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24C-047 17 WOODLAWN AVE BP-2017-1178 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24C-047 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2017-1178 Project# JS-2017-001982 Est. Cost:$7500.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KRIS THOMSON 084152 Lot Size(sq.ft.): 36808.20 Owner: EPSTEIN NOAH Zoning: URA(100)/ Applicant: KRIS THOMSON AT: 17 WOODLAWN AVE Applicant Address: Phone: Insurance: 362 KENNEDY RD (413) 549-1027 0 LEEDSMA01053 ISSUED ON:4/20/201 7 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE CLOSETS AND MOVE A DOOR 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 4/20/2017 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-20I7-1178 APPLICANT/CONTACT PERSON KRIS THOMSON ADDRESS/PHONE 362 KENNEDY RD LEEDS (413)549-1027 Q PROPERTY LOCATION 17 WOODLAWN AVE MAP 24C PARCEL 047 001 ZONE URA(I00)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APP . - £ - IN CHECKLIST CLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid t Building Permit Filled out Fee Paid / Typeof Construction: REMOVE CLOSETS A • ` A DOOR New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 084152 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: 41§proved _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 D-1 olid.I D- oppr Signa eof Building I I al 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 Nanning& Development for more information. Lz .,U,h DepaQteffuse DrrI , , fli City of Northampton StatusrofPermn ' r�' - �k` 2 Budding Department Cc7re-eutrmFvdwa Pe m7i -'-" .- �� _, - I 212 Main Street Sewer1S rc Aveira3)IM1y -cam e,. a s _ �' Room 100 UVaterMfelf-Ava+larolht "r�ury` ' - I Northampton, MA 01060 Twp Sefs;o€STrcturaGPransE ° In' Ni ° ' -' e.", /phone 413-587-1240 Fax 413-587-1272 P,IeSlterPlaano :+ ti< ,�� 2 t�TOtHeryspeci s _- rr -. � " "� A �.,ar>+; Al�ON TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION > 7.7 Property Address 11 ^^ Ll aiTr : This SectmrrtabeIcomplefed�,byoff+ce_ - 11 c goo\ Iajh rd� kaMv - etr44_ 9 5bt irnit At Ori1,�c, , /iG 0 )06 0 2gde a_ Overlay Dls(r i b NElrri�StClsfrct g lst D trent •-=' SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZEDAGENT 2.1 Owner of Reno I. Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Anent: �riS \hvvtspl. pZ .• ., Name • t / Current Mailing •ddress: rig • 69-‘ 44 7 Signature -rm.' Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant - - t. Building 7 0C) O (a)Building Permit Fee 2. Electrical �U0 (h) Estimated Total Cast of Construction from(6): 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection p _ 6. Total=(1 +2+3+4+5) ? 5 ©CD Check Number 387.9 �Ut� r, This Section For Official Use Only Building Permit Number: • - Issti : Issued Signature: - - • Building CommissianeHlnspectaro(Buildings Date Section 4, ZONING Alt Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This coiwm to be find in by auiidine Department Lot Size i .Ii I Frontage 1 . Il i ._ Setbacks Front L I � I �„! SSda ii i R/1—_-1 Li I R:1 I I`i_ Rea* C C 1 I Building Height I - i L_3 Bldg Square Footage I 1 I f % 1-F1 U-FI �.....-� Open Space Footage °/n Mat aka minus bldg&paved FF. I 1 1 I T1 I Ti -#of Parking Spaces L ) F r t t Fill fvnl�e& — Location) t I'-1 i1 A. Has a Special Permit/Variance/Fin din ever been issued far/on the site? NO 0 DONT KNOW YES 0 I IF YES, date issued:L IF YES: Was the permit recorded at the Registry of Deeds? , 4J NO DONT KNOW 0 YES O IF YES: enter Book 7 Pager • .,�cJ and/or Document#1 { B. Does the site contain a brook, body of water or wetlands? NO 'PW. DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: I C. Do any signs exist on the property? YES (3 NO `'r'f W YES, describe size, type and Location: 1 ��\ I D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q IF YES, describe size, type and location: I 1 E. WO the construction activity disturb(clearing,gradin e vallon, orRing/over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES,then a Northampton Storm Water Management Pen from the DPW is required. . SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing E Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [C] Decks [q Siding[CI Other[El Brief Description of Proposed Work: "I,Q in/OJc C-I GSte4S }- W)°VP i 5160T See APG i•-) I'm s ) Alteration of existing bedroom • Yes No Adding new bedroom Yes \NQ' Attached Narrative \ Renovating unfinished basement Yes �'c No Plans Attached Roll -Sheet _,_ ea If New house andor additioril6 existing` liouq, com<smplete the followind: 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. I. 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 kkr 1, ~- �1-.S C ,as Owner of the subject r� , property /'��'� t_JQ\ hereby authorize r) S Ut5inti% to act on my behalf, in all rpatiers relative to work authorized by this building permit application. -7-i A f 1 13/17 Signature of Owner Date 1, LI /,1( v' 4. V iTL,a C`ilr_, ,as Owner/Authorized Agent hereby declare hat the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed ugder the pain�s an ° 'alties of perjury. d) C 1 (M)12- 4Th Print Name • rpt Signature of ON/Agee Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor Not Applicable £ / 5z Name of license Polder:_ � f �✓' ,r�i G License Number :13.12 { In 0 Cr-( Lir) ( ddress Expiration ate, r a .. s • '?Q.ture Telephone 9.ReoFsteredtin'mEtmPiavelfrilpt:Confractoe T,,,,__ LL ;;,;• Not Applicable £ I - � Sc-3 Company Namg,�/ Registration Nu berr Address E uati Date IJ Telephone SECTION 10-WORKERS!COMPENSATION INSURANCE AFFIDAVIT(MCI.c.152,§25C(5)) 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 -... E No...... £ 112411einSmer ancerenffirtnn F'xemption 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 108.3.5.2. Definition of Homeowner:Person(s)who own a pared 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 be required Som 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) yen 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, - . The Commonwealth of Massachusetts �,>—. IDepartmentofIndustrialAccidents Office oflnvestigatians 600 Washington Street ( ifi �+ Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): C'r)S iia Address: .311 L .24,6.../,.t.\lnKr-f 24 2._,t;s4's/ 0 p �3 City/State/Zip: Phone if: (l ( 5—I 6¶7 Are you an employer? Check the appropriate box: Type of project(required): I.MI am a employer with 7--.. 4. I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* - have hired the sub-contractors 2.E I am a sole proprietor or partner- listed on the attached sheet. 7. ®Remodeling ship and have no employees These sub-contractors have 8. fl Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.�Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing thea workers'compensation policy information. tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. • � D Insurance Company -t Name: l hZ, 146,-)-1 or '"fr-�� Policy#or Self-ins.Lic.#:O Gt C) b Q IInl ( 7 ug Expiration Date: Sl ( 4 yyyI) 7 Job Site Address: / v..t O� `Q t,J b City/State/Zip:� C; �/` Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, 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 violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DLA for insurance coverage verification. I do hereby certify under the lains and penalties a/Perjury that the information provided above is true and correct \ ._ /n Date: ' (_ 2 / � Fl Phone#: 4) 3 ' (g-j` (0�-T 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): 1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: City of Northampton +, Massachusetts .471y . DEPARTMENT OF BUILDING INSPECTIONS 'p n, 212 Main Street • Municipal Building 01060 ?� --Mn Northampton, MASpW^y:��d' INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner' as, " Person(s) who owns a parcel on which he/she resides or intends 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 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 regulations. 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 made understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location City of 2\orthampton 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 0111, S 150A. Address of the work: I -7 60 i at.9 The debris will be transported by: _A uS i /il 3 The debris will be received by: Building permit number: Name of Permit Applicant el 4/ 12-/ Ii ri s c:J/0 Date Signature of Permit Applicant ac Ro CERTIFICATE OF LIABILITY INSURANCE WTE,"MI°° moi- 4/19/2017 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(ies)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 endorsement(s). PRODUCER CONTACT Christine Wallin, CISR Bell E Hudson Insurance Agency PPHH[ONNEE Fns(413)323-9611 i mic.Nol"113)323-6117 19 N. Main Street 1DoanE Es s.cwallingbellandhude on.cont INSORERCSJ_AFFORDING COVERAGE I NgIC N• __ Belchertown MA 01007 INSVRERq:National Grange M t C l Ins.Co 1,20]59 INSURED ,INSURER B;AGM Insurance Company Michael Flynn, DBA: Flynn Electrical I INSURER C; •I 110 Kennedy Road11 INSURER o: INSURER E: • Belchertown MA 01007 I INSURER F. COVERAGES CERTIFICATE NUMBERMASTER 16-17 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 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 BEEN REDUCED BY PAID CLAIMS. NCR I 'ADDLSUBR- ----- ' POLICY EFF I POLICY EXP ' TYPE OF INSURANCE !Rimy WVOI POLICY NUMBER (MMIDOIYYYYI I IMMIDDNYYI YI L LIMITS l"'I X I COMMERCIAL GENERAL LIABILITY II I 'EACH OCCURRENCE $ 1,000,000 II l A j,, I CLAMS-MADE X . OCCUR • DAMAGE TO RENTED PREMISES(Ea occurrenceL 6 500,000 X I $250 PD Deductible1MPD63005 5/28/2016 5/28/2017 MED EXP y one person) 8 10,000 XPer Claim Basis li PERSONAL 6 W INLuRY I,S 1,000,000 �_GENT AGGREGATE LIMIT APPLIES PER I GEE AGGREGATE I$ 2,000,000 X 'POLICY�Ii JEI—I LOC ',I PRODUCTS.COMPPP AGO i S 2,000,000 'OTHER'. I I S AUTOMOBILE LIABILITY IIB eSINED SINGLE LIMIT $ I ANY AUTO I I BODILY INJURY(Per person) $ ALL NFD SCHEDULEDBODILY INJURY(Per acodent) $ __ A 'AUTOS I AUTOSNONLOWNED I PROPERTY DAMAGE $ HIRED AUTOS I AUTOS I ($$$sant I $ • CH IUMBRELLA mGOCCURRENCE I� XCESSLIAa lCLAIMs"gDE AGGREGATE S s DED $ I WORKERS COMPENSATION Ii PER '.ANO EMPLOYERS LIABILITY • STATUTE ''I ERH PRETORFARTNEEXECUT VE YI" ANY PRRIi I E.L.EACH ACCIDENT 5 500,000 RIMEMBER EXCLUDED? I N B A - -- "MyyandatoryinNH) "C°63005 10/24/2016 10/24/2017 EL.DISEASE-EA EMPLOYED$ 500,000 IDESCRPiON uOF OPERATIONS Delo I EL.DISEASE-POLICY LIMIT I S 500,000 DESCRIPTION OF OPER/MONS I LOCATIONS I VEHICLES (ADORE 101,Additional Remarks Schedule,may be attached it more space is required) ELECTRICIAN- NO ALARM WORK SOLE PROPRIETOR IS EXCLUDED FROM THE WORKERS COMPENSATION COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Kris Thomson Carpentry THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 362 Kennedy Road ACCORDANCE WITH THE POLICY PROVISIONS. Florence, MA 01053 I AUT"ORIS ED REPRESENTATIVE /I� ,,c '],,, D C Wail:r. _I33/CHRS (she t HC Mme(- eaftassJ ©1988-2014ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INSO261p0Ienn 4 o()el aS ��ac A/- 1'7./17 City of Northampton Building Department 7/ d, Plan Review Ara k 212 Main Street _.^a - --= ++ Northampton, MA01060 7. ISec` lam . g°c{ r i u;. 1.1 iSThci n--. CL RA.. s nt , i _ LI 1- 4. -_ ._"44 �--� i — _'';�^" 'i' S cAiS-f'„ic ' I Pro poce (I J De.Tc_ ; 1 ioo ( pi0.c . C7i. Sedc,>-,C1 (/oor ktGI S W1 ) 1 .W o OM l ct_. tr. , A(c r h v1p t Q ir-) 0 T- Load bcu?tv-> c