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25A-149 (5) BP-2023-1604 52 WOODBINE AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25A-149-001 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-2023-1604 PERMISSION IS HEREBY GRANTED TO: Project# 2023 RENO Contractor: License: Est.Cost: 25000 SEAN MCCARVEL 1 1781 1 Const.Class: Exp.Date: 02/28/2026 Use Group: Owner: CRAIG SAMUEL W Lot Size(sq.ft.) SEAN MCCARVEL dba FRIENDLY NEIGHBORHOOD Zoning: URB Applicant: BUILDER Applicant Address Phone: Insurance: 170 WEST ST (413)406-6678 SOLE PROPRIETOR NORTHAMPTON, MA 01060 ISSUED ON: 11/28/2023 TO PERFORM THE FOLLOWING WORK: ADD EXTERIOR DOOR TO UNIT 54,REPLACE DECKS &ADD STAIRS FOR SECONDARYEMERGENCY EGRESS (WITHIN ORIGINAL FOOTPRINT). 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: • �, ( i Fees Paid: $175.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner 'r Er4a+__ co CV The Commonwealth of Massachusetts *A.,J Office of Public Safety and Inspections WitMassachusetts State Building Code(780 CMR) z - Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number-?A7.3-k.oy Date Applied: Building Official: SECTION 1:LOCATION S0-5y Gvoo) i1e Ave, kiorJ-ki4»tfJbn Ili 4 0/060 No.and Street City/Town Zip Code Name of Building(if applicable) zA -oo 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 tg1 Repair Alteration ;, Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy ❑ Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ® No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No El Brief Description of Proposed Work /kJd Etc4-er,of door 1-of kq;L 5 ' , Reelace dec ant1 acid Stairs 4-0 loc; Ii4-pd-e ewier3tnC7 eyess (sagnc(Gry 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) ❑ Existing Use Group(s): / ?- Proposed Use Group(s): 1Q SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft) f 1500 / 4' /600 Total Area(sq.ft.)and Total Height(ft.) 40001 3 ' 6 3 ' SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0 F: Factory F-1 0 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 0 R Residential R-10 R-2.4E1 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 IBO IIA ❑ IIB ❑ MA IIIBO IV CI VA VBl� 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® Check if outside Flood Zone El Indicate municipal EI A trench will not be Licensed Disposal Site 79 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 El Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No RI Yes 0 No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: cj{h M A Use Group(s): R 2- Type of Construction: V a Does the building contain an Sprinkler System?: U Special Stipulations: Design Occupant Load per Floor and Assembly space: &-ain C P14I3V 3, Corn SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner 5av14 Crf;s 1`1 Colunib�,S 00rdshavrtP�n (11 Pt41060 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: y/3 soT lcr, ' no'o (o56) Yghoo.Cool Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: 1 t co(0 bit 6G►S • _seol Adfc rvei at- - %> w� �s� NorAgmehn Mil- 0060 Name !!fl( Street Address City/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 IS. 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 Friend l 7 tiej911 for 1'10(A 4 't; 11er Company Name 5ertvi ( `Cary -f i C S-I l 7 11 GIN(e5d.rcc.1-4 (.on glracl.t h stiperv,sar Name of Person Responsible for Construction License No. and Type if Applicable 1 70 vV eS+- 5 4- Nor d-k arvi pkvi M 1 01060 Street Address City/Town State Zip q(3 1106 GC 7 `6 913 _(f o6 _ (6 715 Seq0 Q F N 5 L113 .coli Telephone No.(business) Telephone No.(cell) 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 $ 2...5 OUCH Building Permit Fee=Total Construction Cost x7—(Insert here 2.Electrical $ appropriate municipal factor)_$ . 3.Plumbing $ _t,v 4.Mechanical (HVAC) $ Note:Minimum fee=$/76.-(contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ A S 0 00 (contact municipality)and write check number here SECTION 13:SIGNATURE 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 true and accurate to the best of my wledge and understanding. Se4t(1 1vtQ v.,. i eq02. 7 Jcla--1/06 - 667ei /IP3/23 Please print and sign name Title Telephone No. Date 170 weld- Sf- Norl-h ccrtPloh Mq. 61060 5G n 4 FA 6 N/3.001 Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: --/& /t/7'Z6z 3 Name Date 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: Co "S`f W Pule The debris will be transported by: '//3 D pSfer . Con1 The debris will be received by: V a((e r R ecru ,/i Building permit number: Name of Permit Applicant Sit vl cC g r(ie /n/8/1023 Date Signature of Permit Applicant The Commonwealth of Massachusetts _* Pkl Department of Industrial Accidents ;ell_ o' 1 Congress Street, Suite 100 74-11#- y Boston, MA 02114-2017 a1 www.mass.gov/dia mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): 5eq{? Me ii r v o Address: / 70 W C 51 5 f City/State/Zip: /I)0 rd-,/I ca/ V/0n M q-awl Phone#: 4((3 -q D6- C7i Are you an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with employees(full and/or part-time).* 7. ❑New construction 4 .'Cam a sole proprietor or partnership and have no employees working for me in 8. ®Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 10 Q 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 11.❑Electrical repairs or additions proprietors with no employees. / I, 12.D Plumbing repairs or additions ,.:( 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.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.®Other Add S ec on d if i'y 152,§1(4),and we have no employees.[No workers'comp.insurance required.] efil9✓P55 *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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 forward to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c fy under the pains an penalties f that the information provided above is true and correct. Signature: Date: /// (3 / 2_0 2 3 Phone#: /3 —(106 -667`d 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 6.Other Contact Person: Phone#: AC ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMDD/YYYY) 03/03/2023 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 Lilliam Martinez,CISR,CPIA NAME: King&Cushman Inc. PHONE (413)584-5610 FAX (413)584-9322 (A/C,No,Est): (A/C,No): P.O.Box 447 E-MAIL LMartinez@KingCushman.com ADDRESS: 176 King Street INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01061 INSURER A: Green Mountain Insurance Company 20680 INSURED INSURER B Sean McCarvel INSURER C: 170 West St INSURER D: INSURER E: Northampton MA 01060-3739 INSURER F: COVERAGES CERTIFICATE NUMBER: CL233305219 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM/DD/YYYY) (MMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A 20031304 08/14/2022 08/14/2023 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(per person) S OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAR _ OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I 1 DESCRIPTION OF OPERATIONS/LOCATIONS/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 St AUTHORIZED REPRESENTATIVE �f / Northampton MA 01060 1� f �`-L.L%+j ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts \ �r Division of Occupational Licensure Board of Building Regulations and Standards Const{ ion S ,rvisor .y CS-117811 spires:02/28/20'6 SEAN M MCCARVEL p 170 WEST ST42EET NORTHAMPTUN MA 01060 Commissioner g iY&+hita. 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