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31A-034 (5) 7 FRANKLIN ST BP-2021-1294 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:31A-034 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2021-1294 Project# JS-2021-002140 Est.Cost: $5000.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MATTHEW BEAUDRY 177679 Lot Size(sci.ft.): 10018.80 Owner: STEIN CYNTHIA Zoning: URB(100)/ Applicant: MATTHEW BEAUDRY AT: 7 FRANKLIN ST Applicant Address: Phone: Insurance: 117 FERRY ST (413) 320-1348 WC EASTAM PTO N MA01027 ISSUED ON:5/6/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE PORCH ROOF 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. I IS Certificate of Occupancy Signatur:I • 51),PV FeeTvpe: Date 1'aid: Amount: Building 5/6/2021 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner May , . ;� The Commonwealth of Massachusetts_, 6 20 eiv Board of Building Regulations and Standat���� �� FOR 10 r.� UNICIPALITY Massachusetts State Building Code, 780 CIV-IR/,,,';r,,,,��� USE Building Permit Application To Construct, Repair, Renovate Or Uet o7oNSReviled Mar 2011 One- or Two-Family Dwelling - . - This S9ction For Official Use Only Building Permit Number: 40�/ t' Date A lied: � / 5-6-zoz Building Official (Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Proper 34../ 1 4 i n s1 1.2 3(ssQrs Map&Parcel Number�,,� 1.1a Is this an accepted street?yes no Mdp Number' Parcel Number 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 Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c. 90,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private CI Municipal_ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Ow er' Record: it In 5. ,M NoAu NitA oD01 Name (Print) City.State,ZIP 1 BerindiA 51- 511-(1 -{0Ss/ ct r ai .. sr\( , ri\t cow 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. 0 Number of Units Other0,,Specify:AMEI Brief Description of Proposed Work': Fr — wYtip ayood poitk\ 5-frif cold re c)),.4,ytj SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ' ❑ Standard City/Town Application Fee ❑Total Project Cost' (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fe Check No.1773 Check Amount. LP Cash Amount: 6.Total Project Cost: $ t��� 0Paid in Full 0Outstanding Balance Due:` SECTION 5: CONSTRUCTION SERVICES 5.1 Construction upervisor License (CSL) )a r 3 a,3 iNkIr@i License� `Number er Ex ration ate Name of CSL Holder { � 1 11 Pt I S f— List CSL Type(see below) U1 No.and Street A Type Description ru 4 4Di\ gyp- O J 0 -'7 — U Unrestricted (Buildings up to 35,000 cu.ft.) I R Restricted 1&2 Family Dwelling City/Town. State,ZIP M Masonry RC Roofing Covering WS Window and Siding �y ~� (� SF Solid Fuel Burning Appliances � 4t13 3 tV 7 4 �CJ 1 V)plop 1 Insulation Telephone Email address D Demolition 5.2 Registered:I-1ome Improvement Contractor (HIC) ` 77 r_�7 y aa v iv_ _ __ HICIRegistr�aftiionn Number pirati n Date HIC CoI l l NEntor HIC R i,sirant N meMCb ICI( o( � ctei No. id Str � ��/ IS y (,, 1, n � dosoh.� uel '" v! ,7 7g� 3X/4jf 3q Email dddress City/Town,Stat ,ZIP Telephoneon 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 APPLIESFOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize / 1a. iligaSIO' to act on my behalf, in all matters relative to work authorized by this building permit ap 'cation. CInd/ ,'ei,i s l Print Owner's Name(Electrdnic Signature) ate SECTION 7b: OWNERt 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 understanding. 414 &a id ; ,1- Print Owner's or Authorized Agent's Name Electronic Signature) Da e 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 he substituted for"Total Project Cost" City of Northampton //•'''' °41Massachusetts: It- •A 4 �w� '<< DEPARTMENT OF BUILDING INSPECTIONS ; ' 9J �� . r 212 Main Street • Municipal Building c p Northampton, MA 01060 4411, A,-DN'N�� 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: e.-60.* )2-cif Location of Facility: Vt GJ . 624-kr AZ, her i Y NA The debris will be transported by: Name of Hauler: 1411 PL-.1jpTr &k . Signature of Applicant: Date: / -)y /� The Commonwealth of ilas a haseths =:fit !l Department of Industrial leeu e'nts al_ I Congress Street.Suite 100 _ li;•} Boston. .►14 02114-2017 '„+�~ wit'h:nlass.koWmlia 1lwikent'compensation Insurance.lRida%it:Buildervt('ontractors,'Eleclricians,Plunthrn. 10 K.11LI:1)111111 111E PEERMft I-I I Al 11101{111. Applicant Information Please Print Lettibiv Nattle Business t ri;,!.inetatton Indo to@it.th (?).(ttUfJl4 vT4rp rode Address:__ �� Sfi I IiQVY /V' d 1O 7 Cityr'StatcfZip: Plittn. t. + J " i3'1 _ Lea you an empties 1!l hee k the appropriate i o Type of project(required). L l am a.n hen e7 soh ` crttpk.:wts ttnit and en pall-base e• 7. CI Ness construction 20 I am a ache pra.pta:toe err purin.rshrp end has.me entpksters seer.eei fur me in 8. Cl Remodeling am came:sty.1\.,.settlers'estop.uksutanex resputsal.l 9. 