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23A-293 (3) BP-2021-2003 11 LANDY AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23A-293-001 CITY OF NORTHAMPTON Permit: New Build PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-2003 PERMISSIONISHEREBYGRANTED TO: Project# ADU Contractor: License: Est.Cost: 145000 FIRST PEAK CONSTRUCTION 111252 Const.Class: Exp.Date:06/10/2023 Use Group: Owner: SMITH KATHY J Lot Size (sq.ft.) Zoning: URB Applicant: FIRST PEAK CONSTRUCTION Applicant Address Phone: Insurance: 120 EDGEWOOD AVE (860)930-6606 7PJUB5R98583521 LONGMEADOW, MA 01106 ISSUED ON:10/18/2021 TO PERFORM THE FOLLOWING WORK: ADU 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: $259.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner File #BP-2021-2003 APPLICANT/CONTACT PERSON:FIRST PEAK CONSTRUCTION 120 EDGEWOOD AVE LONGMEADOW, MA 01106(860)930-6606 PROPERTY LOCATION 11. LANDY AVE MAP:LOT 23A-293-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST E REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $259.00 Type of Construction: ADU New Construction Non Structural 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: XApproved 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 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 , h, V+ , i© myal Siui ature of Building Official I 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. The Commonwealth of Massac r usett OCT — �E. Board of Building Regulations an. Stan ards 6 2021 OR, Massachusetts State Building Cod , 780, CIPALITY USE .or NopT 80 N Building Permit Application To Construct,Repair,Reno . ; 6 q o,o, Rev ed Mar 2011 One-or Two-Family Dwelling • This Section For Official Use Only Building Permit Number: ,60-2i- a.0V13 Date Applied:zaki rSinature i D e 1 Building Official(Print Name) g 3 .. .0 p SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 11 Landy Ave,Florence,Ma 01062 19c 00157 1.1 a Is this an accepted street?yes x no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: URB TWO SINGLE FAMILY HOMES 9517 SF 77.68' 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 10 75' 15 15.5' 20 23' 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: n/a Outside Flood Zone? Municipal la On site disposal system ❑ Check if yesla SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Kathy Smith Florence,Ma 01062 Name(Print) City,State,ZIP 11 Landy Ave 4132597437 kjs4musik@yahoo.com 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 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2:We are building a new detached unit unit on the property.The unit will be 1 bedroom and 517SF.The unit was reviewed and approved by the plannning board on 9/9 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 145000 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ 0 Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. II I3Check Amount: 26--fCash Amount: 6.Total Project Cost: $ 145000 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 1 i •1 1 Su'ervisor License(CSL) CS 111252 6/10/23 First Peak Construction License Number Expiration Date Name of C - List CSL Type(see below) U 120 Edgewood Ave No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) Longmeadow,Ma,01106 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 8609306606 zach©firstpeakconstruction.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) N/A-New Contruction HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 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 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 Backyard ADUs to act on my behalf, ' all tters relative to work aut orized by this building permit application. h Kathy Smithc ---7-2 / 6 Tj/ 7- ( Print Owner's Nam (Ele ronic Si ature 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 d accurate to the best of my knowledge and understanding. Chris Lee Ni 10/4/21 Print Owner's or Authorized Agent's 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.) 517 (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) 437 Habitable room count 2 Number of fireplaces 0 Number of bedrooms 1 Number of bathrooms 1 Number of half/baths 0 Type of heating system Minisplit heatpump Number of decks/porches 0 Type of cooling system Minisplit heatpump Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton 5/e. Massachusetts . et- DEPARTMENT OF BUILDING INSPECTIONS ;, 212 Main Street • Municipal Building �a 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: 2Valley Recycling,34 Easthampton Rd,Northampton,MA 01060 Location of Facility: The debris will be transported by: Name of Hauler: First Peak Construction Signature of Applicant: �� Date: 10/4/21 The Commonwealth of Massachusetts "F I, Department of Industrial Accidents =;;,fit_ 1 Congress Street, Suite 100 •_07 Boston,MA 02114-2017 www.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): Backyard ADUs Address:247 Coombs Rd City/State/Zip:Brunswick, Me Phone#:7819990773 Are you an employer?Check the appropriate box: Type of project(required): 1.ID I am a employer with 1 employees(full and/or part-time).* 7. 0 New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.E Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 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? 