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17C-230 (13) BP-2024-0428 30 NORTH MAPLE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17C-230-001 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-2024-0428 PERMISSION IS HEREBY GRANTED TO: Project# windows 2024 Contractor: License: Est. Cost: 15000 ROBERT SPELMAN 082172 Const.Class: Exp.Date: 09/07/2025 Use Group: Owner: TRUSTEE ARNOLD WILLIAM J Lot Size (sq.ft.) Zoning: OI Applicant: ROBERT SPELMAN Applicant Address Phone: Insurance: 71 NASH HILL RD 4135755703 WILLIAMSBURG, MA 01096 ISSUED ON: 04/11/2024 TO PERFORM THE FOLLOWING WORK: 7 new replacement windows 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: S105.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner -re -Q- nv► The Commonwealth of Massachusetts APR 1 1 2024 ,z *0, f, Office of Public Safety and Inspections j � Massachusetts State Building Code(780 CMlet) ,r - o=r>un ;nt'=;,-isP�c �oNs , BuildingPermit Application for anyBuildingother than a One-or Twri- ilidiily'I➢we PP � ° ,_,... �/ (This Section For Official Use Only) Building Permit Numberol' ' q Date Applied: Building Official: SECTION 1:LOCATION No.and Street City Town Zip Code Name of Building(if applicable) 30 N, mffa qr Fto 11E, 09 6/0bt- 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[ Repair 0 Alteration [V Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other ElSpecify: P rt "te 1E4 ✓N 6MYZoV5 Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No Er— Is an Independent Structural Engineerin Peer Review r ? Yes 0 No CPS Brief Description of Proposed Work //"S7-L- 7 A/04i Rem x}e /�11..' - W//y/2O U- rAciota • 30 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): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) 3 Total Area(sq.ft.)and Total Height(ft) 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❑ I: Institutional I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3❑ R-4❑ 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 IB0 IIAD IIBD IIIAD nth D IVD VAD VBD 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 0 Public 0 Check if outside Flood Zone 0 Indicate municipal❑ required 0 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❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes 0 or No❑ Yes❑ No ❑ 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 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: ©WAV -- /l3 -. - 3c3—o - - Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: �Og S PrziN 7 l /14951i K/-? / Iftazi sga IAA- v(a% 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 0. 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) f3&�l;0Palr'9A/ L1/3 -57S 5 703 boDeepeI w & S 0/7/72- Name Re trant) Telephone No. e-mail address il/L, 4 egistration Number .7/ i'j rtIu_ o I✓vtu.olrnskc ,} 0/04%6 9l?/?-S Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Company Name /3 c>s oS z Name of Person Responsible for Construction License No. and Type if Applicable 7/ /17 <7 `% W1 ,15 c / - Ulan Street Address City/Town State Zip 71 -5 5: 6'74' 1:2vbekeimaitt &i rz ,C,vm 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 CI No CI SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ /5>Citri 1.Building $ /5 O t.2 / Building Permit Fee=Total Construction ost x� (Insert here 2.Electrical $ appropriate municipal factor) 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ / 00'0 (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 knowledge and understanding. Lf/3 -ems= 703 6/JJ/ '/ Please print and sign name Title Telephone No. Date �1 1v,')4 /lice-- ,o W i(Ui s - 'f OU27& too espekn4A4v b v Street Address City/Town State Zip Email Address COm r Municipal Inspector to fill out this section upon application approval: L'"1!"ZoZy Name Date CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton boa N M p S�5 SI *. 4'1' f, Massachusetts , �-- '1: <<., N; 1 ` 1. DEPARTMENT OF BUILDING INSPECTIONS ' ,r ` 212 Main Street • Municipal Building '"r Northampton, MA 01060 �sk,y0‘ 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: V/9U 1 u1 The debris will be transported by: Name of Hauler: Signature of Applicant: - Date: 51/1/z'/ The Commonwealth of Massachusetts i +► ����l Department of Industrial accidents t. ' .. T= 1 Congress Street,Suite 100 i d f Boston, MA 02114-2017 ' t.a`sv r Www.mass.gov"/dia 11urkers"Compensation Insurance AfTtdavit:Builders/Contractor^s!EkctrkianslPlumbers. TO BE FILED 11 I fit THE PERMMITTING AUTHORITY. Applicant information Please Print Lerihls Name(ilusine sx'orgarazaation/lnditiiduai): /30 -Zfl'719 v Address: it / /4 /'(/44., Weteems&i --, ink City/State/Zip: WL4IA0/5 0/1" Q/U6ZJ'hone#: 4(/31 .57 76-1O3 Are y oa an employ r r'Cade the appropriate boa: Type or project(required): I 1 atn npluyrs with._._ _emptoyees(full anct'w part-time/-' 7. CI New construction 2 am a rote proprietor or partnership and have no cmptuyazs working for me in K- Q Remodeling any capacity.(No woken'coup.insurance required.) ciICI I am a homeowner doing all work myself.(No workers'comp.insurance required.)" g Demolition 40 I am a homeowner and will be hiring ntr'aviors to cuodact all work on my property. I will 1 Q Building addition cm ensure that all contractors either hate workers'curer imastion incuranm or are sole 1 I.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions Sri lam a general contractor and I have hired the sub-contra tan listed on the attached them. 13.a Roof repairs These sub-cunuac tun have employees and hate workers'comp.insurance.: 14.0Othe?� �� f0 corora W-- 60 We area corporation and its officers have exercised ve ercised their right of exemption per MGt.e. (Alf5 152,*Ili),and we base no employees.[No workers'camp.insurance required" 'Any applicant that checks boa e I must als.,till 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 submit a new affidav it indieuars_.u.f: :Contractors that check this box must attached an additional sheet showing the name of the s b-courao:t mand state whether or nla t}v.,.0 rntstic,Ira.: employees. lithe srtb-euniraetovs have v.-rrrr>Ior.era.they must pro%ide their worker`evmp.pulley number. 1 ant 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.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the 's orkers'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 S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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. 1 do hereby certify under the pains and penalties of perjury that the Information provided abuse is true and correct. Signature: -- A �---- Date: i i/C-1 z-1 Phone#: '/3 /67 5 s 7v ' Official use only. Do not write in this urea.to be completed by city or town official ('it's or !Own: Perntit/License# Issuing Authority (circle one): I. Beard of Health 2. Building Department 3.('ityrros►n Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: From: 7/ 114164 kt! tAl!, �f � 2 0/6 / 716 To: Jonathan Flagg Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 The Massachusetts Building Code, section 107.1 allows for an exclusion from requirements for construction control in certain situations. In accordance with code section 104.10, I request that you grant a modification to waive the requirement for construction control of the project at 30 �� mOL tag 6dz because the work is of a minor nature, will not affect structural elements, health, accessibility, life or fire safety, and will be done in accordance with the prescriptive requirements of the code. Thank you for your consideration. • Respectfully, ACGR D CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDO/YYYY) 09/08/2023 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(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 CONTACT Anna Pena NAME: M.R.Shaw Insurance Agency,LLC PHONE (978)7444540 I FAX,No (978)745.8584 fAIC.No.Ed): (AIC 18 Hawthorne Blvd Ej L annie@garrity-insurance.com ADDRESS: PO Box 4428 INSURER(S)AFFORDING COVERAGE NAIC B Salem MA 01970 INSURER A: Mapfre Insurance Company 23878 INSURED INSURER B: Robert Spelman INSURER C 71 Nash Hill Rd INSURER INSURER E: Williamsburg MA 01096 INSURER F COVERAGES CERTIFICATE NUMBER: Master COI 2023-24 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. ILA POI EPF POLICY TYPE OF INSURANCE INSO WVD POLICY NUMBER TY UNITS _(MM/0CY O/YYYY) (MMIDDIYYW) X COMMERCIAL GENERAL LaBILr1Y EACH OCCURRENCE $ 1.000'000 DAMAGE TO RENTED CLAMS-MADE n OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A 8008030006750 07/29/2023 07/29/2024 PERSONAL&ADV INJURY $ 1.000,000 GEML AGGREGATE LTAPPLIESPER: GENERAL AGGREGATE $ 2'000'000 IMI X POLICY❑i ca LOC PRODUCTS-COMP/OP AGO $ 2.000'D00 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 acdtlent) $ UMBRELLALaB OCCUR EACH OCCURRENCE $ EXCESS(JAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION I PER i i T ER AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) EL DISEASE EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL_DISEASE-POLICY LIMIT $ A DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached Xmas apace is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN FOR REFERENCE ONLY ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE el 1988-2015 ACORD CORPORATION. AU rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • • Initial Construction Control Document t $be submitted with the building permit application by a Registered Design Professional ', for work per the ninth edition of the .11 10 Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Date: Property Address: Project: Check(x)one or both as applicable: New construction Existing Construction Project description: I MA Registration Number: Expiration date: ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning:: Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code_ Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a'Final Construction Control Document'. Enter in the space to the right a "wet" or electronic signature and seal: Phone number: Email: Building Official Use Only Building Official Name: Permit No.: Date: Note 1. Indicate with an'x' project design plans,computations and specifications that you prepared or directly supervised_ If'other'is chosen,provide a desciption Version O1 01 2018 Appendix 1 Construction Documents are required for structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where applicable No. Item Submitted Incomplete Not Required 1 Architectural 2 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing(include local connections) 9 Gas(Natural,Propane,Medical or other) 10 Surveyed Site Plan(Utilities,Wetland,etc.) 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review(521 CMR) 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction. Registered Professional Contact Information Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Please follow this link for construction control forms to be used by Registered Design Professionals_