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17C-223 BP-2024-0104 82 1/2 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-2024-0104 PERMISSION IS HEREBY GRANTED TO: Project# BSMT BATH RENO 2024 Contractor: License: PATRIOT PROPERTY Est. Cost: 16000 MANAGEMENT GROUP CSL111802 Const.Class: Exp.Date: 06/12/2025 Use Group: Owner: LLC BLUE MOUNTAIN PROPERTIES, Lot Size (sq.ft.) Zoning: GB Applicant: PATRIOT PROPERTY MANAGEMENT GROUP Applicant Address Phone: Insurance: 268 COLD SPRING AVE SUITE B (413)717-0635 wlr c52795291 WEST SPRINGFIELD, MA 01089 ISSUED ON: 02/23/2024 TO PERFORM THE FOLLOWING WORK: RENO BASEMENT BATHROOM 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+ J ow i , C Fees Paid: $112.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner • L* 71), i - Fs, ~t., r n 1 <411 ,, The Commonwealth of Massachusetts ,� -'U� / Office of Public Safety and Inspections �'���y�i Massachusetts State Building Code(780 CMR) O 4,, ^;,`/.� uIg Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number:c)4' 0 / Date Applied: Building Official: SECTION 1:LOCATION 76-96 Maple Street, Florence MA Parsons Block No.and Street City/Town Zip Code Name of Building(if applicable) 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 IX Repair IX 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 ® No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No S1 Brief Description of Proposed Work:_Renovate existing bathroom in basement to meet building code standards in 82 Maple Street Florence. 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.) 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 0 E: Educational 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 I-2❑ I-3 0 I-4 0 M: Mercantile❑ 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 ❑ IIA ❑ IIB 0 MA IIIB ❑ IV CI VA 0 VB ❑ 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: A trench will not be Licensed Disposal Site❑ Public 0 Check if outside Flood Zone 0 Indicate municipal 0 required❑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 0 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?: Special Stipulations: Design Occupant Load per Floor and Assembly space: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Blue Mountain Properties, 268 Cold Spring Ave Ste B West Springfield MA 01089 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Jordan Healy 4137170635 Jordan@patriotpmg.com Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Patriot Property Management Group, 268 Cold Spring Ave Ste B West Springfield MA 01089 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 CI. 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) Steve Drakulich and Associates Name(Registrant) Telephone No. e-mail address Registration Number 27 James St Greenfield MA 01301 Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Patriot Property Management Group Company Name Jordan Healy CS-111802,Unrestricted CSL Name of Person Responsible for Construction License No. and Type if Applicable 268 Cold Spring Ave Suite B West Springfield MA 01089 Street Address City/Town State Zip __ 413-717_0635 Jordan@patriotpmg.com 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 $ 11,000.00 Building Permit Fee=Total Construction (Insert here 2.Electrical $ 2,000.00 appropriate municipal factor) 3.Plumbing $ 3,000.00 4.Mechanical (HVAC) $ Note:Minimum fee=$ (con . cipality) 5.Mechanical (Other) $ Enclose check payable to �y� 6.Total Cost $ 16,000.00 (contact municipality)and write check number here-�i'6-`6v 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. p +i 44 Manager - - _ Please print and sign name Title Telephone No. Date 268 Cold Spring Ave Suite B West Springfield MA 01089 Street Address City/Town State Zip Email Address 1 Municipal Inspector to fill out this section upon application approval: j�6 �' • Name Date City of Northampton (r, Massachusetts .. !� ° ! DEPARTMENT OF BUILDING INSPECTIONS 0\ 3' • a` 212 Main Street • Municipal Building I. "a, Northampton, MA 01060 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: K&W Materials and Recycling, 138 Palmer Ave West Springfield MA 01089 The debris will be transported by: Name of Hauler: Joe Bruno,All State Disposal 1/22/2024 Signature of Applicant: vioreect4a, 144 Date: — The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MI 02114-2017 wwmmass.govidia %%inters'(ompensation Insurance Affidavit: Builders/Contractors/FiectricitinsiPlumbers. 11)BE FILED WITII IIIE Applicant Information Please Print tAvihtv Name ihitistrirssOrgritura tionflndividual): Patriot Property Management Group Address: _268 Cold Spring Ave Suite B West Springfield MA 01089 413-707-4434 city/State/Zip: Phone#: O eptoyer? 'Ihvt the it priritiorialc box: Type of project(required): alll crrirkryor Si 0E1 9 _IIIIIrpeiUyt.seb I And Or pari-riniti.• 7.. a New construction jt aim a war imirstretor tit Funnakhip and have no employee.:working for me in Remodeling Any capacity,[No v.oilers'comp insurance requiredl 9. El Demolition 30 am a homeowner doing all work myself.[No workers'comp.nbutunix required.]* 100 Building addition 4.0 I am a hurncowncr and will by hinny earadraehars to cveiduct all wink on my property. CiL1101:that all contractors either have.wenters-evinipen_salson insurance cir aitMAC a Electrical repairs or additions proprWtom ith no 12.0 Plumbing repairs or additions 5Ci 1 am a general contractor and I have hated the aub-euntractiart,11,1c,4 an the Altai-in:4 3hect 13.0 Roof mpairs rht.-he sOblAintractors have employees and have workers*comp.insurance.:, 14.0 Other art a corporation and is officm have cavIviaed then nisIrt of caAnripnon pet ldIGL c. I §II41.and we have nu angrluyee's. orkers•,:vinp irniurance requital *Any-applicant that chavles box 41 most alto till out the stvtion below shuns ing their workers'compensation pulley infunrodion *Homeowners who sisinnii this aftidavit inilicattnit they arc doing all work and then kart outside contraetory must submit a new affidavit usIieakai such_ :Contractors that cheek this boa mast atm.-heal an aellitional sheet shiawfing the name of the sub-contructors and 4111/4%further or not Ohmic ottatieca have iri'lcc, II the auh-eLagractin>.ha+<L rn I tta na. intim two id e Thor Ikorkers- poliey number., . „ I am an employer that is providing worAers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Aon Risk Services, Inc of Florida Policy g or Self-ins.Lir.g: WLR C52795291 Expiration Date: 07/01/2024 76 - 96 Maple St Florence MA Job Site Address: CityState!Zip: Attach a copy of the ssorkers compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL e_ 152,§25A is a criminal%iolation punishable by a fine up to S1,500.00 andlor one-year imprisorirnent,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a clay 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 penalties of perfuty that the infOrmation provided above is true and correct St:mature: c10-ra44.4,- D,,, 1/22/2024 r 413-71 7-0635 Official use onir. Do not writr in till.a tiros. to be completed by city or town qfficiaL ( it y or Town: PermitiLicense Issuing Authority (circle one): 1. Board of health 2.Building Department 3.C:101f-won(71erk 4.Electrical Inspector 5. Plumbing Inspector 6,Other Contact Person: 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 onstruction control forms to be used by Registered Design Professionals. e % Y ? R d R _ ,may 0s#3 v` monwealth as -don of C _ .,,censure of uliding Regulationsa r I 1 Con t ' 0. - ion r '. rvsr CS1118O2 e: : Z' p JORDAN PAIIRICK HEAL' 268 COLD SPRING AVE SUITE c WEST SPRINGPELD 01089 (it IN/ --4.: 1;k) 0 iSSI r ., , ,, 21V4 ACC Rra CERTIFICATE OF LIABILITY INSURANCE DATE 10/3(M1/DD/YYYY) 1I2023 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 AON RISK SERVICES SOUTH INC NAME: Aon Risk Services,Inc of Florida 3550 LENOX ROAD NORTHEAST PHONE FAX SUITE 1700 (A/C,No,Ext):833-506-1544 (NC,No): ATLANTA GA 30326 EMAIL ADDRESS: work.comp@trinet.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: ACE American Insurance Company 22667 INSURED INSURER B: TriNet Group,Inc. Patriot Property Management Group,Inc. INSURER C: 1 Park Place,Suite 600 Dublin,CA 94568-7983 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 15676226 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 INSR WVD (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PROJECT LOC PRODUCTS-COMP/OP AGG $ OTHER $ AUTOMOBILECOMBINED SINGLE LIMIT LIABILITY (Ea accident) $ ANY AUTO 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 $ DEC RETENTION$ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE WLR C52795291 E.L.EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? N N/A — 07/01/2023 07/01/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Workers Compensation coverage is limited to worksite employees of Patriot Property Management Group,Inc.through a co-employment agreement with TriNet HR III,Inc.. CERTIFICATE HOLDER CANCELLATION Patriot Property Management Group,Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 268 Cold Spring Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ste B ACCORDANCE WITH THE POLICY PROVISIONS. West Springfield,MA 01089 AUTHORIZED REPRESENTATIVE {On CRi,6k 8etvice6 6out/t Qnc ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD - _ ,;..8 4/ E wi S� �'�]'JjiY�f V