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31A-106 (4) BP-2024-1161 22 FEDERAL ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31A-106-001 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-2024-1161 PERMISSION IS HEREBY GRANTED TO: Project# 2024 INTERIOR REBUILD Contractor: License: Est.Cost: 25000 VLADIMIR AGAPOV CS-060134 Const.Class: Exp.Date: 11/04/2024 Use Group: Owner: M MOLITORIS JOHN V& SUSAN Lot Size (sq.ft.) QUALITY CLEANING AND RESTORATION Zoning: URA Applicant: SERVICES Applicant Address Phone: Jnsurance: 72 MONTAGUE CITY RD (413)774-7737 7PJCB 0009579-24 GREENFIELD, MA 01301 ISSUED ON: 09/10/2024 TO PERFORM THE FOLLOWING WORK: DEMO ALL INTERIOR FIRE DAMAGE TO STUDS 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: ./"Z Fees Paid: $188.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner 1Ca 11 - 4/3 to,/f /0, 06 U p-0-rii fhe ommonwealth of Massachusetts `SAP 6 - Be.rd o Building Regulations and Standards FOR A ` v��� �� 24 .ssa usetts State Building Code, 780 CMR MUNICIPALITYUSE •teaOP' °ATyq 3 t"Ns Permi App ication To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 t'r' on: a PoNg One-or Two-Family Dwelling This Section For Official Use Only Building Permit Numberrp 202i/—//[i ( Date Applied: ((_G17 uilding Official( riot Name) ature SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 22 Federal Street — 31A-106-001 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: URA ,2-55acre_ Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: John&Susan Molitoris Northampton MA 01060 Name(Print) City,State,ZIP 22 Federal Street 413-588-8352 Sarahannmolitoris©gmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: Interior demo of fire damaged walls,floors,ceilings,cabinets,bathrooms-demo all to studs SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $25,000.00 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Ir Q� Check No.6 Check Amount: t D Cash Amount: 6.Total Project Cost: S 25,000.00 ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-060134 11/4/2024 Toshi Kashima License Number Expiration Date Name of CSL Holder 15 Union Street List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) Greenfield MA 01301 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-522-1713 kashimabuilders©yahoo.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 188432 10/26/25 Vladimir Agapov,Quality Cleaning and Restoration HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 72 Montague City Road info@qualityrestoration.com No.and Street Email address Greenfield MA 01301 413-774-7737 City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) Workers Compensation Insurance affidavit 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. Signed Affidavit Attached? Yes . 12 No . 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Quality Cleaning&Restoration,Inc to act on my behalf,in all matters relative to work authorized by this building permit application. See attached authorization Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION 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. Patrick Locklear 9/5/2024 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton Massachusetts x- r: 44 DEPARTMENT OF BUILDING INSPECTIONS r ``•�_+r'�` -� 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,234 Easthampton Road, Northampton MA The debris will be transported by: Name of Hauler: USA Trucking Lazazi Signature of Applicant: Date: 9/5/24 The Commonwealth of Massachusetts tc Department of Industrial Accidents 1- bt 1 Congress Street,Suite 100 c:aa ei Boston,MA 02114-2017 --1,,,,,-,y wruw.mass.gov/din 1%otl(ers'Compensation Insurance.‘fl-idasit:Builders/Contractors/Electricians/Plumbers. TO BE' l'11_I•1)\\MI II 111E PERMlft-rtMM:eta TIlORffv. .tutllicaat Inforination Please Print Leaihh Na iblusiness:Organtration:Indtviduall: Quality Cleaning & Restoration, Incrnty Address:72 Montague City Road City/State/Zip:Greenfield MA 01301 Phone#: 413-774-7737 Are you as enmployer?Check the appropriate Mn: Type of project(required i i.0 i am a employer with 18 ---employees tfull and:or part-time)-' 7. 0 New construction 20 I am a sole proprietor or partnership and have no emptuyecs working for nac m !i. Q Remodeling any capacity-[No written:comp.uwuctncz nspuroll 30 I am a homeowner doing all work myself.(No worktas'eomp-mmarance n-qu rol-j' 9. El Demolition 4.0 I ant a homeowner and will be hiring contractors to conduct all work on my parpiary. I will 1 U Q Building addition ensure that all contrah.'iots either have workers*compensation insurance or art sole 11.Q Electrical repairs or additions proprietors with nu employees.. 12.0 Plumbing repairs or addition 50 lam a general contractor and 1 have hued the subcontractors liskrd sou the attached Ate These sub-eantractors tease employees and Lave workers'comp.insurance 13 Roof repairs 14.©Other interior demo 60 N`e are a corporation and Its officers have exercised their right of exemption per MCA.c-152.¢1i 4t.and we have no ernpluyces.[No workers'comp.insurance invited. *Any'applicant that checks box a1 mihi also fill out the section below showing their workers'compensation policy information. ' Homeowners who submit this atl'adavit indicating they are doing all work and then hire outside contractors must submit a new ailuiavit iniiurting stair. Contractors that check this box must attached an additional sheet showing the name of the sub-runtractars and state whether or riot those entities have employee's If the sub-contractors have enyloyees they must provide their worker'comp policy number. I am an employer that is providing workers'compensation insurance Or net'employees. Below is the policy and job site information. Insurance Company Name: Travelers Insurance Company 7PJUBOG9579-24 06/19/2025 Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: 22 Federal Street City/State/Zip: Northampton MA 01060 Attach a copy of the workers'compensation police declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL e. 152, §25A is a criminal violation punishable by a tine up to 51,500.00 and/or one-year imprisonment,as well as civil penalties in the form o f a STOP WORK ORDER and a tine 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 I)NA for insurance coverage verification. l do hereby certify under the pains anndd penalties of perjury that the information provided above is true and correct Signature: 5iIt.461 Date. 09/05/24 Phone#: 413-774-7737 Official use only. Do not write in this area.to be completed by city or town official Cits or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5, Plunthintt Inspector 4.Other Contact Person: Phone#: AcORDa CERTIFICATE OF LIABILITY INSURANCE DATEIMM'DD,YYYY) �� oa/osv2oza 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 Jennifer Ellinger NAME: Aquadro&Associates PHONE (413)586-7373 FAX (413)584-0859 Aic o,Ex* (NC,No): 355 Bridge St.,P.O.Box 357 L jenn@aquadroinsurance.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL N Northampton MA 01061 INSURER A: Quincy Mutual Insurance Co 15067 INSURED INSURER B: Travelers Insurance Company Quality Cleaning&Restoration Inc. INSURER C: 134 South Shelbume Rd INSURER 0: INSURER E: Greenfield MA 01301 INSURER F: COVERAGES CERTIFICATE NUMBER: CL1571006761 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MAVDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE n OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ - PERSONAL 3 ADV INJURY $ - GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY EPRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED x SCHEDULED Y AFV206793 12/30/2023 12/30/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS XHIRED v NON-OWNED PROPERTY X E $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION Xi STATUTE I 1`&H- AND EMPLOYERS'LIABILITY Y/N B ANY PROPRIETORIPARTNER/EXECUTIVE N IA 7PJUB 0G09579-24 06/19/2024 06/19/2025 E.L.EACH ACCIDENT $ 1'000'000 OFFICER/MEMBER ER EXCLUDED? 1,000,000 (Mandatory In NH) E.L.DISEASE•EA EMPLOYEE S If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more spec*Is required) DKI Ventures,LLC,its subsidiary companies,and its and their respective officers,employees and agents are added as Named Additional Insured to the Commercial General Liability, Commercial Automobile Liability,Follow Form Excess/Umbrella Liability and Contractors Pollution/Environmental Liability Insurance with respect to liability arising out of ongoing and completed operations performed by or on behalf of the Named Insured. 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 l CO 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 111111- Quality Cleaning n Restoration.lire. QUALITYyl` 72 MonLnguc City Koad Date: c., a 3 ; tits: Greenfield MA01301 Restoration tt 413-774-7737 I intinngUnlityTestotation..aui ,Dale t=to EiN:45-41_71b3 FIRE r:,TOrt� lie went SIASSACIIUSETTS POST-LOST.ASSIGNMENT OF INSI'RANC'E RIGHTS&I)IRECTION TO PAY ntto I'olicyhnlder: ej c'/-j/J 4440/-/ t o i , Cs Adjuster:Jrc Z ih; Phone Number: / Insurance Company: Property Address: og /��O C'f '� •S %'' Claim Number: ( ill A/C,i1 !-/4 f/i'l 'O 7 .ks.l. All?, I/ate of Loss: _‘/22/24 Email Address: Type of Lows: s ifti arPe I Imesoeabk Post- As iv me t of 1'xlktho ten' Iuhis A la r Insurance Comnep) To Cnntractsi; lty execution of this urevocabk Post-Toss Assignment of Insurance Rights and Direction of Pay ("Assignment-1.the pnlicyholder(sI 1..`0 identified abode(-Policyholders';completely. uresocably, and fully assign and transfer to the Contractor named above all of tire Policyholders legal and equitable reht_s,title.and interest under all insurance policies arising from claims for the damage Contractor was hired to address(collectiseh referral to as the"Assigned Rights') The Assigned Rights include without limitation the rights to collect insurance policy,benefits and proceeds.and the right but not the obligation to panicipate in appraisal of the loss or the portion of the loss in which Contracts is invoked.The Assigned Rights include without limitation the Policyholders'rights as a first-piny insured under the Policyholders'policy of insurance,the right to sue the insurance company to enforce the Assigned Rights,and to prosecute any applicable causes of action for breach of contract,bleach of the implied covenant of good faith and fair dealing timurance bad faith),fraud,and negligence.This Assignment shall be liberally construed to the fullest extent permitted by law and so that Contractor III iSadeemed to stand in a first party position as to the policies.The Policyholders shall remain obligated with respect to all duties and liabilities under the terms of the insurance policies,including the duty to properly document all claims and cooperate with the insurers investigation.Contractor ones none of those duties.This Assignment may only be resoked by written notice to the Contractor after the contract is terminated in writing,but is permanently irrevocable as to work performed before the contract is terminated f delusions'Nothing in this Assignment shall be construed as an assignment of other pans of the insurance claim that ' are unrelated to Contractor's scope of work.such as additional living expenses.the salue oflost personal property,or sees ices performed after Contractor's services are terminated.Nothing in this Assignment shall be cnnstrucdps a delegation of duties. No Conditions;The Policyholders agree and understand that this Assignment and each of its component parts are irrevocable.The Policyholders expressly'acknowledge that ii is the Policyholders'intent to assign the Policyholders'insurance policy r'rights aid benefits under the claims to the Contractor as explained obove.The Policyholders agree and understand that this i'wesocabtc ' Assignment is unconditional and effective immediately upon execution of this document,and that no further action needs to be taken to '1.-;make it valid.enharceahle,or binding upon the Policy holders and the Policyholders'insurance company. 4. - Cooperation.The Policyholders shall cooperate fully with Contractors efforts to enforce the Assigned rights.and to -_' .� •Ilea police benefits Policyholders agree to execute any and all documents presented by Contractor to the Policyholders,which arc . reasoxnably required for the prosecution of Contractor's claims against the Policyholders' insurance company and or its agents with respect to the Assigned Rights 5 Direction to Pav;The Policyholders hereby authorize and instruct all insurance carriers who may be liable to the tcyholders for this kiss in whole or in part to pay directly to Contractor the amounts due or to become due in connection with the 'Contractor has been aulhonaed to perform,arid to deliver said payments directly and exclusively to Contractor within fifteen tI5) • ked r days of the invoice, lit the event an insurer fails to name Contractor on any check for the Work,the Policyholders shall A"mediatefy non() Contractor in writing.and return the check to the insurer with a written request to the insurer to issue a replacement j c. check payable to(contactor 6. Secants.and Consideration;This Assignment is given to Contractor as security and is made in consideration for Contractor's agreement to perform services without immediate hill payment front the Policyholders upon completion of services.The Policyholders acknowledge the sufficiency of this consideration. • • 7 No Release;The Policyholders remain primarily and ultimately responsible for payment for services rendered by , Contactor. This Assignment does not reheat the Policyholders from the duty to compensate Contractor for any amount due to Contractor that is not paid by insurance,including the cost of the work.deductibles,betterments,depreciation and other amounts not ysid by'insurance.all of which are ultimately the Policyholders'responsibility.Quality will try in its gaud laith discretion to ensure that Ih4 r,B't fur services will be the amount authorized and paid by available insurance.h owever•Quality does not and cannot promise this. Late eharjtts of 18'4,pet annum shall he charted on late payment and I shall be obligated to pay Quality's reasonable attorneys:Pees ;r'Sal"for collection '.dkvholder"(I Read this arid understand it t �l�;, (6.s,c- `4 r-1 ezµ.$) VIc.)L 'i G K"(S ',C�bak one ll o holder DP•., h l c, ,.a i Ptinl Name and I the yJJ r I I ' I �.: I t 3