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25C-234 (9) BP-2022-0678 177 BRIDGE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25C-234-001 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-2022-0678 PERMISSIONIS HEREBY GRANTED TO: Project# DECK REPAIRS Contractor: License: Est. Cost: 4000 KEVIN PERRIER 085319 Const.Class: Exp.Date:01/13/2023 Use Group: Owner: MILO PROPERTIES LLC Lot Size (sq.ft.) Zoning: SC/URC Applicant: FIVE STAR BUILDING CORP Applicant Address Phone: Insurance: 123 UNION ST (413)527-4060 WMZ80080077052020 EASTHAMPTON, MA 01027 ISSUED ON:06/14/2022 TO PERFORM THE FOLLOWING WORK: REPLACE ROTTED FRAMING AND DECKING 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: • • 1 � � I „ , . Fees Paid: $200.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner / T :TE: JUN - $ 202 J The Commonwealth of Massachusetts 2 Office of Public Safety and Inspections E?T Massachusetts State Building Code(780 CMR) NOQ?Nq'1g t Ap lication for any Building other than a One-or Two-Family Dwelling Mq u 1060 (This Section For Official Use Only) Building Permit Number: ate Applied: Building Official: SECTION 1:LOCATION 177 Bridge Street Northampton 01060 No.and Street City/To n �3� Zip Code Name of Building(if applicable) r Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used 9th If New Construction check here 0 or check all that apply in the two rows below Existing Building 0 Repair El 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 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No Brief Description of Proposed Work Replace all rotted framing and decking on existing decks at rear of building 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) ❑ 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) 2 2 Total Area(sq.ft.)and Total Height(ft) 300sf 15h 300sf 15h 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 ❑ F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2❑ 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® 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 CI IB ❑ HA El IIB ❑ IIIA ❑ IIIB ❑ IV 0 VA El VB 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: A trench will not be Licensed Disposal Site lI Public El Check if outside Flood Zone El Indicate municipal El 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 0 Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes❑ or No El Yes 0 No El 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 Milo Properties 4 Birchwood Dr Huntington 01050 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Kevin Perrier 413 _ 246 _ 9845 _ kperrier@fivestarcorp.net Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Kevin Perrier/Five Star Building Corp. 123 Union Street Easthampton 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 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 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 Five Star Building Corp. Company Name Kevin Perrier CSL#085319 Name of Person Responsible for Construction License No. and Type if Applicable 123 Union Street Easthampton MA 01060 Street Address City/Town State Zip 413-527-4060 413- 246- 9845 Kperrier@fivestarcorp.net 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® No D SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 4,000.00 1.Building $ 4,000.00 Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)=$ . 3.Plumbing $ 4.Mechanical (HVAC) Note:Minimum fee=$ (contact munici 5.Mechanical (Other) $ ( -nclose check payable to 6.Total Cost $ 4,000.00, (c tact municipality)and write check ber here /•I 3 CTION 13:SIGNATUR UILDING PERMIT APPLICANT By entering m e below,-I here der the pains and penalties of perjury that all of the information contained in application is d accurate to the best of my knowledge and understanding. �� Kevin Perrier President 413 _246 _9845 05-25-22 Please print a gn name Title Telephone No. Date 123 Union Str et Easthampton MA 01027 Kperrier@fivestarcorp.net Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: /��%2 _ (v-0-7d21 Name Date City of Northampton �/?-�" �\ Massachusetts ,.. -i. c'e rc hi Z. �': (•j t\; �'� Y' DEPARTMENT OF BUILDING INSPECTIONS % 4 . S 212 Main Street • Municipal Building yO. . Northampton, MA 01060 :1;li mil'\ 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: 295 Forest Street,Peabody,MA 01960 The debris will be transported by: Name of Hauler: Casella Waste Management Signature of Applicant: Date: 05/25/22 The Commonwealth of Massachusetts — 1. Department of Industrial Accidents tut is /1► 1 Congress Street,Suite 100 ,-;�:� Boston,MA 02114-2017 � '.�' wwtt:mass.gov/ilia 11 urkers'Compensation Insurance:A1lidas it: Builders.'("antractors/EIectriciynsiPlumbers. TO BE FILED WITH it I Ili I'ERMITI MG Al 11ORff't. Applicant Information Please Print Legibly Name(Husittess,Org nization/indivi&ial): Five Star Building Corp Address: 123 Union Street - Ste 200 City/State/Zip: Easthampton MA 01027 Phone#:413-527-4060 Areyuu an employ,re Cheri the appropriate 110t: Type of pr.frct(required): t.®1 am a rnq,toti ex a ith 10 eanpluy+oc,Oath andortrert-tuna t-' 7. 0 New construction 20 I am a sole proprietor or partncrohip sod haze UM e111100:4.0 ?%urknn lot me in $. Q Remodeling anti caraway-[No,AircIa r,'comp.'immune required" 9. o Demolition 30 I am a lanniowrler Joint:all omit rnylelt.[No N.orkas.'coop.inruruu-c remaridi' 10 0 Buddlllg addition a.Q 1 am a luruwvwnar and na ill be hiring!uunLtn actors to conduct all wank on ru'pnupcit4.. 1 on ill mown that all cuntraetLrr,eider lraae wuricr comp:mai:i nt ur.,uranu or an:sole ILO Electrical repairs or additions proprietor,with no employee._ 12.0 Plumbing repairs or additions NDI am a yen eral contractor and I Ian c hired the!,sob-cL,ntractur,,ta,tcd on tune attached lteer I3.0ROof repairs Thche mb-cuntrackan hater employee,and bane at.urlkcr,'chop.iauuranee.^ 60 We are a cmp.natiun and its officer,hate cinaviaed their riche of exemption per Ott it.c it®Oduer Deck repairs lS2 k 1(0.and we late no L-ng,loyess.[No worker,'comp.intananec required.] •Ana applieant that chocks bo*iii mini also fill nut the xstia-n kcKLna ylurwinr their at mite eonrpem.ation policy infnwtnatiun- t IIoaLlitn tier'.,as 110,nlaanL1 this affnkisit nnik:dimt they are domeL"alt wink and then hire outside contractor,mint submit a Dim atlulac it inht.aizme,nel1. t(,nntractor%that check tit,b,.r mint attached an additional sheet show low the name of the sub-contractor,anti,late whether c4 not ttlta,e entitle,lraae employees- it the sub-contractors hose clop luyLe,.they must pie side their worker,"comp.policy number. I am an employer that is providing worAers"compensation insurance for my employees. Below is the policy and job site infurrnation. AIM Insurance Co Insurance Company Name: — WMZ80080077052020A 05/09/2023 Policy#or Self-ins.Lie.#: _ Expiration Date: Job Site Address:177 Bridge Street Cily/StalerZip:Northampton MA 01050 Attach a copy of the workers"compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required and 'IMMGL c. 152,§25A is a criminal violation punishable by a tine up to S1.500.00 andor one-year imprisonment,as well as 4:: ril 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 ski nt may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. ) t I do hereby certify under the y`nA a erenalties of perjury that the information provided above is true and correct L Five Star Building Corp Signature: , i Date: Five Star Build 1 orp Phone.#: l' O/licial use only. Do not write in this urea,to be completed ks city or town official City or Town: Permit.l'l.icense 4 Issuing Authority (circle one): 1. Board of ilealth 2.Building Department 3.('itsr Fossn Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other contact Person: Phone#: 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 2 Foundation _ 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing(include local connections) 9 Gas(Natural,Propane,Medical or other) 10 Surveyed Site Plan(Utilities,Wetland,etc.) 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review(521 CMR) 18 Workers Compensation Insurance X 19 Hazardous Material Mitigation Documentation 20 Other(Specify) COI,Debris Affidavit X 21 Other(Specify) Historical Commission Project Notification Pkq 22 Other(Specify) CSL Copy X *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 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 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. • Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards • Constructibttbi pervisor CS-085319 Expires:01/13/2023 KEVIN A PERRIER 123 UNION St P. • EASTHAMPTON MA,01027 Commissioner —'O II4rtch&, Construction Supervisor Unrestricted -Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters) of enclosed space. • Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl A ® DATE(MM/DD YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/26/2022 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 Mary Odabashian NAME: Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Ext): (A/C,No): 8 North King Street E-MAIL modabashian@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA: Citizens Ins America/Hanover 31534 INSURED INSURER B: Allmerica Financial Benefit/Han 41840 Five Star Building Corp. INSURER C: Hanover Insurance Group Attn:Kevin Perrier INSURER D: AIM 123 Union Street,Suite 200 INSURER E: Easthampton MA 01027 INSURER F: COVERAGES CERTIFICATE NUMBER: Master EXP 5/2023 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 (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,DAMAGET000 CLAIMS-MADE X OCCUR PREM S SO(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 10,000 A ZBND23859304 05/09/2022 05/09/2023 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PRO 1-1LOG PRODUCTS-COMP/OPAGG $ 2,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ g ^ OWNED ./ SCHEDULED AWND23888204 05/09/2022 05/09/2023 BODILY INJURY(Per accident) $ AUTOS ONLY " AUTOS X HIRED �te NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) Medical payments $ 5,000 J X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 9,000,000 C EXCESS LIAB CLAIMS-MADE UNHD23859404 05/09/2022 05/09/2023 AGGREGATE $ 9,000,000 DED RETENTION$ $ WORKERS COMPENSATION X STATUTE EOTH AND EMPLOYERS'LIABILITY Y/N D ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A WMZ8008007705202A 05/09/2022 05/09/2023 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 10 ,00000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , Inland Marine Leased/Rented $99,752 A ZBND23859304 05/09/2022 05/09/2023 Equipment Deductible $500 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 City of Northampton / �tHAM.PI\ 5 . .. sic ,� .. Massachusetts �?' ( • DEPARTMENT OF BUILDING INSPECTIONS ?\ 4 212 Main Street • Municipal Building Jd., Northampton, MA 01060 f -. ,.SC PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR COMMERCIAL & MULTI-FAMILY NEW CONSTRUCTION/ADDITIONS/ALTERATIONS 1. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work (Digital & Hard copy). 3. Site Plan with location of proposed structure(s) and setbacks. 4. Construction Debris Affidavit filled out and signed by applicant. 5. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 6. Contractors must supply a copy of CSL and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate (if applicable). 8. Note any Conservation and/or Special Permit requirements (if applicable). 9. Driveway Permit (if applicable). 10. Proof of Water and Sewer entry fees paid (if applicable). 11. Trench Permit (if applicable). 12. Initial Construction Control Documents filled out and signed by the Registered Design Professional in responsible charge. 13. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton