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41-181 (7) 129 GLENDALE RD BP-2019-0210 CIS#: COMMONWEALTH OF MASSACHUSETTS Map.Block:41 - 181 CITY OF NORTHAMPTON Lot:- PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:New Single Family House BUILDING PERMIT Permits BP-2019-0210 Proiect# JS-2019-000343 Est.Cost: #236372.00 Fee:$613.50 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Group: PIONEER VALLEY HABITAT FOR HUMANITY 046013 Lot Size(sa. ft.): Owner: PIONEER VALLEY HABITAT FOR HUMANITY zonine: Applicant: PIONEER VALLEY HABITAT FOR HUMANITY AT. 129 GLENDALE RD ApplicantAddress- Phone. Insurance: P O BOX 60642 (413) 586-5430 O Liability FLORENCEMA01062 ISSUED ON.•811712018 0:00:00 TO PERFORM THE FOLLOWING WORK.•NEW MODULAR SINGLE FAMILY HOUSE FOUNDATION AND FINISH 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 Deoartmen[ 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 denature: FeeTYpe: Date Paid: Amount: Building 8/17/2018 0:00:00 5613.50 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File tl BP-2019-0210 APPLICANT/CONTACT PERSON PIONEER VALLEY HABITAT FOR HUMANITY ADDRESS/PHONE P O BOX 60642 FLORENCE (413)586-5430 O PROPERTY LOCATION 129 GLENDALE RD MAP 41 PARCEL 181 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid it Building Permit Filled out Fee Paid TypeofConstruction: NEW MODULAR SINGLE FAMILY HOUSE O N New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 046013 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: __Opproved_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 -Demolition Delay r^� Signature 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 CuUDdvevay Permit 212 Main Street Sewer/Septic Availability Room 100 WaterrWell Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 7 -SITE INFORMATI E I V E D 11- 1 7.1 Property Adtlress: T�� /I hissection to be comple d by office 129 Glendale Rd AUG 1 6 2018 Ma llLot l y l Unit Northampton, MA 01062 DEPT WC FLDINf,INSPECTIONS ZO @_Overlay District NOPTH4THAMPTON.MAOW60 at District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Mineral Hills Realty, LLC PO Box 60642 Florence, MA 01062 Na a(Print) Current Mailing Address, 413-5116-5440 / Telephone Signal 2.2 Authorized Agent: Pioneer Valley Habitat for Humanity, Inc. PO Box 60642 Florence, MA 01062 Na/r/e 1) Current 413- Mailing Address: (/� G 413-586-5430 Sagrakfe 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 not available (b)Estimated Total Cost of Construction from 6 3. Plumbing module,construction Building Permit Fee �1 includes most of these 4. Mechanical(HVAC) trade costs 5. Fire Protection 6. Total=(1 +2 +3+4+5) $236,372 Check Number This Section For Official Use Only Building Permit Number: Data Issued: Signature Building Commissioner/Inspector of Buildings Date Section 4, ZONING Alt Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size .51 acres .51 acres Frontage nla back lot on common drive n/abacklotoncommondrive Setbacks Front 20• Side L: R: L: 15' R: 15' Rear 20 Building Height 0 21' Bldg.Square Footage 0 0 1,210 5 Open Space Footage (Lot arca minus bldg&paved 100 22,163.54 95 trarkork) #of Parking Spaces 0 2 Fill: tbtl based on grading volume&latabon A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW O YES O IF YES, date issued: 9/12/16 IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES O IF YES: enter Book 12486 Page 226 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 O , Date Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO O IF YES, describe size, type and location: temporary construction sign for Habitation Humanity 4'x 3'on wood frame E. Will the construction activity disturb(Gearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Ste"Water Management Permit from the DPW is required SECTION 6-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Q Addition ❑ Replacement Windows Alterationls) Q Roofing Q Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [❑ Siding[0] Other[] Brief Description of Proposed Work. foundation,interior finish work and siding for 2 story single family modular home Alteration of existing bedroom_Yes_No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement _Yes __No Plans Attached Roll -Sheet ea. If New house and or addition to existing housing Complete the following. a. Use of builtling :One Family x Two Family Other b. Number of rooms in each family unit 7 Number of Bathrooms 2 c. Is there a garage attached? no d. Proposed Square footage of new construction. 