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31B-004 (42)
49 ROUND HILL RD COMMONWEALTH OF MASSACHUSETTS BP-2021-1760 Map:Block:Lot:31 B-004- 001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-1760 PERMISSION IS HEREBY GRANTED TO: Project# JS-2022-000235 Contractor: License: Est.Cost: $8000 080885 Const.Class: Exp.Date: 12/24/2021 Use Group: Owner: 1924 LLC Lot Size(sq.ft.) Zoning: URC Applicant: MICHAEL LONGO Applicant Address Phone: insurance: 294N LOOMIS ST (413)569-5452 SOUTHWICK, MA 01077 ISSUED ON:08/19/2021 TO PERFORM THE FOLLOWING WORK: 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 UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fees Paid: $100.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner AOC19 dFr, 202/ The Commonwealth of Massachusetts 1 T AMp 1N��N Office of Public Safety and Inspections I I .'y TON,MA !,ION Massachusetts State Building Code(780 CMR) t I Per it Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Numbera P"21.. qate Applied: Building Official: SECTION 1:LOCATION 48 Round Hill Road Northampton 01060 MA Coolidge Building No.and Street City/Town Zip Code Name of Building(if applicable) 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 x Repair❑ 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 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No ❑ Brief Description of Proposed Work: : Bathroom improvements.Building 4' H wall in front of plumbing wall for fixture relocation. Finishing wall with drywall and wood cap. Installing one new toilet and one sink. 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) 0 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 ❑ 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 1-2 0 I-3 0 I-4 0 M: Mercantile 0 R: Residential R-ID 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 ❑ IIA ❑ IIB 0 IIIA ❑ IIIB ❑ IV 0 VA 0 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 0 Check if outside Flood Zone 0 Indicate municipal 0 A trench will not be Licensed Disposal Site 0 required 0 or trench or specify: Private 0 or indentify Zone: or on site system 0 permit is enclosed❑ 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 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 1924 LLC 46 Round Hill road Northampton,MA 01060 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: President 413-734-1351. 413-896-9962 ]Flebert@CheckWriters.com Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Michael Longo 294 N.Loomis street Southwick MA 01077 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) Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Specialized Construction Inc. Company Name Michael Longo CS-080885 Name of Person Responsible for Construction License No. and Type if Applicable 294 N.Loomis street Southwick MA 01077 Street Address City/Town State Zip 413-569-5452 413-478-5547 Mike@specializedconst.net 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 and Materials) Total Construction Cost(from Item 6)_$ 1. Building, $3000.00 Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)=$_ 3.Plumbing $5000.00 4.Mechanical (HVAC) $ Note:Minimum fee=$1WA1' (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $8000.00 (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I her& ttest under the pains and penalties of perjury that all of the information contained in this application is true and -urete o the st of kn ledge and understanding. Michael Longo ^ /t President 413-478-5547 8/3/2021 Please print and sign name f Title Telephone No. Date 294 N.Loomis street Southwick MA 01077 Mike@specializedconst.net Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: litnittriAL, S:A/115. Cl ' I €241 Name Date Commonwealth Massachusetts .... ,try c Division of Professional $oard i Building Re Licensure Constro.Regulations and Standards shot SORervisor CS-080885 { MICHAEL LONG Expires; 12 21 294 N. LOO O /24/20 S 1�IS S� OUT NICK MA 01077 CommIssioner Coolidge Bathroom Remodel 1924 LLC - 8/12/2021 8' Adding a 4' high wall bumped out for ease of running utilites and locating plumbing fixtures. 11' L \MEW _ f 5H C ''� The Commonwealth of Massachusetts ----- Department of Industrial Accidents 9; ;- (,,p Office of Investigations . =a = Lafayette City Center »'� " = 2 Avenue de Lafayette, Boston,MA 02111-1750 x�t s www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):Specialized Construction Inc. Address:294 N. Loomis street City/State/Zip:Southwick, MA 01077 Phone #:413-478-5547 _ Are you an employer? Check the appropriate box: Type of project(required): 1.0 1 am a employer with 8 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. IN Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in anycapacity. employees and have workers' g P h' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ 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.❑ Roof repairs insurance required.] tc. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:AIM Mutual Insurance Co. Policy#or Self-ins. Lic. #:WMZ-800-8006690-2021A Expiration Date:5/25/2022 Job Site Address: 48 Round Hill road ^_ City/State/Zip:N. Hampton, MA 01060 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 fox_ins •rice coverage verification. I do herd-ceti fy under the pains d pen ides f perjury that the information provided ab ve is true and correct. Signature: /t Date: Y- 3 / t:::/ Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 1®Board of Health 20 Building Department 31:City/Town Clerk 4.1:Electrical Inspector 5C1 lumbing Inspector 6.0Other Contact Person: Phone#: ,_,......„41 SPECCON-01 LAURA ACORO" DATE(MM/DD/YYYY) 441•••••...."----- CERTIFICATE OF LIABILITY INSURANCE 8/4/2021 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 Laura Misseri Phillips Insurance Agency,Inc. PHONE 97 Center Street (A/C,No,Eat):(413)594-5984 FAX No►:(413)592-8499 Chicopee,MA 01013 Miss:laura©phillipsinsurance.com INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Selective Ins Co Of South Carolina 19259 INSURED INSURERB:A. I.M. Mutual Insurance Companies 33758 Specialized Construction, Inc. INSURER C: Mike Longo 294 North Loomis Street INSURER D: Southwick,MA 01077 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER IMM/DD/YYYYI IMM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR S1938108 5/25/2021 5/25/2022 DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY X JECT X LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: $ A AUTOMOBILE LIABILITY (Ea acBINEDtSINGLE LIMIT $ 1,000,000 ANY AUTO A9098571 5/25/2021 5/25/2022. BODILY INJURY(Per person) $ OAED UTOS ONLY X AUTOSULED BODILYO INJURYp (Per accident) $ X AUTOS ONLY x 'kits ONE? (Perracc dent)AMAGE $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED j RETENTION$ $ B WORKERS COMPENSATION I y PER X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N WMZ-800-8006690-2021A 5/25/2021 5/25/2022 100,000 PROPRIETOR/PARTNER/ER EXCLUDED?ECUTIVE N N/A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below A Equipment Floater iS1938108 5/25/2021 1 5/25/2022 Leased/Rented 120,000 I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept. 212 Main St Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD