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31A-293 • City of Northampton Building Department 212 Main Street Northampton Mass 01060 1 r^ 2 Q ,r ` Selma Garber 28 Washington Place Northampton, MA 010160 September 8, 2008 To whom it may concern, In 2006 Nate Davis began a renovation to the upstairs of my house at 28 Washington Place. The electrical work was begun under permits issued to an electrician contracted to Nate Davis. Plumbing work was begun by Claude LaPrade, who was also a subcontractor to Nate Davis. I wish to have the electrical work completed by another contractor to be selected by Joe Connell.) give consent for a permit to be issued under that contractor's name. wish to have plumbing work completed by another contractor to be selected by Joe Connelt,l give consent for a permit to be issued to another plumber. ,9 Selma Garber ACORD CERTIFICATE OF LIABILITY INSURANCE ) 01/23/2009 PRODUCER (413) 527 -5520 FAX (413) 527 -5970 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Finck & Perras Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6 Campus Lane HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR p ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Easthampton, MA 01027 Barbara Van Mourik INSURERS AFFORDING COVERAGE NAIC # INSURED JOSEPH CONNELL DBA INSURER A: NGM Insurance Company 14788 DBA: JG CONELL HOME IMPROVEMENT INSURER B: 2 PETTICOAT HILL RD INSURER C: WILLIAMSBURG, MA 01096 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. I LTR , NSRE TYPE OF INSURANCE POLICY NUMBER DATE POLICY POLICY TE (MM DD/YYIN LIMITS GENERAL LIABILITY MP018703 08/01/2009 08/10/2010 EACH OCCURRENCE $ 300,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 500,000 PREMISES (Fa nrrunanrP) CLAIMS MADE © OCCUR MED EXP (Any one person) $ 10,000 A PERSONAL & ADV INJURY $ 300,000 GENERAL AGGREGATE $ 600,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 600,000 n POLICY n JE9 n LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY — SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY — NON -OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR n CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ I $ WNW M TS [ WORKERS COMPENSATION AND OFR EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 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 THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY City of Northampton OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Attn: Building Dept AUTHORIZED REPRESENTATIVE e C�e� '=1/ ACORD 25 (2001/08) ©ACORD CORPORATION 1988 10" / / ; ,, _ Mil I J ' j I ..,.. r .,.. ; lir mi Ir m o . 1 , 1 ,_ , ,..... t, 1 r m milmiir III il 1 ; 1 1 1 1 1 1 1 1 1 ; ; , , ; ; ; 1 ; 11 11 1 1 1111 11 i I ' - H ' ' ■ ! I 11111111111111 I H ■ ■ 1 1111 ' 11111 i ELEV,,,IoN. TOILET WALL T -6 l' I; 111 ' 1 • ■ L iI I 1 �, i � ,, - r - i �.' ,__.• I Ii 1 � 1 I 1 Odd width tiles along this edge. same on tub 4 box and floor Stone tiles on - - - - -s outside edge of Boxed out wall I _ill i 1 1 1 1 ,i 1 a Rounded ceramic tiles along tub box edge __L _ _•= • X • • — — — — — — — — — — — f This dimension depends on thickness of floor tiles. — — — — — — — — Keep blue shapes level with those on other walls. i_ - -. 1 _ Height of tope row of stone tiles may vary. 10" 10" 8" / / 10" / / / / / ELEVATIONS: TUB BOX & SHOWER BACK WALL T-5 / / / . _ ____.= _ x _ Lr _ � _ — — _ —; Mirror _ _ _ is — — - �' h- 1 1 i - • -- - - - - - - - I - I _ -.- III - II II i = III - • • ; ELEVATION: SINK WALL T... 0 t • • T. 1 __ 1 i 1 n .. FLOOR PLAN T -3 Odd width tiles along this edge. �............... . ....._...._ � ....... ......_ .. _. .._ .... ......... _ ._ . _ .. ....... • 1 . 1 1 0 stone tiles I 1 / 2x6 stone tiles I( -/ _ Ll 2x2 stone tiles. FLOOR PLAN T -2 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 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 Industrial Accidents Office of Investigations 17 600 Washington Street Boston, MA 02111 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders /Contractors/EIectricians /Plumbers Applicant Information Please Print Legibly • /l �/ Name ( Business /Organization/Individual): (,� � , - �' !' _ � p ; � a7 �, "., p r ,� . s 4'4 (,:: .1-, Address: ? ar ✓ - I p1,', : e `-► P/< City/State/Zip: /9 �,✓�' d a - c." Phone #: 7 t ?— e � Are you an employer? Check the ap • ropriate box: Type of project (required): 1. ❑ I am a employer with 4. n I am a general contractor and I employees (full and/or part- time).* have hired the sub - contractors 6. ❑ New construction 2.2] I am a sole proprietor or partner- listed on the attached sheet. 7. M Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10...50 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.LE 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 contactors must submit a new affidavit indicating such. :Contactors 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 $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 andp •nalties perjury that the information provided above is true and correct. / . • ignature• /�„/�� +� _ / Date: e 2 � Phone #: 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 #: • . / 4 SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: / Not Applicable El Name of License Holder : J S ;2E4 C %y. r" � M,'�' / C� i( License Number 2 P 7�y 4, �, j p ,y, /�/ ; «� /'��i✓�%"��.� y ' n �, 4 4 Q/n� Q ' , 7 � / 0 Address - Exp ion D ,h ,8ignature L. Telephone 9. Registered Home Improvement Contractor .a�.,. Not Applicable ❑ Company Name Registration Number ,r Address t � Expiration Date Telephone f6J <' P., 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 Exemption 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. CMMIR 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 - vear 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 41► 1 SECTION 5- DESCRIPTION OF PROPOSED -WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing 17 Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [I= Siding [❑] Other [❑l Brief Description of Proposed l / / / Work: d[A.;�`/' Z �1vA t i, vk� ;'"V Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet i' (474 ,,- + 6a If New house and or addition to existing housing, complete the following: a. Use of building : One Family 4, 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 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, Se /444 , as Owner of the subject property et hereby authorize Yr ' c, y - 1 e2 -'T C ft (a =' " N ✓f ti`• to act on my behalf, i all ma ers relative to work authorized by this building permit application. 4 - i � na l QQ .1/0?-/0., Signature of Owner Date , 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. Print Name Signature of Owner /Agent Date sio 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 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 (3 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW (3 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW (3 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 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed 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, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 0 IF YES then a Northampton Storm Water Management Permit from the DPW is required. di ---,-! ' --- • =-- •' - ' - ' - ''';' - ' , '' - ' , ' , A' - ' - 'Del 6 aitteierrtttl*'.0,ftWiWigri -.. '...-.'-'7,•-.:,.;;-.3-7:4-_,-.;',.--,,,1:::',*1 - . - City of Northampton '-,tef*Olffq1P1..:r:1-:3';:-P';'-•;;;;,?:;;;i0iIiii4."(ki;;U--_,,.:3441:4;,;;,?4„.::: • .‘--- , Building Department , :!66ii;64fibiiiiii(i!4-kCrip I J : ' ;Z '' t=:.:::' , ; , ;: - ;, - ,i.„•:„,::: : : , ,: ,, , -,- ,.:,:,;:'::F:;;::,,,:: ; i: 212 Main Street 'Seciveri§qprf.,?,„..,.:,n„:„.„,,,,,,„ :=.„--.,,,,,K-yg.,.•:•-•,,,-;,:,-..-:;,•,*'-',---,`--.-:-.----,--'".4 ,„,- '' , +. ,-- %. ,- ' , /w' - ' -, .iiA• , /a,fa - ''bilh.::, , ,V , %. , :•.:::=A-, , v,-,-,,,,„-- -,,,-; -:, Room 100 ----- t.,--,,,17,7,7-:•:-,:;-,---.„..,,,,,, • ,.) ?, 2..C Northampton, MA 01060 tit4f$,ftUqqfp•.IFl7,;!,4.47:;.,I,7::,,7.!,,,,,:,,:s.:i.,::-,,,.::„:.i,;-.,..,:;. ' .1,,°. "" - phone 41,3-587-1240 Fax 413-587-1272 /:`10..f11!-t.fl-Tfl1t,-,,,,---:.,---•,.--;-•.,,,i,,,-,,,!:,:•,:,-•,,,,,,,,-,•,,,,,„,,N,,,,:,,,,,,f,,,,,,:,:i,::::,,,;,,,,,,,,,,,.::,,.,., r 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 Address: i 1 Map Lot Unit i f / t lit. Pic( 4- X' ‘ ... it i zi -7 et L 4/14 (7 iL6 Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 47 1 Owner of Record: Se/ 4. 6arbeo Name (Print) Current Mailing Address: 2Z A/451///Vorr-TO/f/ 4 . 09 44 4A i 4AtA Telephone 4L f 3 — ,v). —3 3 9 Signature 2.2 Authorized Agent: , ..,, / , . i j A ,: , 7 4." iv,i (- 6 „ / . 6/ ; Pig -: .4 '6,-;f` ...„ Y fr.., -.. ) . ft Name (P: t) ( . V . ' ' ' 1 . '' V' Current Mailing Address. .., ../ , U 1 /g/c '''''''.,..,■•-='' 7--7.:_:".7, , Telephone A ignature . SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 4, . (a) Building Permit Fee i‘>' , 7,,,, , 4, 2. Electrical i .' (b) Estimated Total Cost of 7 _„) , 4-, /... i Construction from (6) CI 3. Plumbing f7' d Building Permit Fee 4. Mechanical (HVAC) /6/ 5. Fire Protection 3 +4 + 5) rfio l te4‘178( $5 - 5 - "- Check Number 6. Total = (1 + 2 + This Section For Official Use Only Date Building Permit Number: Issued: • Signature: Building Commissioner/Inspector of Buildings Date File # BP- 2010 -0316 APPLICANT /CONTACT PERSON JOSEPH G CONNELL ADDRESS /PHONE P 0 BOX 238 WILLIAMSBURG (413) 268 -9414 PROPERTY LOCATION 28 WASHINGTON PL MAP 31A PARCEL 293 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid /Ina Typeof Construction: RENOVATE BATHROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 080816 3 sets of Plans / Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: pproved 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 Demolit�•n Delay 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. 28 WASHINGTON PL BP -2010 -0316 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31A - 293 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit # BP- 2010 -0316 Project # JS- 2006 - 001380 Est. Cost: $9100.00 _ Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JOSEPH G CONNELL 080816 Lot Size(sq. ft.): 8973.36 Owner: GARBER SELMA R Zoning: URB(100)` Applicant: JOSEPH G CONNELL AT: 28 WASHINGTON PL Applicant Address: Phone: Insurance: P O BOX 238 (413) 268 -9414 WC W ILLIAMSBURGMAO1096 ISSUED ON: 9/24/2009 0:00:00 TO PERFORM THE FOLLOWING WORK: RENOVATE BATHROOM 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: �.L4 - / Final: � � ' e �, Final: /1 I( C.jC1 l P it.--\ Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: 0 K 4- 6 ] f C2 L'`'4415 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupance)--- 4/-4 sc _. signature: . ." 3P '' FeeType: Date Paid: Amount: Building 9/24/2009 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo