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24D-280 (4) 165 CRESCENT ST BP-2021-0921 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24D-280 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Stair BUILDING PERMIT Permit# BP-2021-0921 Project# JS-2021-001576 Est.Cost:$3214.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ACCENT BUILDING & REMODELING 060967 Lot Size(sq ft.): 13808.52 Owner: LEVY BENJAMIN Zoning: URB(100)/ Applicant: ACCENT BUILDING & REMODELING AT: 165 CRESCENT ST Applicant Address: Phone: Insurance: (413) 529-0527 WC EASTHAMPTONMA ISSUED ON:2/19/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:REPAIR BACK STAIRS 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. I ' \JDia Certificate of Occupancy Signatur•1 a: ` . C`4 FeeType: Date Paid: Amount: Building 2/19/2021 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner _._ 1 FEB 192021 ---- The Commonwealth of Massachusetts „ - -) INi770T61oNtioard of BuildingRegulations and Standards FOR N,MA01060 g C-- y/ -Masgachusetts State Building Code, 780 CMR MUNICIPALITY USE USE Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling Q This Section For Official Use Only Building Permit Number: ,gr' . '4 1J Date lied: /6-iilt--) P54, j Z_ iq zort Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers,] /Gr CAeItAvr J . At T of - y O v 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: — Outside Flood Zone? Municipal❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 3e.f ja.,'n be ArJ e%mto n /114 01060 Name(Print) City,State,ZIP q Pale E1' .2.ro1-k3S SI'(a 'c € 7•C30.7 No.and Street Telephone Emil class SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Bri f D cription of Proposed Work': ' �SECTI 4:EST TED CONSgrTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 3 /f 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All F1 Check No. u Check Amount: (� r Cash Amount: 6.Total Project Cost: $5,„,� ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ZO5'L 7 70, 7-020 fjb•4-.1 X. v .li�iio-41 Lcense Number Expiration Date Name of CS folder La / AV 4 List CSL Type(see below) No.and Street Type Description _,,/int44 A. Q.�! U Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town,Stair-ZIP ! R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering C,LG 'U93 V WS Window and Siding SF Solid Fuel Burning Appliances 9/3-eta Attar Qtw 1/.� Q- t��ST,�7 I Insulation Telephone �L'h►ail address I) Demolition 5.2 Registered Ho Improvement Contractor(HIC) Accc�l74 I2 d- �...1�� - LCU � t /v—aL a0�� HIC Registration Number Expiration Date IC Company Name H C Regi rant Nae/ , fi Re Reef ,�tt�/.�ff kCoa.ter. No.and Street Erna address City/Town',State,ZIP Telephone SECTION 6: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 Issuanncce of the building permit. Signed Affidavit Attached? Yes lET No ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize itGf — < to act on my behalf,in all matters relative to work authorized by this building permit application. Berl' 4a�n.4 el11� ig?‘ Print Owner's Name(Electronic Si ature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. ./h.T�j /` ,5�'/1dt�C•� ccc1 Fay/ l—/1 .oJ GLL ,2-/6 rint Ownnef's or Authorized Agent's Name(Electronic ature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of Massachusetts . 1--.11'0 Department of IndustrialAccidents r)'l 1 Congress Street,Suite 1fJf1 � , Boston, MA 02114-2017 �.4;,�' www moss.gor/dia 11u0kers'('ontpensation Insurance Alfidasit:Builderst('ontractnrsiElectriciansfPluwhers. 10 El_FILED%!`Fill HIE,PERM ITIN :Al 1.1101Rfl'1. :Willicaut lnforinatiun I n J► , �_J• Please Print Lettibls Name(llusinnss.t.hgan[zation•lndtvidual): n c4 r BUtidei oLACA4,1 Yy LL C. Address: 61 La / AZ/ ✓ ddd CitvfS, «fZip: l rt t. i.rba.` ,ram A. 0/02 : 7 Phone : y/3—C 26 — 0 9_3 0 .E,rc 3uu au entptorrr?t'6cck the appropriate boa: Type of project(required): I.'ant a employer with V rmpJuy es(full ant m part-tim.l." 7. 0 New construction In I am a MAC prupricttu ur partnership and lane nu employ x,working $or rye 317 N. ID Remodeling any capacity.[Nu workers'comp.insurance required.) 3,10 ete 1 ant a hurnwner doing all wurk myself.Itree walkers'curry,era utuace rcqurr--d 9. ] Demolition I 0] Building addition 4.31 ant a homeowner and will he hirinht cxtntractursto conduct all work on ntv prcapw:rty. I :I. ensure that all contractors either hare to-triers'compensation insurance or ate.sole I] Electrical repairs or additions proprietors w ith nu employees. 12.0 Plumbing repairs or additions SO I ant a scureruJ contractor and I here hired the sub-contractors listed un the attached:sheet These..sub-cuntracton.flaw employee.and hat a wurken'etmtp.insurance.` 13 Roof repairs 6.0 We us a corpieatiun and its officers hays exercised their right<el em.:ml ron per MIGE.,L. 14.MOther 5TIT ss A Ii.m L 151.ti114).and we hare.no ernpluyecs.INu workers•comp.insurance rcyuir►d.1 r • /C` of- r t],a �r t'�1 1,', T6 L. 