43-077 (8) 57 DUNPHY DR BP-2009-0349
GIs#: COMMONWEALTH OF MASSACHUSETTS
a :Bbck: 43-077 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2009-0349
Project# JS-2009-000483
Est.Cost$4000.00
Fee:$35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: CW CONSTRUCTION CO INC 104588
Lot Size(sa. ft): 15855.84 Owner: GIRARD KIMBERLY&CHRISTOPHER GARNER
zoning S . Applicant: C W CONSTRUCTION CO INC
AT: 57 DUNPHY DR
Applicant Address: Phone: Insurance:
46 HOWLAND AVE (413) 743-1846 WC
ADAMSMA01220 ISSUED ON:10/1/2008 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS/DOORS
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: O1: Insulation:
Final: Smoke: Final: Gilt U(28.114 Lpr+s
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occuoancv /Hl -L.X Signature: ' "� or.
FeeTYpe: Date Paid: Amount:
Building 10/1/2008 0:00:00 $35.0015369
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
Deparbnsnt use only
City of Northampton Status of Permit
Building Department Curb Cut/Driveway Permit
212 Main Street Sevier/Septic AvdabiMy
Room 100 WaterNWS Availability
r_—L,----1nrthamptOD, MA 01060 Tro Sets of Structural Plans
"11 I:; 10 e 413$8'C12`[40, Fax 413-587-1272 Plot/Site Plans Other Specify
APt41CATIQHIFTOfONIR.SUCT,ALTER,REPAIR RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
U dd 44JJt�i
SECTION I-S cllF€I-INFORMAAOAL___i
This section to be completed by office
1.1 Proverb/Addriem-
Map Lot Unit
57 Dunphy Drive
Florence, MA Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
3.1 Owner of Record: / AAD C
Kimberly Girard /& Christopher Garner 82 Williams SLt; Northampton
Name(Phi � Current Mailing Address:
411—AA1-1174R
4))m/lL%/t( / 0 4Jhilk Tekyhone
Si
2.2 Autilorlred Aaent:
C W Construction Co. . Inc. 46 Howland Avcnua. Adams MA
Name(Print) Current Mailing Address:
) 11.1 ' 1 -913-743-1846
Signature / 0 Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
$4,000.00 -
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) $4,000.00 Check Number /5269
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Sueding 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 mmmn to be filled m Iw
Building Department
Lot Size
Frontage
Setbacks Front
Side 1'. R: L: R.
Rear
Building Height
Bldg_Square Footage %
Open Space Footage %
(Lit area minus bldg&paved
parking)
p of Parking Spaces
Fill:
(volume&Location!
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW 0 YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO Q
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. VNII the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is 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.
: CI.N5-)h.: " . . tato. I aa :. i . . .
New House 0 Addition 0 Replacement Windows Alteratlon)s) ❑ Roofing ❑
Or Doors IR
Accessory Bldg. ❑ Demolition 0 New Signs [01 Decks CI Siding[D] Other[CO
Brief Description of Proposed
Work: Installation of new windows and doors
Alteration of existing bedroom Yes No Adding new bedroom Yes y No
Attached Narrative `t Renovating unfinished basement Yes Y No
Plans Attached Roll -Sheet
sa.If New house and or addition to existing housing.eomDlete the to0owina:
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?
t 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
I, Kimberly Girard ,as Owner of the subject
property
hereby authorize in W (Yin et runt fn Tin fit
to act on my be ad,in I matters relati to wo uthoraed by this building permit application.
�. 2 Sept. 29 , 2008
Signature otz.nen Date
I, r W Construct-inn Cr, TNr ,as Owner/Authorized
Agent hereby declare that the statements and intormztion on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed un er the pains and/p//8n/a/lti/e/s o/f perju
‘
Plitt Name Marry E. Siliftr five Manager
Sent . 79r 7008
Signature of Amer/Agent Date
•
SECTION 6-CONSTRUCTION SERVICES
§.t Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: Donald F. at rard n1 1878
License Number
46 Howland Ave. . Adams, MA 01270 06/71 /7011)
Address � �/ (� Expiration Date
'lam41*S ,/ 1U%mJ X 413-793-1896
Signature ) �, Telephone
9.Registered Home improvement Contractor: Not Applicable ❑
C W Comet ntrtinn Co_ Tnr 104 SRA
Comoanv Name Registration Number
d6 Rowland A..Q- , Adams, M* 01220 7/14/2010
Address /� ,n � Expiration Date
4,LQ. >L ir/ ZL /NSA- Telephone 413-743-1846'
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.152,k 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_..... a 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 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-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 Conatruekn 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 I52(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
Windows and Doors _ `_ 900,9Q
Kimberly Girard & Christopher Garner
_-_, 57 DunphyAriv_e,- F39sEnce,11A_..—
Sept.• 29,
C W C-777
otruc on Co. I
9/23/08 _a1: 1 7etc J/ �•! v "-� �� 104988 ._
U /
In accordance with the provision of MGL c.40, §54, a condition of Building Permit
Number is that the debris resulting from this work shall be
isposed of in a properly licensed solid waste disposal facility as defined by MGL
§150A.
