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C cam . y � 20 k2 ) � dk © 8 £ m r \ @ E - f k § k o o } 22 [ \ ƒ @ ; o ; ° G ® f § ; 2 � ca § � ;� 5AVU5t1 UN ID:AU CERTIFICATE OF LIABILITY INSURANCE _DATE 219/D/Y3 12!19!2013 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 NAME: Ideal Insurance Agency,Inc. PHONE --,FAX 187 East St. _AIC,AQ,€xe: -- A/c,No): Ludlow,MA 01056 E-MAIL Alexandre Carvalho ADDRESS: INSURER(S)AFFORDING COVERAGE _ NAIC If INSURER A:Atlantic Casualty Insurance Co _ INSURED Sergey Savonin INSURER B: 30 Clifton St — - Agawam,MA 01001 INSURERC_ _ INSURER D: 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. INSR TYPE OF INSURANCE A DL U POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDDIYYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY L021007991 12/13/2013 12113/2014 PREMISk�_(Ea occurrence)_ $ 700,00 CLAIMS-MADE a OCCUR _MED EXP(Any one person) $ 5,000 _ PERSONAL&ATV INJURY $ 1,000,00 GENERAL_AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 1,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Eaaccident)---- - -- .-.. $___ - ----- ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS _ NON-OWNED PROPERTY ACC D_DAMAGE $ HIRED AUTOS AUTOS E UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DIED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN - - --- ----'--- ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,desaiDe under -- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,N more space Is required) REMODELING CONTRACTOR CERTIFICATE HOLDER CANCELLATION CHICO-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Chicopee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1Y P ACCORDANCE WITH THE POLICY PROVISIONS. 17 Springfield St Chicopee,MA 01013 AUTHORIZED REPRESENTATIVE a. c.4, ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD City of Northampton Massachusettso,? _ DEPARTMENT OF HVILDING INSPECTIONS 3 ' 212 Main Street • Municipal BuildingOt nb` v Northampton, MA 01060SI1v'° jlti4 INSPECTOR Louis Hasbrouck Fax:413-587-1272 Chuck Miller Building Commissioner Phone: 413-587-1240 Assistant Commissioner CONSTRUCTION CONTROL DOCUMENT (For professional Engineers/Architects responsible for Entire Project) Project Title:&x2z Date Project Location: W�/TTi1Zt�—�� Map: Parcel: Zone: Scope of Project:6�f�y�..�5;r�/� / In accordance with the Eighth edition Massachusetts State Building Code, 780 CMR Section 107.6: 1,� � � ,�f11��^ Mass. Registration # Being a registered professional Engineer/Architect hereby CERTIFIES that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [vKENTIRE PROJECT For the above named project and that to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable Laws for the proposed project. Furthermore, I understand and AGREE that I shall perform the necessary professional services to determine that the above mentioned portions of the work proceed in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 10.7.6.2.2: 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction documents as submitted for the building permit, and approval for the conformance to the design concept. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine, in general, if the work is being performed In a matter consistent with the construction documents. I shall submit periodically, in a form acceptable to the building official, a progress report together with pertinent comments. Upon completion of the work, 1 shall submit to the building official a final report as to the satisfactory completion and readiness of the project for occupancy. Signature and Seal of Registered Professional a Day of�r•V/"�� 2021-1 (seal) Version 1.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON.ZONING Existing Proposed Required by Zoning This column tore filled in by Building Department LotSize 4�.,�. ... ...�.. ..... ._...� � ..�.__,..__._...___ Frontage Setbacks Front Side L:—' ---J> .., R.I__._.., L:€ _.3 R= '�t.._. ....J _ Rear 1 _. Building Height Bldg. Square Footage - __ % F Open Space Footage % F--7 7 Lot area minus bldg&paved 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 YES 0 IF.YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW (&f YES 0 IF YES: enter Book ' Page, and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: _............ ........ .................. . . _..._. .. ...... ... _.. _...._.............._.. D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0 IF YES, describe size, type and location: .__,���_...._..�. �._..:..�.._...___.._....__�... _....___...._,._..._.____.____ 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 0 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version 1.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSE©SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant): Registration Number Address _.,. Q,./. _.. .,. Expiration Date Signatur Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date i Name Area of Responsibility Address Signature Telephone Expiration Date _..._ . .._ _ .. .,.. .. ._v. _ ,.___ . , -m. v.. _ ........ , Name Area of Responsibility Address Registration Number a Signature Telephone Expiration Date .. . ..----.-.._... ._._ ....... _ .... _........_.._..... ............ Name Area of Responsibility Address Registration Number i Signature Telephone Expiration Date 9.3 General Contractor .....+ ...._._ Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Alle Signature Telephone Version 1.7 Commercial Building Permit May 15,2000 f SECTION 10-;STRUCT.IJRAL PEER'REVIEW 1780,CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes No SECTION 11 -:OWNER AUTHORIZATION-TO BE COMPLETED.;INHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR.MUILDING PERMIT ............ __.....___............................,__..___.__ u..._____._,_ 3 I, _..._._ .. _..x._....._... :,.__..__v_.� .. ._.___,µ _. _...,,._.__. .. . as Owner of the subject property hereby authorize. ....__.__..__ _...._._-.. ao act on my behalf, in all matters relative to work authorized by this building permit application. Signature of 'er Date 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§ofperluryn Print Name Signature of Owner/Agent Date SECTION 12-CONSTRUCTION.SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder:?. G. �tv. �. ..._.»,: ( .L!/e!,.. � Cr' !_.r._l..Sf.. ✓..._4�!._./.. , License Number Addr Expiration Date Signature Telephone SECTION 13-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 ilding permit. Signed Affidavit Attached Yes A No 0 The Commonwealth of Massachusetts Department of In dustrialAccidents ? Office of Lzvesti-ations a 600 Washington Street rt t Boston, MA 02111 � - www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le2ibl Name (Business/Organization/Individual): �" Address: �'� L City/State/Zip: w e3r AW claPhone M �113 V 4/i9 `5 Are you an employe . Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. am a general contractor and I 6. ❑New construction employees (full and/or part-time).* ve hired the sub-contractors I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling hip and have no employees emplosub-contractors es an e have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions �.❑ I am a homeowner doing all work ❑ myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.,insurance required.] *Any 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. '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. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. /-7 Insurance Company Name: '.( Policy#or Self--ins.Lic.#: Expiration Date: oZ"f_3 �r Job Site Address: '�(C _e /5 "T� City/State/Zip: Z,, Attach a copy of the workers' c mpensation 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 D for insurance coverage verficati.on. I do hereby cer ' u er the pains and penalties o erjury that the information provided above is true and correct. Sianatur . - Date: ?j _ Phone#: 717, t 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#: Version 1.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing.Wall Signs ❑ Demolition❑ Repairs❑ 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 l •./ SECTION 5-USE GROUP AND.CONSTRUCTION TYP.E � USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1 B ❑ B Business +® 2A ❑ E Educational ❑ 2B If ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ _ 3A ❑ Institutional ❑ 1-1 ❑ I-2 ❑ I-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ �/ 5B U Utility ❑ Specify: M Mixed Use �/ Specify, I S Special Use El Specify: COMPLETE THIS SECTION'lF EXISTING BUILDING';UNDERGOINGIRENQVATIONS;__ ,ADDITIONS AND/OR:CHANGE IN USE Existing Use Group: Proposed Use Group: L___ I Existing Hazard Index 780 CMR 34):: _.,,. Proposed Hazard Index 780 CMR 34): SECTION.6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE,ONLY Floor Area per Floor(sf) 1 st 1st i,....,._................_..,.........,._._.,........,;--_.,,_..,..._.........:......_._., i 2nd _,_.,_ 2nd 3rd 3rd 4th _— _._ _._ ._.._.___. 4m Total Area(sf) Total Proposed New Construction(sf) ZZ/z .5 F' Total Height(ft) - _------__- —_ _ _ Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone„Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system❑ Versionl.7 Commercial Building Permit May 15,2000 Departure t use,onlX City of Northampton status of Permit `4� c Building Department Currti Gut/Dv ueway Pem 212 Main Street - Sewer`/SepticAVaifabi[rtjr " �1 Ap •• ��jI�j e % ` Room 100 WatoN.V A96ifabiflty Y' /iC No hampton, MA 01060 Two Sets of Structural-Plans 4 i1 � hr� 4 87-1240 Fax 413-587-1272 Plot/Ste Plane h OerSpeclfy El r 71� 3; krISE-18ATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to.be completed by office 1.1 Property Address Y � OC -,L ` Map 1 Lot Unit i r/0 L. (� j Zone Overlay District A ---- - Elm St.`District CB District' SECTION 2-:PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record:., _ Name(Pant);.---? t' /. r Current Mailing Address Tele Signature hone p 2.2 Authorized Agent: ��..___ _.... � Current Mailm Address Name(Print) -> �9. . _._._ .._ ._........ __....._..._. / Signatur Telephone Signature, P SECTION 3-ESTIMATED COSTS' CONSTRUCTION: Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building Permit-Fee 2. Electrical (b)Estimated'Tota[Cost of Construction from- 6 _...,_ ...._,.. . _. .., 3. Plumbing s Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection _ ... _.. _6. Total=(1 +2+3+4+5) Gr7.r'Z> Check Number This.Section For.Official Use Only Building Permit Number Pate Issued ._Signature: Building Commissioner/Inspector of Buildings Date File#BP-2014-1029 APPLICANT/CONTACT PERSON SERGEY SAVONIN ADDRESS/PHONE 11 LIBERTY AVE AGAWAM (413)244-0336 PROPERTY LOCATION 44 MAPLE ST MAP 23A PARCEL 041 001 ZONE GB(99)/URB(1)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: REMODEL TO CREATE 4 OFFICES&BATHROOM(MASSAGE) New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 103381 3 sets of Plans/Plot Plan THE FOL ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management P Delay Si a u ng Of icial Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. 44 MAPLE ST BP-2014-1029 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A-041 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2014-1029 Project# JS-2014-001779 Est. Cost: $6000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SERGEY SAVONIN 103381 Lot Size(sq. ft.): 9365.40 Owner: TURNER MELODIE Zoning: GB(99)/URB(1)/ Applicant: SERGEY SAVONIN AT. 44 MAPLE ST Applicant Address: Phone: Insurance: 11 LIBERTY AVE (413) 244-0336 AGAWAMMA01001 ISSUED ON:41812014 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMODEL TO CREATE 4 OFFICES & BATHROOM (MASSAGE) 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 4/8/2014 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner