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47 Chapel BP-19-933.pdfFile # BP-2019-0933 APPLICANT/CONTACT PERSON NU-WAY HOMES INC ADDRESS/PHONE 10 WHITE AVE EAST LONGMEADOW (413) 563-0085 PROPERTY LOCATION 47 CHAPEL ST MAP 38A PARCEL 029 001 ZONE URB(lOO)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out Fee Paid Typeof Construction: RAZE HOUSE TO CONSTRUCT A NEW HOUSE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 013693 3 sets of Plans / Plot Plan REQUIRED DATE THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: __ Approved __ 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 Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply wi~h 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 ofMGL 40A. Contact Office of Planning & Development for more information. dotloor signature verification: dtlp.us/p4Lo-jlEO-KYvo City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 Department use only Status of Permit· Curb Cut/Driveway Permit _______ _ Sewer/Septic Availability ________ _ Water/Well Availability _________ _ phone 413-587 1240 Fax 413-587-127.2 Two Sets of Structural Plans·---"------ PloVSile Plans . ..,· __ :---- Other Specify ___ _ • APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR lWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office '/ 7 (: L.,,. f'J Sr /JOfl',t.,~ p~ p1,jf O/f)(. 0 Map ______ Lot ________ Unit. ___ _ Zone-------Overlay District. _____ _ 1-------------------------El_,m St. District. ______ CB District ____ _ SECTION 2 • PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ,... Joan Hebert Name (Pnnl) dotloop verified 02/27/19 7:30 PM EST ADGX-DZQH-UW4B-9VAS 1------- SECTION 3 • ESTIMATED CONSTRUCTION COSTS Item 1. Building 2. Electrical ----3. Plumbing -- 4. Mechanical {HVAC} ---5. Fire Protection 47 Chapel St Northampton MA Current Mailing Address .801-814-5188 telephone /0 0 Current Malling Address: C'/1 !») s-c s -O(l 8s- Telephone Official Use Only (a) Building Permit Fee b) Estimated Total Cost of Construction from 6 Building Permit Fee 6. Total = (1 + 2 + 3 + 4 + 5) {) D -Check Number This Section For Official Use Onl Date ~s.ou Building Permit Number: ____________ _ Issued:. __________________ _ Signature: ------------------- Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED ; EITHER HOMEOWNER OR CONTRACTOR} dotloop signature verification: dtlp.us/p4Lo-JIEO-KYvo Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To lnc:omplete Information Existing Prop ed Required by Zoning This column to be filled tn by Building Dcparnncnt ye,~').;. -Lot Size 'fll~ ----- rti. ,~ -11~.tJt_=--, Frontage -- S tbacks Froar ~o --ide L· ---R: L: ___ R:-=------- ~ -R ar -- Building Height -,1~7' -"" - Bldg. Square Footage ----% /71 7 ---- Open Space Footage % (Loi area nunus bldg & paved --~~ )'7 --park.mg) # of Parking Soaces -2- ----------Fill: 1,nlume & Locauon/ -·---·-----·------- A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW @ 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 ¢ DON'T KNOW O YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained C. Do any signs exist on the property? YES IF YES, describe size, type and location: 0 0 , Date Issued: NO p 0. Are there any proposed changes to or additions of signs intended for the property? YES Q IF YES, describe size, type and location: NO~ E. Will the construction act1v1ty disturb (cleanng, grading, excavation, or fifllng) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO ~ IF YES. then a Northampton Storm Water Management Permit from the DPW is required. • I dotloop signature verification: dtlp.us/p4Lo-jlEO-KYvo SECTION 5-DESCRIPTION OF PROPOSED WORK (check all applicable) Addition Replacement Windows Alteration(s} Or Doors D D · Roofing D New House 0 Accessory Bldg. 0 . Demolition New Signs [CJ] Decks [D Siding [Cl] Other [Cl) Brief Description of PropHcd Work: To d,r,z, oo.s.e Alteration of existing bedroom ___ Yes ___ No Adding new bedroom Yes ___ No Attached Narrative Renovating unfinished basement ___ Yes ___ No Plans Attached Roll • Sheet 6a. ff New house and or addition to existing housing1 complete the following: a. Use of building : One Family ___ _ Two Family ____ Other----- Number of Bathrooms ------b. Number of rooms in each family unit: C. Is there a garage attached? d. Proposed Square footage of new construction. __________ Dimensions--------------- e. Number of stories? f. Method of healing? --------------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 ------------ Yes No . k. Will building conform to the Building and Zoning regulations? -------- 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 dotloop verified 02118/19 1 0:01 AM MST I, _._ _____________ F6o_s_-,c_J6-_LZ_eG-_F_ss_,c '---------------------· as Owner of the subject property hereby authorize , to act on my behalf, in all matters relative to work authorized Signature of Owner Date I. '")<Jb..v vV(< ,J~.N&l .asOwner/Authorlzed Agent hereby declare that the statements 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. :!i>h ~ yvt( ~ µJ 7v( Print Name Signature of Owner/ Agent dotloop signature verification: dtlp.us/p4Lo-jlEO-KYvo SECTION 8 • CONSTRUCTION SERVICES I 8.1 Licensed Construction Sueervisor: Not Applicable D Name of License Holder :fol-\» M, )!,,Ju( cs-01.~&?93 License Number LtJ 4..Jb,'it ~(/~ £,. lAt?="'feJIIIN':: 6f>I · 01b t:l . 11~LR Address Expirltion o!te .Q(L lb,;. ~ C~J}Jz.r-.,ol?c . . . S19 u Telep one 9. Registered Home l!!!l!rovement Contractor: Not Applicable D Comean:z'. Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L c. 152, § 25C(6)) I Workers Compensation Insurance affidavit must be completed and submitted with this apphcat1on . Failure to provide this affidavit will result rn the denial of the issuance of the building permit. Signed Affidavit Attached Yes ....... ;;;{ No ...... D The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Wol."kers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A licant Information Please Print Leoibl Name (Business/Organization/lndividual): __ .:...t\J~~U~-.......1.=....:..,-,c,1--~1-1-~~.!......;2...~,4:~:n.-1.. _________ _ Address: / D W h /T-c • /Jue ' £,. l.0"'7!).. M eJc:rtu"-/nJtl, a/tJ :i. F (/ City/State/Zip: () /! 2"? Phone#: Cv/3)s-t_3-ooJ=~ Are you an employer? Check the appropriate box: 1.0 1 am a employer with ____ employees (full and/or part-time).* 2.0 I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.o I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4.o I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers' comp. insurance.I 6171 We are a corporation and its officers have exercised their right of exemption per MGL c. r--is2, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. D New construction 8. O Remodeling 9. ~emolition 10 D Building addition 11.0 Electrical repairs or additions 12. D Plumbing repairs or additions 13.0Roofrepairs 14.00ther _______ _ • Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. I 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. Insurance Company Name: _____________________________________ _ Policy # or Self-ins. Lie.#: ___________________ Expiration Date: ___ ~----- Job Site Address: _____________________ City/State/Zip: ________ _ Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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 ofup to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Si nature: Date: 3 Phone #: 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 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 1 SOA. Address of the work: '-17 The debris will be transported by: lJS4 The debris will be received by: Building permit number: ____________ _ I /fj Date Signature of Permit Appli ant {_ " ~ Co m m o n w e a l t h of Ma s s a c h u s e t t s Di v i s i o n of Pr o f e s s i o n a l Li c e n s u r e · Bo a r d of Bu i l d i n g Re g u l a t i o n s an d St a n d a r d s Co n S\ [ \ ! l ~ M ] f s -l t i> e .rv i so r ... CS - 0 1 3 6 9 3 J ,~. \& · ~• ! 11 < , t ; , e s c 07 / 2 0 / 2 0 1 9 /. ~ . . ;' t; i :r , ' l l - JO H N M HA N ! , : ) Z E L · · . ' _v g 38 WH I T E AV ., . .., ~ E LO N G M E A ~ \i t ~ »D_ ~ O ~ B ' ~ ~ <' \ 1 0 1 ~ 1 0 ~ Co m m i s s i o n e r e, L tl A . - - ACORD9 CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 03/01/2019 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 pollcy(les) must have ADDITIONAL INSURED provisions or 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 .. un,~" Sara Scrivner, CIC NAME: Crimmins/Graveline Insurance Agency, Inc. PHONE (413) 283-8378 I 1.vc Nol: (413) 283-2556 fA/C No Extl: 1382 Main St. i~~s: sscrivner@cgins.com PO Box905 INSURER(S) AFFORDING COVERAGE NAIC# Palmer MA 01069 INSURERA: James River Insurance Co. INSURED INSURERB : Nu-Way Homes Inc INSURERC : 10 White Avenue INSURERD: INSURERE: East Longmeadow MA 01028 INSURERF: COVERAGES CERTIFICATE NUMBER: 2018 GL 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. i•r.;; TYPE OF INSURANCE IN!II> WVD POLICY NUMBER (l~~g~ l~~g~ LIMrrs X COMMERCIAL GENERAL LIABILrrY EACH OCCURRENCE $ 1,000,000 -D CLAIMS-MADE [81 OCCUR Ul"\Ml'\UC I U r"Cl'I I C.U PREMISES fEa occurrencel $ 50,000 - MED EXP (Any one person) $ 5,000 -A 00084084-0 06/27/2018 06/27/2019 PERSONAL & ADV INJURY $ 1,000,000 -GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 ~ POLICY D ~~& DLOC PRODUCTS -COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILrrY COMBINED SINGLE LIMIT $ IEa accidentl -ANY AUTO BODILY INJURY (Per person) $ -OWNED -SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ -HIRED -NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY f Per accident! $ --$ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ -EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION I :ffTuTE I I OTH- AND EMPLOYERS' LIABILrrY ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE D N/A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space ls required) CERTIFICATE HOLDER City of Northampton 212 Main Street Northampton ACORD 25 (2016/03) MA 01060 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD EXISTING DRIVE .:.:,.···.·• .. PROPOSED PATIO (PAVERS) 12' x 15' WITH STAIRS OWNER: MICHAEL J. HEBERT ADDRESS: 47CHAPELSTREET NORTHAMPTON MA HAMPSHIRE COUNTY BOOK OF PLANS: 186 PAGE NO.: 162 LOT NO.: 1 DEED BOOK: 5895 PAGE NO.: 189 LOT 1 4933.0 SQ. FT. PLAN OF LAND AT: SAME DATE: 2/25/2019 SCALE: 1" = 20' SMITH ASSOCIATES SURVEYORS, INC. 466 BALDWIN STREET-EAST LONGMEADOW. MA -01026 (413)525-U01