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29-086 (13) BP-2023-0626 410 RYAN RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-086-001 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-2023-0626 PERMISSIOIVIIS HEREBY GRANTED TO: Project# ADD CLOSET 2023 Contractor: License: Est. Cost: 27000 AFFORDABLE HO E REPAIRS 101797 Const.Class: Exp.Date: 06/09/202 Use Group: Owner: L KRA SE, KAREN Lot Size (sq.ft.) Zoning: WSP Applicant: AFFO ABLE HOME REPAIRS Applicant Address Phone: Insurance: 88 BEMIS ST 7PJUB6R431363 CHICOPEE,MA 01013 ISSUED ON: 05/16/2023 TO PERFORM THE FOLLOWING WORK: ADDITION -7X9 CLOSET 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: • / 1 Fees Paid: S176.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commissioner File #BP-2023-0626 Z- 6, k' APPLICANT/CONTACT PERSON:AFFORDABLE HOME REPAIRS 88 BEMIS ST CHICOPEE,MA 01013 PROPERTY LOCATION 410 RYAN RD MAP:LOT 29-086-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLISI' ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $176.00 Type of Construction: ADDITION -7X9 CLOSET New Construction Non Structural Renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans/Plot Plan Driveway Grade% THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: V 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: t 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 Management Demolition Delay ///i/Z 5- 16-Zo2-3 Signature of Building Official Date Note:Issuance of a Zoning permit does not relieve a applicant's burden o comply with all zoning requirements and obtain all required permits from Board of Health,Co servation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict stands s of MGL 40A.Contact Office of Planning&Development for more information. 1 ____ __ 1 . , , rr----TR. c _t_Ni_i_:_mii 1 1 . The Commonwealth of Massachus tts 2O23� It Board of Building Regulations and Sta dard QY 2 FOR Massachusetts State Building Code, 78 CM MUI11;ICIPALITY _ .�--- ' USE. Building Permit Application To Construct,Repair, Re ova _ tM ',MA o g��ed Mar 2011 One-or Two-Family Dwelling ___ N pTHA t This'Section For Official Use Only Building Permit Number: vdo" A 6-0- i/ Date Applied: ieev,,_ 4z., / -2 5_1t, a)z_3 Building Official(Print Name) Signature I Date SECTION 1:SITE INFORMATION r 1.1 P erty,ll a ss:,,\ , 1.2 Assessors Map&Parcel Numbers 5/ Kya 1.1 a Is this an accepted street?yes X 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. Sewage Disposal System: Public Private❑ Zone: _ Outside Flood Zone? MunicipalMunicipal yi On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP" 2.1 Owner'of Record: N Aate✓t Meteicf "Afe/lek 1444_ Name(Print) City,State,ZIP / WO I fet rL i4, `//3- 7- 406 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) ❑ Alteration(s) ❑ Addition`)4 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: ab 71)(7 ' Jce cel it hla5Ye1 1 Md✓x ovv dad ,e �Q Advse. A ck u.,cl be c6,44e. Y4 )10 bee)', on. SECTIONV 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ a 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee 4�� 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees:$ Suppression) Check No. Check Amount: P 7%0 Cash Amount: 6.Total Project Cost: $ p? 700 0 Paid in Full 0 Outstanding Balance Due: G2c,14; 79wrtr>Yn. 1g /j7 City of Northampton �r * Massachusetts . ` DEPARTMENT OF BUILDING INSPECTIONS . 212 Main Street • Municipal Building �, Northampton, MA 01060 s, F �t"':'" PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW 1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES, FENCES, GROUND MOUNTED SOLAR, ETC. I. 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. Site plan with location of proposed structure(s) and set backs. 4. Construction Debris Affidavit filled out and signed by applicant. 5. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate (new/ replacement windows). 8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable). 9. Note any Conservation and/or special permit requirements (if applicable). 10. Driveway Permit (if applicable). 11. Proof of Water and Sewer entry fees paid (if applicable). 12. Trench Permit- public land by DPW/ private land by Building Dept. 13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit application before issuance of permit. 14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. SECTION 5: CONSTRUCTION SERVICES r.1 nConstructio upervisor License(CSL) cott S col 77 7 c— 7 y 1/License Number Expiration Date Name of CSL Holder U r r 2e47'5 List CSL Type(see below) No.and Street Type Description //���� At Oki /S U Unrestricted(Buildings up to 35,000 cu. ft.) �1.�coft e / 6 / R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding // p SF Solid Fuel Burning Appliances y/3— p?