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32C-019 (4) 7 PLEASANT ST BP-2021-1200 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:32C-019 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: WATER DAMAGE BUILDING PERMIT Permit# BP-2021-1200 Project# JS-2021-001135 Est.Cost: $30000.00 Fee:$210.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RENAISSANCE BUILDERS 013302 Lot Size(sq. ft.): 522.72 Owner: HEROLD JORDI Zoning:CB(100)/ Applicant: RENAISSANCE BUILDERS AT: 7 PLEASANT ST Applicant Address: Phone: Insurance: P 0 Box 272 (413) 863-8316 Workers Compensation TURNERS FALLSMA01376 ISSUED ON:4/21/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE WOOD BEAM WITH STEEL LINTEL 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. A y� + '1 • Certificate of Occupancy Signature: . , FeeType: Date Paid: Amount: Building 4/21/2021 0:00:00 $210.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner r .____-• __ ___„_ Versionl.7 Commercial Buildin Permit May I5 >UUU i , r _,C E t v Department use only -----= city of Northampton Status of Permit: APR 2 a 2021 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 °F"�T°F eU11etNc INSP �413587-1240 Fax 413-587-1272 Plot/Site Plans +OR`____Tp NIA() . ........ ' 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: ?t o 0.L.. - S4c- --4.�- Map, , �� ,1 1,--t t4,- 010 0_0 Zone Elm St.District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: DUv\awa.1-3s-r-iu5 -ord \\e b-ld 151•1ord 5V. 1 Nat�4•_a_w\V6-.., M14 Name(Print) Current Mailing Address: � .I(3 - S tell - `tom Signature ke.PA��&� C.,t, Telephone 2.2 Authorized Agent: \-r?\new, C=�reetnwa A t ?0 Fx 2`2o- 1 2 , 1 vrHed3 r., M its ✓-1 Name(Pr9:filit.„ Current Mailing Address: nal SignatureTelephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building I (a)Building Permit Fee 2. Electrical ti I (b)Estimated Total Cost of _______ ___ _ 1 „ Construction from(6) 3. Plumbing Building Permit Fee JA 4. Mechanical(HVAC) i c 10 I 5. Fire Protection 6. Total=(1 +2+3+4 +5) 1 COO ,00 Check Number 4V:„%q This Section For Official Use Only Building Permit Number n A H I Date fL✓..i/ 023 Issued Signature: r I j p e.�Y� rr Building Co, missioner/Inspector of Buildings t}i!' Date e 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 ID Demolition❑ Repairs N Additions El Accessory Building 0 Exterior Alteration ❑ Existing Ground Sign El New Signs❑ Roofing CI Change of Use❑ Other❑ Brief Description Enter a brief description here. Of Proposed Work: Qp n\0--(�.. Cle-kp,,f"\O,RaN2A, wood bra V," tq YIeg.N rjkf,C11Xai s+C2t , t'►•..k-e_A SECTION 5-USE GROUP AND CONSTRUCTION TYPE 0 C&q�, USE GROUP(Check as applicable) JJ CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 0 A-3 El1A I 0 A-4 ❑ A-5 ❑ 1 B 0 B Business Cia 2A ❑ E Educational El 2B El F Factory ❑ F-1 El F-2 ❑ 2C 0 H High Hazard El _ 3A El I Institutional ❑ 1-1 0 1-2 ❑ 1-3 ❑ 3B El M Mercantile 0 4 El R Residential El R-1 El R-2 ❑ R-3 El 5A El S Storage El S-1 El S-2 El 5B l ❑ U Utility ❑ Specify: I 1 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: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): L__ I ®. E 1..)a CL,Ot vac e. BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1st 1 1st i 2nd 2nd1 3rd 3(d 4th 4th Total Area(sf) Total Proposed New Construction(sf) Total Height(ft) 1 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 ID Municipal ❑ On site disposal system❑ Versionl.7 Commercial Building Permit May 15,2000 ^4 «. a s,t SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110 11) r't�` r .gyp". Independent Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 1 L ►{ - . -. /244 1 ".-"-8 ,as Owner of the subject property hereby authorize Ito act on my behalf, in all matters relative to work authorized by this building permit application. I Signature of Owner Date I, 'f'l t C. IcLe-V\Wa\A ,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. - 0AQ3, (rrcev.waK6 Print N 4? 45/2.1 1 91-4—q,74..„.„.„1.$(. Signa .re`. Owner Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not/ Applicable ❑ Name of License Holder: S�p h (1�i v-tt"f`J GS - 0'&60 2 License Number C:t6 ►- to.,i VI _cZc .1 G C t t , 1•4 14 esL.f oe/r71 Z I j Addre Expiration Date x 4113- eb(03- 83((2 Sign 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 • -VN RENAISSANCE SIBUILDERS PO BOX 272,TURNERS FALLS, MA 01376,413.863.8316 INFO@RENBUILD.NET, WWW.RENBUILD.NET I, Jordi Herold , certify that I am the Authorized Representative of the property located at 7 Pleasant Street, Northampton, MA. I hereby authorize Stephen Greenwald of Renaissance Builders, 390 Main Road, Gill, MA 01376 to submit a building permit application on my behalf for the Structural Repair. I agree to conform to all applicable laws of the town and state, and believe the work proposed to be in compliance with all zoning regulations and the Massachusetts State Building Code 780CMR. Signature of Authorized Representative: 4e-j-Z4 Printed Name: ad)( kk.PCO Date: q \q\ QOQ` AFFIDAVIT FOR DISPOSAL OF DEMOLITION DEBRIS Supplement to Permit Application As a result of the provisions of MGL c. 40, s54, I acknowledge that as a condition of the issuance of a 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, s150A. I certify that debris resulting from this demolition will be disposed of as listed below: Job Site Location: —1 --Qke_a Olin skcett 1 7Q tc cm, t•-414- G/Q Cs 0 Name of Permit Applicant: Renaissance Builders Disposal Facility: F & G Recycling Address of Facility: 15 Mullen Rd., Enfield, Ct 06082 IF SAID FACILITY IS OTHER THAN WHAT I HAVE LISTED, I CERTIFY THAT I WILL NOTIFY THE BUILDING OFFICIAL OF THE CORRECT LOCATION OF THE SOLID WAS 11, DISPOSAL FACILITY WITHIN TWO MONTHS OF THE DA lb OF THIS APPLICATION. 14011.0rriviP Signature of Applicant ate The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations 600 Washington Street `v' Boston, MA 02111 gij www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): RENAISSANCE BUILDERS Address: PO BOX 272 City/State/Zip: TURNERS FALLS, MA 01376 Phone #: 413-863-8316 _ Are you an employer? Check the appropriate box: Type of project(required): 1.l I am a employer with 22 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have theirrepairs or additions 3.n I am a homeowner doing all work exercised 11. Plumbing myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.® Other t �e �e 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 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 INSURANCE CO. Policy#or Self-ins. Lic.#: MCC20020004972021A Expiration Date: 01/01/2022 Job Site Address: -1 Vk.QGSO &c '• City/State/Zip: Aov -4 vviFhv,, M(4- OI0LrO Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certij u r the pains and penalties of perjury this e in formation provided above is true and correct. Signature: ` __-- Date: /// [2 Phone#: 413-863-8316 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#: / 1 ® DATE(MM/DDIVYYY) A�D CERTIFICATE OF LIABILITY INSURANCE 4/12/21 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 CONTACT Andrea Feeley NAME: Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 LAIC No,Extl: (NC,No): 8 North King Street E-MAIL afeeley@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Arbella Protection 41360 INSURED INSURER B: MA Employers/A.I.M. 12886 Gill Building Corporation INSURER C: GuideOne National/BRECK 14167 DBA:Renaissance Builders INSURER D: PO Box 272 INSURER E: Turners Falls MA 01376 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 8/2021 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 w LIMITS LTR INSD VD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A 8500066134 08/01/2020 08/01/2021 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY n JEC LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER'. _ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED X SCHEDULED 1020057016 08/01/2020 08/01/2021 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE 4620085703 08/01/2020 08/01/2021 AGGREGATE $ 5,000,000 DED XI RETENTION$ 10,000 $ WORKERS COMPENSATION XI PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN 1 B ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA MCC20020004972021A 01/01/2021 01/01/2022 E.L.EACH ACCIDENT $ , , OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , Each Occurrence Limit $500,000 Contractors Pollution Liability C ENV562000484 08/01/2020 08/01/2021 Aggregate Limit $500,000 Deductible $2,500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Structural repairs at 7 Pleasant Street,Northampton, MA. CERTIFICATE HOLDER CANCELLATION Dunaway Trust SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Jordi Herold THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 1 Short Street ACCORDANCE WITH THE POLICY PROVISIONS. Northampton,MA 01060 AUTHORIZED REPRESENTATIVE 111^-. y,:1 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1ZN RENAISSANCE (BUILDERS PO BOX 272, TURNERS FALLS, MA 01376,413.863.8316 INFO@RENBUILD.NET, WWW.RENBUILD.NET April 14, 2021 Jonathan Flagg, Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 Jonathan, Enclosed is a permit application to replace a deteriorated wood beam at 7 Pleasant Street, Northampton. Stephen is the project manager. His cell phone number is 772-9430 if you have questions or concerns. Also included is: ❑ An Owner Authorization signature page ❑ A Worker's Compensation Insurance Affidavit and current COI ❑ Demolition Affidavit ❑ Drawing S-1.1 provided by Whetstone Engineering dated 4/5/21 ❑ A check for $ 210.00 ($7 per $1,000 of job costs) Please call Stephen if you have any questions. T ank you, Natasha Olanyk Administrative Assistant natasharenbuild.net