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06-022 (33) 46 EVERGREEN RD BP-2020-0114 GIs#: COMMONWEALTH OF MASSACHUSETTS Mg.-Block:06-022 CITY OF NORTHAMPTON Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Siding BUILDING PERMIT Permit# BP-2020-0114 Project# JS-2020-000190 Est.Cost: $65000.00 Fee: $455.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Group: NICHOLAS RILEY 97077 Lot Size(sg.ft.): Owner. YANKEE HILL CONDO Zoning:URA(99)/ Applicant: NICHOLAS RILEY AT. 46 EVERGREEN RD Applicant Address: Phone: Insurance: 77 MASSACHUSETTS AVE#2 (413) 531-4370 WC CHICOPEEMA01013 ISSUED ON:7/29/2019 0:00.00 TO PERFORM THE FOLLOWING WORK.-VINYL SIDING 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 Sij4nature: FeeType: Date Paid: Amount: Building 7/29/2019 0:00:00 $455.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2020-0114 APPLICANT/CONTACT PERSON NICHOLAS RILEY ADDRESS/PHONE 77 MASSACHUSETTS AVE#2 CHICOPEE (413)5314370 PROPERTY LOCATION 46 EVERGREEN RD MAP 06 PARCEL 022 000 ZONE URA(99)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildina Permit Filled out Fee Paid It Typeof Construction: VINYL SIDING 03F W) New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 97077 3 sets of Plans/Plot Plan THE F09JLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION 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 7 29- 20 i 9 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. Versionl.7 Commercial Building Permit May 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 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 1.1 Property Address: This section to be completed by office _ lavD Map 00 Lot 0,�/^"— Unit t EEbS, MA b1653 Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Cbt�l PAC< y 6 CV- - 9D GSE, M� Name(Print) Current Mailing Address: L41-3 73-74 ,313,5- Signature 743135Signature Telephone 2.2 Authorized Aqent: N k CAAcx AS '�I C 7 7 Ir fiV6CkkT DVC-6— lk?A o f o13 Name(Print) Current Mailing Address: /V 3 S31 4/3 70 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building LS, ooG t C�ro (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee hh 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) GYXO .©a Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: /z -7- Z9-2019 /- Building Commissioner/Inspector of Buildings Date 4E7,70/,-/ : ,,use)FIV��� Version 1.7 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❑ 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� ��U., . /JE?� v1►L A— SIisA- 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 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential R-1 ❑ R-2 R-3 ❑ 5A 9 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 1 S' 15` '57Cry I d n --------- 2nd 2 S7�J _ 3rd 57vU 3 rd :--- -� 4m 4�h ---- Total Area (so 1 Zjts Total Proposed New Construction (so Total Height(ft) 32' _ Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ® Private-n Zone Outside Flood Zone Municipal 0 On site disposal system❑ Versionl.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 '3311) CIyZ sq FT Frontage 600 Setbacks Front So Side L: yO R: 9 8 L: R: f� Rear Z50 Building Height 3Z� Bldg.Square Footage n y0o % i Open Space Footage % I (Lot area minus bldg&paved ?00/cco LJ parking) 5'9 #of Parking Spaces Fill: (volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW © YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW © YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , Date Issued: C. Do any signs exist on the property? YES ® NO O IF YES, describe size, type and location: 15S9 FT A7—% «2ANCE -ri--> 'F/UD'E--k:Uy D. Are there any proposed changes to or additions of signs intended for the property? YES © NO G 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 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 5d 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 f,3; Not Applicable ❑ Company Name: N�G�-lr�c�s 21 LES Responsible In Charge of Construction '7-7 MAS 5 ft U C K kCj:P , rW of a 3 Address 7-A; 7--4 t-V� y 13631 4 3 70 Signature kX 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 © No SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, gAf-)KkZ ASL--- as Owner of the subject property hereby authorize t3, (?-ALA t CDA-D`(QCT/O/U to act on my behalf, in all matters relative to work authorized by this building permit application. St-F, Signature of Owner Date I, !y( oCf�S 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. N(c,"OLI S Wi[�z Print Name &9;;� Signature of Owner/Agent 1k, Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor:: �` Not Applicable p Name of License Holder: /JIG"OLAS }-r«� 09 7077 License Number 77 MAS-,,z, 4\/e Cts tC*CE /n/+ of ol3 9-2q -?10 Address Expiration Date LAS,573/4f.3 7 a 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 provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes W 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: 9G -R�D The debris will be transported by: AU—�y�sztE Wie�jj-q _ The debris will be received by: m dio,G lvwl e T/Msz cg- Building permit number: Name of Permit Applicant Nick-tceAs 7-z G-19 Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name(Business/Orgat&Aion/Individual): /,-Y. Z-1C-� CO/-1,S-VL()CT 0AJ Address: '7-7 /►'IA S t IUC City/State/Zip: CEYIM4 ofoL 3 Phone#: Z)I3S3/ L137Z) Are you an employer?Check the appropriate box: Type Of project(required): I &am a employer with 18� employees(full and/or part-time).' 7. ❑New construction 2❑1 am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 301 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. i will ensure that all contractors either have workers'compensation insurance or are sole 11.E]Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.[]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[]Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other SjpttJG 152,§1(4),and we have no employees.[No workers'comp.insurance required.] • -JL- Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy 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: SC-Lep— l V t✓ /ti):s - Policy#or Self-ins.Lic.#: I.0G`i0$10570 Expiration Date: ZO Job Site Address: 1f(6 E0E2Gt-6aSA-) 7M City/State/Zip: LL E4jS, /►'!/� 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signafore: Date: 7 Phone#: Lf(3 53/ lf3-7 D Oficial 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.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: NRILEYC-01 LAURA A�O�RO CERTIFICATE OF LIABILITY INSURANCE FDAT6/121/221/2D/YYYI) 019 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 TH4 CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an 4DDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject tote terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the c Drtificate holder in lieu of such endorsement(s). PRODUCER C NTACT Laura Missed Phillips Insurance Agency,Inc. 97 Center Street (AHICC,NN, Ext):(413)594-5984 FAX No):(413)592-8499 Chicopee,MA 01013 AEbU :laura@phillipsinsurance.com INSURERS AFFORDING COVERAGE NAIC S INSURER A:Selective Insurance 12572 INSURED INSURER B: N Riley Construction Inc INSURER C: _ 77 Massachusetts Avenue INSURER D: Chicopee,MA 01013 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 F SUCH POLICI S.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TIN TYPE OF INSURANCE ADDL S BR POLICY NUMBER POLICY EFF POLICY EXP LIMITS INSID L. IYYYY MIDD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 CLAIMS-MADE LX OCCUR S2392704 6/22/2019 6/22/2020 DAMAGE TO RENTED 500,000 REMI S Ea occurrence $ MED EXP An one 15'000 PERSONAL&ADV INJURY $ 1'000'000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 1 PPET LOC PRODUCTS-COMP/OP AGG S 2'000'000 OTHER: $ A AUTOMOBILE LIABILITY (Ea accident)COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO A9107217 6/22/2019 6/22/2020 BODILY INJURY Per Persw $ AUTOS ONLY AUTOS BODILY E CH WN BRODILYINJURY Per accident $ AUTOS ONLY AUTO ONLOY PPeor.dent AMAGE $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1'000'000 EXCESS LIAB CLAIMS-MADE 52392704 6/22/2019 6122/2020 AGGREGATE $ 11000'000 DED I RETENTION$ $ A WORKERS COMPENSATION X PIAT OTH AND EMPLOYERS'LIABILITY C9081050 6/22/2019 6/22/2020 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y� NIA E.L.EACH ACCIDENT $ OFFIC.,AM MBER EXCLUDED? 1,000,000 1(�Mandatory n NH) E.L DISEASE-EA EMPLOYE $ If yes,describe under 11000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Leased/Rented S2392704 6/22/2019 6122/2020 Equipment$500 Ded. 50,000 DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES(A(ORD 101,Addltlonal Remarks Schedule,may be attached if more space is required) RE:Proof of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN N Riley Construction Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 77 Massachusetts Ave Chicopee,MA 01013 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ! ©1988-2015 ACORD CORPORATION. All rights reserved. The ACCIRD name and logo are registered marks of ACORD 10, URIV. RUE Construction/Gei ieral Contractor Page 2 of 2 Acceptance of proposal:The listed prices,specifications and conditions are satisfactory and are hereby accepted. N.Riley Construction, Inc. is authorized to do the work as specified. Payments will be made as outlined above. This updated contract supersedes any and all others. Please remit payment and signed contract N.Riley Construction, Inc.77 Mass Avenue Chicopee,MA 01013 prior to the scheduled start date. Project expected to take roughly eight weeks with a start date around August 1st Authorized Signature: Date of I �a19 Job Name: YANKEE HIL Acceptance: 46 EVERGREEN Job Location: ROAD Signature: LEEDS,MA Phone: Signature: Commomriealth of aMassachusetts Division of Professional Licensure Board of Building Regulations and Standards �S-097077 =xpires:D9/29l20?0 NICHOLAS J RILEY f ', TT MASS AVE CHICOPEE MA 01093 - ?: CIL 4, Commissioner l./�`"'' From: -� J 47t� To: Louis Hasbrouck Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 The Massachusetts Building Code,section 107.1 allows for an exclusion from requirements for construction control in certain situations. In accordance with code section 104.10, 1 request that you grant a modification to waive the requirement for construction control of the project at a because the work is of a minor nature,will not affect structural elements, health,accessibility, life or fire safety,and will be done in accordance with the prescriptive requirements of the code. Thank you for your consideration. Respectfully, r