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23C-037 (6)
BP 2022-1155 660 RIVERSIDE DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23C-037-001 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-2022-1155 PERMISSION IS HEREBY GRANT I TO Project# 2022 REPAIR WATER DAMAGE Contractor: License: Est. Cost: 35000 JAMES TROMPKE 071734 Const.Class: Exp.Date:02/28/2024 Use Group: Owner: 660 RIVERSIDE DRIVE LLC Lot Size (sq.ft.) Zoning: GI/WP Applicant: SINGLE SOURCE SERVICES LLC Applicant Address Phone: Insurance: 290 TAYLOR ST (413)427-5320 4220052639 07 GRANBY, MA 01033 ISSUED ON:09/16/2022 TO PERFORM THE FOLLOWING WORK: REPAIR SOME WALLS & REPLACE SOME FLOORING DUE TO WATER DAMAGE 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: ic,14:), 3)11 Fees Paid: $245.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner R.j cti G 1 N The Commonwealth of Massachusetts Office of Public Safety and Inspections i I._`' Massachusetts State Building Code(780 CMR) n_ — I Building Permit Application for any Building other than a One-or Two-Family Dwelling J' (This Section For Official Use Only) Building Permit Number202 ' J 15 Date Applied: Building Official: SECTION 1:LOCATION (a� C) verS —Ort.V _ /1/4iLi 1aMp1crt No.and Street City/Town Zip Code Name of Building(if applicable) "2 03-7 Dol Assessors Map# Block#and/or Lot # SECTION 2 PROPOSED WORK Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Building 0 Repair lcYrAlteration 0 Addition 0 Demolition ffr(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 ❑ No M.'s- -Is an Independent Structural Engineering Peer Review required? // f L�f"""" Yes 0 No Brie Description of Proposed Work /1-err►. (.vr i. A-d 1ic�t r. C tWV1°`�C 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 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business Er" 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 0 I-2❑ I-3❑ I-4❑ M: Mercantile 0 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 El IB ❑ IIA ❑ IIB ❑ IIIA ❑ 'BB CI IV VA 0 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: Public fdK Check if outside Flood Zone 0 Indicate municipal 0 A trench will not be Licensed Disposal Site required 0 or trench or specify: n I./c' 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 0 or No 0 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: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner rJefr J er'n ey Name(Print) No.and Street City/Town Zip Property Owner Contact Information q13 3s- g"c s `O3 -591- d 7.37 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 0. 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 S1 1c ouf CP_ Set Vt C05 Compa�Name �4rt1e s /r'om pk, CS 07/ 7.34 Name of Person Responsible f9r Construction License No. and Type if Applicable V 94 1 e yfbr .S'T f G rart(o •Ylq O ( 037 Street Address ` City/Town State Zip t j34 7 53a U cI3 -Li7- 5'32-cl ,1141-tt-otn @ S;nyf t_SoorceS vc.Cotcq 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 Estimated Costs:(Labor Item and Materials) Total Construction Cost(from Item 6)_$ ..3 •0'0 0. 1.Building $_3 5, 6 o J . -- Building Permit Fee=Total Construction Cost x 7 A/Insert here 2.Electrical $ appropriate municipal factor)=$ p b 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ ,3 c , O U o (contact municipality)and write check number here Al f O 7 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 accura the best of my knowledge and understanding. ,:James /r0my Kc_ Octet;— (03- (az 53z0 Please print and sign nanye Title Telephone No. Date 9 7 0 -5.1/a d- S r(oily 3414 0 10 '2 3 Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: /1Z1.----7 15 Z z p p P PP Name Date City of Northampton �' ' Massachusetts ;'� DEPARTMENT OF BUILDING INSPECTIONS y. 212 Main Street • Municipal Building ' \***...( 'ii % Northampton, MA 01060 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: H ) '6 2, The debris will be transported by: Name of Hauler: Oit/L— fru c_k.w. Signature of Applicant: (i4e't---41 /1-44 Date: r7_ /3 22 The Commonwealth of Massachusetts Is T---- , Department of Industrial Accidents i -. '"'i 1 Congress Street,Suite 100 ,,'"IS is 4Ik t ' Boston. :VA 02114-2017 71 '. www.mass.gov*/dia %l ockers'Compensation Insurance Aflidas it: Builder'( antr tctors%Electricians Plumhers. I()HE FILED 11IIII I III.11:1011 I I I\(:At I B01(111. Applicant Information e� Please Print L 'ibis Name(Business Organizahun-Itilt%ilia .J/,l y�,C O,J C :.._..57c...fs/t:C,. __. Address: 2 f t+ 4 yo r es 4' City/State/Zip: (3r 0.►e 1ty .. _ Phone#: `/I 3 A7-53Z..G_ Art yarn a.atptsver?( heek thr appropriate box: Type of project(rthq ): !suer.a employer with .4-4) ,employ+ers(full anttoe prat-time!.• 7. ®New construction employeesm 21 am a sole peopnetur or partnership and have no employees working for e in 8. ®Remodeling any capacity.[No workers'comp.inauranai imparted" 30 lama homeowner doing all work myself.(No workers'comp.itainnince required.]* 9. O'Qetgtylitwn 4.�'"�I am a homeowner and will be hiring corontetors to crrodaY all w'/A Ors my property. I will 10 Q Building additionis—ter+ensure that all contractors culler have makers'compensation ration mummy or are sale J 1 a Electrical repairs additions proprietors with no employees. 12.0 Plumbing repairs additions ;.(:3 I am a general contractor and I haw hired the sub-contractors hater'on the attn.h'd.beet 1 Roof repairs These subcontractors Erase employees and have workers'comp.i tswance.• 4 GOther ft.®We are a core t:Awn and its officers hat a exirr:ised thee nght of exerrnptiun per WA.c. 1 Q fr I.1,2,(ill 41,and we have DO en nloyets.[No worker.'clamp.iasuianre requital *Any applicant that checks boa al mint ale fill out the section below showing their workers'eompenaation p.+ticw information 'Homeowners who submit this affidavit outwitting they are Joins ail work and then hue outside contractors mint submit a new affidavit tndie g sna:h. :Contractors that check this box must attached an additional abed show ine,its,'name of the gut'-contriwints and state ahether or not those Multi tt hate ,.nip! i.-s. If the sub-contractors have employees.they must pie'.ids the it workers;.'..nip.!cola-} numb, I urn an employer that is providing workers'compensation insurance for my employees. Below is the policy a job site information. insurance Company Name: — Policy#or Self-its.Lic.*4: Expiration Date: Job Site Address: City:State;Zip: _ 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 S1,500.00 andi`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. /do hereby certify under the pains and penalties o/perjury that the in/ormntion provided above is true and correct. Signature: Date: Phone#: Official use on/i•. Do not write in this area.to he t ompleted hi•rite or town official ( its or Town: Permitil.icense a Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City(Towa Clerk 4.Electrical Inspector 5. Plumbing Inspector h.Other Contact Person: Phone#: Et f--- 9 ____............IN JAMEWTR-01 CKELLY A�o�Ro CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYVV) 4/20/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC TE 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 NAME: AXiA Insurance Services A/CC,HNo,Eat):(413)788-9000 FAX 413 886-0190 84 Myron Street ( (A/c,No):( Suite A E-MAILDSS:info@axiagroup.net West Springfield,MA 01089 INSURER(S)AFFORDING COVERAGE NAIC# . INSURER A:Arbella Mutual Insurance Company .17000 INSURED INSURER B: Single Source Services LLC Single Source SVC,Inc. INSURER C: James W.Trompke INSURER D: 290 Taylor Street INSURER E Granby,MA 01033 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 FO THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RES�ECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJEC TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSD SWVD POLICY NUMBERUBR POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY (MMIDD/YYYY1 (MM/DD/YYYYI 1,000,000 EACH OCCURRENCE $ CLAIMS-MADE X OCCUR 8500071811 4/14/2022 4/14/2023 DAA M SESO RENTS ence) $ 100,000 MED EXP fAjw one person) $ 5,000 PERSONALBADVINJURY I$ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY Er- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: BLANKET Al $ A AUTOMOBILE LIABILITY SINGLE LIMIT 1,000,000 (Ea accident) $ ANY AUTO 1020100486 10/5/2021 10/5/2022 BODILY INJURY(Per person) $ AUTO ONLY X SCHEDULED fRE Ory p BODILYO INJURY TAN accident) $ X_ AUTOS ONLY X AUTOS ONLY (Perr a cede t) MADE -- $ _$ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE 4620093366 4/14/2022 4/14/2023 AGGREGATE $ DED X :RETENTION$ 10,000 Aggregate $ 5,000,000 A WORKERS COMPENSATION X PER 10TH- ANDEMPLOYERS'LIABILITY Y/N STATUTE ER .. ANY PROPRIETOR/PARTNER/EXECUTIVE 4220052639 O7 4/14/2022 4/14/2023 E.L.EACH ACCIDENT _ $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) - EL.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below 500,000 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 Proof of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Initial Construction Control Document tr To be submitted with the building permit application by a i v Registered Design Professional Y.y for work per the ninth edition of the 1-si 404 Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Date: Property Address: Project: Check(x)one or both as applicable: New construction Existing Construction Project description: I MA Registration Number: Expiration date: ,am a registered design professional,and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning2: Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my 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 construction 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'. Enter in the space to the right a"wet" or electronic signature and seal: Phone number: Fvnaf• Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an'x'project design plans,computations and specifications that you prepared or directly supervised.If'other'is chosen,provide a description. Version O1 Ol 2018