1.210 Dimensions 13.75'x 44' e. Number of stories? 2 f Method of heating? ductless mini split Fireplaces or Woodstoves none Number of each g. Energy Conservation Compliance. yes Masscheck Energy Compliance form attached? preliminary HER h. Type of construction_modular wood frame construction I. Is construction within 100 Itof wetlands?_Yes ✓ No. Is construction within 100 yr. floodplain_Yes ✓ No I. Depth of basement or cellar floor below finished grade n1a-crawlspace k. Will building conform to the Building and Zoning regulations? V Yes_No I. Septic Tank V City Sewer_ Private well_ City water Supply ✓ SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, s O her t abject properly hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Owner/Authorized Agent hereby eclare that the statements ntl nformation on the foregoing applicatio are true and accurate, to the best of my knowledge and bi Sig d nder the pains d en es cf perjury �L',ja �� duauG xeur�; C Jirec�� Pri e' 8 /lo U Signature f r/A nt ate SECTION 8-CONSTRUCTION SERVICES 81 Licensed Construction Sunanrlsor: Not Applicable ❑ Nemp of Llcenae NOMar: Mich0el8mad 046013 Ucenae Number PO Box 94,36 Briggs Rd,Shutesbury,MA 01072 4/14119 Add n A a Eviration Date � 413-636-6747Signature I Telephone 9.Registered Home Improvement Contractor. Not Applicabk;l Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§26C(e)) Workers Compensation insurance affidavit must be wmpleted and submitted with this application.Failure to provide this affidavit will result in the denial of the issuance of the building permit Signed Afidavil Attached Yes....... V 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 W engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 1083.5,1. 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 peraon who covatweb more than ope home in a two-year ceriod shall not be wgsitlered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official.that hdshe shall be responsible for all such work performed under the belittler,oermut. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion ofthe 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)ofthe 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 Slate 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: 129 Glendale Rd Northampton, MA 01062 The debris will be transported by: Habitat volunteers or Duseau Trucking The debris will be received by: valley Recycling or Duseau Trucking Building permit number: Name of Permit Applicant Pioneer Valley Habitat for Humanity, Inc 8/13/18 ' Exewtrve Director Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 s Boston, MA 02114-20177 www.mass.gov/dia Workers' Compensation Insurance Affidavit Builders/Contractors/Eleetricians/Plumbers Applicant Information Please Print Legibly Name (Business/Orgnnization/Individual): Pioneer Valley Habitat for Humanity, Inc. Address: PO Box 60642 City/State/Zip: Florence, MA 01062 Phone 4: 413-586-5430 Are you an employer? Check the appropriate box: Type of project(required): I.[2'1 am a employer with 6 4. ❑ I am a general contractor and I 6. ®New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' y ❑ Building addition [No workers' comp. insurance comp. insurance? required.] 5. ❑ Weare 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 ❑ Roof repairs insurance required.] ` c. 152, §I(4),and we have no employees. [No workers' 13.❑ Other comp- insurance required.] 'Any applicant that checks box#1 must also fill out the section below shoving their workers'compensation policy information. t num owners who spbmlt this affida,d aulieating they are doing all wed and then hire outside com a rm,must submit a new aftdavit Indicating such. :Contraetors that cheek this box must alued ed an addinomal shoot showing the name of the sub-contractors end sate whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number_ 7 am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Lockton Affinity, LLC Policy#or Self-ins. Lia#: C48747401 Expiration Date: 4/1/2019 Job Site Address: 129 Glendale Rd City/State/Zip: Northampton, MA 01062 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cernjjayy under�,le ppaj\nc and penalties of perjury that the information provided above is True and correct. Sign t !'/� '.X7 Dat8/13/18 Phone#: 413-5 -5430 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as`an individual, partnership, association, corporation or other legal entity, or any two or more ofthe foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant ofthe dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because ofsuch employment be deemed to be an employer." MCL chapter 152, §25C(6)also states that"every slate or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements ofthis chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractors) rami addresses)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Parmerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. Kan LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom ofthe affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the perrnitllicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information (if necessary) and under"Job Site Address' the applicant should write"all locations in_(city or )" townA copy ofthe affidavit that has been officially stamped or marked by the city or town may be provided m the applicant as proofthat a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 Tel. #617-727-4900 ext 7406 or 1-877-NlASSAFE Revised 7-2013 Fax # 617-727-7749 www.mass.gov/dia City of Northampton Massachusetts � W � �. DEPAETb ENT OF BUILDING INSPECTIONS n Fr 212 Mfl re Stet • Municipal Building J� C NOrtd ton, M 01060 h 3'l1 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOMEOWNER EXEMPTION ACKNOWLEDGEMENT The Stale 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 buildinghlggection (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 I, 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 Home Energy Rating Certificate Rating Date: 2018-07-12 6 Registry ID. Unregistered Projected Report ,,•, rte, r Ekotrope ID: VdGpDmly • - aSavings Your home's HERS score is a relative 129 Glendale Rd, Northampton, MA performance score. The lepruer the ramnalge,, 01062 the more energy efficient the home.To $ 2,412 Builder: 41 learn more, visit www.hersindex.com -Relat,.to an average U.S.home PV Habitat Your Home's Estimated Energy Use: This home meets or exceeds the Use[MBtu7 Annual cost criteria of the following: Heating 3.9 $198 Energy Starv3 Cooling 0.4 $22 Energy Star v3.1 Hot Water 10.1 $517 2015 International Energy Conservation Code Lights/Appliances 13.5 $689 Service Charges $0 Generation(e.g.Solar) 0.0 -$0 Total: 28.0 $1,426 Home Feature Summary: Rating Completed by: Horne Type. Singlefamtly detached Energy Rater.Jantle Callan Conditioned Floor Area: ?22 sg.h. RESNET I D3463906 [ase,rr Numberof Bedrooms: HO'"e5 Rating Company:Po:.er House Energy Consulting Primary Heating System. Au Sowce Heat Pump.Electric 3.9 COP M1J91Neff SI Suite 105,AnthersC MA Pdvercew Primary Cooling Svrter,r. All Sourcew Heat Pnp.Electnc-25.3 SEER Horrc �• PrimaryWater Heating Water Heater•Electric.0.9 Energy Factor House Tightness: 2ACH50 Rating PmvideeEnergy Rateau ol MA d«.... N, Ventlla6pn: 500 CFM.24.0 Watts Duct leakage to0utside'. untested Above Grade Walls. R 34 '••• w nH xame Ceiling: Attic B-43 ,o rvodoty Type u-VaIna-0.270.St I GC 0300 Iero[nergy 4 Foundation Wall, N Home Jamie Callan Certified Energy Rater Digitally signed:I:12;183t 8.47 AM illakftope" Permit No. W03-19 Dau Approved: Exp. Date: CITY OF NORTHAMPTON,MA RESIDENTIAL.OR COMMERCIAL BUILDING WATER ENTRY PERMIT A Department of Public Works Trench Permit Shall be required prior to any construction or connection activity associated with this application. To the City of NORTHAMPTON, MASSACHUSETTS: The undersigned,being the OWNER of the property (Owner,Owner's Agent) located at 129 GLENDALE RD ,does hereby request a permit to install and (Number and Street) connect a 2" Water Service to the RESIDENCE at said location. (Sim) (Residence,Commercial Bldg.,etc.) 1. "Owner"shall mean the person holding title to the property served or to be served by the water service. 