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31A-179 19 WASHINGTON AVE BP-2016-1276 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31A- 179 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTIING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INTERIOR DEMOLITION BUILDING PERMIT Permit# BP-2016-1276 Project# JS-2016-002187 Est. Cost: $6000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: COMPLETE RESTORATION SOLUTIONS 103014 Lot Size(sq. ft.): 11282.04 Owner: LOCKWOOD'ALLISON Zoning: URB(100) Applicant: COMPLETE RESTORATION SOLUTIONS AT.- 19 WASHINGTON AVE Applicant Address: Phone: Insurance: 30 HAYES CIRC (413) 592-2772 WC CHICOPEEMA01020 ISSUED ON.5121201§0:00:00 TO PERFORM THE FOLLOWING WORK.SELECTIVE INTERIOR DEMO 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 5/2/2016 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File# BP-2016-1276 APPLICANT/CONTACT PERSON COMPLETE RESTORATION SOLUTIONS ADDRESS/PHONE 30 HAYES CIRC CHICOPEEO 1020(413)592-2772 PROPERTY LOCATION 19 WASHINGTON AVE MAP 3 1 A PARCEL 179 001 ZONE URB(100)1 THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUTr-- Fee Paid Building Permit Filled out Fee Paid Typeof Construction: DEMO WATER DAMAGE New Construction Non Structural interior renovations Additionto Existing Accessory Structure Building Plans Included: Owner/Statement or License 103014 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 -Pen-nit from Conservation Commission Permit from C13 Architecture Committee -Permit from Elm Street Commission Permit DPW Storm Water Management -Demolition Delay I r12_ 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. Department use only _;ity of Northampton Status of Permit: MAY ` 2 c016 uilding Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability -- _. e WaterMeli AvailabilityFo ??? 1v0 _^ _ r n !-tharrpton. MA 01060 Two Sets of Structural Plans p6cme-4?3-667-1 40 Fax 413-537-12 v 2 Plot/Site Plans _— Other Specify_— APPLICATION TO-CONSTRUCT. ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 9 -SITE INFORMATION This section to be completed by office t.°$ Property Address: Map Lot Unit - i U ii`n c,NVto� Fir 1% 010�� Zone Overlay District _ Elm St.Disirict. CH District SECTION 2-P 0PF F'T`!OWNER,-.' P!UTHORIZED AGENT i 1 2.3 Owner of Record: i Current Mailing Address: 3 - 7s�.__Y_ �:�—- ----- j __. _----_ ------- _—__—� elephone 2� a ihoriz r e ,; � ►� kn - �u� c _ _._ .... _ tomic) Nanr, .t; _----- ,, __otI u rent Mailing Acdress - -- ------ .__ _- --- _ -----_Ay Y y Y -- _ eleonosif; —i — � "T CONSTRUCTICN COSTS i r : a ,, C s°, rs c c Jfficial Use Only rC~n_� ` ) i3u!ldr�g Perin-1 Fee (b) Estimates:i ctai Cost of i Construct;on from Building Permit Fee I ! i 4 Met:ilanlcal `, Fire Prov.=.cfion (� 1+ 4 „hi cK Nomber 1 T �3,a ca For Offici,,iI Use 0 r I VI Date I du?d,:7,,moors `s c er!i:'pec ar c-f° Idsngs_ Date ,3ECTION 5-DESCRIPTION OF PROPOSED WORK(ch)ck all applicable) I ! I New House !� .edition � � Replacement Windows I[Alteration(s) Roofing l ° Or Doors D Accessory Bldg DerrloEftion 1 ! New signs [01 Decks [E:] Siding [®] Other[0] Briaf Descripticn of Fro sed I trr3tion of ex s lnp edrocr _ Yes _No Adding r7ew bedroarr. _Yes —4 No Re. :vattngunfimshedbasernent Yes No f ieo DCII :�neei -iouse "md or -�ddifion to r--xisting housing,cornc]ete the following I urc, �:amis T,vc F xr.,!iv �_ Other I c i - i... .i' v�"v:�"?'15 C:c;3c1 mi�J'.init'—._..�._– _ :Vt,mbes'o Batl',iooms_—__--�_� i A .D:irar4 a garage attached r n SCil:a,.; fGos:..e c,;ii:'-J CU(l,tra .I-'J`l.— _ � DirilenS76nS _ I i ~irkplaces or Vloodstoves Number of each i Masscheck nerg',/ ,.ornoli3nce form i I +; i ype U' l.onS'tr�ACi Ofi i I !a construction wth;^ 100 it o'vj ti nds% Yes Nie. is construction within 100 yr. floodplain�—Yes No I t i D ePth of basement or cellar floor Belo vn fimshed grade lI i; bg Con fa ;n tc ?:,i i, g and 7onina r�gu,a er;s7 —�Yes —No . � s i 'ity nater S 'P'y — SECTION a OWNER AUI set RiZATION - 'FO BE COMPLE'ED WHEN OWNERS AGENT OR CO'.° s AC "O R APP iES FOR BUILDING P�RWT as Owner of the subject r. t y Utiv ,von k authorized by this bluilding permit application. �— i q ct C usc. _safe 111 m 11 i j as Owner/Authorized Agent hereby declare fiat fire statements and information on the foregoing application are true and accurate, to the best of my knowledge anc; nehef I ! 1�.neo !finder the pains and penait es of perjury. y .. - JdtP. i �i SEC�TION8-CONSTRUCTION SERVICES L.1' Licensed Construction Superyisor: TNotpplicable ❑ Name afi License Holder: I License Number I i s� Expira+.ion Date I at' - - Not Applicable ❑ :r tr^iNa'ne Registration Number r U hu c� Gtr, w _MA tL)Zo ! 12121 JoLl f Ex�fl-tion Date e_ � I SE :,Old 10- VOP', EPSuCOMPENSATi0N MSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) --� i (:c rpensat on 1, s,, a ce a° 'suit ;i st be completed and sujbmitted with this application. Failure to provide this affidavit will result cf Ifle issu=rIce�of the b,_uing permit, r a ., d No-.. 11 ...:�rlclacic Owmr-OCC@l i w'c•iiira2s 01 OriC(l) (11' t11(;(�� Ianlll!Cs id ..,i iv;'hirc Aihil"ocs!lot a 'ai.ci'e c.prm itted that the Owner acts Ns. )ttyisor.. d;vilk So sixth lf,,�ditioll Section tfi8.3— 1. I?C3sapitia n k�o iit➢iir,��>Q; I'd.�,�;�,(s} „'r:o o�in i piicci ofland on e'she rlrsidCS or intcnds to re idc,on titihich thcrc ,1 tMW or ltv,N l 1,imilA ;.fV'v�liln��.;:itl:ICh,t'd or!ictached St1-UCtU1 S.-]CCCSSoFA tU SUCh LISC and!or l u-ni A i"a_ < ,vh€o�anstr€acts more thali one horny in a two-vear period shalli not be considered a horneowiter. LJ i,i_i i? Main Strect. Northampton, MA 01060 Solid 'Wastc Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as condstion of the bUyNdling permit all 'debris resulting from the construction aclh,.Aty governed by hihis Building Permit shall be disposed of in a properly 'icens-ed scI'd disposal facility, as defined by MGL c 111 , S 150A. of rihe' The debris will be transported by, U J Nanri-- of 'Pemn�'t PAppilica-'n't /4' cp �gnatMe of el-mit Applicant The Commonwealth of,11assachusetts Deptrtment of Industritrl Accialents Qffice (af fn,vestigartiotis t'h l C it ;ress Street, Suite IOf) -2017 veva,rn(tsl's.-nvkliat W'orkers' Citulpealsatioll lusuraac Affi€iatvit:l Builtlers/C`ontractors/Flectriciaans/Plumbers Applicant Information Please Print Legibly ''`ai-iC 11'us iness'Orgai; r.tic)?iilit ji,,t;l_u,I I: -10 P: rip iouO ,�au.1, c c x 4l3 r '"? Chest, uhC a7pt<i?rrS;^7!C box: —� -Type or project(required): t, � -+. + i a31; I'4 al ion'lV it17! and I I d tlhe sub- 1ntractors `lew construction + .J LSA? ,11I� )t + ?::. ), t ;et'-- i.stcd t1ho:attached sil0et, 7. [:] Remodelim slip and L-I\e no es i; .gees These sub c;�nuaciors have 8. LI Demolition t vb't1lkn+r to? t1t- In � <}'-`� �,tV � employees a[7d have workers' 9. E] Building addition 1"Noorhers Cornl+ t+1 wlL,nt i; Wnnp Insurance.< cl �ct.s 5. ;-] We are a corporation and its 10.❑ Electrical repairs or additions It 1 i lio11, f.+{, ;yta v'or, oiiicc S havo exercised their 1 1.[] Pltunbing repairs or additions +.ht }react pi on et M61 1 i 12.� hoof repairs and til + m, i 1 1voo.h ,,. ! ,._� 1111 er ';int�.}nutit;i� ;,e, :,;e du tL-ail w++ti�md thein hire out;iue coniraciorks must slintrrii a new ai! davit indicatin12such. Ck,,l..,.Ct+:s t„a.iheci.01F n:a: �,,, ..... ..,,.,.. ;rat,;i,+,,.._�� �,.',�o.�;n,.t:�e ualt,t�e:ih:..;i�.� v,�ti,tuurs duct tate k,�hcihel of m>t those Lnhtics hrl�c the} ;ru?st t+n:viuc in'n cvor6�US comp,polio'nuniher trier rr)1 etn13,4,•t'er'alirtt e°s prrlvh6n,,workers'compea.silfle ra for surto emplorees. Below is flee polky and job site YS . , ._. -- �_ � $ thirarion Date: ' City%StateZip: - -- -- ----- - � sJlb�0 IIriC t a copy on rhe V orkers;' Compensation policy declaratiojn page(showing the policy number and expiration date). fail_,re to secure c v'em re Is r quir d under Section 25A of VIGIL c. 152 can lead to the imposition of criminal penalties of a C. rtt=?: u..,, e . . a<s \voli as Nil penalties i;t tie form of a STOP WORK ORDER and a fine yr_ 0. a cuplly of this Sta, C!"If-,"t nid" be :"DIT CII-ded to tali;Qit➢Ce oa� ,., ...+€ •. i7 '; ,Zi' I t 'r.1�� c��?f'_e Ve +� C3llOr;- Wk:+1/peri°,;)•that trier in )remarr it provifle_✓l above A true alld correct. ,N 1 J.- -Da[ "horic > aallicirtl tese on1r, Do not w ire in this rueu. tri he completed hiy ify or town officiui. r 4'L'-: �er�l ?tlt�ti'e4?Se ,t. ( '�S :t?t; u.iiht�s• t ( ii'cl cbt�tiJ ----- --- — {eva tnie t 3. (At lc}',vn >7lerk -i. . k-ctrical inspector 5. Plumbing Inspector l S`3. :N"S iFeY Phone DATE(MMODfYYYY) A�oRn� CERTIFICATE OF LIABILITY INSURANCE F8/26/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(Gas)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endomeme s). PRODUCER T Gail Croake -.....__..._.._..___,.____ _. _.....__. Borawski Insurance -- (413)586-5011 ;—FAX—- 588-9413 88 King Street, Suite B WESS:gcroake@borawskiinsurance.com :gcroake@borawskiinsurance.com '... INSURER(S)AFFORDING COVERAGE NAIL# Northampton MA 01060-3257 rsi ERA:CaTa tol_Specialty Ins Group 10328 INSURED R B:Ace Group 22667 Complete Restoration Solutions Inc. ais c Hanover __ _„_-. 22292 30 Haynes CircleD — _.._................ SUMER INS e: Chicopee MA 01020 INSU RF: COVERAGES CERTIFICATE NUMBER:15/16 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 6 EN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOI%AnrHSTANDING 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.LIMITS SHOWN MAY HAVE BEEF REDUCED BY PAID CLAIMS. INR ADDL TYPE OF INSURANCE I vD; POLICY N MBER : I MOS E �CY� LIMIT X i COMMERCIAL GENERAL UABA.ITY - EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE �OCCUR {I{ PR MISS tEa acts re�} '� 300,000 I 1 EV201502528-01 j 8/28/2015 8/28/2016 `MED EXP(Any one person I$ 5,000 PERSONAL&ADV INJURY $ 1,400,040 ......... _._..0 GEN'L AGGREGATE LIMIT APPLIES PER: I I 'GENERAL AGGREGATE s 2,000,000 POLICY JECOT- 17 LOC 1 !PRODUCTS-COMPtOP AGO ,$ ... 2,000,000 I OTHER: I I Trans Poii Lab $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) S ALL OWNER - SCHEDULED AUTOS .AUTOS I t It BODILY INJURY(Peraartlenn $ HIRED AUTOS NON-OWNEDI PROP"P Rl'�Y $ X UMBRELLA LVaBOCCUR I EACH OCCURRENCE ., f A IM EXCESS J, CLAWS-MADE I AGGREGATE S _..._5.,000,040 'X!'DED (RETENTION$ 10,0001 LW0015119-01 8/28/2415 8/28/2016 :S WORKERS COMPENSATION I�.TATUTE 1 AND EMPLOYERS'LIABUJITY Y 1 N S - ._._LTAJ..Y_..._..........:ER _..........__._._ .......-.... :ANY PROPRIETORIPARTNERIEXECUT'IVE --`"I E.L.EACH ACCIDENT is 1 440 t OQQ OFFICERIMEMSER EXCLUDED?`NIA{{{ I - S ;;Mandatory in NH) 062UB-OG12610-0-15 9/1/2015 9/1/2016 EI I,.,DISEASE_EA EMPLOYE $ _ 1;Q40�OQO If ee.desrnbe urWer �. _. DESCRIPTION OF OPERATIONS below { E.L.DISEASE-POLICY LIMIT S 1,000,000 r C aBailment Coverage RAN9659542 8/28/2015 18/28/2016 $350,000Ded$1000 A i CPL ECP240612213 8/28/2015 ; 8/28/2016 .$1,000.000 Ea Doc DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks SchedLde,may de attached N more space is required) CERTIFICATE HOLDER CANC LLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORQED REPRESENTATIVE R BoraWsfi/BORGC1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registelred marks of ACORD INS025tmuros i a Office of Consumer Affairs and Business Regulation 10 Park Plaza - __- Suite 5 170 Boston, Massachusetts 02116 Hoene Improvement Contractor Registration Registration: 164927 Type: Private Corporation COMPLETE RESTORATION SOLUTIONS, I Expiration: 12/2/2017 Tr# 273106 JOSEPH GILLETTE30 ........... ....._......_. HAYNES CIRCLE -------_--_-i___—- CHICOPEE, MA 01020 - Update Address and return card.Mark reason for change. SCA' " -'vt7"°' r - Address (7 Renewal j j Employment Last Card ,•,. ^%,r• �nli,nsrurrrrrlt'f r j C l'lrr.;.;rrclirr;c/f `.... _Office or Consumer Affairs&Business Regulation License or registration valid for individul use only I`u`Jr'iE 1R"PROVEMENT CONTRACTOR neiv�e ii,e expiration date. if found return to: ; Registration: 164927 Type; Office of Consumer Affairs and Business Regulation Expiration: 12/2/2017 Private Corporation -10 Perk Plaza Suite 5170 COMPLETE RESTORATION SOLUTIONS,INC. Boston,MA 0 JOSEPH GILLETTE 33 HAYNES CIRCLE CHICCPEE.MA 01020 - UndersecretaryNot valid without sibnature Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction SO Der,. License:Mi 03014 JOSM iH GH TX� 6 SHADY LANE : r WEST SIMSBi314?4'C��i ~ r xt r` `�.rG. -�' •""�k`' Expiration Commissioner 0413012017