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31B-317 (3)
BP-2022-0518 36 ROUND HILL RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 3 I B-317-001 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-2022-0518 PERMISSION IS HEREBY GRANTED TO: Project# 3 family Contractor: License: INTEGRITY DEVELOPMENT & Est. Cost: 259600 CONSTRUCTION INC 090514 Const.Class: Exp.Date:09/12/2022 • HINCKLEY CHARLES DOUGLAS &JENNIFER E Use Group: Owner: JAMES Lot Size (sq.ft.) INTEGRITY DEVELOPMENT & CONSTRUCTION Zoning: URC Applicant: INC Applicant Address Phone: Insurance: 110 PULPIT HILL RD (413)549-7919 WMZ80080062242021 AMHERST, MA 01002 ISSUED ON:05/20/2022 TO PERFORM THE FOLLOWING WORK: CONVERT TO 3 FAMILY -PHASE #1 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: 59 016, Fees Paid: $1,813.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner t O L.L'R r The Commonwealth of Massachusetts �`t i�� 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) Building Permit Number: 2"� -,5LL Date Applied: Building Official: SECTION 1:LOCATION 36 Round Hill Rd Northampton 01060 No.and Street City/Town Zip Code Name of Building(if applicable) 31B 317 Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used 9th Edition If New Construction check here 0 or check all that apply in the two rows below Existing Building 181 Repair® Alteration ID Addition 0 Demolition El (Please fill out and submit Appendix 2) Change of Use ID Change of Occupancy ® Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ® No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No CM Brief Description of Proposed Work: Phase 1 of a multi-phased renovation converting building to include two additional dwelling units for a total of three. Phase 1 includes renovating the existing building envelope to improve insulation, air tightness and replace windows. Demolish interior walls. Prepare existing mechanical. electrical, plumbing and fire sprinkler systems for completion in phase 2. 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): I Proposed Use Group(s): R-2 SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft) 2 4500 sf 2 4500 sf Total Area(sq.ft)and Total Height(ft) 9000 sf 24'-1" +1- 9000 sf 24'-1" +/- 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❑ 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® R-3 O R-4 0 S: Storage S-1 0 S-2❑ 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 ❑ IIIA ❑ IIIB ❑ IV 0 VA CI VB I 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: 14 Public ID Check if outside Flood Zone® Indicate municipal® A trench will not be Licensed Disposal Site p required®or trench or specify: S&G Recycling, Private 0 or indentify Zone: or on site system 0 permit is enclosed 0 9 Shoham Rd,E.Windsor CT Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable® Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No ID Yes 0 No IN SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: 9th Edition Use Group(s): R-2 Type of Construction:VB Does the building contain an Sprinkler System?: Yes Special Stipulations: Design Occupant Load per Floor and Assembly space: 23 persons per floor, at 200 sf gross per occupant • SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner C. Douglas Hinckley 36 Round Hill Rd Northampton 01060 Name(Print) No.and Street City/Town Zip Property Owner Contact Information 312-404-5933 dhin@gmx.net 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❑. 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) Timothy Lock 207-951-5744 tim@opalarch.us 952417 Name(Registrant) Telephone No. e-mail address Registration Number 137 High St _ Belfast ME 04915 Architect 8/31/21 Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Integrity Development & Construction, Inc Company Name Anna Cook CS-090514 16 L f 7Z/ Name of Person Responsible for Construction License No. and Type if Applicable 113 January Hills Rd Amherst MA 01002 Street Address City/Town State Zip A13 549-7919 413-374 2322 anna@integbuild.com 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)=$ _ 1.Building $ 250,000 Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ 4,800 appropriate municipal factor)=$ . 3.Plumbing $ 4,800 Q 00 4.Mechanical (HVAC) $ 0 Note:Minimum fee=$ 1 d/3, (contact municipality) 5.Mechanical (Other) _ $ 0 Enclose check payable to 6.Total Cost $ 259,600 (contact municipality)and write check number here C1yJ`G 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 understanding. Anna Cook President 413549-7919 12-23-20 Please print and si name Title Telephone No. Date 110 Pulpit Dill Rd Amherst MA 01002 anna(c integbuild.com Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: R. � `` • • s/,./.-A. 41, Name Date CITY OF NORTHAMPTON SETBACK PLAN MAP: 31B LOT: 317 LOT SIZE: 1.1 Acres REAR LOT DIMENSION: 194' REAR YARD 20 SIDE YARD 10' SIDE YARD 10' ,am;K''' 1t1 1 i n 36 Round �.. Hill Rd I _P I j --4 ' i :.. 4 t I t _I _ __ -----„,, s Ewa r FRONT SETBACK FRONTAGE 103.5' • City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building r ` Northampton, MA 01060 �t 'i - 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: S & G Recycling, 9 Shoham Rd, East Windsor, CT The debris will be transported by: Name of Hauler: Wickles Trucking Signature of Applicant: Date: 12-23-20 The Commonwealth of Alassachttsetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 14101. ntass.gor/dia urkers'Compensation Insurance Affidas it:Buiklers/C:ontractors/Electriciansilumbers. -14)Ht.:141.1:1)‘11111 PERMIII1NC At 11101411-1`. Applicant Information Pleast- Print I.erimv Name thiusuwessOmanizatinmquhviduair. Integrity Development & Construction „ Address.: 110 Pulpit Hill Rd City/State/Zip: Amherst, MA 01002 Phone 413-549-7919 Are yam in entiphrytrY lirek the apprupriate hot: Type of project(required): Ira 1 an a cum/oyez with 14___employees(WI anctOr part-time),* 7. ,711 NeW construction 2f:31 21111 a auk pinpnetor or partnership and have AU employees 54 wising for me in 3 Remodeling any capacity_[Nu wuritc&comp,insuramx required.] Demolition ifj Iawna&mow%ma teeing all work m)self.[Nu workers'eunni,insurance remit-WA 10 11 Building addition 4.0 lain a hornoowner and*ill be hiring cordriams so conduct all work on my property. I will ensure that all crmtractors call&have worker.'COMpeltial21-91 insunime ur are sole 110 Electrical repairs or additions pt tit:nu:tura with no Clnpluy cch 1 2.0 Plumbing repairs or additions I ant a general cuntlactor and Ihave hired the sub-contractors listed on the attadhod sheet 13.0Roof repairs Thitse sails.contmetors base ariployees and ltsve workers'comp.irourance. 6.0 We are a corporation and its officers have exercised their right of esamaption rKg MGL. 14.0 Other §1(4i.and c!lawn no nploy,oes.[No workers'comp.insurance required I *An!,applicant that chucLi.boa.1 moat also fill out the section belou shoo In their eiViipensation policy information.. *lionicou nos ho mitririn this affidavit isidicating they are doing all*Ink and then hoc ourAide contractuca inizt submit a new affidavit it heating such. Zeununctun,that check Ihia boa 111125.i attached an sthhhunal sheet showing the name ol the suh—,:ordractor.and mate iv luAlier or nut those...ntitimILIV•V empli.rycc, It tlx iinb-c‘intractori.have citinkech.they must pi-wink:their woukcn,'coati, runtivr I am un employer that is providing workers"compensation insurance for my employees. Below-is the policy and job site information. AIM Mutual Insurance Company Name: Policy#or Self-ins.Lie.4: WMZ80080062242021A Expiration Date: 4/10/ 2422_1_ Job Site Address: 36 Round Hills Rd City/StateZip_ROft MPtOn.„MA.01060 Attach a copy of the workers'compensation policy declaration page(showing the policy numb and expiration date). Failure to secure coverage as required under MGL c. 152. §25A is a criminal violation punishable by a(me up to S1,500,00 anti'or one-year imprisonment,as well as civil penalties in the norm°fa STOP WORK ORDER and a line of up to$251100 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifieation. 1 do hereby certify under the pains unit penalties of perjury that the information provided above is true and correct. SIsnature: A41141 C(1.0-k Date:. 12-23-20 Phone 413-549-7919 Officiai use only. Do not write in this area,to be completed by city or town official. City or Town: PermitiLieenste Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.()tiler Contact Person: Phone#: , , , .,...t..