32A-147 (9) BP-2022-1632
16 MAIN ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32A-147-001 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-2022-1632 PERMISSION IS HEREBY GRANTED TO:
Project# 2022 DOOR Contractor: License:
Est. Cost: 2200 JASON BOULANGER 114940
Const.Class: Exp.Date: 06/12/2024
Use Group: Owner: TRUST 16-18 MAIN STREET REALTY
Lot Size (sq.ft.)
Zoning: CB Applicant: JASON BOULANGER
Applicant Address Phone: Insurance:
102 WARREN ST (413)695-1108 SOLE PROPRIETOR
WEST SPRINGFIELD, MA 01089
ISSUED ON: 12/22/2022
TO PERFORM THE FOLLOWING WORK:
REPLACE REAR DOOR
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:
k
• a . i
' I �
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
N
O
N
The Commonwealth of Massachusetts
FOR
Board of Building Regulations and Standards
•
ti)/ Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only •
Building Permit Number:D P Z022-h.3 z Date Applied:
Vey'0—$/1/20, Z a-ZZ-ZaZ
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Pro erty Address: 1.2 Assessors Map&Parcel Numbers
/ ��;� S7 32A - 141-oot
I.1 a Is this an accepted street?yes 4- no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone information: 1.8 Sewage Disposal System:
Publicl✓ Private 0 Zone: — Outside Flood Zone? Municipal 0 On Site disposal system CI
111 Check if yes❑
SECTION 2: PROPERTY OWNERSHIP' •
2.1 Owner'of Record:
2-55-Ac 6176 ✓
Name(Print) City,State,ZIP
'T 7- T30 -3dg, J2'ohda, ,/10..1
No.and Street Telephone Emar Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) 1 Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': Rci)oi'e eiGher /r/2/11te( Pii°'a✓ 120oc 3 C7i-80
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and-Materials)
I. Building $ oZ Q 1. Building Permit Fee: $ ' Indicate how fee is determined:
2.Electrical $ 0 Standard City/Town Application Fee
0 Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $ v L
Suppression) Total All Fees: $ I40
Check No.1 D31 Check Amount:$ IO Cash Amount:
6.Total Project Cost: $ oZ •0 a, 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 1/2 a y
JA p go ? ,?nC/ License Number Expiration Date
Name of CSL Holder 1
List CSL Type(see below) U
Iva Warr-CA 1
No.and Street Type Description
5,(4F
'/ U Unrestricted(Buildings up to 35,000 cu.ft:
G�1�� I `.fU �L' ��1�. / �� R Restricted 1&2 Family Dwelling
City/Town,State,ZIP/ M Masonry
9�/2-6 9 5 /) ' RC Roofing Covering
7 WS Window and Siding
SF Solid Fuel Burning Appliances
L7 14' /.(VA" I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(IIIC)
�f q�y7, Ys/'023
J 4 5 t n it,0 v 147, HI Registration Number Expiration Date
HIC Company Name or HIC Rtrant Name
02 t„'A.reer-) 5 � )4son.; '>G ,y'r►A,.
No.and Street l/ Email address
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6))
Workers Compensation Insurance affidavit 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.
Signed Affidavit Attached? Yes No .0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
--fifa r (4 Iv /A. /7•v).2
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
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 the best of my knowledge and understanding.
iR
aCCdn ) 0oul4n r / /a '/ 2 ,1?
Print Owner's or Authorized Agente Name ectrodi Signature) Date
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the MC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can beefound at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths _
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
MAPFRE INSURANCE'
•
Rapid Quality Construction LLC
102 Lauren Street
West Springfield, MA 01089
Commercial
Lines
•
US JKT 11/2015
MAPFRE INSURANCE
MAPFRE Insurance Company
11 Gore Road, Webster, MA 01570
BUSINESSOWNERS
DECLARATION
New Business
POLICY NO: 8008030018717
Agency Code : 20613
ACCOUNT NUMBER:
NAMED INSURED AND MAILING ADDRESS AGENCY AND MAILING ADDRESS
RAPID QUALITY CONSTRUCTION LLC NEILL & NEILL INS. AGENCY, INC.
102 LAUREN STREET 662 RIVERDALE STREET
WEST SPRINGFIELD,MA 01089 WEST SPRINGFIELD, MA 01089
POLICY PERIOD: FROM 11/01/2022 TO 11/01/2023 AT 12:01 AM STANDARD TIME AT YOUR MAILING ADDRESS SHOWN
ABOVE.
THE NAMED INSURED IS: Limited Liability BUSINESS DESCRIPTION: plumber
Company (LLC)
ADVANCED PREMIUM. YOUR POLICY MAY BE AUDITED.
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL TERMS OF THIS POLICY, WE AGREE
WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY.
DESCRIBED PREMISES
Prem. Bldg.
No. No. Premises Address:
1 1 102 Lauren Street, West Springfield, MA 01089
SECTION I— PROPERTY
Business
Type Of Property Personal
(Building Or Actual Cash Automatic Property—
Business And Value Of Increase Bldg. Seasonal
Prem. Bldg. Classification Personal Bldg. Option Limit Increase Limit Of
No. No. No. Property) (Yes Or No) (Percentage)** (Percentage) Insurance* Premium
1 1 1 Business No 0 25% $5,000 $132
Personal
Property
US DEC 1000 12 15 Page 1 of 3
MAPFRE INSURANCE
BUSINESSOWNERS
DECLARATION
New Business
POLICY NO: 8008030018717 EFFECTIVE DATE: 11/01/2022
INSURED: RAPID QUALITY CONSTRUCTION LLC AGENT: NEILL & NEILL INS. AGENCY, INC.
Deductibles (Apply Per Location, Per Occurrence)
Optional Coverage (Other Than
Equipment Breakdown
Protection Coverage) Windstorm Or Hail
Prem. No. Property Deductible Deductible Percentage Deductible
(Location 1, $ 500 $ 500 N/A VG
Building 1)
SECTION II — LIABILITY AND MEDICAL EXPENSES
Each paid claim for the following coverages reduces the amount of insurance we provide during the applicable annual
period. Please refer to Section II— Liability in the Businessowners Coverage Form and any attached endorsements.
Location: (Location 1, Building 1)
Coverage Limit Of Insurance
Liability And Medical Expenses $ 1,000,000 Per Occurrence
Medical Expenses $ 5,000 Per Person
Damage To Premises Rented To You $ 50,000 Any One Premises
Other Than Products/Completed Operations $ 2,000,000
Aggregate
Products/Completed Operations Aggregate $ 2,000,000
Liability Premium $ 1,735
Deductible
Optional Property Damage Liability Deductible: $ 500
US DEC 1000 12 15 Page 2 of 3
( ) MAPFRE INSURANCE
BUSINESSOWNERS
DECLARATION
New Business
POLICY NO: 8008030018717 EFFECTIVE DATE: 11/01/2022
INSURED: RAPID QUALITY CONSTRUCTION LLC AGENT: NEILL & NEILL INS. AGENCY, INC.
Deductible
I I Per Claim (Refer to BP 07 03); or x Per Occurrence (Refer to BP 07 04)
Coverage Annual Premium Transaction Premium
Terrorism $ 0 $ 0
Premium for Endorsements $ 100
TOTAL BUSINESSOWNERS POLICY PREMIUM $ 1,967
TOTAL PREMIUM $ 1,967 . 00
FORMS AND ENDORSEMENTS
APPLYING TO THIS COVERAGE PART AND MADE PART OF THIS POLICY AT TIME OF ISSUE:
See Forms Schedule
NOTE: IF NO ENTRY APPEARS ON THE ABOVE ENDORSEMENTS, INFORMATION REQUIRED TO COMPLETE
THE FORM WILL BE SHOWN ON THE SUPPLEMENTAL FORM DECLARATION IMMEDIATELY FOLLOWING THE
APPLICABLE ENDORSEMENT.
THESE DECLARATIONS, IF APPLICABLE, TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE
FORM(S) AND ENDORSEMENTS, AND SUPPLEMENTAL FORM DECLARATION(S), IF ANY, ISSUED TO FORM A
PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY
US DEC 1000 12 15 Page 3 of 3
MAPFRE ( INSURANCE°
BUSINESSOWNERS POLICY
MUSZ 20030 (06/13)
POLICY NUMBER: 8008030018717 EFFECTIVE DATE: 11/01/2022
NAMED INSURED: Rapid Quality Construction LLC PRODUCER CODE: 0000020613
PRIVACY NOTICE
In order to obtain insurance with us, you have provided personal information about yourself. Some of the information may
be nonpublic in nature. We have a high regard for your privacy. We want you to know how we handle your personal
information. This notice lists the categories of information we collect about you. This notice explains how the information is
used and protected. This notice describes our practices for our current and former customers. Any rights you may have as
described in this notice are not limited by any other privacy notice we issue.
CATEGORIES OF INFORMATION COLLECTED
Personal information may be collected from people other than you. We collect personal information about you, including
nonpublic personal information, from:
• Applications for insurance or other forms you complete;
• Your transactions with us, such as your payment history, claims history and investigation files, policy coverages and
limits;
• Your agent or broker;
• Consumer reporting agencies;
• Government agencies or independent reporting agencies, which may include motor vehicle reports, claims reports
and property inspections.
DISCLOSURE OF INFORMATION
We may in some circumstances, disclose the information collected about you to third parties. We do not disclose any
nonpublic personal information about you unless allowed by law. We provide your information to your agent or broker.
We do not sell or share your information with anyone for marketing purposes.
RIGHT TO ACCESS AND CORRECT INFORMATION
You have the right to access personal information collected about you. You have the right to correct any information which
may be wrong. If you want a more detailed description of our information practice, please write us at the address above. If
you want a more detailed description of your rights regarding the information we collect, please direct your inquiry to
MAPFRE INSURANCE COMPANY, 11 Gore Road, Webster, MA 01570 (Attention: Compliance Department).
CONFIDENTIALITY AND SECURITY
We protect your nonpublic information. Access to this information is limited to employees, agents, brokers and
subcontractors who must have it to provide products and services to you. We have information security programs to
protect the security, confidentiality and integrity of your nonpublic personal information.
YOUR AGENT OR BROKER
Your agent or broker is not subject to this privacy notice.
MUSZ 20030 (06/13) Page 1 of 1
MAPFRE INSURANCE
MAPFRE Insurance Company
11 Gore Road, Webster, MA 01570
BUSINESSOWNERS
FORMS SCHEDULE
POLICY NO: 8008030018717
ACCOUNT NUMBER:
NAMED INSURED AND MAILING ADDRESS AGENCY AND MAILING ADDRESS 20613
RAPID QUALITY CONSTRUCTION LLC NEILL & NEILL INS. AGENCY, INC.
102 LAUREN STREET 662 RIVERDALE STREET
WEST SPRINGFIELD, MA 01089 WEST SPRINGFIELD, MA 01089
POLICY PERIOD: FROM 11/01/2022 TO 11/01/2023 AT 12 01 AM STANDARD TIME AT YOUR MAILING ADDRESS
SHOWN ABOVE.
NOTE: IF NO ENTRY APPEARS ON THE FOLLOWING ENDORSEMENTS, INFORMATION REQUIRED TO
COMPLETE THE FORM WILL BE SHOWN ON THE SUPPLEMENTAL FORM DECLARATION IMMEDIATELY
FOLLOWING THE APPLICABLE ENDORSEMENT
BUSINESS OWNERS POLICY FORMS
BP0003 07-13 Businessowners Coverage Form
BP0417 01-10 Employment-Related Practices Exclusion
BP0419 07-13 Amendment - Liquor Liability Exclusion - Exception For
Scheduled Premises Or Activities
BP0501 07-02 Calculation Of Premium
BP0515 12-20 Disclosure Pursuant To Terrorism Risk Insurance Act
BP0524 01-15 Exclusion Of Certified Acts Of Terrorism
BP0564 01-15 Conditional Exclusion Of Terrorism (Relating To
Disposition Of Federal Terrorism Risk Insurance Act)
BP0578 01-10 Limited Fungi Or Bacteria Coverage (Liability)
BP0704 01-06 Business Liability Coverage - Property Damage Liability
Deductible (Per Occurrence Basis)
BP1504 05-14 Exclusion - Access Or Disclosure Of Confidential Or
Personal Information And Data-Related Liability - With
Limited Bodily Injury Exception
BP1560 02-21 Cyber Incident Exclusion
BP0108 03-11 Massachusetts Changes
BP0144 01-21 Massachusetts Changes - Intentional Loss
BP0698 07-13 Massachusetts - Fungi, Wet Rot Or Dry Rot Exclusion And
Limitations
MA164 12-19 Contractors Enhancer Endorsement
MA011 12-17 ASBESTOS EXCLUSION
MA012 12-17 LEAD EXCLUSION
11-01-22 Page 1 of 1
l'�.. .. L ILG l.V//L/LLV/I YVGuLL/L Vf 1►LL{JJL[LLiuuaeiia
^ Department of Industrial Accidents
-i;, ,1. Office of Investigations
'' =1°'' 6
Lafayette City Center
2 Avenue de Lafayette, Boston,MA 02111-1750
y4 ,
wwwmass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): /,3on Sts/41 eV
Address: /0,2 jiiere•h 57
City/State/Zip: Pi .5'iiI A7' D/0?7 Phone #: t__ d,5V/Z-1.4)
Are you an employer?Check the appropriate box: Type of project (required):
1.❑ I am a employer with 4. ❑ I am a general contractor and 1
employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.WI am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. El Demolition
working for me in any capacity. employees and have workers' 9. ['Building addition
[No workers' clomp. insurance comp. insurance.t
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.12 Roof repairs
insurance required.] t c. 152,§1(4),and we have no 13.0 Other
employees. [No workers'
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my emplol'eec. Below i.s the policy an.I job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic. #: 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 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 under the pains and penalties of perjury that the information provided above is true and correct.
Signature: 'l/.--L Date: id 7 .k
Phone#: 7/3 ., of-//7
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority(check one):
10Board of Health 212 Building Department 3❑City/Town Clerk 4.0 Electrical Inspector 5.0Plumbing
Inspector 6.0Other
Contact Person: Phone#: i
1
r.
in T 411"
S5
o firn� oo0
.- un w
THE COMMONWEALTH OF MASSACHUSETTS * 70°
Office of Consumer Affarrt and Business Regulation cQ trz , o.;
1000 Washingtllyrt - Suite 710 �" o
BostorE= d usetts 0 118 4ovoist\g' F a
Home Im ro . jj .s.;i..... Restration . ' g 5
(-i 7) meg=i 17(4
wIs"1 1 Type: Individual i N
JASON BOULANGER t # - e� ration: 194472
D/B/A RAPID QUALITY CONSTRUCTION (,".; E Oration: 04/17/2023 • A
102 WARREN ST. '` UM la k
WEST SPRINGFIELD, MA 01089 ........p ....w... •-
....5.. Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to:
TYPE: ri8ividual Office of Consumer Affairs and Business Regulation
Registration *. Expiration 1000 Washington Street -Suite 710
194472 - , 04/17/2023 Boston,MA 02118
4SON BOULANGER J�
/B/A RAPID QUALITY CON TR[.1IQTION
7 - 0
4SON T. BOULANGER
5 PRINCETON ST ""1(`� 1
IESTFIELD, MA 01085
Undersecretary Not valid without signature