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18D-001 (20)
122 NORTH KING ST BP-2019-0664 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18D-001 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2019-0664 Proiect# JS-2019-001086 Est.Cost: $108700.00 Fee: $756.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CSI CONTRACTORS INC 108538 Lot Size(sq. ft.): 532738.80 Owner. D'AMOUR PAUL H ET AL C/O BIG Y TRUST Zonin :HB(100)/WP(16) Applicant: CSI CONTRACTORS INC AT. 122 NORTH KING ST Applicant Address: Phone: Insurance: PO BOX 978 (860) 571-0029 WC ROCKY HILLCT06067 ISSUED ON.12/12/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:FRAME INSULATE DRYWALL PERIMETER WALS AND BOX OUT COLUMNS 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Deuartment Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 12/12/2018 0:00:00 $756.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0664 APPLICANT/CONTACT PERSON CSI CONTRACTORS INC ADDRESS/PHONE PO BOX 978 ROCKY HILL (860)571-0029 PROPERTY LOCATION 122 NORTH KING ST MAP 18D PARCEL 001 001 ZONE HB(100)/WP(16)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENC REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildina Permit Filled out Fee Paid Typeof Construction: FRAME INSULATE DRYWALLERIMETER WALS AND BOX OUT COLURNS N 0 EINE. fj6Ep; Ro-t� ��EY FgArwt/v�' � INS,&LAT oq. New Construction INS116r:[IV N--!' Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 108538 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: V Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. Versionl.7 Commercial Building Permit Ma 15,2000 Department use only ity of Northampton Status of Permit: DEC 3 2018 uild'ing Department Curb Cut/Ddveway Permit - 212 Main Street Sewer/SepUc'Availability Room 100 Water/Well Avellability DEPT R AMPTVC;INSPECTIpNlf No hampton, MA 01060 Two Sets of Structural Plans NORTHAMPTON,MA 01060 plluilfz -587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify ! APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office rMc f 6 fqp�e� SN c t; CJS Map / � � Lot ' Unit No r7h K In ST, Zone Overlay District N01')*a4)P'fdn M . 01060 Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Reil 01 d,) q 5, 5� (� e./ T Name(Print) Current Mailing Address: Signature Telephone (y, - /a y 3 2.2 Authorized Agent: CSr ComrhcT®r. Name(Print) IEG h a e-1 H Current Mailing Address: P a 666 9 V R6cW y 144 CT 0606 7 Signature Telephone&C_S1'06 9 SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building Q (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of 000 Construction from 6 3. Plumbing a S� Building Permit Fee 4. Mechanical(HVAC) MA5/ _ 0 5. Fire Protection / AOL? CQ 6. Total=(1 +2+3+4+5) 117800 Check Number pZ (� This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildi gs Date ., _ .'�`iii�.�... .:•`;� �j ,_$ ` �. i s ` r ., •. Versionl.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing[:] Change of Use❑ Other❑ Brief Description Enter a brief description here. rf'&M e- -z,7 so/afiG pPy W I I Pe,-Nm el'(!` C t 11s Of Proposed Work: -b 6o Ot!'r evic mAS SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: _ Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1 St 15` 1,91000 2nd 2nd 3rd 3rd 4m 4�h Total Area(sf) jfJ 000 Total Proposed New Construction(sf) Total Height(ft) 1,7' To deeK Total Height It 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: [7rSewage Disposal System: Public [:] Private ❑ Zone Outside Flood Zone❑ Muicipal ❑ On site disposal system❑ Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage - Setbacks Front Side L: R: L R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO () DON'T KNOW ® YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW Q YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW ® YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained ® , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor CSS a,11P&cT6P..0 IR-0160K P7e Not Applicable ❑ Company Name: Aocgy 14,`11 CTt 06o67 Responsible In Charge of Construction /nt`c4ae.) Address S6o-V30 3a� Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes ® No SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, DMPT 1'►G rli'M e l) as Owner of the subject property 11.1 hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signat re of Owner Date I, as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Constructions Supervisor: Q 1, Not Applicable )❑ D Name of License Holder: V @� (R��dl i I U(if Y CS — 10c5 5-3R License Number 5-s ck�.sJ vT )4,'!/ Re-A Star-Y o cT b6 o%" .5-.2 9- 20a o Address Expiration Date Signature Telephone SECTI 13-WORKERS'COMPENS,4TION 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 b ilding permit. Signed Affidavit Attached Yes No 4 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: 122- A o rJA k, '1y s`i'p The debris will be transported by: uSA Hvu4,2 The debris will be received by: U5-A 4a,01i'liq Building permit number: Name of Permit Applicant /Y1 t 1VDGr4 rc Date Signature of Permit Applicant '\ The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: R o, Q ox 9 79 Qdtky 401 City/State/Zip: LT, 06067 Phone#: S6 V -5 7/ " 0 0 `�g Are you an employer:'Check the appropriate box: Type of project(required): 1.E]I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. CK Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 10 ❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.C5 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.* 6.❑We are a corporation and its officers have exercised their right of exemption per MGL a 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] IL *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must 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 employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. / r Insurance Company Name: L! b of tY LNUA L Policy#or Self-ins.Lic.#: X W o (j�) _,5- q7/7 M Expiration Date: c6 AIN 9 Job Site Address: I al /Vot*kL 6(1n City/State/Zip:/1i$�l'';�tQ�h/P6 n PA, 0/0 60 Attach a copy of the workers' compenslition 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$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$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 do hereby ceti nder the pains and penald o perjury that the information provided above is true and correct Si nature: 1 . Pni.A -r Date: 11-30,12 Phone#: 6 Official use only. Do not write in this area,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 6.Other Contact Person: Phone#: a Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constructfbn'Supervisor CS-108538 ' E�pires: 05/29/2020 JONATHAN AVERY ' 66 CHESTNUT-HILL R0I,1jL STAFFORD SPRI607.6 r,c f3� Commissioner - STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION This is your registration certificate. Such registration shall be shown to any properly interested person on request. Do not attempt to make any changes or alter this certificate in any way. This registration is not transferable. In an effort to be more efficient and Go Green, the department asks that you keep your email information with our office current to receive correspondence. Questions regarding this registration can be directed to the Occupational & Professional Licensing Division at dcp.occupationalprofessional«ct.�,ov-. Mailing address: Email on file to be used for receiving all notices from this office: C S I CONTRACTORS INC csicontractors@sbcglobal.net 2251 SILAS DEANE HWY ROCKY HILL, CT 06067-2343 •4 f - C STATE OF CONNECTICUT ♦ DEPARTMENT OF CONSUMER PROTECTION Be it known that C S I CONTRACTORS INC 2251 SILAS DEANE HWY ® ROCKY HILL, CT 06067-2343 has been certified by the Department of Consumer Protection as a r i MAJOR CONTRACTOR Registration #: MCO.0902081 Effective Date: 07/01/2018 j I Expiration Date: 06/30/2019 E i verify online at www.elicense.ct.gov Michelle Seaiup,Commissioner j qCoverage is Provided In: L'bCPolicy Number: Uta. The Ohio Casualty Insurance Company USO (19) 54 471416 M INSURANCE (ITEM 5)SCHEDULE OF UNDERLYING INSURANCE: CARRIER, POLICY NUMBER AND PERIOD TYPE OF COVERAGE LIMITS OF INSURANCE WEST AMERICAN INSURANCE GENERAL $1,000,000 EACH OCCURRENCE COMPANY LIABILITY LIMIT $1,000,000 PERSONAL AND BKW(19)54471416 ADVERTISING INJURY 06/14/2018 - 06/14/2019 LIMIT $2,000,000 GENERAL AGGREGATE LIMIT $2,000,000 PRODUCTS - COMPLETED OPERATIONS AGGREGATE LIMIT OHIO SECURITY INSURANCE OWNED AND HIRED $1,000,000 COMBINED SINGLE COMPANY AND/OR NONOWNED LIMIT AUTO LIABILITY BAS(19)54471416 06/14/2018 - 06/14/2019 WEST AMERICAN INSURANCE EMPLOYERS $500,000 BODILY INJURY EACH COMPANY LIABILITY* ACCIDENT LIMIT $500,000 BODILY INJURY BY XWW(19)54471416 DISEASE AGGREGATE 06/14/2018 - 06/14/2019 LIMIT $500,000 BODILY INJURY BY DISEASE EACH EMPLOYEE LIMIT *EMPLOYERS LIABILITY COVERAGE IS NOT PROVIDED FOR CLAIMS BY EMPLOYEES WHO ARE SUBJECT TO THE WORKERS COMPENSATION LAWS OF NEW YORK To report a claim, call your Agent or 1-800-362-0000 DS 70 23 01 08 06/15/18 54471416 N0089379 470 PCAOPPNO INSURED COPY 004625 PAGE 12 OF 68 Coverage Is Provided In: Policy Number: ty The Ohio Casualty Insurance Company USO (19) 54 471416 ial, ONCE Commercial Umbrella Policy Declarations Basis: Occurrence .MED INSURED&MAILING ADDRESS AGENT MAILING ADDRESS&PHONE NO. "RACTORS INC. (860) 232-4491 978 BOUVIER INSURANCE HILL, CT 06067-0978 29 N MAIN ST WEST HARTFORD, CT 06107-1933 Insured Is: CORPORATION Insured Business Is: JANITORIAL M 2)POLICY PERIOD )m 06/14/2018 TO 06/14/2019 12:01 AM Standard Time at Insured Mailing Location ,TEM 3)PREMIUM CHARGES xplanation of DESCRIPTION PREMIUM charges C'nmmerrial 1lmhrgha $11 0141_nn Certified Artc of Terrarkm C'nv rage $112-00 (Tnrl»Aad) Total Advance Charges $11,343.00 Note: This is not a bill ASIS OF PREMIUM: NON-AUDITABLE( X) AUDITABLE( ) v THE EVENT OF CANCELLATION BY THE NAMED INSURED, THE COMPANY WILL RECEIVE AND ETAIN NO LESS THAN (10% ) OF THE POLICY PREMIUM AS THE MINIMUM RETAINED PREMIUM LUS CERTIFIED ACTS OF TERRORISM COVERAGE AND ANY APPLICABLE TAXES AND SURCHARGES. TEM 4)LIMITS OF INSURANCE DESCRIPTION LIMIT EACH OCCURRENCE $5,000,000 AGGREGATE (WHERE APPLICABLE) $5,000,000 PRODUCTS-COMPLETED OPERATIONS AGGREGATE $5,000,000 SELF-INSURED RETENTION $10,000 sue Date 06/15/18 Authorized Representative D report a claim, call your Agent or 1-800362-0000 PCAOPPNO INSURED COPY 004625 PAGE 11 OF 68 CSI Contractors, Inc. F10 Box 978 Store Maintenance & Construction Rocky Hill, CT 0606? Csicontractors.nel Phone- (860) 571-0029 1 request that you grant a modification to waive the requirement for control construction for the perimeter walls at 122 North.ging St in Northampton because the work-is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements, and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work. Thank*vou.for your consideration, "Alass Amendments, sections 107.1 allowsfor an erclusion frons control construction for this project. Respectfully, CSI Contractors Michael Howard Project Manager Office: (860) 571-0029 Cell: (860) 930-3270