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31B-312-015
BP-2023-0830 26 CRESCENT ST#202 COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31B-312-015 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-2023-0830 PERMISSION IS HEREBY GRANTED TO: Project# KETCH RENO 2023 Contractor: License: Est. Cost: 54346 CHRISTOPHER JACOBS 60475 Const.Class: Exp.Date: 11/10/2024 Use Group: Owner: G. DOWNES-MARTIN, NIKKI &STEPHEN Lot Size (sq.ft.) Zoning: URC Applicant: BARRON &JACOBS Applicant Address Phone: Insurance: 420 NORTH MAIN ST 413-586-8998 WMZ80080063652022A LEEDS, MA 01053 ISSUED ON: 06/23/2023 TO PERFORM THE FOLLOWING WORK: KITCHEN RENO 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: A j It Fees Paid: $357.50 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner atiN The Commonwealth of Massac user . c ?(323 Board of Building Regulations an Sta•1: �� OR Massachusetts State BuildingCode, svito, / CIPALITY V'd ai:°7�� ,� 1 USE Building Permit Application To Construct, Repair, Renovate Or olish; '?'!s Rev sed Mar 2011 One- or Two-Family Dwelling This Section For Official Use Only Building Permit Number: (3P' >3• $ 4,0 Date Applied: k 44 ,u7 I 03/9'2 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers C_)cle.- e-te-,A St: -4 2- 2 a 7j0--0 I c l.la Is this an accepted street?yes X 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) Gr y-�XLCfi 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: Zone: _ Outside Flood Zone? Public Private 0 Check if yes Municipal On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP1 2.1 Ownerl of Record: N w S per, ��,� ,.� � .,.-�p.�v 1 c)10e o Name(Print) City,State,ZIP 2E0 £rc.SL11),C4CtriC *i z �lel vY, ZHI�— ACVN4VSma�fir\O,03 1 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) 0 Alteration(s),$G Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': k),p cka.A4_ 4.AY1 ) Vo\ L t--oes. C km 5 w..i di re--) o.011Ow.c4, .w.d, c v r� XjrcA SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ `Ale LH(' 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa (Item 6)x multiplier x 3. Plumbing $ 2-r °O 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ . Suppression) Total All Fees: r Check No.6a Check Amount:pb Cash Amount: 6. Total Project Cost: $ Y ' ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) � h-C License Number Expiration Date Name of CSL Holder List CSL Type(see below) J LAW N . •No.and Street Type Description 1 ,,� /y— U Unrestricted(Buildings up to 35,000 cu.ft.)_ I.x'z (' ► D ' J R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 140}06Y 1''OYNnyAJ^L-DSS . I Insulation Telephone Email address L/P"'k D Demolition 5.2 Registered Home Improvement Contractor(HIC) �.� /I22i Yy 16QY YO1^ k 1 Q ' )> Nb50(.. HIC Registration Number Expiration Date HIC Compa_ny Name or HIC Registrant Name No.and S reet MK °P cb. S`Y1 b Email addreS City/Town,State,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 41..7 No . 0 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 ZGYVO /\V\ ,c,\0 S to act on my behalf, in all matters relative to work authorized by this building permit application. 'Sea-:Wet- S� V Print Owner's Name(Electt1W�N� ic 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. (c1vvlL5 Print Authori ed Agent ame(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 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" SIGNATURES By signing below,you agree to items A, B and C. DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPAC S. A. Alternative Dispute Settlement(Arbitration Clause): The Seller and the Bu er hereby mutually agree, in advance,that in the event of a dispute concerning this Agreement,the parties shall submit such dispute to a professional,state-approved arbitration service(cost, if any,to be paid by the submitter)prior to either pa proceeding to legal action in the courts. lir By si,zning this agreement,y e oarfof itlebrd, are hereby authorizing Barron&Jacob&Associates Inc.to acts youra all matters pertaining to the building permit application. as authorized ent in C. This is a binding Agreement. You may not cancel it except as stated. This Agreement covers and supersedes all conversations,statements and agreements,expressed or implied,between the rties,their agents or representatives. You,the Buyer,may cancel this transaction Buyer Date at any time prior to midnight of the third / /Si 2C 23 business day after the date of this transaction. See the attached notice of cancellation form Buyer Date for an explanation of this right. Seller retains an equal right to cancel. o f tS/Pe 215 Barron&Jacobs Repre ntati‘ Ihit Contact Information Office Manager: Sandy Scavotto Office:413-586-8998,x102 0 Chris Jacobs. President CT HIS#0554397 Cell phone:413-250-6677 Office phone ext: 100 Home phone: 413-665-9113 l lesha Gomillion,Senior Designer Cell phone:413-923-7003 Office phone ext: 104 MA Construction Supervisor License 060475 MA Home Improvement Contractor 100809 CT Home Improvement Contractor 518617 Purchase Agreement Page 25 of 25 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 =740= 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 nn Please Print Leeibly Name(Business/Organization/Individual): ?)Ov‘6(17v oty-Nel Address: Li2i0 k\c• tr\a,;v% e . City/State/Zip: . -e-i.s U\ Phone#: -15-S$'o- 8 -1 g Are you an employer?Check the appropriate box: Type of project(required): 1 I am a employer with kI) employees(full and/or part-time).' 7. EI New construction I am a sole proprietor or partnership and have no employees working for me in g '- S. Remodeling any capacity.[No workers'comp_insurance required_] 3.01 am a homeowner doing all work myself[No workers'comp.insurance required.]' 9. Demolition 10❑Building addition 4.❑I am 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 1 1.}Electrical repairs or additions proprietors with no employees. 12.9Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c 14.❑Other 152,§1(4),and we have no employees.[No workers'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. :Contractors 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: 1c \ My-(Ve-\ Policy#or Self-ins.Lic.#: i/iWV 2 )(o1)(o 20'1-2 A- Expiration Date: '5 I k 12-02L_ Job Site Address: (i,('r✓SCr—k ', 7�2 City/State/Zip:00 k(kV•o w)p.,_I‘Alk-- 0 020 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 of Investigations of the DIA for insurance coverage verification. I do hereby certify under the p 'is and penalti f perjury that the information provided above is true and correct. Signature: ?AZ/ Date: Co 1 Phone#: -72 - � ' siCal 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 b.Other Contact Person: Phone#: AC RD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 03/03/2022 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 Adina Edgett,CISR NAME: Webber&Grinnell PH No,Ext): (413)586-0111 FAX No): (413)586-6481 8 North King Street ADMDRIESS: aedgett@webberandgrinnell.com INSURER(S)AFFORDING COVERAGE NAIC B Northampton MA 01060 INSURER A: Main Street America/MSA 29939 INSURED INSURER B: NGM/MSA Barron&Jacobs Assoc.Inc. INSURER C: A.I.M.Mutual/A.I.M. 33758 420 N Main Street INSURER D: INSURER E: Leeds MA 01053 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 03/24 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE N W SD VD POLICY NUMBER LIMITS (MM/DD/YYYY) (MMIDDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO REN ruD 500,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 A MPT8049D 03/09/2023 03/09/2024 PERSONAL&ADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 3,000,000 PRO 3,000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER EPLI $ 10,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 1,000,000 B OWNED X SCHEDULED M1T8049D 03/09/2023 03/09/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) Medical payments $ 5,000 UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ B EXCESS LIAB CLAIMS-MADE CUT8049D 03/09/2023 03/09/2024 AGGREGATE _$ DED X RETENTION $ 10,000 $ WORKERS COMPENSATION PER OTH PEATUTE MD EMPLOYERS'LIABILITY Y I N $ 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE L.EACH ACCIDENT O OFFICER/MEMBER EXCLUDED") N NIA ipMgMZ8Q080063652022A ` 03/01/20,3 03/ 1 � (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit # was issued with the condition that all debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L c. 111, s. 150A. The debris will be disposed of in: ( \\LA) C-cAcK Name of Waste-facility Address of Waste Facility 111.5 Debris: As a condition of issuing a permit for th demolition, renovation, rehabilitation or other alteration of a building or structure, M G.L.c.40 s. 54 requires that the debris resulting therefrom shall be disposed of in a pro rly licensed solid waste disposal facility as defined by M.G.L.c. 111 s. 150 A.Signs a of the permit applicant, date and number of the building permit to be issued shall be indicated on a form provided by the Building Department and attached to the office copy of the building permit retained by the Building Department. If the debris will not be disposed of as indicated, the holder of the permit shall notify the building official, in writing,as to the location where the debris will be disposed. 780 CMR—6th Edition Si ature of Permit Applicant Date Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards Const� % tS e S rvisor CS-060475 � y .empires: 11/10/2024 CHRISTOPHR R 420 NORTH MAIN' LEEDS MA . Commissioner or THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington StrEt - Suite 710 Bostcn Massachusetts 02118 Horne Improvement Contractor Registration Type Corporation 100809 BARRON 8 JACOB..ASCOCIATEC INC �� 06/22.2CC4 420 NORTH MAIN STREET LEEDS MA 01063 Update AOOrr,:gnarl Return Card THE COMMOKWEALTH OF MASSACHUSETTS Office of Consumer Affairs K Business Regulation Regr,trauol vasd to WWI lviOual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If'round return to: TYPE._CGaywra:wn Office of Consumer Affans anti Business Regulation Registration Expiration 1000'Nasninglbn.1rert -Suite 710 100809 01c220:5 Boston,MA 0211 o BARRON&JACOBK A:E.00IATE.0.INC. NORTH ERMA 0TR 420 NORTH MAIN STREET ,,,r LEED.S.MA 01053 Under..cut-wry Not valid wit signature