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23A-132 (9) BP-2021-2033 58 MIDDLE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23A-132-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-2033 PERMISSIONIS HEREBY GRANTED TO: Project# 2021 BEDROOM Contractor: License: Est. Cost: 3455 ELI MASTERTON CARPENTRY LLC 201154107069 Const.Class: Exp.Date:03/09/202308/27/2022 Use Group: Owner: REILY JOHN&ANDREA P RAPHAEL Lot Size (sq.ft.) Zoning: URB Applicant: ELI MASTERTON CARPENTRY LLC Applicant Address Phone: Insurance: 189 CHERRY LANE (617)285-3318 AMHERST,MA 01002 ISSUED ON:10/14/2021 TO PERFORM THE FOLLOWING WORK: REMOVE WALL &ELIMINATE DOORWAY 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: " II Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner R The Commonwealth of Massachusetts �_�� 1,� �, �E7 Board of Building Regulations and Stand.rds OR ". Massachusetts State Building Code, 780 I MR OCT 1 4 I�I UN USE A ITY �`% Building Permit Application To Construct, Repair,Renovate ! P•molish a Revis d Ma 2011 DEpr OF One- or Two-Family Dwelling NORTH p,..s MAo�090 oNs This Section For Official Use Only Building Permit Number: j3P-Al �.O Date Applied: 2,1 Building Official(Print Name) / Signature 1 I Date SECTION 1: SITE INFORMATION 1.1 s er dgge.;-t. f M ^ Tlkes r Map&Parcel Num3e•2 ' 1 3c 1.1a Is this an acceptedll street?yes I no / I/'1 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 isposal System: Public Private❑ Zone: Outside Flood lone? Municipal 6On site disposal system ❑ Check if yesla _ SECTION 2: PROPERTY OWNERSHIP' '� 2.1 Owner 'O R cg ord:kvh FN e 1• �.-?U ft (^,� ! V'i A ( 0 t V 4 2_ Name(Print) City,State,ZIP ,1 5Sf m►Ait S'keC1" 1/4'113-ct 131q retphitekeil €)cotAA(co.f. tte No.and Street Telephone Email A dress SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)./ New Construction 0 Existing Building 0 Owner-Occupied i] Repairs(s) 0 I Alteration(s) �] Addition 0 Demolition r—AAccessory Bldg. 0 Number of Units I Other 0 Specify:Brief Description of Proposed Wolk': Rpi✓tplit !)cm— bet,A'5, vl/q 11 171-Fween be1 �(book evr) O ``c . fi :rrt:rk, 1— da,Nry. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ a (.55 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2. Electrical $ 5120 0 Total Project Costa (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) S List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ (aj,ese Check No./0.3 Check Amount: Cash Amount: 6.Total Project Cost: $ 3 q_s5 A Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) S.- I D7%/9 I /1 -fed-DA License Number b Expiration Date Name of CSL Holder , r `D I aver �l2 List CSL Type(see below) v No.and Street / � Type Description /)m h€�`5 V 1- ��4' (o'o U Unrestricted(Buildings up to 35,000 Cu.ft.) / R Restricted 1&2 Family Dwelling City/Town,State,tIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances (617)4; 5 33I ' e -ntsteribA@Yekaotivi Insulation Telephone Email address D Demolition 5.2 RegisteredV Home II provemeentt�Contractor(HIC)` ' r r 1 5 L! 0� �~ { 'el$' e .bn Al lr y L�F-t HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Mine I P9 ceriY 1.44-4Z- c e.1410 10011eY016°%C0N1 NA pd Streejt 14. ©1oo `6 VAFS 33(07 Emai a dress 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 l No .0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUIL}DING PERMIT P I,as Owner of the subject property,hereby authorize ` ; M d-S 7 er#V V` to act on my behalf, in all matters relative to work authorized by this building permit application. so i^ 122 t 6 f I t Print Owner's Name(Electronic SignatuYe) Dat 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. 3:514.," 10 ) 111 -z Print Owner's or Authorized Agent's Name electronic Signature) Dat 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" = The Commonwealth of Massachusetts Ili _;.i Departurent of Industrial Accidents ' -; I'=' I Congress Street"Suite 100 ' Boston, rt1A Q 2114-2017 halters' Compensation Insurance.Aflidaxit: Buiidersfi'ontractortt/Plectricians?Plutubtr.. 'i'O BE:Fli.E9 1111II I IIH_I'I.RMfl mt;At=1'110RrI . Applicant information Please Print Le3tilllx Name 1 Husitrocak Orpautxatltvn ltido,lduall: Ff.- I c.cj 1 OA (cxr r`/ Address:_ 121 c-I eft,y rr-tMtf4e- City/State:2i p 4V 1 kQd 5 J, ./"14s e3 k Phone#: 6 (7 a?iS 3l� ?arc)nu an eni plus t r. t h.e k the appropriate box, Type of project(required): t.Q I met a cngrloyss with .--._- employees I lull andar part-time'!-" 7. a New construction 211111 am a lute proprietor ur pitrtnersltrp and have no employees wart:nna for me in 8. 0 Remodeling ."41manned.] capacity.[No workers'comp.insurance nymL] 9. ..i Demolition 3E3 I am a homeowner doing all work myself.[No workras'comp_insurance mooned" 10 0 Building addition 4.Q I am a homeowner and will tom•bring oil/u o:tun to conduct all wink un my property. 1 will insure that all contractor either have workers'compensation ursuranoe in arc sole 1 l43 Electrical repairs or additions prupnetun with no cnnpluyct.•s. 12.0 Plumbing repairs or additiotu 5 0 I am a general l contractor and I lave hm d the soli-cuntraetcan listed un the attached sheet. 13.0 Roof repairs These sub-curnractun KIS<employees and have swa t&ciMnp.utsurunce.: 6.0 we are a corporation and its officers have exercised then right of exemption per Skit c 1 .0 Ot114�r 352¢lt41.and we have nu employees.[No workers'comp.insurance.requircd.l 'Any applicant that cheeks box al mint abu till out the section below show inp their workers'cuntpens aaun policy rnlbrnwtion 'Human%tiers who submit tins affidavit indicating they are doing all work and then hire outside etmtracton mica submit a new aftirdan it indicating such Cuntractorr,that check the box must attached an additional sheet showing the mane of the sul>cuntraeiurs and state whether or nut those indite,ham: oriplus cc, li the sub-contractors!rave cnrgrloyees.they mom ptv+idc their worker,'comp.ln..licy nwnb v. I am ern employer that is providing workers'compensation insurance for my employees. Below is the policy and job site in formation. Insurance Company Name: --- Policy#or Self-ens. Lie. #: Expiration Date: Job Site Address: City Slate:Z_ip: Attach a copy of the workers'compensation policy declaration page(showing the(olio number and expiration date). Failure to secure coverage as required under NIGL c. 152. USA is a criminal violation punishable by a tine up to 51,5001)0 and'or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and u tine of up to S250.00 a day against the violator.A copy of this,!..iieina:nt may be forwarded to the Office of Investigations of the DIA for insurance etrvi•rase ti.eltl e:t.ttott. 1 rho hereby cerriiiv aurderr the rruir.x and pevarrltir, ul peayurs•that the information provided ohoce its true and correct. U__ / 1 f< .c7 1 Signature: Date: 10 Phone ': 6i 7"(9)R5_ 331U , ()Metal use only. Do not write in this area.hi 1ne i moldered lit tilt`or town 011ie'ataf City or Town: Permit!!icense a Issuing Authority Icirc-le tine}: I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector fa.Other Contact Person: Phone#: City of Northampton y,;,tt rjr 1s... .: si Massachusetts ao,�',.- G' Y4t { DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 4Y" • `^�P 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: A4w.5---)— � '4ns- -i 5 i- (9 Y The debris will be transported by: Name of Hauler: E.- 1- Signature of Applicant: C �� Date: 10( 11 °� 1t .7hi, Ker//,,,,ient,yw�/�V. //9- /7iiP//i Office of Consumer Affairs&Business Regulation 9 HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 201154 03/09/2023 1000 Washington Street -Suite 710 ELI MASTERTON CARPENTRY LLC Boston,MA 02118 I i (/. --74° I 4' ELI C.MASTERTON � �� ;�� . 189 CHERRY LN Not valid without signature AMHERST,MA 01002 Undersecretary Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Consiak `SU4isor CS 107069 Expires:08/27/2022 ELI MASTERTON i , 189 CHERRY LN 'OAS; k.,!: AMHERST MA 01002 �i • Commissioner A'. I7&<nJ.J& Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/12/2021 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 Customer Service Department NAME: Salmen Insurance Services,Inc. PHONE (866)872-5636 FAX (866)472-5636 (A/C,No,Ext): (A/C,No): 3256 Grey Hawk Ct E-MAIL certificates@salmeninsurance.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Carlsbad CA 92010 INSURERA: Preferred Contractors Ins Co. 12497 INSURED INSURER B: Eli Masterton Carpentry,LLC INSURER C: 189 Cherry Ln INSURER D INSURER E: Amherst MA 01002 INSURER F: COVERAGES CERTIFICATE NUMBER: GL 21-22 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 ADDL-SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 50,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A PCA5026-PC391085 03/15/2021 03/15/2022 PERSONAL B ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 X POLICY PRO 1,000,000 JECT LOC PRODUCTS-COMP/OPAGG $ 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 Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (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) Verification of Coverage RE:58 Middle St.Florence,Massachusetts 01062 *Subject to all policy terms,exclusions and conditions" CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Eli Masterton ACCORDANCE WITH THE POLICY PROVISIONS. 189 Cherry Ln ------• AUTHORIZED REPRESENTATIVE Amherst MA 01002 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 45 '4,-M1W 8 5 MEIMINNIMEMENIMMIIMMINEMOININER IMMENEIMIIMMENIIMENIIMMEINIIMMININ EINIMINNIMEMINIMMEMINEMEMENEM INIMMINIMINUMMIIIIMIIMMEMMOMENN NEEMENIEINEMIIIIIMMIIMMEIMMEN MINIMMINNIMENIMINEMENIMININIMMINININ MIIMMEMEIMMINEMMENNINIIIIINIIM MENNUMMENNIEMMENIEMEMMIEMEMEN IINIMEINIMMEMENIMMIENIMEIMMEMEIN IIIIMMIENEMEINIMEINEMENNEMIEEN IMMEINIIIIIMINIMUMMENNIEMEMEME IIIIIIMMENNIMIIIMMEMENNEMMIMENI MIEIIMMMMIMIMMMIMEIEIMMIMIM MIENNIMENNIMENNEMENNEMENNIMEMI __ i � =eo u �