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38A-107
BP-2022-0233 1 1 VILLAGE HILL RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38A-107-001 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-2022-0233 PERMISSION IS HEREBY GRANTED TO: Project# RENOVATION Contractor: License: Est. Cost: 184820 MICHAEL PRIGNANO 104390 Const.Class: Exp.Date:01/08/2024 Use Group: Owner: INC PATH LIGHT, Lot Size(sq.ft.) Zoning: PV Applicant: HILLSIDE BUILDERS &REMODELERS Applicant Address Phone: Insurance: 12 MORGAN ST (413)854-0503 HIWC241467 GRANBY, CT 01033 ISSUED ON:03/23/2022 TO PERFORM THE FOLLOWING WORK: INTERIOR RENOVATION OF PARTITION WALLS 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 7-1 Fees Paid: $1,295.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner Rd iuA 5 3n. riahs t�f7 ! L The Commonwealth of Massachusetts 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 p_ (This Section For Official Use Only) Building Permit Number: p?.Z ' .25.31 Date Applied: Building Official: SECTION 1:LOCATION No.and Street City/Town Zip Code Name of Building(if applicable) 11 Village Hill Rd Northampton 01060 324- /07 Fgzzi Building 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 ® 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 Cif No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No Q9 Brief Description of Proposed Work: Remove about 100' of interior partitions, add 150 feet of partition walls,. Add new doors. Move l changes or work on any exterior walls. 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): B (304) Proposed Use Group(s): B (304) 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 X 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 0 I-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 KI IB IIA ® IIB 0 IIIA 0 IIIB 0 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 Check if outside Flood Zone NI Indicate municipal EN A trench will not be Licensed Disposal Site 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 g Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No 6Z Yes 0 No 0 SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: 9 Use Group(s): B Type of Construction: 2A Does the building contain an Sprinkler System?:Yes Special Stipulations: Design Occupant Load per Floor and Assembly space: 47 first 142 second I ln! SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner (� �TyG/6b`r, /tic ,o I,- ,e4 /. .1�. `'�iY.►,7ce/! /I jr o/tof • Name(Print) No.and Street City/Town Zip • Property Owner Contact Information: a N t✓i a AI. Gq 1 eel AtlAGA ) icy; CFO //"-77/ yr7( WI_ur- 0'17• p4741/fifi r.v,9. •�f Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: /N;c'tote-1 Pr;cyt"tn.o !1- Acir tint 54— L-r-In by /tc� oN a? 3 Name Stree(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 controj 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 141(S;o'C Ov, lecs -'- R t rode/r4 Zxc Company �iCha errr , CJ l 0 1 3 q0 C$L V Name of Person Responsible for Construction License No. and Type if Applicable ? (1- 1 UfesFS�tk 54- 6—Rnby - & c/o 1 Street Address City/Town State Zip L iI -Z lid 51(11 40_ 1VV_ 5)-`t7 Pcf3n cut c @ c Aq;/- cones► Telephone No.(business) Telephone No. (cell) e-mail adtrress SECTION 11:WORKERS COMPENSATION INSURANCE AFFIDAVII (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 fft' No 0 SECTION 1Z:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs:(Labor Item and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ II{ el 7 7 0 Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ 161 100 appropriate municipal factor)=$ . 3.Plumbing $ 1„750 4.Mechanical (HVAC) $ '1 vt'� Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ I yl 8(10 Enclose check payable to 6.Total Cost $ i, - CFO (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 and penalties of perjury that all of the information contained in this application is true and accurate best of y knowledge and understanding. CI f [(Pcf llrnd4 CCA4r�cit7f yt?.. "201 5v-/7 ?/ �- Please print and signna a Title Telephone No. Date/ ty� I�/tr k4� GrNk6 �t O/o?? }_ . esl ;i-�' Street Address City/To n State Zip 4 mail Address Municipal Inspector to fill out this section upon application approval: I: ' 9! ' l i�' /(42.' 1 Name l Date The('amnion weahh of Massachusetts n =`21:9111.Woi; Deportment of Industrial Accidents 1; 1 Congress Street,Suite 100 Boston,MA 02114-2017 atn. w.wwmass.gos/dia 11 pikers'Compensation Insurance Affidavit:Builders1('ontracltirV Electricians,Plumbers. fp BE FILED WITH THE PEIRM17TING Al I DORI 11. Applicant Information m h /'J Please Print l.ciib Nae I iusiness:Organmitton lndn idual): 1 /kid(r 1 o It✓Pis Address: l(4 T72tC ) C'ity''State/Zip:_ �vcJ/cx.v//O'1 0(6C6- phone - (3 Y' k -/ 7 son•stay,as employer'd heck the appruprVAC hn : Type ofproject(required): 1.1217.11111 a employ or with 6 empluyet:s thud and ar part-turn t.' 7. D New construction 20 I am a.ak prupreair or Funnel-ship and lose ma employees Module list MC it 8. ®Remodeling any capacity.]'_No war►en'comp.ansuranse required I 301 am a taaita.t,wnes doing:all nor\myself. work T.'comp.insurance roomed"' 9. Demolition 10 a Building addition 4.a I am a humans and will he hiring maw hours to c.aoduet all wurl on my property. I will ciuurc that all emir k,r.catl.t ii.c Minim-c.map.nsalwn insurance or are sole I l.a Llei.tncal repairs or additions proprietors N ath no employee, 12.0 Plumbing repairs or additions am a general contractor and 1 Icyse hired the sub-camtractors listed i.n the attached sleet. 13.1:Root repairs these sub-contractor,lose employees and base workers'camp.insurance.; b.O N c ale sample-awn and its officer,has,.tact- of theirnght at exemption per M(iL e. 1 4.1]Othet 1�_`.;144).and we hasc no employee..(`.t%taker.'cmnp.msaaancc required.] 'Any applicant that checks box alq�nom also fill out the suction plow showing their wur►crsi compensation pulley infurrnatrw.. t MCP *w he submit tars affidavit aauhcattnr the",an.Joule all Mark and then hire outside contractors must submit a yew adfulan it uadicating such. Contractors that check this hos rant alttaclw-J an additional.Inset shwa mg the name of die sul..a,rttt a.t.'t and state whether or not those onuses hase employees. It the sub-weir ctois hasc curioyoes.dies must prn.ade their worker.-.swap.p..ii..numhei 1 am an employer that is providing worAers'compensation insurance for my employees. Below is the policy and job dee information. Insurance Company Name:J c'lQV 6 vot..rd # s. #: Z�G 1 / I=. irate Date: � Policy or Self-ins.Ln. �+� /G p 6/),4/).4 lob Site Address: 1, I Vi 114'y &T%t1 K v City State Zip: (aft - /t/ -T Attach a cop)of the*sinters'compensation policy declaration page(showing the policy, number and expi lion date). Failure to secure coverage as required under MGL c. 152,*25A is a criminal violation punishable by, a line up to S1.500.00 and or one-year imprisonment,as well as civil penahies in the firm of a STOP WORK ORDLR and a line of up to 5250.00 a day against the 1iolator-A copy of this statement may be tors aided to the Office of Investigations of the DNA for insurance cos erage yerilication. 1 do hereby c •under the pains and penalties of perjury that the information provided above is true and correct Signature: � Phone�: e f(3 2[ v c )'Gi `' Official use only. Do not write in this area.to be completed by city or town official ('its or Town: Permit/License Al Issuing Authority,(circle one): I.Board of(health 2.Building Department 3.('ity,.dTown Clerk 4.Electrical Inspector 5.Plumbing inspector 6.Other Contact Person: Phone#: City of Northampton ?oaHAM >0- 5 �' Massachusetts A,�` ---5 .. r�C'c P DEPARTMENT OF BUILDING INSPECTIONS 1. n ♦4'r 212 Main Street • Municipal Building `.. P te Northampton, MA 01060 rsY; 1 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 /lc � -(- e ,ci S t- R ec aik, -l3 1)tear A-ce Veil )ri mid- A 7 The debris will be transported by: Name of Hauler: 45-506--;(4IeU (�/ )/4- I TPC �rs y Ai N (- S Pc-'it-5 re'elc) Signature of Applicant: Date: V L1 �.•, HILLBUI-01 DALDRICH AFRO CERTIFICATE OF LIABILITY INSURANCE DATE 0/1/2D'2YYY) 10N/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 suc��hppeeNndorsement(s). PRODUCER NAMEAXT Haberman Insurance PHONE (A/C,No,E,t):(413)781 7000 I FAX,No):(413)733.9545 _ 95 Ashley Ave Inf habermanlnsuranC9.COm West Springfield,MA 01089 Rohs; INSURERS)AFFORDING COVERAGE NAIC#___ INSURER A:Preferred Mutual Ins.Co. 15024 ____ INSURED INSURER B:NorGuard Ins Co 31470 Hillside Builders&Remodelers LLC INSURER C: 169 East Street _INSURER D: — Ludlow,MA 01056 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. INSRR TYPE OF INSURANCE ILL POLICY NUMBER (MMM/DIN SUBR POLICYYTYY) (I MIDD/YYYPYI LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR BOP0100727499 10/4/2021 10/4/2022 PREMISES(Es EN T ED ce1 $ 50,000 MED EXP(Any one Person) _$ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGAT UMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 1rzei 11 LOC PRODUCTS COMP/OP AGG $ 2,000,000 OTHER: $ CO A AUTOMOBILE LIABILITY (EEaMBINaccideenntSINGLE LIMIT $ ANY YNAAUTO PCA0100300284 10/21/2021 10/21/2022 BODILY INJURY(Per person) $ 1,000,000 AUTOS ONLY X SCHEDULED BODILY INJURY(Per acddent) $ X AUTOS ONLY X AUOTNOS ONEY (Per! t) GE $ S . A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE _$ 2,000,000 EXCESS LIAB CLAIMS-MADE UC0100611999 10/4/2021 10/4/2022 AGGREGATE A__ 2,000,000 DED X RETENTIONS 10,000 $ B WORKERS I3LR X STATUTE Rµ E IPOYFA LIABILITY f N H1WC241467 6/24/2021 6/24/2022 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE j N/A EL EACH ACCIDENT $ CWFICER/MEMBER EXCLUDED? I I 500,000 (Mandatory In NH) E.L DISEASE-EA EMPLOYEE S _ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached N more space Is required) Partners Michael Prignano&Michael Vumbaco are excluded from workers compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Proof of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 2-Atr i ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD „7/4 Woenserbo,u~ef,f6)41eCzie,44tzelete5ei4, Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home improvement .Contractor Registration K r Type: Corporation • f s • K; M `11 Registration: 174941 HILLSIDE BUILDERS AND REMODEL S==tr - - _ = .�i Expiration: 04/01/2023 188 EAST ST 1,;_ •_.ate=r`__ '� <.__ • LUDLOW,MA 01056 '-” '' `�"::::. ' *.J Update Address and Return Card. iCA t 0 20M-03/t7 • • • • Commonwealth of Massachusetts Division of Occupational Licensure Board of Building R ulations and Standards Const�onf$ rvisor CS-104390 tpires:01/08/2024 MICHAEL J I2IGNANO 12 MORGAN.fT GRANBY MAy1033 ,t• • Y��LI,Vda Commissioner diaga K.