Loading...
38B-125 (5) BP-2023-1396 28 COLUMBUS AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-125-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1396 PERMISSION IS HEREBY GRANTED TO: Project# EXT& INT RENO 2023 Contractor: License: WORTHINGTON CONSTRUCTION Est. Cost: 33000 GROUP INC 069777 Const.Class: Exp.Date: 09/11/2024 Use Group: Owner: DRIVER-SCHRODER CRISPIN M TRUSTEE Lot Size(sq.ft.) Zoning: URB Applicant: WORTHINGTON CONSTRUCTION GROUP INC Applicant Address Phone: Insurance: 254 WORTHINGTON ST (413)883-6171 WCMA000389500 SPRINGFIELD, MA 01103 ISSUED ON: 10/10/2023 TO PERFORM THE FOLLOWING WORK: STRIP AND REROOF 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: �� h9r� rjuil Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner RECEIVED • e Commonwealth of Massachusetts CT - 6 2023 Boar of Building Regulations and Standards FOR Mass chusetts State Building Cade,780 CMR M(TAlICIPAi.k i�T USE nFPT.OF Fill groutAp lication To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 �#M�NORTHAti4PTON.MA 01061 One-or Two-Family Dwelling This i� , or cal a ant •Building P t Numb l � date Applied. . a r BuildingOfficial ). gtsature Date OAI 1-SI TEiIN O ttMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 2.0 doece/Inve? 4 i fMI 1.1 a Is this an accepted street?yes ' 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:(MG.L c.44,§54) 1.7 Hood Zone Information: 1.8 Sewage Disposal System: Public 0 Private C! Zone: Outside FIood Zone?Check ifyesLt Municipal 0 On site disposal system 0 2.1 neri I/4e 6 rc srd Ii/g 4, A4,4// / fl 4'0(00 • Name(Pont) civ,State No.and Street Telephone Salimaaa New Construction 0 Existing Bmlding/2 Owner-Occupied 0 Repairs(s) Cl Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.© Number of Units Other Specify: Brief Description of Proposed Worke: t� t7S IA/ 1/4.7o V.9'd 41/4/ r /j6(r4/'fA ism , ear ;, ,ram.' ^c!yc- -770,tr' SECTION 4 ESTIMATI E C ION -�t,,' Item Estimated Costs ram` K (Labor and Materials) legAII ' I.Building $ J3000 l Bx g ee.S s . 'how fee is determined: 2.Electrical $ 13 S l -own App on:Fee T tiii0 ". her` • x 3.Plumbing $ Other ee H 4.Mechanical (FWAC) $ _ist: 5.Mechanical (Fire Suppression) $ ,� Chegk Amours:: Cash.Amount: 6.Total Project Cost: $ 33 0ao P (To`cWif @ Wo r' Virvtb N C G. (-o^" SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) (1 , ',,q7 77 Q • it , Z y /2,C • ,6// t 4/1/c'6 License Number Expiration Date Name of CSL Holder /7s & 2/C IE List CSL Type(see below) No.and Street f7 Type Description Z � �a u/�� l Unrestricted(Buildings up to 35,000 Cu.ft.) D R Restricted 1&2 Family Dwelling City/Town,State,ZIP & M Masonry z9/2 e RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances ��eh9 ��°(5n / I Insulation ��IFd �{/v��� in L ' L-D9�1 Telephone .Email address D Demolition /4 5 2 Registered Home Improvement Contractor(HIC) ig 52 SrJs Q3,/U Z,/ L47f/Vi4'?,6/44/77M?rbt/e s**(7ll (T/v� —/� HIC Registration Number Expiration Datet HIC Coniip y Name r HIC Regi t Name �'s`� �!/DKT i� r-0A7 Lsr .")' ILY7 ial sfr ,eri recf,me- No.and5peet Email address L✓d y! P/2/, /,40 , 1// Di/42 0? eri7,&/7/ 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 No .[7 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 to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By enterin my name below,I hereby attest under the pains and penalties of perjury that all of the information coma. n this a lication is true and accurate to a best of my knowledge and understanding. / , /keSi4tk,7- �9477D4/ *0-1/S Grf/r 71 & 4XaV ��` 4,43 Print or Authorized Agent's Name(Elec nic Signa /"L��jo �iic, 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" ter, The Commonwealth of Massachusetts Department of Industrial Accidents 9OfI. ?'(:---a ce of Investigations r1 Lafayette City Center rJ 2 Avenue de Lafayette, Boston,MA 02111-1750 yc..(k„.s ' www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organizationhlndividual): Worthington Construction Group INC. Address:254 Worthington Street, Springfield City/State/Zip:MA 01103 Phone#:413-883-6171 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 1 4. 0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction listed on the attached sheet. 7. 0 Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. []Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp. insurance comp.insurance.. required.] 5. 0 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 MGL 12.0 Roof repairs insurance required]t c. 152,§1(4),and we have no 13.®Other See permit application employees. [No workers' comp.insurance required] *My 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: Pennsylvania Manufacturer's Association Policy#or Self-ins. Lic.#:WJCMA0003895000/ Expiration Date:04/25/2024 Job Site Address: 2 g 1/y m� 1l/V City/State/Zi • I D - 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 insu . ce coverage verification. I do hereb,. certify u ,.- th s.•nd penalties of pedury that the information provided above is true and correct. Pdole Signature: �� / ` ' Date: 9 ` � pg �bj" /Q T Phone#: 1 '3 443�/7/ Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: AC R CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/06/2023 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 NAME: Sonia Rivera PHONE CHI Insurance Agency,Inc. WC,No.Extl: (413 )536-2685 (rAjcAx,No): (413)532-0889 416 Main Street E-MAIL ADDRESS: en ADDRESS: g cy.com INSURER(S)AFFORDING COVERAGE NAIC s Holyoke MA 01040 pJRERA: NAUTILUS INSURANCE CO. 17370 INSURED INSURER B: Worthington Construction Group Inc INSURER C: 254 Worthington St INSURER D: INSURER E: Springfield MA 01103 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 BY PAID CLAIMS. INLtRR TYPE OF INSURANCE ;ADDL SUBR POLICY EFF POLICY EXP INSD 1NVD POLICY NUMBER (MMIDD/YYYY)'(MMIDD/YYYY) 1J111TS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ram/ DAMAOMAINTED CLAIMS-MADE n j OCCUR PREMISES(Ea occurrence) $ 1°°+°°° -- — MED EXP(Any one person) $ 5,000 A N N 1570515 06/29/2023 1 06/29/2024 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: 1 GENERAL AGGREGATE $ 2,000,000 X POLICY[ JECaT I i LOC PRODUCTS-COMP/OP AGG $ 2r0�,000 _ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ,_(Ea accident) —_ OWNED _I SCHEDULED BODILY INJURY(Per person) $ _ AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ • HIRED NON-OWNED PROPERTY DAMAGE .AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLAlJA6 OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ II yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) Evidence of Insurance 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 ...e-crJ7 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth or Massachusetts Division of Occupational Licensiire Board of Building;R lotions and Standards Constt�onSrvtsdr.: CS-069777 15tpires 0911512024 ,. MARKC 75 MARCI Alfa. EAST LONG £ 1018! vG3fi"": 'biCtxT..✓sw�W _ ,;,_ nem, vov s L:LL'?ZMLn.L THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affgt a�Business Regulation 1000 Washingtq _Suite 710 Boston,htlassachuskitts.. 118 Home Improyemeit3tz t^ "'Beg stration iI-1 A" °�" ,''- G ,,Type: Corporation WORTHINGTON CONSTRUCTION GROUP Il (il lion: 3/10/2 254 WORTHINGTON STREET lion: 03/10/2024 SPRINGFIELD,MA 01103 ."fs r�..b .. „ Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSE I fs Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMEAITCONTRACTOR expiration date. if found return to: TYPE: alien Office of Consumer Affairs and Business Regulation A9 iRL1119-f1 1000 Washington Street -Suite 710 185375-„.,.-3A MI Boston,MA 02118 NORTHINGTON CONSTR ,GROUP INC. >NTHONY R MATOS ,. ?51 WORTHINGTON STREI�r _,;„ ,- f,/�,..,.,a,:-- SPRINGFIELD,MA 01103<':;M` +'', ; a_x.