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43-097 (3) BP-2023-0072 31 WHITTIER ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 43-097-001 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-2023-0072 PERMISSION IS HEREBY GRANTED TO: Project# ADD SHOWER 2023 Contractor: License: STEPHEN D ROSS GENERAL Est. Cost: 12900 CONTRACTOR 07916007,160 Const.Class: Exp.Date: 04/28/202304/28/2023 Use Group: Owner: LAMSON IRENE M TRUSTEE Lot Size (sq.ft.) Zoning: WSP Applicant: STEPHEN D ROSS GENERAL CONT CTOR Applicant Address Phone: Insurance: 36 SERVICE CENTER RD (413)584-1224 WMZ-800-8006546-20►IA NORTHAMPTON, MA 01060 ISSUED ON: 01/23/2023 TO PERFORM THE FOLLOWING WORK: ADD SHOWER TO BATHROOM 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 VI I LATION OF ANY OF ITS RULES AND REGULATIONS. Signature: a , S. ' / I Fees Paid: $85.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner Ii ; ` ,. ir------_,.....,/,/ ,, , .-: _ The Commonwealth of Massachusetts JAN 0 i *0 N Board of Building Regulations and Standards ?O ' FOR MUNICIPALITY • Massachusetts State Building Code, 780 CMR- v_ USE ' Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demohs2i`a`-r�,,,,, One- or Two-Family Dwelling This Section For Official Use Only Building P it Number: 16 of 3 CJ'J Date Applied: tv apJ a55 I/ _VZ..- L 20 ZeZ3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Proper A dre 1.2 Assessors Map& Parcel Numprsir7 1.1 a Is this an accepted street?yes ✓ no Map Numr 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) At /9. 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❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 1 2.1 Owner'of Record :t - -.A.—t Al Co s,- fl.r-4,",c /Yl it, 0 r C t ?- Name(Print) City,State,ZIP No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK' (check all that apply) New Construction 0 Existing Building Er- Owner-Occupied Er. Repairs(s) 0 Alteration(s) Ell Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units l Other 0 Specify: Brief Description of Proposed Work': ,4 A 5ko.t,J..� -4--a ��`_S i 5 ( 4,fiktco s/z` SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ gi 4-0 6, cr''' 1. Building Permit Fee: $ Indicate how fee is determined: • 2.Electrical $ ZBV, v., 0 Standard City/Town Application Fee �t ❑Total Project Cost (Item 6)x multiplier x 3. Plumbing $ 3 12 00 • e/.4") 2. Other Fees: $ 4. Mechanical (HVAC) $ — List: 5. Mechanical (Fire $ _ e Suppression) Total All Fees: Sr Check No. 41/ Check Amount: Cash Amount: 6. Total Project Cost: $ / 2. Zed, e 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) es 79/G d q .�$ ,4442 a�o en (D• R0,55 LicenseNumber Expiration Date Name of CSL Holder (.1 No. 4 �9ervi' ('mile l List CSL Type(see below) No.and Street Type Description �{ o t` rn m� 6�6 G 6 U Unrestricted(Buildings up to 35,000 cu.ft.) 'w / R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding ' j i�SO4- yahoo.ca SF Solid Fuel Burning Appliances 'f i a.ZL, S��Jeira55 2 yw! I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) ,5 0 NI • ,c/ V4- hen 0, D5 4eneredlo/ irador HIC Registration Number Expiration Date HIC Coinpany me o Regi� am /J6�ded • .rs t � sLtlodrds Dyti e•C.on.� , No.and Street Emai address ,�laer �y, ny4M ii/9 .0) ke 4/3•SY9 ogy City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE Al4FTUAVIT(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 Issuan of the building permit. Signed Affidavit Attached? Yes No .❑ 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�7e� - Cr �"— to act on my behalf,in all matters relative to work authoriz by this building permit application. s�__r--- L4,...s.oA III'/ 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. V",t,)0 4-----s,\ P te--• r4' VO b/Z-7--- ___ Print Owners 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 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" \ � i BASEBOARD HEAT ge KOHLER o O WALL-HUNG SINK: N K-80179-L td t 11114111111111>! irk d I � w D EXISTING DOOR ITO REMAIN 2a ALTERNATE FIRST FLOOR BATHROOM PLAN 1/2"= 1'-0' City of Northampton Y 3 Massachusetts ��?r{ �!<< it A c" .'ii DEPARTMENT OF BUILDING INSPECTIONS �: it ) .w r 212 Main Street • Municipal Building yd'. r'a1 !" +, Northampton, MA 01060 6ss ••• O: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: 10.v("t-7e._(_.tei-if--v c The debris will be transported by: Name of Hauler: �" �`'`-c- A:1___ Signature of Applicant: Date: / O 2 CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD () SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-079160 Expires: 04/28/2023 STEPHEN D ROSS 36 SERVICE CTR RD NORTHAMPTON MA 01060 Commissioner cti.i2A K, JFrni&. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washingtc3�.s t - Suite 710 Bosto ' 118 Home Im•ro -aistration P l .r s = ,I�t il v i Type: Individual 3 ( —e•�� ation: 15 STEPHEN D. ROSS -~----- E4.:tion: 05/03/2024 36 SERVICE CENTER RD.NORTHAMPTON, MA 01060 '� ,_ =az to its=.x = amor < ii v Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Aff &Business Regulation Registration valid for individual use only before the HOME IMPROVEMEN ONTRACTOR expiration date. If found return to: TY.