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38B-097 (6) 36 MUNROE ST BP-2020-0519 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:38B-097 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2020-0519 Proiect# JS-2020-000899 Est.Cost:$37500.00 Fee:$244.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ROBERT WALKER 034783 Lot Size(sa. ft.): 6664.68 Owner: RHODES AMY L&ERIK S Zoning: URB(100Z/ Applicant: ROBERT WALKER AT: 36 MUNROE ST Applicant Address: Phone: Insurance: 36 Service Center (413) 584-1224 Workers Compensation NORTHAMPTON MAO 1060 ISSUED ON:10/25/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-BUILD EXERCISE ROOM AND STORAGE WITHIN EXISTING GARAGE 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 Haid: Amount: Building 10/25/2019 0:00:00 $244.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner V Department use o City of Northamptontus_gf Permit:. Building Department irrbiJ rivevyay Permit -A; ' 212 Main Street OCT 2 3 ewer/S tic 4ailability t� n Room 100 ater/W, II Av ilability Northampton, MA10 a Two Set of S ructural Plans phone 413-587-1240 Fax -58201n,�,NPla eci _ APPLICATION TO CONSTRUCT,ALTER, REPAIR, RE=NOVATE OR DEMGL!SH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office WMU1�'Zc)� �o'1f Map �C Lot 0C?7 Unit N' Y�A ir� Zone Overlay District 1 Elm St.District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: JAA Name(Print) Current Mailing Address: +411, Telephone Signature 2.2 Authorized Agent: J z23 ^fir IiL '2- YJ V k�v Name(P*t) Current Mailing Address: ca-l3 - b4 - \Z 7 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building I ! V (a) Building Permit Fee 2. Electrical t -�U (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC). 5. Fire Protection 6. Total = 0 +2+ 3+4 + 5) 3 J Check Number / 71 This Section For Official Use Only Date Building Permit Number: Issued: Signature: I()/-,-'q/j l B10 1 uilding 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' y Building Departme Lot Size Frontage Setbacks Front Side L:0 R:0 L: Rear Building Height to Bldg. Square Footage �'� C� ON Open Space Footage (Lot area minus bldg&paved parking) #of Parking S es Fil (VI-Ilume&Location A. Has a Spe � l Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW O YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES O IF YES: enter Book Pagel and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained O , Date Is ed: 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 o IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,exc ation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then 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 Alteration(s) Roofing ❑ Or Doors E] Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding [O] Other[E] Brief Description of Pr posed �„n Work: b v►tA -O,-)L ClS� �-GG� ANP ST�'��r' �,� ► TNA"N' K r-1 ST)P L- Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll heJeX 6a. If New and or addition to existing housing, complete the following: 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? V' d. Proposed Square footage of new construction. �, J Di io e. Number of stories? x'` ( f. Method of heating? e Fi aces 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 ands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or ar floor below finished grade k. Will buildin onform to the Building and Zoning regulations? Yes No . I. is 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, P��nyc�-�5" as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Avr��47 Signa t re of Owner Date I, R t �J -1 i,�, aG% f2 as Owner/Authorized 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. Print Name Signature of Owner/Agent Date —� SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ^� Not Applicable ❑ Name of License Holder: T`7"0y3�tQ; J w L'���� c S- o 3 4--7 G 3 rr License Number p S�t�v�Gg C 1E t►-'t`k.0-� . Yy e .4 1PT�'� w%A t L ` Z it Address Expiration Date l 4Xk,_ Signature Telephone Not Applicable ❑ *AZT- 1-72-01t. Company Name Registration Number cam , N o A..%*-,c, Ma Address Expiration Date Telephone4- %2-7-4 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...... ❑ a City of Northampton Massachusetts :G ` DEPARTMENT OF BUILDING INSPECTIONS j 212 Main Street *Municipal Building \i 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: G rev t-j" 4E ST- (Please print house number and street name) Is to be disposed of at: V2 t?c C (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signature of Permit Applicant or Owner 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 I Congress Street, Suite 100 a Boston, MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aimlicant Information Please Print Le ibl Name (Business/Organizatin„/T"-iii ,:(4.,nlN' Address:_ _ t�� City/State/Zip: Il py _ Phone #: q t Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with k I employees(full and/or part-time).* 7. ❑)NA construction 2.21'am a sole proprietor or partnership and have no employees working for me in $. EfRemodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10E] Building addition 4.❑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 11.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.M I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E:]Roof 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#I 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. tContractors 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: ,.fin/r `L -7/ /Policy#or Self-ins.Lic.#:W'�2U U�CJU 1 �O7�DL�(7 Expiration Date: l Job Site Address: Cz�rI rl lel. o rL' V C, � City/State/Zip: rn. 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 cern y under the pains andpenalties ofperjury that the information provided above is true and correct. Signature: Date: to a • I Phone#• C5 — i 4 — (Z Z c Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# L ing Authority(circle one): oard of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector ther tact Person: Phone#: DATE(MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE F07/02/2019 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. PORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)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 CONTACT Barbara Grynkiewicz Webber&Grinnell PHONE (413)586-0111 aNo): (413)586-6481 AIC No, Ea 8 North King Street E-MAIL s: bgrynkiewicz@webberandgrinnell.com INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: West American/Liberty 44393 INSURED INSURER B: American Fife&Casualty/Liberty 24066 Construct Associates,Inc, INSURER C Ohio Casualty/Liberty 24074 Attn:Kim Clairemont INSURER D: AIM 33758 36 Service Center Road INSURER E: Northampton MA 01060 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 7/1/20 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 CONTRACTOR 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. POLICY EFF POLICY EXP INTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MWDD/YYYY MM/DD/YYYY LIMITS R COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ® OCCUR PREMISES(Ea occurrence 5 100,000 MED EXP(Any one person) 5 15,000 A BKW58364577 03/01/2019 03/01/2020 PERSONAL&ACV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT S OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT y 1.000,000 Ea accident ANY AUTO BODILY INJURY(Per person) S B OWNED XSCHEDULED BAA58364577 03/01/2019 03/01/2020 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED X NON-OWNED Per accident S AUTOS ONLY AUTOS ONLY Medical payments s 5,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE S 1,000,000 C EXCESS LIAB CLAIMS-MADE US058364577 03/01/2019 03/01/2020 AGGREGATE s 1,000,000 DED I X1 RETENTION S 10'000 �/ $ WORKERS COMPENSATION /� STATUTE EERH AND EMPLOYERS'LIABILITY Y/N EACH ACCIDENT 5 � 500,000 D ANY PROPRIETOPJPARTNER/EXECUTIVE NIA WMZ80080075072019A 07/01/2019 07/01/2020 E.L. OFFICER/MEMBER EXCLUDED? 500,000 (Mandatory in NH) ELDISEASE DISEASE-EA EMPLOYEE 5 If yes,describe under500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) 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. "For Insurance Info Only" AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACO 06//2® CERTIFICATE OF LIABILITY INSURANCE DATE /21 11220 1 019 Y) 9 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 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 CONTACT Barbara Grynkiewicz NAME: . acNo4 -0111 -6481Webber&Grinnell PHONE Ext): c No: 8 North King Street AE-MAIL bgrynkiewicz@webberandgrinnell.com INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA: Wes,American/Liberty 44393 INSURED INSURER B: AIM 33758 Robert Walker INSURER C Attn:Kim Clairemont INSURER 0: 36 Service Center Road INSURER E: Northampton MA 01060 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 3/1/20 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 DDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1'000'000 AEM100,000 CLAIMS-MADE OCCUR PRISES Ea occurrence) $ MED EXP(Anv one person) S 15'000 A BKW53372253 03/01/2019 03/01/2020 PERSONAL&ADV INJURY $ 1.000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY ©JE 71 LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 (Ea accitlent ANYAUTO BODILY INJURY(Per person) 5 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) 5 HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTION S S WORKERS COMPENSATIONY t N v PER OTH- AND EMPLOYERS'LIABILITY ^ STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 500.000 B OFFICERIMEMBEREXCLUDED? Y N/A WMZ80080065482019A 07/01/2019 07/01/2020 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 500,000 If yes describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN "'For Insurance Info Only— ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE J ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 30 AMP DISCONNECT 20'_9" F FOR SPLIT SYTEM NEW MINI-SPLIT HVAC SYSTEM N 60" v R R R AFF WORKROOM SPRAY FOAM INSULATION AT CAN N EXISTING AND NEW WALLS, CEILING cfl REPLACE EXISTING COLLAR TIES WITH NEW 2 X 8 24"O.C.WITH PLYWOOD DECK ABOVE FOR STORAGE io 1/2"GWB AT EXISTING AND NEW WALLS, CEILING O rn R R R N 101 e N TO (2)STRIP LIGHTS AT ' ADD 1/2"CDX PLYWOOD LOFT ABOVE SHEATHING AT INTERIOR STORAGE AREA SURFACES OF ALL NEW WALLS 0 NEW SUB-PANEL STORAGE AREA EXISTING SOLAR POWER DISCONNECT ' REPAIR EXISTING DOORS ELECTRICAL NOTE: SPECIAL OUTLETS ONLY SHOWN: OTHERS TO BE INSTALLED TO CODE NEW DOOR: T-0"X 6'-8" NEW WINDOWS: 101 O R.O.: 3'-2"X 6'-11" MARVIN INTEGRITY CN 3048 R.O.: 2'-6 1/2"X 4'-0 1/4" RHODES GARAGE 36 MUNROE STREET 1/4" = 1'-0" NORTHAMPTON MA 01060 3-20-19, rev. 9-24-19