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36-284 (15) BP-2024-0416 610 BURTS PIT RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 36-284-001 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-2024-0416 PERMISSION IS HEREBY GRANTED TO: Project# 2024 BATH RENO Contractor: License: Est. Cost: 7500 S-CEL-0 LLC 076237 Const.Class: Exp.Date: 04/24/2025 Use Group: Owner: DARA FISHMAN PETER E& Lot Size (sq.ft.) Zoning: SR/WSP Applicant: S-CEL-0 LLC Applicant Address Phone: Insurance: 142 HANCOCK ST (413)273-1431 085BAIX9625 SPRINGFIELD, MA 01109 ISSUED ON: 04/10/2024 TO PERFORM THE FOLLOWING WORK: BATH RENO 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: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner ":Ts �/ ,tiff-,-- Comonwealthl of Massachusetts I° APR , 9 Boar of) lailding Regulations and Standards FOR i `'� 202QMas achu efts State Building Code, 780 CMR MUNICIPALITY l- .,�T nF r USE /ik \,�p Permit plic4tion To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 -N° '^-,0,1^11spr�J,-- One-or Two-Family Dwelling "'-,u_70s0 i This Section For Official Use Only Building Permit Number:i'd' 1,r#/ Date Applied: 4u10 , /v L -10 2621 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 1Io burl- P1 QA N. ilfiftiphn,IY10. 1.1a is this an accepted street?yes V 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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ _ SECTION 2: PROPERTY OWNERSHIP' 2. (honer'of ecord: Vtv e- L.4 r-n.-e Name(Print) City,State,ZIP q No.and Street Telephone ��wf�Email/Address /OP�1 x SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) lirl Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: EarnooF, Brief Description of Proposed Work': RE MD()F L Sy 10 (5A-11t-t-00 Ai WOO. INC.t Oi .S ' TILE+SltaweRt 5i104 $ "CU1t,.ET SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All F 11ii� /� o�, Check No. Check Amount: A Cash Amount: 6.Total Project Cost: $ 75o0 ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Constructions Supervisor License(CSL) es -0-14D 3-7 E Il{,Y1 boyn 1141 License Number Expiration Date Name of CSL Holder 110 �rp s' �`j„g�t, List CSL Type(see below) No.and Streer �'? J7 f( T Type Description f�/,((p� f} r,(1�j U Unrestricted(Buildings up to 35.000 cu.ft.) r '�3v'+ �✓�t!`1�J R Restricted I&2 Family Dwelling City Todvn,Statc lt1P M Masonry RC Roofing Covering WS Window and Siding /�J� ,f SF Solid Fuel Burning Appliances 4 3 •a7b-1 a ath r eiopam n 1 I Insulation Telephone Email address v Demolition 5.2 Registered Home Improvement Contractor(HIC) I (,�t„3 ,019) 125 5-cEL-0, U-G HIC Registration Number Expiration Date H1C Company Name or HIC Registrant Name i s i4-41QCOCIC sr Ad +knOa o a+otI r:c 1 Nu.and Street P1111'!hFa .i.DT �1 '113-a1 i� E asl addr .. City/Town,State,Zl 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 0 No...........❑ 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 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 knowledge and understanding. El 1 1 -q-aaay Print Owner's or Aut zed Agent's Name(Electronic Signature) Date NOTES: I. 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 wuw mass.govtfoca Information on the Construction Supervisor License can be found at www.ira tro 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 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: t / 65 8u ifS PI 1- Pd The debris will be transported by: CX U c-S fiAN The debris will be received by: cisA B40 \ Ini .5 Building permit number: Name of Permit Applicant Date Signature of Permit Applicant ,..,..."'1 S-CELLC-01 TENNIS ACORO$ CERTIFICATE OF LIABILITY INSURANCE DATE(M �� 3/26/202YYY) 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(les)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 NAME: 84AXiA Insurance Services A/CNNo,Ext):(413 788-9000 I FAX 413 886-0190 84 Myron Street l ) (A/C,No):( Suite A E-MAIL in ADDRESS: ax9rou fo is net p• West Springfield, MA 01089 INSURER(S)AFFORDING COVERAGE NAIL N INSURER A:The Hartford Insurance Company 19682 INSURED INSURER B:Commerce Insurance 34754 S-CeI-O LLC,(SCELO) INSURERC: 142 Hancock Street INSURERD: Springfield, MA 01109 INSURER E: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR 1NSD MD (MM/DD/YYYY1 (MM/DO/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 08SBAIX9625 9/9/2023 9/9/2024 DAMAGE TO RENTED 1,000,000 PREMISES(Ea occurrence) $ X Contractual Liab 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 X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: EPLI $ 10,000 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ _ ANY AUTO BCQL05 7/10/2023 7/10/2024 BODILY INJURY(Per person) $ OWNED —� SCHEDULED — AUTOSRE ONLY X AUTOSNA Ep BODILYO INJURYp (Per accident) $ AUTOS ONLY Awards ((Per acciiident)AMAGE $ _ $ A — UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE 08SBAIX9625 9/9/2023 9/9/2024 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 08WECAT5VXT 9/9/2023 9/9/2024 1,000,000 FICER/MEMg��EXCLUDED? N/A E.L.EACH ACCIDENT $ Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 dyes,describe under 1,000,000 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) Project address:610 Burt Pits Rd,Northampton,MA 01062 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Gandara Center THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 933 Columbus Ave Springfield,MA AUTHORIZED REPRESENTATIVE 3.i ACORD 25(2016/03) /©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD