18C-009 BP-2023-0741
286 HATFIELD ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
18C-009-001 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-2023-0741 PERMISSION IS HEREBY GRANTED TO:
2023 BASEMENT FLOOD
Project# REPAIRS Contractor: License:
DIAMOND RIDGE CONSTRUCTION
Est. Cost: 100000 LLC 103530
Const.Class: Exp.Date: 04/11/2025
Use Group: Owner: MALINOSKI BARBARA
Lot Size (sq.ft.)
Zoning: RI/RR Applicant: DIAMO RIDGE CONSTRUCTION LLC
Applicant Address Phone: Insurance:
80 WINDSOR POND RD N9WC390105
PLAINFIELD, MA 01070
ISSUED ON: 06/07/2023
TO PERFORM THE FOLLOWING WORK:
REPAIR WATER DAMAGE &ADD BATHROOM
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: .5.9
�gra
Fees Paid: $650.00
212 Main Street,Phone(413)587-1240,Fa :(413)587-1272
Office of the Building Commis ioner
.'‹cam
V /
�, 6, 4),•'I O
The Commonwealth of Massachus.i�,&,, cpO2
I Board of Building Regulations and Stand. `ii.-�'^/r, R
I 04, /I, MU CIPALITY
Massachusetts State Building Code, 780 CM' 47 sod USE
c
Building Permit Application To Construct,Repair, Renovate Or I:'.;T t., i a evised Mar 2011
One-or Two-Family Dwelling \
This Section For Official Use Only
Building,Permit Number: ge- .).- -- 7cii
/777
DatApplied:
4,,,, 4Z5 6-7 Zoz3
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: :, ,, 1.2 Assessors Map&Parcel Numbers
1.la Is this an accepted street?y•s 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:
Public El Private❑ Zone: Outside Flood Zone? Municipal❑ On site disposal system 0
Check if yes❑
SECTION 2:
2.1 (llillll! Jlihmrd• r
.,A '11-‘9 tL AUK y I O'A e P QTVA) I fi 0/b
Ian_ . 'C : .... ,
egg /-i.tip;{lb 5 IJ t zrjeLI ‘it ( Th
No.and Street UMW
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 f® ' osW) X Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Brkepairtwater tiamage
Approved by insurance claim. A P P F,'4-fvrE' b&i' ,Vom, r srFArr-
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ S Q OO v,mo 1. Building Permit Fee: $ Indicate how fee is determined:
f 0 Standard City/Town Application Fee
2.Electrical $ r SJ oe v,OB 0 Total Project Costa (Item 6)x multiplier x
3.Plumbing $ /OJ coo,00 2. Other Fees: $
4. Mechanical (HVAC) $ List:
}�ovo,no
5. Mechanical (Fire
Suppression) $ Total All Fee�:,$k �
Check No. 1 Check Amount:
6.Total Project Cost: 0 Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS I a 35 J 2 d 0(7i II a "
n ,/� I r �w
r
/ C •Q/lC e A C 11 C/t0,1/0 License Number Expiration Date
Name of CSL Holder
/,101. M ,„ Rya List CSL Type(see below)
�
No.and Street T •�'- Description
S i/O� /�� O/ j a Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State ZIP , ! Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
y i 3-7Y3 950g L ett✓rcnc i C l[��_tMGt1 GM I Insulation
Telephone Email address J► D Demolition
5.2 Registered Home Improvement Contractor(HIC) Igo )6 c.,/ �j
1_, W r P n�L M 1 C 11 4/{4!y l 0 HIC/Registration Number Expiration Date
HIC Company Name or HIC Registrant/Name
i / -a- M1, . Aan4 Litt 1ip&ice Alt'C 0141'01-pv.:1.69/1 r
N and Street
Savo A & c7a5 6 Li/3�T�-/3-15ot� Email address
City/Town,Sttate,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 m No .❑
• $ ".rr* t#t►.. TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize /JII A 14 e cd l!S L 4 C
to act on my behalf,in all matters relative to work authorized by this building permit application.
liii2e42/14- OALYUCC40 .34 /(9
(Elutronie st) 1
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. .
--a---1&—S-------1//CLCks i1'1 ,/r1 t(i) 3)91,,?,3
Print Owner's orb Name(Electronic Signature) 4
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 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"
R
City of Northampton
V ,i,.M�MpTo
S S
% ti Massachusetts �<i�5� I. °'<<
p - y• 4 , DEPARTMENT OF BUILDING INSPECTIONS A. ,�
�' 212 Main Street • Municipal Building y'. QD
+' Northampton, MA 01060 'Ts'ph' Se3C
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: Northampton Massachusetts
The debris will be transported by:
Name of Hauler: /1/0 f)S iD// OF 'S
Signature of Applicant: Date: a 34 7/ .2
ate.\
�.. The Commonwealth of Massachusetts
n=MA''a
r `.Vt=(.. Department ojlwdrsdia/Accidel Accidents
•
Fee= I Congress Street,Suite 100
•
Boston, MA 02114-2017
)t'PL'H.ntas:s.gov/dia
11 orkers' (situp nsat Insurance.11 idat it: Builders/Co tr ctors/Ekelricians Plumber..
I t)HI. I ILEI) %tilt I III. PERM!I f1NG AUTHORITY.
Applicant Information Please Print l.egibl.
