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37-108 (3) BP-2022-0486 50 ICE POND DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 37-108-001 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-2022-0486 PERMISSIONIS HEREBY GRANTED TO: Project# BASEMENT RENO Contractor: License: Est. Cost: 30000 PRESTIGE BUILDERS 413 077517 Const.Class: Exp.Date:07/01/2022 Use Group: Owner: CARUNER, JORDAN & D'ANGELO, HEATHER Lot Size (sq.ft.) Zoning: SR Applicant: PRESTIGE BUILDERS 413 Applicant Address Phone: Insurance: 20 WARD ST (413)344-7795 656OUB5R75445522 CHICOPEE, MA 01020 • ISSUED ON:05/04/2022 TO PERFORM THE FOLLOWING WORK: FINISH BASEMENT 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I O . (NT , . Fees Paid: $195.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner MAY the Commonwealth of Massachusetts it I - 3 2022 Board of Building Regulations and Standards MUNICIPALITYFOR VI Massachusetts State Building Code, 780 CMR USE EPT oFl3iri pplication To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 ___� NORTHgMProry CT�ONSS Ma o oso One-or Two-Family Dwelling r This Section For Official Use Only Building Permit Number: &' ' } )-. 40'9&. Date Applied: tJ —, 4Z55 //2 5-/-1-20Z2 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 As sors Map&Parcel Numbers 50 I r p o nrl c1 r 7 1.la 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 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record 'So(Aar) Cat c+tv.er 45O t « pon cj Name(Print) City,State,ZIP 5o 1ce pon 1 d- LII3 ` 4A-7915" Co.,ru,nec-j cfn�;i 1 .,e.a1•, No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied [e Repairs(s) 0 Alteration(s) l7' Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: 0 i In i 5 h tikSer"en A.— dfr—/GE space_.. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 2 0j Uo0 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ S v o� 0 Total Project Cost (Item 6)x multiplier x 3.Plumbing $ S,pvo 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees: $ Suppression) Check No. Check ount: Iq sh Amount: 6.Total Project Cost: $ 30 i 6137) 0 Paid in Full is di j ce Due: 5/3/22, 12:56 PM image_123927839.JPG _ SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CC— 0-775-11 Q7 /D/ 1_LZ. ),€,/-ev vAC3 Lec.H License Number Expirafion D to Name of CSL Holder List CSL Type(see below) IA L-1 13/ h i rls A 41 e r i — — Type Description No.and Street ,�y� Ot 2 U Unrestricted(Buildings up to 35,000 Cu.ft.) At R Restricted 180 Family Dwelling City/Town,State,ZIP M Masonry — —_ RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances '('3 3Zet 2735 �e,48eau cioI.CGY`► — I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 2-0 2—ra`! Z- kPre5-l-t c._ t�to I l cl e e S t{13ame or HIC Registrant Name HIC Registration Number rratr n Date HIC Company ZO wG(-cl S�- t fe5414Kbyt I) -rs`!L3 dg alto),(deli No.and Street 0 Email address (J CIA'. c o p-c e f 4 C I O L o t-i r3 3 4 Y 7 715 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 L9r 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 30,Sksc\ R._r-Ll to act on my behalf,in all matters relative to work authorized by this building permit application. )(r 4, ( L'v6 vi V-C'I.- (/ 1 r' ) --3 1 2_2_ Print Owner's Name(Electronic Signature) , 1 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. ... C1/45L,Y1 \-- to-C-14 _ ___ "--- --M----* g7/2-2-- Print Owner's or Authorized Agent' Ironic Signature) Date NOTES: i. 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 net 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) jY. 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 y Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" __ __. - +: https://mail.google.com/mail/u/0/#inbox?projector=1 1/2 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS— 0-77511 7 b/ 2Z J.e eVV‘� La(ec tj License Number Expira on D to Name of CSL Hold r List CSL Type(see below) (A 6Ir,d6kc rc No.and Street Type Description Di 1 " O� 2 L(e U Unrestricted(Buildings up to 35,000 cu.ft.) ' 1 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances y/3 3Zq 2 7 3 5 J.e 146 e% 4& a o 1 .C GM I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 2o2-`{`{ 2 2 l res 4-tc,e %t~1 1 J e c c L(13 HIC Registration Number E irat' n Date HIC Company Name or HIC Registrant Name 20 1/4....NCcc4 CA- pre54-tere 5y, I lets'YE ®_qr►,r,, ,(cssti No.and Street U Email address CV! CAA*. co eke NA wait. t{l3 311 Y 7715 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 le 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 to act on my behalf,in all matters relative to work authorized by this building permit application. 5/31 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. - ‘---6/7/ Print Owner's or Authorized Agent' e I tonic 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 �t01724-#rye 1 ' ' Massachusetts L. DEPARTMENT OF BUILDING INSPECTIONS ;; y 212 Main Street • Municipal Building ��_ ^ -- �. �'\ Northampton, MA 01060 �s vil 1.%' 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: (kcl r`\c‘ Q "t 1 M The debris will be transported by: Name of Hauler: Pt-C—c-c,c �\.2_ Sc-31`-k_A ‹..,•\ 5 Signature of Applicant: Date: S 33 2,Z The Commonwealth of.tfassachusetts Department of Industrial Accidents I Congress Street.Suite 100 ; 41 Boston. MA 02114-201 wwwntass.got/dia 114,fkern' Compensation Insurance.1*11ida%it: Builders/Contractors/Electricians Plumbers. It► BF. F11.ED%%I111 IiIF. 1'F.R III"flti(:Al1i1OKilI. .lfltlicant Information Please Print Lt•_il►Is Name IBus utc.+>tn_.tt ization kith triva= \c]�� ` Address: 2 0 � � s.-k- City'State7ip: ck't_co- e 6"1A 0(02. Phone L() 3 3 `f L( 7 �.5 S- ur you an employer?Check the appropriate laic: Type of project(required): I.004un a employ with employee!.I1ull and or part-time I.• 7. �0 Ness construction :iJ I am a sack proprietor or partnership and have ni...mployecs wurkin}t for cite in 8. Remodeling any capacity.[No workers'comp.insurance rosuar d.l 9. ❑ Ihnwfition ciI am a homeowner doing all work myself.IN(I wirrkcrs'curt; durance regwntl)' !0❑Building addition 4.0 I am a hunx,owner and will he hiring,contractors to conduct all work on my property. I will n ensure that all contractor either have worker•compensation insurance orrc a sole I IC]Electrical repairs or additions proprietors with no employees. 1 7 2.❑Plumbing repairs or additions I am a general contractor and I have hired the sub-euntractun hated on the anacired sheet. 3.❑Roof repairs These sub-Luntracion,have employees and have workers ary.n':Lwurance. 1 6.0 We are a corporation and its uffie•ers have exercised !Nt their right of exemption per ,L L. 14.®Oche'!__ 1 tL J Ii 41.and we have no employees.[Nu worker.'emnp.insurance required.' 'Any applicant that checks but r,I must also fill uut the section below showing thou workers'compensation polio. information. tlomeowMho who submit din ailidasrt indicating they are doing all work and then hire outside—contractors must subnnt a new afffidarit inducting such ICuntractors that check this Fins must attached an_xl.htrorial sheet shims ing€ha Harr:of the sub-cuntraetora and state w hither or nit these entrees.+has.• wnl,l...c 11 ris,i.t.-contractors ban.:ciu;I ..r pn,s idc tYilir Noiker, comp,policy number. 1 ant un employer that is pro►idint workers'compensation insurance for my employees. Below is the polity and job site information. trout. :,a Company Marne: 14 \ o Lk.n C PS ` tLie C S (� +( -/5 2 l Expirai ton Date: 2, 2 I� Pokey#or Self-ins.Lie. #: �j 0 (�_�j ,j 1��'S l '� Job Site Address: 5-O I C . oC �� (its State Lip: IVt r— Vor) (Y(1} Attach a copy of the porkers'dis+1pensation policy declaration page(~hosing the policy number and espiratidn date). Failure to secure coverage as required under MCiL c. 152. ?;25A is a criminal violation punishable by a fine up to SI.500.00 and-or one-year impnsonment.as cell as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the s►ulator. A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage ventication. I do hereby certify under the pains and penalties of perjury that the information provided above/. -z. is true and correct. Sti�21afU2'e. 1).11 7 /�Phone s: H 7—7 9 Official use only. Do not write in this area.to be completed by city or town official ( its or Tossn: Permit:License# Issuing Autharits (circle one): I. Board of Health 2. Building Department 3.CO Town Clerk 4. Ekctrical Inspector 5. Plumbing; Inspector t).Other ('intact Person: Phone*: AC�n DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/03/2022 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: Kathi Hutchinson ORMSBY INSURANCE AGENCY ac°.i o.Ext): (413)737-0300 (Ac No);__._ ADDRE khutchinson ormsb ins.com ADDRESS: @ Y P 0 BOX 718 INSURER(S)AFFORDING COVERAGE NAIC# WEST SPRINGFIELD MA 01090 INSURERA: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: LABEAU JASON INSURERC: DBA PRESTIGE BUILDERS 413 INSURERD: 20 WARD STREET INSURERE: CHICOPEE MA 01020 INSURERF: COVERAGES CERTIFICATE NUMBER: 770559 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. IN SR INSD LTR INSD TYPE OF INSURANCE ADDL SUER POLICY NUMBER (M/DD/YYYY) (MMIDD/YYYY) LIMITS WVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ,$ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEM_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY L I JE o- LOC PRODUCTS-COMP/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 X PER H ST TUTE ER AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? N/A N/A N/A 6S60UB5R75445522 02/24/2022 02/24/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS I 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.gov/Iwd/workers-compensation/investigations/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Jordan Carduner ACCORDANCE WITH THE POLICY PROVISIONS. 50 Ice Pond Drive AUTHORIZED REPRESENTATIVE Florence MA 01062-9501 Daniel M.Crowley,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 THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration ` ri '• ,,Type: Individual ; ---_Fegistration: 202442 JASON LABEAU ';' �* M Expiration: 06/29/2023 D/B/A PRESTIGE BUILDERS 413 w _ 20 WARD ST _ .-. CHICOPEE, MA 01020 • ti 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:Individual Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 202442 06/29/2023 Boston,MA 02118 %SON LABEAU iB/A PRESTIGE BUILDERS 413 SON T. LABEAU WARD ST io„4„„✓dG%i'zGft�c• -IICOPEE, MA 01020 Undersecretary Not valid without signature ConwnOnweOlth or Ailassacnu'setts A . ) Division of Professicnal Liiceisure Board of Building Regul4t19ns and Standards ttiu" _we Construttiot . ,rvisor 4 CS-077517 Expires: 07/01/2022 JEREMY R LABEAU 380 HINSDALE ROAD Of, DALTON MA 01226 4 vOlf .0k" Commissioner cla8(2i Y6ricitoL, i jt aly t P 7Y F Construction Supervisor Unrestricted - Buildings of any use group which contain less than 35,0U0 cubic feet (991 cubic meters) of enclosed space. • Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call (617) 727-3200 or visit www.mass.govldpl V ix wr 44 eN yam: f 2. * # 4F 11 ■ .. ��tk'�YIYgW