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31B-284 (22) 21 CENTER ST BP-2020-0721 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:31 B-284 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: REPAIR BUILDING PERMIT Permit# BP-2020-0721 Proiect# JS-2020-00123 Est.Cost: $17500.00 Fee: $126.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PIONEER CONTRACTORS 017890 Lot Size(sa.ft.): 3179.88 Owner., SUHER PROPERTIES LLC Zoning:CB(100)/ Applicant. PIONEER CONTRACTORS AT: 21 CENTER ST Applicant Address: Phone: Insurance: PO Box 1145 (413) 586-5491 Workers Compensation NORTHAMPTON MAO 1061 ISSUED ON.-1211112019 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE STOREFRONT GLASS WINDOW, ENTRY DOORS, REPAIRS O MASONRY POST THIS CARD SO IT ISI ISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Servic : Meter: Footings: Rough: Rough House# Foundation: 1 Driveway Final: Final: Final: Rough Frame: Gas: Fire DeDartment Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke Final: THIS PERMIT MAY BE RE OKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND GULATIONS. Certificate of Occupancy 7si nature: Feer e: Date Paid: Amount: Building 12/112019 0:00:00 $126.00 12 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Version 1.7 Commercial Building Permit \lav 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 21 Center Street Map 31 LS Lot =:)1S / Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Eric Suher/Suher Properties j IP. Box 790 Holyoke, MA 01041 Name(Print) Current Mailing Address: Signature / Telephone 2.2 Authorized Agent: Pioneer Contractors _� P.O. Box 1145 Northampton, MA 01061 Name(Print) ,� ^�r~ Current Mailing Address: 413.586.5491 Signature V` l/�--- Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant (a) Building Permit Fee 1. Building 17,500.00 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing j Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = 0 +2+ 3+4+5) r`1 r S� Check Number to This Section For Official Use Only Building Permit NumberM Date (1,P o,-o—, Issued Signature: / / rl/ 9Building Commissioner/Inspector 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❑ Additions ❑ Accessory Building❑ Exterior Alteration El Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other ❑ Enter a brief description here. Replace existing storefront glass w/new insulated tempered glass. Repair jambs& Brief Description trim. Replace existing entry doors. Replicate existing style. Repair masonry @ base. 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 ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business 0 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 ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B p U Utility ❑ Specify: j 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: Business Proposed Use Group: Business Existing Hazard Index 780 CMR 34): Low Proposed Hazard Index 780 CMR 34): Low SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(so 1 sc 2nd I 2nd } 3rd r 3`d 4m !- 4m 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: PublicEPrivate ❑ Zone Outside Flood ZoneO Municipal 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 Frontage Setbacks Front Side L: R: L: R:= Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW Q YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW © YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW © YES 0 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: E7 D. Are there any proposed changes to or additions of signs intended for the property? YES O NO 0 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 © 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 ElName(Registrant): Registration Number Address 1 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 AddressRegistration Number Signature Telephone Expiration Date Name Area of Responsibility —t i Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility e� Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Pioneer Contractors Not Applicable ❑ Company Name: David Claxton Responsible In Charge of Construction P.O. Box 1145 Northampton, MA. 01061 Address j (A 4� 586.5491 Signature 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 O No Q SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Eric Suher as Owner of the subject property hereby authorize Pioneer Contractors to act on my behalf, inall matters relative to work authorized by this building permit application. 12/10/2019 Signature of Owner Date David Claxton/Pioneer Contractors , 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. Print Name __._....__..__._.. , t_Z 1 Signature of`Ownei Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: David Claxton CS-017890 License Number P.O. Box 1145 Northampton, MA. 01061 1/19/2020 Address Expiration Date i. 413.626.7267 Signaturef 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 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: The debris will be transported by: (�s r The debris will be received by: v2s' Rmc Building permit number: Name of Permit Applicant py ILS IC( & � Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):Pioneer Contractors Address:P.O. Box 1145 City/State/Zip:Northampton, MA. 01061 Phone#:413.586.5491 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓0 I am a employer with 3 employees(full and/or part-time).* 7. ❑New construction 2.[7 I 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 3.a I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10❑Building addition 4.❑I 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.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F—lRoof repairs These sub-contractors have employees and have workers'comp.insurance.; 14.0 Other Replace Storefront GIS 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *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. TContractors 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:Associated Employers Insurance Co. Policy#or Self-ins.Lic.#:WCC 50059570120019 a Expiration Date:6/30/2020 Job Site Address:21 Center St City/State/Zip:Northampton 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 certify and the pai s apf pe ids of perjury that the information provided above is true and correct. Si nature: LLI Date: Phone#:413.586. 491 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.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800) 876-2765 NCCI NO 40959 POLICY NO. -WCC-500-5005957-2019A PRIOR NO. I WCC-500-5005957-2018A ITEM 1. The Insured: Pi Con Inc DBA: Pioneer Contractors Mailing address: P O Box 1145 FEIN:*'-"'1984 Northampton, MA 01061 Legal Entity Type: Corporation Other workplaces not shown above: See Location 2. The policy period is from 06/30/2019 to 06/30/2020 12:01 a.m. standard time at the insured's mailing address. 3. A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 500,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTRA 000063757 INTER SEE CLASS CODE SCHEDU E i Minimum Premium $507 Total Estimated Annual Premium $2,061 GOOV GOV Deposit Premium $531 STATE CLASS MA 5437 State Assessments/Surcharges $1,647.00 x 3.8300% $63 This policy,including all endorsements,is hereby countersigned by �' 61-� 7—„1!:�: 05/30/2019 Authorized Signature Date Service Office: King&Cushman Inc 54 Third Avenue P O Box 447 Burlington MA 01803 Northampton, MA 01060 WC 0400 01 A(7-11) Includes copyrighted material of the National Council on Compensation Insurance, used with its permission. } 4 6 'r—T PL 1 1 1 1 4. d I. �111 ��F ' t .' •- ��p...... -, �., fy �y �<a �f f Its tit im 7 11 CIA, '�.. a AdPr 14 V Ll J ar t.ar 11 S � � r' r II ry pr AL ' I •Lk I ol •v1 ,�, .or s 1, ,j • , r r � r -- d P 10 it tf Op ML • y