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32C-285 (9) BP-2023-0553 110 WILLIAMS ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32C-285-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREG STERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) + BUILDING PERMIT Permit# BP-2023-0553 PERMISSION IS HEREBY GRANTED TO: Project# BATH RENO 2023 Contractor: License: Est.Cost: 18000 WRIGHT BUILDS S 115196 Const.Class: Exp.Date: 05/31/20 4 Use Group: Owner: GIB IN,M.BERNADETTE &VALENTA, JOHN Lot Size (sq.ft.) Zoning: URC Applicant: WRIGHT BUILDERS Applicant Address Phone:, I Insurance: 48 Bates St 413586-8287 MCC20020005342021A NORTHAMPTON, MA 01060 ISSUED ON: 05/02/2023 TO PERFORM THE FOLLOWING WORK: BATH RENO 2023 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: �, I I II Fees Paid: $117.00 212 Main Street,Phone(413)587-1240,Fa : (413)587-1272 Office of the Building Commis ioner ',Ar ernall WitAl eltff4/ I .m• / r'4 '- 4r, ,,, 1 '. 1 1 / I The Commonwealth of Massachtisetti pt W. Board of Building Regulations and Staridarag°T ouit��Nc 1PALITY Massachusetts State Building Code, 780 CMR `ZtoN Mqp c /USE Building Permit Application To Construct,Repair,Renovate Or DemolisTi`a°. tevised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 8 p•A 3.55.3 Date Applied: a' ► a_44 3 Building Official(Print Name) I Signature / D e SECTION 1: SITE INFORMATION 1 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 110 Williams St 32C 285-001 1.1 a Is this an accepted street?yes x no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: URC URC Existing to remain Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) i Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided ETR ETR ETR 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: >✓.8 Sewage Disposal System: Public El Private 0 _Zone: Outside Flood Zone? Municipal la On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Bernadette Giblin / John Valenta Northampton, MA 01060 Name(Print) City,State,ZIP 110 Williams St 413-387-3428 serene.storm@hotmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) D Alteration(s) ® Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify: Brief Description of Proposed Work': Remove existing tub/sh wer in 2nd floor bathroom. Replace wit tiled shower alcove . Replace existing toile . Repair to existing conditions . SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $8, 000 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 10, 000 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: Check No.Ligheck Amount: (`1 Cash Amount: 6.Total Project Cost: $ 18, 000 ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C S-11519 6 0 5/31/2 4 Ryan Crandall License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 492 State Street No.and Street Type Description Belechertown, MA 010 60 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 802-233-9062 rcrandall@wright-builders.corn I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 6/2 5/2 4 101536 Wright Builders, Inc. HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 48 Bates St rcrandall@wright-builders.com No.and Street Email address Northampton, MA 01062 413-586-8287 City/Town,State,ZIP Telephone SECTION 6:WORKERS' COMPENSATION INSURANCE AFFID4.VIT(M.G.L.c. 152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted wi-h this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes ® No . ❑ 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 Wright Builders, Inc . to act on my behalf,in all matters relative to work authorized by this building permit application. John Valente 5/1/2023 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. Ryan Crandall 5/1/2023 Pri wner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. 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 HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found 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 robm count Number of fireplaces Number of bedrooms Number of bathrooms Number of b alf/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" __ City of Northampton ; S r. ��•.. Massachusetts 4� c<- C. ,; ,� 0 1 DEPARTMENT OF BUILDING INSPECTIONS �'., ' . Y .. for 212 Main Street • Municipal Building yJ J. C•' 7V Northampton, MA 01060 '1sbW N'‘`� 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: Valley Recycling, 234 Easthampton Rd. Northampton, MA The debris will be transported by: Name of Hauler: Wright Builders, Inc . Signature of Applicant: �� Date: 5/1/23 The Commonwealth of Massac4usetts Department of Industrial Accidents • Office of Investigations (Wl= 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Wright Builders, Inc. Name(Business/Organization/Individual): Address:48 Bates Street City/State/Zip:Nothampton, MA 01060 Phone#:413-586-8287 Are you an employer? Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 23 4. ❑ I am a general contractor d I 6. ['New construction employees (full and/or part-time).* have hired the sub-contract rs 2.❑ I am a sole proprietor or partner- listed on the attached sheet., 7. %Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in anycapacity. employees and have workers' P tY 9. ❑Building addition [No workers' comp.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 MGM 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other 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 employees. Below is the policy and job site information. Insurance Company Name:A.I.M Mutual Ins CO. Policy#or Self-ins. Lic.#:MCC-200-2000534-2023A Expiration Date:3/1/2024 Job Site Address: 110 Williams St City/State/Zip:Northampton, MA 01062 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 c ' under e pains and penalties of perjury that the information provided above is true and correct. 5/1/2023 Signature: Date: Phone#: 41 -586-8287 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#: • Construction Supervisor Commonwealth of Massachusetts Unrestricted -Buildings of any use group which contain i. Division of Professional Licensure less than 35,000 cubic feet(991 cubic meters) of enclosed •` Board of Building Regulations and Standards space. .i r Construdt oh Supervisor CS-115196 ires:05/31/2024 RYAN J CRANDALL 482 STATE STREET ,,i 1 BELCHERTOWN MA 01.007 • , • C. tti* . • i Failure to possess a current edition of the Massachusetts �' 'F4'S':�i:!C''`� State Building Code is cause for revocation of this license. c / For information about this license Commissioner cicv,/o. /. D�imc�.'. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: 101536 WRIGHT BUILDERS, INC. Expiration: 06/25/2024 48 BATES STREET NORTHAMPTON,MA 01060 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:Corporation Office of Consumer Affairs and Business Regulation -13egistration Expiration 1000 Washington Street -Suite 710 101536 06/25/2024 Boston,MA 02118 WRIGHT BUILDERS,INC. SETH LAWRENCE-SLAVAS 48 BATES STREET z„?. !;,U 4" NORTHAMPTON,MA 01060 Undersecretary Not valid without signature —""" WRIGBUI-01 ALYSSA "et CCORif) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 3/20/2023 -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 Alyssa Perusse ........... Phillips Insurance Agency,Inc. PHONE 1 FAX 97 Center Street (A/C,No,Ext): 1 (A/C,No): Chicopee,MA 01013 E-MAIL SS al hllll SInsuranCe.Com ADDRESS: Y @p p I INSURER(S)AFFORDING COVERAGE NAIL#, INSURER A EMCL Insurance Companies 121415 INSURED Ili INSURER B:Mas achusetts Employers Insurance Company Wright Builders,Inc. INSURER C s _ I 48 Bates Street INSURER D: Northampton,MA 01060 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 3Y PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR1 POLICY NUMBER ! POLICY EFF POLICY EXP LIMITS LTR INSR WVD' '(MMIOD/YYYY)I(MMIDD/YYYYI A X COMMERCIAL GENERAL LIABILITY j 1,000,000 . _EACH OCCURRENCE � $ CLAIMS-MADE I X OCCUR3/1/2023 DAMAGE TO RENTED 500,000 1 _ 3/1/2024 I_PREMISES I$_ ___ I6D18616 10,000 MED EXP.,(Any one person) __. ___ ......................... PERSONAL&ADV INJURY ,._$_ 1,000,000 GEN'L AGGREGATE LIMIT AP PLIES PER: GENERAL AGGREGATE $ 2,000,000 JECT �( PRO- LOC PRODUCTS-COMP/OP AqG $ 2,000,000 POLICY X __ �EMPLOYEE BENEFI -$ 1,000,000 A ' OTHER: COMBINED SINGLE LIMIT ,ACUTO N O AUTOMOBILE ,„„(Ea accide..nt)LIABILITY $. j 6Z18616 3/1/2023 3/1/2024 BODILY INJURY(Per perso(i) $ OWNED SCHEDULED 1 1000,000 AUTOS ONLY AUTOS ! ! BODILY INJURY(Per accident)1$ ' HIRED NON-OWNED PROPERTY DAMAGE I AUTOS ONLY AUTOS ONLY I per accident) ... $. .— I I I $ A X EXCESS LABAB X CLAIMS-MADE 6J18616 3/1/2023 3/1/2024 EACH OCCURRENCE $ UMBRELLA 5,000 000 5,000,000 . ._. AGGREGATE $.. DED 1 X . RETENTION$ ,000 10 $ B WORKERS COMPENSATION MCC-200-2000534-2023A 3/1/202 E.L.EACH ACCIDENT ORH AND EMPLOYERS'LIABILITY I STATUTE 3 X I 1 ANYPROPRIETOR/PARTNER/EXECUTIVE YJN 3/1/2024 500,000 OFFICER/MEMBER EXCLUDED? ' N N/A! --- $- --- j(Mandatory in NH) 1.._......._. .E.L.DISEASE EA EMPLOYEE $I 500,000 If yes,describe under !, E.L.DISEASE-POLICY LIMIT $ 1,000,000 'I DESCRIPTION OF OPERATIONS below 1 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) 1 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 -'o - ; '-., 1 I 1 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD