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32C-052 (32)
9 PEARL ST BP-2021-1340 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:32C-052 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ALTERATION BUILDING PERMIT Permit# BP-2021-1340 Project# JS-2021-002213 Est.Cost: $50000.00 Fee:$350.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: TEAGNO CONSTRUCTION INC 034716 Lot Size(sq.ft.): 11194.92 Owner: NINE PEARL LLC Zoning:CB(100)/ Applicant: TEAGNO CONSTRUCTION INC AT: 9 PEARL ST Applicant Address: Phone: Insurance: 228 TRIANGLE ST (413)549-0803 Workers Compensation AM H E RSTMA01002 ISSUED ON:5/17/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:INCREASE LOADING CAPACITY OF EXISTING FLOOR PLANS 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: if 4 .52 AIR FeeTvpe: Date Maid: Amount: Building 5/17/2021 0:00:00 $350.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner r ._. T I \ RLL'1 1 f L✓ NS j 0 MAY 1 3 The Commonwealth of Massachusetts 202 1 Office of Public Safety and Inspections Massachusetts State Building Code(780 CMR) n,:run Suxlding.Pejmit Application for any Building other than a One-or Two-Family Dwelling ` (This Section For Official Use Only) Building Permit Numbers O- of-% °iq Date Applied: Building Official: SECTION 1:LOCATION 9 Pearl St Northampton 01060 No.and Street City/Town Zip Code Name of Building(if applicable) 32C 06-a. Assessors Map# Blocx#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used 9th If New Construction check here 0 or check all that apply in the two rows below Existing Building IX Repair 0 Alteration 0 Addition 0 Demolition ❑ (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 III No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No 181 Brief Description of Proposed Work:_ Increase loading capacity of existing floor per plans from Jacob Smith. 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.) Existing No Change Total Area(sq.ft.)and Total Height(ft.) I I I SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub ❑ A-3 0 A-4 0 A-5 0 B: Business fat E: Educational ❑ F: Factory F-1❑ F2❑ 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❑ R: Residential R-10 R-2❑ 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 0 IIA ❑ IIB ❑ IIIA ❑ IIIB (B( IV ❑ VA ❑ VB ❑ 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: A trench will not be Licensed Disposal Site 0 Public i Check if outside Flood Zone 0 Indicate municipal 51 required❑or trench or specify: Private 0 or indentify Zone: or on site system 0 permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable 0 Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0 SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Nine Pearl LLC 600 Kennedy Rd Leeds 01053 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Daniel Gleason - - 413 883 9124 ninepearl@comcast.net Title Managing Member Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: 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 EL 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) Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Teagno Construction Inc Company Name Donald Teagno CS-034716 Name of Person Responsible for Construction License No. and Type if Applicable P.O Box#2298 Amherst MA 01002 Street Address City/Town State Zip 413 549 0803 contact@teagnoconstructi on.com Telephone No.(business) Telephone No.(cell) e-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 El No 13 SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor 50,000.00 and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ 50.000.00 Building Permit Fee=Total Construction •st x.01 here 2.Electrical $ appropriate municipal facto I =$350.00 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$1 OO.00(contact municipality) 5.Mechanical (Other) $ Enclose check payable to City of Northampton 6.Total Cost $ 50,000.00 (contact municipality)and write check number here ? l--0 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 accurate to the best of my knowledge and understanding. Donald Teagno ( j -e President 413 549.0803 5/12/21 Please rint and signname Title Telephone No. Date 228-Triangle-St Amherst MA 01002 contact@teagnoconstn,ction.com Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: t '�i 6bLJ 7 al 1 / J Name Dace City of Northampton � 5a Massachusetts - 11111 IQ t ori' r DEPARTMENT OF BUILDING INSPECTIONS hr +� ' `- 212 Main Street • Municipal Building Northampton, MA 01060 � ° — { 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: The debris will be transported by: Name of Hauler: USA Waste & Recylcling Signature of Applicant: QJ 7 Date: 5/12/2021 The Commonwealth of Massachusetts 1 ;II- 1. Department of Industrial Accidents .- !. " 1 Congress Street,Suite 100 1=;01_ Boston, MA 02114-2017 3‘ www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Teagno Construction Inc. Address: 228 Triangle Street Suite 9 City/State/Zip: Amherst, MA 01002 Phone#: 413-549-0803 Are you an employer?Check the appropriate box: - Type of project(required): 1.©I ain a employer with 15 employees(full and/or part-tine).° 7. 0 New construction 2.❑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.]' 9. 0 Demolition 10 0 Building addition 4.❑1 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. 12.0 Plumbing repairs or additions 5.0 lain 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.: 6.0 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#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 Ins.Company Policy#or Self-ins.Lic.#: WMZ8006223012020A Expiration Date: 4/01/22 Job Site Address: 9 Pearl St 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 certify under the pains and penalties of perjuty that the information provided above is true and correct Signature: (--" t —gZA-V— Date: 5/12/2021 Phone#: 413-549-0803 office or 413-364-8768 cell 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#: Appendix 1 Construction Documents are required for structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where applicable No. Item Submitted Incomplete Not Required 1 Architectural x 2 Foundation • X 3 Structural X 4 Fire Suppression X 5 Fire Alarm(may require repeaters) X 6 HVAC X 7 Electrical X 8 Plumbing(include local connections) • X 9 Gas(Natural,Propane,Medical or other) • X 10 Surveyed Site Plan(Utilities,Wetland,etc.) X 11 Specifications • X 12 Structural Peer Review X 13 Structural Tests&Inspections Program X 14 Fire Protection Narrative Report X 15 Existing Building Survey/Investigation X 16 Energy Conservation Report X 17 Architectural Access Review(521 CMR) X 18 Workers Compensation Insurance X 19 Hazardous Material Mitigation Documentation X 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction. Registered Professional Contact Information Jacob Smith 413 397 3441 jake@thayerstreetassociates.com 47430 Name(Registrant) Telephone No. e-mail address Registration Number 8 Coats Ave South Deerfield MA 01373 civil 6/31/22 Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Please follow this link for construction control forms to be used by Registered Design Professionals. �,..—..ip TEAGCON-01 BROOKE ACORL7. DATE(MM/DD/YYYY) Imo.- CERTIFICATE OF LIABILITY INSURANCE 4/7/2021 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). CONTACT Brooke Barre PRODUCER NAME: Phillips Insurance Agency,Inc. PHONEFAX 97 Center Street (A/C,No,Ext):(413) 594-5984 (A/C,No(413) 592-8499 Chicopee,MA 01013 E-MAIL IESS:brooke@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Ohio Security Insurance Co 24082 INSURED INSURER B:Ohio Casualty 24074 Teagno Construction,Inc. INSURER C:A. I. M. Mutual Ins. Co. 33758 Mr.Donald Teagno 228 Triangle Street INSURER D: Amherst,MA 01002 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 EXP LIMITS LTR INSD WVD (MMIDD/YYYY) (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR BKS57750627 4/1/2021 4/1/2022 DAMAGETORENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X JECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY (Ea accident SINGLE LIMIT $ 1,000,000 ANY AUTO BAS57750627 4/1/2021 4/1/2022 BODILY INJURY(Per person) $ OWNED _ AUTOS ONLY X AUTOSULED BODILY INJURY(Per accident) $ X AUTOS ONLY X NON-OWNED PROPERTY)AMAGE NLY (Per PERTYt) $ $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE US057750627 4/1/2021 4/1/2022 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ C WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY WMZ8006223012021A 4/1/2021 4/1/2022 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N NIA 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/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 Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 7,1,t/1'"rye- -u ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD