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31B-191 (6)
BP-2022-0317 90 KING ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31B-191-001 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-2022-0317 PERMISSIONIS HEREBY GRANTED TO: Project# 2022 REMOVE LOFT&WALLS Contractor: License: DOUGLAS B THAYER DBA DOUGLAS THAYER Est. Cost: 8000 WOODWORKING 107699 Const.Class: Exp.Date:04/07/2022 Use Group: Owner: TRUST NORMA LEE REALTY Lot Size (sq.ft.) DOUGLAS B THAYER DBA DOUGLAS THAYER Zoning: CB Applicant: WOODWORKING Applicant Address Phone: Insurance: P O BOX 60322 (413)5304785 6HUB6R15002A21 FLORENCE, MA 01062 ISSUED ON:03/30/2022 TO PERFORM THE FOLLOWING WORK: REMOVE INTERIOR PARTITION WALLS AND LOFT AT REAR OF BUILDING 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: • r � 2is Fees Paid: $100.00 212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner The Commonwealth of Massachusetts 4it 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 (This Section For Official Use Only) - BuildBuild4 Permit NI;mberl '-2Ol2- 03j7 Date Applied: Building Official: SECTION 1:LOCATION 9O (cry) S} V No.and Street? , City/Town Q I ( Zip Code Name of Building(if applicable) 7 ! —00 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 X(Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other ❑ 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: 1+ Re theca 0 t i 1tPvi.o v Pa rft 1`i d o Wn/R t1r5 q it.( Lo + ' } rPay- o� 13urla<<�h 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❑ 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 0 IB ❑ HA CI IIB 0 MA IIIB ❑ IV 0 VA 0 VB 0 SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Trench Permit: Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal: Licensed Dis sal Site 0 Public Check if outside Flood Zone 0 Indicate municipal A trench will not be Po Private 0 or indentify Zone: or on site system 0 required 0 or trench or specify: permit is enclosed 0 VA I RP tti Railroad right-of-way: Hazards to Air Navigation: MA Historic CommissioreReview Process? • Not Applicable 4, Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes 0 or No)a— Yes 0 No j' SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): /1 Type of Construction: rick Does the building contain an Sprinkler System?: 1V 0 Special Stipulations: Design Occupant Load per Floor and Assembly space: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner FL 01-Mol lee bal1-1 ilfws 4- 00oq ,, Fos Vie , �� SaK oo' Name(Print) No.and Street City/Town 7 Zip Property Owner Contact Information: 4 I T]- /z 0-79 G 9- Te Not t biz katy% - - - - Title Tel hone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: t.iz )Z 4' 1 Ma via f- s N oft 64 oic' Name Street Address City/To n 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 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 00u \a S MIT Company Name Oda laS T he( ti C S 10 767 y Name of Person sponsible for Co truction License Ito, apd Type if Applicable G / lw o )c 603,1_1 FloreKu "M1 l (7 Street Address City/Town State Zip - - kin S30 W(7 155 - 00040S*NA y e csmutzt.cor1„ Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSA l'IONINISURikNCL 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 No D SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ -0 U 0_ Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)=$ . 3.Plumbing $ I� Note:Minimum fee=$ (contact municipality) 4.Mechanical (HVAC) $ �� 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ I (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 thi application is true and accurate to the best of my knowledge and understanding. A. . Ociah)a.s 1 'Ic i yr? -51O V 7ES Please print Ynd si;)or;• ' e Title Telephone No. Date 110 Street Address City/Town State Zip Email Address __4Municipal Inspector to fill out this section upon application approval: ' 3/3 10' Name Date City of Northampton r e Massachusetts Or", : sz, DEPARTMENT OF BUILDING INSPECTIONS $ 212 Main Street • Municipal Building Q'bg 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: Location of Facility: N(',( l e j�P (�1�� o' riNocvt1\ J The debris will be transported by: Name of Hauler: /1\41 1etr5 fiacick Vl Signature of Applicant: Date: .3/d4L. The Commonwealth of Massachusetts i;XV= Department of Industrial Accidents 1 Congress Street?Suite 100 Boston, MA 02114-2017 •_ . www.mtass.govidia It-utters'Compensation Insurance Affidavit:Builders/CamtractorsiElectricians/Plumbers. TO RE FILED WITH THE PERMITTING AI1THT)RITV. Auftcant Information Please Print I ihl% , Name(HusinessiOrga mid t lo n,I nd t v ulna I l',. f r Address: '. 60 F evi ./.1 06 City.State:Zip: Phone#: Are you an employer?I irk thr appropriate Mn: , Type of project(required): Mn a employer with eitspioyeetr(full art&or part-timer' 7. 0 New construction 20 lam a sole proprietor or patineindop and have no employee*%smite% for ine in S. C3 Remodelin N g any capacity,[' o workers'comp.insurance rerquireill 9,kkDernolition Cilain a hornessatms doing all voile myself,[No workers.'comp.insurance required) i 0(J Building addition I am a homemerier and will be hots%contraciort to cendoct all work on my property,. I will ensure that all contractors either have workers°convect:swim insurance or are auk l)a Electrical repairs or additions ;worn:eon with no employees, I ID Plumbing repairs or additions I am a general contractor and I have hired the tub-contractors listed on the*Mulled sheet, Tht,,e Alb-Contractors have employees and have workers comp,insuranc I 3.0Rootrepairse.,", 14.(:::)Other ti E3 We are a a-emit:imbue and its officer*have exert:hied their nghi of exemption per MU e. 152,+1(4 and we have nu employees.[No*mien'etanp.insurance required. •Any applicant that cheeky box al mint also fill out the section below showing their workers'compensation policy information. *Homeowner%who submit this affula,,it indicating they are doing ail work and then hire oi.ittide t:ontra.,:tors must submit a new affidavit indir.ssling such, :Contractors that thca this but must attachysi an additional sheet showing the mum ol the sulYeceitractors and state whether iii not lass entities have employee's It ilk sub-coniractort have employees.they 111U,1 pi 1,i,id,'thee workers'oyinp.Fahey number I am an employer that is providing workers"compensation insurance for my eniployees. Below is the policy and Job site information. Insurance Company Name: ITOVOt 14v 5 _ Policy V or Self-ins.Lic.it: 4. 11(X1 .7F-79609 -7- Expiration Date: 6 30/D2Z Job Site Address: 1 0 1,( wks sf- CityiStateZip: NO1 A Attach a copy of the workers'compensation policy declaration page(showing the policy number and e Oration date). Failure to secure coverage as required under MGL r. 152, §25A is a criminal violation punishable by a tine up to$1,500,00 andior 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. I do hereby cer f A'under the s d penaltks ofperjury that the information provided above I true and correct. Signature: a..4 II ffr 9,..I Date. Phone v. V(3— SIC -Y7i 5 Official use only. Do not write in this area,to be completed by city or town official . . ( Its or l'own: Permit/license# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.Cky/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone i: ,.. AR o CERTIFICATE OF LIABILITY INSURANCE I uhIctmm/vu/rrTrl 03/28/2022 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 Stephanie Herring NAME: Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Ext): (A/C,No): 8 North King Street E-MAIL sherring@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC M Northampton MA 01060 INSURERA: Mesa Underwriters/BRECK INSURED INSURER B: Safety Indemnity 33618 Douglas Thayer Woodworking INSURER C: WCAR-Travelers Attn:Doug Thayer INSURER D: General Star/BRECK P.O.Box 60322 INSURER E Florence MA 01062 INSURER F: COVERAGES CERTIFICATE NUMBER: EXP 4/2022 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGREND CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A MP0018001002352 04/15/2021 04/15/2022 PERSONAL BADVINJURY $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 -1 POLICY JECT PRO LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED 5914386 08/13/2021 08/13/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS XHIRED �/ NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY AUTOS ONLY (Per accident) Uninsured motorist BI $ 250,000 UMBRELLA LIAB -- OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE .$ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN 100000 C ANY PROPRIETOR/PARTNER/EXECUTIVE Y N/A 6HUB6R15002A21 10/16/2021 10/16/2022 E.L.EACH ACCIDENT $ , OFFICER/MEMBER EXCLUDED? (Mandatory In NH) El.DISEASE-EA EMPLOYEE $ 100,000 L If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D IMA336039 04/15/2021 04/15/2022 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I ©1988-2015 ACORD CORPORATION. All rights reserved. ACf1Rfl 9f:f9MRlft41 Thn A rrIon nmmes nnrt Inn"nrn roniefnrnrl mnrke of A f`ARn