Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
32A-243 (2)
131 BRIDGE ST COMMONWEALTH OF MASSACHUSETTS BP-2021-1789 Map:Block:Lot:32A-243- 001 CITY OF NORTHAMPTON Permit: Gas Generator PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2021-1789 PERMISSIONISHEREBYGRANTED TO: Project# Contractor: License: Est.Cost: 50000 Const.Class: Exp.Date: Use Group: Owner: KEYES ELAINE T Lot Size (sq.ft.) Zoning: SC/URC Applicant: KEYES ELAINE T Applicant Address Phone: Insurance: 131 BRIDGE ST NORTHAMPTON, MA 01060 ISSUED ON:08/25/2021 TO PERFORM THE FOLLO WING WORK: REPLACE SIDING 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. Signature:I (P 4 • • y2 - AIT Fees Paid: $60.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner r RECEIVEt AUG 2 3 21# The Co onwealth of Massachusetts „ :.and f Bu. ding Regulations and Standards FOR �� Massac uset State Building Code, 780 CMR MUNICIPALITY DFPT OF pUILDI USE - ^' 34thinlgregr @atio To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 or Two-Family Dwelling Thii,ction For Official Use Only Buildinn Permit NNuuumber: o' 41-l Date Applied: hL-'Jllu ' Kp - 2+264 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address e :rt doveSt-,. 1.2 Assessors Map&Parcel Numbers 1.1 a Is this an accepted sfc98t?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 Waterer Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public!3 Private❑ Zone: _ Outside Flood Zone? Check if yes❑ Municipal Ert n site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 wner'of Record: Elaine. T Keyes Name(Prin City,State,Z No.and Street Telephone Email ctre SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building IiJ"Owner-Occupied 13' Repairs(s) I Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify: Brief Description of Proposed Work': Pleilae-e, 51g1419 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ f cn b0 O 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 Fees:,Ialp_ Check N on Check Amount: Cash Amount: 6.Total Project Cost: 5O)ryt 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) W5 No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry 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) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name i No.and Street Email address 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 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIESS FOR/BUILDING PERMIT f�� V I,as Owner of the subject property,hereby authorize Ai a_ to act on my behalf,in all matters relative to work authorized by this building permit application. 10une T mKe c, S/Z-9 i2O21 Print Owner's Name(Electr is 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 kn wledge and understanding. Print Owner's or Authorized Ag ' 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" City of Northampton •• . S,n Massachusetts ,� DEPARTMENT OF BUILDING INSPECTIONS - y T 212 Main Street • Municipal Building ,• Northampton, MA 01060 HOMED ERS'EXEMPTION ELIGIBILITY AFFIDAVIT Elaine• SIS I NCO I, f ere5c eL(�e3 (insert full legal name), born (insert month, day,year),hereby depose and state the fo yJ'ing: 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. 1 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 24 day of A1/i IA , 2024. guiftir 1. 1_4(2e(c) (Signature) City of Northampton Massachusetts �? '<, ► G 1J _w � DEPARTMENT OF BUILDING INSPECTIONS 'P` z t-. r4; -AP' 212 Main Street • Municipal Building Jb O° Yam' . Northampton, MA 01060 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: VI Location of Facility: b n SV. JJØ4 The debris will be transported by: Name of Hauler: DitP& __ wasv Q{ Signature of Applicant: Lam` f ,"` Date: 3AAL212=1 The Commonwealth of Massachusetts Department of Industrial Accidents °/li=si 1 Congress Street,Suite 100 . ?f;= e Boston, MA 02114-2017 ) www.ma s.gor'/dia II pricers'Compensation Insurance Afiidasit:BuilderssContractorsfElectriciansfPlunthers. TO BE FILED WITH THE PERMITTING At•THOR111. Applicant Information Please Print Leitibl, Name(Business+organiratica ilndividlual):_ L C .--t--&..6/ LUX-, Address: 4litg. \/QC City/StateiZip: ( .e. pA \ 0 304" Phone#: -' 10(2?) ' (g _I Are rue n entitle)er?Cheek tlieapprepruete box: Type of project(required): ]. am a employer with 5 e rrrplu}eca(full and or part-tisnek• 7_ 0 New construction 2.0 lam a sulc prupnctur ur purtnership and have nu emplovcv working fur me in 8_ Q Remodeling arty capacity.[Nu workers'cutup.insurance n.ymed_) 301 am a J11-1mswwnl7 dying till work myself.[No workers`curet.icaunum:required.]' 9. ❑Demolition 10 Q Building addition 4.riftam a homeowner and will be hiring csnctrac1urs to conduct all work un my pmpc-rty. 1 will ensure that all cwumcours either have workers'oonrprruatiun insurance or are sole 11.0 Electrical repairs or additions proprietors with nu employees. 12.13 Plumbing repairs or additions 501 ant a general cuntrcxtur and 1 hate hired the sub-contractors listed un tbe attached shcch. 13 Roof repair • These sub-contractors ha,.employee-sand Iris c workers'coop.insurance.= 14_ Other 6.0 We area corporation and its officers have cxen ised their tight of exemption per MGL c. 151,§1(a1,and we luxe nu employees.[Nu workers'sump.insurance required.] *Any applicant that shoes box a 1 must also fill uut Flu section below showing their workers'compensation policy information. t Homeowners who submit rlu%attuittat indicating they arc doing all work and then hire outside contractors must submit a new affcdat it rndicaung 1Cuntractors that check this but must attxhed an additional sheet show ing the name of the sub-contractors and state whether or nut those citifies lute ernpluyccs, lithe sub-cuntracturs lvtc cuy>luyccs.they must pru,idetheir workers'camp.pulicy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 1 n/� Insurance Company Name: Lam 1M In U. ' gJ ) , . I i l Co . Policy#or Self-ins.Lic.#: WC..2'IS n 2z6 s JO (1 Expiration Date: si3i IS(2.0Z-2-- Job Site Address: 1•5 bri e Sh. CitylState/Zip: N AMA .6(066 Attach a copy of the workers'comensation policy declaration page(showing the policy number and espi tion date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to S1,500.0(1 andJ or 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 eertify.Mader the pains and "enaltit's of perjury that the information provided above is true and aandycorrect. Sienarur: �`S1,),I•I�I•R' O�� `` � U'^� Dale- 5 2 ( Cam/ 2I Phone#:_ O'(\ �� \\' \ Official use only. Do not write in this area,to be completed by city or town official ('its or Town: PermitiLicense# Issuing Authorit, (circle one): I. Board of Health 2.Building Department 3.C'itvlTown Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 08/24/2021 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: Jennifer Lavallee Marshall Insurance Agency, Inc. (acNNo.Ext1: (508)480-8808 ac,No): (508)664-0060 211 Main Street E-MAIL lavallee marshallinsurance rou com ADDRESS: � @ g P• _ INSURER(S)AFFORDING COVERAGE NAIC Marlborough MA 01752 INSURER A: MOUNT VERNON FIRE INS CO 26522 INSURED INSURER B: Bruno Barrato Conceicao dba INSURER C: The Empire Co Maintenance&Service INSURER D: 100 Tower St Apt 708 INSURER E: Hudson MA 01749 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 LIMITS LTR INSD END_ POLICY NUMBER IMMIDD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A CL2741723B 01/10/2021 01/10/2022 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 1,000,000 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 PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? n NIA (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) 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. Ana Alves 131 Bridge St AUTHORIZED REPRESENTATIVE Northampton MA 01060 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ® DATE(MM/DD/YYYY) A�D CERTIFICATE OF LIABILITY INSURANCE 08/24/2021 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: Jennifer Lavallee PHONE MARSHALL INSURANCE AGENCY INC (A/C.No.Ext): (508)480-8808 FAX (A/C, E-MAIL lll avaee marshallinsurance rou ADDRESS: 1 @ g P•com 211 Main Street INSURER(S)AFFORDING COVERAGE NAIC# MARLBOROUGH MA 01752 INSURER A: LIBERTY MUTUAL FIRE INS CO 23035 INSURED INSURER B: _ BRUNO BARRATO CONCEICAO INSURERC: DBA THE EMPIRE CO MAINTENANCE & SERVICE INSURERD: 459 EAST RIVER ST INSURER E: ORANGE MA 01364 INSURER F: COVERAGES CERTIFICATE NUMBER: 688905 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 W /Y LIMITS LTR INSD VD POLICY NUMBER IMM/DD/YYYY) (MM/DDYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENTED $ CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS F 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$ $ WORKERS COMPENSATION \/ AND EMPLOYERS'LIABILITY OTH- Y STPER ATUTE ER A OFFICER/MEMBER EXCLUDED? N ECUTIVE E.L.EACH ACCIDENT $ 500,000 N/A N/A N/A WC231S622683011 08/08/2021 08/08/2022 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.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.govilwd/workers-compensation/investigations/. BRUNO BARRATO CONCEICAO SOLE PROPRIETOR,EFFECTIVE 08 08 2021 have elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ana Alves ACCORDANCE WITH THE POLICY PROVISIONS. 131 Bridge St AUTHORIZED REPRESENTATIVE Northampton MA 01060 Daniel M.Cro9ey,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