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32C-047 (35)
110 PLEASANT ST BP-2020-0812 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C-047 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-2020-0812 Project# JS-2020-001403 Est. Cost: $154000.00 Fee: $1078.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MAROIS CONSTRUCTION CO INC 060872 Lot Size(sq.ft.): 9713.88 Owner: RESINATE OF NORTHAMPTON Zoning,:CB(100)/ Applicant: MAROIS CONSTRUCTION CO INC AT: 110 PLEASANT ST Applicant Address: Phone: Insurance: 262 OLD LYMAN RD (413)533-1320 Workers Compensation SOUTH HADLEYMA01075-2653 ISSUED ON.112112020 0:00:00 TO PERFORM THE FOLLOWING WORK: Buildout Retail Cannabis Store 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: 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 1/21/2020 0:00:00 $1078.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2020-0812 APPLICANT/CONTACT PERSON MAROIS CONSTRUCTION CO INC ADDRESS/PHONE 262 OLD LYMAN RD SOUTH HADLEY (413)533-1320 PROPERTY LOCATION 110 PLEASANT ST MAP 32C PARCEL 047 001 ZONE CB(100V THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CH EN OSED �EQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: INTERIOR RENO TO CREATILOPEN PfOOR PLAN New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 060872 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFyORMATION PRESENTED: V 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 X.Aki -9 -T)8MI I a� a Sign ure of Building Official 11 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. 110 PLEASANT ST BP-2020-0812 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:32C-047 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-2020-0812 Proiect# JS-2020-001403 Est.Cost: $154000.00 Fee: $1078.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License-- Use icenserUse Group: MAROIS CONSTRUCTION CO INC 060872 Lot Size(sa. ft.): 9713.88 Owner: RESINATF OF NORTHAMPTON zoning:CB(100)/ Applicant. MAROIS CONSTRUCTION CO INC AT. 110 PLEASANT ST Applicant Address: Phone: Insurance: 262 OLD LYMAN RD (413) 533-1320 Workers Compensation SOUTH HADLEYMA01075-2653 ISSUED ON.112112020 0:00:00 TO PERFORM THE FOLLOWING WORK.-INTERIOR RENO TO CREATE OPEN FLOOR PLAN 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 1/21/2020 0:00:00 $1078.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner eo W, Ptafl--S Vcrsionl.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 110 Pleasant Street Map 36-C Lot D f 7 Unit Zone Overlay District Elm St. District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Resinate Northampton 120 Gilbola Street Name(Print) Current Mailing Address: Douglas, MA 01516 Signature Telephone 2.2 Authorized Agent: Marois Construction 262 Old Lyman Road Name(Print) Current Mailing Address' South Hadley Ma 01075 Signature Telephone SECTION 3 -ESTIMA ED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 110,000.00 (a) Building Permit Fee 2. Electrical 18 500.00 (b) Estimated Total Cost of Construction from 6 3. Plumbing 5,500.00 Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 20'000.00 6. Total = (1 +2 +3 +4 +5) Q Check Number This Section For Official Use Only Building Permit Number Date 6®.- V _ i/� Issued SignatureWL T I �� Building mmissioner/Inspector of Buildingsl U Date 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 E] Existing Wall Signs LI Demolition❑ Repairs d Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Renovate existing building interior as per attached plans.The work includes selective demolition of existing walls for Brief Description new open floor plan. Misc. upgrades to MEP's 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 El 2A ❑ E Educational ❑ 26 I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B 0 M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 56 ❑ 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: B Proposed Use Group: B Existing Hazard Index 780 CMR 34): 4 Proposed Hazard Index 780 CMR 34): 4 SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1St 2450. 1 St `— NC 2nd 2nd 3rd 3rd 4th 4h I� Total Area (sf) 2450 Total Proposed New Construction(sf) 2500 Total Height(ft) 16' Total Height ft 16 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone[Z] 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 Frontage Setbacks Front Side L:= R:= L:0 R:= Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved J parking) #of Parking Spaces Fill: (volume&Location) - A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW © YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW © YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW O YES 0 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 e NO IF YES, describe size, type and location: Existing 2'x 5'wall mounted building sign D. Are there any proposed changes to or additions of signs intended for the property? YES ©i NO IF YES, describe size, type and location: Replace existing with new sign. 