0 Demolition3 0 itesr ant a Ismruner stomp all sent,myself..I so wertkos ramlt in.orance requited.I 4.0 I am a lteesi omit end sill lee hump Lontraeteen tee eeenduit all se,:I emme pooped!. I sell i t1t3_ Building addition cismr that all cerrttractor%etthet hale sarke're's'ongs'nution!MU:ane1 or ate seek I I I-:.fit'cal repasts or additions proprietors e5ith t►e0,etiteplayeaa. k 12.0 1 lumbtng repairs or additions S I am a genes al contractor and I lose hived the subs ewluaciws huts,}on the attae.hol sheet i 31gRootrepairs van 1lrese subttraerars lust etnplerla s and has.:seesrk.n com p.mnp.etesuranee.'' K-i 60 Ike am ae urporatetai and its officers leak..r>.t seseel theft npht eat a extupti.era pet%tt it 1+1.El Other IS2.111(4 and se haw no emlrkty►-es.INn rwut►rrs'oaints mow ape.is-quirks&j *Any apples-AN that checks heal mast alee till cot the sc.ttwt t.elow she tnp their w ea leri►eeupensation palsy infurnute.en_ tkrnx+ewttets sled submit this atttekes tiedesatm,they axe.Jea rip all%sett,and then here outside a entraeteers must submit a pea alltdak it indicating sus :Contract r%that slice this 1<,s.trust attar heel en addition-at sheet slues tot:'t}a Warta eel tap;sul►c netractoer*an.!.;ate estwitter IV n.•t flu,se eaetrtees trio erteplot,ce% It the silt as}taNe etty.l,.sees,they trued prusadethe+: sotk.r. kvanp.pe•lay trtnulr t /am an employer that is providing worI ers•compensation insurance for an emplarers. Bettor is the policy and job site In r . Insurance.Co mpany Name: Policy#or Sell-ma.Lie_tl: (QS V 2.,�•-$I/j/3 V XI u/_ Expiration Date4� l - — f city 600 At Site tach a Address:s:the Frzin Gunn n5t wiicNi i nf�ja� Ishuwiny;the 0/0 p. 1 1 enp he policy, number and expiration date). Failure to secure coverage as requited under'\IGL c. 152.*2SA is a criminal violation punishable by a line up to Si.5(111.00 ant or one-year imprisonment.as well as en it penalties in the form of a STOP W()RK ORDER and a line of up to S250.00 a day against the violator.A copy of this statement may be fierLvarded to the Office of invastigatteens ol'the DIA for insurance coverage►eritiicatiun a1 do hereby cerlifl•under the p tins and penalties of per. rt'that the in furrnalion prutisle�d^^abate is r die and correct. Signature: ✓l✓/1lL.. Dale J/ f phott . 7 13- 3. - /3 tie Official use only. Do not write in this area.to be completed by city or town official t'ity or Town: Permit/License ft Issuing.tuthurity(circle one): i. Board of Health 2. Building Department 3.City''lown Clerk 4.Electrical inspector 5. Plumbing Inspector (a.Other ( ontact Person: Phone w: ACOR i CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/22/2021 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 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 NAME: Beth Carballo FINCK & PERRAS INSURANCE AGENCY INC (ac°."N.Exu (413)527-3000 (A/C.No): ADDE-MRESS: bcarballo@finckandperras.com _ 6 CAMPUS LANE INSURER(S)AFFORDING COVERAGE NAICt/ EASTHAMPTON MA 01027 INSURERA: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: BEAUDRY MATTHEW INSURER C: DBA BEAUDRY HOME IMPROVEMENT INSURERD: 117 FERRY STREET INSURER E: EASTHAMPTON MA 01027 INSURER F: COVERAGES CERTIFICATE NUMBER: 646315 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 EFF POLICY EXP W LIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY► COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENTED $ CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- CT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS _ AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY A OF ICER/MEMB REXCLU ED?ECUTIVE E.L.EACH ACCIDENT $ 100,000 N/A N/A N/A 6S60UB2E86300021 05/04/2021 05/04/2022 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main St AUTHORIZED REPRESENTATIVE Northampton MA 01060 Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1 ® DATE(MM/DD/YYYY) AccoR o CERTIFICATE OF LIABILITY INSURANCE 04/22/2021 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 Elizabeth Carballo,CISR,CPIA NAME: Finck&Perras Insurance Agency Inc. (q/C E Extl: (413)527-5520 FAX(A/C No) (413)527-5970 6 Campus Lane E-MAIL bcarballo@finckandperras.corn ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Easthampton MA 01027 INSURERA: Safety Insurance 39454 INSURED INSURER B: Matthew Beaudry Beaudry Home Improvement INSURER C: 117 Ferry St INSURER D: INSURER E: Easthampton MA 01027 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2142205525 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 INSDL SWVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TRENTED CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 10,000 A BMA0021095 01/14/2021 01/14/2022 PERSONAL&ADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 X POLICY JECT PRO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ 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/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Proof of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main St. AUTHORIZED REPRESENTATIVE ,/ Northampton MA 01060 ��/1�`�{l� „C 4)lar10 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD