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35-225 ACOFD CERTIFICATE OF LIABILITY INSURANCE OP ID N DATE(MM/DDIYYYY) BARAJ50 02/28/06 'RODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION CRM Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 3arry M. Stephens, CPCU HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 15 North Main St.-P O Box 564 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. :ast Longmeadow MA 01028 Phone: 413-759-0010 Fax:413-759-0017 INSURERS AFFORDING COVERAGE NAIC# NSURED INSURER A: Safety Insurance Co 39454 INSURER B: American Home Assurance co. Barron & Jacobs Assoc. Inc. INSURER C: Central Insurance companies 20230 70 Old South Street INSURER D: Northampton MA 01060 INSURER E: :OVERAGES 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. TR NSR YY)E TYPE OF INSURANCE POLICY NUMBER DATE(MM DD/ PDATE(MM/DD/YY)N LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 C X COMMERCIAL GENERAL LIABILITY BOP7933761 03/09/06 03/09/07 PREMISES(Eaoocurence) $ 100000 CLAIMS MADE a OCCUR + MED EXP(Anyone person) s .5000 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE s2000000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG s 3000000 POLICY. PRO JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT g 'jOOOOO A ANY AUTO 2399802 06/22/05 06/22/06 (Es accident) ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1000000 X OCCUR CLAIMS MADE CXS7933762 03/09/06 03/09/07 AGGREGATE $ 1000000 $ DEDUCTIBLE $. X RETENTION $10000 $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY 3 ANY PROPRIETOR/PARTNER/EXECUTIVE WC8939903 03/01/06 03/01/07 E.L.EACH ACCIDENT $ 500000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE s 5 00 0 0 0 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT s500000 OTHER ESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS r :ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 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 REPRESENTATIVE IRM Insurance Agency Inc. kCORD 25(2001/08) ©ACORD CORPORATION 1988 Versionl.7 Commercial Building Permit May IS,2000 SECTION 10 STRUCTURAL PEER REVIEW(780 CM111' 10 11) Independent Structural Engineering Structural Peer Review Required Yes......❑ No......❑ SECTION;11 OWNER AUTHORIZATION TO!BE COMPLETED WHEN OWNERS"AGENT=OR CONTRACTORiAPPLIES-FOR B_UILDING'PERMIT. 1, 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 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 Signature of Owner/Agent Date SECTION 12 - CONSTRUC7ION'SER1/1GES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone SECTION 13 WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M G L c 152, §25C(S)) 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 O0.(tt/J-f p�O (rii�) of �'Tna=tllal)tpfn1) ----- f ,9Zasar<rhncrlla' DEPARTMEWT OP DUII1Dr>\jC INSPECT)ONS —� 212 Alain Strcet ' Municipal Duildmg Northampton, Mass. 01060 W O R1C E R'S C O MP EN S A'ZT O N M S URAN CE A FFM A V1T (]i cCUScc/Pcrmi ttcc) nth a prm- cipal place. of business/residence at: 2 II ()ICJ(c d !�,Q 7 0 to SIrrDr.- �� . � 9 (1 hone')� `.>�J� °cy I (svG.U6 ty/ c/2�P) do hereby ccr-bly, under Lh.e paint and penalties of perJury, :hat - I am an employer providing the following Nvorker`s COlnoensabon cove S.c for Ind etuplovccs worlaing on'tiiis job: , i-�YlZs2 t sSit c�C�t?t.� Cd. > �1 `� 1 r 112, � (tnsur� Conran)) (Pelie: Nu r) CE=,piratior Dace) O I,am a sole proprietor, general contractor or homeowner (cu cue one) and have hired the conTaCOrs listed below rq6o have the followi�g worker's comoensa6on policies: (Name 0. Co:'=ctor) (InRranc Coinpan)-/POUCi ?,,lumrcr) 1idU0P. Da C) (Name of Coocaeror) -- Rn-s"wa.ncc ComDazwPolic), Number) (—LX-Diriion Date) (Name of Coaa-acto,) (1.r>_surancc Compan)•/Pouq. N;tsbs) (E.xPir 000 Date) (Name of Coau-actor) (Insuranc—c Company/Po�ey Numb:.r) (Expiration Datc). (atur�ad-!it;ocal dcct it acc�siy to arc' iafortn-a'oc pertaiairtg to all ooa5-a n) O I am a sole proprietor and have no one wor-L-ing for me. ( ) I atm..a home oNvDcr perforTning all the work myself. NOTE:pl=s be eW-'Xt thz k-L;J'bCaxtr MCre +bo csaploy PCr% n=to 63=A-jr ,•,•,. a:s---00 c rcpzir u•orx oa or ant moet th a t Toe t �is ultieb ttx bor000waer r'.d�or oa tbz of a zgpurieo:.r7 theme L oo(der—aUy o0cmd.-rcd to be eaxpioye�lace ttx.�ui ers ec r <-+'�pq(GL152y31(S)�applinOoo by n 6omooaacs rer e�c>;v.or peroit ray nrdCD-the Ic-g�.l ct�u of=eralcyx uode dw Wolrolr Co�u Ae(- I uodcst-.ad dva>Dopy of ibis m.r®c:a may be for�.vrd.nd to tbo pcpnnmooa of IndusriJ Acndca!Off o0 or IrLVri000 for llm , covcrxb'e vazczdioa aad lttel L-um to sector cov��ur>dU soetioo 25 A of),(GL 152 caa Iad to the i=Posifioa of a imias!Pc-16a 000azam$ora rsac orup to S 13oo-oo and/or im;risoamcni orup to ooc year and civil pmahia in tx Form of a Slop Wort;Ordc and a rim of 51 DO.00 a d--y tptsnsl mG dcp.rts_-:31 use only -------- C%°L " Pcrmjt Number _ _ N'Jap: wn 6?1 0�Y1Jf/�g (, Board of Building Regulations - '=9 One Ashburton Place ism 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 09/20/1941 Number: CS 030739 Expires:09/21/2007 Restricted To: 00 CECIL R JAC'0I3S 70 OLD SOUTH STREET NORTHAMPTON, MA 01060 Tr. no: 4025.0 Keep top for receipt and change of address notification. CAI :0 5083-(W05-PC86g8 -,llr 60 i31/!l4J1fl(*Yf111t CJ , l/Il r'iflfl7ff iff BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 030739 Birthdate: 09/20/1941 Expires: 09/2112007 Tr. no: 4025.0 Restricted: 00 CECIL R JACOBS 70 OLD SOUTH STREET 4 NORTHAMPTON, MA 01060 Commissioner A IN - Board of Building Regulations and Standards - One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 100809 Type: Private Corporation BARRON & JACOBS ASSOCIATES, INC. Expiration: 6/23/2008 Cecil Jacobs --- —_ 70 OLD SOUTH STREET ------ NORTHAMPTON, MA 01060 Update Address and return card.Mark reason for change. )PS-cA1 0 5oM-04 as-PCe6y6 �'. Address f _j Renewal ( I Employment ' Lost Card r+.� MCP fCOTIUiK'I7llKlC�CIt l�. I�fJJ til!'1{/!J(i�-1„� . Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 100809 Board of Building Regulations and Standards Expiration: 6/23/2008 One Ashburton Place Rm 1301 Type: Private Corporation Boston,Ma.02108 BARRON&JACOBS ASSOCIATES,INC. Cecil Jacobs 70 OLD SOUTH STREET NORTHAMPTON,MA 01060 Deputy Administrator Not valid w' t signature A SAY',... i, .kVT.V*S 'R` } d, a:...'1 { ..,:... s k 1.•..{i l..,.ur i 4 o1 " 6.1 Licensed Construction Supervisor: Not Applicable ❑ Name of i ense Hold jr:_ Led(-, License Number -o CIA_ �� C1 12,112-00 --- Address Expiration hte, 13) 2580 8 cm g Signature T e hone lwl Not Applicable ❑ 1 co 8g Company Name Registration Number z1-U ts?� -I -�� Address l Expiration Date Telephone n a " /A c J'u [ �T+'7T? {!� nLt`•6}i'4IL �Y. 'n'E .::;.'?E `.1T , {l � T"� eVla Y{~i liii�l,' r1 �14� 1 i e. .i 11,11{,t {/ n.;:. ,..S.iS �t1 � Sl••t,, li�i, til,It1 .{4,: ,ll�11 r. i 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...... 0 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 stnictures 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,duriing and upon completion o;Fthe 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 lb liable for persons) 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 _ .R fl . r r X11 1� Iq S I 1I1 f•' A .. t ,C m k .......... s1 l: I Ij�t'I'- tj i, li t9 tfY� L iJ[ 1 1 , 111 I.:.IC a},1" N IlroCll6 ��i G., ...,;i t.s...nIFC._..., ..,•.,1L.4. r..lsys.l tali u.l. •ri.'t 4:u ,.a,. rt •j i r '...i d r' New House ❑ Addition ❑ Replacement Windows Aiteration(s) ❑ Roofing Or Doors D Accessory Bldg. ❑ Demolition[] New Signs [ ] Decks [ ) Siding[ ] Other[ j Brief Description of Proposed Work: FR 67x/ + 4 - Gr / Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative D Renovating unfinished basement Yes No Plans Attached Roll D , Sheet D offam » a. 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 const uction. Dimensions e. Number of stories? f. Method of heatingi' Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance, Mascheck 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`T No , i J. Septic Tank City Sewer Private well City water Supply lilt �`tf,. + ..t I. nad 111 1 t r.ti.,. .ISht t.�1.•' .•' r.; as Owner of the subject property hereby authorize C-:- to act on my behalf, in all matters r a ve to work authorized by this building permit application. Signature of Owner Date Z rte ��C—GL as Owner/Authorized Agent hereby declare that the statements and inforrnation on the foregoing application are true and accurate, to the best of my Knowledge and belief, Signed under the pains and peryalties of perjury. Print Name 1 'J Signature of Owner Agent to i3ection 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be tilled in by Building Department Lot Size Frontage V\K Setbacks )?ront :'Zile L: R: L: R: Rear Building Height Bldg.Square:Footage % Open Space:Footage % (Lot area minus bldg&paved arkin #of Parking Spaces Fill: volume&location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO — DON'T KNOW YES IF YES, date issued: ' IF YES: Was the permit recorded at the Registry of Deeds? NO _ DON'T KNOW YES IF YES: enter Book page and/or Document # B. 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? Needy to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES 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 IF YES, describe size, type and location:_ ------------------------------------------------- Sep 09 00 10: 028 N . c C, G,� f Northampton E %C�; �UL 3 2006 Bu in'g Department X12 Main Street S Robm 100 p M Jo ttr mpton, MA 01060 phone 413.587.1240 Fax 413.587.1272 7n ; APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING 't7 W,It° �'Yr+�' .Itti`t• _�4'rrtI;rli i It +� !i {{{IS I t ttt l}r ': i I�l fst to 'h-:i r l+f {i tj NVIR 1.1 Property Address: S�jlt' 4171�r f V Ir�C.. ly{i, SaS Ix I L ` '�4���•�brx`,°1 N rt.tl t:I..t.rbpp�'l'l�v�w7+a i�d � i�J'r f i"r�{!�� r��r���,y'�l.,�z( sj UY 4r•„tt fi.�.,t �¢�+ 1y1i�4[.I'.i i � 4 l��o-�oyiyt�I i j'� inlV N�(f Mile, t�I,�rw. 6 t i rc ait 4 �,'ilAl ,�+t; l.;,I;�:.�r,rl ;:;! i ���s,,�4!�;tsd .,�-,!t,,.. !.II:.;.:!�,ta,,,:.v '.u..,,n.,„Y.0 tl;`?.,.• i �.�,., , r.!ii.t!,ri,'+ ;:!i 2.1 Owner of Record; Name(Print Current MqQPU A dres y --- Telephone Signature 2.2 Authorized Agent;, J Nam n Current Mailing Address: a Signature Telephone „t 7i...n��;� rs ,..r... ,r.:r.� •m. ...x u,r a ��I �..°j' Item Estimated Cost(Dollars)to be it S iuC xil 3.�°� i {r fl ti i Completed b pert applicant t � !II lr 1 , 1 i1 f lfwl 1.ukl� a�! I r D❑I�f�,�1��L . j 1. ir+""p116 tyF,�,�., 7/ 5e Z � t���3�N���til Yi�Y'�il�� �'}ty 13.;'.•' qe t ,f w !- 2. Electrical Q�!BW kidt1'o {. `C , iattl......•„t �, �1,�',,', t„ t� I i t9�( I ' tt L flISL t°ft I' "u iin' , i)i' a 6 i a:,j �!�fst ,y U1 t � ! 3. Plumbing f" fTlh�3'rtirei'�'EIyy}'t+ItIICE Si(( r n+li'ft s; it ll {At llt I�Iritf iSiL!*+Ipt�'t }ijl t i`i ti�lll� ibrEit' is�I�IL,+{1!A 3lISS i 11 X94 h4 AUt f !l4 I� ; f t r` tt f'.'I t l I,It t n I ii ir i t tt�s,ni�I „}j 1 iis t i�1 n rt,r(lrt u I tt eri R n e '¢�4. Mechanical (HVAC) t t n•4P}t ti7i il m�r r ji[t t r fy 7tFi,p ra I r l t 5. Fire Protection 6 Total =(1 + 2 + 34 4 + 5) itiltI ter i�•.,,{{��,..t i,. , 1. :i•,'..d,liilaifA!tk;illfifi t.tf srnr�`n„r,... t A�!'.. 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I'� _. UM'K !'ahi F78a..1)k..rri}t}..tla ,ii�n¢.-?:::.5 'ii u1t5t1)I�ui:.uHinb .�:CerdllAl_:ai.••:,•?,. ru•• �.s!4f•u.n1. u7+:vi.0 ! i » BP-2007-0072 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2007-0072 Project# JS-2007-0116 Est. Cost: $8000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Barron & Jacobs 100809 Lot Size(sq. ft.): 33846.12 Owner: JACOBS CECIL R&KATHLEEN D Zoning: SR Applicant: Barron & Jacobs AT. 50 LADYSLIPPER LANE Applicant Address: Phone: Insurance: 710 OLD SOUTH ST (413) 586-8998 Workers Compensation NORTHAM PTONMA01 060 ISSUED ON.712112006 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF 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 7/21/2006 0:00:00 $25.0011247 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 50 LADYSLIPPER LANE BP-2007-0072 GIS#: COMMONWEALTH OF MASSACHUSETTS Map.Block: 35-225 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2007-0072 Project# JS-2007-0116 Est.Cost: $8000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Barron & Jacobs 100809 Lot Size(sq. ft.): 33846.12 Owner: JACOBS CECIL R&KATHLEEN D Zoning: SR Applicant: Barron & Jacobs AT: 50 LADYSLIPPER LANE Applicant Address: Phone: Insurance: 710 OLD SOUTH ST (413) 586-8998 Workers Compensation NORTHAMPTONMA01060 ISSUED ON.712112006 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF 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: Finals Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: d jC ggaq'0� , THIS PERMIT MAY BE REVOKED BY THE CI Y OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGUL ONS. Certificate of Occupancy _ signature: FeeType: Date Paid: Amount: Building 7/21/2006 0:00:00 $25.0011247 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo