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32A-171
u n1 I r 22, BP-2023-0444 10 HAWLEY ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32A-171-001 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-2023-0444 PERMISSION IS HEREBY GRANTED TO: Project# ADD BATH 2023 Contractor: License: Est. Cost: 37979 WESTERN BUILDERS INC Const.Class: Exp.Date: Use Group: Owner: LLC O'CONNELL HAWLEY Lot Size (sq.ft.) Zoning: CB Applicant: WESTERN BUILDERS INC Applicant Address Phone: Insurance: 73 PLEASANT ST (413)467-9171 UB-6K239300 GRANBY, MA 01033 ISSUED ON: 05/01/2023 TO PERFORM THE FOLLOWING WORK: 3/4 BATH ADDITION 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: oo Fees Paid: $246.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner '4° a i) a)i-Le i- ___ecej.y R EC F 5\� .: ,_~. " )4tICMCl / F L P i2023 " 7 The Commonwealth of Massachusetts 2 1,ioard of Building Regulations and Standards FOR _� assachusetts State Building Code, 780 CMR MMUNICIPALITY' D�--:>r -;,, USE nl_om:r,Biadirigitrmii Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 yar,m r�,N MA 01060 --- -- One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 60' A 3- ,e- y Date Applied: I v i 'i),4191 0--/ 2 Building Official(Print Name) I Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 10 Hawley St,Unit 2D 32A 275 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: CB Residential -2,220 SF NA Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided Existing Building Existing Building Existing Building 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public■ Private CI Zone: if yes■ Municipal■ On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: O'Connell Hawley LLC Holyoke,MA 01040 Name(Print) City,State,ZIP 800 Kelly Way 413-540-1459 mwelter@oconnells.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply) New Construction 0 Existing Building■ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ■ Addition 0 Demolition 0 Accessory Bldg.❑ Number of Units Other 0 Specify: Brief Description of Proposed Work2: 3/4 bath installation SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees LI„ Suppression) i-(`y Check No.\v. Check Amours : 6.Total Project Cost: $37,979.67 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-051113 Sept.10 2022 Ed Ackley License Number Expiration Date Name of CSL Holder 73 Pleasant St List CSL Type(see below) U No.and Street Type I Description Granby,MA 01033 U Unrestricted Buildin s up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted Dwelling M Masonry RC I Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 127142 Western Builders,Inc. I IIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 73 Pleasant St. rdobrowski@westernbuilders.com No.and Street Email address Granby,MA 01033 413-265-8793 City/Town,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 Western Builders,Inc. to act on my behalf,in all matters relative to work authorized by this building permit application. Matthew Welter,on behalf of O'Connell Hawley LLC 4/12/2023 Print Owner's Name(Electronic Signature) Date • SECTION 7b:OWNER' OR AUTHORIZED AGINT 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. Matthew Welter,on behalf of O'Connell Hawley LLC I 4/12/2023 Print Owner's or Authorized Agent's Name(Electronic Signature) i)atc 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 NA Number of half/baths NA 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" The Commonwealth of,lfassachusetts )t 411111••* . , `1 Department of Industrial Accidents • - s Cr:'firr= I Congress Street,Suite 100 •••a•i= Boston, MA 02114-2017 -'• .�� www.mass.gor/dia 11'orliers' Compensation insurance Affidavit:Builders/('ontractors/Eleetricians/Plumbers. TO BF. FILED WRil 1(IE: PERTtt t-ht\G AUTHORITY. Applicant Information Pfeasc Print I.ei[ibly yMC (Business Organizationlndtaicluall: O'Connell Hawley LLC Address: 800 Kelly Way CityiStaterZip: Holyoke MA 01040 Phone #: 413-540-1459 Are yea as matey eel'Check rise appropriate boa: Type of project(required): 10 1 am a employer x►th crisis/0)ees Ifufl artd•'ct part-time 1.* 7. CI New construction 2 1 I am a sole propn.kx err run.-J,'r and his i no employee/working for me m _ h. . Remodeling any evpacrry.[No workers'camp. insurance required.) real estate development company] 9 Demolition 3u:i I am a homeowner doing all%v inv o workers'coop-insurance nyuintl.1' 4.11l am a and mill he hums catrtractoes to conduct all wort.on my amnesty. 1 will 10 Q Building addition .stittri that ail contra.-ton etcher lose workers'compensation Insurance or are sole 1 1.0 Electrical repairs or additions proprietors with nu employees 12.0 Plumbing repairs or additions S0 1 am a u.'riera1 contractor and I tea.e hoed the alb-contractun listed on the attached sheet_ 13�Roof repairsThese s tb—cute ractors have e-rrtplo:ie s and has c wcarims'comp. insurance. h 14.0Other ionisers v'e area corporation and Its ioser hat c cs.Tcixd their right of cam-option per khrL c. 151 t It 4).and we hose no employees {'.o%oiler) .Liner Insurance rogutrrd.l 'Any apptt.att that checks boa a i must also till out the section helu%showing their'suckers'compensation policy iafarmatnan_ « Homeowners w ho submit tins atfidas it Indt.atlni they arc doing all a on and then hire outside contractors mist submit a new of idas it inlieatang such. ontracturs that ehctil this but must att.alscd an adJrtional sheet show ing the name of the sub-cuntractvrs and stair whether or nut done enuitles lose employers If the sub-contractors have.Ilgtloycc,.they must rl,s ode their %Luken'comp.policy mantic,. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Please refer to the Certificate of Insurance form that follows for coverage details Policy #or Self-ins. Lie. #: Expiration Date: Job Site Address: 10 Hawley St., Unit 2D Ctty-StateiZip: Northampton,MA 01060 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MCiL c. 152. §25A is a criminal violation punishable by a fine up to SI.500.00 and or one-year imprisonment.as wc11 as eiviI penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement May be furvvarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the Information provided above is true and correct signature: { on behalf of O'Connell Hawley LLC Date: 4/12/2023 Phone#: 413-540-1459 Official use only. Do not write in this area, to be completed by city or town official. (rite or Town: Permit/License It issuing Authority {circle one): I. Board of health 2. Building Department 3.('ityri'o sn Clerk 4. Electrical inspector S. Plumbing inspector 6. Other Phony#: Contact Person: City of Northampton pA •"0,t# >ati*:` S1S s1c Massachusetts mow?° - 4� � ar �t �. e �.. r DEPARTMENT OF BUILDING INSPECTIONS y, g 212 Main Street • Municipal Building \\ @�F Northampton, MA 01060 'Psy' gON 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: 73 Pleasant St. Granby, MA 01033, Western Builders, Inc. The debris will be transported by: Name of Hauler: Western Builders, Inc. Digitally signed by Richard Dobrowski DN:C=US, E=robrowski@western builders.com, Richard Dobrowski Western Builders,Inc.." OU=Construction Project Manager, CN=Richard Dobrowski 04/18/2023 Signature of Applicant: Date:2023.04.1810:44:48-04'00' Date: City of Northampton Massachusetts '_. 14r VA It, r! a DEPARTMENT OF BUILDING INSPECTIONS �� • ^r'w . 212 Main Street • Municipal Building eti._• D.7 \ Northampton, MA 01060 �. •yj(�0 HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I O'Connell Hawley LLC (insert full legal name), born_ (insert month, day, year), hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners' exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this 12 day of April , 20 23 ��— on behalf of O'Connell LLC (Signature) �.4,10 WESTBUI-01 MMORSE AFRO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIVYYY) 4/12/2023 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 NAME CT Melissa Morse Watts Group LLC PHONE FAX 65 LaSalle Road#209 (NC,No,Ext):(860)231-7250 IA/C,No): West Hartford,CT 06107 ADDRESS:mmorse@thewattsgrp.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Charter Oak Fire Insurance Company 25615 INSURED INSURER B:Travelers Property Casualty Insurance Company 36161 Western Builders,Inc. INSURER C:Starr Indemnity&Liability Company 38318 73 Pleasant Street INSURER D:Travelers Indemnity Company of CT 25682 Granby,MA 01033 INSURER E:Berkley Regional Insurance Company 29580 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. I TR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER tMM DI OMIT YI ICY EFF YMO11LDl POLICY UNITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CO-7F914719 6/1/2022 6/1/2023 DAMAGETOREN uErenae) $ 300,000 MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JET L. PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: B - COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY (Ea accident) $ 1,000,000 X ANY AUTO 810-0 N700762 6/1/2022 6/1/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOSRE� ONLY _ AUTOSp Ep BODILYOR INJURY(Per accident) $ _ AUTOS ONLY AUTOS ONNLV (Pe�aaccident)AMAGE $ $ C _ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 X EXCESSLIAB CLAIMS-MADE 1 1000585032231 4/1/2023 4/1/2024 AGGREGATE $ 10,000,000 DED RETENTIONS $ D WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY UB-6K239300 6/1/2022 6/1/2023 STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE 1,000,000 QFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S E Umbrella BCS 8800013-11 4/1/2023 7 4/1/2024 2nd layer 15,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /(-P "r Go a-`d—e."---._ ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD — - • cp )„ 2x6 wall with 2'8" j /~ ,b pocket door / / \ / / UNIT 2D FLEX SPACE FINISH -Framing for Bathroom&pocket doorJ Si -Plumbing: -tie into existing drains in slab -fixtures to match unit,stainless finish -36 x 36 shower �_--/ -Vanity with stone top ._ -Tile Flooring in bathroom&flex room -Decorative Lighting in Bathroom&Flex Room _ \°' C---4, r - \ 7 S , :••••••••- 1 w _. _____._ l U W W m_ , h L .UOVV)- .....,N Y 8.-1. 3.-JO. 4.-44413. v. w c .. - -/`L U CrEW 7a O. / 4} i4 Ji g W S,-4. 8 4 w YI _ e D o > _ W U — > le ._., D m __,/ II_ _ -tr, ., o 4/28/23,8:57 AM City of Northampton Mail-FW:[External]Receipt from nCourt 4-L City of It1Nn Kim Carson <kcarson@northamptonma.gov> FW: [External] Receipt from nCourt 1 message Dobrowski, Rich <rdobrowski@westernbuilders.com> Thu,Apr 27, 2023 at 2:48 PM To: Kim Carson <kcarson@northamptonma.gov> Hi Kim, I have finally received the invoice for the renewal of the HIC license you had required for the building permit. Please see below receipt. Could you please send me a paid invoice-receipt for the check I made out? Also, the permit can be simply emailed to me. Thank You, Rich Richard Dobrowski,PHCB/M.Arch Project Manager " `';WESTERN BUILDERS Western Builders 73 Pleasant Street Mobile: 413.265.8793 Granby.MA 01033 From: Healey, D'Lynn <dlhealey@westernbuilders.com> Email:rdobrowski© Sent: Thursday,April 27, 2023 12:25 PM westernbuilders.corn To: Dobrowski, Rich <rdobrowski@westernbuilders.com> Subject: Fw: [External] Receipt from nCourt https://mail.google.com/mail/u/0/?ik=28605c8627&view=pt&search=all&permth id=thread-f:1764356354703981646&si mpl=msg-f:1764356354703981646 1/5 4/28/23,8:57 AM City of Northampton Mail-FW:[External]Receipt from nCourt I finally got through! Here is your receipt for the HIC number. D'Lynn Healey Project Executive Western Builders Office:413.322.3075 73 Pleasant St. Cell:413.427.6396 Granby,MA 01033 Email:dlhealey@westernbuilders.com From: customerservice@nCourt.com <customerservice@nCourt.com> Sent: Thursday,April 27, 2023 12:23 PM To: Healey, D'Lynn <dlhealey©westernbuilders.com> Subject: [External] Receipt from nCourt \euut >> https://mail.google.com/mail/u/0/?ik=28605c8627&view=pt&search=all&permthid=thread-f:1764356354703981646&simpl=msg-f:1764356354703981646 2/5 4/28/23,8:57 AM City of Northampton Mail-FW:[External]Receipt from nCourt Name: Office of Consumer Affairs and Business Regulation - HIC Registration Program Address 1: 501 Boylston Street, Suite 5100 Address 2: City: Boston State: Massachusetts Zip: 02116 Payment On Behalf Of Applicant Name: Western Builders, Inc. Description Convenienr; coo Amount Registration Fee- Initial Application $3.53 $150.00 https://mail.google.com/mail/u/0/?ik=28605c8627&view=pt&search=all&permthid=thread-f:1764356354703981646&simpl=msg-f:1764356354703981646 3/5 4/28/23,8:57 AM City of Northampton Mail-FW:[External]Receipt from nCourt Description Doi tv nience Fee Arrnoi Guaranty Fund Fee- 11 to 30 Employees $7.05 $300.00 Receipt Date: Invoice Number: Total Amount Paid: $460.58 4/27/2023 12:23:36 PM EST 6a0757af-da3f-430a-9bba-94cdd80433a2 Biiiing information Account information First Name Zachary Last Name McFarland Account Number ************0859 Email dlhealey©westernbuilders.com Street 73 Pleasant Street City Granby State/Territory MA Zip 01033 Important Information >> Please verify the information shown above. Your payment has been submitted to the location listed above. https://mail.google.com/mail/u/0/?ik=28605c8627&view=pt&search=all&permthid=thread-f:1764356354703981646&simpl=msg-f:1764356354703981646 4/5 4/28/23,8:57 AM City of Northampton Mail-FW:[External]Receipt from nCourt Powered by nCourt. Please call (888) 283-3757 if you have any questions regarding this information. This electronic mail message and any attachments thereto may contain confidential and/or privileged information intended only for the addressee(s) named herein. If you are not the intended recipient, you are hereby notified that the reading, disclosure, copying, distribution or use of all or any part of this communication is strictly prohibited. If you received this transmission in error, please permanently delete it and any copy or printout thereof and notify our e-mail security officer immediately either by telephone at 413-540-1401 or by sending an electronic message to support@oconnells.com. https://mail.google.com/mail/u/0/?ik=28605c8627&view=pt&search=all&permthid=thread-f:1764356354703981646&simpl=msg-f:1764356354703981646 5/5