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17C-223 BP-2023-0215 82 MAPLE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17C-223-001 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-2023-0215 PERMISSION IS HEREBY GRANTED TO: Project# 2023 82 MAPLE ST RENO Contractor: License: JASON LEBEAU DBA PRESTIGE Est. Cost: 15000 BUILDERS 413 077517 Const.Class: Exp.Date: 07/01/2024 Use Group: Owner: LLC BLUE MOUNTAIN PROPERTIES, Lot Size (sq.ft.) Zoning: GB Applicant: JASON LEBEAU DBA PRESTIGE BUILDERS 413 Applicant Address Phone: Insurance: 20 WARD ST (413)344-7795 CHICOPEE, MA 01020 ISSUED ON: 02/22/2023 TO PERFORM THE FOLLOWING WORK: ADD BATH TO YOGA STUDIO AND ADA BATH TO COFFEE SHOP 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: ' i Fees Paid: $105.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner e-ifyi a GOhi ' , a a d-tj ri fi FEB 2 2 20 The Commonwealth of Massachusetts "' Office of Public Safety and Inspections pEp1�� Massachusetts State Building Code(780 CMR) NpRT q ,. 1Ag ri=it Application for any Building other than a One-or Two-Family Dwelling ..�. (This Section For Official Use Only) BuildingPermit Number:a3 ,2/5 Date Applied: _ Building Official: _. SECTION 1:LOCATION 'k343'5,42.`LS No.an Street City/Town Zip Code Name of Building(if applicable) 82-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 Cr 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 0 No iV Is an Independent Structural Engineering Peer Review required? Yes ❑ No I Brief Description of Proposed Work: '7f, (war ta- yoi 4 CJ-ti•440 L3 l,C-A~.41- p ripvm S 2w6 rtiaf C.,14eLP s lie 12t- 19 Y. r-GC>`Y\ 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.) 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❑ A-5 0 B: Business 0 E: Educ.tional 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 0 I: Institutional I-1 0 1-2❑ I-3 0 I-4 0 M: Mercantile 0 R: Residential R-ID R-2 0 R-3 ■ 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 0 IBD HA IIB ❑ IIIA ❑ IIIBO IV 0 VA El BD 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 'emoval: Public 0 Check if outside Flood Zone❑ Indicate municipal 0 A trench will not be Licensed 1Y.posal Site 0 Private 0 or indentify Zone: or on site system❑ required 0 or trench or specify: permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Revi:w Process: Not Applicable 0 Is Structure within airport approach area? Is their review compl.ted? or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0 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: City of Northampton Massachusetts •e" t );',4 • �t DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building , Northampton, MA 01060d L"" PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR COMMERCIAL & MULTI-FAMILY NEW CONSTRUCTION/ADDITIONS/ALTERATIONS 1. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work (Digital & Hard copy). 3. Site Plan with location of proposed structure(s) and setbacks. 4. Construction Debris Affidavit filled out and signed by applicant. 5. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 6. Contractors must supply a copy of CSL and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate (if applicable). 8. Note any Conservation and/or Special Permit requirements (if applicable). 9. Driveway Permit (if applicable). 10. Proof of Water and Sewer entry fees paid (if applicable). 11. Trench Permit (if applicable). 12. Initial Construction Control Documents filled out and signed by the Registered Design Professional in responsible charge. 13. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton rSECTION 9: PROPERTY OWNER AUTHORIZATION Name and-Address of Property Owner l F441 Name(Print) T o.and Street City own Zip Property Owner Contact Information: 3oec aLr Wted 1 'if 3-7'7- 063S - Joy r p n'rf-rMq n .car Title Telephone No.(business) Telephone No. (cell) e-mail address cJ If applicable,the property owner hereby authorizes: 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 O. 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 ? -le_ ,.% \ 4 Company Mane 1 LACSea,K, CS 0 7-7s1 ? Name of Person Responsible for Construction License No. and Type if Applicable 3 60 kivorbck le- r-J.. t A-'11 1t2$ 012.2G Street Address City/Town Stye Zip AS-16 7I ) - - praohl c-1,41 (lees Alt 3®0 rn4i j-coy, 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 D No D SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ - 7 ,s'�?� / Building Permit Fee=Total Construction t x /( rt here 2.Electrical $ • 1 'O appropriate municipal factor) $ I Q�r. 3 3.Plumbing $ f 7 y'�£'O 4.Mechanical (HVAC) $ l Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ (6, n'o Q (contact municipality)and write check number here 1 b 0 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. J 45n111/1telti � o�new ( I� 3L!Y 1 2'i2.212 3 Please print and signna '/ Title Tele hone No. Date Zs 1 t w �d MI) Ono ... ......... ..p l Street Address Cityrfown State Zip Email Address Municipal Inspector to fill out this section upon application approval: I'� 4 , ", a fa a3 Name Da CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK__ FRONTAGE ,,,,,„ City of Northampton 7 Massachusetts ,� __ ' a; DEPARTMENT OF BUILDING INSPECTIONS ,,, 212 Main Street • Municipal Building -- '� Northampton, MA 01060 i,�_ 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: Le&*— S l4 tl-{i I 01 PVf � Pi' The debris will be transported by: if Name of Hauler: SM S o S E.q4// P Signature of Applicant: Date: Z 22- Z3 The Commonwealth of Massachusetts Department of Industrial Accidents .....,... I___ I Congress Street,Suite 100 214._ Boston,MA 02114-2017 www.massgovidia It al kers'Compensation Insurance.1 ffitiavit:BuildersiContractorsiESeetricianstPlumbers. TO HE FILED it'S I I II THE PERmi-rriNc;AUTIIORITV. Applicant Information Please Print t_egibis . 1 Name(Busmess,organIzationrInchvidual.K, eF(‘-c...-s- 131/4( I CGS ci rl Address: 2- Pe.-4.0.. 1 i v-, r-d- . d_. c› 67 City/State:2i il. 579(1 ets cc-f-e, \ ill 'Phone : 11 3 7 q Y 77 C re Art yam an timployer?Cheek the apprapriate hot: 1-)pe of project(required): i tallia a employer with 3 ..0.,.,(full andLor parr-timel.• 7. 0 New construction 20 I am it Auk proprietor ur partnership and have nu employees working tor roc in K. Erlreinodelin,! any capacity.[Nu a...niers'curnp.insurance requirci.11 9_ El Demolition 30 I am a Iturtle0Vme1 tilling all wurk myself.(No workers'comp Irnurincr mature&r 10 Building addition 4.0 I am a hentveve..1141 and will he hiring sYmitraciurs to conduct all work on my poverty. 1 will aware that all contractors either hate vetnicra.curneinnts.-dion insurance or are suk i 1 a Electrical repairs or additions proprietors with nu ormloyees. 12.0 Plumbing repairs Of at.iditiOnit !ID I ant a general tontractur and I has e lured the sub-contractors listed on the awawa ibeet. 1 3,F1Rouf repairs tt:usc sob-contractors hasse employees and Imse workers'comp.exalgraner,Z 14.00thet (-1.0 V.e-are a eorparation and its officers have cultist:LI their right of exemption pet MCA-e. 1.:2....fi,it-IL and V+e•!Law ciO ampluyeeis.[No wurkiTS'comp,insurance it:Limn:1.41 'Any applicant Mai ekeeLa box 41 must also fill out the section below showing tlseir workers eumpensotii;pokey informatioxi. t lioniinasners who submit this aft-Awn indicating they are doing all work and then hire untside contractors mast stIbttlat a racy:allidat It usilicaltrie suck 1Contraeturs that cheek this hiii%MUM attached an additional sheet showing the name of die inh-euntractors anal state a hether Of nut those extbtie..base emplo2.ces_ 'Ilk sub-ecntracturs hase they mini prot iele-their murices',:urrip,policy number. . . 1 an.an employer that Ls providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Nan : 1--1-esr4-t -e-vr *3 USN't. J--e-C- wyl -je_r — Policy#or Self-ins.Lie.#: L,s C,0 u 6 6P-,75 tH5527Expiration Date: 2. z ..a. / y2. Job Site Address: .-)C 4)C. ie., Ski— CityrState.,Iip: -f-10-rence,_ (4i fi- Attach a copy of the workers'compe isation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under NIGL c. 152.§25A is a criminal violation punishable by a line up to S1,500.00 andior 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 thug statement may be Ibrwarded to the Office of Investigations of the DIA kr insurance cot crag c t initication. l do hereby certify under the pains and penalties of perjury that the infOrmarwn provided above is true and corre,t. Si*nature: iiLDate: 2, Phon . ii I 1, .341 y —7 -7 1 Official use only. Do nor write In this area.to be completed by city or town official ( its or Town: PermitfLicense Issuing Authority(circle one): I.Board of Health 2.Building Department 3.CityiTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 0.Other Contact Person: Phone#: • : rs,.\. Initial Construction Control Document 1 * 10 I t - 14/ To be submitted with the building permit application by a Registered Design Professional S 11, i 0 for work per the ninth edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Date: Property Address: Project: Check(x)one or both as applicable: New construction Existing Constructio Project description: I MA Registration Number: Expiration date: ,am a registered design professio I,and I have prepared or directly supervised the preparation of all design plans,computations and specification concemingl_ Architectural Structural. Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, informa.tion, and belite sucha plans, computations and specifications meet the applicable provisions of the Massachusetts State Buil ' Code, (780 CMR), and accepted engineering practices for the proposed project I understand and agree t I (or ray designee)shall perform the necessary professional services and be present on the construction sit on a regular and periodic basis to: 1_ Review, for conformance to this code and the design concept, shop drawings, same s and other ,...u“ submittals by the contractor in accordance with the requirements of the construction doL exits. 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 iSO CIsiiIR 107_ When required by the building official,I shall submit field/progress reports(see item 3.)together 'ith 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 Contro 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 desist plans,computations and spedficatians that you prepared or directly supervised_If'other'is chosen,provide a description. Version 01_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. AC� DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 02/21/2023 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(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 NAME: Kathi Hutchinson ORMSBY INSURANCE AGENCY (A/c No. ,(f) (413)737 0300 FAX,No) E-MAIL khutchinson orms ins.com ADDRESS b.................. _... @ Y .............. P O BOX 718 INSURER(S)AFFORDING COVERAGE ! I NAIC# WEST SPRINGFIELD MA 01090 INSURER A: HARTFORD UNDERWRITERS INS CO 1 30104 INSURED I INSURER B: LABEAU JASON INSURERC: • DBA PRESTIGE BUILDERS 413 INSURERD: • • 28 DRUMLIN RD INSURER E: • SPRINGFIELD MA 01108 INSURER E: COVERAGES CERTIFICATE NUMBER: 864379 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. 1 INSR ADDLISUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD I WVD POLICY NUMBER (MMIDD/YYYY)I(MM/DD/YYYY)i yMITS COMMERCIAL GENERAL LIABILITY 1 EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED i PREMISES(Ea occurrence) $ I MED EXP(Any one person $ N/A PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _ POLICY PRE c J ECT LOC PRODUCTS-COMP/OP AGG $ OTHER. I $ ' I COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY i ((Ea accidents ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS N/A BODILY INJURY(Peraccirent) $ HIRED NON-OWNED F P OPERTYDAMAGE $ AUTOS ONLY • AUTOS ONLY . (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE I N/A AGGREGATE S DED ! RETENTION$ • _• I $ WORKERS COMPENSATION �/ PER 1OTH- AND EMPLOYERS'LIABILITY Y/N . /� STATUTE ! ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A 6S60UB5R75445522 02/24/2022 02/24/2023 -._........................................_......,....... .,__...._.............-_.._..............._._._________.__._. (Mandatory in NH) I E.L.DISEASE-EA EMPLOYEE $ 500,000 Ifyes,describe under I ',, ........................................................................................._......_.........................................__.........__................ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A • • DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given td pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool et www.mass.gov/Iwd/workers-compensation/investigations/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES E CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WI L BE DELIVERED IN Joel IIIOUZ ACCORDANCE WITH THE POLICY PROVISIONS. 9 Churchill Drive AUTHORIZED REPRESENTATIVE Longmeadow MA 01106 Daniel M.Crowley,CPCU,Vice President-Residual Market-WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Sectional Building Plan i slinks of Assembly: Rafter lechatrior CPitch Or ..--. . 4 s',,,,,. Rottilheadang overin Truss , N".., Lin tierlayine - • -,... fce 13a rrier N. N Ceiling joist . N's, Sheathing- Trun-Cut Sheet Requi?è& . Cla Or w Span,to tho opposite tuppon ril , Ira t Size- " iiil 1 •• • • Rafter acing- 12" 16" 19.2" /4" - tirk . . •.. _ . . ...... . . . . Rafter CI r Span- R . int ;:-.................•-_, _,.__•-.....=.4_,_ , . _fter Spec :__:T.:bs- I Siding lei Ridge- Ceiling Joist Si? - , Shoething E . 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