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39A-004 (26)
90 CONZ ST BP-2021-0972 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 39A-004 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2021-0972 Project# JS-2021-001669 Est.Cost: $29000.00 Fee: $203.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ALLEN GUIEL 054248 Lot Size(sq. ft.): Owner: LAIRD DUNCAN Zoning:NB(100)/ Applicant: ALLEN GUIEL AT: 90 CONZ ST Applicant Address: Phone: Insurance: 63 CHESTERFIELD RD (413) 268-9200 O WC WILLIAMSBURGMA01096 ISSUED ON:3/12/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:COMBINE 2 SMALL BATHROOMS INTO ONE LARGER, CREATE CLOSET, REMOVE SINKS, CHANGE OUT DOORS 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. (-. Au Certificate of Occupancy Signature•, ► • ill • • FeeType: Date Paid: Amount: Building 3/12/2021 0:00:00 $203.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner t✓zi tI✓1!/'7i c z#' r --" i I'`. I i MAR - 5 2021 The Commonwealth of Massachusetts i Al) fice of Public Safety and Inspections ity ___ w_ ! Massachusetts State Building Code(780 CMR) .r r• Building Perinit Application for any Building other than a One-or Two-Family Dwelling p (This Section For Official Use Only) Building Permit Number:Ey-Ai-77 Date Applied: Building Official: SECTION 1:LOCATION 10 GPZ' tiA r 6/060 u .v, 1-5 ( d, No. d Strt City/Town00 q Zip Code Name of Building(if applicable) Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below Existing Building)D Repair] Alteration Addition 0 Demolition A(Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes fi No 0 Is an Independent Structural Engineerin Peer Review required? I ��j �" Yes 0 No B 'ef Des iption of Proposed Work: 10 v ( O��+1A-6v4A.� l� Ghst, ' C5�- ..c-e C'iur2c`a. C z,c (J ' I.C( (cirnw . 1 ko�' e Qzhk��-k -4 Si IA cww' 2uw 'e ut447 C.lnr.1,i9e WI— /0 pcc( SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0 Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) 1J° ( I , a55 0 d55Z, SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business p E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1 0 I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0 S: Storage S-1❑ S-2 0 U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV 0 VA CI VBff SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Supply: Flood Zone Information Sewage Disposal: Trench Permit Debris Removal: kitrench ill not be Licensed Disposal Site 0 Public Check if outside Flood Zone Indicate municipal A tre Private CI or indentify Zone: or on site system 0 required or trench or specify: permit is enclosed 0 Railroad right-of- y: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable Is Structure within airport a proach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No itP Yes 0 No p SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: V.se-- Does the building contain an Sprinkler System?: fir' Special Stipulations: Design Occupant Load per Floor and Assembly space: SECTION 9: PROPERTY OWNER AUTHORIZATION e and Addre5g of Prope Owner 7CTAA CA4 ,/rP % AZ- ,S 1 lAv) 11 1 /i"4Q/oe(Print) No.and Street City/Town Zip Property Owner Contact Information:04.4 C/ LID -csW D26 5_ 4//33(R5 33 4/C c/i,gc 1 /5i r.46) (/P,7 Z l.4, Title Telephone No. (business) Telephone No. (cell) e-mail address If ap t 1e,the roperty owner hereby thorize6:>" ( e3 4e/71ere(r" /z.' 4,,/64./6 /7,, 0/0 9C Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here❑. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) 3 2(Vk( 4 -I•A 60 1(,- 5 B2.) L.)o h 2 (z'+a, ,' / (oM 31°—' 9g5T Name(R . trant) le `hoone No. e-mail addr ss ,Q Registration N �G ce 14 I� I0 (et( ii5v1 Fc` ' treet Address City/Town State Zip Di ipline Ex iration Date 10.2 General Contractctd.t.J C 6114-'7 CU CttlePA Campa mA 11-Q Ctti 1-1.I O 9 j* C&L ' U Name of Persort Res ons'ble for Cionstruction i License No. and Type if Applicable Street Address City/Town State Zip 2It-QvN 0 luk-k I- (-CAA-,___ Telephone No. (business) Telephone No. (cell) mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yes te) No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs:(Labor a,Go Item and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ 1 1 HOC) Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ y )p 6 appropriate municipal factor)=$ . 3.Plumbing $ (0 50O 4.Mechanical (HVAC) $ 6Q Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ U -� Enclose check payable to 6.Total Cost $ d?eloz), (contact municipality)and write check number here U, SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT 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 a rate to best of m knowledge and understanding. b4.e11 C l-12..\ , ( :( (1 13_ r "( . I .a l Please print arld s' Tie Tele h ne No. Date �� C � eAe�' <�\\� q��cc1 G io y� ?l�„+p� u\ e.� • Iraqi• Street Address City/Town State Zip Email Alidress iI Municipal Inspector to fill out this section upon application approval: 1 ! I ► 3 o � Name Date _ \ The Commonwealth of Massachusetts *,zra.=.if, Department of Industrial Accidents E2ill= 1 Congress Street,Suite 100 %Al- Boston,MA 02114-2017 ' ,fit wwx.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name (Business/Organization/Individual):Allen Guiel Address:63 Chesterfield Road City/State/Zip:Williamsburg, MA 01096 Phone#:413 268 9200 Are you an employer?Check the appropriate box: Type of project(required): 1.fi I am a employer with 2 employees(full and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0✓ Remodeling any capacity.[No workers'comp.insurance required.] 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. 0 Demolition 10 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 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We area corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 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. :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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Hartford Underwriters Insurance Company Policy#or Self-ins.Lic.#:6S6OUB-9F66069-2-20 Expiration Date:04/27/21 Job Site Address:90 Conz Street City/State/Zip:NorthamptonMA 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 ver'fication. I do hereby unde .��e pains and!. alties of perjury that the information provided above is true and correct i, . `t Signature: `�,ile Date: - a-' Phone#:413 268 9200 — 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#: City of Northampton S`5 Massachusetts ? * G, DEPARTMENT OF BUILDING INSPECTIONS S. 212 Main Street • Municipal Building yeti csa` Northampton, MA 01060 ssNJ, rD'C 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: 2CL(L \V\C] 4'� € 'Y.0104 /� �, �d The debris will be transported by: Name of Hauler: 6-2:4 Signature of Applicant: Date: 2( Commonwealth of Massachusetts Division of Professional Licensure Board of Budding Regulations and Standards Constru tii}tiSUprtivisor CS-054248 , Empires:04112,2022 ALLEN GUIEL 63 CHESTERFIELD RD W ILLIAMSBURG lam'010I6 c 1' Commissioner / Construction Supervisor Unrestricted -Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Budding Code is cause for revocation of this license. For information about this license Call(617)7273200 or visit www.mass.govidpl A CERTIFICATE OF LIABILITY INSURANCE DATE (M oz� 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 The Dowd Agencies, LLC PHONE Diane LaFleche FAX 226 Russell Street, Suite B (A/c.No,Exy-413-538-7444 tArc.No):413-536-6020 _ Hadley MA 01035 ADDRESS: dlafieche(@dowd.com PRODUCER CUSTOMER ID N: ALLERGU-01 INSURER(S)AFFORDING COVERAGE NAIC/ INSURED INSURER A:Utica First Insurance Company 15326 Allen R. Guiel dba Guiel Construction INSURER B:Commerce Insurance Company 34754 63 Chesterfield Road INSURER C: Williamsburg MA 01096 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:841436190 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 EFF POLICY EXP(MMI LIMITS LTR INSR WVD POLICY NUMBER DD/YYYY) (MMIDDIYYYYI A GENERAL LIABILITY ART5142731 4/22/2020 4/22/202/ EACH OCCURRENCE I S 1,000,000T _ X COMMERCIAL GENERAL UABILRY PR S(RENTED PREEMIMI E SES(Ea occurrence) $50,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEM_AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRO- JFC.T I LOC B AUTOMOBILE UABIUTY RVT614 2/22/2020 2/22/2021 COMBINED SINGLE LIMIT $3lXl 000 (Ea accident) ANY AUTO BODILY INJURY(Per person) 620,000 ALL OWNED AUTOS BODILY INJURY(Per accident) 5Qom X SCHEDULED AUTOS X PROPERTY DAMAGE $ HIRED AUTOS (Per accident) X NON-OWNED AUTOS S $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE S DEDUCTIBLE S RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'UABIUTY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N/A — (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ If yes, under describe DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. New England Cheesmaking Supply Co. 50 Conz Street AUTHORIZED REPRESENTATIVE Northampton MA 01060 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Initial Construction Control Document ;tp To be submitted with the building permit application by a 174 Registered Design Professional � y • for work per the ninth edition of the `'•��`'' Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Learning Solutions. l ii Date: 02 March 2021 Property Address: 90 Conz Street.Suites til & ."'.,Northampton, MA 01060 Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: interior renovations to existing office condominium spaces for new Owner's use. 1, Jody Barker, AIA, MA Registration Number: 50885 Expiration date: August 2021, am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and sped fications concerning1: X Architectural Structural Mechanical Fire Protection Electrical Other for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Cade, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this codde. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, 1 shall submit fieldjpragrees reports (see item 3.) together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a 'Final Construction Control Document'. r. Enter in the space to the right a"wet" or .colEe"ncy� electronic signature and seal: ,' i . e4 Phone number. 617.21649118 Email: jody barker.aia u gmail.com , 4 I� Building Official Use Only e —• IBuilding Official Name: Pvrrnit Nu.: Date: Note 1.!mitt ate with an'x' project design plans.computations and bpec►aitat►otis that ti ou 'nerd red or directly supervised.If'other'is chosen.provide~a description. Version 01 01 201$