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17C-218 (7) 29 NORTH MAPLE ST BP-2019-0802 GIs#: COMMONWEALTH OF MASSACHUSETTS Mggj lock: 17C-218 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-2019-0802 Proiect# JS-2019-000556 Est.Cost: $2500.00 Fee:$100.00 PERMISSION IS HEREB Y GRANTED TO: Const. Class: Contractor: License: Use Group: JAMES PETERSON 107525 Lot Size(sq. 1): 6490.44 Owner: LAFRANCE GERALD D&SANDRA K Zoning: GB(100)/ Applicant. JAMES PETERSON AT. 29 NORTH MAPLE ST Applicant Address: Phone: Insurance: 1310 SOUTH MAIN ST (413)689-8359 SOLE PROPRIETOR PALMERMA01069 ISSUED ON:1/15/2019 0:00:00 TO PERFORM THE FOLLOWING WORK:FIRE STOP, INSULATE, AND DRYWALL 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 Deaartment 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: FeeTyue: Date Paid: Amount: Building 1/15/2019 0:00:00 $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner I - Version 1.7 Commercial Building Permit Ma 15,2000 -7-__, Depatrrent ttsonly City o Northampton �tus of JAN 1 5 2019 BUildi g Department V Permit, - 212 ain Street 5ilbiir �. Rom 100 tare Auk XAt: -- a-- �i6ttham ton, MA 01060 " w*Sets of r �a l alt - �'.', `�� -1240 Fax 413-587-1272 Ptom 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 4-SITE INFORMATION' 1.1 Property Address: This section to be completed by office .a/. 7I1�P/ S.+ Map Lot Unit 14-10 Kc- +'IC C G Zone Overlay District _,....._ ..... Elm St.Distrild CB,District, SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: __J a�.r►�,rs, ��/�er�o�t-._ ��1�.. S 7'17��.+.._ 1�" .�1�(i1S �./mer �Yl� oio�� Name(Print) Current Mailing Address: Signature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) J 5. Fire Protection _. _... 6. Total=(1 +2+3+4+5) Check Number .� This Section For Official Use Only Building Permit Number Date Issued Signature///,,-Z- Building C missioner/Inspector of Buildings Date t w.A e (1-K C cts t, ,vet' Versionl.7 Commercial Building Permit May 15,2000 ' SECTION4 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations M 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: / ` / T+•c 511-1- {o --? — -Iqt-' - n� 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 ❑ 1B ❑ B Business 0`1— 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional Cl I-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 ❑ 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 BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(so 1S2 1St 2nd _ ..... __.. 2nd 3rd 3rd 4th 4th _. ..__... Total Area(so Total Proposed New Construction(so,, 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 E] Private C] Zone Outside Flood Zone[-] Municipal ❑ On site disposal system C] " Versionl.7 Commercial Building Permit May \5.2O0O 8. NORTHAMPTON ZONING : Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (volume&Location) A. Has aSpecial Permit/Variance/Findingever been issued for/on the site? �� NO �~� DON7KNOVY « -�� YES �_� IF YES, date issued: � IF YES: Was the permit recorded a1the Registry ofDeeds? NO K ) DON7KNOVV YES IF YES: enter Gook | Page' and/or Document#| ' �� B. Does the site contain a brook' body ofvvaterorvvetiands7 NO ��/�_ DONT KNOW �~� YES u�� IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs tmbaobtained «�� ~�Obtained �-� Date - ----- -- 1 �_� � ' . C. Doany si �gns � stonthe property �� YES �_� NO w�� 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, orfilling)over 1acre oriobpart ofacommon plan that will disturb over 1acre? YES �� NO K��— �� 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 ❑ 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�m PS rlrrc�. Not Applicable ❑ Company Name: G'�,,p�4 _,�o,'ra_�-1rr►��rt�,Jr�.11��k_� _ _ _ _'. Responsible In Charge of Construction Address 1�1ignature Telephone Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No tom/ SECTION 11OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 4. ,e7ck AP-1 "C4.e O le,,,,. .... as Owner of the subject property _.. .. ...... .... hereby authorizeto act on my behalf, all matters relative t wo authorized by this building permit application. Signature of Owner Date I, 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. Prin ame jai,.. /,,, ignature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: ,. `KCIS... c. r/SOf1 -11111111 _. License Number 6 r _. .S Address Expiration Date ignature 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 build g permit. Signed Affidavit Attached Yes No 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: a 92, 3�4,y/e s The debris will be transported by: The debris will be received by: Building permit number: Name of Permit Applicant Date Signature of Permit Applicant s J The Commonwealth of Massachusetts z Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Business/Organization Name: C z, &jar Address: /jam1�C7 S. Wa;,% 57, Ag f 5 City/State/Zip:/u/ a<oG Phone#: �Z%3 - L Fy -�3 S 9 Are you an employer?Check the appropriate box: Business Type(required): 1. � am a employer with employees(full and/ 5. ❑Retail art-time).* 6. �E]Resjce urantBar/Eating Establishment 2. I am a sole proprietor or partnership and have no 7. fand/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8. 