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17C-034 (5)
BP-2024-0401 101 NORTH MAPLE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17C-034-001 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-2024-0401 PERMISSION IS HEREBY GRANTED TO: Project# BATH RENO 2024 Contractor: License: Est. Cost: 12980 JAMESON NEAL MAJOR 115808 Const.Class: Exp.Date: 05/11/2025 EVANS-PEREZ ALBERT&KIMBERLY DAVID & Use Group: Owner: MICHELLE R PEREZ Lot Size (sq.ft.) Zoning: URB Applicant: TOUGH AS NEAL'S REPAIR Applicant Address Phone:, Insurance: 25 HIGH ST (413)320-3462 VWC1 006025 1 1 22024A HAYDENVILLE, MA 01039 ISSUED ON: 04/05/2024 TO PERFORM THE FOLLOWING WORK: BATH RENO, ADD LAUNDRY 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: Fees Paid: $84.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner V (a 0 -='-- . 4 0/1,aj riv(11`-- ----'-,c111,,,'--- . "t.,,_p/ �,, 14 The Commonwealth of Massaphusetts APR Board of Building Regulations a d Standards S 'FOR w Massachusetts State Building Cde, 780 C � ��Q MUNICIPALITY Puff,. USE Building Permit Application To Construct, Repair, Renovate` r!7 as " isha i Revised Mar 2011 One-or Two-Family Dwelling ?o; ;;°NS �,�yy Thisis!Section For Official Use Only Building Permit Number: �"-,2 Y ttT - Q/ Date Applied: /Cc.-usN / I1•55 - �� 2 '-1- 5.20Z41 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Pro a Address: 1.2 Assessors Map&Parcel Numbers 1.1 a Is this an accepted street?yes_X_ 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: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ 2.1 Owner'of Record: Albert Evans-Perez Florence,MA 01062 Name(Print) City, State,ZIP 101 North Maple Street 4 1 3-5 864844 aperez@smith.edu _ No.and Street Telephone Email Address New Construction 0 Existing Building D Owner-Occupied al i Repairs(s) 0 Alteration(s) ® Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: We are going to demo a section of the bathroom wall so that the sink can be moved to the opposite wall,and a washer and dryer can be installed in the bathroom. In addition to repairing the walls,we will also be building a soffit for the vent stack. Item Estimated Costs: Official Use Only (Labor and Materials) i1. Building $4530 1. Building Permit Fee: $ Indicate how fee is determined: l ❑Standard City/Town Application Fee 2.Electrical $ 7-1 $ o ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $41 9-0 0 2. Other Fees: $ 4. Mechanical (HVAC) $ , O List: 5. Mechanical (Fire $ o _, Suppression) Total All Fees: $ (bli Check No. heck Amour Cash Amount: 6.Total Project Cost: $4530 1 i1.1-11`�v 0 Paid in 11 ❑Outstanding Balance Due: el SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 115808 05/11/2025 ie Neal E Major Jameson License Number Expiration Date Name of CSL Holder 25 High St List CSL Type(see below) U No.and Street Type Description Haydenville U Unrestricted(Buildings up to 35,000 cu.ft.) R _ Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry MA 01039 RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-320-3462 toughasneals@gmail.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 180830 01/12/25 Neal Major Jameson DBA Tough As Neal's Repair HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 25 High St toughasneals@gmail.com No.and Street Email address Haydenville,MA 01039 413-320-3462 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 ..0 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 Neal Jameson to act on my behalf,in all matters relative to work authorized by this building permit application. ,�/ X U1�1.'yVL ci - 14' VL I opal- Print Print Owner's Name(Electronic Si 11 Date By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contain in this application is true and accurate to the best of my knowledge and understanding. 04/02/24 Print Owner's or Authorized Agent's Name(Electronic 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(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" City of Northampton oAYMAMrO S •• 1` Massachusetts �S, '.1 DEPARTMENT OF BUILDING INSPECTIONS :r ° 212 Main Street • Municipal Building\ wore �...� Northampton, MA 01060 41511W arD\',C (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 The debris will be transported by: Name of Hauler: Tough As Neal's Repair Signature of Applicant: Date: 04/02/24 I7►e Commonwealth of Massachusetts T' r�` t—� 7' Departme►►t of Industrial Accidents 1`i 4jt. 1 Congress Street, Suite 100 ' I3 r. Boston,.i4 02 14-201- 'i' i.►nass.goildia _: w'..,t'kers' Compensation Insurance Affidavit:Builders'Contractor-,Electricians'Plumbers. TO BE FILED«ITH THE PERIITTINO AUTHORITY. Applicant Information Please Print Legibly Nance tiBu=inos n:i.Orga vaoulvdividn J2a. /'"a.',br km.e.,S4h • Adrey_: 2 5 1-1 (si 5.k' Cit State:Zi t..J:0-t, /A A 0 t031 Phone : K(3 32..a 3N4 L Are yo■an employer'Check the appropriate box: Iti-pe of project(required): 1.13 I era a employer with 1 amploz-eel(full and or part-time)." ['NeR construction 2.El I an a sale proprietor or parmership and have no employee:'working far ma m S. ©Remodelinz any capacity.p.roworkers cc•mp.nturanco required.] 9. I am a homeowner doing all work myself.[No worker. comp.insurance acquired.)t ❑Demolition 10❑BuilelsnE addition 4.0 I am a homeowner and will be hiring contracton to conduct all work on my property. I will ensure that all contractors either have worker:'compensation insurance or are sole 11.❑Electrical 3ep:us Or additions proprietors with no employees - 1_.❑Plunibit.ng repair:or additions 5.0 I am a general contactor and I have hired the sub-contractors lilted on the attached sheet. These sub-contractors have employees and have workers.comp.insurance.0 13.0 Roof repair 6.0 Ira MD a corporation and it:officer:have exercised their right of exemption per NIGL c. 14. E 152. :1(4).and we have no amp:oyee .[_No workers'comp.insurance rewired.] "Any applicant that checks box a1 must also fill out the section below showing their workers'compensation policy information Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must:nbns t a new affidavit indicating such ontractors that check this box mutt 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 employee:.they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for mr employees_ Below is the polity and job sire irrformatiorn_. In.ittance C ou atr;Name: i', AU i U d L T.S yr vtG- Policy r or Self-ins.Lic. .i: J W L v d C 515 11 22- (7 G Li A Expiation Date: 21q(Z(- Job Site Address: (a( ►J.rl6.1 A4.-et. 5} Citv'State'Zip: '.- !s*r,•,tt M A- o to G Z Attach a cop}-of the workers'compensation policy declaration page(shorting the policy number'and expiration date F. Failure to secure coverage as required under MGL c_ 152_§25A is a criminal lioLation pumsliable by a fine up to$1,500_00 and'or one-sear imp-Ismail-v.:it.as well as civil penalties in the form of a STOP WORK ORDER.and a fine of up to$250.00 a day agairc.t the vioLator. A copy of this state rant mass be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cernf under the pains and penalties ofperjur i'that the information provided above is nue and correct Signature: Date: 04/02/24 Phone413-320-3462 Official use only. Do not wife in this area,to be completed by city or town of c tf; City or Iown: Permit License tF Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City:Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6,Other Contact Person: Phone#: II ACc RD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 04/03/2024 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 Elizabeth Carballo,CISR,CPIA NAME: Finck&Perras Insurance Agency Inc. IPAHONN,Eat): (413)527-5520 FAX No): (413)527-5970 6 Campus Lane E-MAIL bcarballo@finckandperras.cor ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Easthampton MA 01027 INSURER A: Atlantic Casualty Insurance Company INSURED INSURER B: Tough As Neal's Repair INSURER C: 25 High Street INSURER D: INSURER E: Haydenville MA 01039 INSURER F: COVERAGES CERTIFICATE NUMBER: CL244307843 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 CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 50,000 MED EXP(Any one person) $ 10,000 A L185001752-0 03/16/2024 03/16/2025 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY n PRO 2000,000 JECT LOC PRODUCTS-COMP/OPAGG $ , OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (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 NIA 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 S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Job: 101 North Maple Street,Florence 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 Northampton MA 01060 ,�yl� At,Azllo I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ,4Co CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/03/2024 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 Patricia Lumbra NAME: FINCK&PERRAS INSURANCE AGENCY INC ( Cr PHONE Ext): (413)527-3000 FAX No): ADDRESS: pumra lb /�finckandp erras.com ADDRESS: 6 CAMPUS LANE INSURER(S)AFFORDING COVERAGE NAIC# EASTHAMPTON MA 01027 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURER B: NEAL E MAJOR JAMESON INSURER C: TOUGH AS NEALS REPAIR INSURER D: 25 HIGH STREET INSURERE: HAYDENVILLE MA 01039 INSURERF: COVERAGES CERTIFICATE NUMBER: 993464 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 (MM/DD/YYYY) (MM/DD/YYTY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE T $ RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 100,000 W A OFFICER/MEMBEREXCLUDED? n N/A N/A VC1 0060251 1 22024A 02/04/2024 02/04/2025 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers- compensation/investigations/. Sole proprietor has not elected coverage. 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 Street AUTHORIZED REPRESENTATIVE Northampton MA 01060 Daniel .Cro*l y,CPCU,Vice President—Residual Market—WCRIBMA 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD T 4-1 H `Z t f`JatiA 7to/✓ o l Nv ,P-1'H MAPLE •T FL vft-rNC ,A4 4 r'r krs-r��IG, SV`o...1{-.r C ( USci 1 y z L___ 4 S L.,0...rA4- c (0%-t..k R�Post�� (-- ka+toFF 4 4 A.1,� c�;1,ll s-I . Piv , • stick i C� N) 12 v1^S ' I GUI 4'f I-