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31B-286 (19) BP-2024-1602 129 MAIN ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31B-286-001 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-2024-1602 PERMISSION IS HEREBY GRANTED TO: Project# ROOF REPAIRS 2024 Contractor: License: Est.Cost: 2795 DANIEL CARNEY 99798 Const.Class: Exp.Date:08/19/2025 FIRST CONGREGATIONAL CHURCH OF Use Group: Owner: NORTHAMPTON Lot Size (sq.ft.) Zoning: CB Applicant: DP CARNEY CONSTRUCTION INC Applicant Address Phone: Insurance: 34 HORSE SHOE CIRCLE (413)543-4803 R2WC509380 WARE, MA 01082 ISSUED ON: 12/04/2024 TO PERFORM THE FOLLOWING WORK: ROOF REPAIRS 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 Drives‘ Final: Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: /7-Z_ Fees Paid: $125.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner The Commonwealth of Massachusetts DEC - 3 2024 t I Office of Public Safety and Inspections Massachusetts State Building Code(780 CMR) 4ingP knit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number. f-/4/(/O� Date Applied: Building Official: SECTION 1:LOCATION 1d1 n)cii T S} , NOCTha/me 1, mA O )01,0 Churches64- n 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 0 Repairg Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other 0'Specify:3� Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No $ Is an Independent Structural Engine ' g Peer Review required? Yes 0 No at Brief Description of Proposed Work NI$ R f�'tr c ) inS)(d ion on lower la(Wes' �i(<f i a le (hoot' Grp all ladder arcessb(p. {- towe0� re ep pubic. �(7 S ccfes. env,rp s-cp., and Pavia e o I-t-}+,7 rt rr f46n arri Thatas ©r S Ia S anal A lu.Sh'1fl 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.) -ge0octoiA LX•al)Skltes SECTION 5: SE GI OIJ (Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 1$ E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2❑ H-3 0 H-4❑ H-5 0 I: Institutional 1-1 0 I-2❑ 1-3 0 I-4❑ M: Mercantile 0 R: Residential R-ID R-2 0 R-3 0 R-4 0 S: Storage S-1 0 S-2 0 U: Utility 0 I Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 IB ❑ HA 0 IIB 0 MA IIIB ❑ IV El VA 0 VB 0 SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Trench Permit: Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal: Licensed Disposal Site 0 Public 0 Check if outside Flood Zone 0 Indicate municipal 0 A trench will not be lro Private 0 or indentify Zone: or on site system 0 required 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❑ 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 47164- Chu rthes ocUbS140DO (R (ThinS}: )6rO, ►�A Q IUD Name(Print) No.and Street City/Tow Zip Property Owner Contact Information: L II ioI- 1jaiey tit*3 -mil- q :f ,k I - - adniii)eci s1(tura s.oo Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: • Name v ' 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 D. 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 It?,Came.y Cann-ruci;orN, -Z,nc, Company Name flrive 1 Carney OS - Dgq'7 q 3 Name of Person Responsible-for Construction License No. and Type if Applicable 34 *r9ecilfte urct Ware 0. mil 017 a Street Address City/Town State Zip `{1.- -5543 31SO 413 -695- ( 4r7 di ICeectpcac'r•e y . Cowl Telephone No. (business) Telephone No.(cell) e-mail a ldress 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 Al' No D SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6) =$ 1.Building $ cii-ia59O Building Permit Fee=Total Construction Cost x—(Insert here 2.Electrical $ appropriate municipal factor)_$ . 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ 1 (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ .2 r7 l S.©0 (contact municipality)and write check number here 611'J f 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 t of my kno edge and understanding. CI 1 e t_ Pre l el e r c - Y/3 .61/3. 3i 50 II/ 7/ ' Please p ' t and sign name (iXIA Me O (�Y Telephone No. Date -A � (34-E-ice@cypcatAney,c Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: ��<� /2-3-zoZ'/ Name Date CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton o�YHnrir�o: ... e .:P� •, ti. SrS .. C \ Massachusetts ?f L �� M�, ''1, E,, +� ' `'' DEPART1 NT OF BUILDING INSPECTIONS j,° y.. 212 Main Street • Municipal Building yJi� �p�` ' ' �`:'+` Northampton, M7► 01060 'r`'`._ `%0 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. Nu )spas The debris will be disposed of in: Location of Facility: The debris will be transported by: Name of Hauler: N7 A Signature of Applicant: Date: II p1-7/Do The Commonwealth of Massachusetts '`` ►( A/ Department of Industrial Accidents Mte- 1 Congress Street, Suite 100 1.-.44= Boston, MA 02114-2017 wwwmass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/organization/Individual):D.P. Carney Construction, Inc. Address:34 Horseshoe Circle City/State/Zip:Ware, MA 01082 Phone #:413-543-3150 Are you an employer?Check the appropriate box: Type of project(required): LEI I am a employer with 15 employees(full and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. 0 Demolition 10❑ Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or arc sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. ROOF repairs These sub-contractors have employees and have workers'comp.insurance. 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Amguard Insurance Company Policy#or Self-ins.Lic.#:R2WC422171 Expiration Date:11/15/2025 Job Site Address:129 Main St. City/State/Zip: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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or 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 this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi rnd r the pains and penalties perjt?rg'that the information provided above is true and correct, Signature: Date: 1► ( 7! tL1 Phone#:413-543- 50 C — Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/LIcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: CONSTRUCTION CONTROL WAIVER From: D.P. Carney Construction, Inc. 34 Horseshoe Circle Ware, MA 01082 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 129 Main Street Northampton, MA 01060 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, D.P. Carney Construction, Inc. J'oInn Carney, President � � } Initial Construction Control Document a 1 To be submitted with the building permit application by a Registered Design Professional for work per the ninth edition of the Massachusetts State Building Code, 780 CMR, Section 107 ,4) Project Title: Date: Property Address: Project: Check(x) one or both as applicable: New construction Existing Construction Project description: I MA Registration Number: Expiration date: ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerningl: Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 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 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.) together with 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 Control 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 L Indicate with an'x'project design plans,computations and specifications 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 X" 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. ! \ Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards Consttrl rSXpervisor CS-099798 z • �ires: 08/19/2025 DANIEL P C4{2NEY ` , , 34 HORSESROE CIR `„ WARE MA 01082 Commissioner _ �N/ ram THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affait$aci Business Regulation 1000 Washing u;, -Suite 710 BostortMas taeknsetts- 118 Home Impro` -"Cs•. 7 fore istration �;,� . ..._ J, rh t Type: Corporation D.P.CARNEY CONSTRUCTION,INC. (2,•, •r lion: 1211718 �' E (i aUon: 04/11/2026 34 HORSESHOE CIRCLE •! WARE,MA 01082 _M � r F C/ \1 v Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affa$ra3 Business Regulation Registration valid for Individual use only before the HOME IMPROVEUEN1`CONTRACTOR expiration date. If found return to: T,1f.PE:.Capo'ration i Office of Consumer Affairs and Business Regulation R.oi.11011n ts =AM= 1000 Washington Street •Suite 710 12M78''1., j o4r;11r2026 Boston,MA 02118 D P.CARNEY CONST-RUCTION,INC. A , l + 34 HORSESHOE CIRC "..::.. R WARE,MA 01082 '.,�.a ; Undersecretary i / Not 7rId wit,out slgnatur• �.—.1 DPCARNE-01 ANGELA '4`o,�zo.. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/27/2024 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER NON TACT Angela DiAugustino Phillips Insurance Agency,Inc. PHONE FAX 97 Center Street (wc,No,Eat): (413)594-5984 1(A/c,No):(413)592-8499 Chicopee,MA 01013 Miss;angels@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:CrUm &Forster 44520 INSURED INSURER B:Selective Insurance Co Of Southeast 39926 D.P.Carney Construction,Inc. INSURER C:Amguard Insurance Company 42390 34 Horseshoe Circle INSURER D:Selective Ins Co Of South Carolina 19259 Ware,MA 01082 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 SUBRW POLICY NUMBER 1MPOUCY EFF POLICY EXP LIMITS LTR IN SD WM/DDIYYYYI IMM/DO/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR GLO-107731 8/1/2024 8/1/2025 DAMAGE To RENTED 100,000 PREMISES lEa occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE OMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X .ELQT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 X OTHER:$2,500 Deductible B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO A 9094953 8/1/2024 8/1/2025 BODILY INJURY(Per person) $ - OWNED SCHEDULED — AUTOSIEEpp ONLY — AUTOS BODILYBODILY INJURY(Per accident) $ — AURTOS ONLY _, AUTOS ONLY (Peer accident�AMAGE $ . $ A _ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 X EXCESSUAB CLAIMS-MADE SEO-131528 8/1/2024 8/1/2025 AGGREGATE $ 3,000,000 DED X RETENTION S 0 Products $ 3,000,000 C WORKERS COMPENSATION Xy PER STATUTE OERH AND EMPLOYERS'LIABILITY R2WC509380 11/15/2024 11/15/2025 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N NIA 1,000,000 (Mandatory n t ) E.L.DISEASE-EA EMPLOYEE $ If yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Equipment Floater S 1985457 8/1/2024 8/1/2025 All Leased/Rented 250,000 C CT WC R2WC552993 3/17/2024 3/17/2025 Employers Liab 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Workers Compensation includes coverage for the following 3A States: MA,CT RE:Roof Repairs/Inspection on Lower ladder accessible Roofs CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE First Churches of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P ACCORDANCE WITH THE POLICY PROVISIONS. 129 Main St Northampton,MA 01060 AUTHORIZED REPRESENTATIVE r 1 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD