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42-085 (6)
165 GLENDALE RD BP-2021-1549 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:42-085 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:ACCESSORY BUILDING BUILDING PERMIT Permit# BP-2021-1549 Project# JS-2021-001728 Est.Cost: $75000.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ERIC PARHAM 115368 Lot Size(sq. ft.): 41774.04 Owner: BOWLER MAUREEN Zoning: Applicant: ERIC PARHAM AT: 165 GLENDALE RD Applicant Address: Phone: Insurance: 43 SUGARLOAF ST (413)461-8490 SOLE PROPRIETOR SOUTH DEERFIELDMA01373ISSUED ON:6/29/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:NEW 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 NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Si2nat! f � yU - 5� FeeType: Date Paid: Amount: Building 6/29/2021 0:00:00 $100.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner co 0,,y'ra-C Z • AFC c11lt �� Fib .. The Commonwealth of Massach.setts ,40 Board of Building Regulations an. tan.: ; FO' Massachusetts State Building Cod-, 8 f .• ' C 4'ALITY tiolFe 4 SE Building Permit Application To Construct,Repair,Reno . - 1 ,,: Revised Mar 2011 One-or Two-Family Dwelling plON MSOFc This Section For Official Use Only A°'Oso(3Ns Building Permit Number: &O-- al-• iS"Y Date Applied: . I,. ; I . , 6./2 "Lai Building Official(Print Name) I Signature D 3 e SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers I( $ E, kvl A0.Ie. Uya- -09E- oo i 1.1 a Is this an accepted street?yes / no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Lt)FP Pr 5+0r&ce_ l-0 .I�,t Ala ' 081, 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 a o t ,zo` 4 ' la ' il ( 1.6 Wate Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: / Public Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system l7 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Yllaure..J•1 BrOwler Florence- 444- 0/D a_ Name(Print) City,State,ZIP 1 ' I tQs G I-e.ada l.Z Q,J . Lid •was'.5W 9- No. and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. ti/ Number of Units Other 0 Specify: Brief/� Description of Proposed Work': t,elcr-el e_ 7 o u r 4:.)-- r v. fo(Ac €r<c '. ,X' D q..,,,C earL ff,6 sfl1,..c-4-u.re . g 72 GGI r. - Qn1$1 L.Jvi(lj . -Z ck l94-c Ch.tAr qlb e_.,r.5 , L4)r4 fvwS cr, 1 �9.rr‘f� Ac,or SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ -75- o o p 1. Building Permit Fee: $ Indicate how fee is determined: r ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees_ $!! {� Check No..PLO Check Amount[ 160 Cash Amount: 6.Total Project Cost: S 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) R; c, l�arha►� &$ a)0I/90�S License Number Expiration Date Name of CSL Holder List CSL Type(see below) Li5 Suetarloaf- cf No.and Streer Type Description S' °e'er f-e(4 M n e/3'1.3 U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town, State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances • a"6 ertc_pafh4N', aJMk((.ca.-� 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) R;L Pacha"A b o �5 HIC Registration Number Expirati n Date HIC Company Name or HIC Registrant Name • W3 S�j X%oaft" (1 . C,ftCparl�A�M.0.. E diva, I.(o" No.and Street Email address J S .. De..{r,c.,I2 Al4 0/3'73 g13.216I '63LF1 a 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 Issuanc of the building permit. Signed Affidavit Attached? Yes No ❑ 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= R C_ Par T v la m to act on my behalf,in all matters relative to work authorized by this building permit application. /Nu iv E 8ochYt'2. 4/2,/2o0z Print Owner'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. C- Wr‘AA 144 0 la Print Owner's or Authorized Agent's Name(Electronic Signature) ate 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.) Ci[Q(, ' (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" • CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: 11a) [ kQ I Se REAR LOT DIMENSION: I(00 . & , REAR YARD 66 1 ,' • SIDE YARD �� v SIDE YARD /9 .e Iva I FRONT SETBACK FRONTAGE ' 0 4 City of Northampton Massachusetts �4�5 l - DEPARTMENT OF BUILDING INSPECTIONS y 212 Main Street • Municipal Building Northampton, MA 01060 5'115, ''' 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: (,/ GS f_c ‘12-e,^v,rA I V-6h,'cbe_- Location of Facility: 5tr, 15C� I The debris will be transported by: Name of Hauler: 1V45�—c- ( 14,101i , Signature of Applicant: �'� Date: ,W / The Commonwealth of Massachusetts I /, Department of Industrial Accidents _;;�= 1 Congress Street,Suite 100 __ :1 Boston,MA 02114-2017 V< wwx.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information / Please Print Legibly Name (Business/Organization/Individual): t Rt C- t Cf-\a it'( Address: LB S u (t a S(- City/State/Zip:S • per c-etb, Al A4 Di 3 '- Phone #: L'13 • 11( (• 8 Lr1 0 Are you an employer?Check the appropriate box: Type of roject(required): I.1:1 I a employer with employees(full and/or part-time).* 7. New construction 2 a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.El I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑ Building addition 4❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 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 ❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance? e,.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§I(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. tContractors 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. l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: 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. �i ------ Signature: ti Date: �/ / 62 c.)d \ rr'' � Phone#: t1 t 3 • 'IL- ( - 1{1 a 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#: l ® DATE(MM/DD/YYYY) AC D CERTIFICATE OF LIABILITY INSURANCE 06/27/2021 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 NAME: Next First Insurance Agency,Inc. PHONE (855)222-5919 FAX PO Box 60787 IA/C,No.Ems: (A/C,Not: Palo Alto,CA 94306 ADDRESS: support@nextinsurance.com INSURER(S)AFFORDING COVERAGE NAIC N INSURER A: State National Insurance Company,Inc. 12831 INSURED INSURER B: Eric Parham No.6 Design Build INSURER C: 43 Sugarloaf St INSURER D: South Deerfield,MA 01373 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:5038168 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 EFF POLICY EXP TYPE OF INSURANCE INSD SWVD POLICY NUMBER (MM/DDUBR Y/YYYY) 1 M/DD/YYYYt ADDL LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000.00 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $100,000.00 MED EXP(Any one person) $15,000.00 A NXT84KQB9W-00-GL 06/27/2021 06/27/2022 PERSONAl&ADVINJURY $1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000.00 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $2,000,000.00 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 H STATUTE ER AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE I I E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Each Occurrence: $25,000.00 A Contractors Errors and Omissions NXT84KQB9W-00-GL 06/27/2021 06/27/2022 Aggregate: $50,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Proof of Insurance. CERTIFICATE HOLDER CANCELLATION Eric Parham No.6 Design Build SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 43 Sugarloaf St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN South Deerfield,MA 01373 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE am,#4._____ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD