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31A-011 (6)
BP-2022-0520 259 ELM ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31 A-01 1-001 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-2022-0520 PERMISSION IS HEREBY GRANTED TO: Project# ROOF Contractor: License: Est. Cost: 90000 JAMES LUCEY 98839 Const.Class: Exp.Date:08/02/2023 Use Group: Owner: TRUSTEES OF SMITH COLLEGE Lot Size (sq.ft.) Zoning: URB Applicant: JAMES LUCEY Applicant Address Phone: Insurance: 38 Montgomery Road 4136953806 WC000328 HUNTINGTON, MA 01050 ISSUED ON:05/18/2022 TO PERFORM THE FOLLO WING WORK: REPLACE EXISITNG ROOF 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: 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 i • • >2 . Fees Paid: S630.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner L. The Commonwealth of Massachusetts ?022 1 t .' )¢ Office of Public Safety and Inspections _ / t , Massachusetts State Building Code(780 CMR) r:1 y Building Permit Application for any Building other than a One-or Two-Famif3', Sti+ NJng (This Section For Official Use Only) Building Permit NumberOU"5AV Date Applied: Building Official: SECTION 1:LOCATION 259 Elm Street Northampton, MA 01.060 The Ellery No.and Street City/Town Zip Code Name of Building(if applicable) L3(A--011 Assessors Map# Block#and/or Lot # SECTION 2 PROPOSED WORK Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Building 0 Repair In 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 El No ❑ Is an Independent Structural Engineering Peer Review required? Yes 0 No Brief Description of Proposed Work: Replace existing roof in-kind 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.) NA Total Area(sq.ft.)and Total Height(ft.) NA SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2❑ Nightclub 0 A-3 0 A-4❑ A-5 0 B: Business 0 E: Educational 0 F: Factory F-1 ❑ F2❑ H: High Hazard H-1❑ H-2 0 H-3 ❑ H-4 0 H-5 0 I: Institutional I-1 0 I-2❑ I-3 0 I-4❑ M: Mercantile 0 R: Residential R-I❑ R-2 0 R-3 0 R-4 0 S: Storage S-1❑ S-2 0 U: Utility 0 Special Use❑and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ ILIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) WaterDebris Removal: Supply: Flood Zone Information: Sewage Disposal: Trench Permit Public 13 Check if outside Flood Zone El Indicate municipal ISA trench will not be Licensed Disposal Site n required In or trench or specify: Private 0 or indentify Zone: or on site system 0 permit is enclosed 0 USA Waste Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable fn Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes 0 or No L1 Yes 0 No RI 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 Trustees of Smith College C/O James Lucey 126 West Street Northampton, MA 01062 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Manager of Building Trades 413:695-Z806 - jlucey@,srith.edu Title Telephone No. (business) Telephone No. (cell) e-mail address 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 jil. 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) • NA See waiver Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor James Lucey Company Name James Lucey CS-098839 Name of Person Responsible for Construction License No. and Type if Applicable 126 West Street Northampton, MA 01062 Street Address City/Town State Zip _41-3 S9 3fin6 41-3 695 3806 ilucey@smith.edu 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 xl No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 90.000 1.Building $ 90,000 Building Permit Fee=Total Construction Cost x 7 (Insert here 2.Electrical $ appropriate municipal factor)=$ 630 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (Q l'(contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ 90,000 (contact municipality)and write check number here 9 of d(17'?' 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 applicatir nie and ar-T,rate to the best of my knowledge and understanding. James Lucey James Lucey Manager of Building Trades 413-695 3806 2121122 Please putt and sign name Title Telephone No. Date 126 West Street Northampton, MA 01062 jlucey®smith.edu Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: 4 14 4._ yJ • T 4 /iCi)/a� Name Date �.0ra The City of Northampton Building Department <i„ , jh 212 Main Street O�Sfpj t" Northampton. Massachusetts 01060 Phone(413) 587-1240 Fax (413) 587-1272 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVAT ION PROJECTS) In accordance with the provisions of MGL c40, 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, s150A. The debris will be disposed of in: Valley Recycling Location of Facility Easthampton St Northampton, MA The debris will be transported by: USA Waste Name of Hauler USA Waste Signature of Applicant James Lucey Date: 5/4/22 Commissioner Flagg 05/04/2022 Subject: Request for Waiver I request that you grant a modification to waive the requirement for control construction for the Roof Replacement Project at 259 Elm St in Northampton because the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work. All work will be completed within the prescriptive requirements of 780 CMR. Thank you for your consideration. "Mass Amendments, sections 107.1 allows for an exclusion from control construction for this project" Respectfully, ir James Lucey Smith College 126 West St Northampton, MA 01062 ACn DATE(MM/DD/YYYY) �. CERTIFICATE OF LIABILITY INSURANCE 5/6/2022 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 NAME: Sue Doyle Arthur J. Gallagher Risk Management Services, Inc. PHONE 630-285-4010 FAX 2850 Golf Road (A/C,No,Eat): - J uc,Not:630-285-4062 Rolling Meadows IL 60008 ADDRESS: Sue_Doyle@ajg.com - INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: United Educators Ins,a Reciprocal Risk Retention 10020 INSURED INSURER B: Trustees of Smith College College Hall Room 4 INSURER c: - Northampton, MA 01063 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1070159195 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 I LIMITS LTR D/ INSD[WVD POLICY NUMBER ;(MM/DDIYYYY)I(MM/DYYYY) A ' X COMMERCIAL GENERAL LIABILITY 1 UO3-35P 7/1/2021 7/1/2022 EACH OCCURRENCE 1 $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) _I $1,000,000 • X _ - MED EXP(Any one person) $ - -SIR�$200.000 PERSONAL&ADV INJURY I $Included GEN II AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,200,000 i I PRO- 1 X POLICY i I JECT 1 J LOG • PRODUCTS-COMP/OP AGO $Included OTHER. $ COMBINED e I EDt SINGLE LIMIT $AUTOMOBILE LIABILITY !. • ANY AUTO BODILY INJURY(Per person) $ i OWNED SCHEDULED BODILY INJURY(Per accident) $ 1 AUTOS ONLY ' AUTOS ! ! I HIRED I 1 NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY ' AUTOS ONLY (Per accident) • I $ UMBRELLA LIAB ' I I lI I - I OCCUR EACH OCCURRENCE $ EXCESS LIAB 11 'I CLAIMS-MADE 1 I AGGREGATE $ RETENTION$ '�' $ WORKERS COMPENSATION 1 PER 1 OTH- •AND EMPLOYERS'LIABILITY Y/N I,STATUTE ; ER _I ___ ANYPROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? 'N I A - ------ --- - (Mandatory in NH) , E.L.DISEASE-EA EMPLOYEE $ If yes,describe under i IIDESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1 • I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES ACORD 101 Additional Remarks Schedule,maybe attached if more ace is required) ( P Building Permit Start Date:2022-05-07 End Date:2022-05-13 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. Silver Design Inc 473 Revere Beach Pkwy AUTHORIZED REPRESENTATI E Revere, MA 02151 tr 7/ea.a..._ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD _� The Commonwealth of Massachusetts /, Department of Industrial Accidents ► =�* .'�' ?„e= 1 Congress Street, Suite 100 4__tl= Boston, MA 02114-2017 www mass.gov/dia UN Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): l/-i a'2U(5 j5 012 rite tom(,n-f (_.E7L_tEC Address: 1OCP 1.0254- Si City/State/Zip: W oo.1/41-1!'n)A`l1 H' 6J O Phone#: l4)3 s' _ age() Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ['Demolition 10❑ 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.❑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.©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.❑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: DEP`.11 t1 d04S(,dH 'Jelin edRP1RA-776A/ Policy#or Self-ins.Lic.#: WC ¢003:28'070 Expiration Date:/ J10.16013 Job Site Address:t�� Elm. S}'. City/State/Zip:No r uPTO Al, p D(73 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 un the pains and pen • ury that the information provided above is true and correct. t...-4--c — /3 — 22 Signature: / / Date: Phone#: `T/3 5 5 2 i I Z 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#: