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22D-109 (5) 33 AVIS CIR COMMONWEALTH OF MASSACHUSETTS BP-2021-1739 Map:Block:Lot:22D-109- 001 CITY OF NORTHAMPTON Permit: Addition PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-1739 PERMISSION IS HEREBY GRANTED TO: Project# Contractor: License: Est.Cost: $20000 Const.Class: Exp.Date: Use Group: Owner: BARONDES LISA and DAVID B MERRIMAN Lot Size(sq.ft.) Zoning: WSP Applicant: MERRIMAN BARONDES LISA and DAVID B Applicant Address Phone: Insurance: 33 AVIS CIR FLORENCE, MA 01062 TO PERFORM THE FOLLOWING WORK: ISSUED ON:08/24/2021 BUILD 3 SEASON PORCH POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring U.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. Signature: Ti .1 $ Fees Paid: $130.00 212 Ma in Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner File #BP-2021-1739 APPLICANT/CONTACT PERSON:BARONDES LISA& DAVID B MERRIMAN 33 AVIS CIR FLORENCE, MA 01062 PROPERTY LOCATION 33 AVIS CIR MAP:LOT 22D-109-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $130.00 Type of Construction: I3l!Il.D 3 SEASON PORCH New Construction Non Structural Reno v ations 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 Perm it With Site Plan Major Project: Site Plan AND/OR SpecialPermit 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 WaterAvailability SewerAvailability 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 6ett,•.d ,CTIN 01_7().•I Si iature of BuildingOfficial � Date 1 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. RkGE/vE• The Commonwealth of Massachus,tts AUG F� ' Board of Building Regulations and S . dar,s 7 20�� IC!'ALITY Massachusetts State Building Code, 7;0 C R U.E Building Permit Application To Construct, Repair, 'cnoaig.QF ik,.+u-r ,a. • ': ised ar 2011 One-or Two-Family Dwelling THAtiarTOrv.Mq oEo.IONS This Section For Official Use Only Building Permit Number: II' #I 15 Or—I Date Applied: 1 _ALL/al/ Building Official(Print Name) I Signature SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 33 Av s U rck c et a vbw 0106 Z 1.la Is this an accepted street?yes ✓ no Map 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.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 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Omper1 of Record: Det.Wa. tlerrImcn �l ytence �Au, . 01062 Name(Print) City,State,ZIP 33 circle sit-103-5s yb David.Ynerrirltul@ ►,et,he+ 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 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': civi tAi 1y t& �-L,cee Sec.5of (3ck ch W i t'�.� $h1al1 i)ecic Lanr�in8 a SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ ,4x) 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire Suppression) Total All F / Check No. "/ Check Amount: ?O Cash Amount: 6. Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP Mom, RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1.6215- 2 2a23 0AyWorKS }jo'ie . 1-tyverf►eni- HIC Registration Number iration Date HIC Company Name or IN Regi�t Name 117o 1..ong fP tan a. wet 6an4klorics G -COM No.and St Email address Levere4%- Ma, 0t05 4 y13--76V— tti 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 Issuance 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 to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER1 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. t D &4o mP41/1 0 /6 a1 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. 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" Google Maps 8/17/21, 9:30 AM Google Maps5e7' b K t • '.r�t fib: �T' IA Y ..Y 7i tom • •s r � , 4 y + tiR> s �� c• `�y} MM� ��t �t j. ,.„, s r a .4. .. s ltf , ',lr`Z1 t Op . Al ..., , ,G t r „ti ,. w._ r Map data©2021 ,Map data©2021 20 ft https://www.google.com/maps/@42.3275308,-72.6852027,78m/data=!3m1!1e3 Page 1 of 1 CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD f_=___t- SIDE YARD IS -- FRONT SETBACK "D FRONTAGE The Commonwealth of Massachusetts Department of Industrial Accidents zwa • vo ;��r1"" I Congress Street,Suite 100 .14 , Boston. MA 02114-2017 ,: www.mass.gov/dia us kers'('ompensation Insurance Affidavit Builders/Contractors/EkclriciansiPlumbers. 11)BE h'IL I:D W ITN THE PER.%U ri ING At'TNORIi Y. Annlicant Information Please Print 1_ertil►1h Milne( Business(Ngamvata«tn inJts tJual;): I) t rV Address: 33 Pt If. ,S C.f City/State/Zip: f l.p p e,'iCe„ inft Q 1003 Phone 0: 66 0 542 3 -- F?_._.__,____._.. Ate!mu an employee?(tank the appropriate bast: T�pe of project(required): 1 1 am a ki eT with ernpksyees(full and-of part-tine).' 7. ❑ New construction 24 I am a sole proprietor or prttnership and have no employees working for me in S. Q Remodeling arty capacity. No werkcn'cutup.ignorance required" 30 I am a tuco n- atw r donna all murk myself.INu*mien'comp.insurance nquind.I 9. ❑ Demolition 10 M Building addition 41171 am a homeowner and w ill lee Mooing amtradors to conduct all work on in pnrprnv. I will ensure that all contractor.either base waders'compensation insuranccor an:sole i 10 Electrical repairs or additions proprietors with no emmplo*des. 12.0 Plumbing repairs or additions 41:3 I am a"metal cuntraetor and I haw hitdthe eabscuntracturs listeed on the anodised sheet. Theo*wlb-cunisx tun have eirrpinwas and have workers".vrrr>Fr.insurance) 130 Roof repairs 6.�west/a cosporatiun and its officer.hose exc7cised then nght of exemption per IN(iL c. l4. Other 02"pa).and we hale no employees_[No workers'camp.insurance required" "Ann applicant that chocks boa+tI must also fill out the section below showing their wakes"Compoilab to policy iotor ai s. 'l i."rtcvw neon who submit this atfukrs rt Insiw si a they ate doing all work and diem hire outside commute nos submit anew affidavit indicating suck •C'ontraetors that check this box must attached an mlatrtivati sheet showing the Matte of the sut.cuaeateats and dais whuyher or not dame cubes hale ernpluyecs. If the sub-cuntracturs base etit>lrluyces,dies aunt pro.idc their workers'Lump-pudic).number. I am an employer that is providing workers'compensation insurance for my earplotees. Below is the policy and job site information. Insurance C'ontpanv Name: Pokey#or Self=ins.Lie.#: _ Expiration 1}ate: Job Site Address: City Statc Zip: Attach a copy of the workers'compensation polity declaration page(showing the policy number sad 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 andior one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 cerllfj•under the pains and penalties of perjuly that the information provided above is true and correct. >it.mature: lZ'`2A Date R'/i W3o9a 1 Phrtec. (o0 03 .5 5L Official use onrl: Do not write in this area.to be completed by city or town officiaL ('its or Town: Permit/License if Issuing Authority (circle one): 1. Board of Health 2.Building Department 3.Cityll`orlta Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other ('ontact Person: Phone#: rr' `; 1`1CS�SdC:11U5C L.L 4_- DEPARTMENT OF BUILDING INSPECTIONS i ,� 212 Main Street • Municipal Building Jbs $� Northaton, MA 01060 irol- HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT V5 ca I, D m&RR i (insert full legal name), born (insert month, day, year),hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this '1 day of All AST' , 20� (Signature) fif) M/DD/Y DATE(MYYY) C R AL) CERTIFICATE OF LIABILITY INSURANCE 08M/DO21 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 Susan Fleury CIC CISR CPIA NAME: ''� UUC. King&Cushman Inc -Now I(413)584-5610 No): (413)584-9322 tagto.Exit P.O.Box 447 ADDRESS: sfleury@kingcushman.com 176 King Street INSURER(S)AFFORDING COVERAGE NAIC II Northampton MA 01061 INsuRERA: The Concord Group INSURED INSURER B: Daniel O'Dell INSURER C: 470 Long Plain Rd INSURER D INSURER E: Leverett MA 01054-9764 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2181704348 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. R TYPE OF INSURANCE ADDL'SUBR POLICY EFF POLICY EXP INSO WVO POLICY NUMBER £MM/OD/YYYY) (MWDO/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGETO RENTED CLAIMS-MADE X OCCUR PREMISES fEa occu rrence) S MED EXP(Any one person) S 5,000 A 20041227 04/01/2021 04/01/2022 PERSONAL SADVINJURY S GENLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY In jPtei n LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea er:aoent) ANY AUTO BODILY INJURY(Per person) S - OWNED OWNED -SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S _d AUTOS ONLY AUTOS ONLY (Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER I 1OTH- AND EMPLOYERS'LIABILITY YIN STATUTE 1 ER ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? f (Mandatory In NH) E.L DISEASE-EA EMPLOYEE S If yes,desalbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If 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 ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main St. AUTHORIZED REPRESENTATIVE Northampton MA 01060 ����� _ ft--1 f._.LJej ©1988-2015 ACORD CORPORATION. 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' ' i i f ! I 1 I , ; , . : ! 1 1 1 I ., 1 , , , ! i i ; t i i t I t t I 1 i ' i t. t,i,a _40 , 1 ' i • i , . . i 1 \6\ f 1 I . i'. .. . I , 1 i I !, 4 . : .• i 1 i . , I i . , . 1 .. .' . • , • • 4 . .... .l. ....... „....i.. 1 . ........1._J . ...1_it J.. 1 1 ; .0.. i I.J l....;I . . , V . • . . • . . •. . • . . • A noH City of Northampton te r. S,`,._�':..stc r Massachusetts ��?' l._ '-et. DEPARTMENT OF BUILDING INSPECTIONS 7‘ ; ' 212 Main Street • Municipal Building �d's .'*tr Northampton, MA 01060 'rs'yh;w*C 33 4- v : SC, °Get. 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: 4/C The debris will be transported by: Name of Hauler: Signature of Applicant. /i�5f i Vzczi