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25C-251 (112) _ 54 FAIRST-FAIRGROUNDS BP-2018-1375 GIs#: COMMONWEALTH OF MASSACHUSETTS Mao:Block:25C-251 CITY OF NORTHAMPTON Lot: .001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Siding BUILDING PERMIT Permit# BP-2018-1375 Protect# JS-2018-002435 Est.Cost, $1500.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JOSEPH JASINSKI 057025 Lot Size(sa.11.1: Owner: HAMPSHIRE FRANKLIN&HAMPDEN AGRICULTURAL SOCIETY zoning: SC(100VURB(I Applicant: JOSEPH JASINSKI AT. 54 FAIR ST - FAIRGROUNDS ApplicantAddress: Phone: Insurance: 43 Fair St (413) 527-7379 0 WC NORTHAMPTONMA01060 ISSUED ON.612212018 0:00.00 TO PERFORM THE FOLLOWING WORK REMOVE CLAPBOARD SIDING AND INSTALL VINYL ON TWO EXTERIOR SIDES OF GRANDSTAND STRUCTURE 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 if Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Deoartmen[ 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: FeeTvae: Date Paid: Amount: Building 6/22/20180:00:00 $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner 6p_� 9- 135 =phone Versionl.7 Commercial BuildingPermit May 15,2000 Department use only City of Northampton Status of Permit Building Department Curb Orp 0dwiay Permit 212 Main Street SeWgf/SapticAvailabll"ity Room 100 Wata'rl Availability rthampton, MA 01060 TwoSeli of Struc'ral Plans pone 3-587-1240 Fax 413-587-1272 Plot Sih,Plane Oets[5pecify 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 54 Fair Street, Northampton, MA 01060 MapyrG Lot � J�� Unit Zone Overlay District Elm St.District CB Distill SECTION 2-PROPERTY OWNERSHIPIAUTHORIZEDAGEtyT 2.1 Owner of Record: Hampshire, Franklin&Hampden Agricultural Society PO Box 305, Northampton, MA 01061-0305 Name(Pant) Current Mailing Address'. 413-584-2237 Signature Telephone 2.2 Authorized Agent: James Paypek PO Box 305, Northampton, MA 01061-0305 Name(Print) Current Mating Address' Signature / Telephone SECTION 3-ZSTIMATED C STRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit appicant 1. Building $1,500. (a)Building Permit Fee 2. Electrical 0. (b)Estimated Total Cost of Construction from 6 3. Plumbing 0 Building Permit Fee 4. Mechanical(HVAC) 0 �� 5. Fire Protection 6, Total=(1 +2 +3+4+5) Check Number 7 This Section For Official Use Onl Building Permit Number Date Issued Sig re Build' mmissionerllns® of Buildings Data / /� Versimi 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 El Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description Enter a brief description here. Remove clapboard siding and install vinyl siding on two exterior sides of Grandstand structure Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A4 ❑ A-5 ❑ 1S ❑ B Business ❑' 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ I-1 ❑ I-2 ❑ 1-3 ❑ 3B ❑ M Mercantile 1-14 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5AC3S Storage ElS-1 ElS-2El5B ❑ ... . 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 341 SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor left 1 1a `� 2nd 2ntl 3b - 4m Total Area(sh Total Proposed New Construction(sf)_ Total Height(ft) Total Height it 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 E] Versio i Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Depnanment Lot Size Frontage Setbacks Front Side L: . R: L:'. R:. Rear Building Height -- Bldg.Square Footage Open Space Footage (Lot area minus bldg&paved kin #of Parking Spaces --- Fill: (.ommc&Locution) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DON'T KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES O IF YES: enter BookPage and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O 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 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O 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 ENCLOSED SPACE( 9.1 Registered Architect: Not Applicable 71 Name(Registrant): Registration Number Address Expiration Date Signature Telephones 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 J & B Construction Not Applicable ❑ Company Name: Joe Jasinski Responsible In Charge of Construction 43 Fair Street, Northampton, MA 01060 Address 588-4773 Signam Telephone Versioul.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 O SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I James Przypek as Owner of the subject property hereby authorize J & B Construction to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 1 .James Pfzypek 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 perlury. James Przypek Print 1, AUC Signa re of erlAgent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder ,Joe Jasinksi License Number 43 Fair Street, Northampton, MA 01060 CS-057025 Address Expiration Date 413-588-4773 y x� Signalur ♦ Telephone 6161A6 SECTI 13-WO KERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§26C(s)) 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 O City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: �' ��r����ret The debris will be transported by: iC Se C U GtS The debris will be received by: r 2_ Building permit number: n�kY , rr��u tin r44 (,,t� Pjr;u>It��aP Name of Permit Applicant Date ignature of ermit Applicant aco^& CERTIFICATE OF LIABILITY INSURANCE `/ 0312812018 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:I1 the certificate holder Is an ADDITIONAL INSURED, the policy([..) .at Us endorsed. If SUBROGATION IS WAIVED,subject to Me berms and conditions of Me policy,certain Policies may require an endorsement A statement on this certificate does not confer rights to Me cerfihcate holder In lieu of such endorsement(s). PRODUCER UDJS-001 XApMI�pryTEyeCT arse ch 818-1 Webber 6 Grinnell ins Agcy Inc PAIL.No.Etl: (913)586-0111 F�ic qu.: (913)586 6981 8 North Hin Street Suite#1 MAIL — _ -__._ ---- -- NorMampton,MA 01060 IADOREss. exontnesz@veebexanagximell.com . AIM.Mutual Insurance Company 3375&.- INSURED eurpC INBVRER B: BampshCou County Faun 6 Hampden Agximltunal Society — —--—— — INEURIER Q. EX 30 comfy r Si No 303 39 Fair Street01060 Northampton, MA 01060 ..URERF 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, INV AND CONOMONS OF SUCH POLIoCLIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILiR TYPE OF INSURANCE IBRPOLICY HUMBER M�j Yy U.I. GENERAL LUBILM VolU I FACH.000RNEuCS f I COMMERCIAL GENERAL LIARILNY PflEMI 5 Eao u CWMBMPDE OCCUR MED CAR(My me Pewn) �I$ PERSONAL 6 A°V INJURY Ir— GFNERPLAGGREGAIE $ 3.1 AGGREGATE LIMIT APPLIES PER'. i PRODUCTS-COMPIOFAGG $ FLUCY OT 1 LOC - --- - - - - - - - - - COMRNEOSINGLEUMIT AUTOMOBILE LIABILITY Gml S I ANYAUTO Ali BODILY INJURVIPorpe,wnl S I ALL ONNW SCHEDULED BODILY INJURY(PonccidmU $ 'HI)REOAVIOS TCA ANT.. NONJUNMEO 'I, PROPERTYOAMAGE E AVTOB Pc a[u0m) S UMBXFILA WB CCGUR EACH OCCURRENCE 6 E%CES LIAa CWMBMAOE EACH g DEO RETEMION f � f sa �srBirn�n X Ist�slvss az'�' liQW&JMCUTIVE�YIR EL.EACH AccIDENr $ J.QgQ.gg4..Qy A I '•1 x1A AWCi00-T03b31 T-2078A 21418018 21412019 ----NE EJEM ---- IMYa6pJedbry�pin NWWXee) EL.°ISE45E-E4EMPLOYEE 4 �[y[.RI�ION OPERATIONS Eebw EL°ISE45E-POLICY LIMIT S t -001000.110DMCM1 proofoff v rage OXSI LOCAl10N51 VEHICLES(Alta[LAL°RD 1D1,A991Wna1 RemaMa s[IleEule.11more[WroXrequfeMl proof of coverege CERTIFICATE HOLDER CANCELLATION Hampshire Franklin&Hampden Agricultural Attention:Ohs Three County Fair SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Box 305 54 Fair Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Northampton,MA 01060 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPREEENTATNE 7-c- 0 1988-2010 ®1988-2010 ADORE)CORPORATION.All rights reserved. ACORD 26(2010106) The ACORD name and logo are registered marks of ACORD a"l The Commonwealth of Massachusetts Department of7ndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia W\V,wkcrhr' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMIT'fINC AU I HORI'11'. Applicant Information Please Print Lesibly Name (Business/Organinatiow[ndividuah:Hampshire, Franklin & Hampden Agricultural Society Address:54 Fair Street City/Sta[e/Zip:Northampton, MA 01060 Phone#:413-584-2237 Are yon an employe?Check the approprute box: Type of projeM(required): I.Q l am a employer with 10 employees(full mayor part time)) 7. ❑New construction 2.❑I an a sole proprietor or partnership and have no employees working for me in g. ❑ Remodeling any capacity.[No workers'comp insurance required.] 3.❑l as a homwwrs wner doing all work myself[No rrkecomp.insurance required 1 9. El Demolition 4.❑1 aa homeowner and will Ya hiring connectors b condom all work on my property. 1 will 10 El Building addition m ensure that all contractors either have vorkdo'cumpeosation insurance or are rule II.❑Electrical repairs or additions proprietors with no employees;. 12.❑Plumbing repairs or additions s❑1 am a general contractor and 1 have hired the subcontractors listed on the ttached sheet 13.�Roof repairs Riese sobcommaturs s have employees and have workecamp.insurance:_ 6.❑We me a),andeconnotation veJ its offemployees love exercised their right trour exemptionaretr per MGL c. 14.E]Other replace siding 152,§1(4),end we have no employees.pJo workers'comp.insarxrce rryuiredd •Any applicant that checks box 41 must also fill out nitration belmv showing In,,,workers`compensation pulley m ornaramir t Homeowners who submit this affidavit indicating they are doing kI work and then hire uruale eco actors must submit a new efLda,r iodinating anal. [Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and Also,whether or not those entities have employees. If the Aubron craw,haveempluyees,they most provide their workerscomppolicy number, I am an employer that is providing workers'compensation insurance for are employees. Below is rhe policy and job site information. Insurance Company Name:A.LM. Mutual Insurance Company Policy#or Self-ins. Lid.#:AWC-400-7035317-2018A Expiration Date:02/09/2019 Job Site Address:54 Fair 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 ofthe DIA for insurance coverage verification. I do hereby certify under thep ndpena esperju that the information provided aboveis true and correct. Structure: /�.% '/Gf�Y/ Date: Phone#:413-584-2237 �////