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38B-110
BP- 022-1147 12 EAST ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-110-ooi 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-2022-1147 PERMISSION IS HEREBY GRANTEI► TO: Project# BATH RENO Contractor: License: Est.Cost: 15000 ANDREW MADERA 89404 Const.Class: Exp.Date:04/09/2024 REALL ELAINE M &FRANCES CELI Use Group: Owner: CORRIVEAU Lot Size (sq.ft.) Zoning: URB Applicant: ANDREW MADERA Applicant Address Phone: Insurance: 430 ROCKY HILL RD (413)210-4014 SOLE PROPRIETOR FLORENCE, MA 01062 ISSUED ON:09/14/2022 TO PERFORM THE FOLLO WING WORK: BATH RENO 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 VIOL• TION OF ANY OF ITS RULES AND REGULATIONS. Signature: I , • Fees Paid: $97.50 • 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner , .Ni-----R.,______,___ ____ ,� e Commonwealth of Massachusetts oar of Building Regulations and Standards FOR EP 1 ? 20 22 as chusetts State Building Code, 780 CMR MUNIUSEALITY opp Building Per 't A plication To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 or Two-Family NORTH ORT�qjD N Mq 0�T�DNS On This Section For Official Only Y Building Permit Number: )9"4„p.)... II `4 7 Date Applied: t/�,A/Z ,,2 9-!3 Za2Z Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Pro erty Address: 1.2 Assess r ap& Parcel Numbers j� �ok �`�_ I ro l.la Is this an accepted street?yes no Map Number Parcel Number P 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 Recoy4: �� A . -(Aim e�( f I`.l ',►`,'I � Mft— O l O� O Name(Print) City,State,ZIP / Jc Ek f4 i4 dzI°/ _ 77,,� W�I�1� . it Address L/ Li44-1 SECTION 3:DESCRIPTION OF PROPOSED WORK' (check all that apply) New Construction ElExisting Building❑ I Owner-Occupied ClRepairs(s) Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. Number of Units Other CI Specify Brief De cri tion of Proposed Work': I y� re w.ov/«( — ryllk(.L ,rw-1r, /;t A *- SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 13 a) 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ 0 ❑Total Project Costa (Item 6)x multiplier x 3.Plumbing $ 2L07) 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ q7,1/450 / Check No.ow Check Amount: l 6.Total Project Cost: $ S 602) 0 Paid in Full 0 Outstanding Balance Due: City of Northampton ti{TTvt�d _ Massachusetts ' t DEPARTMENT OF BUILDING INSPECTIONS % 212 Main Street • Municipal Building Northampton, MA 01060tti�r PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS, DOORS, ROOFS,RENOVATIONS, ROOF MOUNTED SOLAR, ETC. 1. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work (Digital and hard copy). 3. Construction Debris Affidavit filled out and signed by applicant. 4. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance. 6. Energy Conservation Compliance Certificate (new / replacement windows). 7. Home owner's License Exemption Form (if applicable). 8. Note any Special Permit requirements (if applicable). 9. Energy Code —all new construction (Gut/Rehab) requires a HERS Rater Affidavit 10. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. PPPF SECTION 5: CONSTRUCTION SERVICES 5.1 Co truction Supervisor License(CSL) G -7 rD y V q� r av Madero License Number Expiration/ Date Name of CSL Holden '�`(�_G-�'`� (41( Q /^ List CSL Type(see below)No.and l Type Description c-2 ,„ �1 La 6a Unrestricted(Buildings up to 35,110 cu.ft.) City/Town,r lONCCA,tState,ZIP Nam' R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding �Q�r� I SF Solid Fuel Burning Appliances W / 7 .&4--, I Insulation Telephone / Email ad D Demolition 5.2 Re istered Home I provement Contractor(HIC) 173 /o 7 3/` J rli"/ re., Registration Number xp cation ate HIC ompany Nam or C ReAt t NatiA I ' hi tole No.and t et E ilidress City/ own,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 No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PEgqRMIT I,as Owner of the subject property,hereby authorize "/1/ /7 A E.IN, MADE RA to act on my behalf,in all matters relative to work authorized by this building permit application. EL ik) M. REFILL R— 13- 20 ' 2 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 informati• contained in this application is true and accurate to the best of my knowledge and understanding. eik IN . �A- ea;we- t 4. -(- (3 -20 . Print 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 ontractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitra'on program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can •- found at www.mass.uov!oca Information on the Construction Supervisor License can be found at www.mass.gov/ ps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or torch) 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 =0=. r7-4..„„,v.., ... ...,.. (.71.......... Department of Industrial Accidents neic5 T,- 1 .7 1 Congress Street,Suite 100 •,- ,=:=,, zu.,— Boston,MA 02114-2017 wwW.inass.gorhlia 'Workers' (-Ow ractl'ha lion Itth.tira lace Ii.ffidavit:Buiklers/ContractorstElectriciansTlumbers. 10 liE. Ell.E.I)N11111 I HE PERM!IIING ALTHORI IA. Applicant Information Please Print Legibis Name 1 amines&Organization/Individual'.. ire., jiltJr., Address: y)0, g-,),-7 Ai ( , City/StateiZip:— 44 C(.. )C M — ma P" hone#: c / 0 - VO iy Are y MI lel employer,Cheek the apprupriale twit: Type of project(required): 1.0 I ant a employ as with employees(full:211131part-tinte.1_' 7. 0 New construction 2 p 4 r 1 am a hole prupnettsr or part:m-41m and ha%e no employees*mkt/1g for me in 8)23 Remodeling any capacity [Nu*utters'comp.insurance required.] 9, Ei Demolition 3E3 I am a humtahWIFCT doing all,surk myself.[No vomiters'CU.Mp.ithur.tacc required.] la 0 Building addition 4.0 I ant a lainsiaminer and 00111 be luring contractors to conduct all work on my property. I will ' CTI.11.11Y that all contractors either line%others'eurnpensation inauninix or art hole 1 la Electrical repairs or additions propriekhrs with no employed. ' 11E3 Plumbing repairs or additions 50 I am a general t•oraractor and 1 have hired the mb-cantracturs listed ma the an:tithed sheet. 1.3.0 Root repairs These sub-euntractors lame employees and have 1o:tatters'comp.insurance.: 14,[-j Other 60 laVe are a corporation and its officers have exercised then right of exemption per MU.C. 1 §1{4}..and we hat,e no ernployees.[No workers'comp insurance required.] 'Any applicant that,..he.:Ith bet.1 must also till cut time Net:lion Niuu 3i1L.,I:I:.1:C.1 0 013,2:1 .:urnpcn,diun policy rnformaliOn. +Hiotnaarners,Who m.:ernil flu%atructaint knohearrag they are doing all work and then luxe,M....i,o.'annactOra'nod auberut a new affidm tt”uticatiri such. :Contractors that eheLk Inia box mo attached an additional sheet ihult.mg the name of the sub-contrachicy anal gale*blether or riot Elite entities hate employees'. 1.17he. huh-contractors have empklyeCa.111C'y moat provide their workers'onrip.poke?,moniker I am on employer that is providing worAer.+'compensation insurance for my employees. Below is the policy and job site infOrmation. Insurance Company Name: — Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: ' CityState'Zip: Attach a cop, of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secuic coverage as required under MGL c. 152. §25A is a criminal violation punishable by a fine up to SI.500.00 andior 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 cerrif under[Ire pain!, and penalties of perjury that the information provided abort is twee and correct *maul\:: ( -, ------N._ I D...i... ?— Phone Phone#: Offftial 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 Contact Person: Phone#: .. , _.„...„ City of Northampton i ; Massachusetts w� - �� DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building :',. Northampton, MA 01060 `'px �`' '' 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: V'"Alf/ O ff The debris will be transported by: Name of Hauler: A ,...,1 AAtleirc\litif Signature of Applicant: ( Date: ( '-1 —�o2 City of Northampton Massachusetts1010001F-41 1• ' DEPARTMENT OF BUILDING INSPECTIONS 4r, t :g 212 Main Street • Municipal Building i3 sties Northampton, MA 01060 J �~� HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert full legal name), born_ (insert month, day, year), hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners' exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this day of , 20_. ----- -- (Signature) At7 OIREt CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDlYYYY) fir= 09/13/22 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATIE 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 t,ON(ACr NAME' Michael R.Banas Risk Placement Services Inc PHONE FA) A/C,No, (NC No): 413-527-0849 4 Technology Drive, Suite 105 -Ma Ext): 413-527-27Q0 Westborough, MA 01581 ADDRESS: mb@banasinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Atlantic Casualty Insurance Company INSURED - INSURER B Andrew Bilodeau Madera INSURER C D/BIA Handy Andy INSURER D 430 Rocky Hill Road Florence,MA 01062 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 IADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) IMMIDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RETE CLAIMS-MADE OCCUR PREMISES(Ea occur ence) $ 100,000 MED EXP(Any one person) $ 5,000 A L261003002-3 03/16/22 03/16/23 PERSONAL&ADV INJURY $ 1,000,000 GENT-AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT LOC PRODUCTS.COMP/OP AGG $ 1,000,000 j OTHER: • $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per per4on) $ OWNED SCHEDULED BODILY INJURY(Per acc ent) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE I $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN I STATUTE OERH ANY PROPRIETOR/PARTNERJEXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ _ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY L MIT $ • DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached if more space is required) Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 212 Main Street AUTHORIZED REPRESENTATIVE Northampton,MA 01060 � „e :»> 1t ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD