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32C-020 (13) BP-2022-0258 17 PLEASANT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32C-020-001 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-2022-0258 PERMISSIONIS HEREBY GRANTED TO: Project# 2022 DEMO WALLS Contractor: License: Est. Cost: 40000 KEVIN R SCHNELL CS-109600 Const.Class: Exp. Date: 10/19/2023 Use Group: Owner: J BARC INC Lot Size (sq.ft.) Zoning: CB Applicant: LIVEWELL HOME IMPROVEMENT LLC Applicant Address Phone: Insurance: 33 LAUREL MOUNTAIN RD (413)409-2929 WCC-500-5024695-2021 WEST WHATELY, MA 01039-9604 ISSUED ON:03/22/2022 TO PERFORM THE FOLLOWING WORK: INTERIOR RENOVATION 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. Signature: I 1 .).2 . 1 • Fees Paid: $280.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner The Commonwealth of MassachusettildAR 1 7 2022 I r Office of Public Safety and Inspections 3` Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-11a10 Dwelling" (This Section For Official Use Only) Building Permit Number: 2"1* b 4Date Applied: Building Official: SECTION 1:LOCATION �.[ p(eel 54'1-sC" Nor ptoh(M't OW CO 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 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 0 Is an Independent Structural Engineering Peer R view required? r s , Yes No 0 Brief Description of Proposed Work: C P�'Gv1 i v1 G, Q f i-I C `j f a cjo al- T P( oN 0%d o tf - wati( 5 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 ❑ E: Educational 0 F: Factory F-1 0 F2❑ 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-1❑ 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 0 IB ❑ IIA 0 IIB 0 IIIA ❑ IIIB ❑ IV 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 Check if outside Flood Zone Indicate municipal A trench will not be Licensed Disposal Site Private 0 or indentify Zone: or on site system❑ required or trench or specify: permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicableoe Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or Nolft 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 ToSrph T31vwe41 h%1 31 Chipe( St /Vo•r fh an►pieh/M/f aa/060 Name(I'rint) No.and Street City/Town Zip Property Owner Contact Information: h Lie 1,6__OW__ 41.r o_- (c 5-y doo,'fown Joe bkmili&WW1 e, Title Telephone No.(business) Telephone No. (cell) e-mail address 0h)41teol') If applicable,the property owner hereby authorizes: 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 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) _ Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor L ivy lnl,e Cl 61 orvt e m pro tie VA Yi1 l Company Name k,evin Schnet( C S -ID g600 Name of Person Responsible for Construe 'on License No. and Type if Applicable 33 Laver( MovwtWih Ree Whai-el N(A 0[0g3 Street Address Cify f Town State Zip 1413-5o -1.4 1 't r3 -Y67- NO, DFr►Ge�iAit it[ihow)e tripro✓evApi _tom 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)=$ Q 0Q 1.Building $ L-W t/ Building Permit Fee=Total Construction C.: I •rt here 2.Electrical $ appropriate municipal factor) $ . 3.Plumbing $ p 4.Mechanical (HVAC) $ Note:Minimum fee=$ a�0 (contact municipality) 5.Mechanical (Other) $ 6.Total Cost $ .1J 0,� Enclose check payable to (contact municipality)and write check number here 16/ 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 rstanding. NafM•[n ro5tik Project/von/5 t9(€1() -)37-5-11')76 402-- P ease rint si me Titl elephone No. te em 8af writ[ yf' S- �atel 444- D[o1 � ha'jv to Q t;veweff M oWe efi4�.� Cowl Street Address City/TolGn State Zip Email Address impOve,-- fr / unicipal Inspector to fill out this section upon application approval: w I i -4 1 ' 4 1 LLA.M . 3 �02 as I Name Da City of Northampton op.SNAMP)0� S .x. s, ` Massachusetts °e DEPARTMENT OF BUILDING INSPECTIONS 7" r "W 212 Main Street • Municipal Building N• `J4 Northampton, MA 01060 jh �10C 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: V c1 ([.ey Rec y (ui The debris will be transported by: Name of Hauler: LIW ,el I WQ M C� WI P((oVC WLl ii Signature of Applicant: Date: The Commonwealth of Massachusetts I.=—'` = Department of Industrial Accidents _IiiM 1:�'-=- i Congress Street,Suite 100 ---"` fi Boston.MA 02114-201 t';,. :,, www mass.gow'dia SS orkers'('ompensation Insurance Allidtts it: Builders/ContractorsfEkctricians/Plumbers. 10/BI FILED WITH THE PERMITTING Al`"THORI to. Applicant information �" Please Print L.eeibls Name IBusiness-OrgaritzaLAY"( Co.Individual l: Liv Lill 110 pi e i rnpfo Ye V1111 Address: n't 3 G aU ife l iiigairfq,91 k;t C'ity/State Zip:(Ajht q,-•.e f A44 0 tog') Phone;4_ q r3 - LID q- _ 0. y Are you an resployer?(heck the appry inter hot: Type of project(required): i. 1 am a employer Iv & employees(full arid or part-time t.•• �- 0 New construction rn 2 1 am a aok proprietor or partnership and have no employees working for me in B. Remodeling any capacity.[No%urgers'c:uanp.tmurance required.) 301 am if humw ski ing ing all work myself.[No workers'cutup_nrsurarsce morn:d_J' 9. Demolition 10 0 Building addition 4.C3 I am a homeowner and till be luring cxmtnatarsto conduct all work urn my property I wall ensure that all contractors either have workers'compensation insomnia:or an:sole 110 Electrical repairs or additions proprietors w uth is,employees, 12.0 Plumbing repairs or additions I am a general cuntractin and I hair hired the sub-contractors hated on the attache!sheet. These employee,Muse employe ,and have wurkcm'comp.insurance. 13.QRr►of repairs 6.0 1.a are a corporation and tier officershave exercised their right of exemption per kit&c. 14. Others 152.'iI4I.and we have no employees.'So%tickers'comp.insurance requtred.I •Any applicant that checks boa el must also till out the section Below slaloms their worker,'compensation policy information 'Homeowners who submit that affidavit indicating they are doing all work and then hue outside contractors must submit a ne%afftdasit rrxlicahrig suck 'Cuntraetucs that check this box must attached an additional sheet showing the name of the soh-contractors and state N!tether or not those entities have employees. If the sub-curatractcrs base eartployees.they must pros isle their workers'comp policy nurmbet l am an employer that Is providing tworArrs'compensation insurance for my employee+. Below is the policy and job site information. Insurance Conipan� Name / 1 4 t. n 5/re el-�:4 m i°r j Col. Policy#or Self ins.Lic. »: __ A4 P g (U. �if Expiration Date: 572,fig:2%... Job Site Address:'2%.f Piet 544/ 69/- __City State.lip: _/VQringm 1prl//lvlif 0(0 6Q Attach a copy of the workers compensation policy declaration page(showing the policy number and ezliratl(in date). Failure to secure coverage as required under MGL c. 152. 525A is a criminal violation punishable by a tine 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 tine of up to S250.00 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. !do hereby certify under the pains and penalties of perjury that the informa 'on provided above is true and correct. Si'nature /�yy Date o - Phone:„. q(3 Iv7- ?! ? OJjcial use only. Do not write in this area.to be completed by city or town official ' City or Town: Permit/License k Issuing Authority (circle one): a I. Board of Health 2. Building Department 3.CIty/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other ('ontact Person: Phone#: CONSTRUCTION CONTROL WAIVER From: / i k/6) V" �1 �) e 1/� Vl�r' ill�✓1 P 1 3 to() ire / 44(2< /1101 ;6 QcP (iv h 0444 0 ( q 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 P ( 5c1 ' Dco vcA because the work is of 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, r-IDV ('11 cchne(( KEVISCH-01 LZAPKA ACc Ro CERTIFICATE OF LIABILITY INSURANCE DATE A E(MW 022 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 NAME: Whalen Insurance Agency HONri,Ext (413)586-1000 Fax 71 King Street ( ) wc,No):(413)585-0401 Northampton,MA 01060 alt'fiss:info@Whalenlnsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Main Street America Assurance 29939 INSURED INSURERB:A.I.M.Mutual Insurance Co. LiveWell Home Improvement,LLC INSURER C: 33 Laurel Mountain Road INSURER D: West Whately,MA 01039 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 POUCY EXP LTR TYPE OF INSURANCE IN D POLICY NUMBER (MMM/LDD/YYYY) (MM/DD/YYYY) LIMBS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR MPJ8858A 3/28/2021 3/28/2022 DAMMISAGEES(E TO Ra occurrence) $ENTED 500,000 PRE MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY jEIf LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY (Ea SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ AUTOS ONLY AUTO ONELY (Perr acEclde^t)AMAGE $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION STATUTEPER OT H- LIABILITYANO EMPLOYERSLIABILITY -- ER - WCC50050246952021 4/5/2021 4/5/2022 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate issued as evidence of coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P ACCORDANCE WITH THE POLICY PROVISIONS. Main Street 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 • Commonwealth of Massachusetts Division of Professional Licensure t + ()El 130-10 -35 Board of Building Regulationst and Standards ,� CCnstre tthP )pervisor OSHAE EN TER �' 1 ^ CS-109600 Expires:detf972t 21 This card cerlrf;es KEVIN SCHNELL KEVIN SCHNELL 33 LAUREL MOUNTAIN ROAD .. WEST WHATELY MA 01039 -- has completed a 30-Hour OSHA Hazard Recognition Training for the Construction Industry. { 02/23/2016 Commissioner lam`^ "7'� Cirr.•. . :Jeffrey Pairan Trainer.Tailor Sikes brad unit Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement.Contractor Registration • Type: LLC Registration: 181146 LIVEWELL HOME IMPROVEMENT LLC. tr �`""` ;•3t x' Expiration: 04/11/2021 33 LAUREL MOUNTAIN ROAD WHATELY,MA 01039 -- x wvr�w � f•q Update Address and Return Card. ;CA 1 0 20M--05/7�117 / Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid f ndividual use only TYPE:LLC before the explrat date. If found return to: Realstration Expiration Office of Consu r A irs and Busin ss Regulation 1 !4$ 04/11/2021 One Ashburt lace Suit 1301 LIVEW ELL HOROY'fNT LLC. 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