The URL can be used to link to this page

43-172 470 PARK HILL RD BP-2021-1062 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:43 - 172 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Bath reno BUILDING PERMIT Permit# BP-2021-1062 Project# JS-2021-001799 Est.Cost: $22200.00 Fee: $145.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RICHARD T WEST 086947 Lot Size(sq.ft.): 82938.24 Owner: MCGRATH PATRICIA Zoning: Applicant: RICHARD T WEST AT: 470 PARK HILL RD Applicant Address: Phone: Insurance: 10 BARSTOW LN (413) 584-8528 SOLE PROPRIETOR HADLEYMA01035 ISSUED ON:3/25/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:BATHROOM 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 NORTHAMPTONUPT IOLATION OF ANY OF ITS RULES AND REGULATIONS. I i • '► . Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 3/25/2021 0:00:00 $145.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner The Commonwealth of Massachus 2 4 2421 FOR Board of Building Regulations and S rds ICYPALITY Massachusetts State Building Code,78( Rr� ill) USE Building Permit Application To Construct,Repair,Renova q �N ,gbos° s R ised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: h p-�A/-1 f C 2_, Date Applied: JK C-wry /2•5, ,figC. -Z5-204 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION yl Property Addre ,f✓� 1.2 As s ors Map&Parcel N �berrss �� //� �,�iYlPnG1 Mapr�u>Sber P�celTlumber 1.1a Is this an accepted street?yes no 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Wired Provided Required Provided Required Provided Ill 9 1.6 ater Supply: (M.G.L c.40,§54) 1.7 ood Zone Information: 1.8 ewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ c SECTION 2: PROPERTY OWNERSHIP' �t •/ \ �, c R�cd c�= A`r\ r- kisn v v t (v Name int) City,State,ZIP 1 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building el Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition Jiz Accessory Bldg. ❑ Numberof Units I Other ❑ pecify: Brief Description of Proposed Work2. ) /l�i�/ p�°rn ��/ /4// iiiiiyA4r. 4' t° /'C/YYG,,/,-p ///) fie. S9P, e /6Ga&)4 i SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ /yp00 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ a ❑Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ bte ar 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fein Sep !.•�� -) 4"Cash Amount: Check No. Check Amount: 6.Total Project Cost: $ ,z2i a a2 ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor Lice se(CSL) tZ n e c /, C� License Number Ex Ira on Date Name of CSL Holder /D 84 e.5 /� ��G'� List CSL Type(see below) No.and S et �p Type Description //�/I{ /7)1;2 �jaY� R RestrictedUnrestrict�l&2 uildin FamilysDwellin up to g� ft.) City/Town, te, IP M Masonry ya 5/i - CK RC Roofing Covering �(/ WS Window and Siding ,/ J SF Solid Fuel Burning Appliances /Ye IG'r AZ5p_��i��krl I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) . . I / t Act 1 /' (�es T C Registration Number xpir on Date HICoompAy Nam r HIC Iler,ant Name &3 3(40 z:L.-1-.--,o e/ o /' S ' t ,,,/)9 D/O�c (94 79_,A4 2 Email address City/Town tate,ZIP 7/� Telephone SECTION 6: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 5:c No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize /'J/'At y, / /�/t 5 to Est on ` my behalf,in all matters relative to work authorized by this building permit application. nt Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application/is�true and accurate to the best of my knowledge and understandin . A IC Ah d 42 Print Owner's or Authorized Agent's"Name(Electronic Signature) Date gn ) NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of Massachusetts Department of Industrial Accidents 4 c�� =- rRy ! Congress Street,Suite 100 r �, _ k Boston, MA 02114-2017 ` www rrrass.gov/d a %1ut1cers'Compensation Insurance Affidavit:BuilderziContractors!Ekctrlc1ans/Plumbers. •hi)tit: FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print LeeibIN- ....-1— NaMe I tlusatt s+Orgartiration kilts t;luai t /') r(,,A f ^Li /ia.,.."-- Address:jO 24.'s.4, x,h e City/State/Zip: « Phone#: <j _7 - J� Are yeti an employer?Check the 6prapriate boa: Type of project(required): 1.0 I am a employer with __ employees(full andrer part-Hindi.• 7. 0 New construction 211 am a sok proprietor or p:trtm.-r hip and have no employees working for me in ng cap acity.pacity-(No workers'comp.insurance !umpired] K pzi Remodeling 30 I am a homeowner doing all work myself.(No uake s'cone required] insurance ruired]' 4- Demolition w 4.0 I am a homeowner and will be hiring ouartraa property. urs to conduct all work on my I will 10 Q Building addition ensure that all contractors either hale worker'cvxrrpcmsation insurance or an sole i l.o Electrical repairs or additions prupneton with no employees_ 12.0 Plumbing repairs or additions 50 I am a general contractor and I has c hired the sub-euntracwrn Listed on the attached sheet 130 Roof repairs These sub-contractors bassi employees and have workers'comp.insurance.; 6.0 we are a corporation and its officers have exercised their right of exemption pet MGL t_ 14.0 Other I;'_.§l I41,and we have no employees.[No workers'camp.insurance required.] *Amy applicant that chucks boas a I trust a[so fill out the section below show ing then workers'compensation policy information. t Hose eeuwncn who submit thus off i l esit indicating they are doing all work and then here outside:cmtrac:tors must submit a new of fides it indicating such. contractors that check this box must attached an additional sheet show in,:the name of the sub-contractors and state is}tether or not those tunnies host eanployccs. if the sub-contractors have employees.they ritual 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: Policy#or Self-ins.Lic.#: Expiration Date: _ City of Northampton ?O YhIgMY)p'; StS St -`� Massachusetts a`''~ Lt Ltd R • ` ,� DEPARTMENT OF BUILDING INSPECTIONS y �° 212 Main Street • Municipal Building OC Northampton, MA 01060 44„ CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: //r-� Location of Facility: t �N The debris will be transported by: Name of Hauler: Ckr / 4 7a57/ Signature of Applicant: �! ' 2,% 2 4,4 Date: 07 ACE 1 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/19/2021 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 Linda Eichstaedt,CRIS NAME: Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 wc.No,Ext): (A/C,No): 8 North King Street ADDRESS: lichstaedt@webberandgrinnell.com INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Main Street America/MSA 29939 INSURED INSURER B: Richard T.West INSURER C: 10 Barstow Lane INSURER D: INSURER E: Hadley MA 01035 INSURER F: COVERAGES CERTIFICATE NUMBER: Master Exp 11-2021 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM!DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �/ DAMAGE TO RENTED 500,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 A MPT5855Y 11/01/2020 11/01/2021 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PEO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: EPLI $ 10,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) - E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 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 Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1J11 �r ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD