35-143 27 WESTWOOD TER BP-2019-1348
GIs#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: 35- 143 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category ROOF BUILDING PERMIT
Permit# BP-2019-1348
Jett# JS-2019-002174
Est.Cost: 55781.00
F«: S40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: D P CARNEY INC 99798
Lot Size(so. ft.): 9496.08 Owner. ANDREWS KELLY
Applicant: D P CARNEY INC
AT: 27 WESTWOOD TER
Applicant Address: Phone: Insurance:
34 HORSE SHOE CIRCLE (413) 967-7124 O WC
WAREMA01082 ISSUED ON.5/2812019 0:00.00
TO PERFORM THE FOLLOWING WORK:RE-ROOF GARAGE & PORCH
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of%N bring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Find:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Find: Smoke: Find:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signorine:
FeeType: Date Paid: Amount:
Building 5/28/2019 0:00:00 540.00
212 Main Street,Phone(413)587-1240,Fac(413)587-1272
Louis Hasbrouck—Building Commissioner
�L60r=
Department use only
-j-., City of Northampton Status of Parma:
. , ..�1 Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
.. 1 .r Room 100 Water/Well Availability '
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1
�me®pecify
APPLICATION TO CONSTRUCT,ALTER R AI RENOVATE OR DEMOL4H A E OR TWO FAMILY DWELLING
2 4 2019
SECTION 1 -SITE INFORMATION MAY
1.1 Properly Address: $ n to be completed by officeDFPT OF 6UIlOnK.IB pP�E01�
Non1N Lot Unit
27 Westwood Terrace
Florence, MA 01062 zone Overlay District
Elm SL District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZEDilGENT
2.1 Owner of Record:
Kelly Andrews 27 Westwood Terrace, Florence, MA 01062
Name(Print) Currem Mailln Address:
(413120-8805
Telephone
SgneNre
2,2 Authorized Agent:
D.P. Carney Construction, Inc. 34 Horseshoe Circle, Ware, MA 01082
Name(Pdm) Currant Meiling Address:
(413) 967-7124
ne Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
sem Estimated Cost(Dollars)to be Official Use Only
completedby it a icent
1. Building (Re-roof) $5,781.00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechamml(H �Jp�VAC) 740
5.Fire Protection -
6. Total=(1 -2-3+4+5) $5,781.00 Check Number
This Section For Official Use Only
Date
Building Pemrit Nu Issued;
Signature: 5.26-2619 _
Building Commissiowftspeclar of Buildings pat"
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING JAILinfo otim Must ae Completed. Permit Can B Denied Due To Incomplete bdormatim
Existing proposed Required by Zoning
Ths col mn to be filled I.by
Building Dcparurnt
Lot Size
Frontage
Setbacks Front
Side U R: L: R:
Rear
Building Bcight
Bldg. Square Footage %
Open Space Footage %
(Wt v a minus bldg&paved
p ofParkung Spam
all.-
ill
(volume&Iuurim
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW YES O
IF YES: enter Book Page and/or Document k
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW V 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 O NO
IF YES, describe size, type and location:
E. Will the const uction 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
IF YES.Nen a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Aherationls) Roofing LJ
Or Doors O
Accessory Bldg. ❑ Demolition ❑ New Signs [OI Docks IQ Siding[p] Other joj
Brief Description of Proposed
work: Re-roof garage 8 porch.
Alteration of existing bedroom_Yes V No Adding new bedroom Yea N/ No
Attached Narrative Renovafing unfinished basement _Yes _VNo
Plans Attached Roll -Sheet
Ga.if New house and or addition to existing housing, complete the following: N/A
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 stones?
I. Method of heating? Fireplaces or Woodstoves Numberof each_
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
1. Is construction within 100 h.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__ CitySewer Privatewell City water Supply
SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED=
OMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERNR
1, Kelly Andrews as Owner of the subject
property
hereby authorize D.P. Carney Construction, Inc.
to act on my beha ' all m Nees relative to work authsjLd by this building permit application.
Srenaturs of Oklir Data
I. Joann Camey ,as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application am true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Joann Carney
Print Nacre
May 22, 2019
Sig ure
Date
Owner/Agent
SECTION 8-CONSTRUCTION SERVICES
8.1 1.1censed Construction Superylsor: Not Applicable 'O
Name of License Holder: Daniel P. Carney CS-099798
license Number
34 Horseshoe Circle, Ware, MA 01082 8/19/2019
Address Expiration Dale
413-543-3150
Slpnam
9.Riat Home Im rovemenl C ntra Not Applicable ❑
Daniel P. Carney 121178
Company Name Registration Number
34 Horseshoe Circle, Ware, MA 01082 4/11/2020
Add Expiration Date
Telephone 413-5433150
SECTION 10-WORKERS'CO NSATION INSURANCE AFFIDAVIT(M.G.L c 152,9 25C(8))
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....... ❑ No......
City of Northampton
�,.
Massachusetts - rr
B AR29ar21T O8 BUXWX O rNm!ZCrr0NS x
212 Nein Street • aaniclpal Building
Northampton, M 01060
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
Performing work on such homes,a contractor must be registered as a Home Improvement Contractor
M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair,modernization,conversion,
improvement,removal, demolition, or construction of an addition to any pre-existing owneroccupled building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work: Roofing Big,Cost $5,781.00
Address of Work: 27 Westwood Terrace, Florence, MA 01062
Date of Permit Application: May 22, 2019
I hereby certify that:
Registration is not required for the following reasen(s):
_Work excluded by law(explain):
_lob under$1,000.00
_Owner obtaining own permit(explain):
_Building not owner-occupied
_Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
a
May 22,.2019 D.P. Carney Constru i 121178
Date Contractor N y� HIC Registration No.
OR: /�////
Notwithstanding the above notice,I hereby apply for a budding permit as the owner of the above property:
Date Owner Name and Signature
_ City of Northampton
`R Massachusetts
,A c
DEPARTMENT OF BUILDING INSPECTIONS 1
212 Win Strcet e N icipal Buiid ng J
\ NorNav�ton, MA 01060
Massachusetts Residential Building Code
Section I IO.R5.1.2
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.
Section I10.R5.1.3.1
Any homeowner performing work for which a building permit is required shall be exempt from
the licensing provisions of 780 CMR 110.R5,provided that if a homeowner engages a person(s)
for hire to do such work, then such homeowner shall act as supervisor.
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.
City of Northampton
•'1�
Massachusetts
/ c
l• A �
DEPAR28 W OF ENILDING INSPECTIONS
212 Maio SCZNt •Municipal euilaing
NeztEanpt®, MA 01060
Debris 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.
The debris from construction work being performed at:
27 Westwood Terrace, Florence, MA 01062
(Please print house number and street name)
Is to be disposed of at:
United Material Management, Inc.
896 Main Street, Holyoke, MA
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
All Waste Removal Company
P.O. Box 297, Hampden, MA
(Company Name and Address)
May 22, 2019
igna re of Permit Applicant ner Date
8, for any reason, the debris will not be disposed of as indicated,the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
The Commonwealth ofMassachusens,
Department of InifustrialAccidents,
7 Congress ,Suite 100
Boston,MAA 021 02114-20177
www.mam.gov/dia
USIxtirkeW Compensation Insurance Affidavit:Builders/Conr cton/Elm ricians/Plumbers.
TO BE FILED WITH THE PERMT(TING AUTHORITY.
Applicant Information Please Print Leaiblr
Name (Husincas/OrganintioNfndividml): D. P. Camey Construction, Inc.