\''. = Initial Construction Control Document i ;:, To be submitted with the building permit application by a \\\ Registered Design Professional for work per the ninth edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Date 36 Round Hill Rd Renovation,Phase 1 12/23/20 Property Address: 36 Round Hill Rd, Northampton MA 01060 Project: Check ix)one or both as applicable: New construction X Existing Construction Project description: 'Lock Timothy MA Registration Number: 952417 Expiration date: 8/31/21 ,am a registered design professional,and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning : X Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of tnv knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2_ Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved constructor'documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107_ When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a'Final Construction Control Document . ,,,,/jCikE Enter in the space to the right a"wer or '°\ 4,„:*10 electronic signature and seal: BELFART .. MAINE ,,.;<,i Phone number: 207-951-5744 Email: tim@opalarch.us Building Official Use Only Building Official Name: Permit No.:. Date: Note L Indicate with an'x'project design plans,computations and specifications that you prepared or directly supervised.If other is chosen,provide a description. Version 01_01_2018 • Appendix 1 Construction Documents are required for structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where applicable No. Item Submitted Incomplete Not Required 1 Architectural x 2 Foundation x 3 Structural x 4 Fire Suppression X will be submitted in phase 2 5 Fire Alarm(may require repeaters) X 6 HVAC X will be submitted in phase 2 7 Electrical X will be submitted in phase 2 8 Plumbing(include local connections) X will be submitted in phase 2 9 Gas(Natural,Propane,Medical or other) x 10 Surveyed Site Plan(Utilities,Wetland,etc.) x 11 Specifications x 12 Structural Peer Review x 13 Structural Tests&Inspections Program x 14 Fire Protection Narrative Report X will be submitted in phase 2 if req 15 Existing Building Survey/Investigation x 16 Energy Conservation Report x 17 Architectural Access Review(521 CMR) x 18 Workers Compensation Insurance x 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction. Registered Professional Contact Information Timothy Lock 207-951-5744 tim@opalarch.us 952417 Name(Registrant) Telephone No. e-mail address Registration Number 137 High St Belfast ME 04915 Architect 8/31/21 Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Please follow this link for construction control forms to be used by Registered Design Professionals. DATE(MM/DD/YYYY) ACCORD CERTIFICATE OF LIABILITY INSURANCE fiii.....-„-- 05/02/2022 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 Andrea Feeley,CISR NAME: Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Ext): (A/C,No): 8 North King Street E-MAIL afeeley@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Arbella Protection 41360 INSURED INSURER B: A.I.M.Mutual/A.I.M. 33758 Integrity Development and Construction,Inc. INSURER C: INSURER D: _ 110 Pulpit Hill Road INSURER E: Amherst MA 01002 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 4/2023 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 POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $AMAGE 1,000,000 RETED CLAIMS-MADE X OCCUR PREM SESO(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A 8500065625 04/10/2022 04/10/2023 PERSONAL&ADV INJURY $ 1,000,000 GENIIAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000.000 POLICY X PRO- POLICY LOC PRODUCTS-COMP/OP AGG $ 2.000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED �/ SCHEDULED 1020051526 04/10/2022 04/10/2023 BODILY INJURY(Per accident) $ AUTOS ONLY /� AUTOS X HIRED se NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /... AUTOS ONLY (Per accident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 A EXCESS LIAR CLAIMS-MADE 4620092974 04/10/2022 04/10/2023 AGGREGATE $ 4,000,000 DED X RETENTION$ 10'000 $ WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABILITY Y/N 500,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA WMZ80080062242022A 04/10/2022 04/10/2023 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 It 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 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD