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23A-026 (7)
45 PARK ST BP-2017-0719 cis#: COMMONWEALTH OF MASSACHUSETTS Man:Block:23A-026 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Porch Enclosure BUILDING PERMIT Permit# BP-2017-0719 Project# JS-2017-001185 Est.Cost: $28000.00 Fee:$182.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Grouo ALISHA PHILLIPS 106378 Lot Size(s4.ft.): 17772.48 Owner: GAUTIER!GABRIELLE Zoning:1)RIK 00 Applicant: ALISHA PHILLIPS AT: 45 PARK ST Applicant Address: Phone: Insurance: 40 PINE VALLEY RD (413)586-5986 WC FLORENCEMA01062 ISSUED ON:I F/30/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:TAKE AN EXISTING 3 SEASON PORCH & MAKE IT INTO A 4 SEASON LIVING SPACE, OPEN WALL BETWEEN THE 2 SPACES 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: OI: 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 11/30/2016 0:00:00 $182.00 212 Math Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File# BP-2017-0719 APPLICANT/CONTACT PERSON ALISHA PHILLIPS ADDRESS/PHONE 40 PINE VALLEY RD FLORENCE (413)5864986 PROPERTY LOCATION 45 PARK ST MAP 23A PARCEL 026 001 ZONE URB(IO THIS SECTION FOR OFFICIAL USE ONLY: PERM((„APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid -/A/ Building Permit Filled out tt��'' Fee Paid T peofConsttuctio.: TAKE AN EXISTING 3 SEASON PORCH&MAKE IT INTO A 4 SEASON LIVING SPACE,OPEN WALL BETWEEN THE 2 SPACES New Construction Non Structural interior renovations Addition to Existing Accessory Sttuctme Building Plans Included: Owner/Statement or License 106378 3 sets of Plans 1 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 Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management 4 !T.. 4111CIL:, //3i/t( _ Signa ire 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 _ .. City of Northampton Status of Permit Building Department Curb Cut/Driveway Permit_ 2 ci 212 Main Street Sewer/SepticAvailability L _ Room 100 Water/Well Availability cLL,' • Northampton, MA 01060 Two Sets of Structural Plans_ pfi4 e 13-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify„ APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 P Ad toss: qS Ark Shed. Map Lot Unit Flattest( MA l l c Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 3.1 Ownereof Record: !! �} Gskklle l?Q1A�rtlf �S PIlk Stat F/�-toce l�..f 0/0C. 2 Name(Print) ^^ Current Mailing Address: /f �_ Seg W% q < "t" Telephone Signature 2.2 Authorized Agent: 4 It it PL 'Ill's Yo Pit<. vriue ..Llc_Q F4-egte A14- otvo Nam (Print) Current Mang Address: t1i3 - S%• - Si Sb Signature Telephone SECTION 3-ESTIMATED ✓+NSTRUCTION COST$, Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $ 2N pt U O U (a)Building Permit Fee 2. Electrical 7 V)) tt (b)Estimated Total Cosi of iv 6t dag,n;icoi (6) ._ Construction from 3. Plumbing I J Building Permit Fee ''/��,+[[ T he (Ake-Aimedf $ A- 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3 +4 +5) 42..E UUQ Check Number �"J' `J_ This Section For Official Use Only Building Permit Number: Date Issued: Signature: _....... Building Commissioner/Inspector of Buildings Date A Section 4. ZONING AU Information Must Be Completed, Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be tilled in by ,(�/� Building Department Lot Size 1/f�J/ /(//14Frontage A/7/7 400 Setbacks Front Side L: R: / t.: R::: Rear +f(i lyq� 41 Building Height //A 4/2/1/ Bldg. Square Footage / V! % Open / 4 Open Space Footage °a (Lot arra minus bldg;s paved parking) q //� fi----- _#of Packing Spaces N j/7 Fill. /f // �fl� //� /�/� ... {volumes Location) ? �� A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Regist of Deeds? NO 0 DONT KNOW YES 0 IF YES: enter Book Page and/or Document a B. Does the site contain a brook, body of water or wetlands? NO) DON'T KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO,. ' IF YES, describe size, type and location: E. Will the construction activity disturb((cl"e`a�ring, gradin ,exc tion, or filling)over 1 acre or is it part of a common plan l./ that will disturb over 1 acre? YES NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION S•DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Repiaceme tq, rows Alteration(s)( 1 Roofing (i ,�,/" Or Doors Accessory Bldg. El Demolition )LT New Signs [pi Decks [q Siding_ Othe t Brief Description of Proposed ! Work: S,h i,tX,sttny 1 inv." load, vn4 a5,& it i if Sns04 Priv Vice + an Pike 4F(4Swalld+ 0 0 * ad Alteration of existing bedroom Yes No Adding new bedroom Yes No adi+.«,l S /{ }S, Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Ma�'t rt l Se.If New house and or additio existing housing, complete the following: A// a, Use of building :One Family Two Family Other / b. Number of rooms in each family Ah Number of Bathrooms,,,,, c. Is there a garage attached? /I/Q `_ Y— d. Proposed Square footage of new J COgstru tion_ Dimensions 0. Number of stories? N {J//'7/L 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. I. Septic Tank City Sewer Private well City water Supply SECTION 7a..OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT ORt CONTRACTOR APPLIES FOR BUILDING PERMIT I. (7a (yu,; /.f _®./��c /�� ,as Owner of the sublect property /A� 1 h r'I,'o ..... herebyauthorize /4 kta E S to act on my behalf, in . afters relative to work authoriz d by this building permit application. —. ,r, t rlza/t� Signature of Owner Date 7, A / j Pb 1 ! i to 4 q ` "'t i s?j's ,as best ofAuthorowle Agent hereby declare that the statements d 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. 44:5 44. !'Uififs Prins Name / Signature of w'Agent /9/ Date SECTION 8•CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor f/ /nNot Applicable ❑ y Name of License Holder:_....,41131* 4 / 1 o C.! - /063 / ?Ps Alt Number 0 lit 1/ / Po, /I'/./OC a Al/ 0/06 2 2/16//f Address Expiration bate 913 — 5-5-6— 51“ S' ture / Telephone 9,A Registered Home timprovement Contractorr. Not Applicable 0 *PPM t,ndx, f, 't Ha +M/ Oat 111114/$ Company Name !" / Registration Number . 11, PI U. / • Firt eIli u E' z z( ��/ Address t Expiration Da Telephone 11/3 -rife• • SECTION 10•WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.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 0 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 7S0, Sixth Edition Section 18&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 Supervisor your presence on the job site will he 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 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 _ City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: 1 f Pvfc S{ F4-rect /0,1" 410 2 The debris will be transported by: 1 , 4/X"awt tcnd/tr�fi it ,you The debris will be received by: V 4��r y, Building permit number: Name of Permit Applicant ///5' 4 Ph' (/ps 11/ zib Date r Signature of Permit Applicant .nc lv.nmm{newest r f Iv semen unmra ,a�e Department of Industrial Accidents .,' gt Office of Investigations ~fit 9 1 Congress Street, Suite 100 �" �' Boston, MA 021144017 wn'w.massgov/dila Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information AesPlease Print Legibly Name (Busins/Organizatiorolndividual): /7yt•Ip, /441lAfaf f il. 'J_ /sv n) Address: Lit) PiidC {A ftvL /24 City/State/Zip: Fterrtwe V 4 0fP__42. _ Phone#: HIJ-S5G -S1'$6 .Are yo I. employees(Poll and/or part-time).'n employer?Check the appropriate box: I am a employes with 4, 9tam a general contractor and I Type of project(required): have hired the sub-contractors 6 9 N•w constniction t,9 tam a sole proprietor or partner- listed on the attached sheet. 7. emodeling ship and have no employees These sub-contractors have S. 9 Demolition working for me in any capacity. employees and have workers' 9. 9 Building addition [No workers' comp. insurance comp. insurance.: required.] 5. 9 We are a corporation and its 10.9 Electrical repairs or additions 7,❑ I am a homeowner doing all work officers have exercised their 11.9 Plumbing repairs or additions myself No workers' right of exemption per MGL [ comp. 12.9 Roof Other repairs c. insurance required.] r152,§1(4),and we have no employees. [No workers' 13.❑ Orher comp. insurance required.] My applicant that cheeks box sl must also fill out the section below showing their workers'compensation policy information. I tomeowners who submit this aflidavi;indicating they are doingall work and then hie_ouecide cmtrumrs must submit a new affidavit indicating xueh. :ontracmrs that check this box must rowelled an additional shvet showing the name of the sob-contractors and state whether or sot those entities have nployces If Me sub-contractors have employees.they must provide their workers'comp,policy number am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob.site :formation. tsnrance Company Name: / tiltsf hes 7.1ish rhntC olicy#or Self-ins. Lie. J 4.a_ -k: L S '5GSJ /1, _ Expiration Date:±///I/ / / at: _.., Site Address: .W.3{ (,I k Sired City/State/Zip: P/u4n c ' 0/06 Z .trach a copy of the workers' compensation policy deeiaradon page(showing the policy number and expiration date). allure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties ofa ne up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine I'up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of vestigations of the DIA for insurance coverage verification, do hereby certify under the pains an y alt es o perjury that the information provided above is true and correct immure: ).r l� q...... ........ Date: 11/ 24/76 hone k: LIR.. 71 1 -' St — gel U 6 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: x131° CERTIFICATE OF LIABILITY INSURANCE DATE'MMIOO.TYYT) 11/21/2416 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: N the certificate holder is an ADORIONAL INSURED,the policy((es)must be endorsed. N 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 Ileu of such endorsement(s). PRODUCER NAME:CONTACT Dam Van Mourik NAME FINCK&PERRAS INSURANCE AGENCY INC a�tE E.,- (4j 527-3000 FAX U.G , keekess, bvanmourikgfinctandpemas.00m 6 CAMPUS LANE ,_ _ INSURER(?)AFFORDING COVERAGE NAICY EASTHAMPTON MA 01.027 INSURER A: LM INS CORP 33600 INSURED INSURER B: __ _ AXIOM LANDSCAPE& HOME IMPROVEMENT LLC lxswERG: -. _.• INSURER°: 40 PINE VALLEY ROAD INSURER E: FLORENCE MA 01062 INSURER F: COVERAGES CERTIFICATE NUMBER: 105279 REVISION NUMBER: THIS IS TO CERTIFY THAT 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 DE 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 BEEN REDUCED BY PAID CLAIMS, INBR LTR TNEOPNSURANCE INlD D ?DUCT NUMBER PtLICYECM PMUCYPXi UMne IVIWoerY(YY1 IMMA101'(1'YYI I COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE I -- CLAIM3IMOE J O(`.CIJE -b7RNAGETOTEENNT 6� - PREM! E E. •_________Emgl 1 MED EXP(An ono person) $ N/A PERSONAL 8 AD INJURY $ GOAL AGGREGATE LIMIT APPLIES PER; _GENERAL AGGREGATE $ _ PoVCY IJEECOL j LOC PRODUCTS-CFMPlOPAGG 5 OTHER $ AUTOMOBILE LIABILITY COrfl�t1E 4GLE LIMIT $ 'ANY AUTO PaanEODILY INJURY(Pe'PANES) $ -7 AUTOLY SCHEDULED N/A I ODDWHEW(Per accdent) $ AUTOS •.NON-OWNEDII PROFERW DAMAGE HIRED AUTOS AUTOS Lind.accdmil $ Mil UMBRELLA LAB _ OCCUR EACH OCCURRENUE $ EXCESS IJABCLAIMS-MADE WA `AGGRFSu'TE $ DED RETENTIONS S WORKERS COMPENSATION ©(+8 . 01g. AND EMPLOYERS'LIABILITY IN ANYRIWRIETOR/PARTNERAXECUINE j'A E L.EACH ACCIDENT IS 500,000 A (andatoMEMBEREXCLUDE% INA] NIA PAA WC$315612523016 04/17/2016 04/17/2017 (Mandatory Be NH) Ft.DISEASE-EA EMPLOYEE $ 500,000 CECadeesmNOdM vRATroNsdew EL.'PENEASE.POLICY LUMP $ 500,000 N/A OESCRIPTOM OF WERA110N5/LCCATIONSI VEHICLES(ACIX(D 101,Additional Remarks Schedule,may be attachN11 mare space Is required) Workers Compensaton benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 8,no auNaizMion is given W pay claims for benefits to employees in states other than Massachusetts it the inured hires,or has hired those employees outside of Massachusetts. This certificate of Insurance shows the policy In force on the date that this certificate was Issued(unless the expiration date on the above policy precedes the issue date of this certificate of Insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mase.gov/wdMorkers-componsatIoNinvestigations/. CERTIFICATE HOLDER CANCELLATION „.. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of NorthamptonACCORDANCE WITH THE POLICY PROVISIONS. Main Street AUTHORIZED REPRESENTATIVE Northampton MA 01060 LD.-.- C� Daniel M.CTed ey,CPCU,Wee President-Residual Market-WCRIBMA 01998.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 0;1(4 r, d �2) , Ci-ms o� � gII ii X 3//./ UL S hI 6,/i i' (74,„, n �( 6 V�n I Dog6/L Js Un . 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