{ "tflaiyedual_. Office of Consumer Affairs and Business Regulation Re ist 457ration 1000 Washington Street -Suite 710 Boston,MA 02118 3TEPHEN D. ROSS d ' 3TEPHEN D. ROSS - A ;6 SERVICE CENTER ' d• am' a ,,.o!'=f 'a,G( JORTHAMPTON, MA 0146D 1 ,,, t- Undersecretary Not valid without signature ��"'1 CONSTRAS01 CPOROWSKI ,4o/?O CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 6/20/2022 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 NAME: AXiA Insurance Services PHONE FAX 84 Myron Street (A/C,No,Ext):(413)788-9000 (A/C,No):(413)886-0190 Suite A Et:ass:info@axiagroup.net West Springfield,MA 01089 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arbella Mutual Insurance COmpanY _ , 17000 INSURED INSURER B:A.I.M.Mutual Insurance Co. Stephen Ross INSURER C: 36 Service Center Road INSURER D.: I Northampton,MA 01060 — 1 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 N MAY HAVE BEEN N REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADMSUBRC POLICY EFF POLICY EXP LTR INSD WVD 1 POLICY NUMBER '(MM/DD/YYYY)1(MM/DD/YYYY) UNITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ._X OCCUR 8500071119 7/1/2022 7/1/2023 j DDAAEMISEs rrence) $ 100,000 MED EXP(Any one person) 1$ 5,000 PERSONAL&ADV INJURY 1$ 1,000,000 GEM_AGGREGATE LIMIT APPLIES PER: • GENERAL AGGREGATE j 2,000,000 POLICY 1 XJ JECT 7 LOC PRODUCTS-COMP/OPAGG _$ 2,000,000 .-� OTHER: EPLI $ 25,000 A AUTOMOBILE LIABILITY i (EOMBa BIINEEMSINGLE LIMIT $ 1,000,000 i ANY AUTO 1020098280 7/1/2022 7/1/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED I BODILY INJURY(Per accident) $ AUTOS1RE ONLY X SCHEDULED EE Teti? ,_.X;AUTOS ONLY i X AUTOS ONLY a dent�AMAGE $ i $ A X UMBRELLA LIAB X OCCUR ' EACH OCCURRENCE $ 2,000,000 EXCESS LIAB 1 CLAIMS-MADE 4620098565 03 7/1/2022 7/1/2023 AGGREGATE $---1 DED I X I RETENTION$ 10,000 2,000,000 B WORKERS ND EMPLY 'COMPENSATIONII Y/N PER ATUTE ! !ER ANY PROPRIETOR/PARTNER/EXECUTIVE f' WMZ-800-8006546-2021A 7/1/2022 7/1/2023 500,000 OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (MMandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 I If yes,describe under 500,000 I DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/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 REEPRRREEESSSEENTATIV E ' ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts "s (44 Department of Industrial Accidents s u, 1 Congress Street,Suite 100 _ a» . lam g 'Zil -' Boston,MA 02114-2017 -_ 8�'�- www.mass.gov/dia %%urcers'Compensation Insurance tffldas It: Builders/Contractors/Electricians/Plumbers. 10 BE FILED 11•11'H'I HE PERM!!TING Al11'HOWTI'. Applicant Information /� Please Print Ircihly Name(Husincss,Oganizatiorvindividual): S7''e�h"ie�t"' ? • q49-- _,_.. Address: 7(-- 5-4-✓t/t`€,...._ es-4----4��-Ar '✓� City:State/Zip: /1/1''f "^'',44.'`"` -''s40' Phone#: t't l7 --57q /ZZ y Are yam an employer?('hank the appropriate nos: Type of project(required): a c toyer with sir luyecs tfull andor part tan►).' "�'' - _ _-- �' p 7. 0 New construction 2 1 am a sole proprietor or partnership and hate tea employe working fur me an $_ 0Remodeling any capacity.(No workers'runup.insurance nyu/roof J 9, 0 Demolition 30 I am a homeowner doing all work myself.[No workers'corm.insurance requital' 4.0 I am n hnnnuwner and will be hiring commove.to conduct all work on my property_ 1 wall 10 0 Building addition ensure that all ctmtraciurs either hose workers'compensation uaauranee Of are sole I I..a Electrcal repairs or additions prupnwiors with no employees. 12.0 Plumbing repairs or additions 5C3 I ant a general contractor and 1 hoc hoed the sub-contractors lasted on the attached ahem. These sub-contractors lase cmployea and hose workers'comp.inauncr. 130 Roof repairs rn h.Q We are corporation and its officers have exercised their neat of a tcranption per MUc. I4. O[ltt't' .` 132,$I(al,and w c}use no tanpluyces.(No wurfcrs'coup.insurance requiredl 'Any applicant that checks boa al must also till out the uctum below showing theca workers'contperaataon policy tnfunruition a Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this boa must attached tan additional shirt show ing the name of the sub-contractors and State whether or not Hires entities have employees. lithe sub-contraeturs hose employees,they imas.provide their workers'.caanp.policy nmmber. I am an employer that is prot'iding workers'compensation insurance for err employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie. #: Expiration Date: Job Site Address: City/Stale-Zip: 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 line up to S1.500.00 and'or one-year imprisonment,as well as civil penalties in the form ofa STOP WORK.ORDER and u tine of up to S250.00 a day against the violator.A copy of this statement nuy be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofpeerjury that the information provider i above true and correct Signature: -5�jzl 0 t Date: /20 Z� Phone 4: tf/3 S-6 `6 --l2Z4"/ Official use only. Do not write in this area,to be completed by city or town official C'its or Town: PerniWl.icense tr Issuing Authority (circle one): I. Board of Health 2. Building Department 3.Cityrl'own Clerk 4.Electrical Inspector 5. Plumbing Inspector 6,Other .. Contact Person: Phone#: