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18D-028 (7) BP-2023-0740 8 NORTH KING ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 18D-028-001 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-2023-0740 PERMISSION IS HEREBY GRANTED TO: Project# SIDING 2023 Contractor: License: Est. Cost: 8100 QUALITY RESTORATION CS-060134 Const.Class: Exp.Date: 11/04/2024 WEBBER RICHARD J& WILLIAM D GRINNELL Use Group: Owner: TRUSTEES Lot Size (sq.ft.) Zoning: HB Applicant: QUALITY RESTORATION Applicant Address Phone: Insurance: 72 MONTAGUE CITY RD (413)774-7737 7PJUB-0G09579 GREENFIELD, MA 01301 ISSUED ON: 06/07/2023 TO PERFORM THE FOLLOWING WORK: SIDING REPAIRS 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: , Fees Paid: $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner / `gip / ✓�N ` II/' pa�•�,' -einal / al, Jr sba �;t; .cter, 6 he Commonwealth of Massachusetts o.;.. `�%: 440Office of Public Safety and Inspections 'y r�_I /4 ',//V, Massachusetts State Building Code(780 CMR) oN M` •' Pe , it Application for any Building other than a One-or Two-Family Dwelling G''Osoc)Ns (This Section For Official Use Only) Building Permit Number: 6','s., 7 ` Date Applied: f 16/2 3 Building Official: SECTION 1:LOCATION No.and Stree City/Town Zip Code Name of Building(if applicable) Assessors sj Map N�r�th�n >7 01060 C.Jebhe!' av0 (,tie1 Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below Existing Building 0 Repair 0 Alteration 6if Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No CK Is an Independent Structural Engineering Peer Review respired? Yes 0 o G3' Brief Description of Proposed Work: I oVV�lty GIOI IV Ana P4 ;Nf Uf V;by) S: 117 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.) 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 CIA-4 0 A-5 0 B: Bksiness 0 E: Educational 0 F: Factory F-1❑ F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1 0 I-2❑ I-3 0 I-4 0 M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0 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 0 IB 0 IIA 0 IIB 0 IIIA 0 IIIB 0 IV 0 VA 0 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: A trench will not be Licensed Disposal Site 0 Public 0 Check if outside Flood Zone 0 Indicate municipal 0 required 0 or trench or specify: Private 0 or indentify Zone: or on site system 0 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 0 Yes 0 or No 0 Yes 0 No 0 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: City of Northampton Massachusetts aY ` }$' DEPARTMENT OF BUILDING INSPECTIONS ?,' 212 Main Street • Municipal Building is.... (tia. Northampton, MA 01060 flp� �tiz PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR COMMERCIAL & MULTI-FAMILY NEW CONSTRUCTION/ADDITIONS/ALTERATIONS 1. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work (Digital & Hard copy). 3. Site Plan with location of proposed structure(s) and setbacks. 4. Construction Debris Affidavit filled out and signed by applicant. 5. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 6. Contractors must supply a copy of CSL and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate (if applicable). 8. Note any Conservation and/or Special Permit requirements (if applicable). 9. Driveway Permit (if applicable). 10. Proof of Water and Sewer entry fees paid (if applicable). 11.Trench Permit (if applicable). 12. Initial Construction Control Documents filled out and signed by the Registered Design Professional in responsible charge. 13. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Al � wehht- ant) 6tintU b D lu K;ht 5I- Nora am Ph c oho Name(Print) No.and Street City/Town Zip Property Owner Contact Information: 7bc,.ha- - 6iU q13 -23'L Sggo) - 1 Title Telephone No.(business) Telephone No. (ce e-mail address If applicable,the property owner hereby authorizes: Name Street Address C ty/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 0. Otherwise provide construction control forms(see section 107 in 4e 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 Qf1Gt114 Pc6to014orn Company Mame To5hi 101511 1 ww G5060194 Name of Person Responsible for Construction License No. and Type if Applicable It e1an44ot e C;}y RA Gnef n(cla 114 of 301 Street Address City/Town State Zip 413-S2L 11-I 3 Telephone No.(business) Telephone No.(cell) I 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 0 No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $f S I t W _ Building Permit Fee Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)=$ . 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ �0 (contact municipality) 5.Mechanical (Other) $` ) • Enclose check payable to ____Litcok 6.Total Cost $ (� (contact municipality)and write check number here SECTION 13: GNATURE 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 ue and accurate to the best of my knowledge and understanding. Ali ,...- Planety4x 03 -$l4 osg2 D6f o61 a3 lease print and signam i O' Telephone No. Date c�C,d Street Address City/Town State ip Email Address ress i, i t 6 �3Municipal Inspector to fill out this section upon application approval: v i 'I , < II, I p' , Name 1 to CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE • •s, The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.gov/dia i»kers' ('4Intpensation Insurance Affidavit:BuildersiContractors/ElectriciansiPlunihers. tO BE FILED'N UI 1 I HE PERMITTING AUTHORITY. Annlicant Inforniation Please Print Lteitils Name(lingmess Organization'Individual): feS-)0(441;00 Address: 4Z. AC I i!) f City/StateZip: Greetnt AP- 01301 Phone F: cioetgo5(42. Ate yens an etttplo.t er? 'heck the X pitrairmiti•hot: T)pe of project(required): I.21<am empite.t er ermsloyos(full and ot pant-tirtmt.' 7. Ej New construction 24::,1 ant a ule Fropmetor ur Fano:m*1T and hate nu attployeut%utility Mr rtte 8. EfiRt.InOtichng any eapacny.(Nu tt urkem.'coup.insurance retmanal.) 9. Denisjiltstan .30 I aim a Iturtaxminn thong all uei myself.INo workers'con otturame retmanetli laD Building addition 4E3 1 ant a hotneownea and still b.,:tinny ettutratium to conduct all wok on nry lnup :1y. 1 twill enhure thin all Tonna-km Tither luxe tvoricra"coupemabsni morality to a.m.utic 1 if)Electrical repairs or additions pnipralors with tin empinyet.s. 12.0 Plumbing repairs or alditions sC3 I ant a guteral t untraetur and I bat e hired the sub-tannmettart hated un the anaciaed theet I 3.nRosif repairs These sub-contructurs Mete empluyeet,and bat e tturkera'emnp.instounee.; 14.00tliei is.[D 1.1.e-are ornperation and th OffiCerA hate caetined then or exerraphon per MICA.c. 152.§1i It.arid t*.c hx.e nv enmity:teen.rs...urkerA'euenp,imaarance Te4LIIIVa ' trt at:Inman!that elto.:1,lt,ott mint 4160 rill tot the,,:etp.,11k.t 'ALA,are chea kit 1:1,111N.11:016011 pOttq 14(1.1n0OWnll's'tthu submit dist afrabstat main:ming they Arc&ins:all tt ork weal thol hire out,h1c et:nit:actors mutt ambrzut a new atlielat ii maiming such (ontrartum that:beck dm box tram attached in allthtonol sheet them, rig the nameiii Lh, autiks and nate teht-ther in nut the.t.e.mhttet,hate employees, I*th..:$1.11.ttattrachtn,kit e. irtrItr!ect,they rhwa prut nit their mot-kers'eamp Glen r 1 am an employer that is proriding workers'compensation insurance for my employee.s. Below is the policy and jab site information. Insurance Company Name: 14Cliteta(0 .114.5U(404 Policy It or Self-ins.Lie. q _P 311 6 06-0 9 6 79 Expiration Date: el/f9/11.3 Job Site Address: 8 IV 1.0 ( S Cty/State.,Zip: ft1oalleir11P1,11% MA 01 0 6 0 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiradon 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 andfor one-year imprisonment.as well as civil penalties in the form of a STOP VOORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance ciAeray.e verification. I do hereby"'err' s''ritzier the'tains and penaltie.N of perjury that the inform anon provider!above is true and correct. °6 0 6 2- PI- L'1 13 'el"ZNO5q h. oftido ate will. Do not write In this arca,It.he completed by city or town official City or 1 ow PermittLicense#1 11 Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.CityiTown Clerk 4.Ekettlical Inspector 5. Plumbing I uspectiii- ' a.Other Contact Person: Phone#: City of Northampton li Massachusetts , ,,, 4 i F DEPARTMENT OF BUILDING INSPECTIONS ': 212 Main Street • Municipal Building ��Ab� Northampton, MA 01060 "�SV� �"'� ' 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: 1\100114P)tv1 L'NC fir)) The debris will be transported by: Name of Hauler: Pkyktic )- l iuC kCi.t/1 Signature of Applicant: Date: 06/O6 /Z3 Aco® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 06/06/2023 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 Hollie Kochapski NAME: Aquadro&Associates PHONE (413)586-7373 FAX (413)584-0859 A/C.No,Extl: (A/C,No): 355 Bridge St.,P.O.Box 357 E-MAIL hollie@aquadroinsurance.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01061 INSURERA: Quincy Mutual Insurance Co 15067 INSURED INSURER B: Travelers Insurance Company Quality Cleaning&Restoration Inc. INSURER C: 134 South Shelburne Rd INSURER D: INSURER E: Greenfield MA 01301 INSURER F: COVERAGES CERTIFICATE NUMBER: CL1571006761 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 •.. BUBR- POLICY EFF POLICY EXP LTR TYPE OF INSURANCE •INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE piOCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED v SCHEDULED AFV206793 12/30/2022 12/30/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED *ye NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y I N 1 B ANY PROPRIETOR/PARTNER/EXECUTIVE N/A 7PJUB 0G09579 06/19/2023 06/19/2024 E.L.EACH ACCIDENT $ , , OFFICER/MEMBER EXCLUDED? ri (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN CITY OF NORTHAMPTON ACCORDANCE WITH THE POLICY PROVISIONS. 210 MAIN STREET AUTHORIZED REPRESENTATIVE .......... CAP.R....R...t:.a... .csts'a.{..,u.�es,Fc..:.. NORTHAMPTON MA 01060 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD From: c1it .s To: Jonathan Flagg Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 The Massachusetts Building Code, section 107.1 allows for an exclusion from requirements for construction control in certain situations. In accordance with code section 104.10, I request that you grant a modification to waive the requirement for construction control of the project at K n Norohc; ii p)V f'ffi because the work is of a minor nature, will not affect structural elements, health, accessibility, life or fire safety, and will be done in accordance with the prescriptive requirements of the code. Thank you for your consideration. V7/93 Respectfully, 1