0 Non-profit 3.0 We are a corporation and its officers have exercised 9. 0 Entertainment their right of exemption per c. 152,§1(4),and we have 10.0 Manufacturing no employees. [No workers' comp.insurance required]* 11.0 Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers' comp.insurance req.] 12.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name: Insurer's Address: City/State/Zip: Policy#or Self-ins.Lic.# Expiration Date: Attach a copy of the workers' compensation 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 DIA for insurance coverage verification. I do hereby certi , under the pains a3jik4enalties of perjury that the information provided above is true and correct Si naturex- ��._ . r Date: Phone#: 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.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However,the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely, by checking the boxes that apply to your situation and,if necessary,supply your insurance company's name,address and phone number along with a certificate of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required.Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number.In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary). A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877- IASSAFE Fax# 617-727-7749 www.mass.gov/dia Form Revised 02-23-15 01/14/2019 15:31 FAX 1 413 283 2556 Crimmins Graveline 20001 DATE(MMIDDIYYYY) AC"RL? CERTIFICATE OF LIABILITY INSURANCE 01/14r2019 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 have ADDITIONAL INSURED provisions or 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: Sara Scrivner,CIC Crimmins/Graveline Insurance Agency,Inc. PHONE (413)283-83781FAX (413)283-2556 A1C No Ext): A1C No 1382 Main St. ADDRESS: sscMAIL dvner(dcgins.com P O Box 905 INSURERS)AFFORDING COVERAGE NAIC N Palmer MA 01069 INSURERA: Preferred Mutual Insurance 15024 INSURED INSURERS: James Peterson Sr. INSURER C: 1310 S Main St INSURER D: INSURER E Palmer MA 01069 INSURERF: COVERAGES CERTIFICATE NUMBER: 2018 GL 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. INSIR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Fx—I OCCUR PREMISES Ea occurrence $ 50,000 MED EXP(Any one person) $ 10,000 A BOP0100722956 03/18/2018 03/18/2019 PERSONAL e ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY PECO- 1 LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY CO BIN SINr,LELIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ nWINED SCHEDULED BODILY INJURY(Pei accident) $ AUTOS ONLY AUTOS HIRED NON-OWNEDPOPERTYDAMAGE $ AUTOSONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCEH $ EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION$ $ WORKERS COMPENSATION R O H- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PRO PRIETOR/PARTNER/E),ECUTIVE NIA E .EACH ACCIDENT $ OFFICER/MEMBER E`:CLI IDED� (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ IfV s descuheundpi EFW II_ �� LL CI-C. _L- - _ I DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton Attn Kevin Ross ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main Street AUTHORIZED REPRESENTATIVE Northampton MA 01060 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD -n v 21'-4 3/4" (D M Z N c �V CD CD M Q KMM CID 1ST FLOOR APARTMENT n = 0 9'-3" 3 C o 2'-C" (CD > 1'-6" 4'-6" ENTRN 'STAIR HR' L FOR L E — � �---- - ----- sESIo: INITIAL UN12 rn i ------ --- �- - - --- - _ I I FLOOR UP MCUNTED MCP SINK i BATHROOM �_-- INFILL EXSITING WINDOW I \�\ J d� s°o / op i DEMISE '✓ALL BET'VEEN TEI \".T _ ±6'-1" N3'-4" SPACES -O BE 1-H t RATED. I a CD ex.wall b\4' X F � .0 NEW WINDOW IN EXISTING, RE-OPENED FRAMED z INSTALL:JEW DOU SLE - OPENING.INSULATED rr £ INSTALL NEW PLYWOOD GLAZING, LOW-E, C HUNG WI`JDOW IN =XISTING "51 r DOOR OPENING. x��' y SUBFLOOR AT TENANT SPACE ARGON FILLED rr INSULATE D,LOW-E ARGON a o Y� AND BATHROOM,MIN.3/8". " FILLED GAZING.I!:FILL INSTALL NEW SHEET BELOW V;INDOW V ITH =? FLOORING,TBD. CONSTRICTION T )MATCH INSULATE EXTERIOR WALLS @ a ADJACE�T. q3 TENANT SPACE,MIN.R-20 PER C MA.ENERGY CODE rr � [ INSTALL NEW 5/8"TYPE-X GWB AT EXTERIOR WALLS I INSTALL 5/8" EXIST.C iIMNEY x a < + TYPE-X GWB AT TO REM/IN wa c_ ( ENCLOSURE AT x F c i CHIMNEY TENANT SPAC:EE o D APPROX.602 Si f .z a�g o Z 1.12 N I ff — RGDI A(`G FYICT 7' 10 n§ m VJL6.'cF'D�DL ¢�C/l 6��KCIdJCIC�CC3CC�3 S.i Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: Uggis1ration Expiration Office of Consumer Affairs and Business Regulation _ 1$O?1 7 11/12/20/9 10`Oprk Plaza-Suite 5170 JAMES PETERSON BoA*n,MA i 21fd D/B/A ALPHA HOME IMPROVEMENT JAMESPETERSON tte�a-.MAIN ST APT#5 # fig,MA 0 106 Undersecretary Not valid without signature C., Commonwealth of Massachusetts Division of Professional Licensure Board of Building Rayulations and Standards Const` AU-pfrv1Sor CS-'07625 L;3nire-; iui• X19 re JAMES B PETERSON: 1310 S MAIN STREET PALMER MA 011.0$9 f)r�-iiL cmrn;ssioner I E I r Construction SUDervisor Unrestricted-Buildings of any use group which contain less than 35.000 cubic feet(991 cuesc meters)of enclosed 3 space. J is i i I t Failure to possess a current edition of the Massachusetts State HWIding Code is cause for revocation or this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpi