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110 Pleasant BP-20-812I IO PLEASANT ST GIS #: Map:Block: 32C -047 Lot: -00 I Permit: Building Category: renovation BP-2020-0812 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON PERSONS CONTRA CTING WITH UNREG ISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2020-0812 Project # JS-2020-001403 Est. Cost: $154000.00 Fee: $1078.00 Const. Class: Use Group: Lot Size(sq. ft.): 9713.88 Zoni ng: CB( I 00)1 PERMISSION IS HEREBY GRANTED TO: Contractor: License: MAROIS CONSTRUCTION CO INC 060872 Owner: RESIN ATE OF NORTHAMPTON Applicant: MAROIS CONSTRUCTION CO INC AT: 110 PLEASANT ST Applicant Address: Phone: Insurance: 262 OLD LYMAN RD (413) 533-1320 Workers Compensation SOUTH HADLEYMA01075-2653 ISSUED ON:1/21/2020 0:00:00 TO PERFORM THE FOLLOWING WORK:INTERIOR RENO TO CREATE OPEN FLOOR PLAN 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: Dri veway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building I /2 1 /2020 0:00:00 $ I 078.00 2 12 Main Street, Phone ( 413) 587-1240, Fax: ( 413) 587-1 272 Louis Hasbrouck -Building Comm issioner File # BP-2020-0812 APPLICANT/CONT ACT PERSON MAROIS CONSTRUCTION CO INC ADDRESS/PHONE 262 OLD LYMAN RD SOUTH HADLEY (413) 533-1 320 PROPERTY LOCATION 110 PLEASANT ST MAP 32C PARCEL 047 001 ZONE CB(IOO)/ ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out Fee Paid T eofConstruction: INTER10R RENO TO CREAT New Construction Non Structural interior renovations Addition to Existino Accessory Structure Building Plans Included: Owner/ Statement or License 060872 3 sets of Plans / Plot Plan EQUIRED DATE THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN~RMA TION PRESENTED: _\/_I-Approved __ Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ __________ _ Intermediate Project: ____ Site Plan AND/OR ____ Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER:§ _________ _ Finding _____ _ Special Permit _____ ~~ Variance* ___ _ ____ Received & Recorded at Registry of Deeds Proof Enclosed. ____ _ ___ Other Permits Required: Sign Curb Cut from DPW ---____ Water Availability ____ Sewer Availability ___ Septic Approval Board of Health ____ Well Water Potability Board of Health ___ Permit from Conservation Commission ___ Permit from CB Architecture Committee ___ Permit from Elm Street Commiss ion ___ Demolition Delay ____ Permit DPW Storm Water Management , /r;;..1/r;)o Date I I Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. · * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. Vers10nl.7 ornrnerc1a Bm !Iljl enmt av ' C . I ·1a· P . M 15 2000 Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit - 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING SECTION 1 • SITE INFORMATION 1.1 Property Address: [Tib Pleasant ·street - L ____ _ OTHER THAN A ONE OR TWO FAMILY DWELLING This section to be completed by office -, Map ~c Lot O'i7 Unit i J Zone Overlay District Elm St. District CB District SECTION 2 • PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: [Resinate Norffiampton --------- Name (Print) Signature -. Item com 1. Building 2. Electrical r-- 3. Plumbing 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) [T20 Gilbola Street Current Mailing~Ad_d_re_s_s_: ------------~ [Douglas, MA 01516 Telephone j262 Old Lyman Road Current Mailing Address: !South Hadley Ma 01075 Telephone 110,000.0~ s:soo.oo] Official Use Only (a) Building Permit Fee (b} Estimated Total Cost of Construction from 6 Building Permit Fee Check Number This Section For Official Use Onl Building Permit Number bf .. Date Issued Date Versionl.7 Commercial Building Permit May 15, 2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations D Existing Wall Signs 0 Demolition D Repairs izf' Additions D Accessory Building D Exterior Alteration D Existing Ground Sign D New Signs D Roofing D Change of Use D Other D Brief Description Renovate existing building interior as per attached plans. The work includes selective demolition of existing walls for new open floor plan. Misc. upgrades to MEP's Of Proposed Work: . ·- SECTION 5 • USE GROUP AND CONSTRUCTION TYPE I USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly D A-1 D A-2 D A-3 D 1A D A-4 D A-5 D 18 D B Business 0 2A D E Educational D 28 I D F Factory D F-1 D F-2 D 2C D H Hiqh Hazard D 3A D I Institutional 0 1-1 0 1-2 0 1-3 0 38 0 M Mercantile 0 4 0 R Residential 0 R-1 0 R-2 0 R-3 0 5A 0 S Storage 0 S-1 0 S-2 0 58 D U Utility 0 Specify: I I M Mixed Use 0 Specify: I I S Special Use D Specify: I I COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND/OR CHANGE IN USE Existing Use Group: t? __ Proposed Use Group: ~ __ ---] Existing Hazard Index 780 CMR 34 ):@=.----1 Proposed Hazard Index 780 CMR 34): l4 J SECTION 6 BUILDING HEIGHT AND AREA I BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1•t l - ~-2450J 1st I _Ng ------ 2nd I I 2nd I 3rd I I 3rd I I 4th I I 4th I I Total Area (sf) ,-24501 Total Proposed New Construction /sf) -l 25001 Total Height (ft) '-----~ Total Height ft l 161 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public 0 Private O Zone I I Outside Flood Zone[Z) Municipal 0 On site disposal systemO Versionl.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON WNING I Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size I 11 11 I Frontage I I 11 Setbacks Front c=J c=J c=J Side L:c=J R:c=J L:c=J R:c=J c=J c=J ------------ Rear c=J c=J c=J Building Height c=J c=J c=J Bldg. Square Footage c=J c=J % c=J c=J c=J Open Space Footage c=J c=J % c=J c=J c=J (Lot area minus bldg & paved parking) # of Parking Spaces c=J c=J c=J Fill: I I (volume & Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ® DON'T KNOW O YES 0 IF YES, date issued: '~-----~ IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES 0 IF YES: enter Book I j Pagel.__ ___ ...., and/or Document # ..... I _____ __. B. Does the site contain a brook, body of water or wetlands? NO @ DON'T KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: ,_j _____ __. C. Do any signs exist on the property? YES ® NO 0 IF YES, describe size, type and location: Existing 2' x 5' wall mounted building sign D. Are there any proposed changes to or additions of signs intended for the property? YES @ NO Q IF YES, describe size, type and location: ..... IR_e_p_1a_c_e_e_xi_st_in_g_w_i_th_n_e_w_si-gn_. ___________ ~I E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO @ IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15 , 2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES -FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: L --=_ _l Not Applicable 0 ---------·----- - -----I I Nam~ (~egistrant)_: _ ! -------i Registration Number I I Address [-J Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): I I I I Name Area of Responsibility I I I I Address Registration Number I I I I Signature Telephone Expiration Date I I I I Name Area of Responsibility I I I I Address Ref:!istration Number I I I I Signature Telephone Expiration Date I I I I Name Area of Responsibility I I I I Address Registration Number I I I I Signature Telephone Expiration Date I I I I Name Area of Responsibility I I I I Address Registration Number I I I I Signature Telephone Expiration Date 9.3 General Contractor -----!Marois Co~struction --I Not Applicable D Company Name: ~arl Mercieri -----I Responsible In Charge of Construction --p62 Old Lyman Road South Hadley, Ma 01075 I ~ - . ~13 53 3 13~2] . Signature Telephone Versionl.7 Commercial Building Permit May 15, 2000 SECTION 10-STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes Q No ® SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, [Peter Decaro , as Owner of the subject property h b h . ~ois Construction -Carl Mercieri J ere y aut onze,..!::~=============================---.:==---.:==-==.c:=-==---= to act on my behalf, in all matters relative to work authorized by this building permit application-· ___ _ ..:_A-=-~==--=----=-~-=~:..=::::.=:.....:..:__ ____________ _:c.=[1=11=s1=20=20=======J Signature of Owner Date I, !Marois Construction -Carl Mercieri , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. - Date SECTION 12 -CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: . 'Carl Mercieri --] Name of License Holder :.~l':":========e=:..=::========--====-=' 1413 533 1320 Telephone Not Applicable D jCS-060872 License Number SECTION 13 -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 Q City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: ././d ~~ ~d The debris will be transported by: W&s.k ~~61/£ The debris will be received by: Building permit number: Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Marois Construction Co, Inc. --------------------------------- Address: 262 Old Lyman Road City/State/Zip: South Hadley, Ma 01075 Phone #: 413 533 1320 Are you an employer? Check the appropriate box: l.[2:J I am a employer with 50 employees (full and/or part-time).* 2.0 I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.o I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4.o I an1 a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.0 I an1 a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers' comp. insurance.I 6.o We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. D New construction 8. O Remodeling 9. D Demolition 10 D Building addition 11.0 Electrical repairs or additions 12. D Plumbing repairs or additions 13.0Roofrepairs 14.00ther _______ _ * Any applicant that checks box # I 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 employees. Below is the policy and job site information. Insurance Company Name:_A_I_M_M_u_t_u_a_l ______________________________ _ Policy# or Self-ins. Lie. #: MCC2002000336 Expiration Date:_1_11_12_0_2_1 ____ _ Job Site Address: 110 Pleasant Street City/State/Zip: Northampton Ma 01060 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 $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 $250.00 a day against the violator. A copy of this statement may be forwarded to the Office oflnvestigations of the DIA for insurance coverage verification. Si Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: _________________ Permit/License# _______________ _ Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other --------------- Contact Person: ____________________ Phone#: _______________ _ A.CORD~ CERTIFICATE OF LIABILITY INSURANCE I DAlE (MM/DD/YYYY) ~ 1/14/2020 THIS CERTIFICATE IS ISSUED AS A MATIER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 NAME7~' Sarah Premo Martin J Clayton Insurance Agency, Inc. PHONE (413)536-0804 I FAX IAIC No Extl: IAIC Nol: 14131534-7874 1649 Northampton Street !~cfJ~ss: spremo@mj clayton. com P . 0. Box 989 INSURER{Sl AFFORDING COVERAGE NAIC # Holyoke MA 01041-0989 INSURER A: Hanover Insurance Company INSURED INSURER B: AIM Mutual Insurance Company Marois Construction, Inc. INSURERC : 262 Old Lyman Road INSURERD : INSURERE : South Hadley MA 01075 INSURERF : COVERAGES CERTIFICATE NUMBER:2020 MASTER 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. NOTVl/1THSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO INHICH 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 Auu~ ,~ucn POLICYEFF POLICY EXP LlR ,,.,.,n lu,un POLICY NUMBER IMM/DD/YYYYI IMM/DD/YYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A I CLAIMS-MADE [i] OCCUR LJAMAGI: IU HEN I c:u $ 100,000 PREMISES !Ea occurrence\ ZDN6251989 1/1/2020 1/1/2021 -MED EXP (Any one person) s 10,000 PERSONAL & ADV INJURY $ 1 ,000,000 -GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 3,000,000 Fl 0PRO-OLoc PRODUCTS-COMP/OPAGG 2,000,000 POLICY JECT $ OTHER: PremsasJOperations $ AUTOMOBILE LIABILITY c;uMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) -ANY AUTO BODILY INJURY (Per person) $ A ,__ ALL OWNED X SCHEDULED AMN6632273 1/1/2020 1/1/2021 BODILY INJURY (Per accident) $ ,__ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS <Per accident\ ,__ >--AUTOS $ X UMBRELLA LIAB MOCCUR EACH OCCURRENCE $ 5 000,000 ,__ A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTION s 0 UHN6251990 1/1/2020 1/1/20121 $ WORKERS COMPENSATION XI ~ffTuTE I I OTH- AND EMPLOYERS' LIABILITY ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE D NIA E.L. EACH ACCIDENT $ 500 000 OFFICER/MEMBER EXCLUDED? B (Mandatory In NH) MCC2002000336 1/1/2020 1/1/2021 E.L. DISEASE -EA EMPLOYEE $ 500,000 If yes. desaibe under E.L. DISEASE· POLICY LIMIT DESCRIPTION OF OPERATIONS below $ 500 000 A Installation Floater ZDN6251989 1/1/2020 1/1/2021 In Transit $352,200 Deductible $1000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mo,e apace Is requlredl CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE RESINATE 110 PLEASANT NORTHAMPTON, I ACORD 25 (2014/01) INS025 (2014011 STREET MA 01060 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Michael Regan/FMT ~p~ © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD rzo C, L6<J4-s~ 'DQJ(/16 ~19, 0/SI ~