Loading...
31B-284 (23) BP-2023-0239 21 CENTER ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31B-284-001 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-2023-0239 PERMISSION IS HEREBY GRANTED TO: Project# REPAIRS 2023 Contractor: License: Est. Cost: 5000 STEVEN CZUPRYNA 080726 Const.Class: Exp.Date: 11/29/2023 Use Group: Owner: ES 21 CENTER STREET LLC Lot Size (sq.ft.) Zoning: CB Applicant: STEVEN CZUPRYNA Applicant Address Phone: Insurance: 178 WHEATLAND AVE (413)246-8801 UB- 9TS54049A-22-42 CHICOPEE,MA 01020 ISSUED ON: 02/28/2023 TO PERFORM THE FOLLOWING WORK: REPAIRS TO WALLS 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: $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner RECEIVE[) F E B 2 7 2023 Tlfirrrnwealth of Massachixsetts 6 0 " Office of Publicf Safety and Inspection§ 1J[=?'r OF BUILDING INSPECTIONS fi RTHAMPT N,MA 01060 Massachusetts State Building Code(780 CMR) v o o _ j '— Building P rmiFA tafiki2A^r'olNanxnilding other than a One-or Two-Family Dwelling • THAMprnty M A loco (This Se-akin-For-Official Use Only) Building Permit Number: s2 3"A-31 Date Applied: Building Official: SECT ON 1:LOCATION 1-23 Ge rS.e 5t YJ 6/66f No :atreet Ci, czy L.�T n Zip Code Name of Building(if applicable)15 3.1 Assessors Map# Block#and/or Lot # 4 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 re Repair lie Alteration 0 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 re Is an Independent Structural Engineering Peer Review re uired?_ I Yes 0 No IBA Brief Descriptio of Pr posed Work: 4'r_►�°^' P� `'t" ,�,�t 5 g,��r k So oar, , (N J 0pC ors l . Add wC42-�, q^+ . AIG Al J ,-4- 1 r°" C. (ti—it� N � S� `°� 7 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) ❑ 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.) 212 ig Total Area(sq.ft.)and Total Height(ft.) 7 77 SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2'Nightclub ❑ A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard II-1 ❑ H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1 0 I-2 0 I-3 0 I-4 0 M: Mercantile 0 R: Residential R-10 R-2 0 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 0 IB 0 IIA ❑ IIB 0 IIIA Be IIIB ❑ IV 0 VA 0 VB 0 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 Removal: Public Check if outside Flood'Lone❑ Indicate municipa A trench will not be Licensed Disposal Site❑ required 0 or trench or specify: Private 0 or indentify Zone: or on site system 0 permit is enclosed 0 • • Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable❑ Is Structure within airport approach area? Is their review completed? 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?: IJC Special Stipulations: Design Occupant Load per Floor and Assembly space:_ SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address pf Property 0 ner . I .:., 'C V7: 4,c.I.S01--62-1-- -6144e I /14i 6ver0" Name(Print) No.and Street City/Towry Zip Property ner Contact Information: 6C1C.`JQtJ ', Mcirige;'14 4/I3 2 077( 41/3- ,c2I Tf5-4-- e3bi Cvs � scv: P1 Title .J Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authori es: � Czopr o n - w it A-.e.,. C;6-1104. 0 16-1-u 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 _Otherwise provide construction control forms(see section 107 in the code)as required. -kii( 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 Expirtition Date 10.2 General Contractor - ' lit=i711. Compainy Name 5 ,J. CZ� -i101). C5-0507a I Name of Person R sponsible'for Construction // License No. and Type if Applicable /1 Ir k{AA A---it- C/(6 - AN 0 /U.J Street Address City Town State Zip 4(i IC I 4-03Y;-4 ' 056 I A icy e��,i�Q.c c►.S-fr-c ,-,4 cib MS S c ili'l Telephone No.