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23A-173 (6) 87 BEACON ST BP-2021-1569 , GIS#: COMMONWEALTH OF'MASSACHUSETTS Map:Block:23A- 173 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY',FUND (MGL c.142A) Category: Stairs and porches BUILDING PERMIT Permit# BP-2021-1569 Project# JS-2021-002599 Est. Cost: $24137.00 Fee: $168.96 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: D A SULLIVAN & SONS INC 053667 Lot Size(sq. ft.): 86248.80 Owner: ROMAN CATH BISHOP OF SPFLD CHURCH OF THE ANNUNCIATION Zoning: URB(100)/ Applicant: D A SULLIVAN & SONS INC AT: 87 BEACON ST A_pplicant Address: Phone: Insurance: 82 NORTH ST (413) 584-0310 Workers Compensation N O RT HAM PTO N MA01060 ISSUED ON:7/12/20210:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE STAIRS 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: 1 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. ,, CS) Certificate of Occupancy signatu (: � •' FeeType: Date Paid: Amount: Building 7/12/2021 0:00:00 $168.96 212 Main Street,Phone(413)587-1240,Fax: (413)•587-1272 Louis Hasbrouck—Building Commissioner .e�/ T ® inonwealth of Massachusetts 1 Lf, JUN 3 0 2021 Off ce of Public Safety and Inspections Mas chusetts State Building Code(780 CMR) : -' kin: Permit Appli atio for any Building other than a One-or Two-Family Dwelling �EPr or-6(I1LD.ING N�AT"AMnTOFv IDISPE s S cfion For Official Use Only) Building Pernu t Number to App ed: Building Official: • SECTION1:;LOCATION : SZ rue 4-<c ^ S+ F6 dtp.(,Z 44nvtv41 ,'�le‘ CInt/ l No.and Street City/Tow n Zip gode Name of Building(if applicable) I Cy Assessors Map# Block#and/or Lot # /✓�, SECTION 2:PROPOSED WORK K Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below • Existing Buildings Repair❑ Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use ❑ Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No t1 Is an Independent Structural Engineerin Peer Review required? Yes 0 No IS Brief Depfriptioit of Proposed Worli 2 tit eve h c 19 0. . vte J a 8 ' Inc. re wyO.It Si" et V 5 SECTION 3.COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING.RENOVATION,ADDITION,OR \ ;-': • ' .CHANGE iN USE OR OCCUFAIVCY., Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 1] Existing Use Group(s): fir A Proposed Use Group(s): vvN e- SECTION 4:BUILDING HEIGHT AND AREA•. Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) -j I li,- c .Total Area Area(sq.ft.)and Total Height(ft.) ii t D'a SECTION 5:USE GROUP(Check as applicable)` A: Assembly A-112 A-2❑ Nightclub ❑ A-3 ❑ 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❑. H-5 0 I: Institutional I-1❑ I-2❑ 1-3 0 I-4❑ M: Mercantile 0 R: Residential R-10 R-2❑ 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: SECTION6:CONSTRUCTION TYPE(Check as applicable) IA El IB0 HA IIB ❑ IIIA1 ' IIIBO IV0 VA VB0 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 fi Check if outside Flood Zone el Indicate municipal gar/ t A trench will not be Licensed Disposal Site IV/ Private❑ or indentify Zone: or on site system Elrequired Wor trench or specify: permit is enclosed 0 II&,„..th e.. 'Kt e-1. Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable Er Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No M Yes 0 No fie 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: - � FF SECTION 9• PROPERTY OWNER AUTHORIZATION Name /and Address of Property Owner P ,ram 1 c: Tkrati.L t e5-e ‘.5 ( f, - .). cS r t to 4 t�l.c�1 M-- 7 t L o Name(Print) No.and Street City/Town Zip Property Owner Contact Information: 17W, 0'$ Icils &C (4(4k4/I352- (5kiri5 q2.9 -'5 5 7;7 e,SpatlJe. 9ciiasFr( 3-LU> Title Telephone No.(business) Telephone No. (cell) e-mail address C.''"i If applicable,the property owner hereby authorizes: 1 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 pernut application. '` SECTION Ilk CONSTRUCTION CONTROL(Please fill out Appendix 1) 'If a building is less than35,000 cu.ft.of enclosed space and/or not under Construction Control then check here D.': Otherwise provide construction control forms see'5ecfon 107 in the code as re.uiied 10.1 Registered Professional':Responsible for:ConSthietion Contro1(the professional coordinating docaineiit submittals)',. .:" , . P'L-.r iC 5uLJtv°4,,,1 iid3:g4- 63I v r'k ell ak4 r11crq,.t. CSi tv b 47 N e(Regis apnt� Tele'hone No. e-mail addre �+°> Registr tion Number gZ - di ND -fir - AJZI1�iP1d� / o to tau _ 5 _ fl /fl/al Street Address City/Town . State Zip Discipline Expiration Date 10.2';GeneralContractor Company Name ` a ' -(aa N to �l�' .w Y f� _ �1 , Name of Person Responsible for Construction license D. and Type if Applicable t Z-E 4 N® L El' a-c i,ctvtp -c Iv( I o l o i,i , Street Address i City/Town State Zip L - O3 i a I Li i -5 n- Li 2Li'7 iS4-P tit.0 c�ica_SJ i 1 i t(ckti .�C..o v�l Telephone No. (business) Telephone No.(cell) �l 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 BY No 13 ' . -• &EC1IONI2•CONSTRUCTION COSTS AND"PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ ZA, (31 F -T 1.Building $ �/) Building Permit Fee=Total traction Cost .d07(Insert here 2.Electrical $ appropriate in cipal fail' orj 5 l _ 3.Plumbing $ 1�t_�B-t t-=l- 4.Mechanical (HVAC) $ Note:Minimum fee= IJJ-�_i_ -,t municipality) 5.Mechanical (Other) $ Enclose check payable to - 4 v v✓l lit., 6.Total Cost $ 21 'I ,1 `--' (contact municipality)and write check number here SECTION 13c 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 e ..o,.of m,0o , dge and understanding. ti �in S�leeER Please print ana�ign name j Title Telephone No. Date " 2-g14 !J0eA-1, S = lea✓4-\4gytt.pt,,11 NA 6,16L o ,eeA. �e ___ t✓4 .. Street Address City/Town State Zip Email Address C.o Municipal Inspector io ftll outahis section upon application approval ►' ' ® o " t s `". City of Northampton a +err. 4.% — N. 1a t a F M ,r -- L Massachusetts •.'e to G l''i S � DEPARTMENT OF BUILDING INSPECTIONS '?� fr # s. 212 Main Street • Municipal Building tat., ,b * Northampton, MA 01060 43's".«, ' 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: Wehtft-1've / 4 ' q cC, i tz.0 estektsi'o� Ras ,..3 ke4ikiper-4.kn.mArei,M tai 01 0 s— The debris will be transported by: Name of Hauler: U S Wa54 e. Rec./ CAr Signature of Applicant: �` ` Date: 6l1Z. ,if 1 rite Commonwealth of Massachusetts tvtpurimenl of Inoh iedtti.t4Citieniis 1 a ",,;' 1 Congress Street,Suite 100 Boston,MA 02l14-2017 wnne:nansc.gov/dirt 'Workers'd'onrpensatiant Insurance Affidavit:Buildersff'antractorstfEleclrici anstiRlurnbers. TO BE EJLf 1)►®`ITI1 THE Pt RMITI E G AVT11()RITV. 1tnin icant Information Please Print txttibh • Name 413usirti-sc Orgsinizationslndsuiifual"l: Y �� 111/Q_. �— ��✓1 _ 1'�� • City;State'Zip ce✓' V! - , 49 Phone n: 41.,r t Arc e'rtta an ensphixrr"Chock the appropriate torts: Type of project(required): 1.d1:sn1 a eniptvt•eT±vitro etnpiol,eesfruit a.-tdor•p.art-tirrch.s 7. c New construction 20 am a sale p iaprrclttt or partnir%tnp and have no canployo:s wurlcinsi ramose in 8. Remodeling any capacity.[No cc4ttaet^. i.unta.insurance squired-] a�.J! 9. gD r t Ittaori soot•a lions:0011 r aoing all u.rtls myself.[No workers'comp,insurance c ymreit)' t)0 Building 4.0 rn t I ant a hokssner and ss dt t .ltirm.connus1ursta conduct all wort an not propoiry:. I will tradition 1:nsc;m!kg all 0*ttcr,t.irtr>..tt is lt:t\(1 4+:riI 1% 233:1111X1133iierll tntitstanC•e or are nine I l. ElectricalriLvirs or additions prol'ridtrts N ith rrt+unplug' e^.t.: I T.fl Plumbing repairs or additions S I ant a Li9terat euntnietor and I Irate hired the irk-contractors listed on thin attached shed. LL "I`hei4e attb-contra r.turs have ouipittyo,ant!Inv a workers enrols,insurance. 3.01Roof repairs ici. We:ire a corporation and it;tracers have ex etc tsed d u tight err exentp6'in pcv MGt_e. J 5.2,s 1(ai,acid 's h.3ra r3u itt.,trlu;ces.[Ne:c urkcrs instuartca•zegaivca.) yt&-Z.) „A S • 'Any apptierntt that cheeks hoar 11 recast also fill out the.c.etioit 1 slaw sIia ins?then:workers' 'uttt rtnsatiota rq,fiey ittf tritratien_ tt.rruta3v'n.t1;•antler.rghtnit this arridas t irnlicaiinc they ate doing at1 u otli and thin hire co ide civtirscf<rs ante sttknnit s nc c'iI iJatit i:A e:ding.solos. >(atniractttrs th:yt chccl.this tuts rnist-ati d d an;additional sheet stiuit ing tb-:name,sf'the suhrctsnttact sea and state wirettrer or not those entities base employees_ lithe ttNioniractats have.tr lor'cis.dray,mom provide their tsLake,'wag?. thtc c nutnbe v + I am an employer that is prodding workers'compensation inset ace for racer employees. 8chna is die police and job site information. 1 Insurance Company Name: . • facile)' .toot Self=ins.Lie-w:. 'MC.S`j� _;:t]Q O6 3„.f1 ZD _ • Expiration Dst. 1' Job Site.'address: s 7 P.e4cj) C Sitltc,;'Zi a Mkf 1 Attach a cope of the workers'compensation policy declamation page(showing the policy number and expiration date). Failure to secure coverage.as required under Mt;L c. 152, ,§§"25A is a criminal violation punishable by a tune up to S 1 500_00 aiidior one-year itraprisunrnnent,as trill as civil penalties in the firm ofa STOP WORK ORDER arid a thee-of up to S250.00 a: day against the violator.A copy of this statement may be forwarded to the Office of Investigations of e DIA for insurance coveraie verification. I do hereby etrti,ft't d th prai -and penalties of peajaarp*that the information provided abate is arum and correct. Sien iturc: Date: .c7 AD Z f Official use only. Do no:write in this area,to be completed by city or town oOrial. 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.()their Contact Person. • Phone#: • • ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS'A MATTER OF INFORMATION ONLY AND;CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS' CERTIFICATE DOES NOT AFFIRMATIVELY ORNEGATIVELY 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 polity(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 endorsem sta tement on this-certificate'does not confer rights to the certificate holder_in lieu of such endorsement(s)ir • PRODUCER `, •:;` •:r: :.e . -; r . CAMEACT Barbara Grynklewicz - . Webber:&Grinnell. PHONE ^ (413)586 0111' Fax: (413)586 6481 8 North;King Street ADDDRERESS:- bgrynkiewicz@webberandgrinnell corn INSURER(S)AFFORDING COVERAGE NAIC A " • Northampton MA 01060 INSURERA Continental Western/Acadia • 10804 INSURED.