'Any applicant that ch,xks boa.1 meat;kwPill out the section hcluw shoo ins their workers'compensation pulieyyii n lerrnation. Yt I +I{crmeown:rs who submit this atricla%it indicating they are doing all work and then hire outside euntracteca must,ubnut a new at tdau it rrxlicuting such. teuntractors that check Ilia box must attic b.:d an additional sheet show in tln name of lie rut-euntractcrs and state whether to not those ontities Irate c-trrployees. if the sub-cuntracturs Kw.:etrgeluyecs.they must ptvt:idc their wvrkcrs•comp.ptiie+.ncnncer. I am an employer that is providing workers'compensation insurance.for nil'employees. Below is the policy and job.wire iu formation. ',/ Insurance Company Name: _ )((.., \, Policy#or Self-ins.Lie.4: Expiration iration Date: Job Site Address: City:State:Zip: 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 e. 152. ;25A is a criminal violation punishable by a fine up to S1 00.00 andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA fur insurance coverage verification. I do hereby certlf t omit r the severe%eerie(prraalue'+ r.J pt i ju t.that the i n/irrrrtofion provided u/itn a i%true and correct Signature: l� I t ai �� p�oc Phor:. L/)—QC —0930 Official use only, Do not write in this ureu,to be completed by city or town o,{fci'aL ('its or Town: Pernik/license li Issuing Authority(circle one): I. Huard of Health 2.Building Department 3.City/fovea Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other ('untact Person: Phone 4: mok TRAVELERS/ J WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 89 04 15 (00)— 001 POLICY NUMBER: (7PJUB-1R06041-5-20) POLICY INFORMATION PAGE ENDORSEMENT Item#4 is changed to the following: PREMIUM BASIS Total Estimated Rate Per Code Annual $100 of Estimated Classifications No. Remuneration Remuneration Annual Premium SEE CHANGE DOCUMENT OR INFORMATION PAGE SCHEDULE • o= chi • o� • o= Total Estimated Annual Premium $ Minimum Premium$ Deposit Premium $ ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. 111110111111W _ ` T ASSIGN: MA ACvREP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/08/2020 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: Melisha Colon AXIA INSURANCE SERVICES INC (A/C,No. (413)788-9000 FAX (A/C, E-MAILDSS: certificate@axiagroup.net 933 EAST COLUMBUS AVENUE INSURER(S)AFFORDING COVERAGE NAIC# SPRINGFIELD MA 01105 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B: ACCENT BUILDING & REMODELING LLC INSURERC: INSURER D: 81 LAUREL HILL ROAD INSURERE: WESTHAMPTON MA 01027 INSURER F: COVERAGES CERTIFICATE NUMBER: 531853 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD, POLICY NUMBER LIMITS (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ _ DED RETENTION$ $ AWORKERS COMPENSATION ILI Y/N Pig I /j �, a�•— STATUTE ERH AND EMPLOYERS'LIABILITY 7 ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? n WA N/A 7PJUB1K06041519 121U112019 12/01/2020 ----- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires, or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued (unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Proof of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. 81 Laurel Hill Rd AUTHORIZED REPRESENTATIVE Westhampton MA 01027 Daniel M. Cy, CPCU.Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD STREETMAINTHE Policy Number: MPT2437C AMERICA BUSINESSOWNERS COMMON DECLARATIONS GROUP MAIN STREET AMERICA ASSURANCE COMPANY 4601 TOUCHTON ROAD EAST,SUITE 3400,JACKSONVILLE, FL 32245-6000 Item 1. Named Insured and Mailing Address Agent Name and Address ACCENT BUILDING & REMODELING AXIA INSURANCE SERVICES INC 81 LAUREL HILL RD WESTHAMPTON, MA 01027-9519 933 EAST COLUMBUS AVE SPRINGFIELD, MA 01105 Agent Phone No. (413)-788-9000 Agent No. 200402 Item 2. Policy Period From: 09-10-2020 To: 09-10-2021 at 12:01 A.M., Standard Time at your mailing address shown above. Item 3. Form of Business: LIMITED LIABILITY COMPANY Item 4. In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. This policy consists of the following coverage parts for which a premium is indicated. Where no premium is shown, there is no coverage. This premium may be subject to adjustment. COVERAGE PREMIUM Section I —Property $164.00 Section II — Liability $1,899.00 Inland Marine $1,187.00 CYBER $43.00 Total Policy Premium: $3,293.00 For Coverages subject to premium audit: Annual Audit Applies Item 5. Form(s) and Endorsement(s) made a part of this policy at time of issue: See Schedule of Forms and Endorsements Countersigned: Date: By: Authorized Representative THIS BUSINESSOWNERS COMMON DECLARATIONS AND SUPPLEMENTAL DECLARATION(S), TOGETHER WITH SECTION III —COMMON POLICY CONDITIONS, COVERAGE PARTS, COVERAGE FORMS AND ENDORSEMENTS, IF ANY, COMPLETE THE ABOVE NUMBERED POLICY. BPM D 11207 INSURED COPY City of Northampton _ Qf HIIM T\ ?%, s,A oN`, ;;S ., •SiC ,i� °' Massachusetts �wf .._ 't� 4j 1; DEPARTMENT OF BUILDING INSPECTIONS '� _ x 212 Main Street • Municipal Building y06- tea' t - ,�a"�� Northampton, MA 01060 s -0 sI:j, 37� CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: a/6_ . . hl,,�/ The debris will be transported by: Name of Hauler: jeee1r pc ) - - t'C..w,/,v/ r ` (it Signature of Applicant: /' �� ./ Date: 01 g—oZUa