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38D-018 (13)
BP-2023-0006 25 HAMPDEN ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38D-018-001 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-2023-0006 PERMISSION IS HEREBY GRANTED TO: Project# 2022 SOLAR Contractor: License: HALLMARK HOMES ASSOCIATES Est. Cost: 27000 INC CS-064063 Const.Class: Exp.Date: 03/15/2024 Use Group: Owner: B ROUNDS CALEB M& MARGARET Lot Size (sq.ft.) Zoning: URB Applicant: HALLMARK HOMES ASSOCIATES INC Applicant Address Phone: Insurance: 77 ALEXANDER #14 781-838-0789 6KUB-5B29684-3-21 BILLERICA,MA 01821 ISSUED ON: 01/05/2023 TO PERFORM THE FOLLOWING WORK: STRIP &SHINGLE ROOF, 6"ICE&WATER, SYNTHETIC UNDERLAY 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: • ).2 Cg1/41/ , ' I Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner _ The Commonwealth of Massachusetts , I Board of Building Regulations and Standards FOR Massachusetts State Building Code, 780 CMR MUNICIPALITY USE t Bti 'din Permit Application To Construct,Repair, Renovate Or Demolish a Revised i� g pP P Aur2t)11 One-or Two-Family Dwelling This Section For Official Use Only Building Peirn Number R 2023•-OOb Date Applied: _ /1E1t,,,) 455 / /-Li-ZDZ3 Building Offlcial(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.I Property Address: 1.2 Assessors Map&Parcel Numbers 25 Hampden St 32b. -a( -oo i 1 1.1 a Is this an accepted street?yes X no Map Number Parcel Number 13 Zoning Information: 1.4 Property Dimensions: I UtZl - __ .. 263 Zoning District Proposed Use Lot Area(sq It) 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: l.8 Sewage Disposal System: Zone: Outside Flood Zone? Public❑ Private 0 Check if yes❑ Municipal 0 On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2 Ow ter' f Record: Northampton, Ma .Caleb Founcs Name(Print) City,State,ZIP Hampden St 413-559-1. 8 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Roofing Brief Description of Proposed Work': i -i s r, synthetic uncle-flay, 30—Year e can SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item (Labor and Materials) Official Use Only 1. Building $ 3500 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire ---- Suppression) $ Total All Fees:$____ 6.Total Project Cost: $ Check No./ /L. _Check Amount4gO,"= Cash Amount: ❑Paid in Full 0 Outstanding Balance Due: _ 0( V )e4i.sAD r .veoc y. W c' SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-064063J1 5/24 David Tomolillo License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 77 Alexander Rd. #14 No.and Street Type Description U Unrestricted(Buildings up to 35.000 cu.ft) Bill-i t . 0 o R Restricted l&2 Family Dwelling C'i , tale.Z ' I M Masonry ♦ / RC Roofing Covering w �� - WS Window and Siding SF Solid Fuel Burning Appliances 781 67 3 20 s solar@ hh..team I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 158936 OS I' j Z 44 Hallmark Homes Associates, Inc. HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 177 Alexnder Rd #14 Solar©HailmarkHotnesRemodelimg.corm erica, Ma 01821 (781) 838-0789 8rnail'address City/Town,State, ZIP Telephone t SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.I52.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to rovide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes MI No C7 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 Hallmark Homes Associates, Inc. to act on my behalf in all matters relative to work authorized by this building permit application. Caleb Rounds 1/3/23 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 applicati ' e an accurat1to. he best of my knowledge and understanding. David Tomolillo e '41,,l ' 1/3/23 Print Owner's or Authorized gent's ame(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,mas,,govloca Information on the Construction Supervisor License can be found at walv.mass.aovl 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 j 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" 1/4/23,11:19AM signed by pen jpg . ":=VAI ti'.>r=c 7 77 ram;>: _ _ -ys 3 . uwat 4 R;Egisttk241 flame j t tr it s n cht E chit-actin !ll lz Ma c1162 1 ........ . ,Fi1. . t Ectt t�, r O.<1,O R CtlNtl'1»NS 1 UON ISSF,RAN!I ‘ _'it, °, i '- a ., +a.''r '1er1t19tafts4a,itmust hecompleted and iaiticanithd with,it,w tired:. t<la recall 3r the_efiW of the;,.: !n:'t of`}t'building,{'::t 11:; 1,ftfttc;.c 3 t;AtiaJ + Yea. . . .s,+a' \ ,. ''k,("EION 7attOWSER At='TIIORIZATION'1'o RE t'4'i%IPI I I li WREN ()WIS "S AGE.*<Mt(ONTkACT'Qlt APPLIES FOR IU IJ,t)1NG Pt RMl t t r:ttrott the s litx4ptictpent,„,t.-heathy audh7rize t II#mar7me , 4°t .>a 3z z* tt '.dat:vcto work atnborixed t.thic .tsih.tngpermi .,„;_, . le,14P > i o'v ) 2 r SECt'i°Z `7x OW'Nk#t'OR A UTIIORIZED,'lt,t:.' k`DECI,AR IIts,' I �ka L;,:,arr9t c _ %t pain, 9itka r -r t1 c -,:rszstairtozi. -tiPPfr res at €' 1 e ih_-.3 40.4 ?' h+4s`lti A i 0.0 ,6 t}.3.7i o i to!3.'.3idl+ t i ;ti,s 1,}'G,tst A. ttSS F-:r 2 4 c,tatt;gtmi.t a„tx. *r%' ,i s tt.=€. 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AVOW* 1/2 hops://mail.google.com/mail/u/0/#inbox/QgrcJHsTgshMptbgllBBbMLZGXrzPtsrzZQ?projector-1&messagePartld4.13 - 7VIASSACHLYSETTS DRIVER'S - - LICENSE ' VO is., ,-. ---,,tt••AT' ,- - • DAVE TOIVIOLILLO . 1o/181201i, ' 41011111i OWNER OS/IS/1961 NE ,..,,. , ,;i•-,i.:••[1,••.: -..1....,:-:;,..1c;.1,2 ,m:.(•::‘,.11 •• , --,,q-,4): NO f. NO ' ,TQMOULLO 78 I-S3S-0739 , • r.DAVD F 77 ALEXANDER RD DILLEtticA,MA 01621-5045 77 A lei:ander Road.Sulu: i 4 • Billerica,MA 0 I 8.:.1 ,,,,,,_ dm. ,Il 1441- osEy NI '',4%.1.SAO""I'' 0361 ,DDI17416=17R+:4072itire014 ... . , - . , •'' ' „, •, ' ' ,-,.- . ... • • -',- .... Commonwealth of Massachusetts , ills \ __ - Division of Occupational Licensure --- - —. - .. Board of Building Regulations and Standatds .J.:'.7,.., !,,•,.`„,,,,,,,,,,,,,,,,,,,,,/,'il,./..s.:/,,,:)..;,-,..,..5.,.;/v.e.; on Constelit*oillrApe,/rvisor °flit.of Consumer Aft aiis Ft.,MI siriess Regulati HOME IMPROVEMENT CONTRACTOR TYPE:Corporation CS-064063 4nires:0 15/2024 .4.- nesistration Expiration DAVID 158936 03/17/2024 77 ALEXANDER RO„;::$'::Cle'•- ''::. c-,7 HALLMARK HOMES ASSOCIATES INC. 7818380789 t, BILLERICA Nutr.-418 • , ,/ --4•4autte'.0 DAVID TOMOULLO li 77 ALEXANDER ROAD SUITE#14 f,,..,;•,,,,A,(/",,,,./`,",./,,,,,,ii. . BILLERICA,MA 01821 Undersecretary Commissioner ,,Litel fi. ,..r.•)Q7c,,,,i A.,.fs,:f..';-, --isTiAz7,..tr,--"" .,,,,.... t ,_ -,,-- • , • iht,t;c•Z'Ir,/1•11(BO'Nif.."dge•a It1;31 tbe recipit pas sti,:,c'asal:fli,... 10-0010 0=4/at:tonal Safety and Heaith - Construction Safety and Health . ,...,it :71 L. DAVID TOMOT I' LO d I AaMANDO GAITAN 2/25/17 . ,--,f;.;,..v.„,..,!:.. . e., ,,.„'''..-, ,','4`,.,.."---.':;•-tv,,..,...*". :, '''':'',.'''-:,'.-ig,‘..1 , ., ... , , .., fTramer lame-ow))ol 1N/Pe) 'cou/se and late) , ' . 1 ,-- -- '71 lr -8"- Slate ofRhotie Istrntd and Providence Pionirdions• ,-.7... Contrfictors'Registrtaion and Licensing Bottrd i-maliMark liato es Associates Inc. David Tomotilio Have Tcsairolillo has met the requirements of the law and has been aranted this ,g President certificate of registration p.s a Resitintial/Comm.CONTRACTOR fl • , ki daveasolarslatesolutionS.corn Registiltionq.40196 I Effective:1 0/15113 Eim 10/01 all 1,1 Office: 781..870.7570 ! • *---„,,, P Cell; 781.539.3208 ..,... .. ,p,L 1,,,., :', •••:--*....... :..,,, il ItEillott7RANT' SIGNAT13.R11-- - C.11AIRPERS011 It t'AY)7't4,11./i.)ti.vii.Y.csK;NEJV - 4) 77 Alexander Road, Suite 14 . Billerica, MA 01821 AC CERTIFICATE OF LIABILITY INSURANCE GATE(MMIDoIYYYY) 08/04/2022 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 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 Patricia Nickerson NAME: PeterA Rossetti Insurance Agency,Inc. PHONE,Exq: (781)233-1855 aAc,No): (781)231-4222 436 Lincoln Avenue E-MAIL pnickerson@rossettiinsurance.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC N Saugus MA 01906 INSURER A: Western World INSURED INSURER B: The Commerce Ins.Co. 34754 Hallmark Homes Associates Inc. INSURER C: ARWC-Travelers 77 Alexander Road Unit 14 INSURER D: INSURER E: Billerica MA 01821 INSURER F: COVERAGES CERTIFICATE NUMBER: CL228400552 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 ADOLSUBN POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INS° WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENTED $ 1,000,000 CLAIMS-MADE ' OCCUR PREMISES(Ea occurrence) 5 50,000 MED EXP(Any one person) $ 1,000 A NPP1578297 06/11/2022 06/11/2023 PERSONAL&ADV INJURY 5 1.000.000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 PRO- 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: CARPENTRY s AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) 5 g OWNED SCHEDULED BBXN23 04/23/2022 04/23/2023 BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY (Per accident) Uninsured motorist BI s 250,000 UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LIAR -^ CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION .II PER OTH- ANO EMPLOYERS'LIABILITY /�STATUTE ER Y/N 1,000,000 C ANY PROPRIETORJPARTNER/EXECUTIVE N NIA 6KUB-5829684-3-21 03/17/2022 03/17/2023 E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 It yes,describe under 10 ,00000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S , DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) GENERAL CARPENTRY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN INSPECTIONAL SERVICES ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE — ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD _ The Commonwealth of Massachusetts l!—` �1 Department of Industrial Accidents =;`IBA= a 1 Congress Street,Suite 100 �i =';if►=I" 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 Letibly Name(Business/Organization/Individual):Hallmark Homes Associates, Inc. Address: 77 Alexander Rd. Suite 14 City/State/Zip: Billerica, MA 01821 Phone#: (781) 838-0789 Are you an employer?Check the appropriate box: Type of project(required): I.®I am a employer with 2 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 10❑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.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.®Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 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#1 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. 1Contractors 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: The Travelers Policy#or Self-ins.Lie.#: 6KU B-5B29684-3-21 Expiration Date: 3/17/2023 Job Site Address: 25 Hampden St City/State/Zip: Northampton MA. 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 verificati I, to, I do hereby ce i ,,,r the p' - and p of perjury that the information provided above is true and correct. Signature: ` Pate: 1/3/23 Phone#:(781) 838-0789 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton .. Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building -,' , Northampton, MA 01060 :'It , 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: Valley Recycling Location of Facility: The debris will be transported by: Amherst Trucking Name of Hauler: Signature of Applicant: Date: 1/4/ 23