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35-240 47 LADYSLIPPER LN BP-2021-1394 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35 -240 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-2021-1394 Project# JS-2021-002324 Est.Cost: $213962.00 Fee: $1390.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: LANCE KIRLEY 112063 Lot Size(sq. ft.): 39421.80 Owner: WOOL MATTHEW&ANDREA Zoning: Applicant: LANCE KIRLEY AT: 47 LADYSLIPPER LN Applicant Address: Phone: Insurance: 123 MEADOW ST (413) 341-3375 O WC FLORENCEMA01062 ISSUED ON:6/2/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:MUDROOM ADDITION ON BACK OF HOUSE, RENO SUNROOM & BASEMENT 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. • r Certificate of Occupancy Si ' natu ' � I�. 1 FeeType: Date Paid: .Amount: Building 6/2/2021 0:00:00 $1390.00 • 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2021-1394 -Gk APPLICANT/CONTACT PERSON LANCE KIRLEY ADDRESS/PHONE 123 MEADOW ST FLORENCE (413)341-3375 Q PROPERTY LOCATION 47 LADYSLIPPER LN MAP 35 PARCEL 240 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT it Fee Paid Building Permit Filled out I) Fee Paid Typeof Construction: MUDROOM ADDITION ON BACK OF HOUSE,RENO SUNROOM&BASEMENT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 112063 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 c15411Ak, (A/D/P.41 Si Mature of Building Official 1/ 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. Pla n 5 ile-1 \, P la v,b Fat- c�i� The Commonwealth of MassOhuse s I/4, > ITY Board of Building Regulations acid S lords Massachusetts State Building CO3 '/1©, R �OaUSE Building Permit Application To Construct,Repair, Renovate Or Delmolish a Revised Mar 2011 One-or Two-Family Dwelling _, This Section For Official Use Only Building Permit Number: 6P- 0/i// 7 I Date Applied: I 0/. i Building Official(Print Name) Signature i j Date SECTION 1:SITE INFORMATION 1. Prope A dress: 1.2 Assessors Map&Parcel Numbers t -e 3S a Ito —001 1.1a Is this an ccepted street?yes no Map Number Parcel Number 1.3,ZQ�ng Information: 1.4 Property3Dimepsions: 130 Zoning District Proposed Use Lot Area(sq ft) (p Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 0-01 15 f 0 1.6 Water Sppply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: 11( Public�,// Private 0 Zone: _ Outside Flood Zon ' Municipal 0 On site disposal system Check if yes SECTION 2: PROPERTY OWNERSHIP' 2.1�Owner'of Record: N vJ*Al*t NI\ CA riori✓hc,t, � � 61oG:2. Name(Print) City,State,ZIP /}T tic f fie. No.and Street j Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED ORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied Repairs(s) 13/1Alteration(s) 0 Addition Demolition 0 Accessory Bldg. 0 Number of Units I Other 0 Specify: Brief Descriptionu� f Proposed, niW('rk2: �� 3V1,�i(�.- a F GI,�SIVtk, / VeitelevaaPA SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials 1.Building $ (I(� ' 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 6S�cry 0 Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 3l S01) . Jo 2. Other Fees: $ 4. Mechanical (HVAC) $ ` i`6/00,(114) (1 List: 5.Mechanical (Fire Suppression) $ Total All F--i•l, 3C ` Check No.a i ► Check Amount: , J �sh Amount: 6.Total Project Cost: $ 213 (s�� .7. 