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35-248 (4) /� LIABILITY#} } DATE(IbMFDD/YYYY) TM �� f1�E L�fMBILI INSURANCE 6/10/2005 PRODUCER FAX THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Foley Insurance Group HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 37 Elm Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. West Springfield MA 01089 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Travelers Property & Lorenzo Agustin, DBA: Agustin Construction INSURERS: 49 Washington Street INSURER C: INSURER D: Monson MA 01057 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD M69CATED.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. NSR ADVL POLICY EFFECTIVE POLICY EXPIRATION LTR IUM TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE MMIDOMY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00C X COMMERCIAL GENERAL LIABILITY PREMISES TO RENTED occurrence) $ 300,OOC A CLAIMS MADE QOCCUR TBA 6/10/2005 6/10/2006 MED EXP(Any one person) $ 5,6,0—c PERSONAL&ADV INJURY $ 1,000,00C GENERAL AGGREGATE $ 2,000,00C GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00C X POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON-OVWXD AUTOS PROPERTY DAMAGE $ (Per accxWA) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN ER ACC $ AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE s _ OCCUR CLAIMS MADE I AGGREGATE _ s DEDUCTIBLE $ RETENTION s _ $ WORKERS COMPENSATION AND TO Y LIM S ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMIPLOYEE S If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSILOCATIONS/YEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL Policy No.:1-680-9155B576—COF-05 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIADILITY OF ANY KIND UPON THE INSURER,ITS AGENTS EPRESENT VE AUTHORIZED REPR )1115.._ I ORD 26(2001/08) ®ACORD CORPORATION 198 ° N9026/rrtnlll na AMS VMP Mortaeoe Solutions Inc 1&101327-0545 t of � a _ o S i U-� A 3 AO E _ _�f tvI d 2 '© .1 .S No Ne 1 � 1 b CIA! ? � s rwa►e.� ,rotaN I Agustin Construction 49 Washington St. Monson,MA 01057 (413) 237-5175 Date. Sept 21 ,2005 Floyd Cheung 15 Ladyslipper Lane Florence, MA Work to be performed: 1. Remove existing handrail and decking. (Painted PT pealing) 2. Remove screen in screened porch area porch area. 3. Raise floor in screen porch area. 4. Mechanically fasten existing 2"x8" pt framing. (joist hangers,bolts and 3/8 galv lag to secure sill to house) 5. Build new stair landing and steps 6. Install new handrail. Balusters to be 3 inches apart(cedar 2"x2" ) 7. Re-screen porch area. 8. Resurface deck with 5/4x6 cedar NOTE: Re-using existing 2"x8" pt frame with 4"x4" pt upright's set on 12" footing piers. Re-using 4"x4" upright post holding existing roof over screen porch set on 12" piers. Existing Hot Tub structure will remain unchanged. �StiAMp�, „Grit IgDa11t�TtYYi z �1$SSAthl(Sttf4 DEPARTMENT OF BUILDENYG INSPECTIONS / INSPECTOR '212 Main Street • Municipal Building Northampton,MA 01060 P HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 78OCMR 108.3.4 to act as iris/her construction sup,:zlisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be,a one or""two fame y 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 fegulations. 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 ade understand the above. (Home ovine /resident's sia ture requesting exemption) I will call to schedule all require uilding inspections necessary for the building permit - issued-to me Date Address of work I location (mow o n 6 �' tv.LrPTO f,. Crif >7f Tort hi l alll 1011 _ g7&Z$achnrcIIa' v DEPA.R i MENT OP BUILDD,10 INSPECrlONS 212 Train Street Municipal Duildin� j Northampton, Mass. OIOGO 1 -NVOT U-:R,S CO YOENSATIGN ONSURANCE AFI'II)A.VIT ! (li�ns.•xlpermi Its) %VILL a principal place of businessIresidence at: i i I (l hone') (sar t/ems rJ/stale/a P) do hereby cerZ)-, under the palm and penalties of pcf3uf-y., :hit I ( ) I am an employer providing the iollowine!«•orkcr,5 colnocns:ion cove ale io( III emplovecs %vorlong on this job. (L^�w—mac Comp. ) (PcLi c:?:u--.ib--r) — (c,pirzIior.D2=) i I an a sole proprietor, general contractor or homeowner (ci cie one) and have hired t_he consactgrs listed below rgbo have the 5otlowin2 workers camper-tenon pokiest ('Nalco-, of CO_Incto-) (InR rzrlcc COIT1D1T1}"/1'GUCi ��tLiI1C<:) (r'•71sd 0 l�1lC) (Name of Conractor) (1nstlrznec C.omoanyRoucz• Number) irtion Dare) I ! (Name of Cou=clo.) (I.mvraQ�CompanyfPoUcy Numb,-j) (Expiraoc Daic) j • I (Name of Contractor) Gzsuran� Compaay/Policy Numb) t�xpirtion Date). ! (a.. :das�oc3!>��.itaccL—za_^t-w c�c-iuc�iafocm�ioa pcy�:a:as tv.L cow-�o:-s) ,! { I am a sole pFOprietor and have no one worizng for me. 1 ( } I am,a home owner performing all the work myself. i NOTE:pl==be ewwn ri—u:^..le hee=wj. , a—bo c=pley p=,c=LO do C` C=,-4=oa a rrrxir work on c d--,L,..4 of cot taoce the:t'-oo omits is tech the bomoowac raid. ,,oa the p ou.,d,a7purtc^.^'th,— a t-r ooe C=�—•Ry oee:d--od to be ciiplcr--s U---the..via c=-u---,;oa Act(GUI 52:=1(5)} iPpliaaaa by L bomooax fc a!ice_or emit=y e.-id—tLc lyd l cts3.c of ea=Plcyec under dt.o Wockc e&C.00>pom.iioa Act i I uadeQ.+.od th-a copy orthiu mt®na a y be f r-.rdnd to th<Depe.teeoi of Ind arric!Acod�O O(roe of lug for th. CO'c '^c"e C=ioa and al t:ittac to Ac=M toverxCc wide==ac 23A of MOL 152 m Id to the i oa of cimiasl pcaalSic nazi:>ag of a fmc or up to Sl}DO.00 xsAf«irpcisoomc�l or up to ooc ycr nod coil pcaaPio ia'x(ocm or.Stop Wrk Ord-- aad s G=oC S 100.00 a d_y LP-1 S nirr is=--.c- crsnit1C. t-C l SECTION 8 CONSTRUCTION SERVICES r-' 8.1 Licensed Construction Supervisor: Not Applicable ❑167a Name of License Holder License Number q � 'afk) 6-/7/6-?- Address Expiration Date fQ7 5-- Signature Telephone Reos r �R'o rr , . Not Applicable ❑ Company Name Registration um er ----"-- Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCEAFFIDAVrr(mG.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...... ❑ * 7T T 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-vear 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 alt aaplicable) New House Addition ❑.. Replacement Windows Alteration(s) ❑ Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [E3] Decks [ Siding[O] Other[p] Brief Description of Proposed -1- �ee�fC/ �tM^^£ 1-b fLw �t�N Work: ✓c 41"-b A L 9 ,LS' Attached Narrative g bedroom Yes No Renovating nufn hed basement Yes Yes No N Plans Attached Roll -Sheet sa.��''Nevir�iaase�arrd-�f� c'�cl�t�n� ��s° i>'t stn �corl� �et��he�at�a�rit : 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 L 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.WkEN; OWNERS AGENT OR'CONTRACTOR=APPLIES'FOR 6GILDiN[ ,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, 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] ignatur of bwner/Xgen Dafe ' ~ ^ Section 4. ZONING All Informatio'n 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 Rear Building Height Bldg. Square Footage Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (volume-&Location) A. Has a| Permit/Vahunce/Findi enerbaeniusuedfor/onthesi�? NO 0 DON7KNOVV YES 0 � IF YES, dateissue& IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW (25 YES IF YES: enter Book Page and/or Document# �� �� B. Does the site contain a brook, body of water orwetlands? NO ��/ DO07KNOVV x�� YES �_� IF YES, has permit been or need tnbe obtained from the Conservation Commission? ' Needs tobeobtainmd �~� Obt��ned �~� 0mta |ssumd�' x�� x�� ' �� �� C. Do any signs exist on the proper� v�y� YES �~� NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES0 NO IF YES, describe size, type and location: E. Will the construction activity disturb( hng. K .nr filling)over 1 acre orisd part ofo common plan thowi||distu,bove,1acre? YES NO |r YES,then a Northampton Storm Water Management Permit from the DPW iorequired. / / . i— --- _.___.� rtf ampton a it i partment r , in Street e a` i m 100 e uaab SEP 2 3 20 . �ibrth t n; MA 01060 e �5� 1?Pansns phone 413-5 7-12 0 Fax 413-587-1272 -p e #an� �� 7; i DEFT Or 9i iq Pl'gr.IN ` pact APPLICATION TO CONTT LTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION1 -SITE INFORMATION Thissecttort.to be comQtetedbyoffice 1.1 Property Address. _ +*D Stl�p L�-ivcf .Lot Unit, - �� OverfaY DIstrrcf SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name Print Current Mailing Address: �i3 5�y go 3 fl . Telephone Signature 2.2 Authorized Agent: N ill S/l �lNS e A� l IV7,a Name(Pri t) Current Mailing Address: '//-3 '737 Sign t e V Telephone SE 1ON 3-ESTIMATED-CONST.RUCTION COSTS Item } Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building �® , 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=(1 +2+3+4+5) 0 Q0 0 • a o Check Number This Sect orr!For fficial'Use.Only 19 l Date, Building Permit Number..- Issued: Signature: Building Commissioner/inspector of Buildings Date File#BP-2006-0328 APPLICANT/CONTACT PERSON CHEUNG FLOYD ADDRESS/PHONE 15 LADYSLIPPER LANE FLORENCE (413)584-8030 Q o PROPERTY LOCATION 15 LADYSLIPPER LANE MAP 35 PARCEL 248 001 ZONE SR THIS THIS SECTION FOR OFFICIAL USE ONLY: ` PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: REPLACE RAILS&DECKING 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 INFOJJkMATION 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 Commissi 18 ZCd 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 Office of Planning&Development for more information. 15 LADYSLIPPER LANE BP-2006-0328 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:35-248 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category BUILDING PERMIT Permit# BP-2006-0328 Project# JS-2006-0483 Est. Cost: $10000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sa. £t.): 59677.20 Owner: CHEUNG FLOYD Zoning: SR Applicant. CHEUNG FLOYD AT. 15 LADYSLIPPER LANE Applicant Address: Phone: Insurance: 15 LADYSLIPPER LANE (413) 584-8030 () FLORENCEMA01062 ISSUED ON:912812005 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE RAILS & DECKING 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 Siinature: FeeType: Date Paid: Amount: Building 9/28/2005 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo