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24C-103 (3) 3 MASSASOIT AVE BP-2021-1272 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24C- 103 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Permit# BP-2021-1272 Project# JS-2021-001845 Est.Cost: $32400.00 Fee: $211.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: TIM STOKES 083602 Lot Size(sq.ft.): 8058.60 Owner: HEROLD JORDI & ELIZABETH DUNAWAY Zoning: URB(100)/ Applicant: TIM STOKES AT: 3 MASSASOIT AVE Applicant Address: Phone: Insurance: 20 TURKEY HILL RD (413) 695-2264 O WESTHAMPTONMA01027 ISSUED ON:5/11/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:ADDITION OF SREENED PORCH 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. � 1• v • Certificate of Occupancy signatur FeeType: Date Paid: Amount: Building 5/11/2021 0:00:00 $211.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner z -5K File# BP-2021-1272 APPLICANT/CONTACT PERSON TIM STOKES ADDRESS/PHONE 20 TURKEY HILL RD WESTHAMPTON (413)695-2264() PROPERTY LOCATION 3 MASSASOIT AVE MAP 24C PARCEL 103 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid /N\ Typeof Construction:_ADDITION OF SREENED PORCH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 083602 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: )c 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 l Sign 'ure 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. , t a . f. lisc ICS. The Commonwealth of Massachusetts / --/ ,, Board of Building Regulations and Stan ds IC ALITY Massachusetts State Building Code, 780 MRAPH 3 0 SE c Building Permit Application To Construct, Repair, Ree Or Demolat evis Mar 2011 One-or Two-Family Dwelling tioRlNe0), This Section For Official Use Only oN",P c,.. Aci Building Permit Number: , P-2/ ' I .'7a- Date Applied: cfErdicvN.) - I, .if J 1 Building Official(Print Name) Signature 1 1 I 6 SECTION 1:SITE INFORMATION 11..'1 Property Address: ��, 1.2 Assessors Map& Parcel Numbers �4° ZA-l✓ t o 5 1.1a Is this an accepted street?yes>G no _ Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: U g 'O TZ665)O e JiY at. VZ 7"7 15 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.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Private 0 Zone: _ Outside Flooyes e? Municipal poOn site disposal system 0 Check if yes SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of ecord: d •"4" e)-1-o4 Name(Print) City State,ZIP 3 t"ASS,01 so rc--4/07 / 5 Jo mot IW f%IVA.Cot, No.and Street elep one Email Ad ress 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 NI Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: T. a • 41 °• a. rtzoo-kv '/Attu pelt_ , "Ao{orp l SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ .4410 0 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee 5, o ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All FC � Check No.C jj�7Check Amount: / Cash Amount: 6.Total Project Cost: $ 3 ?j, 40 0 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL)• 060.L Z Z� I ` License Number E pirat n Date Name of CSL Holder (��V /ku+ List CSL Type(see below) U No.X and Street 126! j Type Description VI€4 hn VilOit 1 11 /L Q 14Z1* U Unrestricted(Buildings up to 35,000 cu. fi.) 4T3 R Restricted 1&2 Family Dwelling City/Town,State,ZIP 1 I M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 446, 13 G 95 Zz64. $oV-)31)11, :t' 4 6, I Insulation Telephone Email address A 1M t L.al v`"D Demolition 5.2 Re i ered Home Improvement Contractor(HIC) ' 111X5 oyzo, i M�.�?� › HIC Registration Number Date HICy Name r H Regis t Name 1/uf�j 1�1 V 4-abZ7 A l3 G 1 S LZ64 Email address City/Town,State, 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 0 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 i Ve" - 5in5 to act 4 my behalf,in all ers relative to work authorized by this building permit application. ofvc6 ( L) (V(2 12 / Prin • '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 understanding. � Print Owner's or Authorized Agent's Name(Electronic 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" r City of Northampton ,or„,,.,.._ ,_;, '� `" Massachusetts 4S`i*'1_. !c> ,4. DEPARTMENT OF BUILDING INSPECTIONS f, 1. D� 212 Main Street • Municipal Building y O .^ Northampton, MA 01060 �f '••a,ox 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: _ The debris will be transported by: Name of Hauler: '1MH6p1.551' 1 T1AIC,1C-Aerte—, — Z1 - -‘------, f3-- ‘ Signature of Applicant: Date: fitif /teVi The('ontntonwealth of Massachusetts Department of Industrial.Accidents 11�. C* I Congress Street,Suite 101) 3 Boston. MA 02114-2017 www.nwss.Sov/dia 11pikers'('onepensation Insurance Buikleru'('untractorkiI:Irrtririan+iPIuenbrrr. 11)1t1. I WED M 1111 IRE PERMUTING AI:"i'IIOIUl'► AnnGcant information Plrasr Print I crib.% am a iliustnc., Ivan idu..l 1*". Address: Z n L 1/4., 1O 4,-CD CityfState/Zip: eh 1 E°,4,11, f 13 1 S 7Z6 Art?or an emplisy re 4 bas k nit a pin opt-rat.e but: Tti pc of project(required): 'in later a envies,it%neat crisptrtei,ttull and in pars-time! 7_ (._J New construction t1 la,..le proprietor or partnership anti trine ma thriptoy nottittra Sot ire in . 8_ Q Rcmodeling anti eapaeity.Pio»trrkera'ei..nrnp nl+nr:mer rettwrc'd_1 9. D I)emo11tmon 30 I ant a itortrotioner daain0.all'%font.myself J is Inanrka' euergn.iouu ONX required.l 10p Building addition #.a 1 am a isotherm net and i ill Inc therms evneraeloci.et+:andnit all not k on nrv,property. t a,nit n e are Mat all estiuraelors either laic wu ta rlc erinop inshore nL4nr;aux- are.Ilk I l.aJ Electrical repairs ur addiiions pniprrctarr+i ih no 1.1filp1014ecl. 12.0 Plumbing repairs or additions 1 ant a}`t3h7al tanUaetarr and I trace hired the.ud.-e,..rrtaaeturs tasked,.,n the attach l l 130 Roof repairs x l'he arhvriral'Wra IL3 .employee*ant Irene V.Ali ker9 elcup_at-Wranei.." 6.©We arc a cwpnraerr eu and ih o f cer%tens c exercised then right ofc n,cnopieurn per Art c. 1 i_©Other 12.Ii 1(#'),and ac hanc no scup nci....(hill not-Len'UMW.insurance requirrJ I "Ann applicant that chocks bum=I mot mho till out III.:.+,lxtwwn t km.'lots inn their o l rlcty'eongpsansation policy infirtootius. . ♦11a�artil�on ism*Ito atkinu thus arrant rtrtiicaemi tlici am thinly an cork and then true aattside a rrnar.rctana wren submit a took attidaY'it *ia ti. :finite actor%that check thiri box must attained)an additional sttlxt,.Heininn the name u4 the sulli,c-wttracta and s1ai aMealier a'q not tlx+.c auntie..aurae ciniplo.4 ce.,. It she,nlb-contractors hate employ cc,.they UMW flan idc their worker,'earns+.pone!,nWntt'r. I am an employer that is providing worAers'tompe:nation insurance for my rmptorrest. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lit;.#: Expiration Date Job Site Address: City,'StateeZip: Attach a copy of the workers'compensation polity deck utie•pane(showing the policy, amber and expiration date). Failure to secure coverage as required under MGL c. 152,*25A is a criminal violation punishable by a flute up to$1.500.00 auditor one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250 10 a day against the violator.A copy of this statement may be Into ardcd tci the Office of Investigations of the DIA fOr insurance ccitcragc trriticatian. I do hereab)•certif a cr tin min.s and penalties of perjtert that the information provided above is t tie and correct_ s+•ttaturn Dares:Irltttt c d 1�l l 4v�/e/ 5 t 7/ ZO.1 Official use only_ Do not write in this area,to he completed by city or town official ('it♦ or Tottn: Prrmit,i'License tt Issuing.Authority (circle one): I. Board of Health 2.Building Department 3.('ityrfotsn Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: DATE(MM/DD/YYYY) A� CERTIFICATE OF LIABILITY INSURANCE 04/21/2021 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. (A/C.No,Est): (413)527-5520 FAX No): (413)527-5970 6 Campus Lane E-MAIL bcarballo@finckandperras.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Easthampton MA 01027 INSURER A: Russell Bond INSURED INSURER B: Timothy Stokes,DBA:ACME Design INSURER C: 20 Turkey Hill Rd INSURER D: INSURER E: Westhampton MA 01027 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2142105518 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 ADDTYPE OF INSURANCE INSD w Ro POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MMIDD/YYYI� (MMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000 DAMAGE RD CLAIMS-MADE I M OCCUR PREMISESO(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,(300 - A VBA784122 11/26/2020 11/26/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 )1 POLICY piTa- ❑LOC PRODUCTS-COMP/OP AGG $ 2.000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ O• WNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS_ H• IRED 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 piN/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) 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �7 // ''� of (Lx „CM UO 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Division of Professiona l Licensure Board of Building Regulations and Standards ConstftJ btl"S, p,.visor CS-083602 Expires: 02;06/2023 TIMOTHY C STOKES 20 TURKEY HILL RD -�- WESTHAMPTON MA 01027 ,r+ 111 114110 C4a614 ? h fr • ommtssJoner f E irk, Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR • TYPE: Individual Registration Expiration 175925 06/19/2021 TIMOTHY STOKES TIMOTHY C. STOKES 20 TURKEY HILL RD ��' WESTHAMPTON, MA 01027 Undersecretary