`'`• Undersecretar y Not acid w ut signature DocuSign Envelope ID:4DAADBF9-B82E-47B5-A7F1-17CBC829BDF2 Please read this agreement and make sure you understand it before signing. This agreement is legally binding,non-revocable and non-transferable. Thank you. This agreement is made by the following parties on:9/21/2023 CONTRACTOR: CUSTOMER PHONE: Luke Guisto Worthington Construction Group Inc. ADDRESS Line 1:28 Columbus ave EMAIL:Igiusto8080@gmail.com 254 Worthington Street City:Northampton Springfield,MA 01103 State,Zip:MA 01060 Location of Proposed Project:28 Columbus ave,Northampton,MA 01060 Contractor agrees to complete work in accordance with all laws and in a good workmanlike manner for all of the work detailed below. Section 1:SCOPE OF MATERIALS&WORK TO BE COMPLETED:Numerals(I)through(III) I.)General Conditions A.)On Site Project Manager B.)Coordinate All Permits As Required C.)Coordinate All Materials Required for Roofing D.)Document with Pictures During the Process II.)Scope of Work(Only Checked Segments of the Scope of Work Options for A.)and B.)Apply) A.) Asphalt Roof Replacement:This quote covers the removal and replacement of the asphalt roof of the dwelling/building. Roofing components present on the dwelling will be demoed and disposed of included the existing layers of shingles and wooden shakes if present,the existing drip tape and other strippable underiayment components,and the roofers will tarp where necessary while stripping the roof. Components to be installed as part of the new roof include starter course on the rakes and eaves,drip edge on the rakes and eaves,two rolls of ice and water weather barrier from the eaves and one roll centered in all valleys as per code mandate,synthetic roofing paper in portions of roof where ice and water is not needed,ridge capping,and new asphalt shingles applied over prior components. Contractors shall install components in accordance with manufacturer's instructions and building code mandates. •Dwelling Only 51 Dwelling&Garage • Garage Only Other: B.) Flat Roof Replacement:This quote covers the removal and replacement of the flat roof of the dwelling/building. Roofing components to be installed as part of the new roof include starter course,drip tape,ice and water weather barrier from the eaves and centered in all valleys,roofing paper,capping,and new asphalt shingles. Dwelling Only 5i Dwelling&Garage ❑Garage Only Other: Document ID: 9FCBF5A4-0A8C-444F-BC07-214D3FCF8A1 F Page 2 of 4 DocuSign Envelope ID:4DAADBF9-B82E-47B5-A7F1-17CBC829BDF2 C.) Other/Additional: "This proposal includes the labor and materials of plywood decking installation on the dwelling and garage. This scope of work includes permit,L/1 Ju„��A, .;� s,general site items and clean-up. irtsfeilatior Additional work must be authorized via a signed change order. Ill.) Shingle Color A.)Customer emails or texts shingle color to Worthington Construction Group Inc.72 hours before date of work commencement. Section 2:Project Cost Contractor agrees to complete all of the work described in section I&II for the total price of: $33,000(Thirty Three Thousand Dollars and Zero Cents) Section 3:Disbursement Schedule A Check for the total cost to be paid: 0100%Upon Completion 50%Upon Commencement&50%Upon Completion Other: Section 4:Commencement&Completion Contractor will begin notifying proper parties for utility disconnects before the third day following the signing of this agreement,unless specified herein writing, Contractor will begin work on or about three(3)business days after the disconnects process has been completed barring delays caused by circumstances beyond the Contractors's control. The roofing work will be substantially completed,weather permitting,within one week of commencement of the roofing process. The owner hereby acknowledges and agrees that the scheduling dates are approximate. Section 5:Delays Contractor agrees to start and diligently pursue work through to completion,but shall not be responsible for delays for any of the following reasons:failure of the issuance of all necessary building permits within a reasonable length of time,funding of loan terms,disbursement of funds into funding control or escrow,acts of negligence or omission of Owner or Owner's employees or agents,or acts of God,stormy or inclement weather,strikes,lockouts,boycotts or other labor activities,extra work ordered by Owner,acts of public enemy(ies),riots or civil commotion,inability to secure materials through regular recognized channels, imposition of Government priority or allocation of materials,failure of Owner to make payments when due,or delays caused by inspection or changes ordered by inspectors of authorized government bodies,or acts of independent contractors,or holidays,or other causes beyond Contractor's reasonable control. Section 6: Modification of Work Should the Owner,Construction Lender,or any public body or inspector direct any modifications or additions to the work covered in this contract:the contract price shall be adjusted accordingly. Modification or addition to the work shall be executed only when both the Owner and the Contractor have signed a contract Change Order. The change in the contract price caused by such contract change order shall be as agreed to in writing,or if the parties are not in agreement as to the change in contract price,the contractor's actual cost of all labor,equipment,subcontracts and materials,plus a Contractor's fee of 20%shall be the change in contract price. Any such change to this contract may also increase the time within which the contract is to be completed. Contractor shall promptly notify the owner of(a)latent physical conditions at the site differing materially from those indicated in the contract,or(b)unknown physical conditions differing materially from those ordinarily encountered and generally recognized as inherent in work of the character provided for in this contract. Owner as added work shall pay for any expenses incurred due to such conditions. Section 7:Owner's Responsibilities Owner agrees to allow and provide contractor and equipment access to the property.Owner agrees to provide all utilities to the property. Section 8:Right To Work Document ID: 9FCBF5A4-0A8C-444F-BC07-214D3FCF8A1 F Page 3 of 4 DocuSign Envelope ID:4DAADBF9-B82E-47B5-A7F1-17CBC829BDF2 Contractor shall have the right to stop work if any payment shall not be made when due. Contractor under this agreement;Contractor may keep the job idle until all payments due are received. Failure to make payments within five(5)days of the due date,is a material breach of this agreement and shall entitle contractor to cease any further work. Section 9: Clean Up Contractor shall remove from owner's property debris and surplus material created by the operation and leaves it in a neat clean condition. Section 10:Arbitration,Validity&Damages Any controversy or claim arising out to or related to this contract,or the breach thereof,shall be settled by arbitration in accordance with the Construction Industry Arbitration Rules of the American Arbitration Association,and judgment upon the award rendered by the arbitrator(s)may be entered in any court having jurisdiction thereof. Section 11: Hazardous Materials Unless the contract specifically calls for removal,disturbance,or transportation of asbestos,or any other hazardous substances,the parties acknowledge that such work requires special procedures,precautions,and/or licenses. If the contractor encounters such substances,contractor shall immediately stop work and obtain a qualified hazardous material contractor to perform the work,and do the work at the contractors option.Said work shall be treated as an extra included under this contract. Section 12: Attorney Fees In the event legal action or arbitration instituted for the enforcement of any term or condition of this contract,the prevailing party shall be entitled to an award of reasonable attorney's fees in said action or arbitration,in addition to costs and reasonable expenses incurred in the prosecution or defense of said action or arbitration. Indemnification from contractor,regarding injuries to persons and property and proof of contractor's liability insurance and workmen's compensation insurance to be provided to the owner upon request, �uo�oargne 1uluy. L GtwSfo \--3463E15611 E84EE. D$ ,—DocuSigned by: FD 77 r Luke Garrett '-0660705122A7470_. Guisto Moulton 9/21/2023 Worthington Construction Group Inc. 254 Worthington Street Srpringfield.MA 01103 (413)883-6171 Document ID: 9FCBF5A4-0A8C-444F-BC07-214D3FCF8A1 F Page 4 of 4 City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: a g CQIoro,os Poc'c,m40trw The debris will be transported by: lucirikkyst, GrK,cdmtsc w... 6-,,,,,o The debris will be received by: 5/1 Gro5k Building permit number: Name of Permit Applicant (,4,) ,\Ihn, 6-0.r l" A c, (,4).. 6/6 /D3 Date Signature of Permit Applicant