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24D-161
144 KING ST BP-2021-1447 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24D- 161 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2021-1447 Project# JS-2020-001777 Est.Cost: $298764.00 Fee: $2093.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: LECLERC BROTHERS 49566 Lot Size(sq.ft.): 6054.84 Owner: DUPREY NICHOLAS D&BETTY LOU Zoning: HB(100)/ Applicant: LECLERC BROTHERS AT: 144 KING ST Applicant Address: Phone: Insurance: 64 Worthington St (413) 532-3992() Workers Compensation CHICOPEEMA01020 ISSUED ON:6/4/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:RENOVATION 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 51- ,f x 1 • Certificate of Occupancy Signatu ; : FeeType: Date Paid: Amount: Building 6/4/2021 0:00:00 $2093.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner < V 114/1 NsN°'°1' The Commonwealth of Mass °s ; • s ) ' Office of Public Safety and Inspections 1)264,itis Massachusetts State Building Code(780 CMR) Mq AFC Building Permit Application for any Building other than a One-or Two- Dwelling (This Section For Official Use Only) Building Permit Number60-,1""N'17 Date Applied: Building Official: SECTION 1:LOCATION Ivy �j J r4r' A7V', a'/' No.and Street / City/own I Zip Code Name of Building(if applicable) 2.4 Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Building Repair 0 Alteration pp 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 No 0 Is an Independent Structural Engineerin Peer Review equired? ..- Yes 0 No a'''. Brief Description of Proposed}York [Yew cT 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) ❑ 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.) / G Total Area(sq.ft.)and Total Height(ft.) /1J y .;?r /`3 y ` 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❑ B: Business 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 1-4❑ M: Mercantile 0 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: /)9 ION 6:CONS t RU ON TYPIVeck as applicable) IA CI IB ❑ HA 0 IIB ❑ ILIA CI RIB 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 Check if outside Flood Zone 0 Indicate municipal EK �/ A trench will not be Licensed Disposal Site Ile' Private 0 or indentify Zone: or on site system 0 required 1Q or trench or specify: permit is enclosed 0 Railroad right-of-way. Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable( 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 SECTIONS: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 PS/Yr oti4d,44< 01 W14LE4/ ,d Sid/ je,, � A 9J" 1 ,%Aa(. Sv Name(Print) No.and Street 7/c, City/Town Zip Property Owner Contact Information: ,92 10J90 2P ysP— fr 14rA a4 ,o?.,1.-- Title Telephone No.(business) Telephone No. (cell) e-ma ddress --/a �� If applicable,the property owner hereby authorizes: f Co 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) Mf <Ect,,E4-4-- WAR J)/23 M/cc.`erc, 2 ,--' Name(Regi�ra ?/� � � Telephone No. e-mail address Registration Number i4yStreet Address City/T State Zip Discipline Expiration Date 10.2 General Contractor W "... .f.. . ,,,,..„.e.,_____164_ Company Name AM 4 Lc4�-c- e- o Y 2J tC "n ,•1 ')cI�/ Name of Person Responsible for Construction License No. and Type if Applicable o f loe, 4> 4, So- C Ica /�.� d/U� Stree Address City/Own State Zip r, -.3re i0 yi-3. 'i9 a 4Acje/ic @n..,�Qder,.4a, 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 " o 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor �� and Materials) Total Construction Cost(from Item 6)_$aye -At vU 1.Building $ 4202,3 %& Y Building Permit Fee=Total Constructio ost x (In t here 2.Electrical $S) gvv appropriate municipal fac r)=$2a OQ 3 ' 3.Plumbing $lG VaU 4.Mechanical (HVAC) $ it p air Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ c2 g9 96 d U (contact municipality)and write check number here 6 0 t5G SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,1 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 kno ledge and understanding. 0414e 414-Nr 4EcLx i'/3 Iya_j_ag _4/4, P/lease rin/kk and ame r T tle T eph ne No. (4 t lr0 wQt M/h 1 (/ ►i-- ckp pe 4,4Z 0/0, �i� G�i�G/'G��_!` `'l+/•f Street Address (/ City/'Ifwn State Zip Email Address Municipal Inspector to fill out this section upon application approval: . G e Name ate The Commonwealth of Massachusetts —411.27 Department of Inc/modal Accidents 1 Congress Street,Suite 100 1" Tar Boston. 3fA 02114-2017 „.* tt...j.zet> www.moss.govfirto 5.t orkers ("onipensation insurance Affidavit:BulidersitentractorstEkctricians/Plunibers. TO DE FILED WITH TIIE.PERMITTINI;Al1THORIT V. Applicant Information Pleas Print Lruibh Name(hosinessiOr, 401 )'19(g Address. ‘4")-- City/State/Zip:j9e7/7141 0/0.02.2, Phone# 4/7 I — sy.zr3 2/e Are yea ah erroloyert Check the* upriEdc hax: Type of projeci(required): 1.071 are a etripkrycr with_ 42-_eriap4oyetia(full andior proi-timei' 7. El New construction C1I am a sole propnesor aft pertfunskup oral have no employer*working for mo in 8. emodeling any vsapacity.[No workers'comp.minimum requited.) 9_ Ei Demolition I ant a Ittinvini.,/doing all*kirk myself rho AvIkers'eonsp.mnnmmnumccEalgliftlfari 10 Ei Building addition 4,D I ant a hiss and will b,.hums cimataiLitirt.ii,coadisi:l all week on ray proptety_ ensure thin all evintraelont either hare Mairim'oirrapensatiuti itieutancit fiar 11.1:1 Electrical repairs or additions pmprietes,with ito esaiployees. 12.0 Plumbing repairs or additions 5iI arm a lie:nand emu/actor anti I Inert hired the sub.enritractors lived on the anointed sheet. 3.0Roof repairs 'Mote saki-contracrar%have employees and have workers'cafttp fr.:Warier; , 1,4.0001er 6.0 we use a corporation mid thi officers have exercised their right of,...Aemption per MC11.. 1.S2,§1i41.and we hate no einplo.pees.iNlo workers'comp.Mama-tee felony:di 'Al!!applicant that chock box*1 mug also till nut the sectsof.below shooing their worters"emirensation policy inioi-friatielet. Ikuneowtstss sshu submit this atridnvit midientusg they are doing all work and then him woad.:coansinoto mutt submit a new affidavit yadicafing iConiracturs that cheek this hot must inhaled an itdditional AffeC1 showinc the name of the reb-controstors and aunt whether or not those etttitie.s have umpIue& It thu Etsve emphiyers.they moon pnWide their workers' policy number I am an employer that is providing workers'compensation Mulroney for my employees. Below is the policy and job site information. Insurance Company Name: /eeed, "eat7,16,_ Policy a or Self-ins.Lie. a k.,5-6 a oibloPO/VC,' Expiration Date, Job Site Address: A:4 City,Statclip:01Qfr/6e/o63 Attach a copy of the workers'co , ns,ation policy declaration page(showing the policy number and e i'ratiordatek Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a tine up to S 1,500 00 andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine 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 certi Y an the 'ns and of perjury that the information provided above is true and correct. Sqpiature: Date /7)- Phone a: @3 official toe only. Do not write in this area,to be completed by dry or town official City or Tosvn: „, Permit/License Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.Cityriown Clerk 4.Electrkal Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: coRO` CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD YYYY) ✓ 12/15/2020 (IS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED :PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. 'PORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to e terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the rtificate holder in lieu of such endorsement(s). NICER CONTACT )I/Lavigne&Deady PHONE Kevin M Deady FAx rance Agency,Inc. (A/c,No Ext):413-532-3291 (NC No): 413-534-8982 3rattan Street I PO Box 59 E-MAIL opee,MA 01021-0059 ADOREss: TA O'Keefe INSURER(S)AFFORDING COVERAGE NAIC 0 _ _ INSURER A:Arbella Protection Ins. Co. 41360 2ED Leclerc Brothers,Inc.& INSURER B: M&A Properties LLC INSURER C 45 Worthington St. Chicopee, MA 01020 INSURER D INSURER E: INSURER F: /ERAGES CERTIFICATE NUMBER: REVISION NUMBER: IIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD )ICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE ADDL SUBR) POLICY EFF POLICY EXP _ ---_-------- - --- INSD NNo POLICY NUMBER (MM/DO/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $ 1,000,000 I CLAIMS-MADE X OCCUR 8500028080 06/08/2020 06/08/2021 DAMAGE TO RENTEDoccurrence) 100,000 PREMISES(Ea $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY L JECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE UABIUTY EOMBBIIN�EeDtSINGLE LIMIT $ 1,000,000 ANY AUTO 1020055302 06/08//2020 06/08/2021 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ _ AUTOS _ AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) . I UMBRELLA LIAB X OCCUR EACH OCCURRENCE .$ 1,000,000 EXCESS LIAR CLAIMS-MADE 4620081783 06/08/2020 06/08/2021 AGGREGATE $ 1,000,000 DED , X RETENTIONS 10,000 $ WORKERS COMPENSATION PER OTH- 4ND EMPLOYERS'UABIUTY Y/N STATUTE ER ;IVY PROPRIETOR/PARTNER/EXECUTIVE 4220054850 06/25/2020 06/25/2021 EL EACH ACCIDENT $ 500,000 :FFICER/MEMBER EXCLUDED? N/A Mandatory In NH) YyeS describe under E.L DISEASE-EA EMPLOYEE $ 500,000 DESCRIPTION OF OPERATIONS below f E.L DISEASE-POLICY LIMIT I$ 500,000 II 41P11ON OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,AddlBonal Remarks Schedule,may be attached If more space Is required) TIFICATE HOLDER CANCELLATION CHICO-3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Chicopee ACCORDANCE WITH THE POLICY PROVISIONS. Building Department City Hall AUTHORIZED REPRESENTATIVE Chicopee,MA 01020 ©1988-2014 ACORD CORPORATION. All rights reserved. RD 25(2014/01) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConStrilAAtSpervisor CS-049566 Expires:06/10/2022 MARK D LECLERC , 64 WORTHINGTON STItET CHICOPEE MA 01020 vr- _ .. Commissioner sk B&,Lb., k • 6-~2-40- 1,0/� Office of Consumer Affairs andBusiness Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: 18s,250 LECLERC BROTHERS, INC. Expiration: 1G/17/202? 45 WORTHINGTON ST CHICOPEE, MA 01020 Update Address and Return Card. SCA 1 0 20M-05/17 /674.;iieZiJi/4 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 186250 10/17/2022 1000 Washington Street -Suite 710 LECLERC BROTHERS,INC. Boston,MA 02118 MARK LECLERC 45 WORTHINGTON ST � .w�(GL•�iGf.Y.I' CHICOPEE,MA 01020 Undersecretary Not valid without signs re City of Northampton Massachusetts se DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 411+ „5<1 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: v S,/ 1C/ .,c/if,i17�, The debris will be transported by: Name of Hauler: (I'D/ ! I Signature of Applicant: Date: _k/04