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31B-247 BP-2023-0946 112 ELM ST COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 31 B-247-001 CITY OF NORTHA PTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGI ERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2023-0946 PERMISSION IS HEREBY GRANTED TO: HOPKINS HOUSE PORCH Project# REPAIR 2023 Contractor: License: Est. Cost: 6000 CRAIG SWEITZER 15713 Const.Class: Exp.Date: 12/12/202 Use Group: Owner: SMIT COLLEGE Lot Size (sq.ft.) Zoning: EU/URC Applicant: SWEIT ER CONSTRUCTION Applicant Address Phone: Insurance: 231 BUTLER RD XW061064556 MONSON, MA 01057 ISSUED ON: 07/19/2023 TO PERFORM THE FOLLOWING WORK: REPAIRS TO PORCH -HOPKINS HOUSE POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Gnderground: 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 NOITHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: e • >9 • Fees Paid: $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commiss oner FC ad 1 I - Commonwealth o Massachusetts h%1 r4`Ar �Q Office of Public Safety a d Inspections �' r tip�4-9 �� Massachusetts State Buildin Code(780 CMR) '-'' 9T� 4,g) ding Per 'it Ap.lication for any Building oth r than a One-or Two-Family Dwelling 04 sp 40%70 (This Section For Official Use y) Building Permit Number:0. � � Date Applied: Building Official: SECTION 1:LOCATION I/f 2 e k 1 7 r� 6r VI/5 No.and Street City/Town Zip Code Na ne of Building(if applicable) 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®'Repair I9�Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No 0 Brief Description of Proposed Work: P CP.}-1 4 j eA( a Lo l2-"T1—, \ )o 0 4 a( Flo ors- I-. t.vu - c J ) w tZ, L V c- v.n.*-i-VrYt-t q. L ru 7P41 rG(.) 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 ❑ A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational ❑ 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❑ I-4❑ M: Mercantile❑ R: Residential R-10 R-2 0 R-3 0 R-4 0 S: Storage S-1 0 S-2❑ U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 IB ❑ HA El IIB ❑ IIIA ❑ IIIB ❑ IV 0 VA VB ❑ 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: Public 0 Check if outside Flood Zone 0 Indicate municipal ElA trench will not be Licensed Disposal Site 0 Private 0 or indentify Zone: or on site system 0 required 0 or trench or specify: 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: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner 74,0s1 5 oP. •147 674. . j r sr- i/Ofrif,414(0"I, r14 0/043 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: J'lt 6•4e1 4....VC es 7 - - 4(3 693--3804 3-L.vc76.sr►• ► ,60 L) Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: C2A i 4 J Jl c rt.CM. 23 i 73.dTLarni2-, r a vJd,) $44 of 0J-7 Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work at•,thorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here Cl. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor swcs(rZ.ell C7NJ ,r%.,/c�rzti,.' LC C Company Name fin.--c L S ert r— ce>-t ,.5 a/5-73 Name of Person Responsible for Construction License No. and Type if Applicable 23/ 77QZ� Rs) A toNAP.tJ Nta oio✓"7 Street Address City/Town State Zip _ 4(3 -GI,G- /49t5 Cr-x jw ,- ad L 0Je,ncloreviraJ ti _ C,oi, Telephone No.(business) Telephone No.(cell) `J e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAV4T(M.G.L.c.152.§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes 0 No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ fit 0 0 0 Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)_$ . 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ OD (contact municipality) 5.Mechanical (Other) $ Enclose check payable to �J 6.Total Cost $ 6, J 0 v (contact municipality)and write check number here 144 SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjur))that all of the information contained in this application is true and accurate to the best of my knowledge and understanding.Cc;M fwe I r — C .j_r- kvb4 w Or c,col. 413 - G74- 1498 it/�L3 Pleasenrint and sign nameTitle Telephone No. Date Z 3( ^31/4.41,wt- 1 -D Mc',J J v.v escl_ OI 0 Cr t ertwcitu.i--- C)Allt►,i.AW•(,or,,( Street Address City/Town State ip Email Address Municipal Inspector to fill out this section upon application approval: _____/=/ 7 19ZOz3 Name Date \ The Commonwealth of Massachusetts Department of IndustrialAccidents 117 �_t` ►= ,, 1 Congress Street. Suite 100 e, '; '"''foi � Boston, _t1:1 02114-2017 t ;_ a ww.mass.Rot/din )1 ut kers'('ontpensation Insurance Attidas it: Buildersl'ontractors Electricians Plumbers. 10 1W I•II.f.D 11 till I i1N:PLR II l'I IM;.l 1110R111. Applicant information Please Print Let:ibh Name llitlsftles.I)T,'jflt/JtL l Mitts\]dull). Address: I City State lip: Phone#: Art!pun a piny rrl l hick the appropriate box: Type of project(required): I. am a employer w,lti ki employees(full and{or pal—limey` 7. j New construction 201 am a sole proprietor in partnership and hale no eanpkiyecs working tar lee in g. 0 Remodeling any cavity.No workers'comp.insurance ngatrcxl.) 9. ❑Demolition t .j I am a homeowner doing:all work myself.(No workers'camp.insurance nNwred.)t 4.0 I am a homeowner and will be hiring contrasiors to condud all work on my rowdy. I hit 10 0 Building addition ensure that all contractors either hat c workers`ccrnpertsaiiuri num: ix or an sole ILO.o Electrical repairs or additions pit:imams with no employees. 12.0 Plumbing repairs or additions `0 :u I am a general contractortd I luxe hired the subcontractors lisied on the attached sheet. 13.a Roof repairs 1bcsc suer-contractors have ernplo:%ecs and have worker*'cutup.insurance.; 14.0Other 6.0%v.are a corporal ion and its officers hate exercised their right of exemption per NIGL c. _______ -- 152,¢1(4).and we hair no employees.)Nat vacxkets"wrap,insurance required) 'Any applicant that clacks ten at anust also till out the section below stowing their workers'compensation policy inform:inoa. t It mama nets who submit this affidavit indicating tles sac dome all work and then hire nutaltk:contractors smut submit a new affidavit midair:m:such_ -t ontraciors that check this box trust attached an additional sheet sht+wmg the name of the sub-contractors and state whether or not tiose eattities base cotploy.c,. If tlr..,ul,-ciurtractars lsasc cirgih,yees.ilea) must pi.,sidc their a,nkers'ex nip Hie!,ie)mauler I ant an employer that is providing worAers'compensation insurance fir my employees. Below is the policy and%oh site information. Insurance Company Name: 4 1 fv J v4./9...i C CS— Policy#or Self-ins.Lic.#: Expiration Date: 4 7r/Z/ lob Site Address:__. It 2 6.(,vt-% f 'f` City'Statel .sip:_ / 70r7-1►1'1,//`P ''— Attach a copy of the t%orkers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure covei,tge as required under MGL c. 152,*25A is a criminal s iolation punishable by a tine up to S I,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 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 coverage verification. /elm hereby certify under the mores and penalties of perjury that the inlortnation provided above istrue and correct. Sicnaturc: Roc:. 75/ 7 Phone::: 4(3— (92 Ce --- L 4 L V Official use only. Do not write in this area,to he completed by city or town official ('its or Town: Permit/License 4 Issuing. uthorits (circle one): I. Board of Ilealth 2. Building Department 3.Ckyf1ownClerk 4. Impeder 5. Plumbing Inspector 6.Other Contact Person: Phone 4: City of Northampton 7OY,Knr�,0 5 S t . Massachusetts AJf2 ��!z�, t fit`:� !. x ;5a11,1 ' { 1 g-I6C a 4' DEPARTMENT OF BUILDING INSPECTIONS �S°,. "r1 J, 212 Main Street • Municipal Building JE C,a \,` r '." Northampton, MA 01060 'r ��� 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: A (/-ex 1`�c.j c L, ^ici 6' J7 `V/4)‘`—' The debris will be transported by: , Name of Hauler: CI t T ,-- - Signature of Applicant: Date: -l`W2 3 l ® DATE(MM/DD/YYYY) AR O CERTIFICATE OF LIABILITY INSURANCE 05/30/2023 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 Michelle Lastowski NAME: Alera Group,Inc. PHONE (413)586-0111 FAX (413)586-6481 AIC No,Est): (A/C,No): Webber&Grinnell Division mlastowski©webberandgrinnell.com ADDRESS: 8 North King Street INSURER(S)AFFORDING COVERAGE NAIC U Northampton MA 01060 INSURER A: Ohio Security/Liberty 24082 INSURED INSURER B: Ohio Casualty/Liberty 24074 Sweitzer Construction LLC INSURER C: AIM Attn:Craig Sweitzer INSURER D: Hiscox Insurance Co 231 Butler Road INSURER E: Monson MA 01057 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 6/2024 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 INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE CLAIMS-MADE X OCCUR PREMISESO(Ea REND rence) $ 500,000 MED EXP(Any one person) $ 10,000 A BKS61064556 06/05/2023 06/05/2024 PERSONAL&ADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECT PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED X SCHEDULED BAS61064556 06/05/2023 06/05/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) PIP-Basic $ 8,000 X UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAB CLAIMS-MADE US061064556 06/05/2023 06/05/2024 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION X STA UTE EOTH AND EMPLOYERS'LIABILITY Y/N 1 C ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA MZ80080082652023A 06/05/2023 06/05/2024 E.L.EACHACCIDENT $ , , OFFICER/MEMBER EXCLUDED? W (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , Professional Liability $1,000,000 Professional Liability D ANE2267167.23 05/20/2023 05/20/2024 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 Evidence of Insurance 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 Commivisiononw D of OccupationalealthofMassachusetts Licensure Board of Building Regi lations and Standards Const i on S rvisor CS-015713 � 6ipires: 12/12/2023 CRAIG A S{N€ITZER 231 BUTLER.+tD MONSON MA 01057 11°111 ' Commissioner &i ' - lam ",2/ll "il Le -t7 / � r,iez-} ar///l`to Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC SWEITZER CONSTRUCTION LLC Registration: 189828 231 BUTLER ROAD Expi ration: 09/30/2023 MONSON,MA 01057 Update Address and Return Card. SCA 1 0 20M-05/17 / Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 189828 09/30/2023 1000 Washington Street -Suite 710 SW EITZER CONSTRUCTION LLC Boston,MA 02118 CRAIG A.SWEITZER 231 BUTLER ROAD MONSON,MA 01057 Undersecretary Not out signature