(business) Telephone No. (cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) t 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? Ye; i11 No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT 'E Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$__, 1.Building $ 6-0 D 0 Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)=$ • 3.Plumbing $ 00 4.Mechanical (HVAC) $ Note:Minimum fee=$ dU, (contact municipality) 5.Mechanical (Other) $ 2 Enclose check payable to 6.Total Cost $ a� I `�j 1' (contact municipality)and write check number here I 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. Scc C2LaP/1-yA ,�.� (2.-).....----___ Lt)3 a ogo v Please print and.sign name Title Telephone No. Date /7 g L I..s.4,—c. 0 G_t--'cop 0 /a-- O`Oz-v 5 C dPfuQN�4�i'>1Sn1•�-i Street Address City/Town State Zip Email Address 2 Municipal Inspector to fill out this section upon application approval: I; 'I,' ' 1 >r ►p vim' 3 Name ` Date City of Northampton i1, 2s�s s., Massachusetts .wr: W‘ 4:, fi DEPARTMENT OF BUILDING INSPECTIONS �: 1 ' 1 212 Main Street • Municipal Building y)/', b� • Northampton, MA 01060 ssf ...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: H.--1-1. 1, �n S�{'r�. use f, ., l r C aLocation of Facility: )4_Q_. The debris will be transported by: USA � r . Name of Hauler: V��1 j Signature of Applicant: �,� Date: 27/ The Consmomvealth of Massachusetts , - c, ,..... A‘ Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 0 2114-2017 ,..5. ww)v.mass.goWdia * Workers'Compensation Insurance Affidavit:BuildersiC:ontractors/ElectriciansiPluittbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly* Name illusinesseOrganizanoivIndividual): Sr !. ) T. C--2,LIPP-14-aJd4 Address: 171 Ls_hi-soa-TL$4,,,0 vcor: . City/State/Zip: ail ccPJE: Ote) e 1 Phone#: ild 3-2../,‘-g )1 Are you an ftliployer?Cheek the appropriate loin: -, i ype of project(required): i ErKiiii a employn with 13., employees(full and?oe part-time).* 7. 0 New construct' 2.0 lain a sole proprietor or partneiship and have no encloyres workai.is for me in K. i'," 'ernodeling any capacity.[No workers'crairip.insomnia:, required.] 9. El Demolition I ma.homeowner doing all work myself[No workers*comp.insurance minted.]' 100 Building addi ' n 1.0 lam a homeowner and will be hiring commons to conduct all work on my poverty. I will ensure that all Cf mu:Lours either Ink e workers"Cdialptivalson mhurancr Li'ape MAC f 11.0 Electrical repa' -or additions proprietors with nu unpluyckah. 2E1 i Plumbing repali or additions 5C1 I am a general contractor and I base hired the sub-contractor*listed un the attained sheet_ I I 3.0 Roof repairs Thee.s sub-contractors have employees and have workers'romp.insurance.: 14_in Other h.LJ we ant a corporation and its officers have exercised then right of extmiption per NIGIL e. i 52,4 lit'.and we have ts0 enzplows.[No work comp.insurance required.1 *Any applicant that dref:k%bOX#1 maal also till out the sectiiin below show in g their workers compensation pot ic.), 1 n 1.1 v cci,TI t HIMICIPNISCM who submit this affidas it indicating they an:cluing all work and then lure outside contractors moat,uktli lc a IA:,,,affir.Lx,ir:1st Icaling such. teuntractm that check this b4t must attached an additional sheet showing the name of the sub-contractors and sure v.11,1'ncr..t not lito-,e entities have emplovees, lithe sub-contractors have employers.they most provide their workers'comp.policy mamba. I am an employer that is presiding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 1 lerc?v(e i_F-12•S _ Policy#or Self-ins.Lic.#: _LYID -975 4 vii 9 A-2.2_-'--1 .2_ Expiration Date: Jo lig/2_3 Job Site Address: —21-.23 C.,..CA/r.fo V— A/A=44 City/Statew'Zip: /thiPA44~'7io A7.4- ert-.06c-) 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$1,500.0() and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK.ORDER and a tine 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 certi er t ins and penalties ofpetitity that the information provided above is true and c Signature( -e-1 Date: Z/2-7/2_3 Phone#: 17//3-024/6-9Se)/ ...., Official use only. Do not write in this area,to be completed by city or town offleiaL City or Town: Permll/License a Issuing Authority(circle one): I. Board of health 2.Building Department 3.City/Fowl)Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Aco a CERTIFICATE OF LIABILITY INSURANCE DAtE(MM/DDIYYYY) 2/23/2023 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 CONSTITUE 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 an endorsement(s). PRODUCER CONTACT NAME: PAYCHEX INS AGENCY INC PHONE FAX 225 KENNETH DR (A/C.No.Ext.):(877)362-6785 (A/C.No.Ext):(877)677-447 ROCHESTER,NY 14623 E-MAIL ADDRESS:paychex@travelers.com INSURED INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT STEVEN NULL CZUPRYNA DBA ALDENVILLE WINDOW 178 WHEATLAND AVE INSURER B: CHICOPEE,MA 01020 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE'OLICY 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 4LL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADM SUE POLICY EFF POLICY EXP R POLICY NUMBER LIMITS INSR WVD (MM/DD/YYYY) (MMIDD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea Occurrence) $ MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY n PROJECT nLOC PRODUCTS-COMP/OPAGG $ OTHER AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ BODILY INJURY(Per person) $ - OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ - EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION WORKERS COMPENSATION PER OTH AND EMPLOYERS'LIABILITY YIN N/A UB-9T54049A-22-42 10/14/2022 10/14/2023 X STATUTE -ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? A (Mandatory In NH) E.L.EACH ACCIDENT $100,000 If yes,describe under DESCRIPTION OF OPERATIONS BELOW E.L.DISEASE-EA EMPLOYEE $100,000 E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION STEVEN NULL CZUPRYNA DBA ALDENVILLE WINDOW SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 178 WHEATLAND AVE BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN CHICOPEE,MA 01020 ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE Valet.a ©1993-2015 ACORD CORPORATION.All rights reserved. ACORD 26(2016/3) The Acord name and logo are registered marks of ACORD STEVECZ-01 BSHUNAMAN AC-IL: RL7 CERTIFICATE OF LIABILITY INSURANCE DATD/YVYY) 2/23/223/2023 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 NAppMEACT First American Insurance Agency PHONE - FAX 413 582-0985 PO Box 147 (A/C,No,Ext):(413)5928118 (A/C,No):� Chicopee,MA 01021 FADDRISS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arbella Protection Insurance 41360 INSURED INSURER B: Steve Czupryna DBA Aldenville Window INSURER C 178 Wheatland Avenue INSURER D: Chicopee,MA 01020 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMMIDD/YYY'Q (IIAM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X 9620038413 6/3/2022 6/3/2023 pS Eoccu a rrence) $ 100,000 REM SE MED EXP(Any one person) $ 6,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE I $ 2,000,000 X POLICY PR� LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: E $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per persort') $ OWNED SCHEDULED AUTOS ONLY _ AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY MAGE AUTOS ONLY _ AUTOS ONLY (Per accident(DA $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH• AND EMPLOYERS'LIABILITY Y/N STATUTE ER OFFICEIE ECLUDED PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/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 Cityof Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P ACCORDANCE WITH THE POLICY PROVISIONS. City of Northampton 2123 Center Street LLC 2123 Center Street AUTHORIZED REPRESENTATIVE Northampton,MA 01060 ACORD 26(2016/03) 01988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD V Commonwealth of Massachusetts fit Division of Occupational Licensure Board of Building R ?lotions and Standards Constjisor CS-080726 ti ires:1112912023 • STEVEN T C 41P • t1 p 178 WHEATLAN i:f • i p CHICOPEE rem,� $ Commissioner vi Construction Supervisor Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit wwwmass.gov/dpl