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BP 2022-1024 95 BARRETT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24B-002-001 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-2022-1024 PERMISSIONISHEREBYGRANTEI TO: Project# APMTS ABOVE GARGE Contractor: License: Est. Cost: 28378 FIRE SERVICE GROUP LLC SC145974 Const.Class: Exp.Date:07/04/2024 Use Group: Owner: LLC SUNWOOD GREEN Lot Size (sq.ft.) Zoning: URB Applicant: FIRE SERVICE GROUP LLC Applicant Address Phone: Insurance: 1 01 0 THORNDIKE STREET 14136689100 F1WC290917 PALMER, MA 01069 ISSUED ON:08/23/2022 TO PERFORM THE FOLLOWING WORK: INSTALL FIRE SPRINKLER SYSTEM 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 VIOL• TION OF ANY OF ITS RULES AND REGULATIONS. Signature: .52 I Fees Paid: $203.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner The Commonwealth of Massachusetts , Office of Public Safety and Inspections Massachusetts State Building Code(780 CMR) ttt. Building Permit Application for any Building other than a One-or Two-Family Dwelling o a� m 1 (This Section For Official Use Only) Building—Permit I t r ber: ,x o.)'/'•W Date Applied: Building Official: SECTION 1:LOCATION 95 lirreG,t- St, Northampton MA 01060 Sunwood Green No.and and W City/Tpw^�Z Zip Code Name of Building(if applicable) 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 la Addition❑ 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 ❑ Is an Independent Structural Engineering Peer Review required? Yes 0 No ❑ Brief Description of Proposed Work:Install NFPA 13R Fire Sprinkler System 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.) 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 0 A-5 0 B: Business 0 - E: Educational 0 F: Factory F-1 Cl F2❑ H: High Hazard H-1 0 H-2 0 H-3 0 H-4❑ H-5 0 I: Institutional I-1 0 I-2 0 I-3 0 I-4 0 M: Mercantile 0 R: Residential R-10 R-2 0 R-�3 0 R-4 El S: Storage S-1 El S-2 0 U: Utility 0 Special Use 0 and please describe below: I Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 IB ❑ IIA ❑ IIB 0 IIIA ❑ IIIB ❑ 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 IN Indicate municipal INA trench will not be Licensed Disposal Site required D3 or trench or specify: F S G Private 0 or indentify Zone: or on site system CI permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable la Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No C3 Yes 0 No ❑ 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: City of Northampton tit zr�r, Ct Massachusetts �, _ f,�, ,� s' DEPARTMENT OF BUILDING INSPECTIONS Poi w 'it .4 212 Main Street • Municipal Building C -'� � Northampton, MA 01060 1�5 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 SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Sunwood Builders 84 Potwine Lane Amherst, MA 01002 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Owner 413. 626 0244 _ sunwood@comcast . net Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Fire Service Group 1010 Thorndike Street, Palmer MA 01069 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 Fire Service Group, LLC Company Name Daniel P Belanger SC-145974 Name of Person Responsible for Construction License No. and Type if Applicable Fire Service Group 1010 Thorndike Street, Palmer MA 01069 Street Address City/Town State Zip 4136689100 _ - brenna@fireservicegroup . 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 No C SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs: (Labor and Materials) Total Construction Cost(from Item 6)=$ $2 8, 3 7 8 . 0 0 1.Building $ Building Permit Fee=Total Construction Cost x Insert here 2.Electrical $ appropriate municipal factor)=$ . 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ $2 8, 3 7 8 . 0 0 (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to t be t of my knowledge and understanding. Brenna K Hanechak 0% ►t% Assistant Proj . Mgr . 413_6689100 8/19/22 . Please print and sign name Title Telephone No. Date 1010 Thorndike Steet, Palmer. MA 01069 brenna@fireservicegroup . com Street Address City/Town State Zip Email Address Q Municipal Inspector to fill out this section upon application approval: �� ,T K�/P Yg) Name Date CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton � j 7T`Li�1% - Massachusetts �'� jDEPARTMENT OFBUILDING INSPECTIONS,0212 Main Street • Municipal Building vv Northampton, MA 01060 s$' V." ly A,- 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: Fire Service Group Dumpster 1010 Thorndike St Palmer, MA The debris will be transported by: Name of Hauler: Signature of Applicant: Date: 8/19/22 The Commonwealth of Massachusetts Department of Industrial.4ccidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 wwwmass.gov/&a ---- II mi kers'f'ompensation Insurance Affidavit:Builders/ContractorsfEkctriciansfPlumbers. To BE FILED WITH THE PERMITl'ESC;AUTHORITY. Applicant Information Please Print I Avililv Name(13usinea.Vorgamzationlindreidual): Fire Service Group Address: 1010 Thorndike Street . . . .. .. . , City/State/Zip: Palmer, MA 01069 Phone#: Are you an emplakk er?Cheek the appropriate boa: Type of project(required): 1.E3 1 am a employes with, _err43,10),*es(full amkor part,timet..• 7. 0 New construction 2.171 I JIM a'Iole prodos or partnership and him:no ennployee*working for nbe in K. CI Remodeling any catnicity.[No workers comp,insurance requiriall 9. El Demolition kCi I am a iumneorbner doing all work mytelf.INo workers'comp,insurance roil uned.1 100 Building addition .1.0 I am a homeowner and will be hiring corgratoarg to etioduti all work on my property., I A Ill ensure that all coigne-tors either have wog-kers'compensation Utsurance or are aole i I.0 Electrical repairs or addition:, proprietors with no employees_ 12.E]Plumbing repairs or additions q7jI am a general contractor and l have hired the sub-contractors listed on the;studied street These gob-contractors have employees and have workers'eutrrip.iligarance. B.F.:Roof repairs: 61.0 We are a eorporation and 313 officers have exercised their right of exert per h461..c, 14.MOther Fire Protectio 152,§Hal.and we hage no emplaces.[No workers'tganp,insurance required,' 'Airy ippl IL ini that 4.-her:kb.Lx.r.%4,1 mint alui till out the stetion below showing their workers'eimitperigat IL/CI p.,1 Is.) I II isK IllialOn. t ikomeowners who submit this affidavit Oulieatiror they ate doing an work and then hire(*hide C433111.3.0.0n n11131 aubrtut a new all-Aar-it iriliertg such. :Contractors that check this box must attacked an additional sheet showing the name oldie guts-e:ontractors and state whether ta nut those entities have cmplovees, It the sub-contractors bank.otti3lcoyecs,!Icy nurse pn.103i,lelli,:ir AV rkers"torrip.policy number, I ant an employer that is providing worAers'compensation insurance for my employees. Below is the policy and Job site information. Insurance Compluiy Name: Beacon Mutual Insurance Co & Argonaut Insurance Co — policy#or seg..ins.Lie.#: 87718 & WC928798747364 Expiration Date: 1 0/1/2 0 22 Job SUL,. Address; 95 Barrett St CityfStateiZip:Northampton, MA 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 S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a thy against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby cc 'j.a tiler the/131iii 3 and penalties of perjury that the infOrmation provided above is true and correct. Signature: Date: 8/19/2022 Phone = : 413-668-9100 Official use only. Do not write in this area,to be completed by city or town officiaL City or ToiAn: Permit/License# _. Issuing Autliorii (circle one): I. Board of Health 2. Building Department 3.Cky/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector ().Other Contact Person: Phone 4: --- Client#: 736597 ENCORHOL 'DD/YYVV) ACORD., CERTIFICATE OF LIABILITY INSURANCE DATE(MM 7/27/ 022 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Candace Zubee USI Insurance Services LLC PHONE 855 874-0123 FAx 610 537 9437 (A C,No,Ext): (A/C,No). 475 Kilvert Street, Building B E-MADDREAIL SS: Candace.Zubee@usi.com Suite 205 INSURER(S)AFFORDING COVERAGE NAIC# Warwick, RI 02886 INSURER A:Nautilus Insurance Company 17370 INSURED INSURER B:Navigators Insurance Company 42307 Encore Holdings, LLC Beacon Mutual Insurance Com an 24017 INSURER C: P y dba Fire Service Group Argonaut Insurance Company 19801 INSURER D: 4J P Y 1317 Main Street Federal Insurance Company20281 INSURER E: Palmer, MA 01069 Selective Insurance Company of America 12572 INSURER F: P Y 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 INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY X X ECP203304511 09/30/2021 09/30/2022 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR PREMISESTO(Ea RENTED $500,000 X BI/PD Ded: $10,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X JECOT fl LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ E AUTOMOBILE LIABILITY X X 54326361 09/30/2021 09/30/2022 E0a aocde Dr,oSINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) XDrive Oth Car $ A X UMBRELLA LIAB X OCCUR X X FFX203304611 09/30/2021 09/30/2022 EACH OCCURRENCE S1 0,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE S1 0,000,000 B DED X RETENTION$$0 IS21 EXC9446901V 09/30/2021 09/30/2022 Occ/Agq $1 OM Excess C WORKERS COMPENSATION X 87718 10/01/2021 10/01/2022 X PER ERH AND EMPLOYERS'LIABILITY STATUTE ER Y N D ANYIPROPRIETOERPARTNERDXECUTIVE N N A X WC928798747364 10/01/2021 10/01/2022 E.L.EACH ACCIDENT $1,000,000 OF(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Pollution X X ECP203304511 09/30/2021 09/30/2022 $1,000,000 Occ/Agg A Professional ECP203304511 09/30/2021 09/30/2022 $1,000,000 F Equipment S2444983 07/07/2022 07/07/2023 $50,000 Leased/Rented 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE >41. ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD ffCZL:Rd71 A,7/11A'1F7FQd77 D1A/C7D