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38D-020 (5) BP-2023-0184 36 HAMPDEN ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38D-020-001 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-2023-0184 PERMISSION IS HEREBY GRANTED TO: Project# BEM-2020-001.240 Contractor: License: Est. Cost: FIRETEK INC Const.Class: Exp.Date: 5C 'Z 0 0 Y Use Group: Owner: Lot Size (sq.ft.) Zoning: SC Applicant: FIRETEK INC Applicant Address Phone: Insurance: 140 UNION ST WWC 3578686 VERNON, CT 06066 ISSUED ON: 02/14/2023 TO PERFORM THE FOLLOWING WORK: INSTALL 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 VIO ATION OF ANY OF ITS RULES AND REGULATIONS. Signature: A . .>2 • 5'5) 5 Fees Paid: $ 212 Main Street,Phone 413 587-1240 Fax: (413)587-1272 Office of the Building Commissioner �ECF i f FEB 14 �y, T e Commonwealth of Massachusetts i'�1 2[ Office of Public Safety and Inspections fip7 pF Massachusetts State Building Code(780 CMR) °F�T`MA � T, • it Ajbplication for any Building other than a One-or Two-Family Dwelling 01060 �3 (This Section For Official Use Only) Building Permit Number: ate Applied: Building Official: SECTION 1:LOCATION 36 Hampden St. Northampton 01060 No.and Street City/Town 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 Ei or check all that apply in the two rows below Existing Building 0 Repair 0 Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use ❑ Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes l No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No Brief Description of Proposed Work Install a NFPA 13D sprinkler system in the new town homes. 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.) 2 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❑ A-5❑ B: Business 0 E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 P 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 0 R-4❑ 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 IB0 IIAO IIB 0 IIIAO IIIB 0 IV 0 VA El 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 l Check if outside Flood Zone 0 Indicate municipal CIA trench will not be Licensed Disposal Site 0 Private 0 or indentify Zone: or on site system 0 required 0 or trench or specify: 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❑ Yes 0 or No M Yes❑ N3 ❑ 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 Pioneer Development LLC 32 Perkins Ave Northampton 01060 Name(Print) No.and Street City/Town f r Zip Property Owner Contact Information: Danelle McKahn-Managing Partner _ _ 413-320 -7208 danimckhant gmail.com 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 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 FireTek, Inc. Company Name Christopher Pope SC-210044 Name of Person Responsible for Construction License No. and Type if Applicable 140 Union St. Vernon CT 06066 Street Address City/Town State Zip _ 413. 530 _1510 cpope@firetek.us 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 O No D SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ Building Permit Fee=:$tal ns Cost x (Insert here 2.Electrical $ appropr1 mu ipa t - . 3.Plumbing $ ��`` 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ (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 the best of my knowledge and understanding. Chris Pope cf'Gr(/S- President 413 530 1510 2/14/23 Please print and sign name Title Telephone No. Date 140 Union St. Vernon CT 06066 cpope@firetek.us Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: /L/��Z 2 tLtzoz3 r Name Date Q( � ,..f4 rG1-- (,urGtCAt., L-tti/dolj 4z'9v ' 7 -aaa -2s zy 1416 City of Northampton Massachusetts k l ,:tDEPARTMENT OF BUILDING INSPECTIONS h At 212 Main Street • Municipal Building i Northampton, MA 01060 tNlY � : 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: _ The debris will be transported by: Name of Hauler: Signature of Applicant: Date: ai!.....' The Commonwealth of Massachusetts ,4 - ' V— ...I., 4 --- ii Department of Mdttstrial Accidents I Congress Street,Suite 100 Boston, Atti 01114-2017 wwwmass.govidia %%inters'compensation Insurance Affidavit:Builders/(outractorsiF.kctricianst Plumbers. It)BE FIILED NVII'11111E PEIVAIIIIING All'ilORITY. Applicant Information Please Print I.euilth Name 1 Busint-s.s Organization,Indtvadual): FireTek,Inc. Address; 140 Union St. CityfStatefZip: Vernon,CT 06066 Phone#: 413-530-1510 Ate you an tantilaryer?Cheek the Appropriate twari.: 11),pe of project(required): la i am a ratplo!.'cr with 8,, employees(full and'oe pari-tiniel.* 7, 0 New construction 2[3 1 am a)u1c pturnictut m partttenhip and have/kJ crimloyees working for me an 8. 0 Remodeling any capacity.No workers comp.insurance leitered...1 9. 0 Demolition 30 1 am a lumvart4n4.i doing all wort myself,fNo worites'aunty.../thorax:Lc requireil• I 0 CI Building addition 4.r3 1 am u Imam-v*11a-and will be limn contrat.iyars to conduct all work on rity property I will ....mum that all contractors either have workers-comperegraton nuunance 1St al,C sole 1 I 0 Electrical repairs or additions prupmlerl.lk ith no emplovem. l 2.0 Plumbing repairs or additions ..{-3 I.a,czteral contractor and I have hired the sub-contnietors listed on the attadied sheet 13.Ei Roof repairs These sub-counnetors Eiles,1:Cinployer.and have workers'comp.ISSUISIWC.: 6.0 We art a corpora:nun and Its officer.have exy.'re-iiied their nglu of exemption per IYIGL c. 14.[]Other 152,§it4j.,and we have no employem[No ventkers•comp.inmanaracc minipill.] 'Any appbeent that cheeks hat.el mum also till nut the weetiere below showing their worm'cornpere.at ion policy incur motion.. *Homerwners who submit tins affidavit indicating they arc doing all work and then here outside comm.:tors mint submit a new affidavit andicaing such. leontna:top,that check thin hay most attalred an addition:13 sheet show mg the name a Cite suh-concracioes and stare whether or not those entitks.have employ cc,. It Ilw sialv-contractory.ha)c euiployees.they mum[vow rile their A orkcN-comp 1.5k..h42"y numh.r.. . ...._. — I am an employer that Ls providing workers'compensation insurance for my employees_ Below A the policy and job size information. Insurance Company Name: WESCO Insurance Co. Policy#or Self-ins.Lk. .' WWC 3578686 Expiration Date: 4/13/22 Job Site Address: 36 Hampden St. Ctty(Slate.,Zip:_Northampton MA 01060 Attach a cops of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage2M required under M(.iL t:. 152,§25A is a criminal violation punishable by a fine up to 51,500.00 and'or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the 01Tioe of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the informadon provided above is true and correct Clur is- Pot>e- siimature: Date: 2/14/23 phone , 413-530-1510 Official use only. Dv not wrile in ilti.% area.to lie iiAmpleted hy city or town official. (it.) or Town: PermitiLierense# ____ Issuing Authority (circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspccoir 6.Other • Contact Person: Phone 4:. I * Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the ninth edition of the m Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Date: Property Address: Project: Check tx,one or both as applicable_ New construction Existing Construction Project description: I MA Registration Number: Expiration date: ,am a registered design pro fessionat,and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning:: 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 buildixg 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: Email: Building Official Use Only Building Official Namo Permit No.: Date: Note 1.Indicate with an'x'project desi��r,►plans,computations and specifications that you prepared or directly s if'other'is chosen,provide a desaiption. Version Ol Ol 2018 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 x 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 x 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) 21 Other(Specify) 22 Other(Specify) *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 William Cieslak 413_531 _7832 wcieslak@nefiresystems.com 45999 Name(Registrant) Telephone No. e-mail address Registration Number 140 Union St. Vernon CT 06066 FP 6/30/2023 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. FIREINC-01 JOCELYN ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD YYVY) �-� - 4/14/2022 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 Jocelyn M Douglas NAME: Phillips Insurance Agency, Inc. PHONE FAX 97 Center Street (A/C,No,Ext): (A/C,No): Chicopee, MA 01013 E-MAIL jocelyn@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Wesco Insurance Company INSURED INSURER B: Firetek,Inc. INSURER C: 140 Union Street INSURERD: Vernon,CT 06066 INSURER E: 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 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 NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD ,IMM/DD/YYYYI (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTEDPREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECOT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILECOMBINED SINGLE LIMIT LIABILITY (Ea accident) $ _ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOS ONLY AUUTNOASyy HIED ONLY AUTOS O BODILY INJURY(Per accident) $ AUTOS _ ANELYY (Perr a E ident�AMAGE UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ A WORKERS COMPENSATION X PER AND EMPLOYERS'LIABILITY WC3578686 4/13/2022 4/13/2023 STATUTE ER Y/N W 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? T N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY II,IMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers Compensation Policy includes coverage for the following states: MA,CT CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence 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