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23B-011 (10) BP-2022-0360 193 LOCUST ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23B-011-001 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-2022-0360 PERMISSION IS HEREBY GRANTED TO: Project# 2022 RENOVATION Contractor: License: Est. Cost: 15100 WALTER MAREK III 055201 Const.Class: Exp.Date:06/23/2022 Use Group: Owner: 193 LOCUST ST ASSOCIATES LLP Lot Size (sq.ft.) Zoning: 01 Applicant: W MAREK INC Applicant Address Phone: Insurance: 73 SOUTHAMPTON RD (413)977-9539 WCC-500-5014290 WESTHAMPTON, MA 01027 ISSUED ON:04/11/2022 TO PERFORM THE FOLLO WING WORK: RENO WAITING ROOM & BATHROOM INTO EXAM ROOM AND ACCESSIBLE BATHROOM 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: ' Q Fees Paid: $212.00 2I2 Main Street, Phone(4l3)587-1240,Fax:(413)587-1272 Office of the Building Commissioner APR - 8 2022 The C mnionwealth of Massachusetts DEPT.OF BUILDING Ih15PFCT01Ce o Public Safety and Inspections NORTHAMPTON.MA010 tAetts State Building Code(780 CMR) `Bufidiiig irerrru t application for any Building other than a One-or Two-Family Dwelling Q,i9 (This Section For Official Use Only) Building Permit Number: n 3 '3Oate Applied: Building Official: SECTION 1:LOCATION 143 L i c r" ¶ rtitetLopris, ,11)?" ))o4. vet-rv.. PtPiaktlr5 No.and Street City/Town Zip Code Name of Building(if applicable) -23 ere)/ 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 Lit Addition 0 Demolition 0 (Please fill out and subniit 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 fet Is an Independent Structural Engineering Peer Review re uired?. • �_ 1 Yes 0 No el Brief Description of Proposed Work: P I 5 roor-N 7 t'4°Tk(00 r b I rift, 61" ram -- ctMS-6 bG w� 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) O 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❑ A-5 0 B: Business ❑ 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 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 IBO IIAC IIB 0 IIIA ❑ IIIB El IV El VA VB 0 SECTION 7:SITE INFORMATION(refer to 780 C1141(105.3 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit Debris Removal: A trench will not be Licensed Disposal Site 0 Public❑ Check if outside Flood Zone 0 Indicate municipal 0 required 0 or trench or specify: Private 0 or indentify Zone: or on site system❑ 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 0 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 193 Locust Street Associates 193 Locust St. Northampton,MA 01060 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Andrea Lok 413-517-2226 413-325-6106 alok@napeds.com Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Wally Marek/W.Marek Construction 73 Southampton Rd. Westhampton MA 01027 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 11k 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 U, filarf2A 1.rc.. Cornpav Name (A i kv Mv - C5- Os 5 \ Name of Person Responsible for Constru on License No. and Type if A. licable -3 3 S,;)C -v-rr,U R (fie \ny ►\ a,,: vim\ Street Address City/Toe/ State Zip ill r cfl) 953 c1 t, tG,fzA(3?Carlc4:3--rj Ne,v Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11: OR El.' OMPENSA ' N, it• c' ,FRI)- l't(M.G.L.c.152..5 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 1Z:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ 6ISC5 Building Permit Fee=Total .. e • . ost x (Insert here 2.Electrical $d- 10CD appropriate .-6 . or)=S . 3.Plumbing $ 5 l)CEO I I 'a 4.Mechanical (HVAC) $ 50 Note:Minimum f e' co. . t municipali ) 5.Mechanical (Other) $ Enclose check payable $3 i)3 6.Total Cost S lc )(�3 (contact munici ali )and write check number here SECT! 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 ttr?s and accurate to the best m , edge and undersr di g. 6 , -y 04'ei4 P/c,1 et `'J3 c1) 53.1 L 4,2 Please print a sign name el 09 fylçe 041 Teleph e o. Da�t�ee",,v Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: 1' "— Ll" '/'ZbZ Name Date CONSTRUCTION CONTROL WAIVER From: w' rbtarcp4,—VI Lc ; Jb o-,, re, 01-4 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 mo ification to waive the requirement for construction control of the project at c <Y\, 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, t.umnit IIwediul uw WJdSSdt:UUStlttb Commonwealth of Massachusetts 9. Division of Professional Licensure Fic6Yt� Yt; ?er HE-156708 OXpires:06/23/2023 WALTER L MPTON Ri 73 SOLirHA D WESTHAMP1t. . ON Ft N MA 0t027 - {�V'E')i`SN"`i;O Commissioner dtb A, 81 k11! Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constr4Jc•Ari rvisor ,,r CS-055201 � • Fayires:06/23/2022 WASTER L MilPEK.W ` 7�soUTHAMProN ROAD WESTHAMPTWOfII MA 01027 ..� t )/W1:10''�� Commissioner ( "),2,d(21 . .7lrn m?, --, w M'�r� / re/7- Office of Consumer artsineg Regulation HOME 1FaPROVEMEt4T CONTRACTOR TYPE:Commotion Rectiatratign Exn[ration 158488 -.- 04/29/2022 W.MAREK INC WALTER MAREK I11_ '2 73 SOUTHAMPTON RO f�.f/.zGri✓" WESTHAMPTON,MA 01027 Undersecretary ,-tco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/OD YYYY) ,---- 03/29/2022 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 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: K.S.K.INSURANCE AGENCY, INC. PHONE n F„f).(413)527-7859 C.No);(413)527-8314 203 Northampton St. ADDRESS: FAX EMAIL travissias@ksk-insurance.com P.O.Box 597 INSURER(S)AFFORDING COVERAGE NAIC# Easthampton MA 01027 INSURER A: REPUBLIC FRANKLIN INSURANCE CO INSURED INSURER B: ASSOCIATED EMPLOYERS INSURANCE CO W.Marek Incorporated INSURER C: 73 Southampton Rd INSURER D: Westhampton MA 01027 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INCn WVn POLICY NUMBER (MM/DD/YYYY) IM D/M/DYYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A CLAIMS MADE X OCCUR NTED PREMISESPA EaGE TO Eoccurrence) $50,000 5406031 11/01/2021 11/01/2022 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 _ X POLICY PET LOC PRODUCTS-COMP/OP AGG $1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea arnident) _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS — AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ — AUTOS (Per accident) UMBRELLA LIAB ^ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE FR ANY PROPRIETOR/PARTNER/EXECUTIVE�Y/N E.L.EACH ACCIDENT $100,000 B OFFICER/MEMBEREXCLUDED? I y I N/A WCC-500-5014290-2022A 02/10/2022 02/10/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) GENERAL CONTRACTOR 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 A <DA> Ida ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: 63 LxAkc\-- ( J 1 The debris will be transported by: W' Y16rd� -- c (hill/The debris will be received by: lGIfI 11ZicI Building permit number: k< r Name of Permit Applicant �)cam.\ �C/ ���-- �W - Av'crri("c".' (V.Vdd . Date Signature of Permit Applicant ..,..:,:.:-.a:,un,....„,.,«tw.v*,..,,.. .....,,M,aew,,+:.....+an,.,, vowmp., Vr T...bZ' rw ..*im r .w.s,r+z+-.aiv..,, .Iq .»w.nf..m .;F,,00.:'..k txk�+uS Wx:...,,,i...mrp ..+. 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