The debris will be disposed of in:
NORTH ADAMS TRANSFER STATION
(Location of Facility)
Q,,}}y/,�`C((,,��,`,,jW Construction Co. , Inc.
by: J L I Y .. J rid/4
lana o e .. , A pl t
Date
The Commonwealth of_Massachusetts
Department oflndustrialAccidents
Office of Investigations
=7.-4E= 600 Washington Street
_ = Boston. '14 02111
TA •
- _ www.mass.aov,/dia
Workers' Compensation Insurance Affidavit: Builders,Contractors.ElectriciansPlumbers
.Anulicant Information Please Print Legibly
tic..e a usir s. Cizassihanch inch': iuc _ C
46 HOW, anti Avanue c tL``+-
Adams, MA `r -ac ne=: 413-743-1846
Are you an employer? Check the appropriate box:
Type of project(required):
ermioyees:3Pand or cam-time. nave..tea ,h :t:- ;_..:: on
—_ ' = a sole ]:c^.i 2raltr. fi[ _r. [ere. h. saner. ;aPne
s9 ..,:<e no . ___ 7 se ,r-:.on o none „
n._> i s .,,;..p_:
camp maharanee.-
J a eco' .. _n �c
_e _
chaircia
CCT1CerS niter
- "
.— _ . en:tin _ Dtr
sc 0110V SnOW:nE:.i ::-r
=SS= .:._ca s '... _v: or, -..;s:. au,.c .c._ i:= :u h.
I tin an emnieh e-that is providing .corkers' aontnrnsation insurance for my 3 w,o.eas. Below is the t;wiic;and job site
it1Ornearion.
surance Cotrar:Name: arc ,..........
'()uv = srSedi:tt. Lie WC 687-05-03 - -a:,_h Da__ 7/19/09
This Site Adit ess 57 Dunphy Drive, Florence, MA Cir. cam Zia: 01062
Attach a copy of the workers` compensation policy declaration page i showing the policy cumber and expiration dare).
_ »iia-e to secure coverage as required under Section tid?_of MOT c can lead to h ':rnpOSItien or Df criminalpenalties ies a
., ..
�e uo m �t.>:)U v0 apo-or ,,le-pear_mprim : M well as ,,:vi peasants in the o ,:.. STOP ., C 2+. ORDER and a spa
of en to ttf0. . sshhs against the violator 3e advised the:a coo- statement mai be fora .._a ic :he Office.,f
investigations of me DIA for insurance cover.se verification.
I do herebtertifr under the painsan penalties of perjury that the information provided above is true and correct. - .v
-- 'Y)?iuy (r 2I$ ro )11 r/90/
?hone=: 413-743-1846
0
Official use onh. 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 4:
I a�
1,10.0LU U BY THE STOCK INSUHANCE COMPANY HEREIN :ALMA) IH COMPANY =0=1 POLICY NUMBER
NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH. PA. 71991-0000 WC 697.29.92
'3072
Oi 3-8ZD'08-00
no BRAT B UNDER THE LAWS OF PCNNSYI VAN I A
+! CONSTRUCTION CO. , I NC. �I! Member Companies of
ADAMS,MSW MAD 01220.0000 ATIAmericarinternational trcup
ADAMS-,
ECECUTIVE OFFICES:
70 PINE STRE-T, NEW YORK. N.Y. 10270
3EE EXTEN$ICN OF ITEM 1. OF THE INFORMATION PAGE - WC290610 ,
MA Mt' PRODUCERS NAME Ann ADDRESS
CLUETT COMMERCIAL INSURANCE AGENCY INC
WORKERS COMPENSATION AND EMPLOYERS 8 PEMBROKE ST
LIABILITY POLICY INFORMATION PAGE KINGSTON, MA O236A-i109
NSURED :s PRE OUS TY..t NUMBER
2,0RPORAT I ON RENEWAL 006870503
OTHER 'WORKPLACES NOT SHOWN ABOVE: SEE EXTENSION OF ',TEM t. OF THE INFORMATION NAGE - WC39O610
fEM: OL:CY PERIOD I :t A.M.szaRom m um•at the mmn Pa
m.O,l,e aeon.. =ROM 0/ /19/08 TO 07/ 19/09
a42 A. worxers Compensation insurance; >en One or :he aotcy ao,Nes to the 'Wo vers Camtemsation taw of :he states 1stea
here:
MA
S. ammoyers Sadthey Insurance: Part Two at the =My applies to :he worn In exon stale listed In Item S.A.
The emits on our Imbility unser Pan Two are:
Bodily Injury by Acciaent 5 :00 000 nonccieent
Sootily Injury by Disease S Z00-000 policy'ams
Bodily injury by Disease S °00. 30Q each employee
1 C. Other States insurance: Pan Three at the policy apoues to the states, it any, listed sere:
AK AL AR AZ CD CT DC DE FL GA HI IA :D IL IN KS KY LA MO ME MI MN MO MS MT NC NE NH NL
NM NV NY OK OR PA RI SC Sp TN -X UT VA `r WI WV
D. this polity :ncivaes these
SEE EXTENSION OF ITEM S.D. OF THE INFORMATION PAGE . W C390612
-u s The aremlum for this policy wilt be detatmme0 ay our Manuals of eines. C.'assiiicatidns, Rates anu Rating Pans
All information reduired oelow is subject to verification arm change ov audit.
ea P^& ate Per I
Oassinmx;ont imne
e Nur I� �nune i 510L
IDI Annyal O' aj 'nu0,F,r n Ii A nu , sar
1 I
SEE -S"(TEI$ION OF ITEM 4. OF THE INFORMATION PAGE - WC7754
TAXES/ASSESSMENTS/SURCHARGES 5870
•
O
.X,SMSEZONSTANTIOCar WNERE APPLICABLE 9Y STATE: $318 MA •
4tNMUM PREMUM SERO MA TOTAL*BRMATEDPREMw$ S'6.AOu
nO:<atea stow. nle+m aaustmentt of orem,um sna:t,amaoe:
&•m.-Annually W aianenv ` Monthly DEPOSIT PREMIUM
)6/03/O8 PARSIPPANY 82 =� • Q A _ \r, � L, -
sem ay Inuiny pine. Aamanse ena.
R. nlYm 'ht EO 0301
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