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31B-189 (9) BP-2024-0242 75 GOTHIC ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31B-189-001 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-2024-0242 PERMISSION IS HEREBY GRANTED TO: Project# RENO KITCH/BATH 2024 Contractor: License: Est. Cost: 100000 ALISHA PHILLIPS 106378 Const.Class: Exp.Date: 02/26/2026 Use Group: Owner: BIRDSALL DIEHL WILLIAM A&J Lot Size (sq.ft.) Zoning: URC Applicant: AXIOM LANDSCAPE &HOME IMPROVEMENT LLC Applicant Address Phone: Insurance: 40 PINE VALLEY RD (413)320-9669 WCC5005020083 FLORENCE, MA 01062 ISSUED ON: 03/07/2024 TO PERFORM THE FOLLOWING WORK: RENO KITCHEN AND BATH 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: /7/2 Fees Paid: S650.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner IC V ^ 4!' 1 ; The Commonwealth of Mass4chus tts MAR - q 2024 Board of Building Regulations a d Sta dards FOR Massachusetts State Building Co e, 78 --•-1 MUNICIPALITY i PEPT OF DUII DING INSPECTIONS USE Building Permit Application To Construct,Repair,.Reuo ` r'.')irai ' ° Rimed Mar 2011 One-or Two-Family Dwelling This PAP, For Official Use Only Building Permit Number: )-�" P`C, Date Applied: ,K�t,.-+ /j7 // :7.ZOZ, Building Official(Print Name), Signature Date SECTION 1:SITE INFORMATION 1.1 Property rt Address:S e 1 Adw, 4 n Uf p 1.2 Assessors Map&Parcel Numbers oa Li Is this an accepted street?yes ale no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: . . Zoning District Proposed Use s Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 2 I FFt S 2$f 12y1 /S�� 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Floo Zone Information: 1.8 Sewage Disposal System: Publics Private❑ Zone: _ Outside Flood Z9ne? On Municipa i site disposal system CI�„ »` Check if yes SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Name(Print) City,State,ZIP lc Ga41_ St Nl3 - 32�-�2J� ,►cgnac6;%l1�/l��wiy, .coo? 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) Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed^Work2: QIgrfr+,fion/ 04) el'1tgft✓ t 84 . 9��9es, " C 4S D!4J't IIa t 7'rot?. itm p/4Ct 1/4y/et aimpp SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ $O Gd& 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee o 2.Electrical $ wi 00 d 0 Total Project Costa(Item 6)x multiplier x &j 3. Plumbing $ /C Dr r 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ o. Suppression) Total All Feel: D— /'n Check No.Xi Check Am • /" 6.Total Project Cost: $ APO D 0 U 0 Paid in Full 0 Outstanding Balance Due: 1 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) [,S —/V&3 7 ' I- ZG -4 A''Is 4 4 A �I i/RIPS License Number Expiration Date Name of CSL Holder ' r List CSL Type(see below) No.and Street O Type Description Ft0,,.1 G ei ill o/0G U R Unrestricted(Buildings up to 35,000 cu.ft.) Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding L/ I I loft 1 C +/ SF Solid Fuel Burning Appliances 1 "3�U 5�V �+X ltrwl QM �i � . I Insulation Telephone Email address 641 D Demolition 5.2Registered Home Improvement�/ Contractor(HIC) 11 y 4-#$ Z./& G 2 c r�.0/ te Wife'PAL f' NI1I-t Y/M,C.441, £2 HIC Registration Number ExpirationDate HIC Co any Name or IC eg trant Name 4P ; votftt AY;.�►//440///4lo�c &AS,4 C0/'7No.and Street Email addres Fle4nGt 40 0%G2 111.3Zoll 6 9 City/Town,Slate,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 I suanc the building permit. Signed Affidavit Attached? Yes No 0 SECTION 7a:OWN AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Ns' ti -� PI P1, 'f/r I,as Owner of the subject property,hereby authorize h a l y4� t// to act on my behalf,in all matters relative to ork authorized by this building permit applicatio . jeA-Nab 13fr ,D �sf 3/Slf,it rmt Owner's Name(Electronic Signature ate SECTION 7b: ERt 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 j is true and accurate to the best of my knowledge and understanding. 7 A1:st5 ! Nr/ J/S7ZGi Print Owner's or Auth ized Agent's Na ( ectronic 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(I-IIC)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" s" 6U7-4 STre� f-- tovp Ate cl puvr TSB/ I S fu-5 Q�► fit L4„114, etilk ,'vs IDoe -9S 6o %c %t IMsw- ((Am,N(-S l.. iitt it//7 4�- s 4 D�u�w� City of Northampton o1 --proms ♦S _si /a/� ti, 5..- /� Massachusetts A. * -- r�G v « y e DEPARTMENT OF BUILDING INSPECTIONS �'• `P� 212 Main Street • Municipal Building b C `: Northampton, MA 01060 sJ'J-,4 37��Q 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: i Location of Facility: t,4 1 I 07 ,/,r The debris will be transported by: r ^ Name of Hauler: AvN� �i1�SCq. f /411At J� 4v('(ft'/kl1L Signature of Applicant: Date: 1 1 5 `'/ The Commonwealth of Massachusetts Department of Industrial Accidents .to •... ....... 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.govidia %Yorkers Compensation Insurance Affidas it: BuildersiContractors/Electricians/Plumhers. TO BE FILED Writ'TUE PERMITTING AUTHOR11'1'. Applicant Information Pietist. Prinl l_reilils Name musiness,'OrganIzationilndwidual): Ay/.pm LI 14//fCry C.- , LIC Address: 110 T I)I /AL thibl, 124.61 City/State/Zip: Rofee4Gli, 14//1 ()/6. 2 Phone #: liti— 3Zo - 2CC9 Are!NON a kryer?Check the appropriate imii.: Type of project(required): 1. ani a employer with__ .. employ tiCN(full andOr purt-timet• 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working fur me in /1?1EKRiirnodeling any capacity.[No workers'comp.insurance requinxi] 30 I am a homeowner doing all work myself.[No workers'comç..insurance required] 9. 0 Demolition 100 Building addition 4.0 1 am a humiowner and will be hiring contractors to conduct all work on my pniperty. I will ensure that all contractors either have workers"compi.-nsation insurance or an:sole II.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or altiitions 50 I ant a general contractor and I have hind the sub-contractors listed on the attached sheet. I 3.0 Roof repairs These sub-contractors lose employees and have workers'comp.msurance.: I 4.0 Other 6.0 We air a corporation and its officers have exercised their right of exemption per M(iL e. 151,§1(41,and we lane nu employees.[No workers'eon'''.insurance requited.] An applicant that checks box al IIILlat also till Oct the section below showing their workers'compensation policy information. •liomoiveners.who submit this affidavit inthcaimc they are doing all work and then hire outside contractors must submit a new official/it-indictoing tech. 1Contruetors that cheek this box must attached an additional sheet showing the name of the sub-cimtractors and state whether or nut those entities have employees. lithe sub-contractors base employees.they must pros ide their workers'slump.policy number. I um an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Al-- fri 111 41 ii 6, I Policy#or Self-ins.Lic.#: 1'16 C 5--oo s'o a oo 3 Expiration Date: (IP---/2 4/ Job Site Address: .7 S— Clinfic Si c e d City/State/Zip: /19-1 0/0G0 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$I,500.00 andior 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 du hereby certify under the pains turd pe "e.,o perjury that the iolUrmation provided above IS true and correct. Date: 3/Z/ Z 47 Phone 4: 11 13 - 3 ' 9 9 Official use only. Do not write in this urea. 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 (. Oilier Contact Person: Phone#: ..... .,.,,.....„,, — . AC'�® DATE(MM/DD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 2/28/2024 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 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 Fe Trudell NAME: Clayton Insurance Agency, Inc. 1A/C No.EnD; (413)536-0809 FAX No): (413)534-7874 1649 Northampton Street ADORess: ftrudell@claytoninsurance.net INSURER(S)AFFORDING COVERAGE NAIC# Holyoke MA 01040 INSURER A:Safety Insurance Company INSURED INSURER a:AIM Mutual Insurance Company Axiom Landscape And Home improvement LLC INSURERC: 40 Pine Valley Road INSURER D: INSURER E: Florence MA 01062 INSURER F: COVERAGES CERTIFICATE NUMBER:2029 MASTER 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 EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER IMM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X OCCUR DAMAGE TO RENTED 100,000 PREMISES (Ea occurrence) $ BMA0028548 1/11/2024 1/11/2025 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY piPRO- JECT 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 ALL OWNED SCHEDULED AUTOS X AUTOS 5907002 1/11/2024 1/11/2025 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) $ UMBRELLA LIAB - OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? pi /A B (Mandatory in NH) WCC5005020083 4/17/2023 4/17/2024 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: 75 GOTHIC STREET, NORTHAMPTON, MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF NORTHAMPTON THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN BUILDING DEPT. ACCORDANCE WITH THE POLICY PROVISIONS. 212 MAIN STREET, #100 NORTHAMPTON, MA 01060 AUTHORIZED REPRESENTATIVE Michael Regan/FMT f,4z.-/ ,,y...,_ I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2014o1)