32A-141 BP-2022-1501
58 MAIN ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32A-141-001 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-2022-1501 PERMISSION IS HEREBY GRANTED TO:
Project# INT RENO 2022 Contractor: License:
Est. Cost: 65100 PIONEER CONTRACTORS 017890
Const.Class: Exp.Date: 01/19/2024
Use Group: Owner: SUHER PROPERTIES LLC
Lot Size (sq.ft.)
Zoning: CB Applicant: PIONEER CONTRACTORS
Applicant Address Phone: Insurance:
PO Box 1145 (413)626-7267 WCC--50059570120018A
NORTHAMPTON, MA 01061
ISSUED ON: 11/18/2022
TO PERFORM THE FOLLOWING WORK:
FLORENCE BANK -INTERIOR PARTITION
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: $462.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachusetts E`�`a C_:�__.L �, _'
*[`rl ' Office of Public Safety and Inspections
.7"; Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Two-Pam c)DWenini022
(This Section For Official Use Only)
Building Permit Number.07 A-KO/ Date Applied: Building Official: , r ,:- r i,,-a s
SECTION 1:LOCATION
No.
ari "'^d ' Z 1069
City Town i3 Code Name of Building(if applicable)
Assessors Map# Block#an /or Lot # �bY -tQ_
SECTION Z PROPOSED WORK
iC
Edition of MA State de used w If New Construction check here CI or check all that apply in the two rows below
Existing Building Repair❑ Alteration 12 Addition 0 Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ET' No 0
Is an Independent Structural Engineering Peer Review r ? Yes 0 No tir
Brief Description of Proposed Work .T. .ck2t,,,,1(' t tie ^
C. S<,
010,
la
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): 1
SECTION 4:BUILDING HEIGHT AND AREA
Fxisting Proposed
I
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Ct 4
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 f3 E: Educational 0
F: Factory F-1❑ F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0
I: Institutional I-1 0 I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2❑ R-3 0 R-4 0
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 IBO IIAO IIBO IIIAO MBO IV VAD VBD
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supp : Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: /
Public Check if outside Flood Zone Indicate municipal i� A trench will not be Licensed Disposal Site P7
Private 0 or indentify Zone: or on site system 0 required ittrench or specify:
is 0 encloosed 0
Railroad right-of-way) Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable EY Is Structure within airport approach area? Is their review comple ?
or Consent to Build enclosed 0 Yes 0 or No lIK Yes 0 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
'kts ,,Lzk, ( , c U1i,.,�.._ VArte,c z., , lkAk Of()w
Name(Print) No.and Street City/Town Zip
Property Own Contact Information:
MC147— C V— (413 -S1- 17 Y 'f R -326- 6q>75 µw4)4aagl nGx-e
Title Telephone No.(business) Telephone No. (cell) e-mail addr
If applicable,the pro owner hereby authorizes: � t ,Cv>---
Q►rn.nm r (.rr.ivl vvc g.G , ap, t1Ltd 1J -( - l r�raGr
Name Street Address City/To 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)
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
P •
rosAeoP Cinni be7ir6
Company Name
1:264v ttt C ar- CAS— V7 7590
Namef� of Person Responsible for Construction License No. and Type if Applicable
.p• to , cs� t i y . IY)osr` (p J►�A, bl piA
Street Address City/ wn State Zip
1113- -5AA CI i 413 424- 7247/ Qlvv\Je� • kvG c. ix- -'cagy.---
Telephone No.(business) Telephone No.(cell) 1 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 No 0
SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ H t Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ 1i appropriate m cipal a •r)=$
3.Plumbing $ (o i 1 Ib
4.Mechanical (HVAC) $ um Note:Minim fee $ ''f v .-'contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ bj t t uts— (contact municipality)and write check number here a 13.3/
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.
I
Z 1 i (i6) 41Z-k26- '72177 /r/ro -
Please�ipnt n si . E• Title Telephone No. j Date
Street/Adddr s /Town State Zip Email Ad
V-Q }1bj,s )-to -f�.- friA oftS6�/ e) re--(--!'� serfry—
Municipal Inspector to fill out this section upon application approval: L
Name luate
The Commonwealth of Massachusetts
_ : Department of Industrial Accidents
'_ = i r, 1 Congress Street,Suite 100
=1 •r Bassos.MA 02114-2017
• ,, www mass.gov/dia
- )l takers'Compensation insurance Affidavit:Buildersl('ontractorsiEketriciansfPlumbers.
T()11E FILED WITH THE PEIL%IITI'I1(::U 1'1lOR1T1.
