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29-355 (7) 6 AUSTIN CIR BP-2020-0512 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-355 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: KITCHEN RENO BUILDING PERMIT Permit# BP-2020-0512 Proiect# JS-2020-000871 Est.Cost: $10000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MIKE KRASNOV 102047 Lot Size(sq.ft.): 11282.04 Owner: A J CAPITAL REALTY TRUST Zoning: Applicant. MIKE KRASNOV AT. 6 AUSTIN CIR Applicant Address: Phone: Insurance: PO BOX 491 (413) 328-1778 WC WEST SPRINGFIELDMA01090 ISSUED ON.1012312019 0:00:00 TO PERFORM THE FOLLOWING WORK:KITCH RENO, ENTRY DOORS, SOFFIT & FASCIA TRIM 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 10/23/2019 0:00:00 $65.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability - •�. ` Room 100 Water/Well 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 1 -SITE INFORMATION (QP_ 20 -- 6-i z 1.1 Property Address: This section to be completed by office _ 1j 61 Ma � Lot b Unit Zone Overlay District I Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: A S 4L ' Li l,7 .SP f nW.'e U S4. *f?0 Name(Print) Current Mailing Address: LA,3` a tl_i t 6� Telephone "1 Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: ok "lam 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 6. Total =(1 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Num er: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by N (Building Department Lot Size Frontage Setbacks Front - . . C� 0 Side L:�.-��J R: L•Q R•= Rear Building Height Bldg.Square Footage % u Open Space Footage °k (Lot area minus bldg&paved parking) #of Parking Spaces 0 Fill: volume&Location ILf A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW O YES IF YES, date issued: �I 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#�—� B. Does the site contain a brook, body of water or wetlands? NO Y' DONT KNOW © YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 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 © NO G) IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO Vy IF YES,then a Northampton Storm Water Management Permit from the DPW is required. IC;-fc� -- SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [o] Other 10 Brief De cri tion of Proposed �eP)4« K�'��h�^ �`"�"`ems �"'^ `^ /° S^S �>> r']+ao1 •+� le��S Work: e9� Lt,n1\ �cc:>. Isco_ i-�r�Ct csneiS� Ins )( So ` .-� 1�cLSc.ia -f•(,�r+� . Tns�Ql[ A�W`Il�nu1 ✓c .' Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes X _No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other m, b. Number of rooms in each family unit: Number of Bathrooms Y`� 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 I, �k V. I as Owner of the subject property hereby authorize M K ��S n V to act on my b alf, in all malters,relative to work authorized by this building permit application. Signature of Owner Date I, /���� as Owner/Authorized Agent hereby declare that the sta ements 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. C Print ame ld � Signature rAg t Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 4 Q Mike Krasnov Name of License Holder License Number 900 Riverdale St #224 West Springfield, MA 01089 102047 Address Expiration Date 32g- 7 10/03/2020 Signa r Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ B u i�Ag Const- I LL, C 1 g T q 55 Company Name Registration Number q //111-0-2-) Address 2 Z Expirati Dat Pf Telephone "� 1 Ac SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152,§25C(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 building permit. Signed Affidavit Attached Yes....... ❑ No...... ❑ City of Northampton ;. Massachusetts ��,;• ..<< DEPARTMENT OF BUILDING INSPECTIONS �: x 212 Main Street • Municipal Building 2v,�•, cD� Northampton, MA 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("HIC"). 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 owner-occupied 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: -- QP_ use-;ok Est. Cost: Address of Work: - c A V c rr IC r��-�,,..�p�b„� �'►� Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job 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: (47-0119 �LA,kw C-,)( Co V-X4 V-�C)V1 Dae tontractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton `•� '`_ S Massachusetts � A DEPARTMENT OF BUILDING INSPECTIONS �. 212 Main Street •Municipal Building C ` Northampton, 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: (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address)(L� L Signature of Permit Appli antor caner Date If, 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 of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name (Business/Organization/Individual): BuildEx Construction LLC Address: PO BOX 491 City/State/Zip: West Springfield, MA 01090 Phone #: 413-328-1778 Are you an employer?Check the appropriate box: Type of project(required): I.E]I am a employer with 3 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ✓❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.M I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 ❑ Building addition 4.[—]l 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 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.[]1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[—]Roof p repairs These sub-contractors have employees and have workers'comp.insurance: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *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. lContractors 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: NorGUARD Insurance Company Policy#or Self-ins.Lic.#: BUWC 072218 Expiration Date: 10/10/2020 Job Site Address: 6 Austin Circle City/State/Zip: Northampton, MA 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 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 certify under the pain pe that the information provided ab7-, is tr a and correct. Si nature: Date: 17 Phone#: 413-328-1778 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#: ®Q 60ffmonwealth of Massachusetts `j Division of Professi*nal Licensure Board of Building Regulations and Standards Const rjgotti6iAdpFrvisor CS-102047 A 'pires: 10/03/2020 MIKE KRASNOV 900 RNERDAL'g ST °t > #224 YVEST SPRING4 �{ 0/55391� . Commissioner Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:LLC Registration Expiration 1a7'466:--- _ 04/11/2021 BUILDEX CONSTRUCTION,LLC MIKE KRASNOV 900 RIVERDALE STS #224 Undersecretary WEST SPRINGFIELD,MA 01089 Y Graham Pre—Set Contoured. Panning Rectangular AwSeries: Accessories Manufacturing Code: PPNO8 Architectural Products Drawing 1/2 Scab — For Custom Size Drawing Contact Graham Note: Pre=Set Panning Requires The Use Of Equal Leg Sill On Window C� Centennial Charlestovrn. Special Special 996054 996051 �\ R U llts�vlindow Overlap IYindovr Overlap 5 27/13" Depth Depth "A" Dim. c "A" Dim. o Depth "A"rn "A" Dim. Depth — Depth Gv F]U PQ el k 997015 F/a+A 997027 09/30/2014 997017 997103 ]"--997029 997031 i Centennial Special Charlestown Special Mating Sills Mating Sills Extrusion Slop¢ Extrusion Slope Description 'A"Dim.x T Dim. Die R99 = _ Description 'A"Dim. x 'e"Dim. Oie#99 #10-33 P 1,698 x 3.000 7015 .239 Delaware 2.971 x 4.000 7103 .417 #10-4S P 1.698 x 4.000 7017 .239 i 0-3S P 2.475 x 3.000 7027 .348 #a-4S P 2.475 x 4.000 7029 .348 ,#8-5S P 2.475 x 5.000 7031 .348 155I Mt.Rose Avenue,v^ k,Pennsylvania 17403-2909<800/755-6274"Fax,900/366-5097 oaoa — PPN.os Veb Site:www.grahanirdndows.com ® CERTIFICATE OF LIABILITY INSURANCE 71-0 (MMIDOYYYY) A�O /15/2019 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 policy(ies)must 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 NAME: Marion Lentes, Ext 105 Foley Insurance Group Inc. PHHCONN Ext: (413)214-7474 AC No: (413)214-7447 37 Elm Street E-MAIL mlentes@foleyinsurancegroup.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC# West Springfield MA 01089-2703 INSURER A:Patrons Mutual Insurance Co of CT 20028 INSURED INSURER B:Patrons Mutual Ins Co of CT 14923 Buildex Construction LLC INSURERC:State Automobile Mutual Insurance Co 25135 PO Box 491 INSURERD:NorGUARD Insurance Company INSURER E, West Springfield MA 01090-0491 INSURER F: EEEI COVERAGES CERTIFICATE NUMBER:CL19101512601 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. INSR ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MM/D0/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE A CLAIMS-MADE FX OCCUR PREMISES (Ea occurrence) $ 300,000 BoP2838326 3/23/2019 3/23/2020 MED EXP(Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 FPOLICY ❑X PJECT RO- F-1LOCPRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BAP2456688 3/23/2019 3/23/2020 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIREDAUTOS X AUTOS Per accident X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 C EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED X RETENTION $ 10,000 CXS2141619 3/23/2019 3/23/2020 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A 2020 10 2019 1 10 BOWC072218 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? 10/ / 0/ / D (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space Is required) The certificate holder named below is included as an additional insured for general liability coverage for ongoing operations if required by written contract, permit, or agreement executed prior to a loss. Proprietor/Partner/Executive Officer/Member exclusion applies on Workers Compensation. CERTIFICATE HOLDER 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 Brian Foley/JOANN ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD IIJSn7l;ron­