32C-239 (11) 23 EASTERN AVE COMMONWEALTH OF MASSACHUSETTS BP-2021-1957
Map:Block:Lot:32C-239-
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-2021-1957 PERMISSION'S HEREBY GRANTED TO:
Project# KITCH BATH RENO Contractor: License:
Est. Cost: 14400 JW REMODELING 051584
Const.Class: Exp.Date:03/21/2023
Use Group: Owner: 7Q59 AMHERST,LLC
Lot Size (sq.ft.)
Zoning: URC Applicant: JW REMODELING
Applicant Address Phone: - Insurance:
86 BOOTH ST (413)348-6136
LUDLOW, MA 01056
ISSUED ON:09/29/2021
TO PERFORM THE FOLLO WING WOR ti:
KITCHEN/BATH RENO U it 1 1 t ( "-3
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: I
, > . T'i •
Fees Paid: $100.00
212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
/51\ Ai314.
The Commonwealth of Massa. �`,\' •tts ��co Ali
Ali
Office of Public Safety and Inspectio ° ,t9
O:U3' Massachusetts State Building Code(780 CMR 5,9 <O' cO
Building Permit Application for any Building other than a One-or ty . .milyVWelli
(This Section For Official Use Only) ,-7 AN
ct
Building Permit Number dR/`01Date Applied: Building Official: �' %
r l SE ION 1�.00ATIOO �s�
/ i � .� �id�1�'�
No.and Street City/Town Zip Code 0,IO6O 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❑or check all that apply in the two rows below
Existing Building 0 Repair 0 Alteration 0 Addition 0 Demolition 0 (Please fill out a d sub • Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify: ' J /f•Q VIM (7
Are building plans and/or construction documents being supplied as part of this permit application? Yet. 0 RT p.--
Is an Independent Structural Engineerin Peer evie re uired? • Yes 0 No 0
Bn Descri lion of nand Work:
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 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❑ 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 ❑ IIA ❑ IIB 0 MA IMB ❑ 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:
A trench will not be Licensed Disposal Site 0
Public 0 Check if outside Flood Zone 0 Indicate municipal 0 required 0 or trench or specify:
Private 0 or indentify Zone: or on site system 0
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 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:
City of Northampton
t�.vq" ri,f s
"�'' ? �, Massachusetts ems �'�
4 f w? g
DEPARTMENT OF BUILDING INSPECTIONS ''
' 212 Main Street • Municipal Building Jay a
Northampton, MA 01060 '�:''' 4�.'
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR COMMERCIAL &
MULTI-FAMILY NEW CONSTRUCTION/ADDITIONS/ALTERATIONS
1. Building Permit Application signed by legal owner and filled out by owner or authorized
agent.
2. One set of plans and specification of proposed work(digital and hard copy).
3. Site Plan with location of proposed structure(s)and setbacks.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy CSL and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate(if applicable).
8. Note any Conservation and/or Special Permit requirements (if applicable).
9. Driveway Permit(if applicable).
10. Proof of Water and Sewer entry fees paid(if applicable).
11. Trench Permit(if applicable).
12. Initial Construction Control Documents filled out and signed by the Registered Design
Professional in responsible charge.
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
701 pyP)h eV (-1 I Ea.-tyerh Akre, jj rtk rp-e` ti o/D 6D
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information: •
v Jvpe rrti magi.,e r 413 - 3 -- gqief _ - )6a141301 put I,LOh
Tie Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
7(� ai., ID 0\- 1 E.asrrrh Ave Alp NA a(4.p-fo h A/A- 010 b-t
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 Profession es ois,nsible.for Construction Control(the professional cool,. '. : •ocument submittals)
0 i GI N 0 ; y _ 3 6(o ..4- ,r 15k34 i.CJ
Re ' trant) s Telep e . 4 ve - ail address Registration Num er
op_
Str ddre s City/ • • State Zip Discipline xp' tion Date
10.2 General Contractor
Compan ame ► , �313i 3
Name of Person Responsib a for ons.,i tion License No`and ype Applicable
.E.3.1
1 10 6 0 .
Str t3A3dre s City/Tow C' State ip
5 °)-- fly (Cs WO (.�� 'i
Telephone No.(business) Telephone No.(cell) 'e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AF}•ILAVIT(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❑ No ❑
SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ 3 Olsp
Building Permit Fee=Total Construction Cost x (Insert here
, Q
2.Electrical $ _5 6 b o — appropriate municipal factor)=$
3.Plumbing $ 5 0 b o
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ / 4-/ — (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I hereby attest under the pains..• •- alties of perjury that all of the information contained in this
application is true and ac to to the beFt of wledg- „..,;ti;l •=nding. ra_ ciYit136 !1`' <
`--.01/(
Plea Tint a si na e IX r ' t ��
ele hone _Dabe*l L,
•
Street Address City/Town State Zip jQ ,d•J Email Address
Municipal Inspector to fill out this section upon application approval: Z9ZZ/
Name Date
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
AMC'Rd CERTIFICATE OF LIABILITY INSURANCE DATE IROICIY1rTT1
�...r' C 2 T2021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTWICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERISI,AUTHORIZED
REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER
IMPORTANT_ lithe certthcats holder Is an ADDITIONAL INSURED,the policyf seal must have ADDITIONAL INSURED provisions or be endorsed.
I SUBROGATION IS WAIVED.subject to the terms and corsdRlons of the policy,certain poEcles may require an endorsement. A statement on
this certificate does not confer nghts to the certificate holder in lieu of such sndorsamengsl.
PRonuces FRANCES LEAHY
LEAHY 6 BROWN INSURANCE•REALTY.INC !AIE�__ 4413►Its-11393 I M. 14111?88.61?2
516ALLEN STREET SLIM 1 FL
AnO 'AI EAHY{iLEsHYANDBROWN.COM
11110.111011414 0110111040 OOVEM011 KYC e
SPRINGFIELD MA OIlT6-2039 IRsusea A: NORFOLK IDEOHAMMLJTUAL INS CO 219.65
Rsusm
11101101
JOHN WINDOLOSK INsu/u c
dbara JW REMODELING RsuReR D:
%BOOTH STREET 111111411101R:
LUDLOW MA 01066 I/OIiNlit•
COVERAGE* CERTWICATE NUMBER: CI21927°1690 REVISION NIMAI5It
THE IS TO CERTIFY THAT THE POLICES OF IN6LRANCE LISTED BELOW HAKE BEEN BRED TO TIE INSURED NAMED ABOVE FOR.THE POLICY PERIOD
NOICATED. NOT IAITHSTANDPe i ANY REOUIRETMENT.'TERM OR CONDITION OF ANY CONTRACT OR OTHER DCCtAtENT WITH RESPECT TO WHICH 7H6
CERTIFICATE MAY OE ISSUED OR MAY PERTAIN.TIE INSURANCE AFFORDED BY THE POLICES DESCREED IEREIN B SUBJECT TO ALL THE TERMS
EXCLUSADfc1 AND COM:STTO►aS OF SUCH POLICIES LIMITS SHDLYA MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IIetR ADOLR[IINI" POLICY ESP POLICY OP
List TOME OfM RANO RIM /Wp POLICY N IW (IRIIODIY►YYI t//CWVYYYI ►Ins
COUNERCIAL V(N IAL UNIT 1TY tA:JI accLseeerce s 1,000,000
DASLre TOMMIE°
'CLAAriamoc OCCUR nICYRP3tt.amanruk S 60'.000
WOOP(A.ass srnmi s 5,000
A RdW 1264A 06.11412021 06 09Q022
P050111AL S PM MARY 1
GENE AGQlGit LIMIT OVUM PER GENERALAGGDfCATE S 2.000,000
PRO 2.000,000
POLICY❑A9CT �UK PRm4-rs.oow,oPACG s
o114Ne Emptooment Related s
AUlos&wearer aalBSl�aRwumET S
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-Mir AUTO OCR Y P4JUDY IPw soon $
—orArrn 151105solarium WOO MI{Eev IP�RpdeIS $
.. ��AUTOS OKY KITd$ {{
H e fID Q4-0MPa9 r PARTYmuck
^�AUTLECNY ADTOSOYLY PO nfirnl
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•
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DEICRPnDN OP OPERATRRe/1 LOC ATIOMS!MUCUS IACONO 141,Ad opal Aurrb ScMArr.n.p b.Mohod N non rp.w b rgiAr.fl
PROJECT LCCATIOh`. `EASTERN AVENUE NCRIHAMPTON.AW OTCEO
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
TIE EXPIRATION DATE THEREOF.NOTICE WILL BE DELNERED N
LAN DOLE ACCORDANCE WITH THE POLICY PROVISIONS.
