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42-047 (2) • Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction supers P.01 License: CS t DALE W CRANE 70 BOURN E ST - THREE RTVERSIVIA 1 Ex pi ration 051141201 ,7,ornrnissioner 1.\ le ealt ac Office of Affairs & e Regutation HOME IMPROVEMENT CONTRACTOR Type: Expiration 611 DBA E EXTERIOR DESIGN DALE CRANE 70 BOURNE ST THREE RIVERS, MA 01080 Undersecretary - _ Signatures The signatures that follow constitute confirmation by those signing that they have examined and understand the Contract Documents and agree to be bound by the terms of these documents. This agreement is entered into as of the date written below. Dana Cheverette, Ow ► er / O 2 a -�e - (/� o / / - (Siignature) (Date) D awa (Printed Name) (Signature) (Date) (Printed Name) Crane Exte • /r De i o tractor (At . ; / 2' (Signature) (Date) (Printed Name) Page 6 A CC RD 9 / A CERTIFICATE OF LIABILITY INSURANCE °A� 9/24/12; THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEN, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to i the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PROWLER - CONTRACT NAME: R.G. Neylon Insurance Agency, PHONE__ FAX PO Box 1220 /A/C. Na Esti•: (413) 467 -9133 An. N (413) 467 -9808 AD RESS: 2 Amherst Street INSURERS) AFFORDING COVERAGE NAICit '_ Granby, MA 01033 INSURER A: Safety_ Insurance INSURED INSURERS: Zurich Ins Dale W. Crane INSURER C:_ _ Crane Exterior Design INSURER D: 70 Bourne St INSURER E__ - - __ -- Three Rivers, MA 01080 + INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE USTED 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 TI-E POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1NSR AOOL SUBR POUCY EFF • POLCY EXP U M .� LTR TYPE OF INSURANCE INSEWVD ID POUCYNUMBER tMMOfYYYY) (wAtociYYW) A GENERAL LIABILITY BMAO012691 9/22/12 9/22/13 EACHOCCURRENCE _$ _.. 1,000,000 _ X COMMERCIAL GENERAL LIABILITY . p REM S {E occ TENTED ' $ ___. 100,000 CLAIMS-MADE X OCCUR MED EXP (Any one pasm) S 10,000 PERSONAL 8 ADV INJURY $ 1,000 GENERAL AGGREGATE $ 2,000 GEN'L AGGREGA TE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ _2 0 0 0 , 0 0 0 ,.. POLICY 1 F LOC $ AUTOMOBILEUABIUTY 6207545 9/9/12' 9/9/13: ( CMSI NED SINGLE LI MR �$ ._ ANY AUTO , BODILY INJURY t Per person) $ 20.000 - - ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ 40,000 AUTOS AUTOS - - - 1 HIRED AUTOS NON-OWNED ED (pe $ 100,000 1 ... _.._ —.- $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION 9 /29/12', 9/29/13 WC STATU- OTH B 9962A679 TDRY_LIM1 _ —_ER AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNERIEXECUTNE Y!N - EL EACH ACCIDENT ,- -- ._.... $ 100,000 j NI OFFICER/MEMBEREXCLUDED'! Y (Mandatory in NH) ; _EL DISEASE _EA EMPLOYEE: $_ - .__ -- 10 44 es. desrw:be under DESCRIPTION OF OPE RATIONS below - : E L DISEASE - POLICY LIMIT $ 500,000 . DESCRIPTION OF OPERATIONS ! LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Renarks Schedule, if more space is required) Dale Crane, sole proprietor is exempt from workers comprehensive coverage. siding, gutter CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED )N Dale W. Crane ACCORDANCE WITH THE POLICY PROVISIONS. Crane Exterior Design 70 Bourne St AUTHORIZED REPRESENTATIVE Three Rivers Ma 01080 -.--. Q 88 -2010 ACORD `CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E -Mail: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervis Not Applicable ❑ � Name of License Holder : - 041;‘.. - 041;‘.. t i (22.411/4 C5 { 12,2 tZg License Number it.; 7rr efi .5 ® /aeo ©vi /'ir4 Address / Expiration Date V/3-3 / ' Signatu - Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ ( 4 r . k6 7 ) /‘3?(96 Company Name Registration umber 70 &«. / O3 02/9- c ofi 06 a / /20/ 3 Address r 7 Expiration Date Telephone /3-,37V-5W7 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. 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 El Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [C] Siding gar] Other [D] Brief Description of Proposed _ 1 A Work: 4 r, /w %'t 15 !11 - +4 "7 Ar `72J 5:4 ,,v Alteration of existing bedroom Yes 0 No Adding new bedroom Yes g No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet ea. If New house and or addition to existing housing, complete the following: 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, , as 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, ( 041 11. C , 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 u der the pains and pe alties of perjury. Print NameQ)j/ �j� � s� ....:, I ` v 'r. � f S /nC 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 /Finding ever been issued for /on the site? NO Q DONT KNOW iMil YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO tit. DONT KNOW Q YES Q IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW ie YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO 4 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 Q NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. REC:E -Tt', _ Department use only pity of Northampton S tatus of Permit: :uilding Department Curb Cut/Driveway Permit DEC - 5 2012 212 Main Street Sewer /Septic Availability Room 100 Water/WVell Availability DEPT. OF Buy DZU i ns EC,TION$ N • hampton, MA 01060 Two Sets of Structural Plans NORTHAMPTON .,'. , 587 -1240 Fax 413- 587 -1272 Plot/Site Plans Other Specify APPLICATION 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 completed by office /_ 37 S` /1Pmy g , Map Lot Unit r 4 - r 7n/s9 Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: j ---- 0A/n/g �s �r� 63'7 Gs .i) go i 21' 1 11o/aa Name (Print) Current Mailing_Addr s: 41 j .� ti5 - 3c Telephone Signature 2.2 Authorized Agent: 6 3 6,1 aE ' A ` T,7— ( :011'4 c> c9/o' Name (Print) // Crrent Mailing Addrest: -- ‘ 7/3" -- 3 . 2 4- 3 "- / Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 11 ?7‘35 00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection //t ' 3 5 '�� 6. Total = (1 + 2 + 3 + 4 + 5) e7 `� j; e 4? Check Number This Section For Official Use Only Building Permit Number: Issued: s g I Signature: Building Commissioner /Inspector of Buildings Date 637 WESTHAMPTON RD BP- 2013 -0629 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 42 - 047 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: vinyl siding BUILDING PERMIT Permit # BP- 2013 -0629 Project # JS- 2013- 001019 Est. Cost: $9735.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: DALE W CRANE 102408 Lot Size(sq. ft.): 33105.60 Owner: CHEVERETTE DANA N & LINDA A Zoning: Applicant: DALE W CRANE AT: 637 WESTHAMPTON RD Applicant Address: Phone: Insurance: 70 BOURNE ST (413) 374 -5917 WC THREE RIVERSMA01080 ISSUED ON:12/5/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL SIDING 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: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Hoke: 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 12'5'2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner