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23A-300 BP-2022-0671 160 NONOTUCK ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23A-300-001 CITY OF NORTHAMPTON Permit: Addition PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-0671 PERMISSIONIS HEREBY GRANTED TO: Project# ADDOITION Contractor: License: STEPHEN D ROSS GENERAL Est. Cost: 142500 CONTRACTOR 079160 Const.Class: Exp. Date:04/28/2023 Use Group: Owner: C WEIS RICHARD Lot Size (sq.ft.) Zoning: URB Applicant: STEPHEN D ROSS GENERAL CONTRACTOR Applicant Address Phone: Insurance: 36 SERVICE CENTER RD (413)584-1224 0 WMZ-800-8007507 NORTHAMPTON, MA 01060 ISSUED ON:06/13/2022 TO PERFORM THE FOLLOWING WORK: � `��m ad L�� ' 4-id 1k,•-1-L itu_ 41 <r p rt O 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: ► Q I Fees Paid: $930.0(1 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner File #BP-2022-0671 APPLICANT/CONTACT PERSON:STEPHEN D ROSS GENERAL CONTRACTOR 36 SERVICE CENTER RD NORTHAMPTON, MA 01060(413)584-1224 O PROPERTY LOCATION 160 NONOTUCK ST MAP:LOT 23A-300-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $930.00 6___ Type of Construction: New Construction Non Structural Renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans/Plot Plan THEFOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN,FF RMATION PRESENTED: 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 Perm it from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay Ii / 1, I 6 )J �.Sill ature of Building Official [)ate 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. r ECG. IVE! ?Liao The Commonwealth of Massachusetts JUN - 8 2C22 I Board of Building Regulations and Standards FOR1 Massachusetts State Building Code, 780 �Mi ICIPt#LITY FPT(�F PI 1-)I :r,JNSPF .TIONSUS Building Permit Application To Construct, Repair, Renbvate Or C 1i l~l''h f.'A oiSeyised M r 2011 One- or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 60- ). -,--Ci-11 Date Applied: o 'I' i 1 5):111.16 1Buildin Official ' Si ature -- g (PrintName) SECTION 1: SITE INFORMATION 1.1 Proper Addr ss: 1.2 Assessors Map& Parcel Nu beds /GO Po n.4ie k . ,�4/- �.^- a34 aV 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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Own r'of R cord: , /Zi C Ar`d &0" -1,5 _ f/rc--te e....... /hi¢, 0/06 2 Name(Print) City,State,ZIP /G 6 /4 it 4,-1-'K c k 57: /Y I3 rin-/4 f2- re Ar.c t e "„.(. c e p No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction Er-Existing Building Owner-Occupied Ccr Repairs(s) ❑ Alteration(s) Brl Addition l.' Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: ;3-.4 v—oCn ,fcui 1c`''..A_ 1 4 T 11G L-.-_ reh0 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ �Z d,,,. 'r 1. Building Permit Fee: $ Indicate how fee is determined: ". 0 Standard City/Town Application Fee 2. Electrical $ 4/J Ste- .t. ❑Total Project Cost3 (Item 6)x multiplier x 3. Plumbing $ /O` eat// 2. Other Fees: $ 4. Mechanical (HVAC) $ god°. v List: 5. Mechanical (Fire - "d Suppression) �0 Total All Fees,:y$ , (� ov Check No. 4 U 1 Check Amount`.') Cash Amount: 6.Total Project Cost: $ JI/21. • ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction _�Supervisoror License(CSL) o 9/G ir� ,a$ G.1442 << he_n 0' `0,55 License Number Expiration Date Name of CSL Holder 34 derv,�.e.Cen 7fo� List CSL Type(see below) U No.and Street Type Description AlOg_rs1..s p/z„„ ma_ 6�O le 6 U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP ` R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering ,,55'�// WS Window and Siding Ilig,`J, -'iaz/ S*pdra55 2l e44:40•COM SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) /5 0?L f07 o,� 9 V hen 0, 105.5 6en'CD%f ira o HIC Registration Number Expiration Date HIC C _pQ y Name ored (,j-IIC Ristr ame, `34`Jerthe/7&' a iLG/ Jeepein 53 )g4k,e•GDP No.and Street Emaif address A1a10-hetfly9 i aibb�.I'/A •i3•575-/aa 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 2/ No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTORL APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize S/ /..•-�. P G?6st to act on my behalf,in all matters relative to work authorized?by this building permit application. /eider-El Z")...e-iS' lr ? 2 "aPrint 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. ,-7, w D. /20 fr- /7/ 2 Print Ovditer s or Authorized Agent's Name(Electronic Signature) ate 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 {�'fir' :•v r SAS,...,......S,C Massachusetts 4 p DEPARTMENT OF BUILDING INSPECTIONS I 212 Main Street • Municipal Building Y.:. Northampton, MA 01060 rSb"•-•wox 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: .� /�<- (&C LjG C` l y The debris will be transported by: Name of Hauler: Cox- "tA- e-- 7 A Signature of A licant: �� Jv Date: �( 2 g pp The Commonwealth of Massachusetts Ir. -' -t Department of Industrial Accidents " :_:• .....rks.a.s, �=�- P. I Congress Street,Suite 100 st• -r ' Boston, MA 02114-2017 . www.mass.gov/d1a )huskers'Compensation Insurance Affidavit: BuilderslContractorafEkctriciansfPlumbcrs. to HE FILED N t III THE PE:R%ll7'l ING AUTHORITY. Applicant Information Please Print ixeibly Name(Busitms Or tantrationlndtvidual): sli&+-• ._ P. L -e1y Address: 3 4 s-e ti,Ce-4- ea- -71•-•c le-d CityfState'Zip: 40(d4 ) Phone#: y/3- f'( -ieZ `( Are you an employer?Cheek the appropriate ben: Type of project(required): l.Q 1 an„...i21.-ertiployer with employees I bill and or part-time I• 7. O New construction :Tarim a auk veto or etshr and tease no employees wurkin g fur me in proprietor 1� PMt: $. af6:..modclirtg any capacity.[No worker.'cutup.insurance remained] 9. 0 Demolition 31:j I am a huMdnwnet doing all wink myself.[No workias'cutup. rrritttartee.regtrrred.)' 4.0 I am a hrr onnwner and will be hiring contracture to conduct all work on my property. I will I D 'l n1ding addition =sure that all contractors either hate workers'compensation insurance or are sole l I.a Electrical repairs or additions pnuprt<tors with no employees 12.0 Plumbing repairs or additions 50 tam a getrcral contractor and I tune hired the sub-contractors Listed on the attached sheet 130 Roof repairs These sub-contractors have employees and Isas.e workers'scrap.uuumnce.• ti.0 We are a curpo radium and its officers have sitar t>4cd thou nght of exemptsun per Welt.c. (4. Other-_-_ ` - - 152.§It4i.and we lust no employees.(No workers'comp.insurance required) 'Any applicant that sheds boa a 1 mast also till out the section below show ins their workers'compemauon policy inl nrwtuat. t Homeuwters who submit this att'uda'it indicating they are doing all work and then hire outside contractors mud subnut a new affidavit radie-atrng such. ICunlractun that check this boa most attached un additional sheet show ing the name of the sub-mate actors and state whether or not those entities have employees. If the sub-contractors Isaac employees.they must provide their workers'sump.pt.ulic) number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Nance: — Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City+StateZip: _. 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 tine up to 51.500.00 and/or one-year imprisonment,as well as civil penalties in the form 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 for insurance coverage verification. I do hereb'cerli r under the pains and penalties of perjury that the information prodded abate is t ue and correct: Signature, Date: a/72 -2-- Phone#: i/3 5-.Y / ?2 Lf 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): I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Phone#: Oook ' 4`J e- d AJ'ZCITY OF NORTHAMPTON Pia 6-viz: 3 `7 Q5� SETBACK PLAN )203. 16 MAP: LOT: I LOT SIZE: REAR LOT DIMENSION: Ip I REAR YARD 6 , SIDE YARD b O SIDE YARD C1 C9 c 4 FRONT SETBACK a FRONTAGE 1 �o `� • 0 L( ��.....40 CONSTRAS01 CKELLY 'A��R� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 6/30/2021 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 FAX 933 East Columbus Ave (A/C,No,Eat):(413)788-9000 (A/C,Na):(413)886-0190 Springfield,MA 01105 ADDRESS:info@axiagroup.net INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arbella Mutual Insurance Company 17000 INSURED INSURERB:A.I.M. Mutual Insurance Co. Stephen Ross 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 (MM/DD/YYYYI IMM/DDIYYYYI 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 8,ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JE T LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: EPLI $ 25,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ _ ANY AUTO OWNED _ 1020098280 02 7/1/2021 7/1/2022 _BODILY INJURY(Per person) $ AUTOS ONLY X AUTOSSyUVLNED BODILY INJURY(Per accident) $ 1,000,000 X AUTOS ONLY X AUUTOS ONLY PROPERTY accident)'DAMAGE $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE 462009856502 7/1/2021 7/1/2022 AGGREGATE $ DED X RETENTION$ 10,000 $ 2,000,000 B WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N WMZ-800-8006546-2020A 7/1/2021 7/1/2022 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (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 17 Division of Professional Licensure Board of Building Regulations and Standards . - Construction Supervisor CS-079160 '7'. '^` E,xplres: 04/28/2023 w I ? STEPHEN D ROSS :r 36 SERVICE CTR RD NORTHAMPTON MA 01060 <! Commissioner CJ►,t i t '. ircnit Eta— THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washing rr t - Suite 710 Bosto 118 NialagtHome Im•ro ` ; -- -•istration ,; .__ � 1 It �I a ...------.- S Type: Individual —lilt_ •yS ation: 150847 livid STEPHEN D. ROSS i� _- .. E t; -tion: 05/03/2024 36 SERVICE CENTER RD. ', � NORTHAMPTON, MA 01060 �"I* 7f dEci Update Address and Return Card. T F THE COMMONWEALTH OF MASSACHUSETTS t Office of Consumer Affa &,Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: ;PIPE,iividual::, Office of Consumer Affairs and Business Regulation Re istY` ic— EXgti tion 1000 Washington Street -Suite 710 0z,4 Boston,MA 02118 >TEPHEN D. ROSS { ;TEPHEN D. ROSS r1 " x.` l6 SERVICE CENTER "- 4:' ;,,;;/ ,,, ,L. !z//l ' JORTHAMPTON, MA 010 �, Undersecretary Not valid without signature