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25A-046 (63) BP 2022-1022 51 BATES ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25A-046-001 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-2022-1022 PERMISSION IS HEREBY GRANT I TO: Project# 2022 RENO Contractor: License: Est. Cost: 1000 JIM BOYLE CS107689 Const.Class: Exp.Date: 10/25/2023 Use Group: Owner: NORTHAMPTON MONTESSORI SOC ETY Lot Size (sq.ft.) Zoning: GI Applicant: KITCHEN CONCEPTS & DESIGN CENT ER LLC Applicant Address Phone: Insurance: P O BOX 241 413-586-8010 WCB49466 HADLEY, MA 01035 ISSUED ON:08/23/2022 TO PERFORM THE FOLLO WING WORK: INSTALL WALLS IN BATHROOM 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: ' 5 1 Fees Paid: $100.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner The Commonwealth of Massachusetts ,�r Office of Public Safety and Inspections Massachusetts State Building Code(780 CMR) t Building Permit Application for any Building other than a One-or Two-Family Dwelling rn (This Section For Official Use Only) .Building Fermit Number: 7-24OL2 1 Date Applied: Building Official: a SECTION 1:LOCATION l'jlDfnr► o la_CL .ri Sori ..chow 1 OP No.and Street Ci / n Zip Code ame of Building(if p licable) _ A— d4(F ,cJoaifzir - 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 Buildings Repair❑ Alteration 0 Addition❑ Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other ❑ 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 ReviewI r�d? ,,,, fr 0 No RI Brief Description of Proposed Work *fang g a N L[�Dom/loom- d//S d p 171idd/I_ ci 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.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5 0 B: Business 0 E: Educational 0 F: Factory F-1 0 F2❑ H: High Hazard H-1 0 H-2 0 H-3 0 H4❑ H-S 0 I: Institutional I-1 0 I-2❑ I-3❑ I-4❑ M: Mercantile 0 R Residential R-10 R-2 0 R•3 0 R-4❑ 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 CI IB ❑ HA IIB 0 MA CI 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 CICheck if outside Flood Zone 0 Indicate municipal 0 A trench will not be Licensed Disposal Site 0 rd Private CI or indentify Zone: or on site system CIregmt i 0 or trench or specify: 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 0 Yes❑ or No 0 Yes 0 No 0 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 &&7dn7pl e d Addr s of Pro erty Owner oo S'ori 5i Actis Jo 460_1npkq 6 i orb Name(Print) e No.and Street City/Town Zip Property Owner CoCcortact Information " "d�l li £s ti4q-239- CIa 1 7 - Paei/i his 0 or a� Title Telephone No.(business) Telephone No. (cell) e-mail a ess/90'9 4' O J org If applicable,the property owner hereby authori s: _(---M ) P_ 808 ►e 1( `7 uss-ell S: �1' G 0 i o33— Name treet Address City/To St 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 CI. 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 Company Name Name of Person Responsible for Construction License No. and Type if Applicable Street Address City/Town State Zip 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 I, No D SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ I,00O• — 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 � J 6.Total Cost $ I , . — (contact municipality)and write check number here ,V I V' 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 accuratItryithe best o y wledge and understanding. �m �R do I� I(J -ei` wn�D 46-58b-3stblo ??- Please int and s' e A t i heft C n(,) 13 T'tie Telephon 4?o. Date 117 usse/r < �1184 A o 10.35' deS OWKi lth�en-Corte .net_ ddress City/ToNA to Zip Efnail Address Municipal Inspector to fill out this section upon application approval: 6 ' /'.i \A-d .• 1 4 i g/ ?/aa, Name 1 Date ADVOCATE ADVOCATE ^••*.•••- ..�** "'" °ArmE w r" wzer. ltc en Kitchen Concepts&Design Center *BEST**BEST*P +� N houzz 011Cep tS P.O.Box103 7TREVALLES THFVA�L,1 CHOI HOICE CHOI HOI E CHOI E HOI BBB Hadley, 01035-0241 TO 2 1 'O 'O INNER_ INNER JJINN R FINALIS INALIS INN 4-gas. DREAM m DESIGN m DELIVER CONSTRUCTION SUPERVISORS LICENSE Recognized by the Commonwealth of Massachusetts as a Supervisor. Superior knowledge of Massachusetts laws and code are mandatory. Testing and years of experience are required to receive this license. Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards CorTst io1n1r Srvisor • CS-107689 6pires: 10125/2023 JIM R BOYL -- 117 RUSSELk ST PO SOX 241 HADLEY MA J035 • Commissioner fia+ -A f; If License #- CS 107689 • HOME IMPROVEMENT CONTRACTORS LICENSE Required for remodeling existing property. y1i If rriime.errr max;'/1 r/. :{i_•.1J+i.4 r:+^1'1 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:I IC Rngistrstion Expiration 193350 10/10,2022 KITCHEN CONCEPTS&DESIGN CENTER LLC JIM R.BOYL F +l 117 RUSSELL STREET HADLEY,MA 01035 Undue License #-180308 All licensing information can be obtained through government agencies. Insurance coverage binders and references are furnished upon request. • Office: (413)586-3506 • Fax: (413)586-8051 • Email: design@kitchen-concepts.net •Sie I �--- s>> eoz I` L City of Northampton `t4'.' r 44%,„ S`5 .,, SAC Massachusetts �4t *S << , to w % \ � _ DEPARTMENT OF BUILDING INSPECTIONS 9; j e► -�yt 212 Main Street • Municipal Building Jb "� Northampton, MA 01060 :6i 3<‘4 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: 1ILocation of Facility: la EAdRe,C CI 03 The debris will be transported by: Name of Hauler: IX( khe►) a I(-r7 d. I >?Si i • r) le/ I\ Signature of Applicant: 7 R / �vb Date: 8 filo %0a)- J The Commonwealth of Massachusetts r =IVIMIIMIll 1, Department of Industrial Accidents 1 Congress Street, Suite 100 _�!`�_ Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Business/Organization Name:ASAP Painting, Inc. Address:117 Russell Street/PO Box 241 City/State/Zip:Hadley, MA 01035 Phone#:(413) 586-8010 Are you an employer?Check the appropriate box: Business Type(required): LEI I am a employer with 12 employees(full and/ 5. ❑Retail or part-time).* 6. ❑Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers' comp.insurance required] 8. El Non-profit 3.❑ We are a corporation and its officers have exercised 9. 0 Entertainment their right of exemption per c. 152,§1(4),and we have 10.❑Manufacturing no employees. [No workers'comp.insurance required]** 11.❑Health Care 4.❑ We are a non-profit organization,staffed by volunteers, Wall Builds with no employees. [No workers'comp.insurance req.] 12.12 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. Iam an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name:NGM Insurance Company Insurer's Address:Jobsite Address: 98 East Street City/State/Zip: Southampton, MA 01073 Policy#or Self-ins.Lic.#WCB49466 Expiration Date:01/31/2023 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify, der the ins nd penalties of perjmy that the information provided above is true and correct. Signature: 1Ql0Z!/ Date: U(� ,3,o,I Ja Phone#:(413) 586-8 10 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.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia ®ACCPREP DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/25/2022 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 Elizabeth Carballo,CISR,CPIA NAME: Finck&Perras Insurance Agency Inc. PHONE (413)527-5520 FAX (413)527-5970 (A/C,No,Ext): (A/C,Ne).. 6 Campus Lane E-MAIL bcarballo@finckandperras.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Easthampton MA 01027 INSURER A: NGM Insurance Company 14788 INSURED INSURER B: _ ASAP Painting,Inc INSURER C: PO BOX 241 INSURER D: INSURER E: HADLEY MA 01035-0241 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2251906484 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 500'000 �/ EACH OCCURRENCE DAMAGE TO RE CLAIMS-MADE X OCCUR PREMISES(Ea ocr cu ence) $ 500,000 MED EXP(Any one person) $ 10,000 A M9B49466 06/20/2022 06/20/2023 PERSONAL&ADvwJURY $ 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 X POLICY LOC PRODUCTS-COMP/OP AGG $ 1,006,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 100,000 A OWNED >/ SCHEDULED M9B49466 06/20/2022 06/20/2023 BODILY INJURY(Per accident) $ 300,000 AUTOS ONLY /-• AUTOS HIRED �/ NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY AUTOS ONLY (Per accident) HNTBI $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH-' AND EMPLOYERS'LIABILITY STATUTE ER YIN 100,000 ANY OFFICER/MEMBER PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ p` OFFICER/MEMBEREXCLUDED? Y NIA WCB49466 01/31/2022 01/31/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE♦{ $ 100'000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Proof of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE C4NCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ASAP Painting Inc ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 241 AUTHORIZED REPRESENTATIVE Hadley MA 01035-0241 e'4kV(. ,e44 C.ce I �J ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ADVOCATE ADVOCATE ADVOCATT,�,..•,— „_ �w'E..E a•�,• �/� itchen Kitchen Concepts&Design Center ADVOCATE*VT*ADVOCATE teosT*�N01 �NNI E 'NUI • E ' N /IIDUZZ o n c ep t s P.O.Box 241 THE VALLEY THE VAu Er TABvnuE1 �..opEgr_rou��s r4n ergnvas�cni i 2020 2019 20'1 8 ''C)1 '! BBB' 2 1 2 2 2 0 2 1 2 0 2 0 WPLI�:IVJ/I:Iq�:1PA�d1A�.i4ii..�J�r :�s` u�su°�Ess° DREAM m DESIGN O DELIVER Hadley,MA 01035-0241 1 August 16, 2022 Attn: Building Department City of Northampton 212 Main Street Northampton, MA 01060 Subject: Building Permit Montessori School of Northampton, 51 Bates Street To Whom It May Concern: Enclosed please find our payment for the building permit for the above job. If you have any questions, please contact me at (413) 586-3506. Thank you. Luc ,ry L Brown. Luann L. Brown Executive Administrative Assistant :11b • Office: (413)586-3506 • Fax: (413)586-8051 • Email: design@kitchen-concepts.net