0 Paid in Full 0 Outstanding Balance Due: 1 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction SupervisorVa-loui License(CSL) CS _ 1'l 043 03 R CQ License Number Expira ion Date Name of CSL Holder f List CSL Type(see below) (A lZ No.and Street Type Description MA. 2 U Unrestricted(Buildings up to 35,000 Cu.ft.) tin-es/NM\Qk L R Restricted l&2 Family Dwelling City/Town,State M ,ZIP M Masonry RC Roofing Covering WS Window and Siding p� SF Solid Fuel Burning Appliances 1IIIS\'1 ��n�J `DU�f\\'e(d CCht�hAl , Ci%Y\ I Insulation Tel one Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) ' 9 a big o f G&' 41 ('-e, V� HIC Registration Number Expiration Date HIC Company ame or Registrant Name 12Z IA - 1/4.eg CC-h ern Iim.c-aw1 and C�, P„`n N Email address �a�2 r3�� 335-)18S tty/Town,Stare,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 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 Ofiteard 6:51 L I( fi3W1,,Q.i? i 1 Kt - to act on my, in all matters relative to work authorized by this building permit application. (,r .cf it) Print Own s Nane(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my 4name below,I hereby attest under the pains and penalties of perjury that all of the information con med in i ' .p•lication is true and accurate to the best of my knowledge and understanding. 05Lr 2-1 p.02_, Print Owner. or . thorized 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 q Number of fireplaces Number of bedrooms i' Number of bathrooms o5 Number of half/baths 1 Type of heating system t' Number of decks/porches Type of cooling system k Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" CITY OF NORTHAMPTON SETBACK PLAN MAP: 35 LOT: c)'cip _C573 LOT SIZE: 3 1 i 6 4 n •10 5 F' REAR LOT DIMENSION: / 6 7 / REAR YARD I` O SIDE YARD r, SIDE YARD FRONT SETBACK 6 0 FRONTAGE I 30 ' City of Northampton Massachusetts �7 :A) ti I, it) DEPARTMENT OF BUILDING INSPECTIONS y 212 Main Street • Municipal Building La Jti PD f ` Northampton, MA 01060 SPA, 3r)' 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: VAJAA 2't StAkft-PAAK1�a�, . Location of Facility. 1\1 0--e-44"ei-orilq (k• �I Ut0(9O The debris will be transported by: ccw4J ,Name of Hauler: / cu l—iyvUJ , Signature of Applicant: Date: 051-2/41-1 ,..„,,, , „ '"""_'_ The C i�mmon is ealth of Massachusetts-. Department of Industrial Accidents 1 Congress Street.Suite 100 �} Boston. MA O2114-2017 wis .mass go►•/dia 111»kers'( rampcnsation Insurance.ttTtdasit:Buildersi("ontrartors EiectriciansiPlunibers. 1t)Kt_111.1.1)N 1111 1II11.PEK1111'11N(:AI Tl10R111. Applicant Information Please Print 1.t h b Name(Bt tuincrs rgaataiataa.ti 1ndastahtai): C �' fiN s 1 X J t Address: i -._�__'__Mj`t'`"__: _!, t City/StateZip: _ i f V k CEO 6 iZ�__.__ Plwtic 043- �f ( `' `� rey an tmpk r appropriate awn: Ty grrlICleekIh pc.of project(required): ➢e iaam a eripknyaT .tth 1 ` anpluyee‘thigi:ma.l CI pertenne ` sr construction 201 int a.ale propciehx or pwinearhip ad hew MT Cffipta.4a6:1.anaerlateal tor nue m $. Remodeling ail,ea rtw,.l Pea.wytirteT+.Cam".m".imenrer C'I requared l t 0 I am a bamlx inert&any a➢I nosh aspen.1 MMxtter. camp..m.l lranor regura'art.l 10 Building:addition I❑t ant,a➢w.nttrnwrsa an.➢wail be hiring axxitraaiaxt hr cols itai ail 411,41r t.0211110 prupeny'.. I wall crt.0 that all am lna.l:x.Mow ha*e.* ikcr *mac winnable=aanW7anai to ate Ida 11.0 Electrical repairs or additions pratprwi nr.%Ina no ernpk.Mercs_ 12.0 Plumbing repairs or additions S:1 t ann a gerwral tilntaattaar and I ha*a banal the sa t-a:awrtrachxs➢r.tC..!on the a1Yt➢W don_ 130 Roof repairs Thew w -canatract.aArksatacetlepiavyces:atndfra*ewheelers.co p r:zur sate 14.©Other 6 a the are a corporation and rt%antic er.Iasi.a cIltTeaXra then nithl ant kente aunt pre M(:1_a ------ 152.. hit and AC I14MC era*aTagnianae..[liars ws urktT."ctnrap.rra.ur.rlte realm, •:hatq apptacmt that cht-ci+Sot Awl taw also fill fault the:wccuun helo .AA .a Mg these OOAcaTs Ctly orbrati.wa pot eel.malixrraaarasa_ *I tmIIICCOA nLLTn*Au.ulxnat Clam 41ItioOn anheatrne they are aknng Ai aaOA.mail mailer=hint untskie eontraMtor.raved maim-Ad a meu aftmdar Al antita3tang swap. 'Anil: .113r%that dwell this Sans MUM.attachsrtl an aallhtronal.➢aaa-t-.bow Any the olleilearlfic.ub-carratram;Loan and.state wAlsclb r as isit t➢scwr attain.,➢sane eiagninyces It flea .tyh-C.nttraataxs Eaa.c caapltscc.,the!.nnlst➢,rn9a444c eta,':7 t..'.➢.eri mop.➢kAlo.:s iaainiu: s_ l am an employer that is providing worlaen'compensation insurance/4 airy"employees_ Below is the polity and job site in fii'rmatian. Iltsui,tute t ompam Nam Airy\._ e1/4- _ Knells i. ,tit Seit-in:+. I.h: « �i Y.a C L O' Y-1-O- W 2-°A Expiration Date: t j l 0 I �i01-1 Job Site Address: ' • �S s La/At oh Staw Zip- .ecs-eitc4 MA -O tobt2_. Attach a copy of the workers'cpenlation policy declaration page(showing the pink" number and expiration date). Failure to secure coverage as required orifice M(iL c. 152. ?SA is a criminal violation punishable by a line up to SI.50 .00 and'or one-year ampnsoninent.as shell as cisil penalties in the limn of a STOP WORK()RDl_R and a line of up to S250.00 a day against the violator.A copy of this statement may be toes aided to the(1111ce of Insestigaticnns of the DNA for insurance Colcragte srridicatton. I do hereby c nder the pains and penalties of perjure that the information provided aloe ii true and correct. Signature: Date: SI - `Q. Phone#: l..lfis3)t2 (I Official use only. Do not write in this area,to be compkted by city or town official ('its or Toan: PermiltLicense* Issuing:Authority (circle one): I. Board of Health 2.Building Department 3.( its r'lasso clerk 4.Ekrtrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: ACORO© CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) kirk.....--- 05/21/2021 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 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: Stephen Brochu PIONEER VALLEY AUTOMOBILE CLUB INSURANCE AGENCY INC (AHIcO.N;_Exo: (413)205-2320 A/C No); E-MADDRESS: sbrochu@aaapv.com 150 CAPITAL DRIVE INSURER(S)AFFORDINGCOVERAGE NAIC0 WEST SPRINGFIELD MA 01089 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURER B: CLASSIC COLONIAL HOMES INC INSURERC: INSURER D: 123 MEADOW ST INSURERE: FLORENCE MA 01062 INSURERF: COVERAGES CERTIFICATE NUMBER: 658109 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!NM W LIMITS LTR !NM POLICY NUMBER (MMIDDIYYYY) (MM/DDIYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEM.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JPRO- ECT 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$ 8 WORKERS COMPENSATION �( OTH- AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EX " STATUTE ER A OFFICER/MEMBEREXCLU ED?ECUTIVE E.L.EACH ACCIDENT $ 100,000 N/A N/A N/A AWC40070370362020A 07/10/2020 07/10/2021 (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL 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/. CERTIFICATE HOLDER CANCELLATION INLA-N1,Wi A\1\AXU^--' \I\ICA ` 1— ' P'PPt4Q- - LaliAQ-- IFlorence MA 01062 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