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12C-108 (3)
BP-2022-0089 63 RICK DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 12C-108-001 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-2022-0089 PERMISSIONIS HEREBY GRANTED TO: Project# KITCH RENO Contractor: License: Est. Cost: 12000 JIM BOYLE CS107689 Const.Class: Exp.Date: 10/25/2023 Use Group: Owner: DAVIS ADINA H Lot Size (sq.ft.) Zoning: RI/WSP Applicant: KITCHEN CONCEPTS &DESIGN CENTER LLC Applicant Address Phone: Insurance: P 0 BOX 241 WCB49466 HADLEY, MA 01035 ISSUED ON:01/27/2022 TO PERFORM THE FOLLOWING WORK: KITCHEN 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: Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: ( i . cgi • r � yQ ' 1 Fees Paid: $84.50 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner r- The Commonwealth of Massac usett k t)i Board of Building Regulations and tan rds 6 C PALITY Massachusetts State Building Code 780 MR N2 2�22 USE Building Permit Application To Construct,Repair Re ish a Revised Mar 2011 'aT OF C�UILDING INSPFCTIOVS l One-or Two-Family Dwelling__- kk,o�T�nMr-rN in o,760 i This Section For Official Use Only __,- ' Building Permit Number: 6,- ,),.. �'CJ Date Appli d: : . f,11 , 7/ ,i ' l' i 6 .. ' I T7P' Building Official(Print Name) I Signature 1 i /Date SECTION 1:SITE INFORMATION LI � r er A ess• 1.2 Assessors Map&Parcel Num s l ic rii/e jAC., lb X 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq 11) 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' 2dlcrwner'ofJa lece>�1. a 1-J vis f I orence 1 m 'L 0106 Q Name nt) City,State,ZIP J (05 i c k 'Or we ( i. aio- d 2,i,an009,iehoac. No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bld,t. 0 Number of Units Other ,�Specify:it-I-C leAAPill.01,1 ief Description of Proposed Work':I•Ai 0, ' d- ' • • ' , i ' o r• .! d I'..I0 ,.' .. $ A,' !� d. ilk r r)i'r` . . _ JY ._ i'_ 0 ., [?L [� d Cornoak_ Tor'gr e space. 'move iS iry °or cl- Peplo c e_ lai riff() a .Oa ' SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ -],OW. — 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ 3,000. 0 Total Project Costa (Item 6)x multiplier x 3.Plumbing $ 1000 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ �{ Suppression) Total All Fees s( q�50 Check No. 3 eck Amount:8 Cash Amount: 6.Total Project Cost: $ 1 a,000 -- 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) _ Jo I D 5 0 m R d )� License Number Expi on e Name of CSL Holder List CSL Type(see below) Tv s!III 119 u SSe,l1 S+. No.and Street Type Description Unrestricted(Buildings up to 35,000 Cu.ft.) a f i r (� I o35 R Restricted 1&2 Family Dwelling Ci"Its--) sate,ZIP,, M Masonry RC Roofing Covering WS Window and Siding_ SF Solid Fuel Burning Appliances 1.3)c5g 356(6, de s i e k 1 Pr)- Cbnc-f p1S r)et I Insulation Telephone Email address D Demolition 5 2 egistered Home Im provement Contractor(HIC)It ncrpl5 n (twee; LCG I 93356 101lo doaa c7.r1-1 ;•o le HIC Registration Number Expiration Date HIC company N or HIC egistrant Num Po x a4i 119 usseJ1 des j ©1tl fc`►en-Cbnx?plt h & N .an Street cJ Email address � )e ,nr Q oto35 (ti/v,58b 35e* City/Tow!,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 t )11) Born. e_I i.6d-wn Co h cep�$ to act on my behalf,in all matters relative to work authorized by this building permit application. a it a 14- Davis I ` 1 t?�doa �? Print Owner's Name(Electronic Signature) ate 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. 1 m R- 4le > l i$jaoaa Print Owner's or Aut o ' d 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" / 203+" / / 24" ,8" A-15" / 24"---/ 92+' / / 31-" 33+' / 434-' / 73s' /-16"-/ / 4:: 26a' / 128+" / / 33" 3,D" f 24" / 24" / 92z" / / 261" 7 M 7;. /7a /1530R W2430 M UO / , DISHW24 3DB24 O N QO IX CV .-N r N \ \ m O r -A so Q1 - - SIN -1,, i ._ _____.- 7) AN 2r r GAS.30, BT9P. 3DB30 �1 W930 R W3015 W3030 }\ 1 \ ▪ 3 _ \ co 0 3 P3 SL / 70 z" 4 '—z" _ REPV3096 L :lir W331224 _� �. . AND MODIFY TO 24 X 84 30„ 30„ 37.+" 18"- / 18:"-/ 4 55+" / All dimensions maize designations Kitchen Concepts This is an original design and must Designed: 8/26/2021 given are subject to verification on Design Center, LLC not be released or copied unless Printed: 8/26/2021 job site and adjustment to fit job 117 Russell Street applicable fee has been paid or job conditions. Hadley, MA 01035 order placed. (413) 586-3506 DAVIS KIT 8-26 uscd shaker white All Drawing#: 1 No Scale. City of Northampton r�5,. � ' Massachusetts �4/ . - ••.. . ;`� ( DEPARTMENT OF BUILDING INSPECTIONS y ' -:1.11--:-r--V 212 Main Street • Municipal Building 0% ca Northampton, MA 01060 rs ... •�1` 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: ValiEy Re cii�easA m goad JoR-1-11omp/on, tea, otu 6?0 The debris will be transported by: Name of Hauler: t it-het) ( o eep/3 Signature of Applicant: ),IXYI R. d It Date: I ) 100(90- J - ADVOCATE 11'. lchen Kitchen Concepts&Design Center *BFSTie*: 1j* houzz o n c ep t s P.O.Box 241 s'�LEY'amain FIFO( �N01 E CN�6 oiCE iNOlir TM Ri iN F iii 2O. . 2• 2e =�.isrrirz�sr.Le BBB Hadley,MA 01035-0241 L U l 1 1 1 , N n i r w i v N e k DREAM m DESIGN m DELIVER CONSTRUCTION SUPERVISORS LICENSE Recognized by the Commonwealth of Massachusetts as a Supervisor. Superior knowledge of Massachusetts laws and code are mandatory. Testing and years of experience are required to receive this license. ♦ Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards C o nstfsunskirirvisor • CS-107689 spires: 10/25/2021 JIM R BOYLE d. PO BOX 241 HADLEY MA 01035 •41? O/5S71•,1O Commissioner License#CS10768 has been renewed. New expiration date is 10/25/2023. Waiting for new card to arrive. HOME IMPROVEMENT CONTRACTORS LICENSE Required for remodeling existing property. Ifn"w"0Auvvir.4 ty°:%'14//l4J4eaSil leif t Office of Consumer Affairs 8 Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:LLC Rnoistrrtion Expiration 193350 10110/2022 KITCHEN CONCEPTS&DESIGN CENTER LLC JIM LE .{t.1. "°'k. 117 RUSSELL STREET HADLEY,MA 01035 Undersecretary License#-180308 All licensing information can be obtained through government agencies. Insurance coverage binders and references are furnished upon request. • • Office: (413)586-3506 • Fax: (413)586-8051 • Email: design@kitchen-concepts.net The Commonwealth of Massachusetts =_ ` _r Department of Industrial Accidents =mie 1 Congress Street,Suite 100 _ �_I_ Boston, MA 02114-2017 t"./ www.mass.gov/dia ga Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):ASAP Painting Inc. Address:117 Russell Street/PO Box 241 City/State/Zip:Hadley, MA 01035 Phone#:(413)586-8010 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 1 0 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. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.0I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 El Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 14.❑Other Kitchen Remodel 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 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:Main Street America Assr. Co. Policy#or Self-ins.Lic.#:WCB49466 Expiration Date:01/31/2022 Job Site Address:63 Rick Drive 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 and pen l1ties of perjury that the information provided above is true and correct. Signature: i um LJ l I� Date: l I J D - Phone#:(413)586-8010 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#: ® DATE(MM/DD/YYYYI ACC0Rl- CERTIFICATE OF LIABILITY INSURANCE �', 09/28/2021 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 Finck&Perras Insurance Agency Inc. _1A PHONE,E>tt): (413)527-5520 FAX No): (413)527-5970 6 Campus Lane E-MAIILss: bcarballo@finckandperras.com ADDINSURER(S)AFFORDING COVERAGE NAIC# Easthampton MA 01027 INSURERA: Main StreetAmericaAssrCo 29939 A P Y INSURED INSURERS: NGM Insurance Com an 14788 ASAP PAINTING INC INSURER C: PO BOX 241 INSURER D: INSURER E: HADLEY MA 01035-0241 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2152105584 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 SUBR1OLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) UNITS __.. X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 500,000 DAMAGE TO RENTED 500,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) S MED EXP(Any one person) S 10,000 — A MPB49466 05/05/2021 05/05/2022 PERSONAL8,ADVINJURY S 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 1.000,000 POUCY PRO-JECT n LOC PRODUCTS-COMP/OP AGG S 1,000,000 Individual Risk Mod Prem S OTHER: AUTOMOBILE LIABILITY ((Ea accident)COBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) S — OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED NON-OWNED (Peracddenq $ _ AUTOS ONLY AUTOS ONLY S UMBRELLA LIAB OCCUR EACH OCCURRENCE 5 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION S S WORKERS COMPENSATION OTH- PER ER AND EMPLOYERS'LIABILITY Y/N 100000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y N/A WCB49466 01/31/2021 01/31/2022 EL EACH ACCIDENT S , B OFFlCERIMEMB IXCUIDED7 100,000 (Mandatory In NH)) E.L.DISEASE-EA EMPLOYEE S If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below EL.DISFAc -POLICY LIMIT 5 DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Proof of Coverage CERTIFICATE HOLDER • CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ASAP Painting Inc AUTHORIZED REPRESENTATIVE //'' (1 // '/ 1 `J g 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ADVOCATE .,••.. - c.zer.e itc en Kitchen Concepts&Design Center,LLC *BEST* c .w '0 ho�zz one ep is P.O.Box 241 rnr cal Lcv CHOI CHOI E CHOI E CHOI H01 EH01 E B, Hadley,MA 01035-0241 DREAM•DESIGN a DELIVER ) 0 ) ( INNER WINNER WINNER FINALIST FINALIST WINNER -IMIre�usin'e)ss° January 18, 2022 Department of Building Inspections City of Northampton 212 Main Street Northampton, MA 01060 Subject: Building Permit 63 Rick Drive, Florence To Whom It May Concern: Enclosed please find our building permit application and payment for 63 Rick Drive, Florence. If you have any questions or need additional information, please contact me at(413) 586-3506. Thank you, L bta4444, L 5r0-w14, Luann L. Brown Executive Administrative Assistant :llb • Office: (413)586-3506 • Fax: (413)586-8051 • Email: design@kitchen-concepts.net