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29-068 (2) COPY J(57 _C0Foffu=1n*gTe�4,4,.la ons an tan ar s One Ashburton-Place - Room 1301 Boston. Massachusetts 02108 nome impl 0v el eni Conir ac-Loi iLC"-1Stia%i0i1 – Registration: 121178 Type: Private Corporation - - Expiration: 4/12/2010 Tr# 264754 D.P. CARNEY CONST INC DANIEL CARNEY 34 HORSESHOE CIRCLE WARE, MA 01082 Update Address and return card.Mark reason for change. Address ❑ Renewal ❑ Employment Lost Card DPS-CAI 8 5OM-07/07-PCMW /fxc �am�namuea,�.11 n,� 1Laauicdivae./,�: Board of Building Regulations and Standards License or registration valid for individul use on HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 121178 One Ashburton Place P.m 1301 Expiration: 4112/2010 Tr# 264754 Boston,Ma.02108 Type: Private Corporation D.P.CARNEY CONST'INC'_- DANIEL CARNEY 34 HORSESHOE CIRCLE .1,.. a-�.-� ----- -- — WARE,MA 01082 Administrator -'loot valid*it e From:Romy Barrow At Phillips Inrance Agency,Inc FaXIQ 70:Linda Dale Slj1 nO 1:09 PM Page:1 of 1 OP ID RH DATE(MWDDIYYW) ACORD CERTIFICATE OF LIABILITY INSURANCE DPCARNY 05/21/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PHILLIPS INSURANCE AGENCY INC HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 97 CENTER STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. CHICOPEE MA 01013 Phone: 413-594-5984 Fax:413-592-8499 INSURERS AFFORDING COVERAGE NAIC# INSUREL INSURFPi- First Mercury Insurance Co INSURER Granite State Ins Co D.P. Carney Construction, Inc. INSURER C. Ka V*r-ctcirans Ins Co of A" 31534 34 Horseshoe Circle INSURER D: Ware MA 01082 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 DOCUMEM-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. LTR N TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYY) DATE(MMIDDIYY) LNITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY FMMA001284 08/01/07 08/0108 pREMISES(Eeoccuence) $50,400 CLAIMS IAADE OCCUR WED EXP(Any one person) $EXCLUDED PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GENL AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG s2,000,000 POLICY PRO-T LOC AUTOMOBILE LIABILITY 4- COMBINED SINGLELIMIi $ 1,000,000 C ANY AUTO AMN7590949 08/01/07 1 08/01/08 (Ea accident) AL: O NNED AUTOS i BODILY INJURY X SCHEDULED AI..ITOS (Per lesson) $ X HIREDAUTO5 I 8001LYINJLRY X NON-OWNEGAOS (Per accident) $ A PROPERTY DAMAGE $ Ll (Per acclderV GARAGE LIABILITY AUTO ONLY-EAACCIDENr $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE s2,000,000 A X OCCUR D CLAIMS MADE CUMA000139 09/01/07 09/01/08 AGGREGATE $2,000,000 $ H DEDUCTIBLE $ X RETENTION $10,000 $ WORKERS COMPENSATION AND TORY LIMITS X ER B ANPLOYERIETORIPAR NC4896989 11%15/07 11/15/08 E.L.EACH ACCIDFNT $1000000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L.DISEASE-FA EMPLOYEE $1000000 It yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1000000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Re-roof 2 flat roofs @ 358 Ryan Road Florence, MA CERTIFICATE HOLDER CANCELLATION ROBREA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KID UPON THE INSURER,ITS AGENTS OR Rob Rea 358 Ryan Road REPRESENTATIVES. AUTH R Florence MA 01062 DREPRESE ATTVE Ir ACORD 25(2001108) O ACORD CORPORATION 1988 The Commonwealth of Massachusetts Department oflndustriat Accidents Offlce of Investigations 600 WashbWwn Street U9 . Boston,111A 02111 . I www mass gov/dia -Workers' Compensat on Insurance Affidavit: BuDders/Contractors/Electricians/Plulmbelrs A�nlicant Informattou PIease Print Leeibly xvame(Business/Orgaaizatianllndivitival): D.P. Carney Construction, Inc. Address: 34 Horseshoe Circle City/Sta&Zip: Ware, MA 01082 __ Phone.#: 413-967-7124 Axe you an employer?.Check the appropriate b= Type of pi ciect(required). 1. I am a er vloyer wiib.5 4• [] I am a general contractor anti I 6. ❑-Now construction employees(full and/or put-d=). have hired the sub-contractors 2. .I am a sole proprietor or parfmcr- listed on the anached sheet. 7. Remodchng staip and have no employees Tbese sub-contractors cave S. Demolition, waddng far me many capacity. employe-a and have woricess' 9. Euildiag addition [rVa workers'camp.insv�nee comp.nosuraace. rem] 5. D We are a corporation and its 10.0 Electrical repairs or additions 3.[] I am a homeowner doing a1 work officers have exercised their 11-0 Phrmbing rcpain or additions myself (No workers'comp right of exemption per MGI. 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.E Other employees.(No worktn5' comp.insurance rtgttQed] i 'Any applicant•that cheeks-box#1 must also t53 out the section behm showing their workers'corMmsatien policy infornntion. t Homeowners;who subHt his afUivit indieaang OtcY are doingalt waft and thm hire oetsida conwx:wn must sulnnita new affidaviti Aiming such. 'Contractors ds t chvk this box must ached an 2Mtiasal shaft d n Ono the name of the subeontru-sars and sta4m vixxher or not those en5ra have tntployew. If the stub-conowtots have employees,they wust provide their worms'comp.policyaurnber. .1 gm an employer that is providing workers'compensadon fnsarance for my employers. Below iy the policy ant job site �. ' infornra?ian. Insurance Company Name: Granite State Ins . Co. Policy#or Sci&iw.Uc. #: WC 4 8 9 6 9 8 9 Expiration Date:- 11/15/2 0 0 8 Job Site Address.-_358 , Ryan Rd. Citylst te/L.ip: Florence, MA 01062 Attach a copy of the workers'competuntion policy declaration page(showing the policy number and expiration date). Failure to secure coverage.as required under$action 25A of MGL a. 152 c4 m lead to the imposition of crimb=1 penalties of a fine up to 51,500.00 and/or one-year imprisonmany 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 violatar. Be advised that a copy of this statement may be forwra:ded to the Ot. a of jgvesti e pla fbr insm=c coy=ae v ratio I do hereby c carder the paba. d petedrles of perjury that the information provided above is true and correct Late: May 22 , 2008 Phone 4/3-9 7-7124 rise on y, Wo not write in tkia arctic,?o leted by CKy or lawn offlew City or Torun: PernsitUcense# Issuing Authority(circle one): 1.Board of Health 2.BWlding Department 3.City/'Town Cleric 4.Electrical Inspector 5.Plumbing Inspector f 6.Other Contact Person: Phone#• !� 900f�1 ZLZTL999TV %v3 LS:ZT L007%8Z/90 0 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9,Realstw"Home Improvement Contractor: Not Applicable ❑ D.P. Carney Construction, Inc. 121178 Company Name Registration Number 34 Horseshoe Circle 4/12/2010 Address Expiration Date Ware, MA 01082 Telephone4 13-9 6 7-7 12 4 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(8)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure tD provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... IM 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 148.3.5.1. 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 Superviisor 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 orm work for you under this permit. The undersigned eowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinanc tate and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [E] Decks [M Siding[p] Other[d] Brief Dgscription of Proposed Work: LwOO new flat roofs Alteration of existing bedroom Yes—.X–No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes _ 4 No Plans Attached Roll -Sheet 8a.ff New house and or addition to existina 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. 1. 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, Rob Rea as Owner of the subject property herebyauthorize D.P. Carney Construction, Inc. to act on my behalf,in all matters relative to work authorized by this building permit application. 4r Signature of Owner Date l Joann Carney (D.P. Carney Construction, Inc. ) 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. Joann Canrey P' Name May 22 , 2008 Si nature o Owner/Agent Date 4 * 0 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 © DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained Q , Date Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® 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 ® NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only .Cy-of Northampton Status of Permit= t '-Biyilding Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability _ 2008 Room 100 WaterNVell Availability. uNorthampton, MA 01060 Two sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans A Other Specify L_ARPLICATION T6 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 358 Ryan Rd. Map Lot Unit Florence , MA 01062 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 7k 2.1 Owner of Record: Rob Rea 358 Ryan Rd. Florence , MA Name(Print) Current Mailing Address: 413-244-4741 F- Telephone Signature 2.2 Authorized Anent: D.P. Carney Construction, Inc. 34 Horseshoe Cir. Ware, MA 01082 Print) Current Mailing Address: ��,v--- 413-967-7124 Sgnatur Telephone N 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by rmit applicant 1. Building $4 ,007 . 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 6. Total=0 +2+3+4+5) $ 4 ,007 . 00 Check Number �- This Section For Official Use Only Building ermit Number: Date g Issued: Signature: Building Commissioner/Inspector of Buildings Date P; BP-2008-1082 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2008-1082 Project# JS-2008-001599 Est.Cost: $4007.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: D P CARN EY INC 121178 Lot Size(sq.ft.): 25918.20 Owner: REA ROB Zoning:URA Applicant: D P CARNEY INC AT. 358 RYAN RD Applicant Address: Phone: Insurance: 34 HORSE SHOE CIRCLE (413) 543-4803 WC WAREMA01082 ISSUED ON.61312008 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 2 NEW FLAT ROOFS 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 6/3/2008 0:00:00 $25.0013235 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo