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31A-059 (5)
274 CRESCENT ST BP-2017-1361 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31A-059 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Bath reno BUILDING PERMIT Permit BP-2017-1361 Project JS-2017-002265 Est.Cost: $12000.00 Fee: $78.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: TEAGNO CONSTRUCTION INC 034716 Lot Slze(sq.ft.): 6490.44 Owner: BERGER DAN H& LAURA A Zoning: URB(I00)/ Applicant: TEAGNO CONSTRUCTION INC AT: 274 CRESCENT ST Applicant Address: Phone: Insurance: 228 TRIANGLE ST (413)549-0803 Workers Compensation AMHERSTMA01002 ISSUED ON:5/24/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:RENOVATE EXISTING 2ND FLOOR 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: 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 5/24/2017 0:00:00 $78.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-1361 APPLICANT/CONTACT PERSON TEAGNO CONSTRUCTION INC ADDRESS/PHONE 228 TRIANGLE ST AMHERST (413)549-0803 PROPERTY LOCATION 274 CRESCENT ST MAP 31A PARCEL 059 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENC SED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid �� Building Permit Filled out Fee Paid Tvoeot-Construction: RENOVATE EXISTING 2 IYFLOOR BATH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 034716 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: /.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 olition Dela fair/ e V /- Lai Sign. • e 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. IA : City of Northampton Building Department t ` \ 212 Main Street Room 100 , , .:.�-33 r brilt __Northampton, MA 01060 Sy§n-8t ifffi -31`.'1-4 7At phone 413-587-1240 Fax 413-587-1272 oyyyy,e ; .;:k�g\.-� Stir - 'Yt .� ' 3v+ Y•'�' ,e APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Addressl� Thishisection to be completed�-pby office .01.7E C./Lest-940f- ' Map 311, Lot OS/ Unit NUL(N-Aa-®r t Zone Overlay District Elm St.District Ce District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ib&) 8.4 Ain-- 4 zawc A- L.` 1 Z 106 U&a-A)city ST N d/z rttnM1 Priya N lass id Curre('nTtt'"Mailing Address: Telepdoo ;Z6 3 gnature 2.2 Authorized Agent: i —ytt-,)0 C6wS0W-CT1c/' //DC- 7241/ 7YuI}„)!a/V s ` ! Ltt eter- Na (P /n1 Current Mailing Address: N_ jrz Y' tl3 SK S o 5-o3 Signature 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 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5 Fire Protection e %( 6. Total=(1 +2+3+4+5) 11/4-2 aza . Check Number /efQ ri� /�� This Section For Official Use Only \ Building Permit Number: Isste saved: Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Proposed Required by Zoning This oimnn to be filled in by „ Ea. �'11:ti1:J' Building Meant Setbacks Front Side Reaz 1111111111 Open Space Footage 111111111111.1 (Lal area minus bldg Paved Mina #of Parkin:S races A. Has a Special Permit/Variance/Finding ever been isved forton the site? NO 64 DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW Q YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW ® YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained Q , Date Issued: C. Do any signs exist on the property? YES O NO 0` IF YES,describe size, type and location: 0. Are there any proposed changes to or additions of signs intended for the property? YES © NO O IF YES, describe size, type and location: E. Wig the construction activity disturb(clearing,grading,ex ration,or filling)over t acre or is it part of a common plan that will disturb over 7 acre? YES ® NO F*♦ 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) E Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition C New Signs [0] Decks (O Siding I0] Other(*I Brief Description of Proposed Work: R.GWO MAY' (✓x94,51-1 & bbtto')D gc'drt- &erect Alteration of existing bedroom Yes X -No Adding new bedroom Yes K No 'Attached Narrative') Renovating unfinished basement Yes JL No —Plans Attached Roll -Sheet ea,If New houseandoraddtt1n to'existina housinch omftete thefoltowinq: r-I //} 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 Q Jv \ I, w yDctxt_Gs61t_ ,as Owner of the subject property /'y hereby authorize O(A.f)Sqtef,, tA,i Cil(PiD t io to act gTmy behalf, i ers relative to work authorized by this building permit application. Signs urerof Ownneerr —' Date ‘ �� ` ' 7 I, '1Za4 ALS. 'RikctAoPt �G Te ,ec CAu cc tt tWt5 J IAD C- Ose , asard\uthodzed Agent hereby declare that the stlatements and 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. fiwlA-t.-D tilikw0 Pri Name Is-72.).16 7 Signature of er/Agent Date SECTION 8-CONSTRUCTION SERVICES 4,1 Licensed Construction Supervisor: Not Applicable £ Name orairxnse/Snider: flh7 ") l tt�l'C"G 13-10 CS O% ' '"7l k License Number e• - i ",. £ M,bkt:1es41 e,vt al_oot !f(OLo1 AA es ` -- Expiration D e ♦ 'ut3 3i6tf 7f. Signature I Telephone 67/0/1/ e aa)w c&s. -1-ru&crt OA) 9.Regestered.Home'.NnproyeinenfContractor. z, Not Applicable £ ��= t-Csas caW S¢M..c.,a Lo7S r rj C_ t0 (0 `j Company Name Registration Number 2-2.2 132t fru s t fW M -9S wl r� 8' z 201 Address Expiry ion Oat Telephone*13S ' l a 3 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§2SC(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 build' g permit. Signed Affidavit Attached Yes No £ t.:410` v Qk neit¢IDi*ttMn The current exemption for"homeowners"was extended to include Owner'oteopied 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 108.3.5.1, 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 pesos who constructs more than one home In a two-year period shall not be considered a homeow net. 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 perforin 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_ _vinyl 141 n v7 ' 7 n ynns.51 V,d _ iNi_adt4W s nQa o-vfl J s rim 4-. i cv Lvd - 77ry Iv 1„11nudn IrvU71Ya =7�-1/ Id - Zki-71-S _Yl 1-L -r- y.p b M 1 - nrx a kU-V% -s,ry1_151x-9 atfl39- d.p J.. s) 5 Mp'o S mCtLLYn0cv4 Li/'6//9 ->>v / nn7_1-71'wlbs nw0 c1•—.'zk�) 5 f7.1V ( ocvo-u 4U-1" Lc\c t7S T3 �LZ icr--4) Ants °off ga.rw• b �jt ". DEPARTMENT OF BUILDING 1NSPECIIONS e _:-( EE 2I2 Main Street ' Mamidp i leading tie*— Northampton, Mass, 01060 WORKER'S COMPENSATION INSURANCE Af'MBAvrI I. `tete t*So Crown ttY vt_c-- tow f .+ G (liwnsee/pamiaee) with a principal place oflataln.cdresideace at: 2- -nt_t ffw&t.e :1'^ /Nut t't -r.&31 (phones)%ft3 541. a ro 3 (a`xeYUaty/su1c'rip) do hereby certify,under the pairs and penalties of perjury,thst: `„"� §,e) I am an rreypioyer providing the following workw's compensation coverage.or my employees working on this job: � � ffltk� MJ tUj l Wwz koOGvzyo 120171} 6�i(Jot S anmvatum Company) (Policy Nomh.r) (Expiration Date) ( ) I am a sole proprietor,genual contactor or homeowner(circle one)and have hired the contractors listed belowwho have the following worker's compensation policies: (Noma of Contractor) (Ineuanx Compaq/Policy Nuannr) (E irnaoa Dam) (Name of Cnotnttor) Uaneraam Con ny'/PolegNnmtee) (Egmont Date) (Name of Conn-actor) (1n0tranc'e Compzny/Poicy Numirr) (Expiradoo Dam) (Statue or Cotaraaor) (Ito Compaey/poIiey Ntmdrr) (Ecciratioa Date) (artard Withal mw ifmaavyt soUMe inf mmoe m+t+ eu4 enemsas) ( ) I am sole proprietor and have no one working for me. ( ) I am a home ownerperforming all the work myself NOME:$oar a vat ot&hart aba,mp try p'm to*mabr4a^ aammrioa�r�+nam.c�+ak®4 dont=el agleam than*roe man k chide 2e hemaewnr m or o Ub roads appaustbauo arc as meatywmiAS mar employee under the wadcn msp�Seitu Aa(DW52,a1(3n,nppaa%aby tbommwrcrfar a tiame a pa*may ani IS 1001 dant aploy rodae0a WalaaGmpaabnAm. t amd.rwadthaaoap,offtde aatmanaay .raa.dd to M rhw�anfroSatnal ArodrdfOS ofks as fat 4a %stag verandas acdWeSDn ton=m u4rrxcemRSAedN6.t31 mYdmila i tmmbd tmtia =drag oft few Map m 21,30.00 mUam <ali to me yeaae4 da7pahi=in Ea ram of a Stop Wok OrdceeSa 51*t2100.W qday apabs mt. Fa dk+t Num m.aah Pe..Number !� '� mils lAth .......�._.SMS18e6E 1lF ..»\_ 'ermiucc Date �.�� ,.•^�� TEAGN-1 OP ID:IR ACORD CERTIFICATE OF LIABILITY INSURANCE °A 04/28/MM2017ttT 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 le an ADDRIONAt.INSURED,the po lcylias)must be endorsed, If SUBROGATION IS WAIVED,subject to the tens and conditions of the poky,certain policies may require an endorsement A statement on this certificate doss not confer rights to the Certificate holder in lieu of such endoreement(s). PRWIICf.R NAMEllyssa Riley PHILLIPS INSURANCE AGENCY INC sT CENTER STREET Ns rffi4135945984 WC.uek 4133924499 CHICOPEE,MA 01013 mss:IIyssaefhMipainsurance.com PHILLIPS INSURANCE AGENCY INC MCURERNI AFFQROMC CONSUME NMCS MEURER A:Ohio Security Insurance Co 24082 mums Teagno Construction,Inc. MSUREs B.A.I.M.Mutual Ins,Co. 33758 Mr.Donald Teagno mamas.0100 Casualty_ 24074 228 Triangle Street Amherst,MA 01002 MISURERO: INSURER E: INSURER F: .... COVERAGES CERTIFICATE NUMBER: 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. NOTWIHSTAICING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER Orn%4ENT WITH RESPECT TO WHICH THIS CERTFICATE MAY SE 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, Tut MDL SUER POLICY WM POLICY ERCP TYPE OF WUMANCE MEM ENO POLICY MUMMA Iawm'vv, Ononotc(YYL, Liens A X COMMERCIAL GENER.UASUTY EACH OCCURRENCE 1,000,000 CLAWS {OCCUR BK557750627 0401/2017 04/01/2018 PRFfmFe JF � CLAWS-WNW 500,000 IRO EXP XS o,_.parses! 10,000 — ... PERSONAL a MY INJURY 1,000,000 GEML.AQGREGATE LIMIT APPLIES PER: GENERAL MGREOATE 2000,000 wtICY Iiecpi ICC PRODUCTS-COLMAP AGG 2,000,000 OTHER: AUONO°rs aam (6 i tGL5 ws 1,000X00 A ANY AUTO BAS5T/50627 04/01/2017 04/01/2018 BDDILY MORS'CPewxmy ALL OWNED )(SCHEDULED DOORS EYURY IPV accident) $ —AUTOS ?OTOS X Fe sumsX MMaOWNED PRH E .. tl X UwiH1.A Lw X OCCUR EACH OCCURRENCE 5 1,000,00d B EXCESS UPS CLAWS-WM UUSD57750627 04/01/2017 04/01/21* AGGREGATE $ 1,000,000 BED X MEIEHmoNs 10,000 e WORKERS COMPENSATIONPER OTS" ANG IMPOSTERS LIMNERIx STAKE ER B ANY PROPRETORPARENEXCUINE MWM28008223012017A 14/01/2017 0401/2018 EL spot ACCXIENT T 1,000,000 CFECERSEWIER EXCWOEM ❑NI A (XWOMPOSMl EL DISEASE-EA EWIOYEE 4 1,00000U vs demste DESORPTION OF opERAHONs beim. EL.DISEASE.POLICY UNIT $ 1,000,000 CESCRPTIW OF OPERATIONS I LOCATORS I VENOMS"MEMOS NL AMMmN Rmtb S t**a may b NUMMI M mem space Nauman H CERTIFICATE HOLDER CANCELLATION PROOFOF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE TNF8FOF, NOTICE WILL BE DELIVERED M Provide Proof of Coverage ACCORDANCE WITH THE POLICY PROVRKRS, AUMAR®°REPRESENTATIVE QQj,t,,,,,a XXX14 r". ®1985-2014ACORD CORPORATION. An rights reserved. ACORD 25(2014/01) The ACORD name and logo ars registered marks of ACORD A 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 L( C - S The debris will be transported by: U:: OE &murt�rutic,-iQ The debris will be received by: W W. Building permit number: Name of Permit Applicant-- 30 Deli/cc-Tien") hictr e ow S Del 57.71A 7 Date Signature of Permit Applicant