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39A-078 BP-2024-0804 518 PLEASANT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 39A-078-001 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-2024-0804 PERMISSION IS HEREBY GRANTED TO: Project# RENO CTSCAN ROOM 2024 Contractor: License: Est.Cost: 200000 MATTHEW WAINSCOTT 104496 Const.Class: Exp.Date: 08/17/2025 Use Group: Owner: 518 PLEASANT STREET LLC Lot Size (sq.ft.) Zoning: GB Applicant: WAINSCOTT BUILDING Applicant Address Phone: Insurance: 37 STAGE RD (413)559-0825 WC533SB24V3R014 WILLIAMSBURG, MA 01096 ISSUED ON: 07/16/2024 TO PERFORM THE FOLLOWING WORK: RENO SPACE FOR CT SCAN ROOM - 290 SQ FT 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: $1,400.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner r iVerZ I:001 A*..+S - .5e- r EI14L 7-9 The Commonwealth of Massachusetts Office of Public Safety and Inspections Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) r Building P4rnut Numberity. S C Date Applied: Building Official: _ SECTION 1:LOCATION r5153 4\tay4..1 c�� t•-- oCVw"11..ku IAA 61060 • No.Ind Street City/Town Zip Code Name of Building(if applicable) Assessors Map# Block#and/or Lot SECTIOSZ 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%I_ Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use ❑ Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes a No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No LI' Brief pAicription of Proposed Work:/C4 styli / L x►S � S lort'..c ��Apt or CV SC.O i 0 Z o u AA- 2 So s),J- 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) I] Existing Use Group(s): Proposed Use Group(s): 13, 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-4k— 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❑ 1-3 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 D IB 0 IIA 0 IIB 0 IIIACI IIIB 0 IV CI VA 0 VBD 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: PublicA trench will not be Licensed Disposal Site Er Check if outside Flood Zone 0 Indicate municipal 1� Private 0 or indentify Zone: or on site system CIrequired 0 or trench or specify: 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 ❑ 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 Ad ress of Property Owner Name(3"rint) No.and Street City/Town Zip Property Owner Contact Information: Ov.-.),..-a-rL y r V- 93y 4 _ - Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the roperty owner hereby authorizes: 14\4-1 - C 41,..54 1wco ?o&oc 3-`1v co -s S IcAl e S4- 'A w\.• MP- 0 i 0 3 3_ 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 her 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 c-JC., uSe4 k% �.Lie cc I L ( Company Name M �WA..) Znir LS- I Oy4S L v t-e .s1.r,t_ A�..J Name of Person Responsible for Construction License No. and Type if Applicable 9 o 20r, 7`k.0 C-PP4 r-six IA& Cho`3 Street Address City/T �/► State Zip V4 -C9i- Q - - MLiv� i oSc a-bv I.rier's wM 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? Yestr No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ CO 1.Building $ 00 dv 0 Building Permit Fee=Total Construction Cost x l) (Insert here 2.Electrical $ 1 Z O 1.70i) appropriate municipal factor)=$ . 3.Plumbing $ if It�i— 4.Mechanical (HVAC) $ Note:Minimum fee=$i 7 (contact municipality) 5.Mechanical (Other) $ Enclose check payable to /� 6.Total Cost $ .