Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
31A-249
BP-2023-1484 70 DRYADS GREEN COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31A-249-001 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-2023-1484 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: Est. Cost: 28900 JS CONTRACTORS INC 058968 Const.Class: Exp.Date:08/28/2024 Use Group: Owner: SMITH COLLEGE Lot Size (sq.ft.) Zoning: EU/URB Applicant: JS CONTRACTORS INC Applicant Address Phone: Insurance: 126 SUMMIT ST (413)537-5379 6HUB-2E38599-8-23 BELCHERTOWN, MA 01007 ISSUED ON: 10/23/2023 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: '0 • if • >2 (pi * Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 17/(" The Commonwealth of assA usetts <20 v Board of Building Regulatio _ an ards <2Q FOR u Massachusetts State Building Co. ICIPALITY by USE Building Permit Application To Construct,Repair, Ren. . oli a Revised Mar 2011 One-or Two-Family Dwelling '4o��ooys This Section For Official Use Only Building Permit Number: $�},3- �� `7 Date Applied: Vet) / Z,, //%Z 16.23-20Z j Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers "710 l7g.7 o5 &Rr=x0 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(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 Record: Name(Print) / City,State,ZIP �U 0�y&l` f's►kee ' W,l3 sy,7 5,726 (tit C/e Gi"1 1i �7f 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: Brief Description of Proposed Work2: S`t e r p 4 Kg goer(' w%t,(/ c.t- s-rmAl 1..m Yg sQ SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2._Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All F/5 #4 0 owl Check No. Check Amount: 6.Total Project Cost: $ c.`19 U� ❑Paid in Full 0 Outstanding Balance Due: City of Northampton 4. ', Massachusetts VA DEPARTMENT OF BUILDING INSPECTIONS ft4 212 Main Street • Municipal Building ti Northampton, MA 01060 4 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. I SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) osgg6% g 2� -3 A rr ES 5-EG Z 3 A K License Number Expiration Date Name of CSL Holder List CSL Type(see below) V Z6 SUM#If- No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) -3 a- -GIIEi..J MN R Restricted 1&2 Family Dwelling City/ own,State,ZIP M Masonr y RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 5-3-75.j74 'JZE.1tdZA k e. Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name ( G Su»,M;+—S—r' -q:C ZA 61'"'tt- F." No.and Street Email address ea a(rc.11 LV6w J yi 01%67 4135'3757299 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 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 s. CC/.1k2A d-- to act on my behalf,in all matters relative to work authorized by this building permit application. Zddct 2,3 Print er'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 containedon in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(El onic Signat e)J 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/dos 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 =1= 411 Department of Industrial Accidents '111 =47,41.4=1 I Congress Street,Suite 100 7S1, Boston, M.4 02114-2017 www.mass.goildia ‘Vor'kers'i'ompensation Insurance Aflidi it BuildersiC'ontractors/Eketricians/Plumbers. TO Itt_111_1.0 X1 WI 1 11E PEILNIEVIING Alit101111111. Applicant Information Please Print Lettihh Name Husincss,'Organizat ton,kids%"dual : cot-ft-4k C.tau yi Address: S urn rv, 14' • City'StatelZip: -70 ctie..--e.tont4 4-) PITA Phone#: 1-4 I 6-31 s-3 you mni milk,or?it heck the nppriprutIttiot: Type of project(required): gi I am a cnicolo•yer 14 craployves(fa maul-met-tinael..• 7. 0 New construction .:Di.m..1crrupnetut or purtneralup and have no erupkrytes veorkura format in gc3 Remodeling 4„-vacity.(Nu workers'cLarip.insurance respuresl I 9. 0 Demolition 4111I husrauthwner thring all Nutt myself[No VOOtit.V5'Cutup_Insamance • IQfl Building addition ; I am lun and*di be hums AtAltrActOta i xiduct ult 2 Mk tin niy pnoperty. 1 will oni.rr that all ominous%tither have washers"enaspenl.nion 1.11:114/11rIll:or ane sule 1 i Electrical repairs or additions prupnoans with nu cmployee%, 12.0 Plumbing repairs or additions .301 I am a gameTal untractan and I have tined the sub-contractors listed on tome ATLIchexl.sheet I 3121Roof repairs These aub-s-untractors have employees and has c workers'comp.insuraricel 144 Other nO We are a curpuration and its on-MCM'S have a:use:Ned their right or exempram per c :-.I, '52,(rift),and Fve have nu [No workers't:uttip.insurance requrrettj 'Any applittnt that ciserka bok al aunt also al out the swum below show ins!then workers'conipensatiOn potty!, rntorrnanori Iliorneowiscrs,sato submit this affistasu sashcanug they 2Yr doini all w to-1.and then lure outside conk-A.:Aar4 most submit a new Affsdas it Ind',sung such :Contractors that area this bus must arca:heti an Addniunal sheet silos in the name nf the sub-enntraktur*and,,,atc hobo:,va not those s-ntatios lone ernplo-,es-s If the sub-LoimraL(UT i:. if their workers"4.-,nrip. number I am an employer that is providing woriers'compensation insurance for my employees. Below is the polity and job Aire information. Insurance Company Narne: rcio Policy#or Self-ins.Lie. C --Z .3 6 .•5 9 q - Expiration Date: Z -Z7— Z3 Jub Sac Addresi: 10 Ay AA RAE gl•S City-State/Zip: Arnri.-s Attach a copy of the workers'!compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MILL c. 152. §25A IS a criminal siolation punishable by,a fine up to S1.500.00 anti or one-year imprisonment,as well as civil penalties in the form°fa STOP WORK ORDER and a tine of up to S250.00 day against the violator.A copy of this statement may be forwarded to the Offwe of Investigations of the DIA far irisurance cos.,,:raf.:e ertrh:at ion_ I do hereby ceruft under the pins am(itcooltieA i) perjury that the information provided abate is true and correct Siviaturr: Date z..c) c) ' Z Nione#: 4-2—7 5 3 Zci" Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitiLicense Issuing Authority (circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other ( outset Person: lilIlli • : City of Northampton ,,,_:::,,r(r.;.1-4 ,,( Massachusetts _ '�, DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building ,.), $' i Northampton, MA 01060 s4 %N ' CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: I,%l1 L l /4e-s yc.C4`,--1 I•-lo A=t I,/A etp 0.j The debris will be transported by: Name of Hauler: 'S C oxstad c-'far-$ Signature of Applicant: /( Date: Z 0 oc- Z3 City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS ,S, :110' ,r, itfit 4 212 Main Street • Municipal Building r-, - Northampton, MA 01060 ssp.k 0, HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert full legal name), born_ (insert month, day, year), hereby depose and state the following: 1. 1 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) ,� '1 JSCONTR-01 CPOROWSKI ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY, � _ _ ___ 8/21/2023 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 C NTACTE; N M AXiA Insurance Services PHONE FAX 84 Myron Street INC,No,Eat):(413)788-9000 (A/C,No):(413)886-0190 Suite A o1Ess:info@axiagroup.net West Springfield,MA 01089 INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:Evanston Insurance Company 35378 INSURED INSURER B:MSA Main Street America Assurance Company 29939 J S Contractors,Inc- INSURER C:Travelers Casualty Ins Co of America 19046 Tammy Szczebak 126 Summit Street INSURER D: Belchertown,MA 01007 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY1 (MM/DD/Y AI LIMITS A 1 X COMMERCIAL GENERAL LIABILITY i EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 3AA697209 8/23/2023 8/23/2024 PREM SES(Ea occur ence) $ 100,000 H _ .MED EXP(Any one person) E 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 'GENERAL AGGREGATE S 2,000,000 POLICY X_IRO-- i _LOC ��_PRODUCTS-COMP/OP AGG_-_S 1,000,000 I---t - -- _. --- ----__. i OTHER: — • $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ i ANY AUTO M1 P7360E 12/1/2022 12/1/2023 BODILY INJURY(Per person) S F OWNED SCHEDULED AUTOS ONLY X ,AUTOSNN EEDp BODILYO INJURY(Per accident) $ �.X_ AUTOS ONLY ._X AUTOS ONLY '_(Per°accRMenYIDANIAGE $ I I j _ ) $ I UMBRELLA UAB OCCUR i EACH OCCURRENCE $ ! EXCESS L.IAB CLAIMS-MADE i------ _ i_ AGGREGATE $ _ 1 DED RETENTIONS $ C WORKERS COMPENSATION X PER i OTH- AND EMPLOYERS'LIABILITY _STATUTE-__._._1ER- _._....-----_------/000 6HUB-2E38599-8-23 2/22/2023 2/22/2024 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N1,000 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) El.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under - 1,000,000 DESCRIPTION OF OPERATIONS below : : E.L.DISEASE-POLICY LIMIT $ 1 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 Proof of Coverage THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD