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11A-059 (4) BP-2022-0571 107 FRONT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 11 A-059-001 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-2022-0571 PERMISSIONIS HEREBY GRANTED TO: Project# NEW DECK Contractor: License: STEPHEN D ROSS GENERAL Est. Cost: 40000 CONTRACTOR 079160 Const.Class: Exp.Date:04/28/2023 MIRANDA SANCHEZ, JULIO A& PATTERSON Use Group: Owner: CAROL J Lot Size (sq.ft.) Zoning: URA Applicant: STEPHEN D ROSS GENERAL CONTRACTOR Applicant Address Phone: Insurance: 36 SERVICE CENTER RD (413)584-12240 WMZ-800-8007507 NORTHAMPTON, MA 01060 ISSUED ON:05/25/2022 TO PERFORM THE FOLLOWING WORK: NEW DECK, RESCREEN PORCH 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: �. • a' _5.2 . 1 • Fees Paid: $260.00 212 Main Street,Phone(413)5 87-1240,Fax:(413)587-1272 Office of the Building Commissioner File #BP-2022-0571 APPLICANT/CONTACT PERSON:STEPHEN D ROSS GENERAL CONTRACTOR 36 SERVICE CENTER RD NORTHAMPTON, MA 01060(413)584-1224 0 PROPERTY LOCATION 107 FRONT ST MAP:LOT 11A-059-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $260.00 Type of Construction: NEW DECK, RESCREEN PORCH New Construction 4 0,10 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 INytRMATION PRESENTED: J Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit 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 Mana gement Demolition Delay t IP' i 41' ,s7a5/ga so ature of Buildmg Official / 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. F , O The Commonwealth of Massachusetts MAY 1 9 2022 F R twi Board of Building Regulations and S nda ds Massachusetts State Building Code, 80 I IPAL,ITY FPT of SE Building Permit Application To Construct,Repair, ettavati f er- �i9�i cr isell Mar 2011 One- or Two-Family Dwelling MA ono This Section For Official Use Only Building Permit Number: ea- a a.• 67/ Date Applied: ,.2 -CT 0 'w.. ‘.5.../ A9, Building Official(Print Name) Signature l Da SECTION 1: SITE INFORMATION 1.1 Property Address: �� ds 1.2 isieszors Map& Parcel Ntudn T �/et _ / /`�f 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 Eler Private❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Rec t C..-or ore 1 nit-, i✓rr•'. I-e- et 7 /e1A,_ U/D(l Name(Print) City,State,ZIP /v7 xr..K 1 sq-e- - << A eusgtm A el.n4,41_ - No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2 (check all that apply) New Construction 0 Existing Building Cr.-Owner-Occupied 0 Repairs(s) Eri Alteration(s) 0 Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other ❑ Specify: Brief Description of Proposed Work2: /tkel l7c`. .'C Sc r-40.' K gG e i S nOn f SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ Gil t vv. efri 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ .- 0 " 0 Total Project Costa (Item 6)x multiplier x 3. Plumbing $ - C. - 2. Other Fees: $ 4.Mechanical (HVAC) $ • 6 - List: 5.Mechanical (Fire $ Suppression) Total All Fee(s:' Check No.4Check Amount: Q Li, Amount: 6. Total Project Cost: $ y/ ,d/, 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) es7 91 L ` hen 2 . !`0,55 License Number Expiration Date Name of CSL Holder 34 'ierv;'[.e een e �a List CSL Type(see below) v No.and Street Type Description A/O K ipibn f mmet. e/U�t 4 U Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town,State,ZIP Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 564NaA' S- pdro55 y a)•CO I Insulation Telephone Email address D Demolition 5.2 Registered- _ Home Improvement Contractor�� (HIC) /5 D�L fr, c5•3 a 41,2 V i i1ien O. loss ben e/ UJ,/�YG HIC Registration Number Expiration Date HIC Cofnpany Name or IC Registr ame cup s5erVi ct ,fir a.) i ecoi ss a� aliaV•Gorn1 No.and Street Emai address /o nlerh� i �lA al4bd ,i3•S114<•1aay 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 0 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 S'i'j h04-.' ,2df1 to act on my behalf,in all matters relative to work authorized by this building permit application. ecvS c//f/0 Print Owner's Nvie(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. Cf/f 2 05qOk— Printor 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" 1. 0 -J._ - 22:-- 4.52 128 11A00 _;___— 103 100 11 A-( 102.18 / / E \oa-T044 1 \ , age, I I \ \, /, 111FJ/////.% -�-- atil 56 I \ \ / / E.D 1 .0, , 161-kNCB iAOT I've, � i \ 340.4 11A-05 _9 _ -- - - - 344 11A-037 341 11 A-038 \-1/41, 185.56 • t . \ 417.26 2/5.04 150 .. "' ' CONSTRUCT ASSOCIA T E S , I N C. City of Northampton aYHAMp- -w . i Massachusetts S -s� � * `G ��: 44 4 DEPARTMENT OF BUILDING INSPECTIONS a# •" 212 Main Street • Municipal Building �%), it ' Cs Northampton, MA 01060 rS' ••... ,�� 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: V417i'-t-C ((- 1--- The debris will be transported by: Name of Hauler: C',►-< ,j-ir�-,c.‘""L i I AI Signature of Applicant: _`-� 2Z pp .�� Date: �� ir -` = The Commonwealth of:Massachusetts .. ..,i....._,N.., i =?i Department of Industrial Accidents l., . 1 Congress Street,Suite 100 ax'ilCi' a'�-s Boston, MA 02114-2017 www:mass.gov/dia 11 or kers' Compensation Insurance:"Affidavit:BuikdersiContractorsjEtectricianuPlumbers. i'()tIL FILED% R H I HI:PI:RAIIrUUM:AU I'HORil"1. Applicant Information Please Print Leeihh Name(Bus/hes- Organtzotion'Tndividualt: - (7 r4 c--I Address: 3 4 s-0v...e,e �."---.— keg City/State/Zip: ��frt: /h,Q/.00 Phone#: `7/3 f `I / 2 ZY Are yeti an cntpluyer?Cheek the appropriate hen: Type of project(required): l.❑I ant a engaluyer with employee (full and of part•timc)-' 7. 0 New cOnstrt tion t am a sole proprietor or partnership and have no employees working fur me in S.Q Remodeling any capacity_(Nu workers'comp.insurance nvluinzl.j 1.0 I ant a hucawrner dung all work myself.f wi wcntiva•corny.insurance required.)' 9. ❑ Demolition m 4.('1 i am a homeowner and will be hiring contractor, in property.to conduct all wink on my r I will 10❑ Building additiontu_t c wire that all contractors either!race worker;compensation insurance or arc sole I ID Electrical repairs or additions propritioi,with no employees. Ma Plumbing repairs or additions 50 I am a general contractor and I cruse hind the sub-contractors listed on the anuefw-d sheet These sub-contractors lawn employees and has c workers'comp.wurwnen. 13.0 Roof repairs 6.❑We arc a corporatunn and its officers have exercised then nest utexemption per Wit.c 14.6ihe'r L ------- 15 2.,1141.and w e'rase no employees.[No workers'comp.insurance resluin-d.) 'An1 unpin:tan that chocks hart n I cunt also till out the sedum below showing their workers'compensation policy information f I{unwuwtnni who submit thin atladasit[rube:Mop they are doing all work and then hire outside euntractur,must subrut It new affidavit indicating such. 1C'ontracton that check this box must attached an additional sheet show mg the n:utne of the sub•contractcrs and state whether iw not those entities have cmpluyeca If Ilse sub-contractors base employees.ihCio must proside their workers'comp.policy number. I um 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: City/State.'Zip: Attach a copy of the workers'compensation police declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MiUL c. 152. §25A is a criminal violation punishable by a line up to 51.500.00 and:'ur one-year imprisonment.as well as civil penalties in the fonn of a STOP WORK ORDER and a tine 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 fur insurance coverage verification. I do hereby certi , rid penalties of perjury that the Information provided ab re is tru and correct Si matu . Dote: ? -2— Phone 4: ii (3 < ey-(Z'i.tl Official use only. Do not write in this area,to be completed by city or town official City or Town: Perniit/License# issuing Authority(circle one): 1. Board of Health 2. Building Department 3.('it.►it-oan Clerk 4. Electrical inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: CONSTRAS01 CKELLY AcoRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 6I30/2021 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 NAME: AXiA Insurance Services PHONE IFAX 933 East Columbus Ave (A/C,No,Eat):(413)788-9000 (A/C,No):(413)886-0190 Springfield,MA 01105 ADDAIL RESS:info©axiagroup.net INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Arbella Mutual Insurance Company 17000 INSURED INSURER B:A.I.M. Mutual Insurance Co. Construct Associates Inc. INSURER C: 36 Service Center Road INSURER D: Northampton,MA 01060 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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DD/YYYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 8500071119 7/1/2021 7/1/2022 DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY L N& 0 LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: EPLI $ 25,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Fa accident) _ ANY AUTO 1020098280 02 7/1/2021 7/1/2022 BODILY INJURY(Per person) $ _ A TOSS ONLY X SCHEDULED 1,000,000BODILY INJURYD (Per accident) $ -_ 1,000,000 X AUTOS ONLY X AUTO ONLY ((II'er a dent)AMAGE A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESSLIAB CLAIMS-MADE 8500071119 7/1/2021 7/1/2022 AGGREGATE $ DED X RETENTION$ 10,000 $ 2,000,000 B WORKERS COMPENSATION PER STATUTE ERH AND EMPLOYERS'LIABILITY WMZ-800-8007507-2020A 7/1/2021 7/1/2022 500,000 AFFICER/PMRIMBER EXCLUDED?ECUTIVE Y/N N IA E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I 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 Proof Of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I , ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-079160 Expires: 04/28/2023 STEPHEN D ROSS 4 36 SERVICE CTR RD NORTHAMPTON MA 01060 'v0I S•I:%001 Commissioner _14R. YE 1". • Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual Registration: 150847 STEPHEN D. ROSS 36 SERVICE CENTER RD. Expiration: 05/03/2022 NORTHAMPTON, MA 01060 Update Address and Return Card. SCA 1 0 20M-05/17