(RJ" yp Cth e- /�lxe.. 90S�4 I Insulation Telephone �/ Email address D Demolition /5.2 Registered Hpne Improvement Contractor(HIC) /53, /1 ,3-v7 f J Scott %(Muth HIC Registration Number Expiration Date HIC Comp Any Nvrre or I-IT Registrant Name No.and Street Email address Cit i‘aret i /m oloil yi3-g6r Yis-6 City/Town,Sfate,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 PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. 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 4 contained' this applicati is ue and accurate to the best of my knowledge and understanding. 5- --l42 — A2 3 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 contractor (not registered in the Home Improvement Contractor(HIC)Program),will nJvt 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 canlbe found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) 43 `r)fit (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable rodm 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 SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD 7c' 1 SIDE YARD 01 5-' Eje .))1Nixe SIDE YARD Se- FRONT SETBACK VO FRONTAGE .Z\ The Commonwealth of Massachusetts -112•,.. Department of Industrial Accidents I Congress Street,Suite 100 -.! TI..... Boston, MA 02114-2017 .— N'WW.ntass.govidia -- 1Vorkers i'ompensation Insurance Affidavit:Builders/ContractorsfElectriciansfPlumbers. Ill BE FILED SS I 1 ll 111E PtitAllITING All'HORH'V. Applicant Information Please Print Ixeitils \k e Name ilitusancss an tfrgization=lndividualr. /9'ncilke ,te_.. 11/11/4.(_ Pea-1,-- Address: gr Pt in t-S ‘..5)/' di cope City,StateiZip: ch,y4Ikei,fita 61013 PI Ione ,,,, Y/3 -2 ,s- yr-s-es Are yen an ertiplik,er?Cheek the appruprorte box: 11)‘pe of project(required): ,D I am a=into)a%ith ,” ,croployees full=dor part-time 1.• 7 0 New construction in a sok proprietor or purinerslup anti have no employees iivortuta fist iiiie in ' 8_ a Remodeling • :cspseiry.f.Nu winters,'comp.insurance reiturred.1 9_ Ej Demolition i.0 I stilt a lionsixosttet doing all wort myself.[No Vr4)1itet%'4L't Inc Ittstir311..V requital r I o 0 Building addition i I aiia a lairrscowiles caul will be lariatg vatittactars to oanduet all iviirls un my property. I tEl ensure that all contractors either have isorkets'compensation insurarkx or are sole I 3 0 Electrical repairs or additions proprietors IN nth no employees_ I 10 Plumbing repairs or additions :‘,C3 I am a V-11s22:11eontrxior aisi I base hmal the sub-eutitraeturs listed on the attached sheet I 3.C:I Roof repairs These sub-contractors hate...inplinees and brie winters'comp.insuranec.; 14.0 Other 6.0 We arc a kAneatAb011 And its otikers have exereiseil then right of exemption per PillCiL r. 152,§li 4 i,and wv kroil no emplu)erx.[NO winters'camp insurance required.) Any applicant that cluselts but;thrust also till out the seetiini below showing then workers'corripensation policy info *Kinn...0%1km who%ottani this Aid:via intheataut they are doing.all work and then hire outside conks:tun must submit a new alliaLai it indicating suck IL ontraetvis that check'dna box MUNI auebeit an additional sheet showing the name oldie tors and ILIL:N hatICC o nut thime mimes luso.: employee, 11 tliesirli-eontraetors hate oriployeew they must pro., de their A ork,:rs'weir polwy number. I am an employer that is providing workers'compensation insatunee far my employees. Below is the indity and fob site inform anon. A tr illittranCe Company Name: 4e;I e lye,L /\ A..COtariCe ___ Policy#or Self-ins.Lie: piration Date: Job Site Address: 0 gpt 4 P-a. / Or C ity:Statc'Zip: r C''.._. / _ Attach a copy of the workers compensation policy declaration page(showing the polies number and eipiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal S.,iolation punishable by a fine up to S I.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 5250.00 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 certify nk rthe pains a !p nuttier of perjury that the ii m tforution provided dho is trite trite(mil correct , /c2 -o?Oo? 3 Signature: Phone r : 5// --- 02 .c; Ys(50 Official use only. Do not write in this area.to be cvmpleted by city or town IfficiaL ('By or Town: Permit/License#j, 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#: "--- - Pr City of Northampton )0r1.ri ,.' 4 f ` �' Massachusetts �. DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building ; --'� Northampton, MA 01060 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 554, 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: Kew WaS/<- 'oe 7' Sei\;ti el0 The debris will be transported by: Name of Hauler: 4 a,b)e_ #124a 1 €44f-` S I Signature of Applicant: qr/ Date: AR® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/12/2023 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 David R Jarry Neill 8,Neill Insurance Agency Inc PHONE 413 732 4137 F°X (413)731-6629 662 Riverdale Street (A/C.No.Extl: (413) (),4/C,No): West Springfield,MA 01089 ADDRESS: dj@neillandneill.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Northfield Solutions NOF INSURED Affordable Home Repairs INSURER B: Travelers Insurance TIC 88 Bemis Street INSURER C: Chicopee,MA 01013 INSURER D: 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 ADDL'SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCEW M/INSD VD POLICY NUMBER (MDD/YYYY) IMMIDD/YYYYI A ii COMMERCIAL GENERAL LIABILITY WS526165 08/30/2022 08/30/2023 EACH OCCURRENCE $ 1,000,000 ^j I'""�"'� DAMAGE TO RENTED 100 OQ� ' __.I CLAIMS-MADE I (OCCUR 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 1POLICYL__^,„_ PEa 1_ LOC 2,000,000 PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) =ANY AUTO BODILY INJURY(Per person) $ IOWNED I 1 SCHEDULED BODILY INJURY(Per accident) $ „,.iAUTOS ONLY 3._..,I AUTOS IHIREO °-- i NON-OWNED PROPERTY DAMAGE ',,, ,,'AUTOS ONLY 1.—...1 AUTOS ONLY (Per accident) $ - I UMBRELLA LIAR ^ ,OCCUR EACH OCCURRENCE $ r EXCESS LIAB i 1 CLAIMS-MADE AGGREGATE $ 'DED l RETENTION$ — .$ B WORKERS COMPENSATION 7PJUB6R431363 06/03/2022 06/03/2023 , ✓ 'PER I 1OTH- AND EMPLOYERS'LIABILITY I STATUTE _...''.ER Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBEREXCLUDED? Y N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Emailed to: kross@northamptonma.gov CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 210 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Northampton,MA 01060 AUTHORIZED REPRESENTATIVE , I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 6;2 In the event of a default under this Agreement, the defaulted party shall reimburse the non-defaulting party or parties for all costs and expenses reasonably incurred by the non-defaulting party or parties in connection with the default, including without limitation, attorney's fees. Additionally, in the event of a suit or action is filed to enforce this Agreement or with respect to this Agreement, the prevailing party or parties shall be reimbursed by the other party for all costs and expenses incurred in connection with the suit or action, including without limitation, reasonable attorney's fees at the trial level and on appeal. 6.3 No waiver of any provision of this Agreement shall be deemed, or shall constitute, a waiver of any other provision, whether or not similar, nor shall any waiver constitute a continuing waiver. No waiver shall be binding unless executed in writing by the party making the waiver. 6.4 This Agreement shall be governed by and shall be construed in accordance with the laws of the State of Massachusetts. 6,5 This Agreement constitutes the entire agreement between the parties pertaining to its subject matter and it supersedes all prior contemporaneous agreements, representations, and understandings of the parties. No supplement, modification or amendment of this Agreement shall be binding unless executed in writing by all parties. 6,6 If any provision of this Agreement is held unenforceable, then such provision will be made modified to reflect the party's intention, All remaining provisions of this Agreement shall remain in full force and effect. 6,7 Contractor agrees to indemnify, defend, and hold Employer and his/her/their successors, officers, direotors, agents, and employees harmless from any and all actions, causes of action, claims, demands, coat, liabilities, expenses, and damages (including attorney's fees) arising out of, or in connection with any breach of the Agreement by contractor. 6.8 Contractor shall not assign any of his/her rights under this Agreement or delegate the performance of any of his/her duties hereunder, without the express written prior consent Of Employer. WITNESS THIS o SIGNATWES THIS/! THE/^1�2nth DAY O AP2RIL 2023 Customer: ie,,,,,,,, li-f I'�lrcw'; !// ! Q 3 Contractorsc } (' Affordable Home Repairs Office - 413-315--9112 MA CSL - C8-101797 Address - Chicopee, MA MA HIC* 153268 Cl c)Set a x6 ci,5 L S a s /c "o,c e Py coat( shy :a ® „ S6 S - /02 ��ame�t� r1,Q. e �( L 0 7/y" plyw rlac10AI o2X$x 3x9 CaN' -r 1ea.44_ O / ;nSUla-'ftm2 ,& w&CC Gg R_30 t`dar �nsuier,,a2 —yve4c mac c co r -'° p,C yi 3- 42a Sc,uk_-tube_ 654/tadt_ rce/vds Cs f/o6(' figerrliaL7 a c2) floc r- J`6-4f /G '' O- C czxg Cu- x3x9 140. r bea.�t ® 3 - 12 Conti -, - -- fOC/I S 6 6 rlooI" e►-S CrA-+`-n; eZ" l�u� vrt P CK�Y'S Ala A 9 " _ \ Cla5et 5' (:)t.- 0e,i..0 siz Pick D a Y vnyL s,a:(1_7 L - ______ _ iyve( cuita a o 1�,�'.jec'�vi`a,L �'�.,'nij le LA0,440 a a 5-/2._. md, __..__L_L__L__ v;if_ 1.___. G, I cif —.-I di,,, Uu_ / .