35-127 (7) 27 CAHILLANE TER BP-2019-1407
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:35- 127 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateemy shed BUILDING PERMIT
Permit# BP-2019-1407
Project# JS-2019-002270
Est.Cast:
Fee:$30.0o PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License.-
Use
icense:Use Group: HOMETOWN STRUCTURES98186
Lot size(sa.R.): 9844.56 Owner: THOMAS MARGOT E
Zoning, Applicant: HOMETOWN STRUCTURES
AT. 27 CAHILLANE TER
Applicant Address: Phone: Insurance:
627 SOUTHAMPTON RD (413) 562-7171 WC
WESTFIELDMA01085 ISSUED ON:611312019 0.00:00
TO PERFORM THE FOLLOWING WORK.160 sq ft shed
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Fooling%:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Qit 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 6/13/20190:00:00 $30.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File k BP-2019-1407
APPLICANT/CONTACT PERSON HOMETOWN STRUCTURES
ADDRESS/PHONE 627 SOUTHAMPTON RD WESTFIELD (413)562-7171
PROPERTY LOCATION 27 CAHILLANE TER
MAP 35 PARCEL 127 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ZONING FORM FILLED OUT ENCLO REQUIRED DATE
Fee Paid
Building Permit Filled out
Fee Paid 17
Typeof Construction: 10 so It shed
New Construction
Non Structural interior renovations
Addition to Existine
Accessory Structure
Buildin Plans Included:
Owner/Statement or License 98186
3 sets of Plans/Plot Plan
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
a;" At.4m4k, IsAyi ks
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all inning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
r Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning& Development for more information.
_.:alns \` :coo�SCN^C`54�
Mifij of Xart4nmptan
I�. �, �lassarhusells x
DEP�1R`�' ENT OF BUILDING INSPECTIONS 0+
21E Lin reet . Municipal Building
- qortl ampton, MA 01060
JUN - 7 2019
T r'. I rtrlq 1::SFFCT10;s 3 s
ACCESSORY STRUCTURE PERMIT APPLICATION
(For freestanding structures less than 200 sq. ft., at least 5 feet from any other structure)
Check# CI-(+ C a r-LL pc�y 3o -t
�
, PLEASE
11TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: fT� ^'^ S4"0T'n 4
Address: GP7 So �c '-n RJ. Telephone: 1//3— SIG a- '7/7
Wu1 la, M if We 8. l
2. Ownerof Propertin rl of E• 1/LeMoy
Address: SS Ccl`�)l4"L IVract Telephone. Yl 3- Sao,/- ;)-7S9
b^Ncc, M Ulo d
3. Status of Applicant:_Owner KContractor
4. Structure Location: /vor4lt- c-.4 COrM1+! 01 hi, W 1 , p
Parcel ID: Zoning Map # Parcel # District(s) S I
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Use of Property: Single or Two Family:_k Multifamily: Commercial:_
6. Description of Proposed Structure:
One Story Shed under 200 sq. h.: t Freestanding Deck under 200 sq.ft., less than 30^above grade:
SIZE OF STRUCTURE: I Io�G/
Other(describe):
7. Attached Plans: Sketch Plan Site Plan Plot Plan x
8. Does the site contain a brook, body of water or wetlands? NO k' DON'T KNOW YES
IF YES: Has a permit been, or need to be, obtained from the Conservation Commission?
Needs to be obtained_ Obtained _ , Date issued_ _
CONT/NUED ON NEXT PAGE
—® Wccerc�o"�{fowl-a.5��to�vvtal � .cota•)
9. ALL INFORMATION MUST BE COMPLETED: PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION.
This column to be filled in by
_ the Building Department
Existing Proposed Required by Zoning
Lot size 9 S $3 .
Frontage N/A N/A N/A
Front:
Setbacks: Side: L; y't
Rear.
t
Height
% Open space: �f
(Lot area minus bldg and 957
paved parking)
70.Certification: I hereby certify that the information contained herein is true and accurate to
the best of my knowledge. _)'� PIA,
6 - 7- /5 APPLICANT'S SIGNATURE �-/'
NOTE: Issuance of a permit does not relieve an applicant's burden to comply with all zoning requirements
and obtain all required permits from the Conservation Commission, Department of Public Works and other
applicable permit granting authorities
e Commonwealth of Massachusells
sm
DMn of Professional e
Lcnsure
BaarE of Boetlmg Regulations ano 6bnUartls
ConstrucNOn Supervisor
C"98186 Expires 08/01,7019
ANDREW D KUF
296 BROMLEY RD
HUNTINGTON MA 01060
Commissioner C4
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Types LLC
HOMETOWN STRUCTURES,LLC Registration: 159772
527 SOUTHAMPTON RD Expiration: 05/20/2020
W ESTFIELD,MA 01005
e
Update Atltlreee erltl Re unt Card.
. . ...,.> a
plica of ME IMPR er EME 8 seeress CONTRACTOR
CTOR On valld
HOMEIMPROTYPENLCONTRACTOR befoelre eexpiratfor ate. ifueluaeonly
etur
TYPE:LLC before f Consumer A date. and Bu return to:
Renletral'on IEtmlatlm OKIroot Consumer -Suite 13 auainps Raaulallon
159T]2 0&2820m One ASHWrton Race-Suite 13x1
HOMETOWN STRUCTURES.LLC Boston.MA 02109
ANDREW KURTZ
S2)SOUTHAMPTON RD
WESTFIELD.MA 01065 Lkdwswmwy Not valid without signature
The Commonwealth of Massachusetts '
Department of IndustrialAccidents
I Congress Street,Suite 100
Boston, MA 02114-1017
www.mass.gov/dia
Ulkirke"' Compensalion Insurance Affidavit:Buildern/ContractomMectricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY!
Applicant Information Please Print Legibly
Name(Business/OrganintioNlndividual):Hometown Structures
Address:627 Southampton Road
City/State/Zip:Westfield, MA 01085 Phone#:413-562-7171
An yon an employer?Cl ak the appropriate hoz: Type of project(required):
1.E! I am a employer with 15 employ.Th all and/or pans-lime).' 7. ❑New construction
2.❑lama sol,sespneuncrlarnsnall and have noemployasworking formem 8. Remodeling
any capacity.(No workers'compinsurance required]
1.❑1 am a homeowner doing all work myself Mo wrokers'comp.insurance remained] 9. ❑Demolition
10❑ Building addition
4.❑Inot a homeowner and will be hiring contractors to conduct all work on my pmperty. [will
ensure that all contractors either have workers'compensation announce or arc sale Il.❑Electrical repairs or additions
proprktors with no employees. 12.❑Plumbing repairs or additions
dE31 am a general contractor and I have hired the subrumtatos,listed oa the attached sheet 13�Roef rep81rs
The.subcontractors have enees gloyand have workers'comp.inmrmae.e
6.❑Wrerea),ands hand itsomrers Neveexercised @earnight ornme, gasper MCL c.
14.g)Other accessory building
152,§1(4),and we have no employees.Mo workers comp.insurenre required)
'Any applicant that checks box el must also fill out the section below showing their workers'compen.tion policyMformation.
I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors most submit n new emdavlt indicating such.
fContrnetore Net check this box most smashed an additional shat showing the name of the subcontractors and state whether or not those entities have
employees. Tom sub-contucrors have employas,they most provide their wmkers'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:Berkshire Insurance Group
Policy#or Self-ins.Lic. #:AWC-400-7028459.201 SA Expiration Date:11/27/2019
Job Site Address:55 Cahillane Terrace City/State/Zip:Florence, MA 01062
Attach a copy oftbe 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 offa STOP WORK ORDER and a fine of up 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.
I do hereby certifyuu� en er thpain and penahiev of perjury that the Information provided above is true and correct.
S'enatum ✓'y1--✓✓ Date-
Phone 4:413-562-7171
ate:Phone#:413-562-7171
Official use only. Do not write in this area,to be completed by city or town oofticial
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#:
i
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
INFORMATION PAGE
A.I.M. Mutual Insurance Company
54 Third Avenue, Burlington, Massachusetts 01803-0970
(800) 876-2765 NCCI NO 26158
POLICY NO. AWC-400-7028459401
PRIOR NO. AWC 400-7028468- 17A
ITEM
1. The Insured: Hometown Stuctures LLC
DBA:
Mailing address: 627 Southampton Road FEIN:"-"'8332
Westfield,MA 01085-0000
Legal Entity Type: Limited Liability Company
Other workplaces not shown above: See Location
2. The policy period is from 11@7/2018 to 11M27/2019 12:01 a.m.standard this at the insured's mailing address.
3. A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the
states listed here: MA
B. EmployersLiability Insurance:Part Two of the polity applies to work in each slate listed in item 3.A.
The limits of liability under Pan Two are: Bodily Injury by Accident $ 100,000 each accident
Bodily Injury by Disease 6 500,000 policy limit
Bodily Injury by Disease $ 100,000 each employee
C. Other Stales Insurance: Coverage Replaced by Endorsement WC 20 03 06 B
D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE
4. The premium for this polity will be determined by our Manuals of Rules,Classifications,Rates and Rating Plans.
All information required below is subject to verification and change by audh. a
Clesaificetions - Premium Basis Rales _
Cob ENmeted per$100 Estimated
No. Total Annual 01 Annual
flMnuneralbn --Remwrerahon Premium
INTRA 000337067 a
INTER SIR CLASS CODE SCHEDULE
Minimum Premium $50D Total Estimated Annual Premium $14,697
GOV GOV Deposit Premium $16,240
STATE CLASS_.
MA 2802 .i State Amessmeras/Suroharges
_ - $14,186.00x3.8300% $543
This policy,including all endorsements,is hereby countersigned b ��/ 11/2812018
P Y 9 Y 9 Y __.____._��� ryro.._._. Mu
Service Office: Berkshire Insurapce Group Inc
54 Third Avenue P O Box 4889
Burlington MA 01803 Pittsfield,MA 01202
WC 00 00 01 A(7-11)
Indudes copydehrad maudal M are National Council on Compenurbn Inureno,
used with its pemlisslon.
30-year architectural 2 x 6 rafters 16" on
singles over 1/2" CDX center with collar
lywood roof sheetin ties 4' on center
ridge vent
exclusive detailing, 1�
rith large roof overhang
a
double 2 x 6 header
over windows and doors pressure treated floor
system, 4 x 4 rails, joists 12
on center, 5/8" plywood
vinyl over 1/2 CDX plywood
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