32A-024 Kitchen Plan
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Client#: 18092 MILLR3
ACORDTM CERTIFICATE OF LIABILITY INSURANCE 07/31/2013�Y)
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
King &Cushman, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
King &Finn Streets ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 447
Northampton, MA 01061 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: First Financial Insurance Compa
Mill River Co.
INSURER B:
15 Willow St. INSURER C:
Florence, MA 01062 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 AD TYPE OF INSURANCE POLICY NUMBER POLICY(MM/DD/YYE POLICY
DATE(MM DD/YYIN
LTR NSRC LIMITS
LTR RD
A GENERAL LIABILITY 241 F000400 10/30/12 10/30/13 EACH OCCURRENCE $500,000
DAMAGE RENTED
COMMERCIAL GENERAL LIABILITY PREM SESO(Ea occurrence) $50,000
CLAIMS MADE OCCUR MED EXP(Any one person) $5,000
PERSONAL&ADV INJURY $500,000
GENERAL AGGREGATE $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000
PRO-
-1 POLICY r7 JECT fl 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 $
71 OCCUR CLAIMS MADE AGGREGATE $
__ $
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND
WC STATU- ER
TORY LIMITS ER
EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE
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 I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Northampton Building Dept. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1(1 DAYS WRITTEN
Northampton, MA 01060 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED� '
y- REPRESENTATIVE
TIVE
ACORD 25(2001/08)1 of 2 #S13146/M13145 SMF O ACORD CORPORATION 1988
. . ,
City of Northampton
-'' Massachusetts 4 e.e.,
aaE Ur, ;w
k �.'?j, j DEPARTMENT OF BUILDING INSPECTIONS :
` { "+ - 212 Main Street • Municipal Building rJ� c...
,Ar �mNorthampton, MA 01060 'i S.
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
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 any 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
71` l Office of Investigations
°` 600 Washington Street
111000 A
r Boston, MA 02111
WWW.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information u Please Print Legibly
Name (Business/Organization/Individual): r I hie..N v I- bu t-•e U _
Address: IC 3 C \ c,S-r tJ
0i0(c---
City/State/Zip: Fl v it A. 1 ,, t /0 Phone #: `I 1 3 .-c5 V Ks---G, (A
Are you an employer? Check the appropriate 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. I am a sole proprietor or partner- listed on the attached sheet. 7.NISI Remodeling
These sub-contractors have
ship and have no employees 8. [' Demolition
working for me in any capacity. employees and have workers' 9. n Building addition
[No workers' comp. insurance comp. insurance.t
required.] 5. n 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.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.n 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 $250.00 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 certify un i' r th' pains an' i. •naltie ,f perjury that the information provided above is true and correct.
4
Si• attire: ''- '' Date:
/�3
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#:
• .
SECTION 8 CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable (fl /
Name of License Holder: M b it IA J • 1W1-001 ., Y/ tJ (Q
License N mber
E3 cvkc ST�uT, S , rt i ce MA 3 7/1
Address Expiration Date
Signature 17 T phone
9'.Registered a Improve rit Contractor , M ..... 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 ❑
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
f • •
s
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing n
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [D]- Decks [D Siding[ID] Other[El]
Brief Description of Proposed /
Work: /L rc Rkx7H i( i t..eL96"CS// ITFi- =7 /U -s
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes ---k° No
Plans Attached Roll -Sheet
sa If New house-and'or'add ition 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 1 0 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basemen r cellar floor below finished grade
k. Will building con rm 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
C,� L.�.•.tt r�5`�'
2ea 3 '1 A-, 4i• /1r,„5 ao''�v`'^ /4 as Owner of the subject
property -T-
hereby authorize / eaei �/ .Dv c0
to act on my behalf, in all matters relative to work authorized by this building permit application.
!/ 7x31/)3
Signature of Owner D e
-17-A-( /4/e-/k V c3 f® , 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 f perjury.
Print Name
L 7'
Signa ure of Owner/Agent / Date
1
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
y ' •
Existing Proposed Required by'Zoning
This column to be filled in by
Building Department
z
Lot Si�. !....�____ _ I v — ..__" i
Frontage
Setbacks Front 1----1 -
Side L:L- R: L:;._—_-3 R 4 i
Rear
Building Height 1 1 I
Bldg. Square Footage 1'--1 i % 1-- 1
-- Open Space Footage
(Lot area minus bldg&paved l I 1 I
parking)
#of Parking Spaces F l s
Fill: y 1 f
(volume&Location) =—A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES Q
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 i Pagel 1 and /or Document#1 i
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T 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: 1
C. Do any signs exist on the property? YES 0 NO ep
IF YES, describe size, type and location: 1
D. Are there any proposed changes to or additions of signs intended for the property? YES l 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.
P-
, .
Department use only
j�., .�� ..--- -- `} pity of Northampton Status'-of Permit
j i uilding Department Curb Cut/Driveway Permit"...
11 j JUL 3 1 2013 1 1 212 Main Street Sewer/Septic Availability" "---..
{ Room 100 Water/Well Availability
.t;W) ham ton MA 01060 Two Sets of Structural!Plans L ' .;:
Electric, i- i-i L ,6,v ..e p
tvc l'.011i• = _ 87-1240 Fax 413-587-1272 Plot/Site Plans ,4-4 " t
y
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
/!J C/`+'6—/C�y s 7 Map Lot • Unit ,
No Q, 7-7-/Aft/'t-4/'D TO/v'1 /2,,i/1 Zone Overlay District
EIm St District CB District „ -
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED
` _ . _AGENT .<_
2.1 Owner of Record: Peil;5 e 7114X-cif)r-) /�^i<s-te e
OOJ72Lc,r� ,,, A ;,/ S p,,, ,7' Sl-.G' Tf...01 f2 t4, 4tie„1)1 r A/orfih<, f,to,- /OA `liOOO
Name(Pri Current Mailin Address:
r 3 3 2r�- 2.�S
/ +^ 'iJ 2 ��jd'' Telephone
II// Signature
2.2 Authorized Agent: /
fl 4/Z/4 ,,,%, Dr>i-=cG U •-- l c"-2 Cf' S r/JC i- ” s '-
Name(Print Current Mailing Address:_V.,
re; i g I y c."-- -.• a" ,)'-'-' ..S—Le (.(;.'
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be r Official Use Only .. ! -
completed by permit applicant , _
1. Building 00 (a)Building Permit fee
2. Electrical C, ` v (b)Estimated Total Cost of - •_ _
Construction from(6) -
3. Plumbing `_ 5?--,0 0 t 0,b Building Permit Fee - -
4. Mechanical(HVAC) , -.
5. Fire Protection p�
6. Total=(1 +2+3+4+5) 1 Check Number -
This Section For Official Use Only - ,
Date
Building Permit Numbe - _d.
Signature , �..r f _
Building Commissioner/Inspector of Buildings_ Date
(./, ,2E/2 /Oa 0.°4
18 CHERRY ST BP-2014-0106
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32A-024 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-2014-0106
Project# JS-2014-000207
Est. Cost: $26300.00
Fee: $157.80 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MARIA J DUFOUR 84569
Lot Size(sg. ft.): 3310.56 Owner: KAHN DANIELLE J&DENISE A MCKAY
Zoning:URC(100)/ Applicant: MARIA J DUFOUR
AT: 18 CHERRY ST
Applicant Address: Phone: Insurance:
183 CHESTNUT ST (413) 588-8566
FLORNCEMA01062 ISSUED ON:7/31/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:REMODEL 2 BATHROOMS & KITCHEN
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 7/31/2013 0:00:00 $157.80
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner