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35-128 (4) 47 O'DONNELL DR BP-2017-1225 GIS#: COMMONWEALTH OF MASSACHUSETTS Man:Block: 35- 128 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeory:renovation BUILDING PERMIT Permit# BP-2017-1225 Project# JS-2017-002060 Est. Cost: $21110.00 Fee:$136.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Grou tom' JOSEPH KENNEDY 055440 Lot Size(sq, ft.): 11717.64 Owner: EAGLE DAVID Zoning: Applicant: JOSEPH KENNEDY AT: 47 O'DONNELL DR Applicant Address: Phone: Insurance: 38 HARKNESS AVE (413) 525-1735,...0 Liability EAST LONGMEADOWMA01026 ISSUED ON:4/26/20170:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 2 NEW EXTERIOR DOORS, 6 BASEMENT WINDOWS, STRIP ROOF & NEW SHINGLES, REMODEL BATH 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: OilInsulation: 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: FeeTvpe: Date Paid: Amount: Building 4/26/2017 0:00:00 $136.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis I lasbrouck-Buiidine Commissioner File k BP-2017-1225 APPLICANT/CONTACT PERSON JOSEPH KENNEDY ADDRESS/PHONE 38 HARKNESS AVE EAST LONGMEADOW (413)525-1735 O PROPERTY LOCATION 47 O'DONNELL DR MAP 1�5 PARCEL 128 001 ZONE '.HIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid f Building Permit Filled out 4 k-49 Fee Paid Tvneof Construction- INSTALL 2 NEW EXTERIOR DOORS,6 BASEMENT WINDOWS,STRIP ROOF& NEW SHINGLES REMODEL BATH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildin Plans Included: Qwner/Statement or License 055440 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: pproved 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 Pemiit 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 Den+ i. i [/ .�..I / 7 409 /7 .. __ Signature • Building Official a 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 I i 212 Main Street Sewer/Septic Availability_ APR 2621111 Room 100 Water/Weil Availability Northampton, MA 01060 Two Sets of Structural Plans rr E F .FAD a�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 1.1 ProperW Ad•�tlress: This section to be completed by office 1/7 OlO0hPeU Q,' . Map 35 Lot /c3 ✓t/ Unit {- ( o f 7 kc e I i `G Zone Overlay District U0f4Lu4 ut--etn rue, am St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: /s Douid eGS'� ` 7 O 'IJdnw FII Dr(0-e Name(Print) ^ N ' Q V Current Mailing Address: Telephone Signature Dirtt2.2 Authori Mont: �" cceFL A ttw'tt•P� �� Wff Ain Fad- tem/min,- Nam (Print) Currrent Mailing Address: W�a oloae - yrs - rar- r7 7s Sig ure Telephone S TION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 1 l c, 6i O (a)Building Permit Fee ( o 2. Electrical $ I /J 00 (b)Estimated Total Cost of Construction from(6) a 3. Plumbing 1 -7 Q Cio Building Penni Fee yg 2 4. Mechanical(HVAC) 5 I =1I ,/ij 5. Fire Protection N O t'lQ l.✓" / 6. Total=(1 +2+3+4 +5) ,ra ) If 0 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled is by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&location) A. rias a Special Permit/Variance/Findingp� ever been issued for/on the site? NO O DONT KNOW 1CY YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW O YES O IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO gi DONT KNOW O YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained 0 ,�Datte Issued: C. Do any signs exist on the property? YES O NO g) IF YES, describe size, type and location: Com' D. Are there any proposed changes to or additions of signs intended for the property? YES O NO a/ IF YES, describe size, type and location: E. WlI the construction activity disturb(clearing,grading, vation,or filling)over 1 acre oris it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House n Addition ❑ Replacement Windows Alteration(s) n Roofing rpr Or Doors it Accessory Bldg. D Demolition ❑ New Signs [D] Decks [D Siding(DI Other[Di Brief Description of Proposed Work: Sns++.[I 1 hoc, ea.1+rac. d carry 6 boceo.- wirJocrr, sLy rep+pc.... cll.lib r, -euTndl( L-I4 Alteration of existing bedroom Yes VNo Adding new bedroom Yes ✓. No Attached Narrative Renovating unfinished basement Yes �No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing. complete the following: 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 OWNERSAGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I. `/ a V`-C \`�' FQ Iy_ ` I` ,as Owner of the subject hereby V °c—ip f_ ` A �l hereby authorize � //[ to act on my ehalf,in all matters r alive to work authorized by this b -ding permit application.mili Signatureiiin of Owner ( I^ Y Date — I4 I / I, v` 0 Ce V " ` A o Ll v `4T ,as Owner/Authorized Agent hereby decla that the statements and inform on on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pns an penalties of perjury. --2-0 SP e � 4e [Awe ay Print Nam Signature Owner/A pc Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: �1t �/� Not Applicable 0 Name of License Holder: TOS?Pl` R Kk Wil 4. 0 c>ic`r q0 License Number (Ce 4-ore4ir S-I- ?otti)Soi[(1 fc, 0(0 09 7 - aa - ( ss Expiation Date 10?-sa7-7371 S �� p..77 turaTelephone 9.Registered Home Improvement Contractor: Nott / rt [�' Applicable 4l ! I -Idvt Com nName Registration Number�� Cti0.N (S CO0SA/VCI- 0C1 S-- i6 - ( 2s Address ,( f l Expiration Date 78elL-- ike rr AV-� FV d L 4 Mte end Telephone �r�r-(73S OI O0Q 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 t 5.- No ❑ 11. - Home Owner Exemption 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 10835.1. 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 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. omeowner 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: 117 o 'Da In int /I. Dr • The debris will be transported by: US A tAq The debris will be received by: DCA a S - u ST U i ,aro r Ck Building permit number \ I Name of Permit Applicant J 6 cceL �QIAI I P��j Date Signature of Permit A . _ ' ant The Commonwealth of Massachusetts n Department of Industrial Accidents it=2 — ' Office of Investigations ia- a .. mi 's =. I Congress Street,Suite 100 •.a: 0m : l Boston,MA 02114-2077 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Busines(s/OrganizationAndividual): ( A LIUj CO 1C�-n/C4CI Ot+ Address: 7? 1^2 ff&U-e FG 54 t 0 t•ty Lx.err)0 et) City/State/Zip: PA et 0 l 0 a ? Phone#: ill? - S a S - l 7 ?C Are n employer?Check the appropriate box: I. I am a employer with 7 4. ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).' have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- These on the attached sheet. 7. remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insutance.s 9. El Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I1.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 ITS'�taof 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 suction below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contra an must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name ofthe sub-contractors and state whether or not those entities have employees. lithe subcontractors 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. Insurance Company Name:TPA ik.srurauce a frBoy t( 9 Policy#or Self-ins. Liffe.#: W( D OO as?7 Expiration Date: 1 (Up -\i 7 p^ p lob Site Address: ` / 01 ool'i teII Df. City/State/Zip: p oP&aky1 recn PA-6 ©Io00) 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 ofa 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License fi 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#: ^� CERTIFICATE OF LIABILITY INSURANCE wap,......"" 6/7/2016 ) THS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THS CERTIFICATE DOES NOT AFHRMATNT3Y OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. TICS 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*MIRED,the poocyfies)must be endorsed- If SUBROGATION S WANED,subject to the terms and conditions Mere policy,certain politics u.w require an endorsemeCt A statement on this reritmR does not cot rights to the certificate holder in lieu of such endarsemerd(s). PRODUCER Nat Lisa Leeson BAT Berkshire Insurance GROW, Inc. PRONE (413)935-1200 WG NK(413)567-5300 138 Longmeadow St- :11oca@berksli - g n .cs INSURER/3,AFFORDeactOvERAER MACS Longmeadow OA 01106 NBIEeA The Seating Grow INSURED eBaER a Safety Indemnity Co- 33618 Cheri sta Construction Services, Inc- maim c TRA Insurance Apency Inc. 38 Harkness A NBrNER O: East Longmeadow NA 01028 INSURER F: COVERAGES CERTWICATE NUIB(3tC1165443989 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES Of INSURANCE uSTED BELOW RAVE BEEN LSSUED TO THE INSURED NAL®ABOVE FOR THE POLICY PERIOD INDICATED. NOPMTHSTANDING ANY REQUIREMENT.TERM OR CONDITION OE ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOW ICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERON IS SUBJECT TO ALL THE TERMS, OCCLUSIONS AND CONDITIONS OF SUCH gPpOLLICCEMITTSMITTSS.. TS SHOWN MAY HAVE BEEN REIN ICED BY PAM CLAMS. LPOUCT BP POLICY EGT ITH TYROF DOURAN(E )I N!Nyal FOIL,MM39[ me oonyrrY) arimeornen LEVIS X COMMERCIAL GENERAL UARSITY EACH OCCURRENCE S 1,000,000 DAMAGE RENTED A CARIS-MACE X (Yfl TDjEy ) $ 300,000 I_ 51026017 5/6/2016 5/6/2017 LEDER,(Anyone pssn.) 5 EcJ.nded. PfT✓SOtwlaADV eAJRY $ 1,000,000 GENt AGGREGATE inert APPLIES PER GENERAL AGGREGATE 5 2,000,000 $ POJCY JEER8sr LOC PRODUCTS-COMPOPAL 5 2,000,000 IO_ Properly Demme Detuc 5 AUTOMOBILE LIABILTTYCOMBINEDSINGLE LIMIT 5 r-1AAUTO BODILY NABS(rya Tam,) 5 250,000 B M,All OWNED SCHEDULED Av. x AUTOS 5021567 6/2/2016 6/2/2017 BODILY NASRY(PaflE) 5 500,000 PROPERTY DAMAGE X HIRED AURA $ AUT NON-OWNED m� 5 100,000 I $ UMBRELLAW I UMBRELLA es (1-12 IR ( EAO ?C 1OGCt E �S YCE4s Lore �)n.wsu.rr AGGREGATE 5 DED I 1 RETENTIONS i 5 WORMS cOrMNeA,IDN I I PER I TR- AraEMPLOYERS'HAMM ANY PROPRIETOWPRTNEREHERTHV£ YN j NIA EL EACH ACCIDENT 1,000,000 OPRCERAGEISEER C (YMpm 'm TRH EXCLUDED" M0002537 6/8/2016 6/8/2017 EL r4a¢-EA EMPLOYEE 5 1,000,000 Idescnbe rscm OFFOOPERATrors below EL T{3AW-PC../CY HIST 5 1,000,000 DFSCRPDON OF OPOMTNN6 I LOCATIONS/mean MCOIE in A6dtioM pIDUY Ss®I Ne Fae.Si wee Wwabw9or.0 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE MORE DESCRIBED ROUGES BE CANCEUJED BEFORE Proof of Insurance HE ETPRMTION TATE HEREOF. NO510E WILL BE OELNEAED M ArrORDAMGC WflH THE POLICY PROVISIONS. Rumoatmo RepaimernuivE Judi Mabee/.Til Or— ®1988-2014 ACORD CORPORATION, AN rightte reserved. ACORD 25(2014101) The ACORD name and logo are registered marts of ACORD M5025 omen Q 2 J// / { P1f"�... flu be troinimoneceC�2�I"(,, o 2ilref•JC,feA/(.toetito Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration 171982 Type: Corporation Expiration: 5/10/2018 Trm 289969 CHARISTA CONSTRUCTION SERVICES IN MARYBETH BERGERON 38 HARKNESS AVE. EAST LONGMEADOW, MA 01028 -... -.... ___... ___ _.. .. Update Address and return card.Mark reason for change. I; J Address j ] Renewal pi Employment f—I Lost Card SCA1 ii 30ML5/u ry/Zr- [`uar„//.9 AZ 9-76/.umrf License or registration valid for individual use only Office of Consumer Affairs&Business Regulationg tf1r I;3 HOME IMPROVEMENT CONTRACTOR before the expiration data, If found return to: A4 IF .9 RegIsBatton: 111982 Type: Office of Consumer Affairs and Business Regulation s9 l'4"' Expiration: 6/10/2016 Corporation 10 Park Plaza Suite 5170 Boston,MA 02116 CHARISTA CONSTRUCTION SERVICES INC. MARYBETH BERGERON. 38 HARKNESS AVE. �..,,_ .�,. ._........ EAST LONG.EAOOWY.MA 01028 U deraccrMary Not valid without signature IIMassachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-055440 ;?i' Construction Supervisor JOSEPH A KENNEDY 10 FOREST ST POBO%1086 BONDSVILLE MA 01008 �.�. Expiration: Commissioner 07)22/2018