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29-174 (7) 81 DEERFIELD DR BP-2021-1256 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29- 174 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: shed BUILDING P E RM I T Permit# BP-2021-1256 Project# JS-2021-002083 Est.Cost:$10250.00 Fee: $43.20 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HOMETOWN STRUCTURES 98186 Lot Size(sq.ft.): 20778.12 Owner: CALLAHAN DAVID A Zoning: Applicant: HOMETOWN STRUCTURES AT: 81 DEERFIELD DR Applicant Address: Phone: Insurance: 627 SOUTHAMPTON RD (413) 562-7171 WC WESTFIELDMA01085 ISSUED ON:4/29/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:12X18 ACCESSORY BUILDING 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 NOR HAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. ( a .„9 Certificate of Occupancy Signature: f FeeType: Date Paid: Amount: Building 4/29/2021 0:00:00 $43.20 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Z- © K File# BP-2021-1256 APPLICANT/CONTACT PERSON HOMETOWN STRUCTURES ADDRESS/PHONE 627 SOUTHAMPTON RD WESTFIELD (413)562-7171 PROPERTY LOCATION 81 DEERFIELD DR MAP 29 PARCEL 174 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCL REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 12 �1`"G�V Fee Pai1/\d eof Construction: 12X18 ACCESSORY BUILDING New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building 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: X 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 , Tiat Sign.e re of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. The Commonwealth of Massachusetts \\`.', Board of Building Regulations and Standards '`�, � • FOR Massachusetts State Building Code, 780 C'MR�p9 �`':, NICIPALITY -..„.„W 2 8 USE Building Permit Application To Construct, Repair, ReiiO e�Or Demo1497 2viseiMar 2011 One-or Two-Family Dwelling `;�,,i� ,, 'z„; r,7 e This Section For Official Use Only -,,,,ti, s �"� i30..l./ cs e ` /v Building Permit Number: '���� Date Applied: `{°�sooNs ,, _ 1 .2 , I v li c Building Official(Print Name) Signature i Date SECTION 1: SITE INFORMATION 1.1 Prf�op'rty�de,eAr ti to la 1.2 Assessors Map& Parcel Numbers 1.1 a Is this an accepted street?yes tl no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property_ Dimensions: /5� `7CO 215 / Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided izo ' L7 /125" 15 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Private❑ Zone: Outside Flood Zone? Check if yes Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP1 2.1 Owner1 ofRecord; O�,vTc Cam,llJ. o,r) A/orliqaerytorl MIA 0i062— Name(Print) City,State,ZIP Dee rfce 1ci Ur;v-e gI?-535-q/3.CeJoc I05tQcc mcctc ,' i No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.11t, Number of Units Other 0 Specify: 1 Brief Description of Proposed Work2: De , v-la/if/I o -y re as s Ci,/ed (2c.')( i t olcc•es S IA;16.)- SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ ( a 25� 1. Building Permit Fee: $ Indicate how fee is determined: , 2.Electrical $ ❑ Standard City/Town Application Fee ❑ Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire Suppression) $ Total All Fees: $1 � ,� Check No 31OCheck Amounf` :� Cash Amount: 6. Total Project Cost: $j G12v G 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ( _M`C. 0W031202I Andrew wiz License Number o Expiration Date Name of CSL Holder List CSL Type(see below)2A 5 er�tie� No.and Street Type Description rtizt- rn&foin /4�Q /1 V,'D5 U Unrestricted(Buildings up to 35,000 Cu. ft.) 7 I R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances / `6 7I2-7/ nd AZilo Tnef( -KirG(,ctui es,((c, i I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) /6—oJ 772 /\�� / 2 F{� rjul own 5to cf(,u-e 5 HIC Registration Number WExpiration Date H02.7m y Naps orb R(isil / b l^- AG1 p �'� P'�i (,�V'IGr�W(� �C7Nt1S�?"�lC�(�,IeS,C(�'! N(�%si e, l'VI� oZj �t���2�7 i7 Email address City/Town, State,ZIP 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 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 l71- ine w41 Sf-i?/G fe-4 to act on my '.half, in all matters relative to work authorized by this building permit application. 1-( 2/ e 21 Print I wner's Name(Electronic Signature) Da 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 a lication is true and accurate to the best of my knowledge and understanding. /zi 7z ' Pri t Owner's or Authorized Agent's Name( tronic Signature) Date 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" Commonwealth of Massachusetts Division of Professional Lecensure Board of Building Regulations and Standards Construction Supervisor CS-098186 E,[�ires: 08/0312021 ANDREW D KURTZ 295 BROMLEY RD ., HUNTINGTON MA 01060 ''rrltyei �,, Commissioner. 4,/,....,44/404-4*-01.---- . ...de'a4,-%CGC//- %e9/ Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration 1 Type: LLC HOMETOWN STRUCTURES, LLC 9 �- � r' Registration: 159772 627 SOUTHAMPTON RD �+¢: Expiration: 05/26/2022 WESTFIELD,MA 01085 Update Address and Return Card. SCA 1 u 201,1-05 17 Office of Consumer Affalfs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 159772 05/26/2022 1000 Washington Street -Suite 710 HOMETOWN STRUCTURES,LLC Boston,MA 02118 ANDREW KURTZ 627 SOUTHAMPTON RD •��� '�!��' WESTFIELD,MA 01085 Undersecretary Not valid without signature The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 _'t i- Boston, MA 02114-2017 Ar.,06� wwwmass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le2ibly Name (Business/Organization/Individual): Hometown Structures Address:627 Southampton Road City/State/Zip:Westfield, MA 01085 Phone #:413-562-7171 Are you an employer?Check the appropriate box: Type of project(required): I.ID I am a employer with 15 employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself. [No workers'comp.insurance required.] 9. ❑Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑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 accessory building 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. I.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: Berkshire Insurance Group Policy#or Self-ins.Lic.#:AWC-400-7028459-2020A Expiration Date: 11/27/2021 Job Site Address: City/State/Zip: 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 pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#:413-562-7171 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia 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-400-7028459-2019A PRIOR NO. AWC-400-7028459-2018A ITEM 1. The Insured: Hometown Stuctures LLC DBA: Mailing address: 627 Southampton Road FEIN: "-"'6332 Westfield, MA 01085-0000 Legal Entity Type: Limited Liability Company Other workplaces not shown above: See Location 2. The policy period is from 11/27/2019 to 11/27/2020 12:01 a.m. standard time 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. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States 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 policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per S100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTRA 000337067 INTER SEE CLASS CODE SCHEDULE Minimum Premium $500 Total Estimated Annual Premium $12,618 GOV GOV Deposit Premium $6,523 STATE CLASS MA 2802 State Assessments/Surcharges $12,155.00 x 3.5100% $427 This policy, including all endorsements,is hereby countersigned by 11/25/2019 Authorized Signature Date Service Office: Berkshire Insurance Group Inc 54 Third Avenue P 0 Box 4889 Burlington MA 01803 Pittsfield, MA 01202 WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation Insurance. used with its permission. v e fv, SI II ex .11 4.0 fir rwr 't)k Xy 30-year architectural 2 x 4 rafters 16" on shingles over 1/2" CDX center with collar plywood roof sheeting ties 4' on center 4: exclusive detailing, --.."� painted eaves, �_ and wood corners G double 2 x 4 top wall illOti► •r plate, 2 x 4 wall studs double 2x6 , , k 16" oncenter ,, * 1?0* header over doors pressure treated floor 5/8" DuraTemp T1-11 fastened with system, 4 x 4 rails, joists 12" galvanized nails, exterior acrylic on center, 5/8" plywood latex paint - or 1/2" CDX with vinyl City of Northampton �asHaktPo (/�` ti Massachusetts tx. k DEPARTMENT OF BUILDING INSPECTIONS f, s 212 Main Street • Municipal Building Northampton, MA 01060 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: Location of Facility: Y1 Z't l/C,' c r cC 0B 2 The debris will be transported by: Name of Hauler: USA / ok-m-/i Signature of Applicant: ,—,4 F, Date: q 2 1 2 / City of Northampton j'"ff �" Massachusetts C� 'A' DEPARTMENT OF BUILDING INSPECTIONS fi 212 Main Street • Municipal Building ti Northampton, MA 01060 'r.1, Phone: (413)587-1240 Fax: (413)587-1272 Effective July 1, 2015 Residential One and Two Family Building Permit Fees http://www.northamptonma.gov/702/Buildinq-Department Fees for work not listed will be determined by the Building Department Any work beginning before a permit has been issued is subject to double fees and a stop work order removal fee Hours of operation are typically Monday thru Friday 8:30 to 4:30, Walk-In hours are closed at 12:00 pm Wednesday Permit Fees are paid to the CITY OF NORTHAMPTON CHECKS OR MONEY ORDERS ONLY: NO Cash or Credit Cards Checks or Money Orders Must Be Submitted with the Application or it will not be acted upon To Be Processed,Applications Must Be Complete and Include ALL Required Attachments All Applications Are Subject To Zoning Review. The Weekly Filing Deadline is 12:00 pm (noon) on Wednesday. Building applications - Require a plot plan, floor plans, elevations, structural and energy information as appropriate Sign applications - Require a photo of the existing elevation and a photo shopped placement of the proposed sign Applications may be subject to Central Business, and or Historic and Demolition Delay reviews It is the Owner's responsibility to verify property bounds and conservation issues COMPLETE DEMOLITION Accessory Structure $30.00 One or Two Family House $75.00 NEW CONSTRUCTION All Occupied Floors per sf $.50 1/2 Floors,Walk-In Attics, Basements, Garages per sf .$.20 Decks, Porches, Canopies, Porticos per sf $.20 NEW ACCESSORY STRUCTURE Free Standing Decks $.20 per sf, Minimum $50.00 Shed up to 200 sf zoning review $30.00 Shed over 200 sfl On Minimum $35.00 Tent over 200 sf $30.00 Above Ground Swimming Pool $40.00 In Ground Swimming Pool $75.00 REPAIR, RENOVATION, ALTERATION $6.50 per$1000 of estimated cost(rounded up) Minimum $65.00 SIGNS Wall Sign for Home Occupation $40.00 SPECIALTY PERMITS Roofing $40.00 Siding $60.00 Non-Structural Door&Window Replacement $40.00 Solid Fuel Burning Appliances $40.00 Sheet Metal $25.00 with building permit on site; Otherwise $50.00 SOLAR Roof Mount $75.00 Ground Mount up to 8kw or 100% of demand $75.00 Ground Mount up to 200% of demand $100.00 Ground Mount over 200% Use the commercial rate calculator OTHER SERVICES Request For Zoning Determination $30.00 Home Business Review& Registration $30.00 Replacement Permit $30.00 Contractor Change $30.00 Temporary Certificate of Occupancy $75.00 Additional or Requested Inspections $75.00 Removal of Stop Work Order $75.00