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31B-254 (6) BP-2022-0635 62 STATE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31 B-254-001 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-2022-0635 PERMISSIONIS HEREBY GRANTED TO: Project# TRIM WORK Contractor: License: Est. Cost: 37261 WRIGHT BUILDERS 065521 Const.Class: Exp.Date:01/25/2024 Use Group: Owner: COLLEGE SMITH Lot Size (sq.ft.) Zoning: CB/EU Applicant: WRIGHT BUILDERS Applicant Address Phone: Insurance: 48 Bates St 413586-8287 MCC20020005342021 A NORTHAMPTON, MA 01060 ISSUED ON:06/06/2022 TO PERFORM THE FOLLOWING WORK: EXTERIOR TRIM REPAIRS 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: • . , TIT Fees Paid: S261.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner ,! v �� The Commonwealth of Mass ch es, _ Office of Public Safety and Insp 'ons 3 2022 Massachusetts State Building Code(78 Building Permit Application for any Building other than a/On .¢ '1 Dwelli (This Section For Official Use Only) 1 NpF3THZ07/p�INSPECT1oNS Qo1080 Building Permit Number: . Date Applied: Building Official: SECTION 1:LOCATION 62 State Street Northampton, MA 01060 Hungry Ghost Bakery- Smith College No.land Street City/Town Zip Code Name of Building(if applicable) 254-001 Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used 780 C M R 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 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 0 No gl Is an Independent Structural Engineering Peer Review required? Yes 0 No Brief Description of Proposed Work. New asphalt shingles bisplIMIRKIWN5ERIEWoopt Exterior trim repairs and exterior painting 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) 61 Existing Use Group(s): B or M Proposed Use Group(s): B or M no change in use group SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) 1 1,226SF 1 1,226SF Total Area(sq.ft.)and Total Height(ft.) 1,226SF Building Height 18' i 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❑ 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 0 IIA 0 IIB ® 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 IIIIndicate municipal® A trench will not be Licensed Disposal Site Fcl required®or trench or specify: Private 0 or indentify Zone: or on site system 0 permit is enclosed 0 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❑ Yes 0 or No® Yes 0 No DI SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code:780 CMR 34 Use Group(s): B or M Type of Construction: I IB Does the building contain an Sprinkler System?: No Special Stipulations: Design Occupant Load per Floor and Assembly space: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Karl Kowitz 126 West Street Northampton, MA 01060 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Project Manager 413-585- 2404 - kkowitz@smith.edu Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Wright Builders Inc 48 Bates Street Northampton, MA 01060 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) Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Wright Builders Inc Company Name Steven Barrett CS-065521 Exp: 1/25/2024 U Name of Person Responsible for Construction License No. and Type if Applicable 97 Federal Street Po Box 503 Belchertown MA 01007 Street Address City/Town State Zip 413-586-8287 - - sbarrett@wright-builders.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 El No D SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 37,261.50 1.Building $ 37,261.50 37,261.50/ 1,000 = 37.27 x$7.00 = 261.00 Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $0 appropriate municipal factor)=$ 3.Plumbing $0 $7.00 per$1,000 of estimated cost(Rounded Up) 4.Mechanical (HVAC) $ Note:Minimum fee=$ 100.00 (contact municipality) 5.Mechanical (Other) $0 — Enclose check payable to The City of Northampton 6.Total Cost $ 37,261.50 (contact municipality)and write check number here Cf 8 ern_ 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 • the best of my knowledge and understanding. // 5/31/2022 Nicholas Wright j�1�///%� Estimating 413 -923-2870 Please print and sign name Title Telephone No. Date 48 Bates Street Northampton MA 01060 nwright@wright-builders.com Street Address City/Town State Zip Email Address ;///27a2. 4,21.6r Municipal Inspector to fill out this section upon application approval: � �. Name Date City of Northampton Massachusetts �? x_ <<. F � 1 t r DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 Sbyt ���`, 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: The debris will be transported by: Name of Hauler: J&J Trucking 11 Goshen Road Williamsburg, MA 01096 Signature of Applicant: Nicholas Wright Date: 5/27/2022 , The Commonwealth of Massachusetts witii- i ( Department of industrial Accidents _�eilll_ I Congress Street,Suite 100 —„,_ t Boston, MA 021 14-20!7 --- wtvw.niass.gov/dia 1,4u kegs' Compensation Insurance Affidavit:BuildersitontractorsfElectrici Ill 11uuthe•rs. 1 .)HE FILED WITH THE PERMITTING AUTHORITY. Applicant Info rntaliurt Please Prinl l.t.oiltlti Name(llustncss L)rt;,nntxstuonlndtvidual):_Wright Builders Inc Address: 48 Bates Street City/State/Zip: Northampton, MA 01060 Phone#: 413-586-8287 Are ynr in employer:'t htek the appropriate boa: Type of project(required): LEI I am a employer with 22 employees(full andhor part-time).• 7. Q New construction 2.0I am a sole proprietor or lurinemhip and have no employees working (or me in 8_ Cl Remodeling any capacity_[No workers'cutup.Insurance ri quurcdj 9. ❑ Demolition 30 I am a homeowner doing all work myself.[No workers'coop_insurance required"' 4.0 lam a homeowner and will be hiring c urorae1urs to conduct all work on my property_ I will 1©❑ Building addition ensure that all contneNurs either have weaker-compertSaliOn ucsurance in are sole 1 I.❑ Electrical repairs or addition a proprietor with no employees. 12.0 Plumbing repairs or additions 50 lam a general contractor and I have hired the subcontractors listed an the attached sheet_ These sub-contractors hove employees and have workers'euarip.insurance.; I 3.1=1Roof Rootrepairs 60 we are a corporation and its officers have exercised their nght of exemption per Mf,L e. 14_®Other 152,¢1(41,and we have nu employees.[Nu workers'comp.insurancrrequired.l Trim Repair and Painting 'Any applicant that chocks box al roust also fill out the section below showing their worker:compensation policy information_ +Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors roan[submit a new affidavit indicating such. :Contractors that cheek this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employed lithe sub-curaractoas have employ ecs.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: A.I.M Mutual Ins. Co. Policy#or Self-ins.Lie.#: MCC-200-2000534-2021A Expiration Date: 3/1/2023 Job Site Address: 62 State Street City/5tateiZip: Northampton, MA 01060 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 tine up to S I.500M0 and/or 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. Ida hereby certify under the pains and penal `iiiterjnry that the information provided above is true and correct Signature: Nicholas Wri•ht %/0 r Date: 5/27/2022 Phone 4: 413-586-8287 k Official use only. Do not write in tin%area.lie be rorriple^lett by city or too-n official_ City or Town: Permit/License k Issuing Authority(circle one): I. Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: WRIGBUI-01 KAYLA ,a CCU?o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) `—� 2/28/2022 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 Kayla Marie Drinkwine Phillips Insurance Agency,Inc. PHONE I FAx 97 Center Street (A c,No,Eat):(413)594-5984 (A/C,No):(413)592-8499 Chicopee,MA 01013 noMORIEss:kayla@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:EMC Insurance Companies 21415 INSURED INSURER e:Massachusetts Employers Insurance Company Wright Builders,Inc. INSURER C: 48 Bates Street INSURER D: Northampton,MA 01060 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 NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 6D18616 3/1/2022 3/1/2023 DAMAGETORENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: EMPLOYEE BENEFI $ 1,000,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO 6Z18616 3/1/2022 3/1/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS �y Ep BODILY INJURY(Per accident) $ AUTOS ONLY _ AUTOS ONLY (Per acEcldent)AMAGE A X UMBRELLA LIAB X OCCUR _EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE 6J18616 3/1/2022 3/1/2023 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ B WORKERS COMPENSATION X PER AND EMPLOYERS'LIABILITY STATUTE ERH ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N MCC-200-2000534-2021A 3/1/2022 3/1/2023 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? W N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 1,000,000 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 Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /ram t ^t� ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD