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18-035 66 EMILY LN BP-2020-1215 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18-035 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-2020-1215 Project# JS-2020-001764 Est.Cost: $46655.00 Fee: $306.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: WRIGHT BUILDERS 047146 Lot Size(sg.ft.): 42383.88 Owner: WRIGHT BUILDERS Zoning: Applicant. WRIGHT BUILDERS AT: 66 EMILY LN Applicant Address: Phone: Insurance: 48 Bates St (413) 586-8287 (1 16) Workers Compensation NORTHAMPTONMA01060 ISSUED ON:6/9/2020 0.00:00 TO PERFORM THE FOLLOWING WORK.KITCHEN RENO 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 6/9/2020 0:00:00 $306.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only rr_ City of Northampto `" Status of Permit: Buildin De art t G g p Curb Cut/Driveway Permit �A 212 Main Street'', \19 r/Septic Availability Room 100 ��ti � � Wa NVell Availability Northampton, MA 0106�'n'^%,, 0 Zot/Site Sets of Structural Plans phone 413-587-1240 Fax 413-5 Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR QEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office `' � A wrG Map � � Lot V J� Unit lQ�o G rh' � �" C� Ar,` fv J �� Zone Overlay District Elm St. District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: SI-�B�► �,P'p V00 ( o S(5 II O A, (_ 610 6MI!�j LV, PrbAIN+ l/ k vp Name Print) Current Mailing Addr ss: log e f Telephone Signa ure 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature' Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building GI 15 (a) Building Permit Fee 2. Electrical 0 b g' (b) Estimated Total Cost of Construction from 6 3. Plumbing '� 9 i Building Permit Fee (� 4. Mechanical (HVAC) 5. Fire Protection 6. Total = 0 +2 + 3 +4 +5) r7 , Check Number This Section For Official Use Only Building Permit Number: '(�i��o o Date Issued: Signature: 6- q_Z0zo 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' y Building Departmen Lot Size Frontage Setbacks Front Side L: R: L: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parkin Spa Fill: ume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW © YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO a DONT KNOW O 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? YESO 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 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, gradin xcavation,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 ❑ Replacemenr?r Windows Alteration(s) Roofing E]rs 4W Bee Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [O] Other[p] Brief Description of Proposed P-e(Ja V AJ< V-7 I fS'��M E &D-r, t-fN 0 G-,t� C Work:--4/yo N, crf-uL 11L , A-t--AA' :'t' W, 'lioDl�/'i(/ T 5WK- lni� Alteration of existing bedroom Yes—K No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes 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 b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimension e. Number of stories? f. Method of heating? Fir ces 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 w nds? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or c r floor below finished grade k. Will building orm to the Building and Zoning regulations? Yes No . I. Se ank City Sewer Private well City water Supply SECTION 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, `a ( � 0 f "S�+ 6ke-+J- 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. -:�7\ , -�A :3 Signature of wner Date as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best ot my kn-67Mne a'adU'elief. 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: License Number W �AMS s�', o rt P-��, M )-/I/a-( Address Expiration Date Signature /Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ W P (sem i Ube l 1) l Gs 6 Company Name Registra ion Number (f( "-M"A-A4 P-fq N, Ml -- � I)!!:!�)2b Address ((,,,, Expiration Date Telephone j-- (3- �X �8d 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 1S `� DEPARTMENT OF BUILDING INSPECTIONS •��'„' 212 Main Street •Municipal Building wti CDS 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: W CT-bes, (Company Name and Address) 't L Signa bre 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 'e 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 Legibly Name (Business/Organization/Individual): w P:! (r � XVI iA�.-,b4e Address: City/State/Zip: (VoP-" AM?"I'J) AAA- 0'b(oaPhone Are you an employer?Check the appropriate box: Type of project(required): 1.E]I am a employer with 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. Memodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Fj 1 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑ 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.