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25C-069 (11) BP-2024-0350 32 DAY AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25C-069-001 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-2024-0350 PERMISSION IS HEREBY GRANTED TO: Project# 3RD FL BATH/KITCH RENO Contractor: License: KENT HICKS CONSTRUCTION DBA Est. Cost: 10000 EAST BRANCH STUDIO 066104 Const.Class: Exp.Date: 01/12/2026 Use Group: Owner: LLC DAY AVENUE PROPERTIES Lot Size (sq.ft.) KENT HICKS CONSTRUCTION DBA EAST BRANCH Zoning: URB Applicant: STUDIO Applicant Address Phone: Insurance: P O BOX 57 (413)296-0123 5H9686925 WEST CHESTERFIELD, MA 01084 ISSUED ON: 04/01/2024 TO PERFORM THE FOLLOWING WORK: RENO 3RD FLOOR BATH AND KITCHEN,REPAIRS TO ROOF 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:' 17Z- Fees Paid: S100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner z 40 2 8 2,024 The Commonwealth of Massa husetts Office of Public Safety and Inspecti ns + ' Massachusetts State Building Code(780 R c 1 OF suiTiNc_NSI O',o1,,s Building Permit Application for any Building other than a O e- tiirig (This Section For Official Use Only) Building Permit Number:o} '/ 3SA0 Date Applied: Building Official: SECTION 1:LOCATION 32 Day Ave Northampton 01060 No.and Street 2 tyy5C/To n Zip Code Name 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❑or check all that apply in the two rows below Existing Building RI Repair J1 Alteration Jill Addition 0 Demolition (if (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes No ❑ Is an Independent Structural Engineering Peer Review required? Yes 0 No 0 Brief Description of Proposed Work Renovation of third floor bathoom and kitchen. Repair of roof leak 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): .&sPL Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) same same Total Area(sq.ft.)and Total Height(ft) same same 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 Cl H-5 0 I: Institutional I-1 0 I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2 R-3 0 R-4❑ S: Storage S-1 0 S-2❑ U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION&CONSTRUCTION TYPE(Check as applicable) IA 0 IB ❑ IIA ❑ IIB 0 IIIA ❑ IIIB ❑ IV 0 VA 0 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: A trench will not be Licensed Disposal Site gi Public¢a Check if outside Flood Zone XI Indicate municipal Ji;1 required WJ or trench or specify: Private 0 or indentify Zone: or on site system❑ permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable fitl Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No gi 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 Hala Abdul-Rasool 47 Lincoln Ave Northampton 01060 Name(Print) No.and Street City/Town Zip Property Owner Contact Information Hale 413 559. 7006 hala.abdulrasool@gmail.com Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: East Branch Studio 634 Main Rd Chesterfield MA 01084 Name 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 14. 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 East Branch Studio Company Name Kent Hicks CS-066104 Name of Person Responsible for Construction License No. and Type if Applicable 634 Main Rd Chesterfield MA 01084 Street Address City/Town State Zip 413-296-0123 413 -559 - 7006 h.abdulrasoola.eastbranchstudio.com 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 tif No D SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs:(Labor Item and Materials) Total Construction Cost(from Item 6)_$ 10000 1.Building $ 4000 Building Permit Fee=Total Construction Cost x.07 (Insert here 2.Electrical $ 3000 appropriate municipal factor)_$ 70 3.Plumbing $ 3000 4.Mechanical (HVAC) $ Note:Minimum fee=$ 100 (contact municipality) 5.Mechanical (Other) $ Enclose check payable to City of Northampton 6.Total Cost $ 10000 (contact municipality)and write check number here 1051 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 urate e best of my knowledge and understanding. Kent Hicks 7( General Contractor 413 - 296- 0123 3-1 S`27 Please print and sign name Title Telephone No. Date 634 Main Rd Chesterfield MA 01084 pm@eastbranchstudio.com Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: 1/�/// 3 26 ZOZ Name Date City of Northampton _ iO0.t MAM \S T'. s Massachusetts ,f c%` • w * v t £•:$! DEPARTMENT OF BUILDING INSPECTIONS r• w " r 212 Main Street • Municipal Building Jti �D '� Northampton, MA 01060 441,1 N'‘ 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: Valley Recycling, 234 Easthampton Rd, Northampton, MA The debris will be transported by: Name of Hauler: Hala Abdul-Rasool Signature of Applicant: 7 Date: 2�-9-7 in I . A6, I- ' iiiii BO Original Floor Plan 8'-0" / 1 41 New Tempered Glass D ,,, �i Casement Window Exhaust Fan • Tg Plumbing y Wall Chase o / 12'-6" / / II ,___ T Proposed Floor Plan 1'S"1sExl sink Tr 3'-1013/16" 1 4 0" t Plumbing Wall Chase Elevation View from Window 1/30/24,9:12 AM Kent Hicks Construction Mail-Fwd:Expired HIC Debra Pithln<d.pftklnak nt ickaconatruction.com Fwd: Expired HIC Sangura,Marian(OPL)<Marian.8angura@mass.gov> ��— —�� Thu,Jan 25,2024 at 11:15 AM To:Debra Pitkin<d.pltkin@eastbranchstudio.com> Search Results Page I of 1 Fn * shcw Al ilcant Name/License Type Address/License nse Address b 'License Number HoWANrt Expiration Dots Status NumHICKS,KENT S PO BOX 57 West Chesterfield MA 01084 Construction Supervisor PO BOX 57 West Chesterfield 255054 CS-066104 01/12/2026 Active MA 01084 peeled text Mdden) The Commonwealth of Massachusetts Department of Industrial.-fccidents �JP���} 1 Congress Street,Suite 100 . is...-: /" Boston. MA 02114-2017 www.mass,gov/dia 11mkers'Compensation Insurance Affidavit: Buildrrsit"oatractorlfEkctrkianx/PIumbers. t0 HE FILM WITH THE PtKMiITING AUTHOR'T't. :Apntkant Information Please Print Lei:ibis Name IHustnessiorganszatwn'Indivadttai): East Branch Studio Address: 634 Main Rd City Statr.`Zip: Chesterfield, MA 01084 Phone#: 1(413)296-0123 ire you an tmpkayrr"( here the appropriate bit: Type of project(required): 1.0l am a earl n•er nuts 18 ten icrtiecs t full and cut petit timei' 7_ a Ness COnstnicUon 20 tar a sots proprietor to partnership and hate no emptwees working,. rot am in K. Ga Remcxlehn>; any csiooty.(No workers'comp.insurance n:turnd.) 9. J Demolition 30 lam a 11011)COV.714.1 Lining all wort[msscll.1No wstrkcas'canal nnauran.r ncputr li 1' I 0 El Building addition 4.l'�1 am w a trtma.oaver and will he taring sztruaaitur7ts.cceiduc-i all m m ere an t pnsperty I will p� t,J ensure that all e nui:atom either!Lose workers'compensation e 'to nsation ittsuuant sir air!WIC I 1 fd.f Electrical repairs or additions prupnciuna with no employees. 12.0 Plumbing repairs or additions 5 tam a general contractor and t base hird the sob-i:c+ntra.iurs listed on the atta.itrsi sheet. These nth-ctmtsacwrs Kato:cnsphiyecs and has 4...authors'comp uuuran.r I .0IZUt?f repairs 14.00thei fit]We an a eoeporataon and its Linkers base exert:lied their ngItt of cren-na.n parr 4K.1.e - --------- 1 t'. i i 4 t.and we have no erupkryres.(NU workers'comp insurance matured.I *Any applucarit that dhotis hos a t muss aliti 11 all out ills: erw tar yati kr showing their worieas'conspierisatunn polies mn1a atn�n I nw.s,wners ahu suBrrui this analas it it16F41;ai nit itICy AM doing all wefts and then hue outside contractors mint subrut a new aitittas it indicating such :i otWaactors that check this hot must aita tied an aaklrtiorwi sheet shoo mg the name s I the sub-,tvttra:t.z-i and itaac a flcth:t e>t rh?t iliuse snhtit"hint empty yets. It She sub-.atntra.ti.n>has c empty!,eon.!boas nrttsl prosaic their wtrrltetx".xnirp tx,itE::tria nts' I am an employer that is providing workers'compensation insurance jOr my employees. Below is the policy and job site information. Insurance Company Name. E M(.. AifsSiecAt..2 co.,. ro.lt€S Policy g or Self-ins.E-ic.g: SNRIa8bR Z S— -- Expiration Date: a I 1120ZS Job Site Address: 32 bol Noe `t city/State:Zip:.__Nero se}of t wll1 01060 Attach a copy of the workers'compensation polky declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152.~i25A is ii criminal violation punishable by a tine up to S1,S(X).(X) and'or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.(Xl a day against the violator. A copy of this statement may be forwarded to the Office of Insestigations of the DIA for insurance coserage vertf-K:ation I do hereby certify nder the ►cries and penalties of perjury that the information provided above is true and correct. Sry;n.tturc Date 3 ' S C-1-- — 2 7 Phone»: 1(413)296-0123 Official use only. Do not write in this area,to be completed by city or town official ('it) or Town: PermiWLicense tt Issuing Authority (circle one): I.Board of Health 2.Building Department 3.(it'll—oven Clerk 4.Ekctrkal Inspector 5.Plumbing Inspector - 6.Other I I Contact Person: Phone#: I 1 AC4E? D® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `� 01/16/2024 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 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 Meghan Kelleher,CIC,CISR NAME: Alera Group,Inc. PHONE (413)586-0111 FAX (413)586-6481 (A/C.No.Ext): (A/C,No): Webber&Grinnell Division ADDRIESS: mkelleher©webberandgrinnell.com 8 North King Street INSURER(S)AFFORDING COVERAGE NAIL i Northampton MA 01060 INSURER A: Miscellaneous INSURED INSURER B: EMC Insurance Companies Kent Hicks Construction Co.,Inc. INSURER C: Attn:Kent Hicks INSURER D PO Box 57 INSURER E: West Chesterfield MA 010840119 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 2025 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 ADDLISUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000,000 CLAIMS-MADE DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 1U,000 A 5D9686925 01/01/2024 01/01/2025 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2'000'00B POLICY XI JEC pi LOC PRODUCTS-COMP/OP AGG $ 2'"'" OTHER: $ AUTOMOBILE UABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED 5Z9686925 01/01/2024 01/01/2025 BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 1'000,000 A EXCESSLIAB CLAIMS-MADE 5J9686925 01/01/2024 01/01/2025 AGGREGATE $ 1,000,000 DED XI RETENTION$ 10,000 $ WORKERS COMPENSATION )/t PER OTH- AND EMPLOYERS'LIABILITY Y/N I�STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBEREXCLUDED? n N/A 5H9686925 01/01/2024 01/01/2025 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ c '00D If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ '" 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 Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. 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