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. 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 0 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 Marois Construction Not Applicable ❑ Company Name: Carl Mercieri Responsible In Charge of Construction 262 Old Lyman Road South Hadley, Ma 01075 Ad s 413 533 1320 Signature Telephone 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: ,�'/z 2!--� The debris will be transported by: L4S The debris will be received by: Building permit number: Name of Permit Applicant Date Signature of Permit Applicant Version 1.7 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 Peter Decaro as Owner of the subject property Marois Construction - Carl Mercieri hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. P9&12 DQC� 1/15/2020 Signature of Owner Date Marois Construction - Carl Mercieri 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. Carl Mer i Print N 1/15/2020 Signature of Own r/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Carl Mercieri CS-060872 License Number 26201d Lyman Raod S th Hadley Ma 01075 12/29/2020 Address Expiration Date �IA��_:� 413 533 1320 Sig ure 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 No 0 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 y www mass.gov/dia Wohkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Amulicant Information Please Print Leeibly Name (Business/Organization/Individual): Marois Construction Co, Inc. Address: 262 Old Lyman Road City/State/Zip:South Hadley, Ma 01075 Phone#:413 533 1320 Are you an employer?Check the appropriate box: Type of project(required): 1.E✓ I am a employer with 50 employees(full and/or part-time).' 7. ❑ New construction 2.M 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 3711 am a homeowner doing all work myself.[No workers'comp.insurance required.]t ]0 0 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.Q Plumbing repairs or additions 5.M I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[:]Roof p repairs These sub-contractors have employees and have workers'comp.insurance., 6.E]We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#I 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:AIM Mutual Policy#or Self-ins.Lic.#:MCC2002000336 Expiration Date:1/1/2021 Job Site Address:110 Pleasant 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 of the DIA for insurance coverage verification. I do hereby certif ndert p n n nalties of perjujy that the information provided ab oie is tr re and correct. Si ature: 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.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: ACO CERTIFICATE OF LIABILITY INSURANCE DATE IMM/1/14/22020020Y) 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 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: Sarah Premo Martin J Clayton Insurance Agency, Inc. pHHCFAX ONN Ext: (413)536-0804 AIC NO: (413)534-7874 1649 Northampton Street ADDRESS, spremo@mjclayton.com P. 0. BOX 989 INSURERS AFFORDING COVERAGE NAIC# Holyoke MA 01041-0989 INSURERA:Hanover Insurance Company INSURED INSURERB:AIM Mutual Insurance Company Marois Construction, Inc. INSURER C: 262 Old Lyman Road INSURER D: INSURER E: South Hadley MA 01075 INSURER F: COVERAGES CERTIFICATE NUMBER:2020 MASTER 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDNYYY MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X1 OCCUR DAMA E T REN 100,000 PREMISES Ea occurrence $ ZDN6251989 1/1/2020 1/1/2021 MED EXP(Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 M*OTHER LAGGREGATE LIMIT APPLIES PERGENERAL AGGREGATE $ 3,000,000 POLICY �PRO-F LOC PRODUCTS-COMP/OPAGG $ 2,000,000 . Premises/Opemttons $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ `A ALL OWNED SCHEDULED AUTOS X AUTOS AMN6632273 1/1/2020 1/1/2021 BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AEXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 4DED I X I RETENTION$ 0 URN6251990 1/1/2020 1/1/20121 $ WORKERS COMPENSATIONX PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? El N I A B (Mandatory in NH) MCC2002000336 1/1/2020 1/1/2021 E .DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Installation Floater ZDN6251989 1/1/2020 1/1/2021 In Transit $352,200 Deductible $1000 DESCRIPTION OF OPERATIONS I LOCATIONS(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 RESINATE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 110 PLEASANT STREET ACCORDANCE WITH THE POLICY PROVISIONS. NORTHAMPTON, MA 01060 AUTHORIZED REPRESENTATIVE Michael Regan/FMT ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) 021