�i'�I060 (contact municipality)and write check number here rod 1 SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest der the pains and penalties of perjury that all of the information contained in this application is true and accurate to the f m k owledge and understanding. Nm......., L.JA4,,�,,-. .5 satr Y8-SSS-081 S Please print and sign name Title Tele lyne No. Date 4 p)o 6,, 710 c'o W-.9*h\ b-rA...Av Mk of o 3 3 04we ✓ot WSce i: u.U'fS.c..,,✓v\ Street Address City/TovVri State Zip Email Address Municipal Inspector to fill out this section upon application approval: ../ '1- 7/4-20ly Name Date City of Northampton Massachusetts �4� i. '<<. � �. a 1 DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building sk, ra - � Northampton, MA 01060 '14ijr ib 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: 1)p 1Vc� I2 c ..N� 1, k The debris will be transported by: Name of Hauler: LI 13 1�,,,.AvsA-e 2 Signature of Applicant: ( Date: GI 2 41 I 7 4-f sA REV1 19.-iN" 7' Unit l NighlEond Heights ilhir i (888, 505-O w I DIMENSIONS REVISED DUE TO GANTRY WIDTH ^ell r W• .er., €emelDI hervm,r.Ih.pO., ,,i M eMED MBOno SeluuOM.M ne b E.veal/.CM(TerRnr.h 1 / j i , -/ /; /i/�./j .. _ I i / Me,educed ..m r. ell le o \ rlicoloe/.nr.ou!Th p.f.i 0,,rlvof 'MIIMe...verMn e(onaMED 1 Im..,3 SOeeYm. 1 / 4 V W Z 0 11-j7 ZD. • 14r-7" C7 a Z • O Q 3'8z"/ O w a C1 0 3'-1I" C o z :• 16'-2e F +91•, a W Z EXIST z ti a a wf.. T. 2 a 4' EXISTING ELECT ' a tr i CC ! PANEL VERIFY ELECT. - w a 0CC 0 A/ TRANS. • • W z"Dr o - 8' ' z ! Err: ; REV1 VERIFY _ 2-14-24 ? r 24244 wlUrt cR SKEfCN VERIFY EXACT LOCATION OF - ....i..234.4 PRELw$ TRANSFORMER AND PANEL :}Ib2AFlNaLS ISSUED TO REMAIN. - . 2024-01 W-4849 // North 4" SHEET i ISSUED FOR COORDINATION PURPOSES ONLY-NOT TO BE USED FOR PERMITTING OR CONSTRUCTION PURPOSES A-1 The Common wealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 1017 4=. - Boston, .V402114-2017 www mass.gav/dirt L1 tuckers'Compensation Insurance Affidavit:Budkiersi ontractursiEkctriciaa PIrmmber%. T'O 81~FILED WITH f:HE P£R.N1"11'v%G AlTHORITI. ♦pplic;ant Information Please Print Legibly NatlIC ;i3usuy:.:.0, pm:raticn.Ind*usual?. 1 Rt.), ia.t-rS L +r.� ----------- Address: ?r 43 o ( City:StateZip: 6- MA ow 3 3 Phone 7#: 1413 559 L' 1 ere,.r a.e.tpk.rv?Chart Ike appropriate bum. Type of project(required): orrj-t am a rmplkrvci aritb _..emplrr}Yes[full tail u part-ansci.• 7. 0 New construction 201 am a auk peopneforuc partnunshrp oral have nu eirinbuyecs wurkiae for roc as lung a.y,:apace N. w..nlhers'rump.insurance :wired.; y_ Deraoiitiori k.a I am a itucmcvrner doing sli wu,rinsed.[No wurktrs-.amp naerrenuc requanni 10 Budding addition 11.0 taiga a bete.**nee end*ill be Awing:wntradurs w uumthet all work un my wormer). 1'will nosiest*rah am,nxrtra►wrs either have workers ginnpnanatann msuranur of are:xrlc 1 10 Electrical repairs of additions prupneicArs*ilk An employee,. 12.0 Plumbing repairs or additions 50 1 un a grinner/confraelor and 1 bane'hared the wb-CUtiWat orS Iisity!on?he atteLihoti inert. ❑ Nese orb.-».�xtun haw,asopluers.zni lsrve*otters :urnp.insurance 13. Root repairs In Other h.a hire are a voepu ycwrr and lb urYwc-n Katie ts.ereinea their nght tat cxsape ctum per MICA•:- I 1 i1 If af,nail we have nu.anclu+yes.{No*criers'zump in:uraoer required. •-tiny app{:ic-no dart ducks.hers 41 mite Alan till out die srI min below finning then-iourtcr :ornpea=auun pttht)irrfi rnI inn. l#r,.nca wn:rs a.ito Aiken(dos alfu lava:n,hcaunu they are:lutes aril Murk and hen'Ante-*aside tarty¢i.uflmut a ne a.al'6akw.t:neb.. v5 mark. �C oalrac'un deer[:nett hiss.t.irt mnna anndxd an Additional•laret.buwtng eht,:one d the..11b,-uorrs.tx,,rd,tree .ether..a:wt d ux.e at.ttie,b S e _rrplu--i- If`ha:1131b.-40.3tarIX ins ite-r--rtgzlureta.they rnsut prus1.J :lhe',s .n..11e17, nun1 'r 1 am an employer that is providing worLers'compensation insarwrce for my emplo}-et-s. Below is the policy and job site informations_ Insurance C.xuatrany Name: 1_i 'Us Po(id'y#or Self-tins.LIC. #: WGS g 'Z(LDl`-I Expiration Date: t2%/0I f 2 Job Site.address: I S Pf c¢qn,.. C ir. Stacc.Zip:.(LAvpe [AA U i tr Co Attach a copy of the workers'compensation policy declaration page(showing the polo number and expiration date). Failure to secure coverage as required under MGL c. 152.§25A is a criminal violation punishabk by a tine up to S1.500.00 andi'or one-year imprisonment.as well as civil penalties in the Corns of a STOP WORK.ORDER and a fine of up to S250.00 a stay against the violator A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage vet/ticatier'. !do hereby certify under As and penalties of perjury that the information provided above is true and correct Sigpatute:`%� ' Date /, d-i/d-1Phone Ar: 1)3 3tc5' G 1 1 Official use only. Do nut write in this area,to be completed by city or town official City or Tern: Permit.License#^ _-- —_— leaning A1at(rerity(circle one): I.Board of Health 2.Building Department 3.t'itvrlown Ckrk 4. Electrical Inspector 5. Plumbini; Inspector 6.Other Contact Person: Phone#: Client#: 20059 WAIBU ACORD:. CERTIFICATE OF LIABILITY INSURANCE DATE(M/WODIYYYY) 6/24/2024 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CNTNNAMEACT Anne E.Daley T.P. Daley Insurance Agcy, Inc PHONE(A/C,No,Ent):413 788-0977 FFAXpuc,No): 413 739-2645 1381 Westfield St. ADDRESS: annedaleyytpdaleyinsurance.com P.O.Box 1150 INSURER(S)AFFORDING COVERAGE NAIL$ West Springfield,MA 01090 INSURER A:National Grange Mutual INSURED --- INSURER B:Liberty Mutual Insurance Wainscott Builders, LLC INSURER C P.O. Box 740 INSURER D: Granby, MA 01033 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 ADDLSUBt� POLICYEppF pppp��r�CC EES�P LTR TYPE OF INSURANCE INSR WVD I POLICY NUMBER -{MMIDorrnm (MMIDD/YWYL LIMITS A X COMMERCIALGENERALLIABILITY MPJ8918T 01/01/2024 01/01/2025 EACH OCCURRENCES1,000,000 -TI J CLAWS-MADE E OCCUR PRAEMiSEs EaEom r°nce) 1$500,000 MED EXP(Any one person) S 10,000 PERSONAL&ADV INJURY S1,000,000 GENtAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S2,000,000 1-1 PRO POLICY JECT LOC PRODUCTS-COMP/OP AGG S2,000,000 _ OTHER: S AUTOMOBILE UABILITY CO(Ea BI SINGLE LIMB $ ANY AUTO BODILY INJURY(Per person) $ _ OWNED AUTOS ONLY SCHEDULED BODILY INJURY(Per accident) S _ AUTOS HIRED NON-OWNED PROPERTY DAMAGE _AUTOS ONLY _ AUTOS ONLY (Per accident) S A x UMBRELLA LIAB OCCUR CUJ8918T 01/01/2024 01/01/202 EACH OCCURRENCE $2,000.000 EXCESS(JAB CUUMS-MADE AGGREGATE $2,000,000 DED X RETENTION$10000 S B WORKERS COMPENSATION WC533SB24V3R014 01/01/2024 01/01/2025 X STATUTE OTH- ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N EL.EACH ACCIDENT S1,000,000 OFFICER/MEMBEREXCLUDED? y N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S1,000,000 DESCRIPTION OF OPERATIONS'LOCATIONS'VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Excluded LLC Members: Christopher Lapinski and Matthew Hoey Job Location: 518 Pleasant Street, Northampton, MA CERTIFICATE HOLDER CANCELLATION CI of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City p THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 212 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Northampton, MA 01060 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S165307/M164362 TMG CONSTRUCTION CONTROL WAIVER From: ff 11 r\ lll )A10Scv'I 1tc1Qrs LLCr vo� 'tO To: Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 The Massachusetts Building Code, section 107.1 allows for an exclusion from requirements for construction control in certain situations. In accordance with code section 104.10, I request that you grant a modification to waive the requirement for construction control of the project at because the work is of a minor nature,will not affect structural elements, health,accessibility, life or fire safety, and will be done in accordance with the prescriptive requirements of the code. Thank you for your consideration. Respectfully, L—e77