Applicant Information Please Print Leeihli
Name ilIustncsa Organtrationr[ndi idual): Ply /eLCA -44-s-
C��Ads: Q.� . 3� iki
City/State/Zip: i A/lk• Phone#: 4f13-Sit.-s�t't l
Are yea as amplayei?CUedt the bow Type at P (required):
I ant a employer with 3..___ employees tfill adddor panaime),.•
7. ❑New construction
I am a sole proprietor for partnership and hart no employees working fin o e in gRemodeling Remo�
ant capacity.[Nu wotkch'comp.insurance required"
30 I am a homeowner doing all work myself.[No worker*comp.mousses it wml.j' 9. ❑Demolition
ilia 1 am a homeowner and will be hiring cordractorsto oendud all souk on my property_ I will Id❑Building addition
enure that all anima:tom either have wakes'oarnpensatioa insurance or are sole i la Electrical repairs or additions
proprietor,with no employers_
12.0 Plumbing repairs or additions
1.0 I am a general contractor and I has a herd the subcontractors listed on the;utadiial sheet. I3.QRoof repairs
t._s 1 hese subs-csmtractvn have employers and have workers'comp.insurance
6.0 11'c arc a corporation and its officers have exentised then right of exemption per MMGL c.
14.0Otter
W..ti 1141.and we have no employees.[No workers'comp.insurance required.]
'Any applicant that dials box a I must also fill out tlx:section below sbuwving their worked'Compensation policy information.
i Homeowner who submit this at1'/tdastt indseattug they aredorng all work and then hire outaic4•Contractors must aubaat a new affida it mdioa*lg so:h.
1Contra ton that check this box must attached an adtbtioral sheet show tag the name of the sub-contractors and state whether or not those ankh:t base
anyloyees. If the sub-contractors hove employees.the)mum provide their twrkcn"wrap.policy number.
I am an employer that is providing workers'compensation instltrarce for sty employees. Below is the policy and job site
information. I
Insurance Company Name: ��.fa z A Fl/0- Y-S I S- &y
Policy#or Self-ins.Lic.t: L✓CC.-gAj- 'SW Sti SZ - ZOZ i A Expiration Date:. \30\Z,--
lob Site Address: SS flit p.;a,. • City,State.+Zip: >kft
Attach a copy of the workers'compensation policy declaration page(showing the policy number and a date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a tine up to SI .00
and'or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to .00 a
day against the violator.A copy of this statement may be forwarded to the Of ice of Investigations of the DIA for' nonce
coverage verification.
I do hereby certify an r the pal a ,, nalties ofperjuryy that the information provided above is true and correct.
Signature: '� - "' Date: 1 /f'O t2--',-
Phone e: y(3' / 2.6- 2'4'7
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.('ityfTownClerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
r .
City of Northampton
NAM
o/ �.. St
j�=�' '�t' � Massachusetts 5' "�c
i DEPARTMENT OF BUILDING INSPECTIONS 41
212 Main Street • Municipal Building vA. ; �
Northampton, MA 01060
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, 554, 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: \( )U119...(AfjiA�
The debris will be transported by:
Name of Hauler: 2szo4cAl/
Y
Signature of Applicant: 0a" vV n Date: ///70A-v
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
INFORMATION PAGE
Associated Employers Insurance Company
54 Third Avenue, Burlington, Massachusetts 01803-0970
(800) 876-2765 NCCI NO 40959
POLICY NO. WCC-500-5005957-2022A
PRIOR NO. WCC-500-5005957-2021A
ITEM
1. The Insured: Pi Con Inc
DBA: Pioneer Contractors
Mailing address: P O Box 1145 FEIN:"-"'1984
Northampton,MA 01061
Legal Entity Type: Corporation
Other workplaces not shown above: See Location •
2. The policy period is from 06/30/2022 to 06/30/2023 12:01 a.m.standard time at the insured's mailing address.
3. A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the
states listed here: MA
B. Employers'Liability Insurance:Part Two of the policy applies to work in each state listed in item 3.A.
The limits of liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident
Bodily Injury by Disease $ 500,000 policy limit
Bodily Injury by Disease $ 500,000 each employee
C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B
D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE
4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans.
All information required below is subject to verification and change by audit.
•
Classifications Premium Basis Rates
Code Estimated Per$100 Estimated
No. Total Annual Of Annual
Remuneration Remuneration Premium
•
INTEA 000063757
INTER SEE CLASS CODE SCHEDULE
•
Minimum Premium Total Estimated Annual Premium
GOV GOV Deposit Premium
STATE CLASS
MA 5437 State Assessments/Surcharges
$1,739.00 x 4.1800%
This policy, includingall endorsements,is herebycountersigned by '
P Y 9 06/02/2022
Authorized Signature Date
Service Office: King&Cushman Inc
54 Third Avenue P 0 Box 447
Burlington MA 01803 Northampton,MA 01060 •
WC000001A(7-11)
Includes copyrighted material of the National Council on Compensation Insurance,
used with its permission.