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18C-141
I , ■ _._,_ °_,= Boars o . ui • mg • egulat ons an• tan• ar• s _ One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement-C-bntractor Registration Registration: 101718 Type: Private Corporation Expiration: 6/29/2010 Tr# 267344 S.E. SULENSKI ROOFING & SIDIN6, „. John Rigalis 103 South St '- t..: - - -... — --- Holyoke, MA 01040 -- -- ._--- _-- .__ - -- ____ Update Address and return card. Mark reason for change. Vh (l Address G1 Renewal ❑ Employment ❑ Lost Card CPS -CA1 0 50M- 07/07- PC8490 2e -6" ot". / a4 c/u aetta Board of Building Regulations and Standards License or registration valid for indi'vidul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: --V'--i Registration`. 101718 Board of Building Regulations and Standards - One Ashburton Place Rm 1301 Ex_PSE"to kI 4 /2010 Tr# 267344 Boston, Ma. 02108 Tjipe. Private Corporation S.E- SULENSKI R00€.IN:G:&=SIDING, CO John Rigalis '- . IZ /7 103 South St ��-40 ` ,e�vL_ (.(2,1,,,,,,,,_ Holyoke, MA 01040 Administrator Not valid without sign re ,` -C/ • , G� ■ / 4' /4 �'_� Board of Building Regulations =_ One Ashburton Place, R m 1301 Boston, Ma 02108 -1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 06/22/1945 Number: CS 022840 To: 00 9 9- \l assachusetts - Department of Public Safety Board of Buitdina Regulations and Standards Construction Supervisor License JOHN R RIGALIS license: CS 22840 103 SOUTH STREET Restrictedzo; q0 HOLYOKE, MA 01040 JOHN R RIGA! 1S 103 SOUTH I STREET HOLYOKE, MA 01040 Y change of address notification. D P S - CA? 0: 50M 04/05 PC8688 �L -y-- - Expiration: 6/22/2010 • ('ommis ioner Tr=: 26956 ■ 4� Date: 1/6/2818 Tiirie: '3:12 PM To: DINETTE @ 536 -8354 ri 2/3 ACORD CERTIFICATE OF LIABILITY INSURANCE 01/0 /2o 0 PRODUCER (413) 536 -0804 FAX (413) 534 -7874 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Martin J. Clayton Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1649 Northampton Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I P. 0. Box 989 1 Holyoke, MA 01041 -0989 j INSURERS AFFORDING COVERAGE NAIL ## misuRED Sulenski Roofing & Siding ; INSUPER AI ATLANTIC CASUALTY INSURANCE CO. 103 South StrFet 1 IlV,I IPF? F 0rF PRf1PFRTY RI f AS110I TY TNSI IRANI rn Rol yoke, MA 01040 ' INSURER C INSURER 0 I INSURER E COVRAGES THE POLICIES OF INSURANCE LISTEC BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO'LiCY PERIOD INDICATED. NOTWITHSTANDING AN Y 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I lF: AOD' TYPE OF INSURANCE POLICY NUMBER PO DATE tMMFDDNY1 DATE (MMDi I I LIMITS POLICY EFFECTIVE POLICY EXPIRATION �T 9 GENERAL LIABILITY L081000533 06/04/2009 j 06/04/2010 !EACH OCCURRENCE I $ 1,000,000 r DAMAGE TO RENTED I SO, 000 �OV1v1ER.LAi GENERAL. LABILITY P�'FMLSF:i rra , ry Y4rr I I CLAIMS MADE X OC` �,R fAED EXP (Amy one person) j $ 5,000 A I PER OVAL a DV INJURY j $ 1,000,000 I GENERAL AGGREGATE l S 2,000,000 GE ?7L AGGREGATE LIM T APPLIES PEP I PRODUCTS r G j f 1 GTS - C..MF,'OE P�G_ $ 1,000,000 'OLIcY ,LC 1 AUTOK:OBtLE LABILITY 1 COMBINED SINGLE LIMIT $ FNf AUTO accident) 1 I — ALL GINNED .=,U T US 1 _,_ 1 BODILY iFWLRY $ SCHEDULED AUTOS i (parprr ;oo) ' - ii ;EDAUTOS BODILY INJLR'+ $ NON O`f N ED ALIfGS I \Per sr cicent) I PRC7ERTY DAMAGE . ..— i (Per acciceili} $ GARAGE LIABILITY j 1 I AUTO ONLY •EAACCIDENT I $ { � AN'r AUTO I I OTHER. TPA,. EA ACC $ r I AUTO ONLY AGG $ { E XCESSIUMERELLA LIABILITY EACH OCCURPENCE 1 $ H - JCOUR I DLAItatS MADE j AGGREGATE $ 1 $ DEDUCTiELE — ' $ RETENTION $ 3 • WORKERS CO3APEN ATK?N AND NWCC458479011 12/31/2009 12/31 /2010 pe -ru- 1 I° 1 EMPLOYERS' LIABILITY g ANY PROF'R IFTORIPARTT(ERlEXECJT IJE E L EACH ACCIDENT 6 100 O01' OFFICER/MEMBER EXCLJDED' E L. DISEASE - EA EMPL D" EE, 3 100,00$ If yes describe under SPECIAL PROVISIONS beictn E.L DISEASE- FOLIC`' LIMIT $ 500, 00i OTHER ' I I I DESCRPTION OF OPERATIONS {LOCATIONS 1 VEHICL ;EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE iSSUIN3 INSURER WILL ENDEAVOR TO NAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OSLIGATON OR LIABILITY OF ANY KIND UPON T'-IE INSURER, !TS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE �1 y� , Harold Cl a on Jr. 'MEG C� l ACORD 25 (2001/08) ©ACORD CORPORATION 1988 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations —° �— a 600 Washington Street • =" Boston, MA 02111 ° ;.. www.mass.gov /dia ,-Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name (Business /Organization/Individual): 5. E . &LL4.14.) SIG ea . I Mk • Address: 1 o 3 City /State /Zip: 4=1"14n/ex Yr, a of 0 4 0 Phone #: 'O 3- s. - 3 t.30 Are you an employer? Check the appropriate box: Type of project (required): 1. © I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part- time).* have hired the sub - contractors 6. ❑New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no eloyees These sub - contractors have 8. ❑ Demolition for me in any capacity. employees and have workers' working y p ty. $ 9. ❑ Building addition [No workers' comp. insurance comp. insurance. 10. Electrical rep airs or additions required.] 5. ❑ We are a corporation and its ❑ officers have exercised their 11.(] Plumbing repairs or additions 3. ❑ I am a homeowner doing all work myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.❑ Other S� employees. [No workers' comp. insurance required.] *My applicant that checks box #1 must 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. IContractors 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. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: S a u-'q. Policy # or Self -ins. Lic. #: Expiration Date: - Job Site Address: (o go C11'i R al.. City/State/Zip: fl), a t ,,.f`t"o lu iq Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 and penalties of perjury that the information provided above is true and correct Signature: j_g,, 7 . Q,l Date: t/ oe 0A7 Phone #: A // - 53 tn- 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 #: 4 Version1.7 Con,uiercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEERREVIEW (78O CMR:1.1011 . Independent Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION-11- - 0WNERAUTHORIZ.RTION -- TO-BE-COMPLETED OWNERS. AGENT OR CONTRACTORAPPLIES FOR BUILDING`PERMIT 1, `, as Owner of the subject property hereby authorize ! to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, ! , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name t. 1 Signature of Owner/Agent Date SECTION 12 - , CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ s i Name of License Holder : Sbh iN R • "R to r. l t g e $ o as $ i o License Number ■ 10 Sm.1 4in fi nks. r I A 01o I 1 fa a .- Qo/o Address Expiration Date • 1� �M H1 3- 533. -3(o E Signa Telephone SECTION 13 WORKERS' COMPENSATION:" INSIJRANCEAFFIDAVIT(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 0 No 0 • r f � � � Y Version1.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES- FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANTTO;780 -CMR 116 (CONTAINING MORE THAN,35,00liC.F. OF ENCLOSED-SPACE) 9.1 Registered Architect Not Applicable ❑ Name (Registrant): Registration Number i 4 • Address Expiration Date I Signature Telephone 9.2 Registered Professional Engineer(s): • Name Area of Responsibility Address Registration Number f ! ! 1 Signature Telephone Expiration Date Name Area of Responsibility > F 1 • Address Registration Number • ! 1 Signature Telephone Expiration Date • Name Area of Responsibility Address Registration Number I Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number � I i Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: r Responsible In Charge of Construction r Address Signature Telephone • Version1.7 Commercial Building Permit May 15, 2000 S x1NOR'CHIMOPIZQ .. :4- , Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size i 1 , Frontage Setbacks Front I I Side L:' ' R:' 1 L: i R:! 1 I _ f � Rear } - uiilding Height.— 1 I --., I , Bldg. Square Footage i I 1 ; % i Open Space Footage I % (Lot area minus bldg & paved ! i i 3 parking) # of Parking Spaces • Fill: ' i (volume & Location) A. Has a Special Permit/Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 ' � IF YES, date issued: i I IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES Q IF YES: enter Book I Paget i and /or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Q , Date Issued: : C. Do any signs exist on the property? YES 0 NO Q IF YES, describe size, type and location: I ! D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO Q IF YES, describe size, type and location: 1 1 E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q ` NO Q IF YES, then a Northampton Storm Water Management Permit from the DPW is required. f t Version1.7 Commercial Building Permit May 15, 2000 r.. SECTION - 4- CONSTRUCTLOL SERVICES FORPROJECTS LESS THAN 35,000• CUBIC FEETOEENCLOSED=<SPACE - Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs IiiI Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Enter a brief description here. Of Proposed Work: ! m . Ro . , S Lu.L L,4 LW4.5 i _ SECTION 5 - USE GROUP ANI N" CONSTRUCTIOTYPE ,? , _ USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 ❑ A -2 ❑ A-3 ❑ 1A 1 ❑ El -- - ? -4 ❑ A -5 ❑ 1B I ❑ B Business ❑ 2A 1 ❑ E Educational ❑ 2B 1 ❑ F Factory ❑ F-1 ❑ F -2 ❑ 2C I ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S -2 ❑ 5B [ ❑ U Utility ❑ Specify: l I M Mixed Use El Specify: S Special Use ❑ Specify:1 i 1 COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOI RENOV ADDITIONS IN USE Existing Use Group: I l Proposed Use Group: Existing Hazard Index 780 CMR 34): c Proposed Hazard Index 780 CMR 34): E SECTION 6 BUILDINGHEIGHTAND�AREA -_ BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION � r L ro Floor Area per Floor (sf) : z , 151 — 1st r 1 a - � - . ,. .v t ` , r 2 2 nd 1 M a . .. mt. � � 'T j 2 a n " 3 rd I i Al i r , -. rd _ �' Total Area (sf) l Total Proposed New Construction (sf) �x „ .�, y 4. Total Height (ft) i i . °� * , Total Height ft i ' � < ° � � m ` w- mo " 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone! 1 Outside Flood Zone❑ Municipal ❑ On site disposal system❑ s t • . ■ Version1.7 Commercial Building Permit May 15, 2000 City of Northampton Sta i7 �' Building Department .0.,..3„,„„,,,,:-:::.. � � uewa ," ; 1 -V 2'f2 Main Street ewe , - ® ra y . - ; -,' �\ t L Ro a te .e :.° a ® " w Northampton, MA 01060 'tea S a ` - , ; phone 413- 5.87 -1240 Fax 413 - 587 -1272 Plo e g lans , _ n } ., APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING . sECTipi!1;1 - SITEINEORMATION This s ection tote completed'. by office_ _- - - El - Property-Address: x i Map Lot Unit (o So r 'wax. Rd � � ' a .� IUor hhawte on) ml a Zoe O �erla Distric - f ' eXI rmSt. D►stnct __._.. p CB Distnct ..Lit:. _4 SECTION/2, PROPERT■r OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: { J t� k ni.istMiYc� ! !odQnsstd ,rvok Du. s7ham nfal,W1jq oioa7 Name (Print) . Current Mailing Address: i MIZ 586 - 0006 tO.c1< Coo par 3 Signature !�� —fv Telephone 2.2 Autho ed Agent: i i 5.e _ Sti*.tlw sKi. Co. ova.- 103 sower- • , Hoi.goit ma.. o /oNb Name (Print) Current Mailing Address: i l 4t3 53a- 3630 Signature 4n�•\ - �1L...e {c , Telephone SECTIO 3 - ESTIMA CO C OSTS •. Item Estimated Cost (Dollars) to be Official Use °Ora completed by permit applicant 1. Building 1 • 1 ," (a)-BuildingPermit Fee , i 2. Electrical 1 (b) EstimatedTotal Cost of 66 i. 1 I .. - Construction from (6), - t. 3. Plumbing i i ` Building_PerniitFee 1 4. Mechanical (HVAC) I .: 1 5. Fire Protection i / f 7, / 7 /, 6. Total =(1 0.2(3, </ DS. 0 !. C heck- N / umber 63 . 1 , - ' _. -. _ - . _ - .. _ _ '" . Thi For Official Use Only Bmlding:Pennif l''urmber Dates'!" Issued r Signature: Building Commissioner/Inspector of Buildings - ,'.. Date : t BP- 2010 -0658 GIS #: COMMONWEALTH OF MASSACHUSETTS rap t k..18 - i4I CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0658 Proiect # JS- 2010 - 000957 Est. Cost: $228405.00 Fee: $1370.43 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: S E SULENSKI 022840 Lot Size(sq. ft.): 1497897.72 Owner: LATHROP COMMUNITY INC Zoning: Applicant: S E SULENSKI AT: 680 BRIDGE RD Applicant Address: Phone: Insurance: 103 South Street (413) 532 -3630 Workers Compensation HOLYOKEMA01040 ISSUED ON:1/12/2010 0:00:00 TO PERFORM THE FOLLOWING WORK:RESIDE BUILDINGS 1,2,3,4,5,6,8 & 10 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 1/12/2010 0:00:00 $1370.43 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo