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18D-001 162 NORTH KING ST BP-2021-1421 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18D-001 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-2021-1421 Project# JS-2021-002362 Est.Cost: $9200.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: NETWORK DESIGN AND CONSTRUCTION INC 109066 Lot Size(sq. ft.): 532738.80 Owner: D'AMOUR PAUL H ET AL C/O BIG Y TRUST Zoning: HB(100)/WP(16)/ Applicant: NETWORK DESIGN AND CONSTRUCTION INC AT: 162 NORTH KING ST Applicant Address: Phone: Insurance: 35B ROBERT JACKSON WAY 2N FLOOR (860) 621-9164 WC PLAINVILLECT06062 ISSUED ON:6/1/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT NEW STRUCTURE 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: - 3)41.5/ FeeType: Date Paid: Amount: Building 6/1/2021 0:00:00 $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner The Commonwealth of Mass, ch .eta �✓ Office of Public Safety and Inspecti. qr ' Massachusetts State Building Code(780.C1�I4 c�8 Building Permit Application for any Building other than a Oneti-(0 Famil� +velli g (This Section For Official Use Only) >^tis ' Building Permit Number —a I / /Date Applied: Building Official: �q\o, S SECTION 1:LOCATION 136 North King Street Northampton 01060 No.and Street City1 Townam/ Zip Code Name of Building(if applicable) �p 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 I Repair 0 Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No JAI Brief Description of Proposed Work: Construct a 15'-3"x 4'-0"framing structure and provide thick custom wall with laminate,FRP panels and shelves. 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) Cl Existing Use Group(s): Mercentile Proposed Use Group(s): Mercentile 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.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 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 0 I-4 0 M: Mercantile C R: Residential R-10 R-2 0 R-3 0 R-4 0 S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA El IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV 0 VA 0 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: Public 0 Check if outside Flood Zone 0 Indicate municipal 0 A trench will not be Licensed Disposal Site 0 Private 0 or indentify Zone: or on site system 0 required 0 or trench or specify: permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable f�( Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes❑ or No tQ Yes❑ 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 Big Y World Class Market 136 North King Street Northampton,MA 01060 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Title 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 K. Otherwise provide construction control forma(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 Network Design and Construction, Inc Company Name Jacqueline Laramee CS-109066 Construction Supervisor Name of Person Responsible for Construction License No. and Type if Applicable 35B Robert Jackson Way,Second Floor Plainville CT 06062 Street Address City/Town State Zip 860- 621- 9164 - - Jackie.Laramee@ndccorp.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 0 No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor 9,200.00 and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ 9,200.00 Building Permit Fee=Total Construc u.n Cost x ( sert here 2.Electrical $ appropriate municipal fac .r) 66 . 3.Plumbing $ I 4.Mechanical (HVAC) $ Note:Minimum fee=$ 70.00 c. .: rnicipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ 9,200.00 (contact municipality)and write check number here SQ 89 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 ac to to the be of my kn ledge and understanding. i Jacqueline Laramee y� M� Vice President 860_ 621 _9164 Please print and sign n/74 a Title Telephone No. Date 35B Robert Jackson Waecond Floor P mville CT 06062 Jackie.Laramee@ndccorp.com Street Address City/Town State Zip Email Address ( -__Municipal Inspector to fill out this section upon application approval: � i %�� I Ile 0 i 4 I 4: Name 1 Date \ The Commonwealth of Massachusetts =t t Department of Industrial Accidents 1 Congress Street. Suite 100 WI 11 Boston, MA 0211-1-2017 ^„ -a. wwtt:ntass.gorfdia 11 .ukers'('ttrnprtt+al. Insurance Afftda%it:Buildersl('ontvertu`s/FlertriciansirPluinhers. PO 13L FILED 111111 1 III:I'H:RN111 11M: Al I HORI11. Applicant Int-urination Please Print I A_rihh Name(l3usuress tlrganrratwa Ruin trJu ill):_J Network Design and Construction, Inc Address: 35B Robert Jackson Way Plainville,CT 06062 860-621 -9164 City/'State`Zip: Phone#: Arty*.au employ Fri t hark the appropriate bore: Type of project(required): i.Oti I am a curlr40rn cr ,Of )5 ____errrpiuyeitir(full andiut part-time)-• 7. New construction 201 am a wile proprietor or purtner,hip and have no employees ti etkuig for are to S. 0 Remodeling any capacity.[No under,'comp.msuranee itquinat) 30 I am a hm oaiwvnrer dolma all work ni r It.(No%soly s`comp.m,ur.moe roomed"- 9. ❑ Demolition 4.0 I am a homarw rice and+kill Ise Itiuma5 wN nps raetors kr medial all Murk on my perty. t will 10 El Building addition ertNure that;ill exnrrlra►Aon other LOC wisdom'cumpenuatiwe insurance or are sole 110 Electrical repairs Or additions proprietary rnith ro ernpluyres_ 12.0 Plumbing itpairs or additions SO lam a I:corral cumtractor amid I lame hired the,ub,eontraetors listed on the:attached sheet.. These,ub,cr_rutraietora hate eirrployeesand h»ewurkerC comp.cresurance. 1 �RUUfrepairs 6.0 We arc a eorpuraanon and nts otfficers have CUM-4sed their right of exemption per kk L e. 1 OthC/ 132,i 1(4 and w.e have rao etraplaytes.[No wurkenC comp.msurance requrrtal[ •.Ally appitarm that cltstks hot is t rnu,t also till out the section below showing their worker. corigiematron piney mfaanaatirnn. 'Hoonounnen who submit ibis affidavit uaiheating they are doing all work and then hire outside uNracrwnr must salbuirn 3 new:affidavit m acati ig sock (ontraeiun dot ehedt dis box musa attached an additional sheet shim ire the name of the web-cwurretur,mit state tthLlher or not those etches have airkeyeey. It the subti411dr•tka lute ergiloyee%.thee'y nwo provide their workers'wrap.policy nrrnber i ten,tin employer that is providing worlters•compensation insurance for my employees. Below is the polity and job.rite in,fnrnration. tnnuranec Company Name: Smith Brothers Insurance,LLC Policy u or Self-ins.Lic.#: WC 9083085 Expiration Date: 9/30/2021 Job Site Address, 136 North King Street Cityr'State+Zip: Northampton,MA 01060 Attach a copy of the workers'compensation policy declaration page(showing the policy number sod estpiration date). Failure to secure coverage as required under NIGL c. 152,*25A is a criminal violation punishable by a tine up to$1,500.00 and+or one-year imprisonment,as well as civil penalties in the fonn of a STOP WORK ORDER and a line 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 th pnins and pen ties of perjury that the information provided abate i.s true and correct_ Stunature: •� C° rat- "-1 I/( `� Date: 5/27/2021 Phone 860-621.9164 Official use only. Do not write in this area,to be completed by city or town official City or Town: Perrnih'Lieense 4 Issuing Authority (circle one): I. Board of Ilealth 2.Building Department 3.('ity A ns n Clerk 4.Electrical Inspector 5. Plumbing Inspector b.Other ('ontaet 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 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing(include local connections) 9 Gas(Natural,Propane,Medical or other) 10 Surveyed Site Plan(Utilities,Wetland,etc.) 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review(521 CMR) 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 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 Pepin Associates Architects 860 -243 -1471 Name(Registrant) Telephone No. e-mail address Registration Number 45 Wintonbury Avenue Bloomfield CT 06002 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. gt6:oorra,4a Department of Code Enforcement °. V$ Building Division 70 Tapley Street, Springfield, MA 01104 ai� �� (413) 787-6031-TTY (413) 787-6641 I.,,,,,,> FAX (413) 787-6023 Contractors Affidavit I certify that the building located at 136 North King Street, Northampton,MA 01060 , Building Permit# , has been built/altered under my supervision and in accordance with Chapter 116.3 of the Massachusetts State Building Code, as follows: 1. Execution of all work is in accordance with the approved construction documents. 2. Execution and control of all methods of construction is in a safe and satisfactory manner is in accordance with all applicable local, state and federal statutes and regulations. 3. Upon completion of the construction, he shall certify to the best of his knowledge and belief that such has been done in substantial accord with Items 1 and 2 above and with all pertinent deviations specifically noted. Name of Construction Company: Network Design and Construction, Inc Construction Supervisors Signature:Si nature: / L A.'v` � '�NU`i 2/4,/t Construction Supervisors License #: I CS-1 9066 Subscribed and sworn to before me this 27th day of May &Lk t)a juuL\10 (Notary Public) My Commission Expires tit al a , 202� �...iN NETWDES-01 PATRA3 ACORO DATE(MM/DD/YYYY) 4....----- CERTIFICATE OF LIABILITY INSURANCE 10/30/2020 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 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 Megan Le PRODUCER NAME: Smith Brothers Insurance,LLC. PHONE Ext (860)430-3386 FAX 68 National Drive (NC,E- ): (A/C,No): AIL Glastonbury,CT 06033 ADDRESS:M mle@smithbrothersusa.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Group 2429 INSURED INSURER B:Selective Insurance Co of SC 19259 Network Design&Construction,Inc. INSURER C:Indian Harbor Insurance Co 36940 35B Robert Jackson Way 2nd Floor INSURER D: Plainville,CT 06062 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 IMM/DD/YYYY1 IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR S 2393272 8/4/2020 9/30/2021 DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1'000'000 GENII_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2'000,000 GENII_ POLICY X JECT X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ CMBINED A AUTOMOBILE LIABILITY Ea accidenSINGLE LIMIT $ 1,000,000 X ANY AUTO S 2393272 8/4/2020 9/30/2021 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED ONLY NON-OWNEDS PROPERTY DAMAGE AONLYPer accident) $ $ A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE S 2393272 8/4I2020 9/30/2021 AGGREGATE $ 10,000,000 DED RETENTION$ $ B WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC 9083085 9/30/2020 9/30/2021 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A 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 $ C Poll/Prof Liability PEC0054786 8/4/2020 9/30/2021 Annual Aggregate 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Information Purposes onlyTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE r? , s0c I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD - -1 Commonwealth of Massachusetts le Division of Professional Licensure Board of Building Regulations and Standards ConstructiQdi#StUpervisor t. CS-109066 3` Expires: 07/26/2021 JACQUELINETLARAMEE r 50 PIERCE STREET ^ � r APT 46 .;•.f a it • PLAINVILLE di 06062 ' O ! fi1S�;':i-1031 Commissioner n- -c - A YL-V31CeV VO:13 STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION This is your Major Contractor registration certificate for your records. Such registration shall be shown to any properly interested person on request. Do not attempt to make any changes or alter this certificate in any way. This registration is not transferable. Questions regarding this registration can be emailed to the Occupational & Professional Licensing Division at dcp.occupationalprofessional@ct.gov. In an effort to be more efficient and Go Green, the department asks that you keep your email information with our office current to receive correspondence. You can update your email address or print a duplicate certificate by logging into your account with your User ID and Password at www.elicense.ct.gov. Mailing address: Email on file to be used for receiving all notices from this office: NETWORK DESIGN & CONSTRUCTION INC jackie.laramee@ndccorp.com 35B Robert Jackson Way 2nd Floor Plainville,CT 06062 TN:: :ANT¢ • 't(' •YY% :.r5. 'f—..',~ .4: .J. VI ASY. I.•'`h is 4' ♦X'C :\•K, :�h4\ \•%r f i::: r. �..,.., ., + ..�' f•.;. '4 �' .• f i f.;.. 9fr, •• ;.R.5';2 + 1 ,0 +�,r *_• a 4 4�r i 1 r h i t i 4 i ♦ r 4 *i a r 4 it' 4 al, 4 k 4 .F 4 h 4 * `1. .,.:_� 8127871 STATE OF CONNECTICUT ! DEPARTMENT OF CONSUMER PROTECTION ti ` , Be it known that , >.-f, -` I i-fit. NETWORK DESIGN & CONSTRUCTION INC - <I. ;.; ': I 35B Robert Jackson Way st 2nd Floor {s Plainville, CT 06062 ` '_4 mr i has satisfied the qualifications required by law and is hereby registered as a ` '$ ' MAJOR CONTRACTOR , =+. r Registration #: MC0.0903642 ,., �� •- 1 Effective Date: 07/01/2021 .'..� Expiration Date: 06/30/2022 -;'.` Michelle Seagull,Commissioner , 6- verify online at www ehcense c ov '-. 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