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.ID Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors 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. I 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: 11 Landy Ave City/State/Zip:Florence, Ma, 01062 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 unde the pains and penalties of perjury that the information provided above is true and correct. Signature: 1 Date: Phone#:7819990773 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#: City of Northampton * :• =.mot . , Massachusetts mow, Nefill v -ix `. DEPARTMENT OF BUILDING INSPECTIONS ?�. €r It 212 Main Street • Municipal Building °A,W ��°� Northampton, MA 01060 sbjq< lh HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT i2 D �^ I, / i<Lh. I v \ (insert full legal name), born (insert month, day, year), hereby depose an 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 day of , 20 . (Signatur ) DATE(MDD/YYYY) '`��Rom M/CERTIFICATE OF LIABILITY INSURANCE 7/28/2021 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 CON1AC! NAME: Matthew Dennctt Lotfey Dennett Ins Brokers ((A/EC,NNo,Ext): 2073706773 FAX No): 500 Washington Ave ADDRESS: matt@lotfeydennett.com Ste 201 INSURER(S)AFFORDING COVERAGE NAIL# Portland ME 04103 INSURER A: CRUM&FORSTER SPECIALTY INS CO 44520 INSURED INSURER B: Backyard ADUs LLC INSURER C: 247 COOMBS RD INSURER D: INSURER E: BRUNSWICK ME 040113629 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 AULH-SIA Fr POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDNYYY) (MM/DD/YYYY) LIMITS K COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE x OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A BAK-66731-2 07/24/2021 07/24/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X. PRO-POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMI I $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ —OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS —HIRED —NON-OWNED PHGPEH I Y 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 N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/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 Manufactured Housing Board ACCORDANCE WITH THE POLICY PROVISIONS. 35 STATE HOUSE STA AUTHORIZED REPRESENTATIVE 1 AUGUSTA ME 04333 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Client#: 1844421 FIRSTPEA1 ACORD„., CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/05/2021 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(les)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 any rights to the certificate holder In lieu of such endorsement(s). PRODUCER ACT Peggy Foote USI Insurance Services LLC PHONE 845-285-3619 FAX 610-537-2231 (A/C,No,Ext): (A/C,No): 333 Glen Street, Suite 302 AIMDRESS: Peggy-foote@usi.com Glens Falls, NY 12801 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Evanston Insurance Company 35378 INSURED INSURER B:Travelers Property Cas.Co.of America25674 First Peak LLC; First Peak Construction INSURER C: LLC; P.O. Box 2673 INSURER D: Middletown, CT 06457 INSURER E: 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 INSR WVD POLICY NUMBER (POLICY M DIDY/YYYY) (MMM/LDCD�YY) LIMITS A X COMMERCIAL GENERAL LIABILITY 3AA504590 09/17/2021 09/17/2022 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $100,000 X BVPD Ded:$500 MED EXP(Any one person) $5,000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY J CT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ _ OWNEDONLY S�pDULED BODILY INJURY(Per accident) $ AUTOSHIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 7PJUB5R98583521 07/21/2021 07/21/2022 X PERTUTE OTH- AND EMPLOYERS'LIABILITY STA ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? N/A (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 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Backyard ADUs SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 247 Coombs Rd. ACCORDANCE WITH THE POLICY PROVISIONS. Brunswick, ME 04011 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S33630664/M33630651 HYTZS Your Confirmation number is 20211006495870 Date of Confirmation: 10/6/2021 NOTE: When paying by ACH (Checking) it will take two business days for the payment to be debited from your bank account. Your account number is not verified until this payment is presented to your bank. They have the right to return this payment if unable to process this transaction against your account. Your request for payment(s)of$12.50 has been received and is subject to approval by your financial institution. No email was entered so a confirmation was not sent. Account Information Payment Information Name: TIM OREILLY Payment Type: Credit Card Note: QUICK PAY TRANSACTION Payer Name: TIM OREILLY Card Number: **************2368 Transaction Information Transaction Quantity Amount Fee Payment Type City of Northampton Clerk 1 $10.00 $2.50 Credit Card Miscellaneous - QP Name: Tim O'Reilly Comment: Certified Copy Planning Decision • Total: $12.50 H II1JI III 1100H1111 0 10 10 2021 00025041 Bk: 14297Pg: 331 Page: 1 of 3 om' , , Recorded: 10/06/2021 09:06 AM c �' i l'^ . Pi" CITY OF NORTHAMPTON PERMIT DECISION ^,-- `P DATES PROJECT INFORMATION Submitted 7/24/2021 Owner Kathy Smith 11 Landy Ave, MA 01062 Name/Address Florence Hearing 9/9/21 Applicant Name/ Tim O'Reilly 25 Morgan St, MA 01040 Address(if different) Holyoke Extension Applicant Contact Tim O'Reilly 413-262-8309 Tim.oreilly@backyardadus.com Hearing 9/9/21 Site Address 11 Land Ave Florence MA 01062 Closed Decision 9/15/21 Site Assessor Map ID 23A-239 Zoning District Urban Residential B Filed with 9/15/21 Permit Type Planning Board Site Plan for a Detached Residential Unit Clerk Appeal 10/5/21 Project Description Request to build a detached 450+sf detached residence on Deadline property with existing single family home. An appeal of this decision by the Planning Board may be made by any person within 20 days after the date of the filing of this decision with the City Clerk, as shown.Appeals by any aggrieved party must be pursuant to MGL Chapter 40A, Section 17 as amended and may be made to the Hampshire Superior Court with a certified copy of the appeal sent to the City Clerk of the City of Northampton. Plan Sheets/Supporting Documents by Map ID: 1. Site Plan Survey for Proposed Detached Accessory Dwelling Unit, Daniel Sails, dated 6/30/21. BOARD MEMBER PRESENT FAVOR OPPOSED ABSTAIN/NO COUNT VOTE TALLY (Favor-Opposed) George Kohout, Chair ✓ ✓ ❑ ❑ Marissa Elkins,Vice Chair ✓ ✓ ❑ ❑ Janna White ✓ ✓ ❑ ❑ David Whitehill ❑ ❑ ❑ ❑ Christa Grenat ❑ ❑ ❑ ❑ Sam Taylor ✓ ✓ ❑ ❑ Melissa Fowler ✓ ✓ ❑ ❑ Chris Tait,Assoc. ✓ ✓ ❑ ❑ Corinne Coryat,Assoc ✓ ✓ ❑ ❑ 7-0 4w J L SEP 1 5 2021 I CITY CLERKS OFFICE NORTHAMPTON. MA 01060 pg. 1 CITY OF NORTHAMPTON PERMIT DECISION Te" APPLICABLE ZONING APPROVAL CRITERIA/BOARD FINDINGS 350 URB Table of Use The Planning Board approved the permit for site plan to create a second unit in a new detached 11.6 structure on the property. The Board determined that the criteria in 350-11.6 had been met. A. The requested use protects adjoining premises against seriously detrimental uses. Two family units are allowed by right in URB. Site plan is triggered because the use will be in a detached structure. B. The requested use will promote the convenience and safety of vehicular and pedestrian movement within the site and on adjacent streets. No changes to the site access are proposed. The project, including any concurrent road improvements, will not decrease the level of service (LOS)of all area City and state roads or intersections affected by the project below the existing conditions when the project is proposed and shall consider the incremental nature of development and cumulative impacts on the LOS. Since a second unit could be approved by right without site plan approval if it were attached to the house,the project is eligible for exemption from traffic mitigation. C. The site will function harmoniously in relation to other structures and open spaces to the natural landscape, existing buildings and other community assets in the area as it relates to landscaping, drainage,sight lines,building orientation,massing,egress,and setbacks. D.The requested use will not overload, and will mitigate adverse impacts on,the City's resources, including the effect on the City's water supply and distribution system, sanitary and storm sewage collection and treatment systems, fire protection, streets and schools. E.The requested use meets any special regulations set forth in this chapter.(NONE) F. Compliance with the following technical performance standards: (1)Curb cuts onto streets shall be minimized. The site is already served by a driveway. (2)Pedestrian,bicycle and vehicular traffic movement on site must be separated,consistent with single/two families. CONDITIONS Prior to Issuance of a Building Permit 1. Final Plans showing conformance with minimum open space shall be provided to the Building Department. Minutes Available at WWW.NorthamptonMa.Gov I, Carolyn Misch, as agent to the Planning Board certify that this is an accurate and true decision made by the Planning Board and certify that a copy of this and all plans have been filed with the Board and the City Clerk and that a copy of this decision has been mailed to the Owner,Applicant. ataAecrn pg. 2 October 6, 2021 I, Pamela L. Powers, City Clerk of the City of Northampton, hereby certify that the above Decision of the Northampton Planning Board was filed in the Office of the City Clerk on September 15, 2021 that twenty days have elapsed since such filing and that no appeal has been filed in this matter. „Pantat". .1312z,Le)24,, Attest: City Clerk, City of Northampton ALGIalat ATTEST: HAMPSHIRE,MAiIV I,BgRD The Commonwealth of Massachusetts I,, Department of Industrial Accidents ;;w 1 Congress Street, Suite 100 = 1E- Boston,MA 02114-2017 www.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):First Peak Construction Address: P.O. Box 2673 City/State/Zip: Middletown, CT 06457 Phone#:8609306606 Are you an employer?Check the appropriate box: Type of project(required): 1.Q I am a employer with 3 employees(full and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 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.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We area corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Travelers Property Cas. Co. of America Policy#or Self-ins.Lic.#:7PJUB5R98583521 Expiration Date:07/21/2022 Job Site Address: ll Landy Ave City/State/Zip: Florence, Ma, 01062 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) the pains and penalties of perjury that the information provided above is true and correct. Signature: ' 2 ' Date: 10 /06 / 2021 Phone#:8609306606 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#: n,.,. In. 4..-.G')hnnf']nnuG..C'1C'7.,f]']7...Jnnagif-,,,AA, rl..h