2. The person or firm who will perform the proposed work is: BRADWAY CONSTRUCTION ,of 396 WEST ST, LUDLOW, MA (Name) (Address) 3. Plan/sketch and specifications for the proposed water service shall be attached to permit. In Consideration of the granting of this permit,the undersigned agrees: I. The Water Department shall make all taps to the water maim 2. WATER ENTRY PERMIT FEE IS$1250.00 SUBDIVISION ENTRY FEE$2,500.00 3. Additional work performed by City forces from the water main to street line shall be paid at the prevailing labor rates and cost of material. Water Meters 5/8" $450.00 Water Meters 3/4" $450.00 Water Meters I" $550.00 ,Radio Read N/A $150.00 ••••Water Meten>I"will be murchased by the City and charged to the customer. ••*• 4. A Radio Read Fee is charged with the purchase of a am meter. 5. The Water Superintendent shall be notified for water Bre imp"don prior to backfill of trench. blq-13 11 Wb4 i1 201,- 6' 2 SEE ATTACHED UTILITY CONNECTION REQUIREMENTS Permit No. W03-19 CITY OF NORTHAMPTON,MA RESIDENTIAL OR COMMERCIAL BUILDING WATER ENTRY APPLICATION DATE: 7252018 SIGNED• PIONEER HABITAT FOR HUMANITY (Name of Applicant) PO BOX 60642,NORTHAMPTON, MA 01060 (Address of Applicant) 413-586-5430(MEGAN MCDONOUGH) (Telephone No.of Applicant) $ 200 Entry fee paid Check No. 8875 $ 130 Meter The paid Check No. 8875 Ud an avatleh���}„) S135 Radio Reed fee paid Check No. 8875 Applicationapproved and /permit issued: DATE: ! ZS/� )S SIGNED 14/(Director- o the Department of Public Works) Fee Schedule: Fire Line Fee included in Water Envy Fee Water Entry Permit Fee $1,250.00 Subdivision Entry fee $2,500.00 5/8"Meter Fee: $450.00 3/4"Meter Fee: $450.00 1"Meter Fee: $550.00 Radio Read Fee: $150.00 SEE ATTACHED UTILITY CONNECTION REQUIREMENTS Glendale Rd Square Footage 0.5 0.2 permit total permit Gross permit cost porches cost cost per house lot area %of lot bldg %of lot open space 125 Glende lot 2 1,210 $ 605.00 42.5 $ 8.50 $ 613.50 16724.69 7% 93% 15,515 129 Glendc lot 3 1,210 $ 605.00 42.5 $ 8.50 $ 613.50 22163.54 5% 95% 20,954 133 Glend:lot 1,232 $ 616.00 42.5 $ 8.50 $ 624.50 41785.43 3% 97% 40,553 Total 3,652 $ 1,826.00 127.5 $ 25.50 $ 1,851.50 Total per floor 1,826 $ 913.00 127.5 $ 25.50 City of Northampton Massachusetts I Il` i DEPARTMENT OF BUILDING INSPECTIONS _ 212 Main Btrcet • Municipal Building `fib C Northampton, !A 01060 yH; apo Fee Calculator for Residential Properties Location : 125, 129, R 133 Glendale Rd Square Footage Amount Basement @ .20 15T Floor @ .50 1,826 $913 2nd Floor @ .50 1,826 $913 / Floors, Finish Attic, Garage @ .20 Deck / Porches @ .20 127.5 $25.50 Total : $1,951.50 4C0 CERTIFICATE OF LIABILITY INSURANCE 06/08/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: It the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: S ckton Affinity, LLC "TONE .888-553-90°2 qIC Na'.913-652-3967 Lock[on Affinity, LLL E. O. Box 873401 >OOXESS: Xaneas City, Dq 64187-3401 INSURIM5 AFFORDING COVHtAGE NAICY IN$IIRFRA'..un INSURED INSURER B' Pioneer Valley Habitat for Humanity, Inc INSURER C:eanReea St1roNa1 PO Box 60642 INSURERD: Florence, to 01062-0642 INSURER E: _ INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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 POUCIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPEOFINWRFNCE POLICY NUMBER MwMRxWY mw LIMITS A X COMMERCIAL GENERAL LIABILITY y M1064964-18 04/01/201a 04/01/2019 EACHOCCURRENCE $1,000,000 I�CLAIMS-MADE OCCUR PREMI66IEattaaoence) 51,000,000 MFFITF( ryenepe,son) $° PMAANALa ADVRUURV $1,000,000 _ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 % POLICY LEST CLOC PRODUCTS-COMPKIP AGO 32,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMI I $ Ea—rent A110 ROCILY INJURY(Pa,peocn) $ ALLONNED SCHEOUIEO SCALY INJURY(Per ameanO $ - Pe,a AUTOS AUTCS NBEO NJTO$ NCN OWNED PROPEeRTYxm DPMAGE $ AIITC$ $ UMBRELLAUAB OCCUR EACH OCCURRENCE $ 'IXCESa LIRE CLAIMS-MADE AGGREGATE $ DED I I RETEINON$ $ C WORNERSCOMFENSATICN S' BIC48747401 04/01/2018 04/01/2019 y- PERTUTE ERN AND EMPLOYERLIABILITY ANY PROPRIETORNARTNERE%ECUTIVE YIN EL EACH ACCIDENT 81,0°0,000 (McERIMEweER ExcI.uOED+ NIA aNeamry in KH) I E.L DI SEASECEAEMPLCY $1,o00,DDD I mm DRimIONOOF OPeeAnous 6aloy. EL DISEASE-Pouw umr al,DDD,DOD DESCRIMIGN OF CHERI i LOCATIONS I VEHICLES NCORD l a,Maltlonal Rameh3SJ,etlma,may M enaTetl N mom apece Is repwreE) CERTIFICATE HOLDER CANCELLATION 1064964 City of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main St AUTHORI2¢$EORESE.I I_ VF NorNa,q+ton, HA 01060 ///��~!(j//'T2((J)//R44-fC-(- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 27325707 1064964