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31B-081 (22) 131 KING ST COMMONWEALTH OF MASSACHUSETTS BP-2021-1900 Map:Block:Lot:31B-081- 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-2021-1900 PERMISSIONIS HEREBY GRANTED TO: Project# WINDOWS Contractor: License: HILLSIDE BUILDERS & Est. Cost: 34000 REMODELERS 104390 Const.Class: Exp.Date:01/08/2022 Use Group: Owner: SERVICENET INC Lot Size (sq.ft.) Zoning: CB Applicant: HILLSIDE BUILDERS & REMODELERS Applicant Address Phone: Insurance: 12 MORGAN ST (413)854-0503 HIWC241467 GRANBY, CT 01033 ISSUED ON:09/20/2021 TO PERFORM THE FOLLOWING WORK: • NEW WINDOWS 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: ,( • 1 • yg . ''1 Fees Paid: $238.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner '7€ C�/ SFA nF 72 O The Commonwealth of Massach Office of Public Safety and Inspectio)1; °9ry� � Massachusetts State Building Code(780 CMR) M' 'rill "—' Building Permit Application for any Building other than a One-or Tw TI • ing o (This Section For Official Use Only) ,050 Building Permit Number. 4.„,i V ite Applied: Building Official: SECTION 1:LOCATION 131 King Street Northampton 01060 Servicenet No.and Street City/Town Zip Code Name of Building(if applicable) 31B-081-001 3i 13 - 0 i l 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❑ 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 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No 0 Brief Description of Proposed Work:Installation of new windows 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) 2 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 •Iii/# 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❑and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA El IB ❑ HA JIB 0 IIIA ❑ IIIB ❑ IV ❑ VA El 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 Private 0 or indentify Zone: or on site system 0 required 0 or trench or specify: permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes❑ 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 Servicenet Inc? c ss129 King St Northampton 01060 Name(Print) No.and Street City/Town Zip Property Owner Contact Information 413 _584_6855 `A ro s s)Ser✓iis-eJ.o5 Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Hillside Builders & Remodelers 169 East St Ludlow MA 01056 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 O. 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 Hillside Builders & Remodelers Company Name Michael Prignano CSL 104390 exp 1/8/22 Name of Person Responsible for Construction License No. and Type if Applicable 12 Morgan ST Granby MA 01033 Street Address City/Town State Zip 413 _308-5405 - - hbrinc2020@gmail.com 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 Cl No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor 34000.00 and Materials) Total Construction Cost(from Item 6)=$ 1.Building $34000.00Building Permit Fee=Total Col -- ;on Cost x $7 (Insert here 2.Electrical $ appropriate m i'pal facto =$238.00 . 3.Plumbing $ ' 4.Mechanical (HVAC) $ Note:Minimum fee $ 3 ontact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $34000.00 (contact municipality)and write check number here /4'3 7 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. (hkr ✓; 7.-----1� - 0 co 0/3-30- syos .0y, Please print and sign name Title Telephone No. Date A q Toni" sf &1), me #f t /aco 4k,s,i'74tott973 ,119,7te-z, Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: ql �I: "0 Name I Date The Commonwealth of Massachusetts au=°In=0 Department of Industrial A ccidents I_! 1 Con, ress Street.Suite 100 Boston,MA 02114-2017 ""8!J www.mass.gor/dia 11 urkers'( ontltensation Insurance.AiTidas it:Builders/('ontractur+'Flectricians,'Plumbers. ID Kt. 111..k1)1%1111 1111:PI.R111 I-17NG All lIlORI t 1. .'ltonlicant Information / �p /� ���_ Please Print Le-gilds Naml',klirsarts-+ylMrant:.,,tr,nInaniJtta1►: `!/s�.l�[, :✓._ax./ r-e.s . � -�'n ��/J- -...�...._.__._.__ . Address: /69t __-- City/StatefZip: !en()/ ?4_D/o. ‘ Phone#: _4�/j-3 d -- S Arc ssa tin r loyee!Check Or appropriate box: Type of project(required): 1.0 I am a employer with 6 employees(dull and or part-tun 1.• 7. Q New construction 20 I am a sok proprietor or partnership and hale no employees working for n-m $. Q Remodeling caprarei}.[No warkeri comp eresuranee marmot] 9. Demolition 30 I ant a homeowner wner dory all work miser_l\o wort.xs'conc. insurance Damned" 4.0 1 am a homeowner and wild be hump contractors to cu,idnct all work.on inn ln7 pn, t: 1 Q Q Building addition erasure that all contractor.either Fuse workers"compensation insurance or an:side I l.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 1;0 1 am a general contra:tor and I hale hired the sub-aoritra:turs listed om the attached sheet. tlese sub-contractors.hase employees anal haw workers'comp.insurance' I3.oRWf repairs 14.®Other Installation of new windows is 11c ire a corporation and its officers has c e k.xuxd then rngtet of etc-whoa'per\1(:t_c. I4_s.*II44.aml w e talc nu eriipkyres.{No workers insurance required_i *Any applicant that choxks box al musst also till out the sCctaa,ra h dow slummy then worker. compensation policy-mdrrmaiiorr. °ikrrioom,nn wh,submit do,aiiiikasit nrelrcatnar tbcy is damp all work awl ilia bue outside contractors rota submit a new atfadas rt maluallny arch (ontr mom that cheek On Nos must attached an additional shear showing the starse of ikon sits o'nuaeters anal stag wtuyb.i or not arose otLrres haw crarple°s .cs It the sub- krs.croe;olinues-ttcii,must pro%ide their workers"rump.pohcs ntaul'er. I um an employer that is providing worriers'compensation insurance for my employees_ Below is the policy and job.site in/trrnlution. Insurance Company Name: NorGuard Ins Company Policy#or Self-ins_Lic_#: HiWC241467 E xpiration Date 6/24/2022 Job Site Address: 131 King St CilyState:Ltp: Northampton,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 MCA_c. 152.§25A is a criminal violation punishable by a tine up to Si.500.00 and or one-year imprisonment.as well as cis it penalties in the corn 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 fires ardcd to the Office of investigations of the DIA for insurance coverage Seriticatiom. I do hereby certify under the pains and penalties of perjury that the information provided Iss true and correct Ili Date: 9 A/ 7-1Phone#: '7 i 3 3e f_st/ci S ` Official use only. Do not write in this area,to be completed b y.city or town offtciaL ( its or Torn: Permit/License Issuing:Suthorits (circle one): I.Board of Health 2.Building i)epartment 3.[`its,Two n Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other ("ontact Person: Phone#: ---'"m41 HILLS-2 OP ID:DA '4�Ro CERTIFICATE OF LIABILITY INSURANCE °A06/1"1/2021Y' 06111/2021 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 POUCIES 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 413-781-7000 g A=* Kevin Mayo Haberman Insurance Group PHONE 413-781.7000 I FAX 413 733.9545 95 Ashley Ave (ArC,No, West S ringfield,MA 01089 No). Kevin Mayo ; ayo@habennaninsurance.eom INSURERS)AFFORDING COVERAGE NAIC 0 INSURER A:Preferred Mutual Insurance Co 15024 am:Builders&Remodelers LLC INSURER B:Guard Insurance Group 18331 169 East Street INSURER C: Ludlow,MA 01056 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER; REVISION NUMBER; THIS IS TO CERTIFY THAT THE POUCIES 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. INS EFF POLICY EXP RR ADTYPE OF INSURANCE 3°0L Weep POLICY NUMBER POUCY JIALUDDITYYT1 us= A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X BOP0100727499 10/04/2020 10/04/2021 ppRAMEMAR;rOmaRENTED ) $ 50,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 _GEM_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY j LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER; _ $ A AUTOMOBILE LIABILITY aBINED SINGLE LIMIT ccid $ 1,000,000 ANY AUTO PCA0100300284 10/21/2020 10/21/2021 BODILY INJURY(Per person) $ _ AUTOOS ONLY X SCHEDULED BODILY INJURY(Per accidentL $ X AUTOS ONLY X AUTOS ONIY (Per PROPERTY DAMAGE $ A X _ $ UMBRELLA UAB X OCCUR EACH OCCURRENCE _$ 2,000,000 EXCESS UAB ' CLAIMS-MADE UC0100611999 10/04/2020 10/04/2021 AGGREGATE $ 2,000,000 OED X I RETENTIONS 10,000 $ B WORKERS COMPENSATION X PER OTH- ANo EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNERIDfECUT1VE H1WC241467 06124/2021 06/24/2022 500,000 FFlCER/MF�MBER EXCLUDE°? Y N!A EL EACH ACCIDENT $ (OMandatoryInNH) EL DISEASE-EA EMPLOYEE $ 500,000 IT yyees,describe under EL DISEASE-POLICY LIMIT $ DESCRIPTION under OPERATIONS below 500,000 1 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) North Brookfield Housing Authority is listed as additional insured with respects to general liability when required by written contract.Partners Michael Prignano&Michael Vumbaco are excluded from workers compensation coverage. CERTIFICATE HOLDER CANCELLATION NORTH2B SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Kevin Mayo At ©1988-2015 ACORD CORPORATION. All rights reserved. r„e-kee1.,,...tame and logo are registered marks of ACORD • i. ic•k ,:(4.244,•.« •Ve riosa$:"._ •s• s .•., ' •rk.'"' ; - . — • , • • . I", s, • '.)'.k.;1, ;,. i . • •• • , " • , e;h • , • 7•: .'"'." r.• • • ; • „. • • . • • :' ;* • . . •"" ,,„ , ..;; ' ; • • -fr i• •: • • i'• 't- • ! !"••''''''•;' '•'•• •= ; .•... • ,4 , • • ' . " . — • . . . • ; • • _ _ L. :• t.. h- ," • .", 4/ 11,' • • •••••••• . •.• .•••• }....••••• •••••-, • • NY •• •••••.•••••••MArd.RA •••", •• • • •••••• • . .to —ci •••.• ) y,'?:1: r : • t40 4„ 1.1 ,..+/Wg1"; Cqj • ,4. ',..-.OW-.41,7•44 VP.") x7,i•-• "kr ' City of Northampton 1��y�:rr w� •• Sj Massachusetts �4 '<<J p w: v.)! ,`a *� (: DEPARTMENT OF BUILDING INSPECTIONS\ . y, - 212 Main Street • Municipal Building 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: sfrf tift-“-& Location of Facility: al490S/€4/ er7/ 5//C- — / ZD o% &i Xli The debris will be transported by: Name of Hauler: /9.559-C-M I e 624../7 e`.1-s Signature of Applicant: Date: ?MA/ Licensee Details Demographic Information Full Name: MICHAEL J PRIGNANO Owner Name: License Address Information City: SPRINGFIELD State: MA Zipcode: 01118 Country: United States License Information License No: CS-104390 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 1/7/2020 Issue Date: 7/15/2010 Expiration Date: 1/8/2022 License Status: Active Today's Date: 6/16/2021 Secondary License Type: Doing Business As: Status Change Reason: License Renewal Prerequisite Information No Prerequisite Information No Available Documents Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: 174941 HILLSIDE BUILDERS AND REMODELERS fNG a �� � Expiration: 04/01/2023 169 EAST STD LUDLOW,MA 01056 `- Update Address and Return Card. SCA 1 0 20M-05/17 __