❑Plumbing repairs or additions 5.D(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.t 13.�Roof repairs 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. #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: k, I- M . M WtiAti C IN5:. �iO�O• Policy#or Self-ins.Lic.#: MC - Iia- � '' ob ��3 T — a'U�xpA ation Date: -3 Job Site Address: (k LA446 City/State/Zip: N014TW)44UPON, IM Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date)0 1060 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 pains andpenalties of erjury that the information prodded above is true and correct. �} Signature: t. Date v 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#: WRIGBUI-01 KAYLA ACORO DATF(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 3/312020 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 Kayla Marie Drinkwine NAME: --_ Phillips Insurance Agency,Inc. PHONE 413 594-5984 FAX No: 413 592-8499 97 Center Street (Alc,No,Ext:( ) Chicopee,MA 01013 EMAIL :kayla@phillipsinsurance.com INSURERS AFFORDING COVERAGE NAIC* INSURERA:EMC Insurance Companies 21415 INSURED INSURER a:A. 1. M. Mutual Ins. Co. 33758 Wright Builders,Inc. INSURERC: 48 Bates Street INSURER D: Northampton,MA 01060 INSURER E INSURER 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. 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS L IN M M A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE n OCCURTBD 3/1/2020 3/112021 DAMAGE TO RENTED 100,000 PREMISES Me occurrence) S -. MED EXP An one person) 5'000 PERSONA L_&ADV INJURY 1'000'000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _ 2'000'000 X POLICY XJE� u LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: EE Benefits 1,000,000 A - CBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY EOMci ANY AUTO TBD 311/2020 3/1/2021 BODILY INJURY Perperson) _ OWNEDX SCHEDULED _ AUTOS ONLY AUTOS BODILY INJURY Per accident X HIRED X NON-OWNED PROPERTY AMAGE AUTOS ONLY AUTOS ONLY Per accident $._._ A X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 5'000'000 EXCESS LIAB CLAIMS-MADE TBD 3/1/2020 3/1/2021 AGGREGATE $ 5'000'000 DED I X I RETENTION$ 10,000 B WORKERS COMPENSATION X 1PER OTH- AND EMPLOYERS'LIABILITY _ STATUTE YIN MCC-200-2000534-2020A 3/1/2020 311!2021 500,000 ANY CERIMEMBER/PXCLUDElEXECUTIVE ❑ E.L.EACH ACCIDENT $__ (Manila R/MEM NH)EXCLUDED? N NIA 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under 1,000 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT ' DESCRIPTION OF OPERATIONS!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 Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts 101 Division of Prdfessional Licensure Board of Building Regulations and Standards Construction,$u�Qigor,1 & 2 Family J. CSFA-047146 y` Ejpires: 021/09/2021 t MARK F LEDWELL 231 W HAWLEY RD CHARLEMONT NIA 01339 S3C Commissioner . z.l��Pi �P��� ��iG���c�•C2 i�i'GcLcy Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, lel Ctracior setts 02118 Home Imprave�� Registrailon '—' r7' Type: Carporrton INRIGHTBUILDERS, 16LC. w (z` �Regisi°n: 101536 lW 4t3 BATES ILD E`t� '�� `t' iramon: 06/25/2020 NORTHAMPTON, MA 01060 rte' =� al G�f yam/ - Update Address and Retum Caryl., SCA 1 4 2flM-0.5/17 .�i e (�isrunonr�clG�o�./�¢k1or/��Je�s Office of Ccnsumer Amies&Business Regutation HOl1AP IMPROV MEDI7 CONTRACTOR Registca".ion vaiid for indMduai UL oTdj 1'Yor�tion ,baffcre the�cpisat3on ' If found m--Wm to: Expiration O a�cf,Corsueate5 ams and Nu=_in ss Reguiatan Go/2520?_G 10@0 Nt ashington eat-Suite 7'10 BUI J 96Boston,NJt�021d- WRIGHT JONATHAN A- 43 43 RATES STRE o valid without signature NORTHAMPTON,MA 01060 Undersecretary � d replace o- demo existing i existing flooring with flooring new tile at -- Kitchen Entry i Rm & L s and insl demo new wh existing I oak floc closet & I I install new ------- - tall cabinet I I T & custom bench with _� I i replace coat hooks b i i handrail at remov( above stair & basebc landingJui�r e Z r-r�ra6- Rm, Ei replace i and Kil kitchen and re window, white, basebc i same size I replacE bedroc demo existing kitchen cabs & countertops and N install new cabs & countertop in °�`�`'� same footprint, f�1GE i new plumbing. disconnect & rhPe _: reconnect existing gas stove in same locationX S__ f i # e a ...�..... _ "� .-...oR�m .sn.ras ...�.. ...mss �-�.-...� ..,w.r +ossa.« e*.�>.�_•a�72.r r_�c..acs —..._.tea �.".s' ............... _ aL NSc a � A i E ' f Art, f �12 Xoq - � �S+`-'-we+�xw` ��m.++�anive..rwes-•— ^�,w.+aa�eun �n,Tr. �- Qd� a��� CWrssr al- � 2, 5 N ati: -TT � i7' �►-�- Mix t� _, w/ �Eve,1-C9 - — LAV ! � 1,