- . ...:; -' '• -' :, • -' INSURER'13 Acadia Insurance Company, , - D.A Sullivan&Sons,Inc. INSURER c .MA Employers/A;I M ' .: "- 12886 - Attn Mark Sullivan / INSURER D Darwin Select ins Co/BRECK ` • - 82-84 North Street ;I'NSURER C Northampton:. �- • ;-MA 01060 ,. INsuRER F. r COVERAGES;.=' , "', CERTIFICATE NUMBER Exp 7/1/21 K , . .- ' ',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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS•, -' CERTIFICATE MAYBE ISSUED•OR MAY PERTAIN THE INSURANCE,;AFFORDED BY THE.1?(*idI,ES D ESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS • } _ EXCLUSIONS AND CONDITIO NS OF;SUCH POLICIES LIMITS SHO,WN MAY HAVE BEEN REDUCED BY PAID.CLAIMS,;" .. INSR - ADDLBUBR - -'POLICYEFF. 'P.OLICYEXP = " _ 'LTR _i.=c�..,TY.PE OF,INSURANCE—, INSD WVD' POLICYNUMBER . :jMMIDD/Y1CYY)••(MMIDDIYYY1� „.'` �+ ,-t LIMITS ,+ COMMERCIAL GENERAL LIABILIT("'' : - .. • - '"`� - 1•900000 X. „ .❑ DAM OCCURRENCE $ __- - DAMAGETO:RENTED 1'000 000 CLAIMS-MADE x OCCUR - , .PREMISESlEaoccurrence) V. ,' ' ' MED EXP(Any one person) $ 10 000 A CPA130002432 07/01/2020 '07/01/2021 PERSONAL&ADV INJURY _• $,1,000 000 ,..A ;000 00 . GENLAGGREGATELIMITAPPLIESPER - - GENERALAGGREGATE: $ 3i 0 .' r,: . PR0. l i 3,000 000 n POLICY X JECT I I LOC - PRODUCTS COMP/OPAGG $ r. AUTOMOBILE LIABILITY` '`• .,-. - ° '`.-" "- ' �' ' COMBINED aBcciINdEeDnt)SI N G LELI I $ 1,000 000 " _.. ANY AUTO BODILYINJURY(Perperson) $. ' , • A .OWNED. SCHEDULED MAA130002632 07/01/2020 67/01/2021 BODILY INJURY(Per accident) $' AUTOS ONLY • X AUTOS HIRED X NON-OWNED - - , , ''PROPERTY DAMAGE X AUTOS ONLY AUTOS ONLY (Per accident) $ ` , z Underinsured motorist BI $ 260 000 ' X'UMBRELLA LIAR •)< OCCUR .. - EACH_OCCURRENCE: -'' $ 10 000 000 ..; B EXCESSLIAB CLAIMS-MADE CUA130002732. • :, 07/01/2020' 07/01/2021 'AGGREGATE, ,,_;`- $,10,000000 WORKERS,COMPENSATION`,r • .. -, . . •. ,- ,. t AND.EMPLOYERS LIABILITY ,, X STATUTE" I ERH _ Y 1.N 1,000 000 ANY PROPRIET.OR/PARTNER/EXECUTIVE I� ` E L,EACH ACCIDENT $ C OFFICER/MEMBEREXCLUDED? I 1 N/A MCC20020000932020A ' 07/01/2020 07/01/2021 ,,, .., , (Mandatory in NH) - • - E:L:,DISEASE---EA EMPLOYEE $••1�,000 . Ifyes,:desoribeunder. _ :-. . DESCRIPTION OF OPERATIONS below: ,.' ' -: '- -.• -- ,: • ---. •. `'-, ., -' ..' `. E.L';DISEASE;,POLICY LIMIT $ '„l! - `000 000 , •„ :. Limit ' ; $1 000,000 , , - . Professional Liability D • . 03043363 ' 07/01/2020-, 07/01/2021 Deductible- 810,600 ' ' DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD-161,Additional Remarks Schedule,may tie attached If more space Is'required)I '` ' ' - ' . CERTIFICATE HOLDER,.. • ':.:.. . _ ''CANCELLATION.. SHOULD ANY OF.THE ABOVE ESC D ICES DRIBE POLI BE CANCELLED BEFORE , - • - THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED`IN ACCORDANCE WITH THE POLICY PROVISIONS: ' 'FqR INFORMATION PURPOSES ONLY" . ' AUTHORIZED REPRESENTATIVE'•, 1 _ . • ' . ,., ' ` ©19 TION All rights reserved"``- 88 2015 ACORD CORPORA ` ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ,. .