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17A-064 (3) 257 BRIDGE RD BP-2020-0409 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-064 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-2020-0409 Proiect# JS-2020-000694 Est.Cost: $23000.00 Fee: $150.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: FIVE STAR BUILDING CORP 085319 Lot Size(sg. ft.): 9147.60 Owner: NORWICH PROPERTIES LLC Zoning: URB(100Applicant: FIVE STAR BUILDING CORP AT. 257 BRIDGE RD Applicant Address: Phone: lis urauce: 123 UNION ST (413) 587-4060 O WC EASTHAMPTONMA01027 ISSUED ON:9/30/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-NEW ROOF, REPLACEMENT WINDOWS, RENO KITCH & BATH, INTERIOR FINISHES 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 Department 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 Siq_,nature: Feel'ype: Date Paid: Amount: Building 9/30/2019 0:00:00 $150.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2020-0409 APPLICANT/CONTACT PERSON FIVE STAR BUILDING CORP ADDRESS/PHONE 123 UNION ST EASTHAMPTON (413)587-4060() PROPERTY LOCATION 257 BRIDGE RD MAP 17A PARCEL 064 001 ZONE URB000)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildina Permit Filled out Fee Paid Typeof Construction: NEW ROOF, REPLACEMENT WINDOWS RENO KITCH&BATH IMNTERIOR FINISHES New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 085319 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: 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 J , TJ. - � 30 Sig ture 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 4pA.Contact Office of Planning&Development for more information. l -� Kj ID Department use only i City of Northa,pto atus of Pe mit: Building Depa amen SEp 3 durb t/Dri eway Permit '> 212 Main Str et Sew eptic vailability j Room 100tNell Availability �. Northampton, MA 10atolNai� �;o� o e�Structural Plans phone 413-587-1240 Fax 13-5.8. o Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING � SECTION 1 -SITE INFORMATION V~ 70 9 1.1 Property Address: This section to be completed by office V Map Lot C�( Unit 257 Bridge Road, Florence, MA 01062 Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Norwich Properties LLC 123 Union Street,Easthampton,MA 01027 Name(Print) Current Mailing Address: 413-527-4060 -wIte'14A 9/30/19 Telephone Signature 2.2 Authorize gent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 19,500.00 (a) Building Permit Fee 2. Electrical 1,500.00 (b) Estimated Total Cost of Construction from 6 3. Plumbing 2.300.00 Building Permit Fee 4. Mechanical (HVAC) #16-6 5. Fire Protection N/A 6. Total= 0 +2+3+4+5) 23,000.00 1 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date Kperrier @ fivestarcorp.net EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information 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 O DON'T KNOW O YES o IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO () DON'T KNOW O YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW © YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained , Date Issued: C. Do any signs exist on the property? YES o NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES NO O 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 0 NO C) IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑✓ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[0] Other[ice] Brief Description of Proposed Install new roof,replacement windows&garage doors,remodel existing kitchen&bathroom,upgrade aJl inte icg finishes. Work: ! 1 Alteration of existing bedroom Yes X No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes x No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Norwich Properties LLC as Owner of the subject property Five Star Building Corp. hereby authorize to act on my behal4inallm ters rel to work authorized by this building permit application. 9/30/19 Signature of Owner Date I, riv¢ VwLir '& dila rnrp as Owner/Authorized Agent hereby declare that the staterTferits a d 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. Keyin Print Name AIA 9-so -/9 Signature of Owner/ n Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Kevin Perrier CSL#085319 License Number 123 Union Street, Easthampton, MA 01027 CSL-1/13/21 Address Expiration Date Signature Telephone 413-527-4060 9. Registered Home Improvement Contractor: Not Applicable ❑ Five Star Building Corp. HIC#162559 Company Name Registration Number 123 Union Street,Eastham to MA 01027 HIC -11/29/19 Address Expiration Date Telephone 413-527-4060 SECTION 10-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...... ❑ City of Northampton �•• S,5 :• S/0 Massachusetts 4F ��c DEPARTMENT OF BUILDING INSPECTIONS �. 212 Main Street • Municipal Building yv`,• C Northampton, MA 01060 rJyti••• �15 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes.Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered. Type of Work: Remodel of existing interior&exterior Est. Cost: 23,000.00 Address of Work: 257 Bridge Road,Florence,MA Date of Permit Application: 9/30/19 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): _Job under$1,000.00 _Owner obtaining own permit(explain): Building not owner-occupied _Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: 4 9/30/19 Kevin Perrier HIC#-162559 Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton •�" Massachusetts A y` ; DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building Northampton, MA 01060 Debris 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. The debris from construction work being performed at: 257 Bridge Road,Florence,MA (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: Cassella Waste Systems,686 Main St,Holyoke,MA 01040 (Company Name and Address) q-30-/q Signature of fm A licant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts f Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 M www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aimlicant Information Please Print Le¢ibly Name(Business/Organization/Individual):Five Star Building Corp Address: 123 Union Street, City/State/Zip: Easthampton, MA 01027 Phone #:413-527-4060 Are you an employer?Check the appropriate box: Type of project(required): 1.Q I am a employer with 24 employees(full and/or part-time).' 7. ❑New construction 2.n I am a sole proprietor or partnership and have no employees working for me in 8. ❑✓ Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.M I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 [:] Building addition 4.[:]1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I L[✓ Electrical repairs or additions proprietors with no employees. 12.Z Plumbing repairs or additions 5.M 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 c. 14.M Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *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. Insurance Company Name:Webber&Grinnell Policy#or Self-ins.Lic.#:WHND22326301 Expiration Date:5/9/20 Job Site Address:257 Bridge Road City/State/Zip:Florence, MA 01062 Attach a copy of the workers' 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$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 certify under the pains allies f erjury that the information provided above is true and correct. Si nature: Date: 9/30/19 Phone#:413-527-4060 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#: ACo 05/10/22019019 Y) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ 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 Mary Odabashian NAME: Webber&Grinnell qHC, Ext): (413)586-0111 n/c,No): (413)586-6481 8 North King Street E-MAIL modabashian@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA: Citizens Ins America/Hanover 31534 INSURED INSURER B: Allamerica Financial Benefit/Hanover Five Star Building Corp. INSURER c: Hanover Ins/Hanover 22292 Attn:Kevin Perrier INSURER D: 123 Union Street,Suite 200 INSURER E, Easthampton MA 01027 INSURER F COVERAGES CERTIFICATE NUMBER: MASTER EXP 2020 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 CONTRACTOR 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 AIJUIL bUIJK POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTEU CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 10,000 A ZBND23859301 05/09/2019 05/09/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑ PRO- LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ A OWNED Ix SCHEDULED AWND23888201 05/09/2019 05/09/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Medical payments $ 5,000 XUMBRELLA LIAB OCCUR EACH OCCURRENCE $ 9,000,000 A EXCESS LIAB CLAIMS-MADE UHND23859401 05/09/2019 05/09/2020 AGGREGATE $ 9,000,000 DED RETENTION$ $ WORKERS COMPENSATION X1 PER STATUTE EORH AND EMPLOYERS'LIABILITY Y/N 1,000,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE � NIA WHND22326301 05/09/2019 05/09/2020 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Leased/Rented $99,752 Inland Marine A ZBND23859301 05/09/2019 05/09/2020 Equipment Deductible $500 DESCRIPTION OF OPERATIONS I LOCATIONS I 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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