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' „,,z4 ., ' ., , '' * '''r ' ''' ' R 'L s x LI /M o n ,.. « A v sa,t ' Zup -.,.' ,. , ::: i i :ii:A10.,,Itp?::.1 ri..--• E Y z *ti I .' a , s F g, lle ' . " r4 ,yo n ; . ' � ,.� --yE-- , L.I.4. - 6 7 0/17WCW,Peaai L ‘ == _ T Board of Braiding Regulatio an Standards "=_ = One Ashburton Place -Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration • Registration: 131955 Type: Private Corporation Expiration: 10/13/2010 Tr# 276770 SKIP'S OUTDOOR ACCENTS, INC. JOHN ANSART 1265 SUFFIELDST - - - AGAWAM, MA 01001 -- -- Update Address and return card. Mark reason for change. DPS -CA1 t5 50M- 07/07- PC8490 CJ Address (J Renewal ❑ Employment fl Lost Card • °°� Board of Building Regulations and Standards License or registration valid for individul use only 5� I � �� HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 131955 Board of Building Regulations and Standards ° �" ; o One Ashburton Place Rm 1301 Expiration: 10/13/2010 Tr# 276770 Boston, Ma. 02108 Type: Private Corporation SKIP'S OUTDOOR ACCENTS, INC. / ! J'~ " '` • JOHN ANSART 1 C/ ' -�-- .. ' 1265 SUFFIELD ST ,,, Q,.a,,..., __ __ AGAWAM, MA 01001 Administrator Not valid without signature ■ ■ • . ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID PM DATE(MId:DD;YY;'Y? SKIPS -1 06/30/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PHILLIPS INSURANCE AGENCY INC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 97 CENTER STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CHICOPEE MA 01013 • Phone: 413-594-5984 Fax:413- 592 -8499 'INSURERS AFFORDING COVERAGE NAIC= INSURED INSUREPA Selective Insurance 12572 INSURER E. Skips Outdoor Accents Inc INSURERS 1265 Suffield Street INSUREFD Agawam MA 01001 -3800 INSURER E COVERAGES THE POLICIES OF INSURANCE L T_D BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO PERIOD INDICATED. NOT°:'ITHTTAND }NG ANY REQUIREMENT, TERM C;R CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO A H CH THIS CERTIFICATE MAY BE ISSUED MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DEC-CREED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF OUCH POLICIES. AGGREGATE LIMITS SHOWN NAY HAVE BEEN REDUCED BY PAD CLAIMS. INJK AUUL POLICY EFFECT IVE POLICY EXPIRAI TUN LTR NSRP TYPE OF II.1SURANCE POLICY NUMBER DATE {MM/DDm'j DATE (MM /DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1. 0 0 0. 0 0 0 Rtrn tu A X COMMERCIAL GENE" LIABILITY S1843627 06/21/09 06/21/10 ! PREMISES. {Ea occurence) $ 100,000 CLAIMS ' X OCCUR j PLED EYF {,Any one person) $ 5,000 PERSONAL ? ADV INJURY $ 1, 0 0 0, 0 0 0 GEr /ER?,L AGGREGATE $ 2 , 000 , 000 GEN'L AGGREGATE LILOT A RLIES PER: ! PRODUCTS - COMP!OP AGG $ 2,000,000 PRO 7 POLICY _ LOC AUTOMOBILE LIABILIT'i CO',':BivED SINGLE LIMIT $ 1 0 0 0 0 0 0 A ANY AUTO A9091547 06/21/09 06/21/10 :E eC" ALL OWNED AUTOS • =T� BODILY INJURY X SCHEDULEDA_`O.. `' - s0r' X HIRED AUTOS BODILY X NON -OWNED AUTOS. !Per azerdent) PROPERTY DAMAGE Per ��- cider /l GARAGE LIABILITY AUTO O.1'L` - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY': AGG $ EXCESS /UMBRELLA. LIABILITY EACH OCCURRENCE $ 1,000,000 A X OCCUR 7 CLAIMS MADE S1843627 06/21/08 06/21/09 AGGREGATE $ 1,000,000 DEDUCTIBLE RETENTION S $ .. �'ti�. Si AIL UTH- WORKERS COMPENSATION AND X TORY LIMITS ER EMPLOYERS' LIABILITY A ANY PROPRIETOR.IPARTN R! 'ECITI`JE WC7265887 06/21/09 06/21/10 EL EACH ACCIDENTf $ 100 , 000 OFFICER/MEMBER EXCLUDED % E.L. DISEASE - EA EMPLOYEE $ 10 0 , 0 0 0 If yes, describe under SPECIAL PROVISIONSbeow DIVESE - F'OLICr'LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION • TOPROVI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL To Provide Proof of Coverage IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTH'i • 0 REPRESEI' ATIVE • ACORD 25 (2001/08) • • © ACORD CORPORATIr • • • • • • 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 occupancy 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 — - - - --- permit- in- conjunctionto thehuilding permitissued,_and_ 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 L 11— understand the above. (Home ow er /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Address of work location ' The Commonwealth of Massachusetts Department of Industrial Accidents 1 Wit P Office of Investigations • ie1 of Investigations ^y 600 Washington Street J' Boston, MA 02111 . www.massgov /dia -Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/PIumbers Applicant Information Please Print L • • - blv Name ( Business /Organization/Individual): ��‘ ) (,;) � - e _ 1i. . Address: \'a- 6 iii r (a S City /State /Zip: P \JcAw" - 1 UI �J Phone. #: ( - 4 R - - — 7 &Cs - 0 1 Are,you an employer? Check the appropriate bo Type of project (required): /,- I am a employer to er with I ) . 4._ 0 I am a general contractor and I / _ t ti have hired the sub - contractors 6. ❑ New construction employees (full and/or part-time).* 2. Q I am a sole proprietor or partner- listed on the attached sheet 7. ❑ Remodeting ship and have. no eu loy ees These sub - contractors have. 8. ❑ Denol on working for me in an ca act employees and have workers' Y P n' 9. C Building addition [No workers' comp. insurance comp..;nsT,rance. required.] 5 . D We are a corporation and its 10.0 Electrical repairs or additions 3. C I am a- homeewaer doing -all -work 9_ c_cuhave x-ctcjsndhee ir__ — : 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 13 . Other Ste.J1 ) � ' - ll 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 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. lithe 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 the Insurance Company Name: C�' ` ‘ S. .-\r v. I Yij L • Policy # or Self -ins. Lic. #: � CI ' CPS ` `� Expiration Date: ' I Y 1 loc.\ Job Site Address: � t" City /State/Zip:' - - 3 4 "`�'`p ` ��", 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. 'rle advised that a copy of this statement may be forwarded to the Office of Investigations of e a AIL ■ insurance coverage verification I do hereby certi ` 1' ® and penalties of perjury that the information provided_above is true .and_ correct. __ .i 1 ` lik Signature: (( 1 Date: • l Phone #: �� CL` - Vffid it use only. � Do riot rvrzte i this area, to be completed by city or town ofjkthL City or Town: Permit/License # – • Issuing Authority (circle one): - I: Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector _ _ _ _ 6. Other r Contact Person: Phone #: w • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : License Number Address Expiration Date Signature Telephone 9. Registered:, Home ;im"provementContractar .,v r � ... ,T,.. Not Applicable ❑ C > C)U/ /- C &4 . 13 I � � S S Comi anv Name Registration Number ( (QS S 6m * Si - io /cc /ac)i Address Expiration Date G JL Telephone" 714 - 6S SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G:L. c. 152, § 25C(6)) J 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 ❑ T_he_current_exemption for "homeowners" was extended to include Owner 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 1083.5.1. 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 Noittiairipfon Ur inad`nce a e an -• - .1 • • - s- er(er-al-- l=.aws- Annotated. Homeowner Signature _ _ — , 1 ar. 4/1 Ai/ r SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House Addition [] Replacement Windows Alteration(s) Roofing ❑ Or Doors 0 Accessory Bldg. [S. Demolition ❑ New Signs [0] Decks [[] Siding [p] Other [D] Brief Description of Proposed Work: ,S . l'1 bc.. Gk yc xd I Z X 21 Alteration of existing bedroom Yes x No Adding new bedroom Yes _ >C No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll - Sheet 6a .I "f Neuvrh� use:. :��ad "+or:additlon. #Q °exrsti "rq �ousl�q �otiip�ete t�i��f'o�laiiirinq: 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, ® tc.4-t-(17Q as ,y_ ti)I"t7 J (7T CL Pee Glyerpflas Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, 0 n t n 0 , as Owner /Authorized Agent hereby de fare 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. Print Name 511 Signature r/Agent Date , N 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 i Side L ::— . R.:..._.__._ L: _ I 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 /Finding ever been issued for /on the site? NO 0 DONT KNOW er 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 t Page= and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 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 , Date Issued: C. Do any signs exist on the property? YES (3 NO IF YES, describe size, type and location: D. "fie t e er any proposed - c angel to or a rtions of signs intended oar tii ; property ? YES 0 NO e IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, 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. S City of Northamptont��ttzs o rrnt#3 £ Building Department r 212 Main Street sew /svaatt Room 100 1 -) Northarrton, MA 01060 r\\`' phone 413-587-1240 Fax 413 - 587 -1272 o &e P 4 : . / a 4S W ,s APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by office 1.1 Property /y Address: I I C� , v ©1 'x-14 C t� .41 S 1 + Map Lot Unit Zone Overlay District Elm St °District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: _ PAT TA 1 Name (Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: �� 5 c P N O. TA R/44/TWO 110 /ids rt1 i if 21 ,ST Name (Print) Current Mailing Address: , gi Signature Telephone SECTION 3 - ESTIMATED' CONSTRUGTIONCOSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building / ® �� K (a) Building Permit Fee i 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) - 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) � 130 4--17,6,0 Check Number p This Section For Official Use Only Building Permit Number. Date Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2010 -0197 APPLICANT /CONTACT PERSON TARANTINO JOSEPH B ADDRESS/PHONE 110 NORTH ELM ST NORTHAMPTON (413) 584 -3608 Q PROPERTY LOCATION 110 NORTH ELM ST MAP 24C PARCEL 026 001 ZONE M(1)/URB(99)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid / V Typeof Construction: ERECT 12 X 24 SHED New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 131955 3 sets of Plans / Plot Plan THE F LLOWING 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 rV e O s1 Signature of Building Official 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. BP- 2010 -0197 GIS #: COMMONWEALTH OF MASSACHUSETTS 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 -0197 Project # JS- 2010 - 000240 Est. Cost: $6130.00 Fee: $57.60 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SKIP'S OUTDOOR ACCENTS INC 131955 Lot Size(sq. ft.): 23391.72 Owner: TARANTINO JOSEPH B Zoning: M(1)/URB(99)/ Applicant: TARANTINO JOSEPH B AT: 110 NORTH ELM ST Applicant Address: Phone: Insurance: 110 NORTH ELM ST (413) 584 -3608 () WC NORTHAMPTONMA01060 ISSUED ON:8/21/2009 0:00:00 TO PERFORM THE FOLLOWING WORK: ERECT 12 X 24 SHED 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 8/21/2009 0:00:00 $57.60 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo