37-022 (3) 09/20/2013 10:15 4137733188 LAMORE #1982 P.007/007
go
INN
_1 •
u,
C.
054 Alb
g: -
4
o0
os
09/20/2013 10:15 4137733188 LAMORE #1982 P.006/007 r-T--
II I
1 MO 1100.
I . . ` I I i ,
fill II i
I All1111111111111Eignialall IL 1--1 I
I.
I ; I 1 N OL- IZ ; • I 111111
•
t .. !
____1_::7;p: .„. , , ,
I 1 . 11•011111110MITriall 1 1 --1 r f....._. "xi !'" [ I I I I I i
' 1 VI"IV-
' " " IiiiiillalliMINIIIIIL 1 i I. 1 , .
1....c):H• I I ill"; I : I I I -t- - ....
: , 1 iri ; ! i
`
GO
<4.
-..,,
Cc)
N--
V
CA
Ct
0
0
,5..
iii
4.a
/ VI
..2, 0.
E
4
4 CI .17-
-'4AD 4
I C-,
, ..
1 kr)
e c Z
--, '
. 0 cu Z La
E n w L.
E o w cc
o = w
0 0
\ 0 u
1
1;1 i' til
0
0
0
i 4--
ci
.,-
U0/10/GU13 11:1b 41.5/r.131.56 LAMUEE #1981 P.003/004
0p6-16-13;01�: 2PM; n `, •
DATE(114NIDONYYY)
�„� l� • ', CERTIFICATE OF LIABILITY INSURANCE e�is�za�3
r115 CERTIFICATE IS .SUF.,D AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS 1
ERTIFICATE DOES . .T AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
ELOW. THIS CERTI GATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
EPRESENTATIVE OR RODUCER,AND THE CERTIFICATE HOLDER.
IIPORTANT: If the co fcato holder Is an ADDITIONAL INSURED,RED,the po)ICySles)must be endorsed. If SUBROGATION IS WAIVED,subject to
re terms and conditio 4 of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
orttfIcate holder In lie pf such endorsement(S). 1 ,.OUCER , • CONT$1CT Na Lanoto ,
7; NAME:
rtridge--Zechau Insurance Agency, Sae. PH° p t), (413)563-4331 FA(, (413)963-9426
Millers Falls goad -MAID 93:mlenctoepzinc.mom ADDRH
0. Box 312 II �yCeR 00002216 :
cvsrdtt>x to
mere Pe-11S E MA 0137 6 INSURER(S),AFFORDING COVERAGE NA)C 0
•
IREn INSURERA:Western World Insurance Co. 0026 •
l
INSURER a Arbella Protection Ins,,_C_o
lliam R.IramOre i INSURER C
more Lumber Company _
INSURER 0:
4 Greenfield Rgad INSURER E;
erfield E NA 01342 INSURERF:
VERAGES ),I CERTIFICATE NUMBER>CL1 381602713 REVISION:NUMBER:
HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERM()
4DICATED, NOTWITHSTJNDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT To WHICH THIS
ERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE.INSURANCE AFFORDED BY'THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
XCLUSIONS AND COND1IONS OF SUCH POUCIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
caarscak POI:ICY'EFP—pbriaral,
VP O INS NCE Ml LIM175
iNSR WVD POLICY ; (MDD�YYYYZ W YY
(MDDIYY )
GENERAL LABILITY t _EACH OCCURRENCE $ 1,000,000
X COMMERCIAL 0514 LIABILITY PnDEp ) S 50,000
CLAIMS-MADE OCCUR t7PP6103965 5/31/2013 5/31/2014 MED am,(Arry on.por4ca) $ 5,000
I; PERSONAL aADDVINJURY $ 1,000,000
I. GENERAL AGGREGATE 5 2,000,000
OEML AGGREGATE UMrT (PLIES PER • PRODUCTS_COMP/OP AGG S 1,000,000_
X POLICY JRCT I I LOC _ _
AUTOMOaLE LIABIL TY G C MBI� SINGLE LIMIT S
ANY AUTO IF BODILY INJURY(Par person) S 000,000
ALL ON?IEDAUTOS I: 1020001173 ' /24/2013 6/24/2014
BODILY INJURY(Per:widenl) S 1,,000,000_
,X SCHEDULED AUTOS , PROPERTY DAMAGE S 500,000
X HIRED AUTOS beerier*
x NaN•owNEUAVrosr s
_w„ s
UMBRELL4LtMH a OCCUR EACH OCCURRENCE S
Pa(CP,SS UAB CLAims_MADE AGGREGATE s
DEDUCTIBLE S■REIENnON $ k _ s
WORKERS COMPENSAT) TWCRy6TATU JOTii-
,
Fa1PLOYER9'L1AB) "'�S,
ANY PROPR)ETOR PAR N CUTIVE Y/NI E.L.EACH ACCIDENT $ __-
OFFICER/MEMBER EXCLU D7 I N/A ••'—
(mammary Is NH) EL DISEASE•EA EMPLOYE$ $
•
Dy�s RIPTIOW under
DESCRIPTION OF OPERA NS below _ EL JCY DISEASE•PO[ miff•
I •
SC)ziPTIDN OF OPERATIONS/LOCATIONS I VEI-IJOLFS (Attach ACORD 101.Additional Ranartu Sched4e.If more apace It required) •
•
•
c •
:RTIFICATE HOLDER: CANCELLATION
9 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE. WILL BE DELIVERED IN
7rAMORE L R CQ2�PANY ACCORDANCE WITH THE POLICY PROVISIONS.
724 GREENE' Lt) ROAD
DEERFIELD f ; 01342 AUTH'• EVRE9ENT VE
i �
Peter sclle 1`•: •
•
:OM 26(2009109) il. 'V 988- t 09 ACORD CORPORATION,'All rights reserved,
3025(2000 14 Tho ACORD name and logo are registered m rks o •CORD
f
• f
UU/1U/GU13 11:lb 41311 dil d LA1t1UKE 471001 Y.VUG/VV4
•
h.. The Commonwealth of Massachusetts
Department of Industrial Accidents
AY Office of Investigations
it
.; .
_. ilia ti,. 1 Congress Street, Suite 100
r. --- .11.- Boston, MA 02114-2017
,.r ,. www:m.ass.gov/dia
Workers'compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
William,R Lamore dba Lamore Lumber
Name (Business/C)rganizationilndividual):
Addl'ess:Rte 5 S.` 10, 724 Greenfield Road
Citv!State/ZipPeerfield, MA 01342-9752 phone #:413-773'8388
Are you an emptc4yer? Check the appropriate box: Type of project(required): .
1. 0 i am a empl'c yer with 6 4. 0 I am a general contractor and 1 6, a few construction
employees(lt.tll and/or part-time).* have hired the sub-contractors
2.❑ I am a sole pruprietor or partner-
listed on the attached sheet. 7. n Remodeling
ship and hay.p no employees These sub-contractors have 8. n Demolition
working forimc in any capacity. emplo-yetis and have workers' 9, n Building addition
I.No workersf comp. insurance comp- insurance.=
r equired. comp. n 5. We are a corporation and its 10.n Electrical repairs or additions
r
3. n i am a homeowner doing•a' work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No'jworkers' comp. right of exemption per MGL 12.n Roof repairs
insurance aired.re c. 152, §I(4), and we have no
l 1 ' - 13.II Other
employees. (No workers' —
• comp. insurance required.(
• •
`Any apphcant that checks box ii I must also till out the section below showing their workers'compensation policy information.
t Homeowners who sulrnit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
•C_ontractors that checkiihis box must attached art additional sheet showing the name of the sub-contractors and state whether or not those entities have •
employees. I f the sub-fntractors have employees,they must provide their workers'comp.policy number.
1 am an employer that is providing workers'compensation insurance for mV employees. Below is the policy and job site
information.
Insurance Compari Name:The Travelers indemnity Company
6KUB-0248N15-A-11 expiration Date: 04/08/2014 •
policy #ur Sell-ins. I',ic. !l: .-_____..._._._
Job Site Address: '/l LG_ure! Pat) City/State/Zip:UO1 lm" OlOCva .
- -Attach a copy of tic workers'.compensa(ion policy declaration page(showing the policy number and expiration date).
Failure to secure overage as required under Section 25A of MGI_ c. 152 can lead to the imposition of criminal penalties of a
tine up to $1,500.(.(f 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 of41e DIA for insurance coverage verification.
I do hereby certifi tu:der the ins and pena;'s of)erjury that the information provided above is true and correct.
' ,7 # /l_
S g n a e: .u .items Date- (1. ? l3....
t'honc #: 413-773-8388
• Official use ailp. Do not write in this area, to he completed by city or town Official.
t.
City or Town ' Permit/License#
issuing Authority (circle one): •
I. Board of Hialth 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector ,
6. Other - -
..-- .1..,.t Do, Phone#: .
9. ALL INFORMATION MUST BE COMPLETED: PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION,
This column to be filled in by
the Building Department.
Existing Proposed Required by
Zoning
Lot Size
Frontage N/A N/A N/A
Front
Setbacks:
Side: L: R: L: R:
Rear:
Height 7.5
c�
% Open Space:
(Lot area minus bldg and
Paved parking)
10. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
19-Q-Cri 4
DATE: �ll°(1�' APPLICANT'S SIGNATURE
NOTE: Issuance of a permit does not relieve an applicant's burden to comply with all zoning requirements
and obtain all required permits from the Conservation Commission,Department of Public Works and other
applicable permit granting authorities.
SNAmp (�_ r �`/7 City of Northampton
r� Massachusetts x, ,
I t: t F J, SEP 2 ':M• 'TMENT OF BUILDING INSPECTIONS I. e
\ w ' y„ ��r f.O I -in Street • Municipal Building JAf� `�a
\` Id Northampton, MA 01060 M1Y TO\
INSPE∎' tric. Plumbing&Gas Inspections
Northampton, MA 01060
ACCESSORY STRUCTURE PERMIT APPLICATION
(For freestanding structures less than 200 sq. ft., at least 5 feet from any other structure)
Permit Fee: $25.00 Check#
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: IPA a /l z IP'0
r
�,r r ,-�(° a r ' , Telephone: ...,i r,1 ..`S ..' ) 5 `"(
Address: ���(/jrr;��`'�+ :,� ),a(it' � � � � � r
0
nn �1 P .
2. Owner of Property: 1"d s. An A ti r T `--$.}:;,: CA' '4"„ te%,
Address: 2'S AAfigs-,°t aft ,k. ..-a..ur t C: `4„ ' r''::''e Telephone: 9 t '3 SZio (9 50
S Ar'Fl C�iC`,, ? 4( Ds ex 04', Ll'E.b2 r'�`
3. Status of Applicant: Owner Contractor
� t
�`�'�
y -€.1" ,J 4 i & V,, �4 r2j Pax ; i;.f r , c.io c 1.1
4. Structure Location: COQ ,, � (.L.
yd'
Parcel ID: Zoning Map# Parcel# District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Use of Property: Single or Two Family: Multifamily: Commercial:
6. Description of Proposed Structure: / Iv\ SIn ..0 at. o ;( a-rr( 6c{ Jr^, k;,.e.7 .;,
One Story Shed under 200 sq.ft.: I./ Freestandin De ck u delr 00 sq.ft.,less than 30"above grade:
Other(describe): u I
7. Attached Plans: Sketch Plan ✓ Site Plan V Plot Plan t.-"'"'-
8. Does the site contain a brook, body of water or wetlands? NO ✓ DON'T KNOW YES
IF YES: Has a permit been,or need to be,obtained from the Conservation Commission?
Needs to be obtained Obtained , Date issued
CONTINUED ON NEXT PAGE
File tt MP-2014-0031
APPLICANT/CONTACT PERSON MACLEOD PEGGY L
ADDRESS/PHONE
PROPERTY LOCATION 25 MT LAUREL PATH-COMMON HOUSE-600 FLORENCE RD
MAP 37 PARCEL 022 000 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out fit,
Fee Paid
Typeof Construction: ZPA-ERECT 10 X 16 SHED
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO 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
/■ (A 77-L6/13
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 the Office of
Planning&Development for more information.
25 MT LAUREL PATH - COMMON HOUSE -600 FL MP-2014-0031
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: 11526 1 oazHmwp,o
7
Block: 022 1 4 � : '
Lot 000 �� ZONING PERMIT
Permit: ZONING PERMIT APPLI T£RCENIE;R
[Category: shed , APPLICATION PERMIT
;Permit# MP-2014-0031
;Project# JS 2014-000596
PERMISSION IS HEREBY GRANTED TO:
'Est Cost: Contractor: License: Expires:
Fee Charged:$25.00 {Homeowner as Contractor
Balance Due:$.00 ;Owner: MACLEOD PEGGY L
1#of Fixtures:
#xtures: ;Applicant: MACLEOD PEGGY L
#of Fi
AT: 25 MT LAUREL PATH-COMMON HOUSE-600 FLORENCE RD
UseGroup
IConstClass
ISSUED ON: 30-Sep-2013 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
ZPA-ERECT 10 X 16 SHED
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
shed REC-2014-001307 23-Sep-13 1234 $25.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov
GeoTMS®2013 Des Lauriers Municipal Solutions,Inc.