Nameniuinc organrzatuaintividual : Diamond Ridge Construction LLC
Address: 80 Windsor pond road
Cityfstate 7_ip: 01070 p}t„t,, „ 413-347-2732
t.re tun an emplu,rr:'I hark the apprupnate bus: Type of project(required):
10 I am a enipkn tz„eth employees trod and or part-time • ]_ Nc% construction
-'.LJ I am a suk pnrptxtor or purtnrshtp and have no cniptusee..urkutg for me in K. ®Remodeling
am,capacity.(No worker.'chirp.insurance repined]
9. ❑Ihnx►htton
t,O I am a humouwrr-r doing all um,.myself.(No Murkurs-cutup.insurance nogwrni.(°
4.0 I am a homeowner and will be luring VonicLns to conduct all sttk on in property. I w ell
10 Q Building addition
ra
ensue that all contractor.either haw Market.'comp.-nsatk+n insurance or are sole 11.0 Electrical repairs or additions
propncturs w ith no emplosces.
12.EI Plumbing repairs or additions
50 I am a geraral contractor and I hat e hued the sub-contractor.listed on the attached sheet.
13 Roof repair,
These sub-contractors tease cmplowt..and hate%,u t►ar comp.insurance. Repair water
iw
14. )thei
6.0 W.are a ca pation and its ofTatrs hate exercised their nght of exemption per WiL e. damage
I5?§1(�),and we hase no eaiplu�ees.(No wur►ers'camp.insurance required(
•Ms applicant thai checks box=I must also till out die section below slime mg their worker,'compensation pubes inhumation.
*hairs m nets who submit this aitida'it indicating they arc doing all Mark and then here outside cotitr.Ntors must submit a new atfida,it indicating suck
:Contractors that check this box must attached an additional sheet sh tt mg the name at the sub-contractors and state weather or not those tailtties hate
cinpko:tees. It the sub-contractors his emplmees.they must pn+side door Morkers-comp.pubes number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Conipan. Name: Bi Berk business insurance _
Policy#or Self-ins.Lie.#: N9wc3901 05 fixptration Date: 02/15/24
lob Site Address: 286 Hatfield Street City/State Zip: 01060
Attach a copy of the workers'compensation policy declaration page(shim ing the polio 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 S1,500.00
and'sir one-year imprisonment.as well a!,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 of Investigations of the DIA for insurance
coverage verification.
l do hereby cern:ft under the pains and penalties of perjury that the information provided above is true and correct.
Signature: late:
phone#: 413-347-2732
Official use only. Do not write in this area.to be completed by city or town official
('its or fuss n: Per ti License
Issuing.‘uthurit. (circle one):
I. Board of Health 2.Building Department 3.('ityfhown Clerk 4. Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone N.
Worker's Compensation and Employer's Liability Policy
Berkshire Hathaway Direct Insurance Company - A Stock Co.
Policy Number N9WC390105
Renewal of NEW
NCCI No. [11754],
Policy Information Page
[1]Named Insured and Mailing Address
Diamond Ridge Construction LLC
80 Windsor pond road
Plainfield, MA 01070
Federal Employer's ID XXX-XX-0298 Insured is Limited Liability Co. (LLC)
Business Description Construction: General Contractor
[2] Policy Period
From February 15, 2023 to February 15, 2024, 12:01 AM, standard time at the insured's mailing address.
[3] Coverage
A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation
Law of the following states: Massachusetts
B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed
in item [3]A. The limits of our liability under Part Two are:
Bodily Injury by Accident - each accident $100,000
Bodily Injury by Disease - each employee $100,000
Bodily Injury by Disease - policy limit $500,000
C. Other States Insurance - Part Three of this policy applies to all states, except any state listed in
item [3]A. and the states of North Dakota, Ohio, Washington, and Wyoming.
D. This policy includes these endorsements and schedules:
See Extension of Information Page - Schedule of Forms
[4] Premium
The Premium Basis and, therefore, the premium will be determined by our Manual of Rules,
Classifications, Rates, and Rating Plans. All required information is subject to verification and change by
audit. (Continued on another page)
Total Estimated Policy Premium $ 4,936
Total Surcharges/Assessments $ 218.00
Total Estimated Cost $ 5,154.00
INTERNAL USE XX Page- 1 - Information Page
MGA : N9WC390105 WC 000001A
Date : 02/14/2023
MANOTE
Issuing Office: 100 First Stamford Place, PO Box 113247,Stamford,CT 06911-3247 •www.biBERK.com
Includes copyright material of the National Council on Compensation Insurance, Inc. used with its permission
. .4k3PFEIE I INSURANCE,.
MAPFRE Insurance Company
11 Gore Road, Webster, MA 01570
BUSINESSOWNERS
DECLARATION
New Business
POLICY NO: 8008030019255
Agency Code : 20325
ACCOUNT NUMBER:
NAMED INSURED AND MAILING ADDRESS AGENCY AND MAILING ADDRESS
DIAMOND RIDGE CONSTRUCTION LLC FINCK & PERRAS INS. AGENCY, INC.
80 WINDSOR POND ROAD SIX CAMPUS LANE
PLAINFIELD,MA 01070 EASTHAMPTON, MA 01027
POLICY PERIOD: FROM 04/03/2023 TO 04/03/2024 AT 12:01 AM STANDARD TIME AT YOUR MAILING ADDRESS SHOWN
ABOVE.
THE NAMED INSURED IS: Limited Liability BUSINESS DESCRIPTION: remodeler
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 80 Windsor Pond Road, Plainfield, MA 01070
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 % 25% $1,000 $23
Personal
Property
US DEC 1000 12 15 Page 1 of 3
FRE I INSURANCE'P '
BUSINESSOWNERS
DECLARATION
New Business
POLICY NO: 8008030019255 EFFECTIVE DATE: 04/03/2023
INSURED:DIAMOND RIDGE CONSTRUCTION LLC AGENT: FINCK & PERRAS 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, $ 1,000 $ 500 N/A %
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 $ 10,000 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 $ 5,254
Deductible
Optional Property Damage Liability Deductible: $ 500
US DEC 1000 12 15 Page 2 of 3
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