Loading...
16A-020 THOMAS C. MCCARTHY GENERAL CONTRACTORS, INC. LISTING OF SUB - CONTRACTORS AND THEIR WORKERS COMP INFO Paul Champagne d/b /a Homeworks Travelers #1660988X3761 TIL05 Exp. 01/19/08 #1660988X376TIL06 Exp. 01/19/08 RCI Roofing LLP Chris Thompson & Mark Delisle Admiral Insurance #CA000010768 -01 Exp. 3/4/08 Commerce Insurance Co #HQX422 Exp. 9/30/08 American Home Assur. #WC8966415 Exp. 10/5/08 Jim Walunus — WALUNUS PLUMG & HEAT National Grange #WCK47067 Exp. 1/29/08 John P Grygorcewicz National Grange #MPJ19544 Exp. 11/28/08 Mario Perfito Safety Insurance Co. #BP000010000 Exp. 8/1/08 G & M Enterprises Inc. d/b /a MR. GUTTER Patrons Mutual Ins. #CTR0005095 Exp. 5/12/08 Commerce Ins. Co. #K20699 Exp. 10/14/08 American Int. Group #2922113 Exp.11/08/08 RICHARDS FLOOR SERVICES R. & J Dion Travelers Co. #UB844X418 -8 -06 Exp.4/22/08 Bryon Grise Travelers Ins. #16803991A572C0F05 Exp. 10/8/08 Andre Seneca/ & Sons, Inc. National Grange #MPI35576 Exp. 6/14/08 #VK9814 Exp. 5/18/08 Commerce Ins. Co. #WCI35576 Exp. 6/14/08 s -.i .mo w' irT4 %I L t l ■ WS •. . . PRODUCER ( 1 3)527 -5520 FAX (413)527 -5970 - THIS CERTIFICATE IS ISSUED ASA MATTER OFRaruninmiive. Fink & Perras Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 6 Campus Lane ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Easthampton, MA 01027 Rebecca Kubosiak INSURERS AFFORDING COVERAGE NAIC # INSURED ThomaS Mc art y Genera • ntractars, Inc . INSURER a General Casualty 24414 3 Broderick St INSURER B: Easthampton, MA 01027 INSURER C: INSURER D: — INSURER E: COVERAGES THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANOMI 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 DESCRSED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND COMMONS OF SUCH POLICES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I NSik TYP OK IN SURANCE POLICY NUMBER PO E , ,., i • ∎ POLICY EXPIRATi a UWTS 11.0 NS GENERAL LIABLITY CC10395169 02/10/2008 02/10/2009 EACH OCCURRENCE 4 S 1,000,000 X cOMMERCWL GENERAL LIABILITY OA AGET � S 100,000 ' CLAIMS MADE ii OCCUR MEO ExP (My one person) S 5,000 A ! PERSONAL 8 AOV INJURY S 1,000,000 GENERAL AGGREGATE S 2 , 000 , 000 ..__, GEM. AGGREGATE LIMIT APPLIES PER i _ PRODUCTS • COMP /OP AGO 3 2,000,000 PDUCY n JECT IOC _ • , , • AUTOMOBILE LIA11tIUTY DOWNED SINGLE UNIT — ANY AUTO (Ea aeaaent) S . • ALL OWNED AUTOS - . • _ I BODILY INJURY — SCHEDULED AUTOS . (Pet person) S HIRED AUTOS BODILY INJURY � NON•OWNED AUTOS (Per =mere) _ S (� DAMAGE $ GARAGE UAPIUTY AUTO ONLY • EA ACCIDENT S R ANY AUTO EA ACC $ OTHER AUTO ONLY: ASS S — , EXCESS/UMBRE LA LIABILITY EACH OCCURRENCE L S OCCUR 0 CLAIMS MADE AGGREGATE $ S DEDUCTIBLE 5 r-- RETENTION S S YORKERSCOMPENSAT'VONAND CWCO395169 02/10/2008 02/10/2009 E M�0 H- U EMPLOYERS• A$IUTY • , A ANY PROPETORIPARTNERIEXECUTIVE E L EACH ACCIDENT RI S 100,000 OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 100, 000 H yes. desaibe under SPECIAL PROVISIONS below E.4 DISEASE• POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS E 1 :. 1 • _ •'i __ 1.1, — SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 , DAYS WRITTEN NOTICE TO TILE CERTIFICATE HOLDER NAMED TO THE LEFT, Thomas C. McCarthy BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 3 Broderick St OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. Easthampton, MA 01027 AtirmORizE0 REPRESENTATIVE ., i ��_) �` ' Y fix' Rebecca Kubos i ak /BECKY J `�^ ACORD 25 (2001108) FAX : (413) 527 -6893 © ACORD CORPORATION 1988 2008 -03-16 22:39 4135275970 1 413 527 5970 Page 1 Board of Building Regulations and Standards , ' t y HOME IMPROVEMENT CONTRACTOR ' Registration: 100364 , :M ., < Expiration: 6/1612008 Type: Private Corporation THOMAS C. MGCARTHY GENERAL CONTRACT ■ Thomas McCarthy 3 BRODERICK ST C ; ).4, Easthampton, MA 01027 Deputy Administrator i :g e (now non4w,ea &X r/ , /(7.[7duar,ifaldF..4 j� i' i t ^' Board of Building Regulations and Standards ; Constrrsctbrt Supervisor License 1 4;4..,., , y , license: CS 53221 t ., = Bir d 5/23/1958 ; li f1f 4 Expltutla�n: 5/2312009 Trill 12646 Restriction: 00 l THOMAS C MCCARTHY li 3 BRODERICK ST c?..--...e.... --� EASTHAMPTCNi, MA 01027 Commissioner f I WWW.RUGGLUMBER.COM Email: TCMGCI@AOL.COM Jody & Diane Kean 586.3977 6/4/2008 315 Fairway Village Leeds,Ma. MA HIC #100364 Exp 5/16/10 MA Const. Supervisor #053221 Exp 5/23/09 Estimate for the following renovations to the second floor bathroom at the above listed address. This Estimate includes gutting the tub /shower, all sheetrock on the ceiling, all around the shower area & the skylight well. We will frame and prepare the shower area, walls, floor, ceiling and skylight well for custom tile shower and seat. We will gut the existing vanity, top and mirror, we will gut all the baseboard, prepare the floor for new ceramic tile. We will install new plumbing for the customer supplied double sink and vanity, new drain and base pan for shower, Electrically, we will install a customer supplied fan /light combo. Wire for new vanity lights, lights supplied by the customer, we will duct to the exterior. We will prepare & install new baseboard elec heat. We will sheetrock the ceiling, taped and spray texture to match the existing. We will install ceramic tile, 64 square feet that the customer will supply, for the entire shower area, including, the walls, seat, step, ceiling, skylight well and the main floor. Ceramic tile to be Florida tile, in Britannia, #127A in the size 12" x 12" for all area's. All to be grouted in the customer's choice of color. We will install the supply vanity, sinks, faucets, mirror - cabinet's, lighting, and supply and install 1- new Toto elongated handi- capped toilet in white. We will install 2 new bath locksets We will install vinyl base. Included in the price is a $1,000.00 for shower doors and installation. All priming, painting, staining polying, brass plumbing parts by the customer. All rubbish removal and cleanup is included. Add for Northampton Building Permit, we will get. Fifteen Thousand Eight hundred and xx/100 $15,800.00 20% Down for custom order: $3,160.00 50% Upon Start: $ 7,900.00 30% Upon Completion: $4,740.00 45 Days . The Commonwealth of Massachusetts _ , _ e Department of Industrial Accidents r r, - 5w,=-- r / Office of Investigations VW -+ 600 Washington Street Boston, MA 02111 : www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print . ' r iv , Name ( Busiiness /Orgsnization/Individual): //.0 4 ....4.' 1 - � .r ten.. , .0f f 75 7 O - Address: d 1jiJ , 41 `?1 . City /State/Zip: d/ 439 4 . Phone. #: 03. 7 57Y/ Are n an employer? Chec the appropriate box: Type of project (required): 1 Iama employer with p 4. 0 I am a general contractor and I employees (full and/or part-time). _ have hired the sub- contractors 6. 0 New construction 2.0 I am a sole proprietor or partner - listed on the attached sheet 7. 0 Remodeling ship and have no employees These sub - contractors have 8. 0 Demolition . working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.: 9. ❑ Building addition required.] • 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers' comp. • right Of exemption per MGL 12.0 Roof repairs insurance t c. 152, §1(4), and we have no 0 required.] employees. [No workers' 13.0 Other 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 are doing all work and thm hire outside contract=s east submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whetter or not those entities have employees. lfthe sub-contractors have employees, they must provide their workers' comp. policy number. yam an employer that is providing workers' compensation insurance for my employees. Below is the policy and Job site information. / Insurance Company Nam ame: 1 �(�!Qi4' . Policy # o Self-ins. Lic. #: 0/6 /J 5/e 7 Expiration Date: 4 1* r Job Site Address: .?!5 / / /i'i'i !r/ lie � P — C ?if )City /State/Zip: / l a ii5 f'i// , C9II ) . 1 . Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 ofperjury that the Information provided above is true and correct S ,nature: -' �''� 19 — Date: 6 _`IL' e d' _ Phone #: 0 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.Otber • Contact Person: Phone #: s SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: &((a / Not Ap / plicable ❑ Name of License Holder : P11704 C d / - �hy C 5 53 1i2/ License Number �f &6 . sf � /49 Q%027 'S /z ��,U Address Expiration ate Signature Telephone 9. Registered Home ImpcovementContractor -; : ;= Not Applicable ❑ i (� /, d 2 Noe/ � G Clii�'� Company Name Registration / N � bier Address j 7 P E iration Date 4, t 'V fr � iG ) ? 7 Telephone 5"/ y// — SECTION 10- 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 buildin ermit. Signed Affidavit Attached Yes No ❑ 11.iv— Homex:OwnerExerriptiori The current exemption for "homeowners" was extended to include Owner occupied Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780. Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person (s) who own 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 homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors ED Accessory Bldg. ❑ Demolition ❑ New Signs [ID] Decks [p Siding [I]] Other [d] Brief Description of Proposed /11/I119:l 6'"? /t '1 C 4 A, ,, ve X 4 1 al L/flG Work: . 40hiiLQ. MI zu), 77') a- -t Mir /i:� 0'2a-09;4.C- Alteratiokof existinq bedroom Yes No Adding new Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a tf New house: and oraddltlon:ato= existln4=[ ousin .co mptete.thei#ot owlnq: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stones? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes lo. s cons ruc ion 1 - r + • • . •••.. - es No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . L Septic Tank City Sewer Private well City water Supply SECTION 7a - OWNER; AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, t1 �"" G `l % J( / 0 /71.—. ///2. , as Owner of the subject property J h- r :,... e �l' .i 1 l - / i ' '/f ..f, C1 /7..S //9() .... to on 1 in all atters relative to work authorized b this buil. ing permit application_ / /- 4 ignature •f Owner Date P C.- , 1 / as Owner/ orized , gent hereby declare that the statements and infor ation on the foregoing application are true and accurate, to the best of my knowledge elief. Signed under the pains and penalties of perjury. Print Nam 1 4 ‘ " 1 0 ‘ 1 4 --- 6 -/c9 - 01 Signature of Owner /Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department __ _ Lot Size . —._ —. __ _— Frontage — Setbacks Front Side L: R: L:: R:_ Rear Building Height Bldg. Square Footage % Open Space Footage (Lot area minus bldg & paved , parking) # of Parking Spaces Fill: — ____ __ _- (volume & Location) A. Has a Special Permit /Variance /Findino ever been issued for /on the site? NO Q : e. a A� i IF YES, date issued: IF YES: Was the permit recorded at the Reg try of Deeds? NO 0 DON'T KNOW YES 0 IF YES: enter Book ��� Page ' and /or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q Date Issued: C. Do any signs exist on the property? YES 0 NO Gi IF YES, describe size, type and location: D. Are there any ro osed changes to or additions of signs intended for the property ? YES 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading a cavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. - ,--, — r w \ - \,., De aseronl „ . - �1� 1 t a�, , ,.* #'� .° P.: '�..,, ,, V S , y+ 'ter' , ".,p..` _,- — Cit of Northampton a tus : ►t t �. . „ \ � ` �, BuiI Department eriue � Q� 212 Min Street Sewe� t l i ty :; \ ? Roo 100 1t11aferLW ep va alu ' � r - t, , p 0 No ampt , MA 01060 Se'sa r _} phone 413 =5�' - 240 Fax 413- 587 -1272 4 it _ �la n s � Y APPLIC j1ION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be y- completed by ffi oce j � 4 /40 & i ; a gb a �MBp Lot Unit : Z one " ° 4!a District Gimps /phi dj4 Eim S t. District " "= C B District" SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: tfd ii - * A; -5/5" ci4/7/eithfl ,/ it // .,- Name (Print Current Mailing Address: Telephone /J Ignature' . ' 7/3 - ? Z6 "39 2'7 2. • utho •ent: Name (Print) / 7 Current Mailing Address: ,19 2 e ', (.9Z-- -'14/17 : _ t-^-7 -, W -? ±.;,;12, (571/ Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant _ 1. Building (a) Building Permit Fee 2. Electrical ,c�,y� � - (b) Estimated Total Cost of /� Construction from (6) 3. Plumbing C,( > Building Permit Fee if 4. Mechanical (HVAC) 5. Fire Protection 6. Total= (1 +2 +3 +4 +5) f■j/�( Check Number 4.. /'9 7 This Section For Official Us e Only Building Permit Number. Date <Issued: Signature: Date Building Commissioner /Inspector of Buildings File # BP- 2008 -1112 APPLICANT /CONTACT PERSON Thomas C McCarthy ADDRESS /PHONE 3 BRODERICK ST EASTHAMPTON (413) 527 -5141 PROPERTY LOCATION 315 FAIRWAY VILLAGE MAP 16A PARCEL 020 045 ZONE URA /WP/WSP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid e?S ?� 479 Typeof Construction: RENOVATE 2ND FLR BATHROOM - NO STRUCTURAL CHANGES New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 053221 3 sets of Plans / Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN O ATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission _ Permit DPW Storm Water Management Demolition Dela, Si g natur of B dint • fficial Da Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. ' r ., , .P BP- 2008 -1112 GIS #: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -045 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2008 -1112 Project # JS- 2008 - 001637 Est. Cost: $15800.00 Fee: $79.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Thomas C McCarthy 053221 Lot Size(sq. ft.): Owner: KEANE DIANE & JODY Zoning: URA /WP /WSP Applicant: Thomas C McCarthy AT: 315 FAIRWAY VILLAGE Applicant Address: Phone: Insurance: 3 BRODERICK ST (413) 527 -5141 Workers Compensation EASTHAMPTONMAO1027 ISSUED ON: 6/17/2008 0:00:00 TO PERFORM THE FOLLOWING WORK: RENOVATE 2ND FLR BATHROOM - NO STRUCTURAL CHANGES 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department 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. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 6/17/2008 0:00:00 $79.002897 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo