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38B-019
„emu ,, 04 ... li ,,,,,,,.„,,,,,,,,,,„,,,....,,,,,,,,,,,, ...• . _ . ,, .„. ,. .. .,„..... . 4 , .:,, . , , , , .. . ,. . 1 , ,,, . . . ft, _, ,..:1,..„...,..,.,......„..._.:,..,...:7,,....: „....,, .„..,..,,,..., .:::, N ..., :-. , - fl, -- ..f.„:_____:• - = - _,::..._ , - ft - ' , — d i 4 ,, ,...: ii,t41• , r ' "..7:, 1 ) • * _ _. ms s, �� n AI gF! .,„„..„.,,,„,..?-1-%„,..„ z s u r w . ,,,,:::,,,,,,, ..,: - ., ,-.,,,,,,,... ', ,,,,,,-:,--, , , 1 L .--. - -...---:.: flr:: -'="111." R d , H a � ,' �s�w ' , I x x ii1t e 4 1V c/r - :,,,,,,,,,,,„„ ..... ......... . ,,......,„,,,,, . . .., . . „..,......,....„::.:„,,...,....,,_ ,i.,..,....... , . „......,....„...„..,:„..„....,,,,,, ' i Workable Woods Shawn Allen General Contractor Whately MA (413) 665 -1499 Contract to Thalia Pandiri at #29 Fort Hill Terrace, Northampton Ma. 7 -14 -2009 Total contact price is $18,494.50. Scope of work: 1 Town building permit and inspections. 2 Remove south west corner downspout leader and install next to entry portico. At this location, the leader will tie into new drain line. See # 9 3 Replace approximately seven feet of old gutter to eliminate old downspout leader funnel. 4 Clean the front and west elevations brick foundations, and prepare areas of damaged brick for repair. 5 Remove round vent in foundation wall just east of the portico stoop if possible. 6 Remove garage door, header and jamb trim, and shore up header to allow for brick repairs. 7 Provide and install a temporary door and wall to secure garage bay each night. 8 Remove concrete steps from second landing to brick portico stoop at main entrance. 9 Remove existing material behind retaining wall along driveway. Add new drain line which will outlet under sidewalk to gutter. Cut and patch sidewalk. 10 Back fill retaining wall with crushed stone. 11 Demolish three foot by eight foot section of brick wall to the east ( right) of existing garage door. Rebuild wall with existing brick if possible, or with similar brick. 12 Re -point brick work on portico stoop, and at south west foundation corner left of garage door. 13 Build and install a new pressure treated closed stair from brick portico stoop, to old second concrete landing. �' j 14 Install new pressure treated handrail on both sides of the new stair. c:A rvic:7 All work will be done in a workman like manner. � r All debris will be removed from site. � i b -, Site will be maintained and left broom and rake clean. A $8,000.00 deposit due upon signing. Balance of $10,494.50 due upon completion. Project complete when all above work is complete, and all town inspection are signed off. ,,,,,.. i ) / -/-3 J r I HIC# 123295 CS# 069965 • ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 8/28/2009 PRODUCER Phone: 413 -538 -7444 Fax: 413 -536 -6020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION James J. Dowd & Sons Ins ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 14 Bobala Road HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 10300 Holyoke MA 01041 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:Acadia Insurance Company 31325 Scapes Builders & Landscaping, LLC INSURERB: Mutual Insurance Compa 33758 & TAOS Enterprises, LLC 110 North Hillside Road, P.O. Box 469 INSURER C: South Deerfield MA 01373 INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY NUMBER POLICY EFFECTIVE POLICYEXPIRATION LIMITS LTR NSRD TYPE OF INSURANCE DATE (MMIDD/YY) DATE(MM /DD/YY) A GENERAL LIABILITY CPA012075015 6/25/2009 6/25/2010 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) $250,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5 , 000 PERSONAL &ADV INJURY $ 1 , 000, 000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP /OPAGG $ 2,000,000 POLICY X MT X LOC A AUTOMOBILEUABILITY MAA012075115 6/25/2009 6/25/2010 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 10 0 0 0 0 0 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ 1000000 (Per accident) GARAGE LIABILITY AUTO ONLY- EAACCIDENT $ ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ A EXCESS /UMBRELLA LIABILITY CUA012075315 6/25/2009 6/25/2010 EACH OCCURRENCE $1,000,000 X OCCUR CLAIMS MADE AGGREGATE $1,000,000 DEDUCTIBLE $ X RETENTION $ 0 $ WC STATU- OTH- B WORKERSCOMPENSATIONAND WMZ8005664012009 6/25/2009 6/25/2010 X TORY LIMITS ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 5 0 0 0 0 0 ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 5 0 0 0 0 0 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 5 0 0 0 0 0 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS *20 Days on Automobile & 10 Days on Workers' Compensation for Non - Payment. Shawn Allen, dba Workable Woods is named as Additional Insured per written contract in regard to General Liability only. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER Shawn Allen, dba Workable Woods WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN NOTICE TO THE 28 Laurel Mountain Road CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO West Whately MA 01039 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESE�� AUTHORIZED REPRESENTATIMC'"�� Irhp ,4 ACORD 25 (2001/08) ©ACORD CORPORATION 1988 • HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his /her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he /she resides or intends 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." The building department for the City of Northampton wants person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation /footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancv until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location , • . ' The Commonwealth of Massachusetts �. Department of IndustrialAccidents ...._..a:4 it , Office of Investigations 600 Washington Street . r Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders /Contractors /Electricians /PIumbers Applicant Information Please Print Legibly r Name ( Business i0iganizaLiuniIndividual): � O / �r .� ?C --� �tis�� , ^ j �Lt.E2.i Address: f L' 9L)7Z - /8771, , City /State /Zip: W"J° 4TEZY M' d/ Y7 3Phone #: ! ✓ '&6 S — 1 1 /99 Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I m a employer with 4. 0 I am a general contractor and I mployees (full and/or part- time).* have hired the sub - contractors 6. ❑New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employers and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. ❑ 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 required.] t c. 152, § 1(4), and we have no 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 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: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City /State /Zip: 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 $2.SO 00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certift under the pains and penalties of perjuly that the information provided above is true and correct. Signature: . c S /4 ktliki .4 ) Date: ! 1C'' _ " 9 Phone #: g/3 -'U (DS / 4 ' Official use only. Do not write in this area, to he completed by city or town official I 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 #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : ,7� 4-1-4,54'N) -s / 6 License Number 4402 AniJ ?zb 1 G1 4/ /44, all 3 i _20/0 Address Expiration Date tg - 665 7 4 1 799 Signature Telephone 9. Registered -Home improvement Contractors Not Applicable ❑ �cl -,s Al 2)01- 1 23 Company Name Registration Number Address Expiration Date // Telephone ""12"' 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 building permit. Signed Affidavit Attached Yes ❑ No ❑ 11: Home: Owner,Exeniption' 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, vou may be liable fui persun(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 D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[a Siding [0] Other [I;EtT Brief Description of Proposed Work: /- pI.4 E Ei J?)a y 5P /i2 ,6 arts . �Tiuc�C , (;0} 'A /zva4. �. Alteration of existing bedroom Yes .� No Adding new bedroom Yes / No /� Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. If Now house and or addition to existing housing, complete the followinq: 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 stories? 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 No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. 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, ' Ac Vl `g" T \ i 3 2 -' , as Owner of the subject property .. hereby authorize N ee to act on my behalf, in all matters relative to work authorized by this building permit application. ar Sig .ture of Owner Date .5'047`0(+11),! '-} as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. ll!' 4 -1 Print Name Signature of Owner /Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Exirting Propomi Ruquit t.,L1 by ailing This column to be filled in by Building Department Lot Size „ Frontage Setbacks Front Side Rear Building Height Bldg. Square Footage % Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces _ Fill: (volume Be Location) A. Has a Special Permit/Variance/Findin ever been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO (2 DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO er IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, exc ion, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only , • • City o Northampton Status of Petro x :,, Budding De partmen t Curb Cut/Dpu Pe' t rmi 212 Ma in et Se w e r IS �pticAu a itab�tit y Roo 10 Wat e r lWefl Aval 2-'7-9413-587- Nort h a mpton, MA Stre D1060 T o Sets of Structura Pl b L.i - hoe 40 Fax 413-587-1272 Plot/S to P l a ns u�: x r Other- fy APPLICATION .TO CONST A LTER, REPAIR, RENOVATE OR DEMOLISH A O NE OR TWO FAMI DWELLING SECTION 1 - SITE IN 1.1 property—Ad dress: This section to be completed by o ffice • � 9 - j' }4st.l.'rat.+4G£ Map L ot Unit Zone Overlay Distr Elm St District CB D i s trict SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Nam ( P Current Mailing Address: 7 / L l 3 - `1 C Telephone nature 2.2 Authorized Agent: / ti�2 L C'� Fns - tiiZz - Alm/. )b. eve) 39 Name (Print) Current Mailing Address Signature ESTIMATED CON Cost ( Telephone SECTION 3 - STRUCTION' COSTS Item Estimated Dollars) to be Off Use Only completed by permit applican t 1. Building (a) Building Permit Fee 2 Electrical -- Estimated Total C of Construction from ost (6) 3. Plumbing Bu ild i ng Pe rmit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) ' �� Check Number � � This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2010 -0276 APPLICANT /CONTACT PERSON SHAWN ALLEN ADDRESS /PHONE 28 LAUREL MT RD HAYDENVILLE (413) 665 -1499 PROPERTY LOCATION 29 FORT HILL TERR MAP 38B PARCEL 019 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out � dpi �/ Fee Paid ']"rte / Typeof Construction: REPLACE ENTRY STAIRS,BRICK REPAIRS, POINTING,GRADING /DRAINAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 069965 3 sets of Plans / Plot Plan THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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 Delay 0.' Signature of Building Officia Date 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. 29 FORT HILL TERR BP- 2010 -0276 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38B - 019 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0276 Project # JS- 2010 - 000355 Est. Cost: $18494.00 Fee: $110.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SHAWN ALLEN 069965 Lot Size(sq. ft.): 4791.60 Owner: PANDIRI THALIA A Zoning: URC(100)/ Applicant: SHAWN ALLEN A?: 29 FORT HILL TERR Applicant Address: Phone: Insurance: 28 LAUREL MT RD (413) 665 -1499 WC HAYDENVILLEMA01039 ISSUED ON: 9/14/2009 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE ENTRY STAIRS,BRICK REPAIRS, POINTING,GRADING /DRAINAGE POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: f � Footings: o � � ( i„1 —€114 Rough: Rough: House # Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: A �p - � CN / THIS PERMIT MAY BE REVOKED BY THE CITY OF ORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REG S if ,fr Certificate of Occu•anc Z nature: g FeeType: Date Paid: Amount: Building 9/14/2009 0:00:00 $110.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo - t