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406 ACREBROOK DR BP-2021-1422 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-304 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 PERMIT Permit# BP-2021-1422 Project# J S-2021-002363 Est.Cost: Fee: $30.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ALISHA PHILLIPS Lot Size(sq. ft.): 12763.08 Owner: MACIBORSKI MELISSA Zoning: Applicant: ALISHA PHILLIPS AT: 406 ACREBROOK DR Applicant Address: Phone: Insurance: 40 PINE VALLEY RD (413) 586-5986 FLORENCEMA01062 ISSUED ON:6/3/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:TIKKI BAR 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 Certificate of Occupancy Signatur • r , )2 . FeeType: Date Paid: Amount: Building 6/3/20210:00:00 $30.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Z.-OK File#BP-2021-1422 APPLICANT/CONTACT PERSON ALISHA PHILLIPS ADDRESS/PHONE 40 PINE VALLEY RD FLORENCE (413)586-5986 PROPERTY LOCATION 406 ACREBROOK DR MAP 29 PARCEL 304 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: TIKKI BAR 1167/)—/ New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 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 jcuL, (0/0.1 Sigiature 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. City of Northampton - i tis Si Massachusetts 4" — f ' tk wA it �, DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building gyp �� Northampton, MA 01060 PSI'A ', A�� / o ;'g ' q O� ACCESSORY STRUCTURE PERMIT APPLICATION` `\To,/G''��A '' 1 A1r (For freestanding structures less than 200 sq. ft., t least 5 feet from any other strut e 0 Check# i�3a so tis PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: 4)(' iti ��fC�i/`,( f r .fllG{ .T94'1,-/ (;e/// S /tiler) Address: (a AU_ Vq//( e4 r/�'«L' `/y Telephone: 11� 5-5-6-- 516fiv rt M4 s A0,4.'6U/fk,' 2. Owner of Property: S �j [/ ? Address: -r U Iv ifCrCb lw rc Q6%C Telephone: /`J - Z/o- 70S-7 3. Status of Applicant: Owner Contractor 4. Structure Location: I)l'Gair dt Ile bi1C-14rp/ or, ey fM. CChc. eI Hp/ Parcel ID:Zoning Map# Parcel # District(s) (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Use of Property: 1911or Two Family: Multifamily: Commercial: 6. Description of Proposed Structure: One Story Shed under 200 sq.ft.: Freestanding Deck under 200 sq.ft.,less than 30"above grade: SIZE OF STRUCTURE: 10 ''/6 Other(describe): Ti r K, /Rg Q ,•' Si-foc/-+ /e-- 7. Attached Plans Sketch Pla Site Plan Plot Plan 8. Does the site contain a brook, body of water or wetlands? NOT DON'T KNOW YES IF YES: Has a permit been,or need to be, obtained from the Conservation Commission? Needs to be obtained Obtained , Date issued CONTINUED ON NEXT PAGE 9. ALL INFORMATION MUST BE COMPLETED; PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. This column to be filled in by the Building Department Existing Proposed Required by Zoning Lot size Frontage N/A N/A N/A Front: Setbacks: Side: 321'� Rear: ZS-PA Height q_ 104 % Open space: (Lot area minus bldg and paved parking) 10.Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: 31 it/Zi APPLICANT'S SIGNATURE I NOTE: Issuance of a permit does not relieve an applicant's burd o comply with all zoning requirements and obtain all required permits from the Conservation Commission, Department of Public Works and other applicable permit granting authorities I „�,�...«��^A j .V L.?";54,(...,di , .t._,,,,, ,„„>c • i.:::. _ N f • ;., 11 ill. , .1 ,.,i.'..g......?2.'!:4.4:441--...1 I ill,.‘ \/Ie. 1 . uJ • :.yam, .a. _ �.v.�_ �,� ._.�.� �� A,,. ...., ..,...a..,,an .n.,..wn+n:•w nFsaan�'mm. ma • JIIIITT ..... \i �` It,.01, 1,7 , . fd\\IC\ -.0f)ci\\o /',1 ----, t : , • ,\. .. . L ) r ' ‘5 ,\,\i\\I!Ct. 1(1 /;71%, Or 1 ' ,1%i .. \ ''...\ QI . 1• , . Liii . \ F , 1 1�1i . i , "N, , . il i ; .1 . 1 t . . !,, ) .z;.,i); V- 1 —,1 . 1,. ' ir� N.,. • u� SGmI / I , 3 4' -ii 1 • ii' . AC ORE) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) Iiikr...-----.- 05/25/2021 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 Sarah Premo NAME: Clayton Insurance Agency,Inc. PHONE (413)536-0804 FAAic,No: (413)534-7874 1649 Northampton Street E-MARess: spremo@daytoninsurance.net ADDP.O.Box 989 INSURER(S)AFFORDING COVERAGE NAIC B Holyoke MA 01041-0989 INSURER A: Safety Insurance Company INSURED INSURER B: Safety Indemnity HO Preferred Axiom Landscape And Home Improvement LLC INSURER C: AIM Mutual Insurance Company 40 Pine Valley Road INSURER D: INSURER E: Florence MA 01062 INSURERF: COVERAGES CERTIFICATE NUMBER: CL211704333 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 ADDLSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MMIDDIVYYY) (MM/DDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE CLAIMS-MADE XI OCCUR PREMISESO(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 10,000 A BMA0028548 01/11/2021 01/11/2022 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY n JE T LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B - OWNED >/ SCHEDULED 5907002 01/11/2021 01/11/2022 BODILY INJURY(Per accident) $ _ AU IOS ONLY 1. AUTOS HIRED v NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY AUTOS ONLY (Per accident) Medical Payments $ 5,000 UMBRELLA LIAB - OCCUR EACH OCCURRENCE $ - EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION OTH- AND EMPLOYERS'LIABILITY X STATUTE ER YIN 500,000 C ANY OFFICER/MEMBER Y N/A WCC5005020083 04/17/2021 04/17/2022 F.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ II yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it 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 CITY OF NORTHAMPTON BUILDING DEPT. ACCORDANCE WITH THE POLICY PROVISIONS. 212 MAIN STREET,#100 AUTHORIZED REPRESENTATIVE NORTHAMPTON MA 01060 f72n / /�-2 4. I �" ©1988-2015 ACORD CORPORATION. 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