Loading...
24C-166 (2) BP-2023-1201 52 FRANKLIN ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24C-166-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2023-1201 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: Est. Cost: 17200 RONALD KEITH 085204 Const.Class: Exp.Date:02/09/2025 Use Group: Owner: LOVELAND REBECCA Lot Size (sq.ft.) Zoning: URB Applicant: RONALD KEITH CONSTRUCTION Applicant Address Phone: Insurance: 5 BIRCH MEADOW DR (413)584-5589 HADLEY, MA 01035 ISSUED ON: 09/01/2023 TO PERFORM THE FOLLOWING WORK: STRIP AND REROOF 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: a • r . . d' '� • I ' I Fees Paid: S40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner CFI The Commonwealth of Massachuse troot Board of Building Regulations and Sta oar (V OR Massachusetts State Building Code, 7:I C1shd 20M US. CIP ' ITY Building Permit Application To Construct,Repair,Reis' t�,6 ar 2011 One-or Two-Family Dwelling 4 1414n c;1/4 This Section For Official Use Only � °�oso NS Building/Permit Number: 862- Z ' /1l1- / Date Applied: a5 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 5'2 Peed kcC ,IY) S� . 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(It) 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 Record: 12-ebecrct... L-o vim\a nc\ 3 cc tA\02 mR\on \4( c cam© Name(Print) City,State,ZIP Z .. 1raCt(C Con SIT. '732.53S•3329 n\0.. No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building PI Owner-Occupied,B1 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other ® Specify: 2COC' Brief Description of Proposed Work': SFr to j ce v us 30 yY - -P 1-i1c o /arms (c)� czpmax. e' lvct v kck\e � d --rvL.10 YC-►'1,e... SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1-t Zb 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 Fe ,G(� Check NobI 3 Check Amount: "�v Cash Amount: 6.Total Project Cost: $ l 2 .(DO 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS—p�65 Zoe\ l J t cl, ���'��l License Number Expirati Date Name of CSL Holder List CSL Type(see below) _5 B6( c No.and Street P T Description � �� ice(G�� cu.ft.) City/Town,Stat ZIP Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances CVe; -:\q‘z=6L O �q(N'O,,\ I Insulation Telephone Email address �] D Demolition 5.2 Registered Home Improvement Contractor(HIC) l vJe 1 HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.anDcoirl\Q� �1Le ��/� 8�r�c) mom\ d Street Email addres 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 Cat No ❑ 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 L'.e"klr1 to act on my behalf,in all matters relative to work authorized by this building permit application. Zei�Pcca� Lost-eland %\31}2-3 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. Vcx,)-\6\ \7-3 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 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" The Commonwealth of Massachusetts ",,, — L. Department of industrial Accidents 1w _ TZVAIR .; 1 Congress Street.Suite 100 • '�t= Boston. MA 02114-2017 • www.mass.gov/dia 11rukers'('ompensation Insurance:ttTldin it: Builder•s/t'ontractors/EkctriciansrPlumbers. t)1*. 111.E1)N Fill 1 HI. Pk:R%IITi IM:Al 1 lft) 11'l .lnnlieant Information Please Print I.eiibls Name USIncss.'04tanuattonIndtviduall C' 1-/eS‘eN ( t t(r\ Address: 4 QDCsr kv.00. LC)U) OY • City/State/Zip: F CAC . \& oto35 Phone#: '- . 5%Us-SS$9 Are yaw as suelayerto Chide the appropriate bet: .t.YP Preiect_ : 101 am a erttpkn cr with employees hull archer pert-tirm:1' 7. 0 New construction 2 1 am a sole proprietor or purinenhep and have no employer,%cairns for me in K. Remodeling any Capacity [Nu porkies'comp.trnurante rrquirczl j 30 I ant a homeowner doing all work my wit No posits.'cusp +unce tnra required.]' 9. ❑Demolition 4.0 I am a honrttrwner and w ill he Menge oonwcwrs w eunduty all work un my property. I will I Q Building addition ensure that all contractors either have worker."oom ensatoun insurance ter air!WIC I I a Electrical repairs or additions proprietors w ith no employees. 12.0 Plumbing repairs or additions TiI am a -m rid contractor and l kav c hued the soh-cuntractata Melted on the anadied duet These.sob-camtrittonin hint emplyer%and have workers'comp.1me'a unce.: 130 Roof repairs 6.0 We arc a corral-anon and eG officer.have etcn.ised dicta nghi of tntmptr.n per MUI4.❑Other 152..1141.and we have nu aatsluyaes.(No wttkers.comp.Insurance required.( 'Any applicant that cha ks boo al must also till out the xYttant below show me thews workers'tom ematton pultcv Information *Ika c+uwncn who submit thas an-attain utdacain they arc doing all work anti then hue mutdt contractors must submit a new athala'tt trxdttattnc such C marrctors that chcci this box must attached an additional short show ens the name oldie soh-caner d ors and state w hethtr or not those cititttcs ltn.c employee, It the,uh-ctniractors bane attpiusccs.they must prt•t Id,their workers`temp pohcy number I am an employer that is providing workers'compensation insurance jar my employees. Below is the policy and job site information. lmuiJikc{. orrirt.tnt \ants: Scit-tns. 1_tc Expiration Date: Job Site Address: City.'State:Zip:__ Attach a espy at the workers'compensatloa policy tleclar•ad.n page showing the polity number and expiration date). Failure to secure coverage as required under MNGL c. 152,§25A is a crinunal violation punishable by a tine up to SI.500.00 anti'or one-year impnsonment.as well as civil penalties in the form of a STOP WORK ORDER and a fine 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 senlication. I do hereby certi un er the pains and penalties of perjury that the information provided abate is true and correct. Signature: I ���c� Date S`3.\\7 Phone#: kke . `-1/4 •`J:X�1 Official use links. Do not write in this area.to be completed by city or town official ('its or Town: Permit/License p Issuing Authority !circle one): I. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone 0: City of Northampton •'' Massachusetts A."S• c` DEPARTMENT OF BUILDING INSPECTIONS �' j•° 212 Main Street • Municipal Building O. 1.` Northampton, MA 01060 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: V e,t,, Q }cV• Location of Facility: 23',•1/4 Wes,(.1 C m nktr) C`k cCt_ C tip f �{Pr The debris will be transported by: Name of Hauler: .-(xYa, �e Signature of Applicant: Date: 5a31\Z3 / 1a DATE(MM/DD/YYYY) O ACOR CERTIFICATE OF LIABILITY INSURANCE 08/31/2023 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 Denise Sawicki NAME: Amherst Insurance Agency Inc PHONE (413)253-5555 FAX (413)256-8354 (A/C,No,Est): (A/C,No): 20 Gatehouse Rd. E-MAIL dsawicki@nathanagencies.com ADDRESS: P.O.Box 48 INSURER(S)AFFORDING COVERAGE NAIC# Amherst MA 01002 INSURERA: Preferred Mutual 15024 INSURED INSURER B Ronald&Kyle Keith DBA Ronald Keith Construction INSURER C: 5 Birchmeadow Dr INSURER D INSURER E: Hadley MA 01035 INSURER F COVERAGES CERTIFICATE NUMBER: CL2383104299 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 TCLAIMS-MADE X OCCUR PRS l RENTED PREEMIMI ESES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 A BOP0100738143 06/02/2023 06/02/2024 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ O• WNED S• CHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS_ H• IRED N• ON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE 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 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 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main Street AUTHORIZED REPRESENTATIVE Northampton MA 01060 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD