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31B-227 (5) 26 BEDFORD TER BP-2022-0079 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31B-227 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2022-0079 Project# JS-2022-000145 Est.Cost: Fee: $210.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: 4 U SIDING AND ROOFING/DMITRIY BRUTJIY 109297 Lot Size(sq.ft.): 8624.88 Owner: SIMPLE ABODE LLC ATTN JILL FORTIER Zoning: EU(100)/URC(100)/ Applicant: 4 U SIDING AND ROOFING/DMITRIY BRUTJIY AT: 26 BEDFORD TER Applicant Address: Phone: Insurance: 605 SOUTHWICK ST (413) 657-9246 WC FEEDING HILLSMA01030 ISSUED ON:7/23/20210:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & RESHINGLE 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: I r I FeeType: Date Paid: Amount: Building 7/23/2021 0:00:00 $210.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner RF The Commonwealth of Mas ch settk Office of Public Safety and Ins ecti Massachusetts State Building Code(7:i M4 op _, ; �� Building Permit Application for any Building other than a One a ily Dwel ng (This Section For Official Use Only) 70h: �cpFr� Building Permit Number:f ZO?Z-0o74DateApplied:1(2ZjZo3I Building Official: U7060 /vs SECTION 1:LOCATION No.and Street City/Town Zip Code Name of Building(if applicable) £6-.. 7 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 0 Repair 0 Alteration 0 Addition 0 Demolition 0 (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 0 No Er Is an Independent Structural Engineering Peer Review required? Yes 0 No QI— Brief Description of Proposed Work: 2SLW\OQ S d1/4 L60J-c1( I wc.S1 Jl c.v..t.1; rz d, 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.) Total Area(sq.ft.)and Total Height(ft) 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 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❑ I-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: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA CI IB ❑ HA IIB ❑ IIIA ❑ RIB CI IV El VA CI VB 0 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 0 A trench will not be Licensed Disposal Site 0 Private 0 or indentify Zone: or on site system 0 required El or trench or specify: 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 ib 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 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: s L 3 -1a3 - 353 ____ _ \\l\ _'' ',(\ek-v, CiAll Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Dom:"kJ -b�Et-SL 4I S ar -ems (C-s ��/a 7 Name Street Address i� 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 0. 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) �MA41( V/ P$k45LL4 �106,54cU4C (169ILi.db€ I ctik» CSi0'1a91 Name(Re tra ) Telephone No.... _t e- ail address Registration Number Lk 1 s Nl� 1r11.U4 rd .el i OA n ' to Ill )i 41a0a I Street Address CityClbwn State Zip Discipline Expiration Date 10.2 General Contractor� tipiilk Company Nam ' �' Name of Persob Responsible for Cbnstruction License No. and Type if Applicable (a10c Sow wki� q\ V'PJ�cVi tts h (010 30 Street Address Cityown State Zip 415-1o5A-°i tl, - - (k[ot 11.E •d tJ 6 ( 1 Loon Telephone No.(business) Telephone No.(cell) e-mail aadress 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? Yesg No D SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)=$ . 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ 2( (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ � (contact municipality)and write check number here J�6 O 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. 1 zn stzi 41,tapOt and si na1/4�Y �c\ me ('[ 1\ Oli��Title Telephone No. Date USU� l9s Street Address Ci Ili own State Zip Email Addres 72 Municipal Inspector to fill out this section upon application approval: ____71Z7-Z3-7Z( Name Date City of Northampton ?oa-i Mp S�5 ..• SAC �'� Massachusetts �� x. '<</ p *,0.. 4, , DEPARTMENT OF BUILDING INSPECTIONS y t .ice ` 212 Main Street • Municipal Building ' OD • ,.�,1,,:_." Northampton, MA 01060 'rh',, VD° 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: (p' L -,(GLU \ `-UM0V_,C \—k PI Q 10 4"o The debris will be transported by: Name of Hauler:1). - U'` .. \Signature of Applicant: Date: c (Qj AC D ® DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 07/14/2021 411......../ 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 David R Jarry Neill&Neill Insurance Agency Inc PHONE FAx 662 Riverdale Street (A/c,No,WI: 413 732 4137 (A/C,No):413 731 6629 West Springfield,MA 01089 ADDRESS: dj@neillandneill.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Penn America 32859 INSURED 4 U Roofing&Siding INSURER B: Commerce Insurance Company 34754 34 Laurelwood Lane AMGUARD INSURANCE COMPANY 42390 Springfield, MA 01118 INSURER C: INSURER D: 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER IMMIDDIYYYY) (MMIDDIYYYY). A COMMERCIAL GENERAL UABILITY PAV0279357 10/10/2020 10/10/2021 EACH OCCURRENCE $ 1,000,000 Y RENTED CLAIMS-MADE OCCUR PREM SESO(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- POLICY , JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ 2,000,000 B AUTOMOBILE LIABILITY BCPL18 09/06/2020 09/06/2021 COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 100,000 OWNED - / SCHEDULED BODILY INJURY(Per accident) $ 300,000 AUTOS ONLY V AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ 100,000 AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION R2WC163900 12/04/2020 12/04/2021 V PER H AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE r Y NIA E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? 1 OO,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION City of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Dept. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20012 Main St. ACCORDANCE WITH THE POLICY PROVISIONS. Northampton,MA 01060 ' AUTHORIZED REPRESENTA IVE f IR ©1988-2015 ACORD COR TION. II ri is reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD `� The Commonwealth of Massachusetts Department of Industrial Accidents ,-_ '''-!° Office of Investigations _ '' 600 Washington Street A ` Boston, MA 02111 `�h\s:•�,s r www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):4 U Siding and Roofing Address:41 S Marchioness Road City/State/Zip:Springfield MA 01129 Phone#: 413 6579246 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P tY 9. ❑ Building addition [No workers' comp. insurance comp.insurance.: required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.EI Other3;4 , comp. insurance required.] ,Ati *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: Neills and Neills Policy#or Self-ins.Lic.#: R2WC163900 Expiration Date:e 12/04/2021 Job Site Address: bX( � 'df City/State/Zip: N ILG1.�1�GaDitt iq ©i� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 perjury that the information provided above is true and correct. Signature: ` Date: 1 i Q.0 I a.i Phone#: 4136579246 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#: Division of Professional Licensure Board of Building Regulations and Standards Constructioil'Siipervisor CS-109297 Expires: 11/14/2021 DMITRIY BRUTSKIY 41 S MARCHIONESS ROAD SPRINGFIELD MA 01129 v•k Commissioner Al"." `)/1 ,"., c)( --' Benin rrofrutra'6,1,- ,167,,mtrclu.�ll Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration valid for individual use only before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 04/12/2022 1000 Washington Street -Suite 710 DMITRIY BRUTS -;'` Boston,MA 02118 DB/A 4 U SIDl( G= NG DMITRIY BRUTSKIY'-=°,__.� i) 605 SOUTHWICK STREET' f% FEEDING HILLS,MA 01090 Undersecre Not valid without signature Y From: L '� 5�11v vvi �IIQcrC. 4(i� CA CIA t(OVl4SS Cc To: Jonathan Flagg Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 The Massachusetts Building Code, section 107.1 allows for an exclusion from requirements for construction control in certain situations. In accordance with code section 104.10, I request that you grant a modification to waive the requirement for construction control of the project at d(o 5ed peo-1 .—Vr (J JO because the work is of a minor nature, will not affect str ctural elements, health, accessibility, life or fire safety, and will be done in accordance with the prescriptive requirements of the code. Thank you for your consideration. Respectfully, Lk)