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23B-035 (5) 6ILOCUSTST BP-2017-1231 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23B-035 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:ROOF BUILDING PERMIT Permit# BP-2017-1231 Project# JS-2017-002067 Est.Cost: $10120.00 Fee:$100.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: D P CARNEY INC 99798 Lot Size(sq. ft.): 27007.20 Owner: WOHL CARINA Zoning:NB(100)/URB(0)/ Applicant: D P CARNEY INC AT: 61 LOCUST ST Applicant Address: Phone: Insurance: 34 HORSE SHOE CIRCLE (413) 967-7124 O WC WAREMA01082 ISSUED ON:4/27/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:RE-ROOF FRONT OF BUILDING 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 14 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: FeeTvpe: Date Paid: Amount: Building 4/27/20170:00:00 $100.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Versionl.7 Commercial Building Permit May 15,2000 \� Department use only ity of Northampton Status of Permit C6 - Building Department Curb Cut/Driveway Permit - \� *%- /� 212 Main Street Sewer/Septic Availability z Room 100 Water/Well Availability \N, ' � Northampton, MA 01060 Two Sets of Structural Plans ° phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans 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 5P-• t 7-1,23/ 1.1 Property Address: This section to be completed by office 61 Locust Street Map A 313 Lot 036 Unit Northampton, MA 01060 Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Carina Wohl 397 Prospect Street, Northampton,MA 01060 Name(Print Current Mailing Address: (267)974-1833 Signature , t,t _ - -- Telephone 2.2Aut ._ '. 'MIM D. P. .e, a r . ion, Inc. 34 Horseshoe Circle, Ware, MA 01082 Name(Print) Current Mailing Address: (413) 967-7124 Signature L p.r . .a- Telephone SECTIO 3-ESTI TED CONSTCrlOn yOSTS Item EstimatedatCost(Dollars)to be Official Use Only completed by permit applicant 1. Building $10,120.00 (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 $10,120.00 ,/r 6. Total=(1 +2+3+4 +5) Check Number / 9990 41176/,,,/) This Section For Official Use Only Building Permit Number Date Issued Signature' �� Y- 7-/7 Buildin ommissioner/Inspector of Buildings Date 67411/ icCarnel H S �� Curr)C a-S-h, nd -�-- Versionl.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 0 Repairs 0 Additions 0 Accessory Building Exterior Alteration 0 Existing Ground Sign❑ New Signs❑ Roofing Change of Use 0 Other❑ Brief Description Re-roof Front of Building at 61 Locust Street-Northampton,MA Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 0 A-2 0 A-3 ❑ to I ❑ A-4 ❑ A-5 ❑ 1B 0 B Business ❑ 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 0 2C I ❑ H High Hazard 0 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 38 ❑ M Mercantile ❑ 4 ❑ R Residential 0 R-1 ❑ R-2 0 R-3 ❑ SA ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B 1 ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Spedal 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 BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1' 2c 2id 31° 3,e 4th Litn 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❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system❑ Version!.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 (l.ot area minus bldg&paved park me) #of Parking Spaces Fill: (volume&location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document k B. Does the site contain a brook, body of water or wetlands? NO (3 DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over acre or is it part of a common plan that will disturb over'I acre? YES O NO O IF YES.then a Northampton Storm Water Management Permit from the DPW is required Versionl.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 0 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 D. P. Carney Construction, Inc. Not Applicable ❑ Company Name: Daniel P. Carney Responsible In Charge of Construction 34 Horseshoe Circle,Ware, MA 01082 Address (413)967-7124 ure - Telephone Version!.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes O No :' SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Carina Wohl as Owner of the subject property hereby authorize D. P. Carney Construction, Inc. to act behalf, in all matters reIatve to work authorized by this building permit application. 04/25/2017 lgn re Owner — Date Joann Carney ,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. Joann Carney 04/25/2017 S nature of♦ :tent Date S•CTI• 12-CONSTRUCTION .ERVICES 10.1 Licensed Construction Sup- ' •c Not Applicable 0 Name of License Holder Daniel P. Carney CS-099798 License Number 34 Horse e Circle,Ware, MA 01082 08/19/2017 Address Expiration Date 1 ti (413) 967-7124 re 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 building permit Signed Affidavit Attached Yes Q No The Commonwealth of Massachusetts Ik =71 Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 � www.mass.gov/dia \Yorkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Busincss/Organizationnndividual):D. P. Carney Construction, Inc. Address:34 Horseshoe Circle City/State/Zip:Ware, MA 01082 Phone#:413-976-7124 Are you an employer?Cheek the appropriate box: Type of project(required): I. l am a employer with 15 employees(full and/or part-time)• 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $. tEl Remodeling any capacity.[No workers`compinsurance required.] 3 am a homeowner doingall work myselfNo workerscomp. 9. LI Demolition ❑1er I ' insmancerywred.]' 10❑ Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole I1.❑Electrical repairs or additions proprietors who no employees. 12.❑Plumbing repairs or additions 5 E I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.O Roof repairs These sub-contractors have employees and have workers'comp.insurance. 14. Other Roofing 6❑We are a corporation and its officers have exercised their right of exemption per MGL c. — 152,C1(4),and we have no employees.[No workers compinsurance required] *Any applicant that checks box 41 must also fill out the section below showing their workers-compensation polity 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Granite State Insurance Company Policy#or Self-ins. Lie. #:WC009930624 Expiration Date:11/15/2017 Job Site Address: 61 Locust Street _City/State/Zip:Northampton, MA 01060 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 hereby r '• under the pains .nd - allies of perjury that the information provided above is rueand nd correct Signature: r. Date: `t ( Q5 r t r Phone#: 41 4 24 Official use only. Do not write in th'.area,to be codeted by city or town official City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2. Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i- .1.1 DPCARNI OP ID:AD a`coao CERTIFICATE OF LIABILITY INSURANCE n ""o��"' 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 POUCIES 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 PHILLIPS INSURANCE AGENCY INC PHON Angela DlAugustino. __ _ 97 CENTER STREET INC No ExO:4l3 59M1-.5984 FM NOT 413-592-8499 CMICOPEE,MA 01013 AE-MAIL Angela@phiilipsinsurante.com PHILLIPS INSURANCE AGENCY INC - -- -- -- --- - _ INSURER/Si AFFORDING COVERAGE RACA INSURER A:Selective Ins Co of Southeast INSURED D.P.Carney Construction,Inc. INSURERe Kinsale Insurance Company Mr. Dan Camey -- - _- -- 34 Horseshoe Circle INSURER C:Evanston Insurance Company Ware,MA 01082 INSURES D:Granite State Ins Co 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. INS0. TYPE OF INSURANCE ADOCSUbR - - - pdt1CY EFF POLICY EXP - - - LIR, q$D WVD POLICY NUMBER IlWOD!YYYY) (MMDDMIY'n CHATS B I XCOMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _$ 1,1)00,000 I CLAIMS-MADE X I OCCUR 0100041217-0 08/01/2016 08/0112017 DAMAGE