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35-160 ,S,,,i‘A ‘; earnOn e 1 LA24clad14141016 - t - -1 *F ri.4 17 .1,. 1 Office of Consumer Affairs & Business Regulation !..t4 HOME IMPROVEMENT CONTRACTOR 1-ta , Registration: 158891 _ 1 4-# . -.F.7.-,--7 Expiration: .3113/2012 Tr# 293213 Type: PrWate Corporation P&P MARKETING dba FIRESIDE DESIGNS JEAN PELOQUIN 1769 RIVERDALE ST VVESTSPRINGFIELD, MA 01089 Undersecretary NI its's"' hum: tt%,.. Diltil 11 Mtn I i fr I 1 imitt. ''N..iit , ,, OP Board Ail Buildion., Kegulatimi, 31141 4 .44intiara% Construction SuperviSOt Spet ility License License: CS SL 991944 Rtstricted to: SF JEAN PELOQUIN SR --, , FIRESIDE DESIGNS e,Xpir k.M1 . 40612012 I r4.' 99194 ( •Ifittt41- , 1, I CERTIFICATE OF LIABILITY INSURANCE 06 /0 1 413..536, 0$0.1, FAX 413.534: 7374 I no LATE * 13SUED AS A MATTER OF INFORMATION Martin 7. Clayton Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1649 Northampton Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. Box 989 Holyoke, MA 01041 - 0989 SRS AFFORDING COVERAGE NAIC # ions= Fireside Designs PISLIIER A Marl eysvilie/Worcester 084: P & P Marketing, Inc. , Mamma Safety Insurance Company 0014 1769 Riverdale Street c Ace Property & Casualty Ins. West Springfield, MA 01089 INSURER D INSURER E COVERAGES THE POLICES OF WSURANGE LISTED WOW HAVE SEEN ISSUED TO THE INSURED NPMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTW THSTANDING ANY REGUIR'EMENT, TERM OR CONDITION CO Of ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICES. AGGREGATE UNITS SNOYVN MAY HAVE BEEN REDUCED BY PAID CLAMS. I . ,, -. a: TYPE OF 111111MNCE PCLICT Nu seat wins BARN. LUMP( NM 1996W 06/07/2010 06/07/2011 EACHCCCURRENCE $ 1,000,1 a , * commeRoAtGENERALurstor RENEWAL MPA19961F 06/07/2011 06/07/2012 a MACaE so RENTED � . $ 300, , i ' IMO CI:ANS MADE 0 OCCUR LED EXP (Any aas parson) 1 5 , a a a A PERSONAL s ACDV IvruRY $ 1, 000, a i a CIEFERALAGATE $ 2,000,11 a GENL AGGREGATE :LIMIT APPLIES PER: .PRODUCTS COMM? AGG $ 2 000 a i 4 POUCT ri PIS fl we Ain aSOS1:E 6210727 07/17/2010 07/17/2011 c sa+ Lahr 11 ANY AUTO (Ea aodeens) AU. OWNED AUTOS BCXIL.Y INJURY it r Li SCHEDULED AUTOS I»� I I B ei FIRED AUTOS BODILY *WRY / U HON-OWNED AUTOS an s 300 i i 111 PROPERTY DAMAGE $ 100 I t i WAAGE UABAJIT AUTO ONLY - EA ACCIDENT i7 S ANY AUTO OTHER THAN EA ACC I AUTO ONLY. AGG s uII .flY EACH OCCURRENCE I ® : OCCUR ri CLAIMS MADE AGGREGATE 8 $ Ili DEDUCTIBLE _ III RE1E (ILO$ $ : mousse COYPsf kooN AND NaCC45733581 03/31/2010 _ 03/31/2011 VAITATII-m. Cm+- EMPLOYERS' L MEJTY 5:L EACH ACCIDENT 3 100, I i i C C F'C NI R EXCLLE:ED? E L CHEEASE - FA EMPLOYE :.$ 100, I t i WPM dnalbmi wear sPECS+►L PROW/Ioysmew/ Et DISEASE - POUCY LIMIT I 500, I i I OTHER D 'HON OF OPERATIONS LOCATIONS i V6SCLE$ i EXCLUSIONS ADDED BY ENDORSORDIT/ SPECIAL PROVISIONS CERTIFICATE HOLDER a ANCELLATION MOVE POLICIES SE CANCELEDSERRIETHE EXPIRATION ISM THEREOF, THE !E&1N8IlIEURER PALL INDEAVOR TOMS. 15 EMS* ITEMNOlK TOnHC CAIEHOLDERI 1O THE LEFT, Liireside QesigNl<s MiTFMumETOWR suat Nona slue . WOWND commcntot umnuTy 769 Rivserdal a Street orMIy MIND UPON THE INSURSR, ITS MEETS OR R ENTATIEES. est Springfield, MA 01089 Ammo eeseesomsrvs pl;. Harold Clayton 3r. /SANDY . /CORD 25 (2001/18) OACORD CORPORATION 1988 SPECIFICATIONS Fuel Blower Out BTU Range Hopper Capac Type Size Air Size Electrical Weight Height Width Depth Venting Size Feed Rate ACCENTRA 'ELLET INSERT 20" fireplace opening:38 lbs. 4" PL pellet vent pipe standard, W Pellets ood Avg. 450 lbs with 3/4 lbs. /hr Min. 0 - 42,000 22" fireplace opening:48 lbs. 180 cfm 3" 32.06" 41.78" 29.91" 3" PL pellet vent pipe option 24" fireplace opening: 57 lbs. watts surround with fireplace housingt 5 lbs./hr Max. CLEARANCES AND DIMENSIONS Front View Side View Top View ISO View 12.577 --- 24 675 '"": n H i 4 1.+.,a. q _ m ,1`; d a ---- ".. F ... 74, i 1 N C II M1 1 e., @ ,:„. , 41.781 15.815 14.396--I 26.916 I _„ 1 29.912 I CLEARANCETO Side wing to trim Front hearth protection Top of insert to mantel trim or ledge Zero clearance housing (optional) COMBUSTIBLES 0" 6" * 12" 3" from exhaust vent * 16" for Canada Heat Your Home with Wood Pellets Cleaning Your Pellet Insert Wood pellets have become a popular ', . ` ,, As with all Harman pellet stoves, maintenance is minimal form of heat because they are environ- and cleaning is easy. The Accentra Insert lets you burn mentally friendly, extremely clean burn- close to a ton of pellets before ash removal is needed. ing, and cost - effective. Made of wood by- And what is even better, the Harman Insert Track System products such as, sawdust, wood chips, lets you slide the insert out of the fireplace so that it can and other wood waste products, wood Wood Pellets be cleaned or serviced without having to disconnect the pellets typically measure I /4" in diameter venting system. This innovative design is only available on and 3/4" long. Wood pellets vary in cost, depending on the Harman pellet inserts and lets you reach key components quality and ash content however all are conveniently pack- for yearly cleaning. aged in 40 pound bags for easy handling. • At Harman, we strive to provide home heating products that warm your home efficiently, are dependable, and easy to use. The Accentra Insert keeps with this tradition. Limited Lifetime Warranty ** The strongest in the industry, Harman provides a limited l warranty on the most important aspects: firebox and heat exchanger. =a U , '°k. ^�r :' "" "° r . a 352 MOUNTAIN HOUSE ROAD � O � + 7032 �' "*^".q T �dm'�� ��c+ �� ,$kwn � � . , WWWH HALIFAX, ARMA RP NSTOVES. COM . t .', s S ', �"- ° A BRAND OF HEARTH & HOME TECHNOLOGIES 1169 Ri ter9 �� t. s , r.- ' i" �` � , s�u'@� �e �'`� P ,� ,� �T A'''' p' duce apV' ncltd ng (lame, may drrer iron nage. f a ,w " a les,ed b °MNI T''' Labora[o, - AST M-f 1509, ULC C1462 I I 1 F.I f method 23A and SG Weiit ySp ing i+�l� L, l� ' ,[ � ,94 � °d �. � �Y ��'� �� ��'q ��� s P due[ p f cons ,nd pr ng sublet[ co t g ,hour no „cc. 1 he ■mages ana dose, p,'ons in [his s�4i T 7 33.'? 9 1 e �" � b chur p.v ded to ass s[ ynu , prod d se s„gh y due I ) 1 "I'''''''''''.4 ;"` H Ling ap a g d f a only and may differ sl f the due co an climate, b ld ng t . ,her ° and /ww f:-iresid$ dea �GIIIX a c�nn. a m nd q „ali,y or I I Ia, on Incaron o f the nea[o, and movement .n ,he caom n "re, ,o " Y , "Fo, s,a11 fa , m,n, al fo tom ple,e Ilea, ante e u emen[s ana specif ca[io ns. cull w„ a ,[y de[ails go [n www na mans[es.com HAR -1 103U -1010 • 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 ofNorthampton wants person(s) who seek to use the home owner exempt on, 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 jermits 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 k 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 Date Address of work location 0 , e`,Y7o • The Commonwealth of Massachusett Department of Industrial Accidents i M Office of Investigations ' Tal -5 600 Washington Street f. Boston, MA 02111 www. mass.gov /dia -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): f % 1.1 Address: 1 7 ` ,�� Ul City /State/Zip: `.F/ r , e ., j c-,e- /y"y . 1-= Phone. #: 7 7/ 3 6),5 7,5 Are ou.an employer? to er ?.Check the appropriate box:. r� Y P Y Type of project (required): 1.0 I am a loyer with 4.. 0 I am a general contractor and I Y 6_0 New construction___,__ full and/or arf-ttithe * have hired -the sub- contractors — — employees ( P - ' �. 2_0 I am a sole proprietor or partner = listed on the attached sheet 7. 0 Remodeling These have ave.- - • ship have no employees h 8. ❑ Demolition working any ca for me an tY employees and have workers' capacity. $ • 9. 0 Building addition [No workers' comp insurance comp. insurance. 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 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 13.84°J Other i A.4 T-fra // 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 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 and pen " of perjury that the information provided above is true and correct ture: /J� �/ �L% Date: S 1 /1 . Phone #: v/3 — ' S 7 � � _ . • 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 Y I Contact Person: Phone #: �I SECTION 8 - CONSTRUCTION SERVICES . 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : 5 Z . 1) / e --I ©? v4' S License Number Address Expiration Date Signature Telephone ii . -" = irct. .en .ice. :. . r -, Atk , 1 , -n:ozia: , !'::: - , , int., , ,- , 47 , 47 4 Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone 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 ❑ , a 4 1 'ri __. ° ' r ° 61i, ° i 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 buildine 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 an to 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 [D] Decks ED Siding [CI] Other [01 Brief Description of Proposed Work: / .l x 7-0 91 , 1 t/c oti (5 t /7'i9 2 M4.3 f / G7 � " S7-0 t l Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 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 constructibn 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. WiII 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, T2-u , as Owner of the subject property hereby authorize r's-5i .S . "- to act on my behalf, in all matters relative to work authorized by this building permit application. T g //a jig Signature o 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 S/A1/ 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 Zotting ; r,t {> This column to be filled in by Building Department Lot Size I I ' } 1 ..,;.:.I„► Frontage L 1 i i l Setbacks Front = = I Side L: R: L:l I R:! I I I i s Rear 1 I I I I Building Height J = 1 Bldg. Square Footage %= ; I _Open Space Footage ; % _ _ -_ - - -- (Lot area minus bldg & paved I 1 I i I 1 parking) r # of Parking Spaces Fill: g (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES Q i IF YES, date issued:; I IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book 1 Page and /or Document #' J B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES Q 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: I ' D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO 0 IF YES, describe size, type and location: 1 1 I 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. City of Northampton = '.k tY p Building Department ,„ Atj6 i U L[) I I 212 Main Street 1 M • Room 100 : . ,,,s��, Northampton, MA 01060 l.:11...: l.i.... 01060 ' r ne 413- 587 -1240 F ax 413 587 - 1272 ,te 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: - 7 7 c' Y"9 ,� ) / C "1 d Map "Urnt j � �'� Ce ,1,9 ® , Zane t OYerlaypistacf Elm St D istrict .... _ - CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: _ 14ii R/ c, ( t'- d 1 7 r /'ey 11 J " .(3/ Name (Print) /! 'L/ vG �// Current Mailing Address: SB — c> S 7.5 Telephone Y43 Signature 2.2 Authorized Agent Name (Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) :Building'; Perna Fee 2. Electrical (b) Estimated Total Cost or Construction from (6) )e 3. Plumbing Building Perm Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number This Section For Official, Use Only Building Permit Number: Issu ed: %/ ,, / •/'/ Signatu Building ,Commissioner /Irispeotor Bu Date 779 RYAN RD BP- 2012 -0162 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35 -160 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: woodstove BUILDING PERNIIT Permit # BP- 2012 -0162 Project # JS- 2012- 000243 Est. Cost: Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 43385.76 Owner: RICE 130TH M Zoning: SR(1 ^n) /AVSP I1 Applicant: RICE REIN MM AT: 779 RYAN RD Applicant Address: Phone: Insurance: 779 RYAN RD (413) 586 -0575 O FLOREN CEMA01062 ISSUED ON :8/10/2011 0:00:00 TO PERFORM THE FOLLOWING WORK :INSTALL PELLET STOVE POST THIS CARD SO IT 1S 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. i d-cA4 h t4trA410#' Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 8/10/2011 0:00:00 $25.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner