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31B-239 LCK Construction Inc. 120 Commercial St PO Box 1764 Brockton,MA 02302 15+yrs Experience Luis Castro:50&742-7350 Cell Free Estimates Office:508-510-50$6 Fully Licensed&Insured Fax: 508-510-5086 Email:I&mnstrucdon@comcasLnet Proposal Submitted To Work To Be Performed At Name"B Con i �a revolof Street !"o a S ' Street al Vii Dod I yic( -14LA City tjor4h State City �a5-t -44r-I Forl Date of Plans 0 - Q91 - 13 State N AW4 i P_A b 6 W Architect Telephone Number 81oQ- M- 01171455ell aQf-o l- We hereby propose to furnish alliMs mmook k and perform all the lab r necessa for the completion of S r� n S -Wu b er vnT ern u a re oC F r d M 0vt aA A A e- re Mk V\Q,tttlaI5 8K 1 S' ll t on U amiq -°t r W. 3A SQure L A0 r I u- i S 4 1 q6 .06 k, 64 r a o �n r, ' i5 Clete i Y No-� nCluA,eA 'in fr; tZ 16 Perm-,+ r,- and tyid gybe- disouss�td xt S;r,h,nG All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workman like manner for the sum of Dollars($ 6 , 000- 06 ). with payments to be made as follows: Any alteration of deviation from above specifications involving extra costs, will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our controOwner to carry fire,tomado and other}ecesparry ins��annce ppon a �� ���mwen's Compensation and Public Liability Insurance on above work to taken out b j Lh 6 J-� Respectfully submitted Per Note—This proposal may be with drawn by us if not accepted within days ACCEPTANCE OF PROPOSAL. The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Accepted Signature Date ( � L- / l Signature 1 0 DATE(MM/DD/YYYY) AC R" CERTIFICATE OF LIABILITY INSURANCE 04/25/2013 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 JO M Keller NAME: MassPay Insurance Services,LLC PHONE FAX 27 Garden Street,Unit 1B M o :t: (A+c,No): E--MAIL hlrichardinsurance.com Danvers,MA 01923 ADDRESS: joNce@phlrichardinsurance.com INSURE S AFFORDING COVERAGE NAIC# INSURER A: Northland Insurance NOR INSURED LCK Construction,Inc INSURER B: Ace Property&Casualty Ins. ACE LUIS Castro INSURER C: 27 GraridviewTerrace INSURER D Brocldon,MA 02301 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 MINED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUdENT 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.LIMTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LLTTRrUABIUTY SUER POLICY EFF POLICY EXP R RANCE POLICY NUMBER MM/DDIYYYY MM/DDIYYYY LIMITS A WS175128 04/17/2013 04/17/2014 EACHOCCURRENCE _ $ 1'�'0w DAMA RE D 50 L LWBILITY PREMISES Ea occurrence $ � OCCUR MED EXP(Any one person) $ 5+�PERSONAL&ADV INJURY $ 1'000'GENERAL AGGREGATE $ 2'�'�GENL AGGREGATE PPLES PER: PRODUCTS-COMP/OP AGG $ 2'�'� POLICY PRO- LOC $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident BODILY INJURY(Per person) $ ANY AUTO ALL OVOED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE NON,OV*ED Per accident) $ FIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ B WORKERS COMPENSATION 6S62UB-5B38269-0-13 05/17/2013 05/17/2014 \,.; M STATLL OTH• AND EMPLOYERS'LIABILITY 100,000 ANY PROPRETOR/PARRNER(E)ECUlIVE ❑ 6S62U B-5B38269-0-12 05117/2012 05/17/2013 E-L.EACH ACCIDENT $ N!A OFFICERIMEMBER EKCLUDED? E.L.DISEASE-EA EMPLOYEE $ 5W,000(Mandatory in NH) — Iyes,describe under E.L.DISEASE-POLICY LIMIT $ 100,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,H more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BK Construction THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Burnett Home Improvement 60 North Hampton,MA Street North AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Version 1.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes ® No C-) SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,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 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 Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone SECTION 13-WORKERS'd6MPENSATION 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 0 No 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 ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature, Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor �- C. K C 0 +'' " c TN° rte- Not Applicable ❑ Company Name: L_ vi S Responsible In Charge of Construction 12, a C c C, ij (l') h/t Address J 0S -7`lz-?3,I o Signature Telephone Version 1.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ® DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW ® YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW e(YES 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 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO IF YES, describe size, type and location: E. W+II the construction activity disturb(clearing,grading,exca ion,or filling)over 1 acre or is-it part of a common plan that will disturb over 1 acre? YES ® NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version].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,❑:l Additions [I Accessory Building❑ Exterior Alteration [1 Existing Ground Sign❑ New Signs❑ Roofing Il Change of Use❑ Other❑ Brief Description Enter a brief description here. Sit '3 z Of Proposed Work: �ti; ; Z J _f, P ) r SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ ❑ A-4 ❑ A-5 ❑ 113 ❑ B Business 52r 2A ❑ E Educational ❑ 213 ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 313 M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 56 ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA OFFICE USE ONLY BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Floor Area per Floor(sf) 1St 1St 2nd 2nd 3rd 3rd 4th 4m Total Area(sf) Total Proposed New Construction(sf) 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 ❑ I Zone Outside Flood Zone❑ Municipal ❑ On site disposal system[-] Versionl.7 Commercial Building Permit May 15,2000 Department use only - "-� � City of Northampton Status of Permit: Building Department CurbCut/Drivewa Y Permit - 2013 j 212 Main Street Sewer/Septic Availability APR 2 Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans D� OF 6u" N -PTO t(p 0A Ns 13-587-1240 Fax 413-587-1272 Plot/Site Plans NORT�A�pTO Other Specify APPLICATION 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 1.1 Property Address: This section to be completed by office jy J K r s j-1- R t ti J Map Lot Unit /" }�• 1 /�'`r'�° ' r� �' Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Aclent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1..Building / C (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2013-1025 APPLICANT/CONTACT PERSON LCK CONSTRUCTION INC ADDRESS/PHONE P O BOX 1764 BROCKTON (508)742-7350 PROPERTY LOCATION 60 KING ST MAP 31B PARCEL 239 001 ZONE CB(100)/ THIS SECTION FOR OFFICIAL U; PERMIT APPLICATION CHEC r ENCLOSE) ZONING FORM FILLED OUT Fee Paid Building Permit Filled out A" Fee Paid T_yueof Construction: STRIP &REROOF New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 28560 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 Demolition Delay Signature of Building Official 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.