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31B-286 (16) 129 MAIN ST BP-2021-0106 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31 B-286 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:ROOF BUILDING PERMIT Permit# BP-2021-0106 Proiect# JS-2021-000170 Est.Cost: $6400.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: D P CARNEY CONSTRUCTION INC 99798 Lot Size(sg. ft.): 31755.24 Owner: FIRST CONGREGATIONAL CHURCH OF NORTHAMPTON Zoning:CB(100)/ Applicant. D P CARNEY CONSTRUCTION INC AT. 129 MAIN ST Applicant Address: Phone: Insurance: 34 HORSE SHOE CIRCLE (413) 967-7124 () WC WAREMA01082 ISSUED ON.7/28/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPAIR REGLET FLASHING,RE-SOLDER VERTICAL SEAMS IN WALL FLASHING AND ONE PATCH 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 7/28/2020 0:00:00 $100.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner _ Version].7 Commercial Building Permit May 15,2000 Htur-IV 1_ Department use only City of Northampton Status of Permit: j Building Department Curb Cut/Driveway Permit - 4 JUL 2 7 9(190 212 Main Street Sewer/Septic Availability Room 100 WaterMell Availability DEPT.OF SUILDING It PPFGTI rthampton, MA 01060 Two Sets of Structural Plans �,nrIT,44�.irTONpr�tyanii,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 Ma �J � � Lot �U "' Unit 1 129 Main Street p (Northampton, MA 01062 Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: First Church of Christ In Northampton 129 Main Street,Northampton, MA 01060 - Name(Print) Current Mailing_Address: (413) 584-9392 Signature ,l �- Telephone 2.2 Authorized Agent: ID.P. Carney Construction, Inc. F34 Horseshoe Circle Name(Print) Current Mailing Address: (413) 967-7124 Signatur Telephone S CTION'3 -ETIMATE ONST CTION OSTS 74 1 Item Es ' ated Cost(Dollars)to be Official Use Only m feted by permit applicant 1. Building __ $6,400^00 (a) Building Permit Fee $100.00 2. Electrical �..._. (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total= (1 +2+ 3+4+ 5) 7 )d Check Number This Section For Official Use Only Building Permit Number Date Q _ t oc�o Issued Signature: -0 ZU Building Commissioner/Inspector of Buildings 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 ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑✓ Change of Use❑ Other ❑ Brief Description Repair reglet flashing by re-seating into wall, re-solder vertical seams in wall flashing and one Of Proposed Work: patch. 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 ❑ 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 Specify: Fhurch ��� �,_ 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: L-- Existing _ ..._.__-_____Existin Hazard Index 780 CMR 34):Li 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(sf) 1 5f sc 2nd 2nd aro 3 r _.._..__ ch 4 "._ 3 �J th -__ 1 7 Total Area(so 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 ❑ Private ❑ Zone� ] Outside Flood Zone❑ Municipal ❑ On site disposal system❑ Versionl.7 Commercial Building Permit May 15,2000 8.NORTIIAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size -- -------- Frontage Fronta a ------- Setbacks -------- --Setbacks Front Side L:= R:= L:= R:= Rear L L� Building Height Bldg.Square Footage % Open Space Footage (Lot area minus bldg&paved �...�....1 parking) #of Parking Spaces Fill:(volume&Location)A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW e YES 0 IF YES, date issued: µ IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW e YES 0 IF YES: enter Book II Page and/or Document#[ B. Does the site contain a brook, body of water or wetlands? NO (F) DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES (D NO 0 IF YES, describe size, type and location: Name of Church, Front right of stairs D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO e 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 0 NO Q 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: N/A Not Applicable Name(Registrant): �w-----�- - N/A Registration Number _- F Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): N/A 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 r Registration Number Signature Telephone Expiration Date F. Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor D.P. Came Construction, Inc. Not Applicable ❑ Company Name: Daniel P. Carney Responsible In Charge of Construction 34 Horseshoe Circle, e,MA 01082 Addres (413) 967-7124 Sig lure Telephone Version 1.7 Commercial Building Pen-nit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT First Church of Christ In Northampton I, as Owner of the subject property hereby authorize D.P. Carney Construction, Inc. to act on my behalf, in all matters relative to work authorized by this building permit application. Signaturtfof Owner Date D.P. Carney Construction, Inc. 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 penaltiesWof perjury. Pri Name Sign ture o Owner/Agent Date SECTI 12 -CONSTRUCTION SER 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Dantel P. Carney CS-0,99798 License Number 34 rseshoe Circle re, MA 01082 08/19/2_021 Address Expiration Date (413) 967-7124 m_J Telephone SECTION 13-WORKERS,COMPEN ATION 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 (D 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: 170 Glendale Road, Northampton, MA 01060 The debris will be transported by: All waste Removal, Inc. The debris will be received by: United Material Management, Inc. , 896 Main Street, Holyoke, MA 01040 Building permit number: Name of Permit Applicant D.P. Carney Construction, Inc. Date Signature of ermit Appli ant The Commonwealth of Massachusetts x Department of Industrial Accidents = I Congress Street, Suite 100 0 Boston,MA 02114-2017 www.mass.gov/dia NVorkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):D.P. Carney Construction, Inc. Address:34 Horseshoe Circle City/State/Zip:Ware, MA 01082 Phone #:413-967-7124 Are you an employer?Check the appropriate box: Type of project(required): 1 Q✓ 1 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 QI am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4 ❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 1 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 1.❑ Electrical repairs or additions proprietors with no employees. 12.F1 Plumbing repairs or additions Q 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 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. $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 joh site information. Insurance Company Name:Guard Insurance Company Policy#or Self-ins.Lic.#:R2WC991807 Expiration Date:11/15/2020 Job Site Address:129 Main Street City/State/Zip:Northampton, MA 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 certi nder the pains and pe s of perjury that the information provided above is true and correct. Signature: Date: 1_30,1 07 Phone#:413-9 -712 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#: --, DPCARNE-01 ANGELA . ila --�'�R CERTIFICATE OF LIABILITY INSURANCE DAT 7/2212/22/2 02(MMIDIY0 ` 0 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 CONT Angela DiAugustino Phillips Insurance Agency,Inc. PHONE FAX 97 Center Street (A/C,No,Ext):(413)594-5984 (A/c,No):(413)592-8499 Chicopee,MA 01013 ppR'E ,angela@phillipsinsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Kinsale Insurance Company 38920 INSURED INSURER B:Selective Ins Co of Southeast 39926 D.P.Carney Construction,Inc. INSURER C:Guard Insurance Group 34 Horseshoe Circle INSURER D:Ohio Casualty 24074 Ware,MA 01082 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 SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000'000 CLAIMS-MADE [X OCCUR 0100041217-4 8/1/2020 8/1/2021 DAMAGE TORaENTEoccurePREMISESnce $ 100,000 MED EXP(Any oneperson) $ 0 X $5,000 Deductible PERSONAL&ADV INJURY $ 1,00000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 7X PEST F LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Ea accciden SINGLE LIMIT $ 1,000,000 X ANY AUTO 9094953 8/1/2020 8/1/2021 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOSBODILYBODILY INJURY Per accident $ HIRED ONLY N0N95 ONLY Per a�Rd�I AMAGE $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE 0100054375-2 8/1/2020 8/1/2021 AGGREGATE $ 5,000,000 DED I X I RETENTION$ 0 Prod/Comp Ops 5,000,000 C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY T R2WC000105 11/15/2019 1111512020 1,000,000 AFFICER/M IMBER/EXCLUDED ECUTIVE N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1'000'000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Equipment Floater S1985457 8/112020 8/1/2021 Limit 107,000 D Builders Risk TBD 8/1/2020 2/1/2021 297,025 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Roof Repairs 129 Main St.Northampton,MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Church of Christ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN First FirstWhitham ACCORDANCE WITH THE POLICY PROVISIONS. Chuck129 Main St. Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CornmA,)nwealth of MassachuseltS Olviston of Protesswoal Licensure Board Of 8"JIdq9 R", (41,11'01116 and Standards Construction Supervisor CS±0997'98 Expires: 08119,,2021 DANIEL P CARNEY 34 HORSESHOE CIRCLE, WARE MA 01092 Commissioner Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home improvemehf"Gontractor Registration Type: Corporation Registration: 121178 D.P.CARNEY CONSTRUCTION,INC. M wExpiration: 04/11/2022 34 HORSESHOE CIRCLE WARE,MA 01082 a ti Update Address and Return Card. SCA 1 0 20M-Ml 7 office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. if found return to: before the expiration rat 1 on date "'ou found re'urn to Registration Expiration office of Consumer Affairs and Business Regulation 121178 04/11/2022 1000 Washington Street Suite 710 D.P.CARNEY QONPTRqC-nbN,INC. Boston,MA 02118 DANIEL P.CAR'4�'k4a K Out Sig t 34 HORSESHOE WARE,MA 01082 Undersecretary of valid without sign ture D. P. Carney Construction, Inc. 34 Horseshoe Circle Ware, MA 01082 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 First Churches of Northampton, 129 Main Street 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, Daniel P.Carney