I EASTEFLNAVENIJE
AYTIgRQEO IRMI01 NTATVt tt
NORTHAMPTON MA 01060 .7lAN.•rJ• /+
t966.2OIS ACORO CORPORATION. A6 rights reserved.
ACORD 25 1201UO3) The ACORD name and logo are registered marks of ACORD
The Commonwealth of Massachusetts
I Department of Industrial Accidents
e __1 ww� 1 Congress Street,Suite 100
=y Boston,MA 02114-2017
r www mass.gov/dia
11 a,rkers'('ompens lion Insurance Affidavit:BuilderslCMtractorsiElectriciansJPlumbers.
!O BE FILE)%17 i H THE PERMITTING AVTHOItiI S.
:tnt►Iicant Information _ , Please Print Ihr ib
Name 1)3ustnrys:ckRer►l�nc�ir�cin�idual): �,r� �/I/�G� i•
Address: tb17\City/State/Zip: )_U .0 0 Q ' r #: 19l 3 3 / F6 ibZ
Are yea as ttttolryer?(leek the appnaprtate but: Type at PMita(required):
laII e am a nipkryar with a,ripluyre part-time)."
.(full and or part- me)! 7. l w construction
ter a ni n a sok pprintotar partnership and have nu employees working for me ang. Remodeling
x—+any capacity.INowrmlttre comp.insurance required"
^ 9. ❑Demolition
3E31 am a laonu,Ow net&liraall wort.myself INo sou ins'comp.insurance n:quinsfl`
4.0 1 am a humcuwnc,and will be hiring contractors to conduct all work on my property. I will Ill Building addition
cn+un:that all contractors either have wsrken'coupenSatnrd insurance or are sole 11 i__J Electrical repairs or additions
praprdeton with no employees. 12.0 Plumbing repairs or additions
t I ant a general contractor and I have hired the soh<untrxlurs listed om the attached shed.
These sub-contractors have employees and have worker.:corn}..rewaadxe 13 Roof repairs
6.0 we ate a corporation and its utficers have exercised their night of exemption per!N(.1.c.
14.0 Other
151$1(4)and we have no employees.INu*cakes'comp.insurance required-I
*Any applicant that dirks but tot must also fill out the section below showing then workers'compensation policy iofanratiun.
f thinioownen who submit this affidavit indicating they are doing all work and rhea hire outside contactors mutt submit a new affidavit indicating such..
:Contractors that check this but mint attached an additional sheet show tug the name sot the sub-wined}rs and stale whether or not those imbues hate
employees If the sub-corttractors have employees.they mosd provide then workers'sup.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: ----_- -_
Policy#or Self=-ins.Llc. g: Expiration Date:
Job Site Address: CityiStatefZip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a tine up to$I.500.00
and/or one-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up to$250.00 a
day against the violator_A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby c y er t Los and perjury that the information provid�l obove is true and correct
Signature: 9-,_. �' Dale: S
Phone#:
Official use only. Do not write in this area.to be completed by city or town official
City or Town: Permil/License#
•
Issuing:authority (circle one):
1.Board of Health 2.Building Department 3.('i$%Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
�t NA AF•1
7?`�; ,�1= S�
MassachusettILA
<
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' `' y 7S'tt k DEPARTMENT OF BUILDING INSPECTIONS i�°
v -'! 212 Main Street • Municipal Building C��
a^� Northampton, MA 01060 •• -"�10
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:
The debris will be transported by:
Name of Hauler:
Signature of Applicant: Date:
City of Northampton
Massachusetts r
w
A
DEPARTMENT OF BUILDING INSPECTIONS ;;
a 212 Main Street • Municipal Building
-Wj Northampton, MA 01060
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:
4.
Location of Facility: U 1Mity rCi k.).5 ���I v A o,v P AttA-
The debris will be transported by:
Name of Hauler: / A N 'SQ
(E)
-:;-
Signature of Applicant: Date: 9o&-7i _j
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,211A 02114-2017
• -,•
www.mass.govittlia
°Akers'Compensation Insurance Affidavit:Builders/ContractorstElectricians/Plumbers.
TO BE FILED wall THE PERMITTING AUTHORITY.
.1nolierint information Please Print Legibly
Name flusimessA)ranni2tItionandividuall):-.
Address:
City/State/Zip: Phone #:
Are you an entpktyer?Chick i appropriate hot: Type or project(required):
1.0 I dril:1 tlItrk ,,LUI ,rtripl+)}ves(lig!anstor part-tinnel.• 7. New construction
21:3 lam a sole peoprietor or pftnnerlbsp and have no employee%..,,urlonN tor roe in 8. 0 Remodeling
am capacity.NO*Otters.'i:oirtm.insurance ierthired..)
9_ Demolition
Lam a ittlilICOW IICT doing all work myself[No workers cump,iititran‘ requismil
lO Building addition
AO I ant a homeowner and wit!be hiring,xnaracturi e.nodum all work an my pron. I will
ensure that all cmtractars either have.workers'cregnrensanan insarance m are sole 11E3 Electrical repairs or additions
pimprecrors with nu employees.
12. Plumbing repairs or additions
. I am a general euntraciar l 1 have hired the tub-contractors listed ari the Madly!shiqd....
13.[jRoof repairs
Ttuse 0k-cut:a:so.lki+t employers tad have*sorters'comp,insurance.;
14.00ther
6.E3 We are a corpitrahon and irs tinkers have exercised their right ir exerraphon per hiltiL c.
§1t4i.and Nve have no employees.[No uarkcsa.comp.mama:tee lemirredi
*Any apt:die-mu that checks box 41 1111A/1 360 till oar the w:cturn helkiw showing their warier,'cerii.,mation ndrtvintentlalbal
110/1100WOCIli*t.10 adroit this affidaNit Indicating diary are doing all%sok and then hare outside eiyatnetiors read Tiabitur a new attitlak ii irslisazug
Contractors that cheek tam Nis Inns'attached an silditiunal sheet showing the name t the substontractori and Awe whether or nor those entli re,has,'
employees It the sah-euntractors ha..: mi-l1.3?erc..,they must riro,.ide.their workers comp.Folic)flambe!
um an employer that is providing workers compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy 4 or Self-ins.Lie.4: Expiration Date:
Job Site Address: Citv,Sure:Zip:
Attach a copy of the workers'compensation polky declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation pimisluble by a tine up to S1.500.00
andor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and aline of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Otlice or Investigations of the DIA for insurance
coverage serification.
I do hereby certift under the pains and penalties 11, perpin that the in/or-m.11143n'WO rf deli 6,170 re iN mete and correct
Signature: I _
Phone
Official ase only. Do not write in this urea,to be Completed by city or town uffiaiaL
City or Town: Permit...License 4
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone 4:
• CONSTRUCTION CONTROL WAIVER
From:
To:
Jonathan Flagg
Budding 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 104.10.1 request that you grant
a modification to waive the requirement for construction control of the project at
15:44KVL
becausekiwtk is oe-a-minor nature,will not affect structural 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,
•
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.161k) koipskit