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24D-151 (2) BP-2022-0028 14 CARPENTER AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24D-151-001 CITY OF NORTHAMPTON Permit: Demo PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-0028 PERMISSIONIS HEREBY GRANTED TO: Project# renovation Contractor: License: Est. Cost: 1000 ULTIMATE ABATEMENT INC null 102916 Const.Class: Exp.Date: 11/20/2022 Use Group: Owner: 14 CARPENTER AVENUE, LLC Lot Size (sq.ft.) Zoning: URC Applicant: ULTIMATE ABATEMENT CO INC Applicant Address Phone: - \Insurance: 34 MOUNTAIN ST (413)246-0472 WC9082083 PLAINFIELD, MA 01070 ISSUED ON:01/12/2022 TO PERFORM THE FOLLOWING WORK: DEMO FRONT AND SIDE PORCH 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: Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: Smoke: Final: • THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. • F Signature: Fees Paid: $100.00 • • • • 212 Maid Street,Phone(413)587-1240,Fax:(41 3)587-1272 Office of the Building Commissioner ) The Commonwealth of Massachusetts 1nni Office of Public Safety and Inspections Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling 0 (This Section,For,Official Use Only) ' Building Pei umber Obrdzi Date Applied:y 10 i 2-02%2-- Building Official: _ ' -SECTION 1:LOCATION t , r n C.012e1 aye mAcm No.and Street City/Town Zip Code Name of Building(if applicable) 2241) IS' •0C9 I Assessors Map# Block#and/or Lot # SECTION 2 PROPOSED WORK Edition of MA State Code used If New Construction check here 0 or ch all that apply in the two rows below Existing Building 0 Repair 0 Alteration 0 Addition 0 Demolition (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)it Is an Independent Structural Engineering Peer Review required? Yes 0 No 0 Brief Description of Proposed Work ad ilea/7 10 tie?, 47-0 <gy• frOl r-cA corr),onf-) P ; c /j ,flh)6 t'ad,c-)d s, -rie cc' h ‘? K-45) / -it-/-1 e-4_, 0- , ,SECTION'3:,COMPLETE THISSECTION IFXXISTINg BUILDING UNDERGOING1RENOVATION;AlDDITION,OR , . CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) El 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 ID 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 1-2 0 1-3 0 1-4 0 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 0 HA CI IIB El MA CI MB 0 IV CI VA 0 VB SECTION 7;SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: A trench will not be Licensed Disposal Site 0 Public 0 Check if outside Flood Zone 0 Indicate municipal 0 required Olor 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 CI 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: ° SECTION9:,PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner c� ` a����i, pl4/ Q.l.� �Jl'F � �� /P1� /7T°.f_c �c ✓ 1' %I �ti c� l 1P1d/Y Name(Print) No.and Street City/Town Zip Property Owner Contact Information: a 14 - - 9LLaQ_ - 9 c) chr�oxr�GaVQ Title Telephone No. (business) T ephone No. (cell) e-mail address ,/ If applicable,the property owner hereby authorizes: �C Jey . 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) '.' , t<If a building is less than 35,000 cu ft'of enclosed space and/or not under Construction Control then check here❑ , ,.•° ° ,°Otherivise provide=construction control'forms`(see•sectiori107°in'the code),as required. 10.1•Registered:Professional Responsible for Construction Cantrol.(the professional coordinating document'submitt'als) \Nrc. Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General-Contractor ' ,( t9-I c —IA- ` 1z /a Company Name J a.... --4) c )exrd, r)2A -,JQ__Ovyl_ey-- 4 /-cloovey Name ofPerson Responsible for Construction License No. d Type if Applicable 0)-) .1n 'c ' �ot//1-6mJ, .rye0/ ,6btreet Address City/Town State Zip A'ls3 -c2J7i/n/A., 0 7a �� r) )� J& ( d'. t.6fh Telephone No.(business) Tel phone No.(cell) rw 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'1.2:CONSTRUCTION COSTS AND PERMIT FEE °° Item Estimated Costs:(Labor and Materials)? Total Construction Cost BuildingPermit Fee= from Item 6)=$ 1.Building _�d'"$ Tot "ens u 'o 4 Cost x (Insert here 2.Electrical $ `'a, appropriat: unif;pal factor)_ . . 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee= j�(co P •ct municipality) 5.Mechanical (Other) $ • i nclose check payable to 6.Total Cost ..„$. � _„,„„.q°' (contact municipality)and write check number here (9.qi, , SECTTON'f3:SIGNATURE,OF BUILDING PERMIT'APPLICANT By entering my name below,I hereby attest under the pains and ,enalties of perjury that all of the information contained in this application is true and accurate to the best of m knowl erstanding. „. ' 7-1-) C/9 1 I 11/3_c>7Y‘-01,1di* Please print nd sign name Title I Telephone/N9 Date c3h1 o v l 51 r /�, Oyu r lhQ i 01 U7s LQ >i�h Z-� ' Street Address �City/Town State Zip I Email Address Municipal Irispectorto fill out this section upon applrcatron approval 0 `� . `, !/ � . t Date ,, . r ame ofio Commonwealth of IVIlssachusetts Division of Profesm, Lic ensure . ard of Buildin gRegu�!_sak'kA+r con t a o%}pe is r CS1o98 % ~ � ' ` C AM»E1120/202 / NINA INCHAIgn � \ < --. / 34 MOUNTAIN STREET /al » PLAINFIELD b#& \ ; \ & .S 2\ \ W ! Commissioner 2 / t /6 Construction Supervisor Unrestricted -Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. 4' I i Failure to possess a current edition of the Massachusetts f State Building Code is cause'for'revocation of this license. j For information about this license Call(617)727-3200 or visit www.mass.gov/dpl III i , Mass.gov ! . IA. • t a [in ,IMP ' i (OCABR) Home Improvement Contractor Registration Lookup To search by registration number, enter the registration number in the textbox below and click the 'Search' button. Please note pressing the Enter key will clear fields. Search by Registration Number Search You must click the"Search Registrant" button to search by name or location. Please note pressing the Enter key will clear fields. Search by Registrant Company ultimate abatement co. mcG name ,Search Registrant.: Search by Registrant Last name 'WInchardi j Search by Registrant First name ;Nina City/Town PLAINFIELD MA I State MAj Zip code !won Click on the registration number to view complaint history. You can als9 view arbitration and Guaranty Fund history. The list is current as of Thursday, January 6, 2022. Search Results RegistrantN . me RESPONSIBLE REGIS`fRANAUDRESS EXPIRATIO STAT S INDIVIDUAL NUMBER I DATE ULTIMATE INCHARDI, NINA 163690 34 MOUNTAIN ST 11/30/2022 Currert ABATEMENT PLAINFIELD, MA COMPANY, INC. 01070 Site Policies Contact Us © 2018 Commonwealth of Massachusetts. Mass.Gov® is a registered service mark of the Commonwealth of Massachusetts. • The Commonwealth of Massachusetts } =;rw1= 1, Department of Industrial Accidents __11 1=. 1 Congress Street,Suite 100 =:= " Boston,MA 02114-2017 JOy www.mass.gov/dia 1.0 Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY., Applicant Information Please Print Legibly Name (Business/Organization/Individual):ULTIMATE ABATEMENT Address:34 MOUNTAIN ST City/State/Zip:PLAINFIELD MA 01070 Phone#:413-246-0472 Are yo an employer?Check the appropriate box; Type of project(required): 1. I am a employer with .5 employees(full and/or part-time).* 7. ,❑New construction 2.0I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. 11=1 Demolition 3.12 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13 i Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14:El Other 152,§1(4),and we have no employees.[No workers'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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:LIBERTY MUTUAL Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address:12-16 CARPENTER AVE City/State/Zip:NORTHAMPTON MA 01 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 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.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 ins a pen [ties of perjury that the information provided above is true and correct. Signature: � Date: 1- -7 "� Phone#: -') 3 - )4(/o - O ' D ye 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#: • f BUILDING DEPARTMENT DEMOLITION PERMIT SIGN-OFF SHEET ) - - 27__ Date: � Address: Imo C_/?/ `Building Use: a t---1 air,/ Owner: + n i�U,Z7 Phone: Owner's Address: UTILITY CUT OFF (Signature of Authorized Representative of Utility Department required) As required by the Massachusetts State Building Code (780 CMR), a permit to demolish shall not be issued until a release from the utilities is obtained, stating that their respective service connections and appurtenant equipment have been removed or sealed and plugged in a safe manner. Eversource (Gas) _ Signature Title National Grid (Electric) Signature Title DPW (Water) Signature Title DPW (Sewer) Signature Title DPW (Storm water) Signature Title DPW (Tree Warden) Signature Title DPW Director Signature Title Historic Comm. Review Signature Title ASBESTOS REMOVAL / V /A All residential, commercial and institutional buildings are subject to Massachusetts Department of Environmental Protection (MassDEP) asbestos regulations at 310 CMR 7.15. Therefore, owners and/or operators (e.g. building'owners, renovation and demolition contractors, plumbing and heating contractors, flooring contractors, etc.) need to determine al asbestos containing materials (ACMs), both friable and non-friable, that are present at the site, and whether or not those materials will be impacted by the proposed work, prior to conducting any renovation or demolition activity. Examples of commonly found AGMs include, but are not limited to, heating system insulation, floor tile and vinyl sheet flooring, mastics, wallboard, joint compound, decorative plasters, window glazing, asbestos containing siding and roofing materials and fireproofing materials. Failure to identify and remove all ACMs prior to its being impacted by renovation or demolition activities, can result in significant penalty exposure, and higher clean-up, decontamination, disposal and monitoring costs. A DOS certified asbestos consultant must be contracted to determine if asbestos is present and whether removal/repair is necessary. If the building is a state owned facility, contact DCAM and DOS. DOS provides a list of licensed asbestos abatement contractors and consultants. You may wish to inquire if a contractor has any history of violations. Only DoS licensed and DOS certified asbestos abatement contractors and consultants may be hired to pe orm asbestos related work in Massachusetts. Received by: Print Name Title Signature Date 5 City of Northampton 'a°A NAME SS S!G` . V-k4' Massachusetts ' : ."� "'1 " olr DEPARTMENT OF BUILDING INSPECTIONS p ' ��y aZ �� 212 Main Street • Municipal Building J «'b Northampton, MA 01060 'rs'�, •1,$4. 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. r' will be disposed of in: l y The debris p ® �o� C �m a/,--Le,-/) Gem Location of Facility: ! _ J j4 r4ffrQ-e�e- .ems rt 1 _ The debris will be transported by: Name of Hauler: 775 Signature of Applicant: Date: / 7 e . ( ' . ,,-----Ros 0 ACCIR EP -CERTIFICATE OF LIABILITY NSIT NCE DATE(11,110IDDANYY) iltium.,. .-'-- 1 09/09/2021 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(les)must 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 endorsemeht(s). PRODUCER . , CONTACT' ' I NAME: Beth Carballo • FINCK&PERRAS INSURANCE AGENCY INC PHN OE (q/c.No,EA: (413)527-3000 1 1 FAX , E-MAIL • ADDRESS, bcarballo©finckandperras.com • . , 6 CAMPUS LANE, . 1 Il•PSURERiSjAFFORDING COVERAGE NAIC II EASTHAMFrTON MA 01027 INSURER A; LIBERTY MUTUAL FIRE INS CO 23035 INSURED . INSURER B: - ULTIMATE ABATEMENT COMPANY INC INSURER C: INSURER D: I • 34 MOUNTAIN ST • INSURER E: , . , PLAINFIELD MA 01070 INSURER F: COVERAGES ‘, CERTIFICATE NUMBER: 693314 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 ADDLISUBRI 1 POUCY EFF 1 POLICY EXP LIR TYPE OF INSURANCE 1 1NSD I wvo POLICY NUMBER I(MMIDINYYYYI l(MIAKIDITYYr LENTS , COMMERCIAL GENERAL LIABILITY I, EACH OCCURRENCE II$ DAMAGE TO RENTED _,CLAIMS-MADE i—I OCCUR PREMISES(Eo occurrence) S MED EXP(Any one person) S N/A , PERSONAL&ADVINJURY iS , GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S PRO- L1 ' I POLICY j_ JECT i 4 L LOC PRODUCTS-COMP/OP AGG $ ' I OTHER:' ^ $ AUTOMOBILE LIABILITY ICOMBINED SINGLE LIMIT .s (Ea accident) ANY AUTO BODILY INJURY(Per person) S , I Au_OWNED . r----1 SCHEDULED N/A BODILY INJURY(Per or:I:Went) S UA TOS I I AUTOS , I 1 i NON-OWNED ' PROPERTY DAMAGE $ r.HIRED AUTOS i AUTOS . • _Ter accident) I i 1 • $ OCCUR I , , UMBRELLALIAB ,___ EACH OCCURRENCE S —1 __ EXCESS LIAB I CLAMS-MADE I_ )N/A AGGREGATE $ DED 1 RETENTIONS ' . $_____ _ j WORKERS COMPENSATION \ 1-‘,..79 PER I OTH- 1.'''..1 STATUTE I ER ,]_ I AND EMPLOYERS'LIABILITY YIN II i1 ANYPROPRIEMR,PARTNER/EXECUTIVE --, EACH ACCIDENT 1,000,000 A OFFICER/MEMBEREXCLUDED? NIA NIA I NIA WC231S317874041 06/16/2021 061/6/2022 (Mandatory in NH) I E.L.DISEASE-EA EMPLOYEE1$ 1,000,000 i If iInPTIAggPERATIONS below 1 EL DISEASE-POLICY LIMIT 1$ 1,000,000 ' I . , N/A 1 „ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES iACORD 101,Additional Remarks Schedule,may be attached if more swipe is required) Workers'Compensation benefits will be paid to Massachusetts amp/aye-es only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. , • , This certificate of insurance shows the policy id force on the date that this certificate was issued(unless the expiration date on the'above policy precedes the . issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool et www.mass.gov/Iwd/workers-comperisation/investigations/. CERTIFICATE HOLDER CANCELLATION . .SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN . ACCORDANCE WITH THE POLICY PROVISIONS. . . ' . • AUTHORIZED REPRESENTATIVE 1 . , 1 4 - . „.....}..„,.(. ,-,.... ,),,\-- - • Daniel M.Crowjey,CPCU,Vice President-Residual Market-WCRIBMA ®1988-2014 ACORD CORPORATION. All rights reserved. 1 ACORD 25(2014/01) The ACORD name and logo are registered marks of ACOFID , . , I