARK DPAVER -i 1 in
_ 49 BALCOMTREET
MANSFIELD* 02048 'f
� ,
1�'V��LL�'d:1�').
Commissioner c'c a K. VErnc@sa,
s of any use group which contain
Unrestricted
Building 991 cubic meters)of enclose
Construction Supervisor d
less than 36,000 cubic feets(pace.
tts
to possess a current for revocation f this license.
Failure Code is cause
State Building mass.govidpl
617ense
r information 727.3200 or visit twww mass.
Call( 1
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CONSTRUCTION CONTROL WAIVER
From: m ( dt0/I ie �L C
9 ?) /71/,;-1 c3 r Svd /e /v/
1 7ah,5kie/d 17'?,4- OzcG/
To:
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
Ak -I-boo,ply 5,�-,p F 12e,-1 G;(7 .6r,/54 ,S-/" A0�4,a 71-0,,-? /VI/a-
because the work is of a minor nature,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,
A