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31A-147 (6)
BP-2021-2237 16 FORBES AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31A-147-001 CITY OF NORTHAMPTON Permit: Demo PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-2237 PERMISSION IS HEREBY GRANTED TO: Project# DEMO POOL Contractor: License: RED BRANCH LANDSCAPE Est.Cost: 17500 CONSTRUCTION LLC Const.Class: Exp.Date: Use Group: Owner: BORER,JEREMY&EMILY GILBERT Lot Size (sq.ft.) Zoning: URB Applicant: RED BRANCH LANDSCAPE CONSTRUCTION LLC Applicant Address Phone: Insurance: 24 RICHARD EGER DRIVE (508)873-9837 XWS626229648 HOLYOKE, MA 01030 ISSUED ON:11/30/2021 TO PERFORM THE FOLLOWING WORK: DEMO INGROUND POOL 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: ft raa Fees Paid: $30.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner The Commonwealth of Massachu '&/V r"` Board of Building Regulations and S ndar. F wi Massachusetts State Building Code, 80 C i' NOV ` IC ALITY Building Permit Application To Construct,Repair a . • - Or Demos 9 / R vised ar 2011 One-or Two-Family Dwel n„op8,. This Section For Official Use Only ��'4M�o A/ o 0 o�'"s Buildin Permit Number: is A I- .22 3 7 Date Applied: LV�J s� ,�/ II-)-20 0�5 Zl Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 16 Forbes Avenue,Northampton — 1.1 a 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 CIPrivate❑ Zone: — Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Name(Print) City,State,ZIP 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 I ( Accessory Bldg.0 i Number of Units I Other 0 Specify: Brief Description of Proposed Work2:Adjustment of existing fencing,removal of in-ground pool and concrete deck,removal of 75% of wood deck at back yard SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $17,500 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $0 ❑ Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $0 2. Other Fees: $ 4.Mechanical (HVAC) $0 List: 5.Mechanical (Fire $0 Total All Fees:$ Suppression) Check No. Check Amount. f30 Cash Amount: 6.Total Project Cost: $17,500 0 Paid in Full ❑Outstanding Balance Due: • ,yfliP/ 1 /i i/f • 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 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) 203644 11/7/2023 Red Branch Landscape Construction LLC HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 24 Richard Eger Drive johnm(uuredbranchlandscape.com No.and Street Email address Hotyoke MA 01030 5088739837 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 B No 0 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: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. jZZ d 11/4/21 Pr' 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.) (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 aa�nFr.rr i `� sic Massachusetts �? '� t A r ; w ti DEPARTMENT OF BUILDING INSPECTIONS a • 212 Main Street • Municipal Building % QD 'AO Northampton, MA 01060 sjrh vol1J 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: Concrete-Hathway Construction 20 Arthur St.Easthampton MA Wood-Valley Recycling 234 Easthampton Rd,Northampton MA The debris will be transported by: Name of Hauler: K&F Construction,Red Branch Landscape Construction Signature of Applicant: 29/41 �d-- Date: 11/4/21 The Commonwealth of Massachusetts _' 3 Department of-Industrial Accidents r = 1 Cougros Street,Suite 100 :tz Boston, 11.4 02114-2017 , lt'Wt:,rtutss.gor/dia e 5lurker.' ( urniicnsation In.0 ranee.ttlidtiyit:BuiIdersControrters/Elect tic lamalato hen. lc)Bt. I-lI Et)%Sill{ I Hi_I'LR'I1IIItt: tit IN(iWil. ttrt,kt lit InIurniatiuu I'ha.e Print 1.tviltls Name alas.....thganvtn ou Inft.,duall Red Branch Landscape Construction LLC Address:_ 24 Richard Eger Drive Citv'State Zip: Holyoke MA 01030 F'kt one#: 5088739837 trc van au eiupluxtr". t'heck the appugartatt but: l 1 lie of project(required): 1.0 I are a srplo..T*tin 2 cmduti ce,i lull and or pat-brit• 7. 01Jew CQritructnin 2rJ I ant a wit:reupnctur or pumetxhrp and hate au ctrpiwa,*tektite tin:Ix::n B.O Remodeling any caparkt !\.a nurkrn'cavil mammy required.) 9. Demolition 301 nisi a huunw ua-r doing all work myself. o workers'comp.:bur-save ave[nosed"v ® m 4.0(am hornet**a tic?and w dl be bon tw g aastraduct ry ndu t all work un on prnpert). 1 v.tl, 1 U CI Building addition crr,t.re that al/.aatra.tun ether hate aorlas'comp.-n,aiws mwxan.i to art stir I I.1JElectrical repairs or additions pruprhtun w rth n•cripkfwc3- 12.0 Plumbing repairs or atkittions 5O I are a racial cuteractta au!I laaxa heal t6c nub-ntntnctun Iid.d un the anadhcd hart j 13.0Roof repairs Those sub-amtlractun luxe employees anti have intake c'comp.un .c I ��^ 14.00thei 6.0 We are a co:p.x alit/and Is off cer%hate exercised den i hi.,l exemption per Mt.zL.. i 152,$1141.and vie kale no ranrkiucx.Nu workers'coop.insurance tmpared J 'Antappbcaai that.hacks box.1 mot.tiu fill tirade scrubs bairn showing their.tul.n':t ation ualarmatwn 11.m-ou rsces*no,ubeei dux Aida.d rn.:icalig they art,dorx all work aid tlti-n bur cut,idc..aira.t xs Mina*tidier a rxw at5daa it ndwaing,vh. •t .tatr:sewn that clock flux box mu,.t t,Ia,i an addrtitrual,h.rt xhtrworg the runic ul the aeb-.antra gar,and stare whctba or nut dune.antic.tine cm 4..a..c, lithe xub-.taatracturx tux,curio?.cc,.the,toad Few.wk-then s mien:vrrq, puk'wamb.T. I ripe on employer that h provitling workers'compensation itrtarancr for ml•employees. Below is the policy and gob site infiaewtiur. Insurance Company Nam: OHIO Security Ins. Co Policy g or Self-ins.Lic. _: 74D82-- --- Expiration Late: 2/3/22 Job Site Address: 16 Forbes Avenue _city State Zip: Northampton, MA 01060 Attach a copy of the aorkers'coinI ten sit ion policy deciaratia ,page(Amman thepoliotoaatherantiaspirationdate). Failure to secure txiyerage as required wider MGL c. t52.§25A is a criminal t salatwn punishable by a fine up to SI_500.00 and'or one-year imprisonment_as*ell as civil peisalties 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 co%aragc%enfieation. do hereby certify trader the pains and lh nnities of perjury hunt the information provided uboce is tram aptl correct 5irnat ore. - Pali: 11/4/21 Phone 5088739837 Official one only. Do nut write in this area.to be completed by city or town official ('it%or Tow a: PermicI-ictnse INstiing Authority(circle one): I. Berard of Health 2_Buikliti1 Department 3.Ckyfietwit Clerk 4.Electrical Inspector S.Phewhi*2 Inspector fi.fluter I. noise(Person: Phone 4: THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration w4 � _ �..... Type: LLC - � Registration: 203644 RED BRANCH LANDSCAPE CONSTRUCTION, LLC Expiration: 11/07/2023 24 RICHARD EGER DRIVE = HOLYOKE, MA 01040 illil ;a. / lei i ' A4 N$ Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE: LLC Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 203644 11/07/2023 Boston, MA 02118 RED BRANCH LANDSCAPE CONSTRUCTION,LLC c JOHN M. MILOS .A.,* "--- 4,/ c- ',....' , t 124 RICHARD EGER DRIVE !`r �,,,,,,�a,�,�(,(04,. ''c/ HOLYOKE, MA 01040 Undersecretary Not valid without signature REDBR-1 OP ID: DB ACORO DATE(MMIDD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 02/10/2021 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 413-534-5343 CONTACTME Deborah Dostal-Pijar A.J. Pijar Insurance, Inc. PHONE 413-534-5343 1 FAX 413-535-1627 1793 Northampton St. (Alc,No,Extl: (A(C,.No): Holyoke, MA 01040-1955 ADMDRESS:debbie@pijarinsurance.conl Mark A. Pijar, CIC INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Ohio Security Ins. Co. 24082 INSURED INSURER B:Ohio Casualty Ins. C.O. 24074 Red Branch Landscape Construction LLC 24 Richard Eger Dr. INSURER C: _. Holyoke, MA 01040 INSURER D: 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 ADDL SUBR 1 POLICY EFF POLICY EXP r LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER IMM/DD/YYYY1 IrrM/DD/YYYYI f LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 3 1,000,000 CLAIMS-MADE X OCCUR BKS62629648 02/03/2021 02/03/2022 DAMAGETORENTED 300,000 PREMISES!Ea occurrence) $ MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1 2,000,000 POLICY xj ECT l __] LOC PRODUCTS-COMP/OP AGG $ 2,000,000 I OTHER: $ A AUTOMOBILE LIABILITY (EOMBacicid DtSINGLE LIMIT) $ 1,000,000 ANY AUTO BAS62629648 02/03/2021 02/03/2022 BODILY INJURY(Per person) S OWNED X SCHEDULED BODILY INJURY(Per accident) $ _ AUTOS ONLY AUTOS�.} NE X AUTOS ONLY X AUTOS ONLDY (Per accidTentDAMAGE $ i I $ B X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB ,I CLAIMS-MADE US062629648 02/03/2021 02/03/2022 AGGREGATE $ 1,000,000 DED X 1 RETENTIONS 10000 1, $ A WORKERS COMPENSATION X 'STATUTE EMPLOYERS'LIABILITY STATUTE ER - Y/N XW 562629648 02/03/2021 02/03/2022 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT �—__ ._ OFFICER/MEMBER Mandatory in NH)EXCLUDED? I� N/A 1,000,000 E.L.DISEASE-EA EMPLOYEE $ If yes,describe under i 1,000,000 DESCRIPTION OF OPERATIONS below ,E.L.DISEASE-POLICY LIMIT S 1 i i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Landscape Contractor Oerations, including herbicideesticide applications ******************************************* ************* ********************************************************* ********************************************************* ********************************************************* CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Red Branch Landscape ACCORDANCE WITH THE POLICY PROVISIONS. Construction LLC 24 Richard Eger Dr AUTHORIZED REPRESENTATIVE Holyoke, MA 01040 kaS dIO d.Q .p-0O3 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD