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17C-253 (26) 29 NORTH MAIN ST BP-2019-0231 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C-253 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateamv: REPLACEMENT STAIRS BUILDING PERMIT Permit# BP-2019-0231 Proiect# JS-2019-000371 Est.Cost: $3000.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Gro= ERICH PRICE 097602 Lot Size(sp. IT): 18948.60 OWner: CLINICAL&SUPPORT OPTIONS INC C/O PATRICK LEVELE Zoning:GB(100)/ Applicant. ERICH PRICE AT: 29 NORTH MAIN ST Applicant Address: Phone: Insurance: 6 ARCH ST (413) 325-6777 WC GREENFIELDMA01301 ISSUED ON:8/22/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE EXTERIOR STAIRS AND LANDING WITH NEW 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 8/22P20180:00:00 $100.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File d BP-2019-0231 APPLICANT/CONTACT PERSON ERICF 'RICE ADDRESS/PHONE 6 ARCH ST GREET:4IELD (413)321-6777 PROPERTY LOCATION 29 NORTH MAI ST MAP 17C PARCEL 253 001 ZONE Gfk )0)/ THIS SECTION FOR OFF(AAL USP ONLY: PERT T APPLICATION CHECKLIST ENCLO D UIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Vk Fee Paid TypeofConstruction: REPLACE EXTERIOR STAIRS AND LA iTH NEW New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 097602 3 sets of Plans/Plot Plan THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN RMATION PRESENTED: Approved_Additional permits required(see below) I PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project Site Plfn AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: §; ti 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 emolition Delay Si eofB iIdling tial Date Note: Issuance of a Voing 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. Versionl.7 Commercial Buildin PermitVIa 15.2000 Department use only City of Northampton Status of Permit. Building Department Curb Cut/Driveway Permit - 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Pic ite Plans - APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANG THE ORD MOLISH ANY BUILDING OTHER THAN A ONE OR TWO AMILY DWELLING SECTION 7 -SITE INFORMATION AUG 2 1 2018 (� 1.1 Property Address'. This section tob com leted by office DEPT OF OUIlDINOINSP�G7IONS Unit 29 North Main st,Florence,MA MaP NonnaAMPTON.MA bmBo Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Clinical and support options 8 Atwood Drive,Northampton,MA 01060 Name(Print) --- Current Mailing Address. c .. -. (413) 774-1000 Signature Telephone 2.2 Authorized A ent: Erich Price 76 North Hillside rd, South Deerfield,MA 01373 Name(Print) Current Mailing Address: (413) 824-9684 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by Pfruit applicant I Building $3,000.00 (a)Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4, Mechanical(HVAC) 100 OLS 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section ForOfficial Use Only Building Permit Number Date Issued tignatuCommisafmer$a,,(,tor r of Buildings Date 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❑ Repairs 71 Additions ❑ Accessory Building 11 Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description Replace existing exterior stairs and landing with new ones. 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 ❑ to ❑ A4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2/Y ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A E21 I 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 ❑ Speedy: 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 BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(st) 1 1m 2nd 2r.e aid 3,d 4m 4in Total Area(sI) 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 7] Private [3 Zone Outside Flood Zone❑ Municipal Q On site disposal system❑ Version 1.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This Mcmm�m be filled in by Bellaire a'ixr ment Lot Sizc Frontage Setbacks Pront Side L: R: L: R: Rear Building Height Bldg.Square Footage % Open Space Footage (Lot ema ri bldg&pave Ain g of Parking$ aces Fill: (volume&Lorstion) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW 0 YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO e DONT KNOW © 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 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 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 Nodhamptoc Storm Water Management Permit from the DPW is requlred- Version t.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 118{CONTAINING MORE THAN 38,000 C.F.OF ENCLOSED SPACE) Al Registered Architect: Not Applicable ❑ Name(Registrant): Regisvation Number Address Espha9am Urge Signature Telephone 9.2 ReSYxtered Profexxianai Engineer(s): Name �— Area of Responsibility Address Registration Number Signature Telephone Expiration nate Name Area of Rea ponsibtlify Abtlress Registration Number Signature Telephene Expiration Date Name A@A f Reb'pon6L ty Atltlress Registration Number Egnature Telephone Eimandron Data Name Area of Responsibility Atltlress Registration Number Signatum Telephone Expiration Date 9.3 General Contractor Erich Price Not Applicable ❑ Company Name: Erich Price Responsible In Charge of Construction 76 North Hillside rd, South Deerfield, MA 01373 Address � � (413) 824-9684 Signature Telephone VersionL7 Commercial Building Permit May 15.2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yea 0 No 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, / ohne l7f�y'� as Owner of the subject property hereby authorize Erich Price to a y hal s relative to work authorized by this building permit application. 08/21/2018 Signal of Own r Dale I, Erich Price 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 rtthe pains and penalties of perjury. Prim g7 7Y CA �/// 08/21/2018 Signature of O nabAgenl Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Homer Erich Price cs-097602 License Number 76 North Hillside rd, South Deerfield,MA 01373 05/30/2019 Address Expiration Date (413) 824-9684 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 provitle this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes @ No 0 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: xz"e " /-/e-- The debris will be transported by: The debris will be received by: 21 Building permit number: ��JJ Name of Permit Applicant rri OrNeC , Date Signature of Permit Applicant CERTIFICATE OF LIABILITY INSURANCE DATE/"MmG YYY) 081212018 THIS CERTIFICATE IS ISSUED ASA 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 PROOUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. 11 SUBROGATION IS WAIVED,subject to the terms and conditions of Ne policy,cerialn policies may require an endorsement. A statement on this certificate doe"not confer rights to the certificate holder In lieu of such endomemengs). PRODUCERAME°°T B rTMa Grynk'lewia WebberB Gunnell CNE (413)586-0111 `At Na: (413)5SGE461 8 North King Street ADDRESS: b9rynkiewi¢@webbereedgurnell.win R SIAFFOROING COVERAGE Northampton MA 01060 INSUPERA. Philadelphia lnderTHWPA In.. NAIC INDUCED MEMBERS: WCAR-Acadia Clinical 8 Support Options,Inc. NUSUPERP Atlas DUN.Thomi CFO BANmod Or#301 SsuaER B: Northampton MA 01W0 INSURERF COVERAGES CERTIFICATE NUMBER: EAR 7/1119 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDASOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINGANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WHIK 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. IOn ttPE OF IN3VPPNCE POLICY NUMBER UMEN YY MM WYYY LINDA X COMM ER[IALGENERALLNBNtt EACH OCCURRENCE S 1000,000 TED CIAIMS�MAOE OOCCUR ES[ea 111 s 100,000 MEDExPNn cm mm $ 5,000 A PHPK1675570 07012018 07/0112019 MEEG.NALSABISCUNY 3 TW0,000 OGREWTE IIMITM ES PER: GENERALAG°REGRE $ 3000,000 Ex✓CLIcv wECT PO LED UCTS�COMPIOP AGO 3 3000,000 T. Employee Benefits 31,000,000 AUTOMOBSE"Aewry ...MeB61N°LE LIMIT 31000000 G.Mrcel X ANYAVTO DOGUYINJURY(Perli $ A ORENAU UFUEONLv SCHEDULED ioB LED PHPK16]5577 0]10112010 0]10112018 SGXUYmmRY(Peremmeml i AVTO6ONLY AHIRED .TC60NEOV �4�PROPERTY DAMAGE 3 E X UMBRELLA/IAB GUR EACH OCCURRENCE $ 1,000,000 A EXCEsa CA. DvSUISANE PHUB590240 071012018 070112019 AGGREGATE 3 1,000,000 O I X1 RETENTION 3 10,000 6 WORRERe COMPENSATION x STA UTE EHH ANO EMPLOYERS UAB Wry B AN OF FI CERIMEMBSREXcwDEo ECUTrvE Y❑ xlA MMRP300268 10`221201] 1012212018 EL EACH ACCIDENT 11 500,000 "mGSMryIn Np 1.DISEASE-FA EMPLOYEE S 500,000 acnbe wAn E 500,000 DESCRIPTION OF OPERATIONS belox E.L.DIS SE POLICYLIMIT 3 Proftsional,SBAUS Abass& A Molesta4on Liability PHPK1875570 0710112018 0710112 19 Llmif OCwrrence $1,000,000 Aggreg°te $3000,000 DESCRIPTION OF OPERATIONSILOCATIONSIVENICLE9(ACORD IOLAEIIBentlR-Mas Si may be im-Nd II MIN NNNM Mini Replacement of sleirs at 29 Nom Main BE Florence,MA 01062. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of NDmempton ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main St iH°RCED REPNEBENTATVE �1p Northampton MA 01060 1),Jl-� r' --^f ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 08/20/2018 23:27 4137737304 PAGE 02/02 The Commonwealth of Massachusetts Department of lndustrial Accidents �e l Congress Street,Suite 100 k Boston, MA 02114-2017 www.mass-gnv/dio Workers'Compensation use ounce Affidavit:8uilderr/Contractars/i ricians/Plambers. TO RF,FILED WITH 7HE PERMITTING Ali 110RITV. Applies tInformation Please Print 1-eeibly Name (Rnsinos/Ora.17.alion/Individua1):Clinical and Support options Address'8 Atwood Drive City/State/Zip:Northampton, MA 01060 Phone#.413-774-1000 Ayu an C.Mlr eRCheck thoap ,amaw his: Type of project(req uired)I h�IamamnNover wim_employees Gull an0.br vroirc) 7, New emntruelion z lama v,lC rcwrleror or parturs.so and Hove co m,Ii working for,-n. g. Remodeling al W, cuacm.INH no,kcr, u+mp Imanncc reg,--cd.l l in ann acownerdoilrg an work n,scr Ino worker,'enmp.in:Han�m,atc I? in Demolition ❑70QBuilding addition a Into a'tome0tl'ner and-11 Ic hiring enmmemrs b curd"l n I woo¢no my mnpenyiwill um rnacall mnVnaorsei;her'nvc worker.onmpcneeion lmnrnx Drove sole 11.Q Electrical repairs or additions p�nnri.rnn with nn emNmea:_ 12.7 Plumbing repairs or additions 1 am a¢encrxl wnmcmr end i M1avc rind chc snpunln¢tors I nest or tM anortnd chert. These mh-wniocrors have employees and hove worker,'comp.innormva. 13.❑Roof repairs n❑wours ocorpowuo ord N Omcer9 hnv[everduG Gcrrgln ol'cxwpCan pvrMCL c. 14.❑Olhcr__ 152,31(gt and we hvenor-+npinymaa.l,Nnworkon'cmnp m v,o-dl Ay Mr nFr1 k I. fll rtl di .rel M1 1 kan o,,.—,oc,,rnsi I Ho n,nw,or,who v,iia,elidml.nd'w['r6 Noy in,dung a work and toon h M isnindE wnneat _ air a is,ifficir,in indiwouis; cIh :Co,,,,no,Is,,heck his iso Inlet arae vri an addin'annl A.showmP Ills came or the a,l%anTem¢mdsrne whctnnr or not In.mads,Inv, employees. I r nit wb csnnocrors lmve inninym,tbry mun provid their workrn comp poli,rrober. lam an employer thatis providing workers'compensation histaraaee for me employees. Re/ow is the policy andjoh site information. Insurance Company Name..Weber and Gi nnell Policy 4 or Self its ].is.f'f NP K��p��_Q F_'xpimtion Dow: lob Site Address:29 North Main at City/StatNZip:Florence, MA Attach a cagy of the workers'compensation policy deelarntian page(showing the policy number and expiration date). Failure to secure coverage as required under MGI.c. 152.§25A is ecriminal violation punishable by a fine up to 51.500.00 and/or ane-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250 Ord day against the violator..A copy ofthis statement maybe forwarded to the Office ofinvestigations all DIA for insurance coverage verifichtion. ldohere yl uder the pains andpamuficr nfperjury that the infwoondenpmvided above is hue aodcnrred. Si Ah - - _ Dare' //� Phone k:41 a-1 - Official use on(f. Do not write in this area,to he completed hf rhy or town ofclat City or Town: Permit/License 4 Issuing Authority(circle one): 1. Roa rd of H ca lth 2. Ru ildi ag Department 3.City7awn Clerk 4.Electrical I inspector S.Plu robing Inspector h.Other Contact Person- phone a: