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43-031 (3) BP-2022-0094 456 WESTHAMPTON RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 43-031-001 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-2022-0094 PERMISSIONISHEREBYGRANTED TO: Project# GARAGE RENO Contractor: License: Est. Cost: 90000 CHRISTOPHER JACOBS 060475 Const.Class: Exp. Date: 11/10/2022 Use Group: Owner: CERNAK KENNETH S TRUSTEE Lot Size (sq.ft.) CERNAK KENNETH S TRUSTEE, Zoning: WSP Applicant: BARRON &JACOBS Applicant Address Phone: Insurance: 462 WESTHAMPTON RD FLORENCE, MA 01062 420NORTH MAIN ST 413-586-8998 wmz80063652020 LEEDS, MA 01053 ISSUED ON:01/31/2022 TO PERFORM THE FOLLOWING WORK: CONVERT 2 CAR GARAGE INTO LIVING SPACE 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: Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: ( 1 51z, Fees Paid: $585.00 2l2Main Street, Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner 14 The Commonwealth of Massachusetts r ,! Fes, 1 I Board of Building Regulations and Standatds ' i Massachusetts State Building Code, 780 CMR, ' MII IPAL ITY fr' U E Building Permit Application To Construct, Repair, Rerio t ' r olish a ("90 vise Mar/011 One-or Two-Family Dwelling '`�� Ty�k,1/,,,� i This Section For Official Use Only t:,,r� Building Permit Number: ', — gC Date Applied: 0'vs i 1i,Q,�„ ) '-i73i/a N Building Official(Print Name) Signa ture 1 U ' Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers -5co 1rJ�.skA,.o, 1 rw Y� . 0')D l l.la Is this an accepted street?yes no Map Number Parcel Number 1.3 Zonkg Information: 1.4 Property Dimensions: UJ c. V Si - (c' s 5 exc,rcS 200 Zoning District Propose se Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) t\j (...A�,,,ync..) kv gam;SyI 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: Zone: _ Outside Flood Zone? Public RI Private 0 Check if yes Municipal On site disposal system 0 SECTION 2: PROPERTY OWNERSHIPI 2.1 Owner'of Record: Name(Print) City,State,ZIP lri(o W AS Ir xvV,NC,''` a-A- `kVb-`A1"1- (S-s No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction ❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 'a Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work'-: CO —JQ.{)( iin s 2.C,wr .1 av e.....3.... IV+ tfVelAzA, SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only (Labor and Materials) 1. Building $ — , 5-2— 1. Building Permit Fee: $ Indicate how fee is determined: / i ❑ Standard City/Town Application Fee 2.Electrical $ Yot� 0 Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ % 900 List: 5.Mechanical (Fire $ Suppression) Total All Fees: Check No. Check Amount: G Cash Amount: 6. Total Project Cost: $ c,0,D"0-0 0 Paid in ull 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) GLC,"\ \ /` I �� C-,V\(k SV(V� / �AC��I� License Number Expiration Date Name of CSL Holder • List CSL Type(see below) L\t,o J . �Mckty. No.and Street Type Description „IV n,1 n_. �`�S 3 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 1)-)'SSlo' 1f4`18' ;v e.IQC-oYr rNm,rl 'et,ok05.Ly, I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 113"Dan e2•\ Wt, . G\VO\ \'C-005 k-S,•07i 4 --5. \V' HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email ad Le-e.dU ,OA- (>pc') 417)-Stb- 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 BUILDING PERMIT I, as Owner of the subject property,hereby authorize ?ew NrOw-N tr-wADS to act on my behalf,in all matters relative to work authorized by this building permit application. MM-4 -✓\4— D, -r- b Print Own ame(Electronic i ture) 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. G7/' Ivv Print Owner's or Autho zed 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" The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 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): ? OW\(�(Ur 'we • — Address: LA N',.','(k\c‘ a,.y-\. ce . City/State/Zip: Utz- -e&s pAAr O\o`�'> Phone#: 1 -Sro- XC1,og Are you an employer?Check the appropriate box: Type of project(required): I.C51 I am a employer with `0 employees(full and/or part-time).' 7. ❑New construction 2.0[am a sole proprietor or partnership and have no employees working for me in g 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.] 9. Demolition 10 0 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 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 30 I am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers'camp.insurance.: 13•❑Roof repairs 6.❑We are a 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.] *Any applicant that checks box 41 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: Pc \ NA My 0,1 Policy#or Self-ins.Lic.#: ,ii if V -- �j 2 '(e)-3?C 0 --O Pr � Expiration Date: 1)1 t I 2Z- Job Site Address: -S(o W•f,S-V w,-0 ^ k City/State/Zip: ov-c.r- `-ems �/c DI Oto2 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 under the pal and penalties of perjury that the information provided above is true and correct. Signature: �� Date: 1 f Z i 121-- Phone#: _11� S "� Val 411 Official use only. Do not write in this area,to be completed by city or town ofcial City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector ' 6.Other Contact Person: Phone#: DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit # was issued with the condition that all debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L c. 111, s. 150A. The debris will be disposed of in: (k\\ 9-e_e:4. C1, Name bf Waste 'acility 1 Address of Waste Facility 111.5 Debris: As a condition of issuing a permit for the demolition, renovation, rehabilitation or other alteration of a building or structure, M.G.L. c. 40 s. 54 requires that the debris resulting therefrom shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L.c. 111 s. 150 A.Signature of the permit applicant, date and number of the building permit to be issued shall be indicated on a form provided by the Building Department and attached to the office copy of the building permit retained by the Building Department. If the debris will not be disposed of as indicated, the holder of the permit shall notify the building official, in writing,as to the location where the debris will be disposed. 780 CMR—6th Edition Signature of Permit Applicant Date ACC le CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) kii.....----- 02/23/2021 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 Adina Edgett NAME: g Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 8 North KingStreet E-MAIL Ext): (A/C,No): ADDRESS: aedgett@webberandgrinnell.com INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Main Street America/MSA 29939 INSURED INSURER B: NGM/MSA Barron&Jacobs Assoc.Inc. INSURER C: A.I.M.Mutual/A.I.M. 33758 70 Old South Street INSURER D: INSURER E: Northampton MA 01060-3833 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 03/22 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 SUER LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP {MMIDDIYYYY) (MMIDDIYYYI) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A MPT8049D 03/09/2021 03/09/2022 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 3,000,000 POLICY PRO- 0PRODUCTS-COMP/OP $ JECT LOC 3,0 , 0000 OTHER EPLI $ 10,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 1,000,000 B OWNED SCHEDULED M1T8049D 03/09/2021 03/09/2022 BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ B EXCESS LIAB CLAIMS-MADE CUT8049D 03/09/2021 03/09/2022 AGGREGATE $ r. a'r.,? . RETENTION$ 10,000 $ ,T6iN1ii` PER OTH- a ,,Valli*. STATUTE I I ER ANY PROPRIETOR/PARTNER/ECUTIVE YIN ,„- -- _ _ E.L.EACHACCIDENT $ 500,000 C OFFICER/MEMBER EXCLUDED? N NIA d^sesfa mta r a -' a :0 112. 1 (� (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 Inland Marine Borrowed or A MPT8049D 03/09/2021 03/09/2022 Rented Equipment $100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Division of Professional Licensure ��® Board of Building Regulations and Standards Consk t$A1typprvisor r CS-060475 A * `` fA�pires 11/10/2022 CHRISTOPHER R ." 70 OLD SOUYI1 ST V i` fr NORTHAMPTOfI ; ^ ,-' vOiS _[UPS i Commissioner , ,freQz R. EYEkrd . e &Cy,/'2-?ii/7l/'f'o- X/' Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation BARRON &JACOBS ASSOCIATES, INC. Registration: 160809 70 OLD SOUTH STREET Exppi ration: 06/22/2022 NORTHAMPTON, MA 01060 Update Address and Return Card. SCA 1 Cr 20M-05,17 ./fir !�ii...v./iiii//, Office of Consumer Maki&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 100809 06/22/2022 1000 Washington Street -Suite 710 BARRON&JACOBS ASSOCIATES, INC. Boston,MA 02118 CECIL R.JACOBS 70 OLD SOUTH STREET NORTHAMPTON,MA 01060 Undersecretary Not valid without signature SIGNATURES By signing below,you agree to items A, B and C. DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES. A. Alternative Dispute Settlement(Arbitration Clause):The Seller and the Buyer hereby mutually agree,in advance,that in the event of a dispute concerning this Agreement,the parties shall submit such dispute to a professional,state-approved arbitration service(cost,if any,to be paid by the submitter)prior to either party proceeding to legal action in the courts. B. ,ing thi ertvnetecord,` tereby authorizing Barron_&J Associates Inc.to ad. as your authorized agent in all matters pertaininn to the building permit application C. This is a binding Agreement. You may not cancel it except as stated. This Agreement covers and supersedes all conversations, statements and agreements,expressed or implied,between the parties,their agents or representatives. an41-1,1 C /- -'?o `er You,the Buyer,may cancel this transaction Buyer [)ate at any time prior to midnight of the third business day after the date of this transaction. See the attached notice of cancellation form Buyer I)atc for an explanation of this tight. %� Seller retains an equal right to cancel. Barron&Jacobs Representative I) c ********************************************************************************************* Contact Information Office Manager: Sandy Scavotto Office:413-586-8998,x100 © Chris Jacobs, President CT HIS#0554397 Cell phone:413-250-6677 Home phone:413-665-9113 Office phone ext: 103 ❑ lesha Gomillion,Senior Designer Cell phone:413-923-7003 Office phone ext: 106 MA Construction Supervisor License 060475 MA Home Improvement Contractor 100809 CT Home Improvement Contractor 518617 Purchase Agreement Page 30 of 30 r 3231DH i 3331DH I I 1 -, 1 \ 1 I I .. I I 1 I I i I Fb\ B36 B33 B3b U152496L J152496R 630 1 B30 BF? \ 0 9 I I \ S m \ 111 / \ y� Elevation 3 �-.� x �j © U, LL \ cci cn \ \ \ �/\ 4.) , \ N I . 0 .,, ,_ . / > w / W / .• 's . / \►� Sdy . / ` / rr. / g a ►n 1 / / E\ / \h� 1 / l- r FLOOR PLAN L_ / il 3068 -L. 6068 I SCALE - 3/8" = 1' SCALE: AS STATED DRAWING TYPE: PROJECT: CLIENT INFO: DRAWING PHASE: SHEET: CERNAK CERNAK RESIDENCE 1 GARAGE CONVERSION 456 WESTHAMPTON RD. DATE: 01.18.22 70 OLD SOUTH STREET,NORTHAMPTON,MA 0I060 FLO REN CE, MA 01062 DRAWN BY: J. IRWIN ALL DRAWINGS,PLANS,& DESIGNS ARE PROPERTY OF BARRON&JACOBS,INC. '• , • : I 3/4"PLANKING E PLATE FAUX BEAM PLATE 4X4 POST 3/4"DRYWALL I 3/4"PLYWOOD 2"FURRED WALL 24" xZH'' x g'' I EXISTING STUD HALL hN� (3)2X10 RIM JOIST 12"PYLON AS NEEDED 2 -' 0- INSULATION 3/4"HARDWOOD FLOOR 3/4"SUBFLOOR I 2X10 FLOOR JOIST GONGRETE LAG 2X10 RIM JOIST 3/4"PLYWOOD Al v v v v v v v v_ ° • ° ° d°° 7—IATHTINH= = = LT- =II ITT( I I�I I—I I I ° ETI -ITS ' -IIIaIHII ail • • II IT • III -°° ,-- JOIST LAYOUT CROSS SECTION SCALE - 1/4" = 1' SCALE - 1/2" = 1' SCALE:AS STATED DRAWING TYPE: PROJECT: CLIENT INFO: DRAWING PHASE: SHEET: CERNAK CERNAK RESIDENCE 2 GARAGE CONVERSION 456 WESTHAMPTON RD.FLORENCE, MA 01062 DATE: 01.18.22 70 OLD SOUTH STREET,NORTHAMPTON,MA OIOGO DRAWN BY: J. IRWIN ALL DRAWINGS,PLANS,& DESIGNS ARE PROPERTY OF BARRON&JACOBS,INC. A A.9 X W e- O _ , - _ Kr 5 3/4" I ?„ 2„ 1 1/4° 36" 33" < 36"J „15" 15 L30" ,, 30" x 14, 70u� cN / / CC7N�. /� N'\ /7 N\vcc„.7 s• / / CABINET ELEVATION SCALE - 1/2" = 1' SCALE: AS STATED DRAWING TYPE: PROJECT: CLIENT INFO: DRAWING PHASE: SHEET: CERNAK CERNAK RESIDENCE 3 GARAGE CONVERSION 456 WESTHAMPTON RD.FLORENCE MA 01062 DATE: 01.18.22 70 OLD SOUTH STREET,NORTHAMPTON,MA OlObO , DRAWN BY: J. IRWIN ALL DRAWINGS,PLANS,& DESIGNS ARE PROPERTY OF BARRON&JACOBS,INC. i L I L I L Cr 1 WINDOW ELEVATION SCALE - 1/2" = 1' SCALE: AS STATED DRAWING TYPE: PROJECT: CLIENT INFO: DRAWING PHASE: SHEET: CERNAK CERNAK RESIDENCE 4 GARAGE CONVERSION 456 WESTHAMPTON RD.FLORENCE, MA 01062 DATE: 01.18.22 7C OLD SOUTH STREET,NORTHAMPTON,MA 01060 DRAWN BY: J. IRWIN ALL DRAWINGS,PLANS,& DESIGNS ARE PROPERTY OF BARRON&JACOBS,INC.