Address: 34 Horseshoe Circle
City/State/Zip: Ware, MA 01082 Phone#: 413-967-7124
Artyou.a easel tot Cluck tbe.ppnprWe boss: Type of project(required):
I.2(Iama employer with 15 employem(fdi.drolwo.time.' 7. ❑New construction
2.❑iama¢olc yropdamor Pasmnnhry and have ao anployccs woskivgf mein 8. Remodeling
any .cal ocity.IN.wwrkms'comp.insmmce rcquiml]
tti�ll 9. ❑Demolition
3y t am alwmmwnm doing an work myself Mo wmkus'come,ws,va,nenquircd.7'
9.❑itm tinmmwnm and will6e hiring eonmmors to wriNmt all workmmy peaµmy. Iwtli 10[]Building addition
ensure that all carandon citW boom workers compemation insmaoce m are role 11.❑Electrical repays or additions
proprietors wiN no employees. 12.❑Plumbing repairs or additions
So 1 am a gmmral connmor and 1 have bind the s„b-c..muams lined on Ne snacked ghee[ 13 r7'poof repays
Theo subsontnem.Moe employett and M.e woken'comp.im came.: ILCY
6.❑we an a carpmadon tad As amens have ammiaea Neirdrh tar aaempduap=.MGL c. 14. JR{-
Other Roofing
151,41(41 eM we love no mvployccs.[No wohers'comp.insulin¢required)
'Any applicant that chects box ql nee also fill out the section Wow she wg theirwarken'compematian polity Wooden...
I Homeownms who submit this affidavit iaxh a iag Ncy am doing at work anANen him omtide contractors must subnur a nen affidavit indicating such.
lContr.etom that check this box must enacted an additional sham showing the mode of Ne mbcont ana and n:d,whmher or not hose mtitin bee
employees. Ifdn subcwtramwa hevc emploYas Ncy must psmidc Nair wmrkas'comp.policy numlxr.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site
information.
Insurance Company Name: Guard Insurance Company
Policy#or Self-ins.Lie.#: R2WC991807 Expiration Date: 11/15/2019
/obsitcAddress: 27 Westwood Terrace City/satdZip: Florence, MA 01062
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to seem 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 fee of up in$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.
I do hereby T ' underthepa' penalties ofperjuy that the information provided abowis irue and correct
s&gnature: a Date: Ma 22, 2019
Pin #: 413- 7-7124
Official use only. Do not write in this area,m be completed by city or town ofjldai
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2,Building Department 3.Cityrrown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
/'1 DPCARNE-01
A11. � CERTIFICATE OF LIABILITY INSURANCE D slzzn0ts 1
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORIMTION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EMEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORRED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: H the certificate holder is an ADDITIONAL INSURED,the policy(les)must he"ADDITIONAL INSURED provisions or Be endorsed.
N SUBROGATION IS WANED, subject to the terms and conditions of the policy,certain policies may require an Nldorement. AstatameM can
this ce"Mcate does not confer rights to the certiOcats holder In lieu of such andonemsnl•.
NRODVCER XTADT Angela DlAugustlno
Phillips Insurance Agency,Inc, NiNN,EM: 413 594.5981 P'w x.:473 592-0499
97 Center Street
Chicopee,MA 01013 .angelsQphillipalminersenctiLicom
IX M MFOMMOCOVERADE NAC#
INSURER A:Kinsale Insurance Company
wsusm INSURER. Selective Ins Co of Southeast
D.P.Carney Construction,Inc. INSURER c Guard Insuramm Group
34 Horseshoe Circle INSURER D
Ware,MA 01082
INSURER E:
WaURER 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. NOTWITHSTANOING 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,
EBCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
SUMTYR OF INSURANCE AD0.MIN POLICY NU. da. dMATIVOCOO POUVEFF POUCYEXP LIMIR
ArXp—W.C.L GENERAL LMYlTY rear 1,000,000
aLAME-MAK QX Dccu, 100041217.2 51112018 81112019 DAMAUETOREMED 100,000
MEDEV M w Excluded
PERSONALBAOYI Y a 1,aDD,099
ENL AGGREWTE LIMB MP APER: ENERALA T 2.00a'OOa
POLICYO j� EL. PRODUCTS-COMPIOPA 2'000'000
om R, BVPD Deductill, a 5,000
B A OBILEW LT COMBINED MINGLE LIMIT I.W0,00D
% ANY AOMNUTO �y 9094953 8/1/2018 81112019 son,lI Per ,.
AQUA�pTEEO��FSONLY XpµOpSWLLXE�Op BODILY INJURY
AUTOS OmY /J1}OSONLY PItOPE Q1 ANwGE
A X uLMr.11s. X COOLS EADX OCCURRENCE 3 5,000,000
EYCESB WB CWMSHMDE 100054375.1 &112018 8/112019 AGGREGATE 51000,000
MD I X I RETENTIONS a
C MORNERS CON1.11ATON X PER OTH-
MIDEMPLOYERs'LY.I YIN
ANY PROPRIETORFARTNEIVEXECUTNE R2WC991007 1111512019 1111512019 E.L.EACH ACCIDENT 1•000'000
p[FISEFr EXCLUDED? O NIA1,000,1100
IISY,J Pry In NXI MP
D6.a.me.L.d. - 1,000,000
DESCRIPTION OF OPERATIONS 1I EL.DMEASE-POI IMIT
B Installation 5198545781 01 Limit 107,000
B LersedlRentad 51985457 8,12018 811.2019 250,000
OEaCR41too Gars ATnd ft DUTMMsILFxCIF31ACORO.L Adam-wl Rm,.h...tAw.m.r.owswONaEnMX.pi.M N Ivstl
RE:Reitoof Garage mtl Wrt Posh 22 Wsanvootl Tema Florence,MA 01052
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
KeIIY Antlravn THE EsPIR&TION DATE THEREOF.ACCORDANCE NRH THE POLICY PROVISIONS.CE MILL BE DELIVERED IN
27 Westwood!TaTTaca
Florence,MA 01082
AU(}n�O-r�LUD REPREXMATNE
ACORD 25(2016103) 01988-2015 ACORD CORPORATION. All rights mserved.
The ACORD name and logo are registered marks of ACORD
vie woVnzo crle o��a�iu '
Office of Consumer Affairs and Business Regulation
One Ashburton Piece- Suite 1301
Boston, Mausetts 02108
Home Improvem tractor Registration
F cc.
p _. ._., 5 Type Corporationi'^""—=
D.P. CONSTRUCTION,INC. " •. – r }
Registration; 121178
34 HORSESHOE CIRCLE
Expiration: 04/11/2020
WARE,MA 01082
Update Address and Return Card.
.c" a mwaMn
HOME
IMPROVEMENT
CONTRACTOR
beforefetlonvalid Indlol ate.Individualuse
return
TYPfion- ora00n before theexplretl0ndate. If foundreturn fe:
Re12."3!flen..- 041/1/020 One e ofAsh Crton Ma e-Suit.
a 13 Business Regulation
12AT78�'eu,s�;x'y'..:04/112020 One Ashburton Recs-Sake 1301
O.P.CARNEY CO tiSMAt'Aii1&4 NC. Boston,MA 02108
t
DANIEL P.CARNEW ` '::i?:`};~
34HORSESHOECIFtCef:-:.1' (; i
WARE,MA 01082 -' Undersecretary elid wllt91 atu
Cammanweiep of Meauelwseni Coneadcoon Supervisor
Division of Prolessbnrt Lteensure OnresVlcted-Sulldlrgs of any use group wMChyteln
Boartlo1 9uildr1R.gu1allan3 and standards Its.than is,00 a.W.lost(991 cubic mehrsl trennea.d
Sgns[rllCtibrt5lSPprvl9or Nett'
LS-099798 .6..3'.y;. �plres:OM1B2019-
OAMh PCARNEY (X'
34 HORSE SN9E C9rBM.aE -
WAREMA010182
Eallum to bans.a Nrntnt edldomottha Mess.drvs.M
a� Sate Building CNN recluse as rcvocadan of this Homes.
r`(_ per informatbnabOultM1li llttnae it
oomm6aioner a/""_ /v Call 1917)727420 or visit w nwas:gov/dol
i.