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31B-312 (13) 26 CRESCENT ST 104 BP-2022-0003 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:31B-312 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONT C FORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND ( GL c.142A) Category: KITCHEN&BATH RENO BUILDING PERMIT Permit# BP-2022-0003 Project# JS-2022-000003 Est.Cost: $32000.00 Fee: $208.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ALVIN HALL 042574 Lot Size(sq. ft.): Owner: MITZ OWEN Zoning: URC(100)/ Applicant: ALVIN HALL AT: 26 CRESCENT ST 104 Applicant Address: Phone: Insurance: 109 WEST ST (413) 586-4633 O HADLEYMA01035 ISSUED ON:7/2/20210:00:00 TO PERFORM THE FOLLOWING WORK:KITCHEN & BATH RENO 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 UPO VIOLATION OF ANY OF ITS RULES AND REGULATIONS. ' 11) Certificate of Occu•anc Sianature: . V 6 kit r I " FeeType: Date Paid: Amount: I Building 7/2/2021 0:00:00 $208.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner ,/ iiiN , fN.NNc:.,....„..N. .., The Commonwealth of Massachusettt c/G/ . o ,qV„ Board of Building Regulations and Stan a••.. ` J �. ; FOR Massachusetts State Building Code, 780'63 G% c7p),.. CIPALITY Building Permit Application To Construct, Repair, Renovate ��. i .lish a evisec Mar 2011 One-or Two-Family Dwelling �-In ,pFe ,' This Section For Official Use Only iOol''v,s /' Building ermit Number: 6 f--,A)-- 3 Date Applied: L.--1.1//J 4Z5 5 /t/ Z 7-I-202( Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 PrAporty Address: 1.2 Assessors Map& cel Numbers e it iCQ �fi 4- 107 d --3/2 6967 1.1 a Is this an accepted street?yes_Le-ho Map Number Parcel Number 1.3 Zoning Information: 7 ^ 1.4 Property Dimensions: reSs ,C941C/C1/71 uM., C :,,-1 a,,, /, /k3 s-- Zoning District Proposed Use Lot Area(sq ft) Frontage(fl) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public j/Y/Private CI Municipal Outside Flood Zone? Municipal tOn site disposal system ❑ Check if yeses SECTION, 2: PROPERTY OWNERSHIP' 2.1Owe i ofRecord:-7,,. eh £ !r pi oritt&Akrivo Name(Print) City,State,ZIP 7-4 C�.sc 1 s* Ti- /01 l- 77- 7 s 30 0 udeti 2 l Vcd e . i' e 1- No.and Street Telephone Email Address V/ SECTION 3:DESCRIPTION OF PROPOSED WORK' (check all that apply) New Construction ❑ Existing Building Owner-Occupied 6.---Repairs(s) 0 Alteration(s) ik1Addition 0 Demolition I3' Accessory Bldg. 0 Number of Units Other 0 S ecify: Brief Description of Proposed Work': ett/t4►'' Q( i\S fi!1 D feii At t ' iA/e64 k,'iFixoI �rvtc� CW.d Ag-y c i tnsitt�( vleu1 C litt ln.c 4/i -fr/e s Ao l SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 'Z, 6110 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire Suppression) $ Total All Fees: . I Check No. 'kV Check Amqunt4, �� ash Amount: 6. Total Project Cost: $ 2 (1))))---- ❑Paid in Full ❑Out di alance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C5 d Lz57 It z6 zj 2 -2� `4T/11 ' "L /lI;^ License Number Expiration ate Name of CSL Holder 1 0' 1/V ft `S. : List CSL Type(see below) le No.andl Street Jeti ! Type Description M A ® /0 +3 6 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,Zl M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances LP 3 6� `7 - 77��J� ,�hQl�. Of. I Igilelatioit Telephone Email Email address f fl D Demolition 5.2 Registered Home Improvement Contractor(HIC) A676V-6 (O Jz 1v SatesC.. HIC Company Name or HIC Registrant Name HIC/Reg}stration Nu r xpir Date Q 101 iii 'i t a t(c)w' — No.and Street EmaiNtar City/Town, State,ZIP Telephone SECTION 6: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 Issuan of the building permit. Signed Affidavit Attached? Yes .......... No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize //114,1 /!' I-At 1/ to act on my behalf,in all matters relative to work authorized by this building permit application. • O 4r dlll�42-- ?-9 _'_j Print Owner's Name(Electronic Signature) e SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in is application is tr aand accurate to the best of my knowledge and understanding. 0hJ/ 2.— Print Owner's or Authorized Agent's Name(Electronic Signature) ate NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Infoiniation on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) iI IIY' (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count If Number of fireplaces 0 Number of bedrooms 2i Number of bathrooms Number of half/baths Type of heating system . rot 71 ,r, r Number of decks/porches Type of cooling system ',AMilin Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of Massachusetts Department of Industrial Accidents 1.1111 i!t , 1 Congress Street,Smite 100 �t '►� Boston,MA 02114-2017 ,.T`. ._ sI www ntass.gov/dra II or kern'Compensation Insurance AItida%it:Builders/("ontractnrs'Electririans/I'lu.nbers. an ME FILED♦S Mt 7"nt_PF:R'NI"1'1'l1(:AI 11101trI'. r / , ! } /�� Print Lrenhh NametHuxlnesttOr+:tn►iailtin.Intlaw renal►: ' nn Ilan/Information V`n. � Please/ . _' Address: /f J4s1S7' City StatelZip: `( (V U 35 Phone#:- c /�, & 7 -"77‘ o ____ Are yen an arpiover'('►ark dieap prints.hot: Type of project(required): I. I am - toyer with employees tiWt aatl:+`or part-tint a.' 7. ®Neu. 'un+[ruvUcrn . 3 oat a,tile Ku tear Of ncnh and have no employees Durkin,:• tar me an I F� IK++t ip trip IC tr+delttaL any carm:sty_INu workers'comp.insurance riropuredi 9. ❑Demolition 30 I am a homeowner eowner doing all work myself."No workers'comp,insorarre requiem 10.Building addition 4.71i am a ta,mcx.wrrcr and V:III ter hiring isinuariurs to conduct all work on my property. I a ill ensure that all conorarlont either have worker;compensation insurance or arc scdc I I 0 Electrical repairs or additions proprietors with no employees_ 12-0'Plumbing repairs or additions sCI I am a k*cmzal contraiior and I has<hired the sut„eunoactor.tisted..n tow attached sheet- Them aah-etatttactota have►anpluylcs and Irate u urkccs'.ramp,utvurance. 134:21 ROA repairs. I4.DOther 6.0 We are a corporation amid its uf1ccrs have cvc7cas tMd u right of escropition per hatiL c. 152.fi It 4i,and we hose no employees.!No workers'sump.insurance a revised" 'Am applicant that checks bin al mint also fin out the section blow showing their workers'compensation policy information. t l t ctttcvpw Imes who submit this affidaett tntlrealma they al a doing all work and then hire outside tanrtraet*rs mud suhttttt a rrew 4tlid tt it indicating str:lt. 4(.ontraekus that check this lxrx must attached an additional shirt showing she name of the sub-o rttracttrs and state whether.er in not those entities have employees_ If the sub-et ror:xkrs have canpluyces,they nrnst provide their rAurk.r. r rrrp.policy number. I am an employer that is providing worAers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date:_� lob Site Address: CityState"Zip: _ Attach a copy of the workers'compensation policy declaration page(showing the policy number and exiairation date). Failure to secure coverage as required under MGL c. I52,*25A is a criminal violation punishable by, a tine up to$1.500.00 anti o r one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance co crape verification. I do hereby cent i, under the erns a n its of perjury that the information provided abo a is t dated correct. Signature:,/ ` • . Date: t 2? "IV Phone#: 9/ 3/ / 761% Official use only. Do not write in this area,to be completed by city or town official ('its or Town: Permit/License Issuing Authority(circle one): I.Board of Health 2.Building Department 3.Chsi/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other ('untact Person: Phone#: 6 29 2021 img004 jpg Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction tUpervisor CS-042574 Expires: 06/26/2022 ALVIN M 109 WEST STr Ammei HADLEY MA 01035 Commissioner c/a, 2A. 6rnme,1-/ketiecx4(ofyie--0:4,)eze4)(y/4 Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE: Individual Registration Expiration 167646 10/12/24)24P 2.0 7-a- ALVIN M. HALL ALVIN M. HALL 109 WEST ST HADLEY, MA 01035 Undersecretary https•llmail google comimail/u/l/Mnbox/FMfcgtGlawNbqTyRgmGrnKLIfgCsVnvzh?projector=1 1,1 ACORCP CERTIFICATE OF LIABILITY INSURANCE DATE(MIWDD/YYYY) 06/29/2021 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). PRODUCER CONTACT Susan Fleury CIC CISR CPIA NAME: King&Cushman Inc. PHONE (413)584-5610 FAX ��A/C,No,Ex,t1: , (A/C,No): (413)584-9322 P.O.Box 447 A-DD IEss: sfleury@kingcushman.com 176 King Street INSURER(S)AFFORDING COVERAGE NAIL# Northampton MA 01061 INSURER A: Main Street America Assurance Co. 29939 INSURED INSURER B Alvin Hall INSURER C: 109 West St. INSURER D: INSURER E: Hadley MA 01035 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2162904289 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. ILTR TYPE OF INSURANCE NSD WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS {MM/DD/YYYY) (MM/DDlYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 A MPP6994G 04/24/2021 04/24/2022 PERSONAL SAOVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY n PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER GDAL $ 25,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ ^. AUTOS ONLY ^ AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE n NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) T� 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. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD City of Northampton oa?=^M o ' . ; \s • = s � 'f" 1 ri Massachusetts 44, c'c� � t DEPARTMENT OF BUILDING INSPECTIONS r Q► ,r. 212 Main Street • Municipal Building tii ^e Northampton, MA 01060 dsPh1-%`� 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: c/; klc,11Z 3 t'I 17 I ? /4,47/,4 r4 Location of Facility: �� The debris will be transported by: Name of Hauler: a‘71441044 AiSignature of Applicant: Date: 2� 20 L/