TORENreO - - Lit XCU PREMISES occurren)). .. s 10Q000 MED EXP(Any one person) E Excluded L PERSONAL S ADV INJURY S 1,000,000 000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE b 2.000,000 Poucv`.X icr PRooucis-coMProP AGO E 2,000,000 I 'OTHER 1 S AUTOMOBILE UABIUYI COMBINED SINGLE LIMIT E 1,000,000 (Ea y _ A X ANY AUTOIA9094953 08/01/2016108/01/201] BODILY INJURY (Per person) E —_ J AOSCHEDULED BODILY INJURY - __ AUTOS _,AUTOS NON-OWNEDI PROPERTY DAMAGE accident) $ 1 HIRED AUTOS �,AUTOS accident) s Included UMBRELLA UAB - XI OCCUR MS MADE :XOBW6]02516 08/01/2016 08(01/201] !EACH OCCURRENCE E 5,000,000 C X EXCESS WB l C AGGREGATE' S 5,000,000 1i DED I X I RETENTIONS 0' WORKERSAND EMPLOYERS' LSATON PER 0TH- AND LMBIUTYX STATUTE D ANY PRWRIETORNARTNER,ExEcunvE YIN IIWC009930624 11/15/2016 11/15/2017_EL EACH ACCIDENT 5 1,000,000 OFFICERrNEMBER EXCLUDED' N NIA _ (Mandatory in NH) EL DISEASE-EA EMPLOYEE E 1,000,000 II ee aeunbe un0er -- - -- - D SC0.IPTION OF OPERATIONS bear 1 EL DISEASE-POLICY LIMIT S 1,000,000 A Installation Float 51985457 08/01/2016 08/0112017 Limit 106,383 DESCRIPTION OF OPERATORS I LOCATORS VEHICLES(ACORD 10T AGYltiowi Remarks Sehdule.nay be attached if more space Is minim!) RE:Re-Roof Front of Building-61 Locust St.,Northampton,MA 01060 CERTIFICATE HOLDER CANCELLATION MARKARS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Mark Arsenault 61 Locust St Northampton,MA 01060 AUTHORIZED areREsexTATNE yt.pciA M (aRt,WLrpp ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1 r Massachusetts Department of Public Safety 4�4 Board of Building Regulations and Standards License: CS-099798 Construction Supervisor • DANIEL P CARNEY ty 36 HORSESHOE.CI WARE MA 01024 L- i;G>r Expiration: Commissioner 08/1912017 Construction Supervisor Restricted to: Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet 1991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit W W W.MASS.GOV/DPS E _ >i Office of Consumer Affairs and Business Regulation '1/4':L -_;9 10 Park Plaza - Suite 5170 Boston, Massacg etts 02116 Home Improvement ,vs N. tor Registration _ Registration: 121178 a�.� ; Type: Private Corporafon t+iS' 2.1,-.� W Expirafon: 471212018 Trb 419291 D.P. CARNEY CONST INC ,' � ,. DANIEL CARNEY 1; g '"- 34 HORSESHOE CIRCLE WARE, MA 01082 4J Jp — % =.a`v N4 4 Update Address and return card.Mark reason for change. SCA? 0 zomn;vu 0 Address 0 Renewal El Employment ❑ Lost Card r1�ke%ne.maxuuea//,,i.ol'C .z*jac4n2 OiBceor Consumer Anairs&Hushes Regulation License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: 'el Registration '121178 Type: Office of Consumer Affairs and Business Regulation l Expiration a i 8 Pnvate Corporation 10 Park Plaza•Shite 5170 c - Boston,MA 02116 D.P.CARNEY COMS.71fic j e DANIEL CARNEY z 4lP4f % 34 HORSESHOE CIROtr-' '•^�'_} /�a� � WARE,MA 01082 Undersecretary 2" val teho + gnn . e D.P. CARNEY CONSTRUCTION, INC. We Have the Cure for Flat Roof Problems." 34 Hore%hoe Gmle,Ware,MA 01082 Shop-Tea 413,543Ji5Q Office-Tee 413457-1124 Tod Fme:& -58012M Far 4139671100 Far413-5434803 E-nad:dpomey45(dcomcatnet E-rnatl•tiprarneyrcofingekgmaP cam April 27,2017 City of Northampton Building Department 212 Main Street-Room 100 Northampton.MA 01060 Atm: Kim Carson -Ph: 413-587-1240 Fax: 413-587-1272 Email: kcarson(ujnorthamptonma.gov Dear Kim: I request that you grant a modification to waive the requirement for control construction for the (Re- Roof of Front of Building)at(61 Locust Street) in Northampton because the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work. Thank you for your consideration. "Mass Amendments, sections 107.1 allows for an exclusion from control construction for this project" Respectfully, Joann Carney President D.P.Carney Construction,Inc. 34 Horseshoe Circle Ware, MA 01082 Phone: 413-967-7124 Fax: 413-967-9100 Email: dpcarney45@comcast.net JC(lmfj