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32A-124-002 BP-2024-0201 57 KING ST UNIT B COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32A-124-002 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-2024-0201 PERMISSION IS HEREBY GRANTED TO: Project# BATH RENO 2024 Contractor: License: Est. Cost: 32000 STEPHEN ROSS 079160 Const.Class: Exp.Date: 04/28/2025 Use Group: Owner: R. LOTSTEIN, RICHARD M&JENNIFER Lot Size(sq.ft.) Zoning: CB Applicant: STEPHEN ROSS • Applicant Address Phone: Insurance: 36 SERVICE CENTER RD (413)584-1224 NORTHAMPTON, MA 01060 ISSUED ON: 02/28/2024 TO PERFORM THE FOLLOWING WORK: BATH RENO 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: lie I Ii Fees Paid: S208.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner ,c1-. A The Commonwealth of Massachusetts c*J N`'. `• Board of Building Regulations and Staiidar4 cb 'FOR Massachusetts State Building Code, 780 CMRN �� MUNICIPALITY /^ USE Building Permit Application To Construct,Repair,Renovate Or., o. Ji5ti a Revised Mar 2011 One-or Two-Family Dwelling "•°"3,,,'04,6, Building,Permit,Number: 6/7..?11(0 2 0/ I Date Applied: _ — UL) ss /47 2-27-zozz/ Building Official(Print Name) Signature Date SECTION 1 :SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 57 B King Street 1.la Is this an accepted street?yes 0 no i— 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 ElPrivate❑ Zone: _ Outside Flood Zone? p ❑ p y ElCheck if yes❑ Municipal On site disposal system SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Jennifer & Richard Lotstein Northampton Ma 01060 Name(Print) City,State,ZIP 57 B Kinq Street ienniferlotstein(&..amail.com No.and Street Telephone Emat7=;idkre&s SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑ Demolition ❑ Accessory Bldg.0 Number of Units Other ❑ Specify: Brief Description of Proposed Work2: remodel existina bathroom SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $24,000.00 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ 1,500.00 ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 6,500.00 2. Other Fees: $ 4.Mechanical(HVAC) $0 List: 5.Mechanical(Fire $0 Suppression) .�` Total All Fees/ 6.Total Project Cost: $32,000.00 Check Nog 99 W Check Amount: O�t�0 Cash Amount:- SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 079160 4/28/25 Stephen D Ross License Number Expiration Date Name of CSL Holder 36 Service Center Road List CSL Type(see below) U No.and Street Type Description Northampton Ma 01060 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-584-1224 stepdross(a�yahoo.corn I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Stephen D Ross 150847 5/03/24 HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 36 Service Center Road stepdross anvah o.com No.and Street Northampton Ma 01060 413-584-1224 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 9 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 Stephen D Ross to act on my behalf,in all matters relative to work authorized by this building permit application. I ry 4.0- f 174-k z( tjy 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. Stephen D Ross Z/!TZ`( 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 CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton • oaY H A My�o� +s. Massachusetts goer' _�<< DEPARTMENT OF BUILDING INSPECTIONS DX 212 Main Street lb Municipal Building yJ't few Northampton, MA 01060 rs .� -4Ss 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: VA/0-712-cC w Y - The debris will be transported by: Name of Hauler: 6-grife,--.7 Signature of Applicant: Date: 2 /V2 r Commonwealth of Massachusetts IP Division of Occupational Licensure Board of Building Re L rations and Standards Constion Srvisor CS-079160 - E5.1crpires:04/28/2025 STEPHEN D CROSS 36 SERVICE€TR RD NORTHAMPT'QN MA 01060 r ,'t O .t.01.f.v,0 3' vv�...missio„ci ,zej)f{{1� �. _.7.iii ai.•..2. v'V • • THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affa Business Regulation 1000 Washing _ Suite 710 Bosto - - 118 Home Im•ro • --- - - -.Isstration 111i Fa/NW .i' l I I I I I I 111 I 111 ei '�j'`�' j0! Type: Individual STEPHEN D. ROSS "4n 7 e.- -tion: 150847 36 SERVICE CENTER RD. _ E ' =tion: 05/03/2024 NORTHAMPTON, MA 01060 ' _ —�""'"' ofti 7 Ait 111111 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affa3'ks,&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE_Ii dual. Office of Consumer Affairs and Business Regulation Registr tion-�:::--'.--ffitiiiiration 1000 Washington Street -Suite 710 150 -r T.°'+5/Q3t2,p24 Boston,MA 02118 STEPHEN D.ROSS — r — STEPHEN D.ROSS 0 '__ -w=_ v ,7 , mi 16 SERVICE CENTER 3' y'== _ •^ �o ,tea�/ '•k" JORTHAMPTON,MA 0 . . y4` _t�' Undersecretary Not valid without signature The Commonwealth of:t!assachusetts mho::, ( Department of!ndustrial.Accitlents i L.,:, / Congress Street,Suite 100 mete . ...,.,. , as Boston, MA 02114-2017 ' www.mass.gm'tdia 11 tokers'compensation Insurance Affidavit:Builderslt'ontractorsiElectriciant,('lumbers. 10 BE FILED WITH'I HE PERSII I'll ALCM/Ian. Applicant Information Please Print Legibly Name(Business Organtratiun'lndividual): , .-r/4•---rti.Dr l/�r 7 __ - Address: 36.- c-t- v e.-- C'. ,/, 1pd City/State/Zip: 4// -- /l?/fi d/it D Phone #: V/3 ' SS '. (Z z! Are you ru employer?Cloth the•ppropristc but: Type at project(required): 1(�1�,rt a.ruptuy�� �rtt, _ employees DWI and'or parkin) .* 7. D 'cw construction 2 t/am a site proprietor or p rtnership and have nu employed working fbr use in S. Remodeling any capacity.(flu workers cutup.rmuntncti rcyuaMl.) 9. D Demolition 30 l am a homeowner doingall uurk myself-.[Nu untktat'curry, n urntce nyuned.)' 100 Building addition #.DI am a Iatmeos4m r and wilt be hiring contractors to curitluct all work on my property_ I will ensure that all contratun either hate wurken'compensation insurance to an:sole i I.D Electrical repairs or additions pruptia'futr a nth nu cmpiuycrs. 12.0 Plumbing repairs or additions SO I am a general contractor and I lust:hind the sub-contractors listed on the anuchect sheet 13E3 Roof repairs Chose subcontractors luxe employees,and have workers'camp.insurance.; 14.D Other lw 6.0 We are a ierriiiin and its officers bare exercised then ne..ht of exemption per Mule e. --- 152.§Ital.and a c Katz no employees.(No wurfers'ctanp insurance required.] •Any applicmtt that clux:ks Ku.at moat also till gut the sectwm below shun.ing then wwkera compensation policy ir'tforiYntion ,tiumcuwttcn who submit this atfiidavit irubcating they are do.ng all w ork and then bee outside contractors nuts/submit a new all lavit indicating such. :Contractors that check this box mulct attached an additional sheet idiot ing the name of the sritrtururactors and state whether tv not those entities have employees If tb.stib•cuntracturs,rate einpiti,eca.they mu>t pm,.'de their harken'cramp.policy number. I am an employer that is providing workers'compensation insurance for my employee-c. Below is the policy and jab site information. Insurance Company Namc: __. Policy#or Self-ins.Lie. ri: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration dale). Failure to secure coverage as required under LMGL c. 152, *25A is a criminal violation punishable by a fine up to S 1,500.00 and or one-year imprisonment,as well as civil penalties in the form afa 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 Verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above it true and correct. Sitrnature.. , r Date: Phone 4: ! J- _ /2 2 et Official use only. Do not write in this area,to be completed by city or town official C'itt or Town: Permit/License :r Issuing Authority(circle one): I. Board of Health 2,Building Department 3.Cityrronn Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone it: I ____.......IN CONSTRAS01 CDANDY AWREY DATE(MM/DD/YYYY) ��. CERTIFICATE OF LIABILITY INSURANCE 6/29/2023 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). CONTACT PRODUCER NAME: --.— AXiA Insurance Services PHONE 84 Myron Street E-MAIL (A/C,A No,Ext):(413)788-9000 (A/C,No):(413)886-0190 Suite A ADDRESS:info@axiagroup.net_ West Springfield,MA 01089 INSURER(S)AFFORDING COVERAGE I NAIC# INSURER A:Arbella Mutual Insurance Company 17000 INSURED INSURER S:A.I.M. Mutual Insurance Co. Stephen Ross INSURER C: - 36 Service Center Road INSURER D: Northampton,MA 01060 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 TYPE OF INSURANCE 1ADDL SUBR, POLICY NUMBER POLICY EFF POLICY EXP , LIMITS LTR _INSD !fVD (MM/DD/YYYY1 (MM/DD/YYYY) A ', X '.COMMERCIAL GENERAL LIABILITY1 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ' X OCCUR 8500071119 7/1/2023 7/1/2024 DAMAGETORENTED 100,000 _ PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5'000 I PERSONAL&ADV INJURY ,_$ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 'i , . GENERAL AGGREGATE ,_$ 2,000,000 1,`JI POLICY X sr LOC '; PRODUCTS-COMP/OP AGG $ 2,000,000 I'! OTHER: IiEPLI $ 25,000 COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LIABILITY (Ea accident)_ $ ANY AUTO 1020098280 7/1/2023 7/1/2024 BODILY INJURY(Per person) $ 20,000 OWNED ONLY X SCHEDULED BODILY INJURY(Per accident) $ ' 40,000 X I HIRED I X NON-OWNED I PROPERTY DAMAGEp AMAGE $ AUTOS ONLY _,AUTO ONLY ,$ A X UMBRELLA LIAB 1 X OCCUR EACH OCCURRENCE $ 2,000,000 �,I EXCESS LIAB CLAIMS-MADE 4620098565 7/1/2023 . 7/1/2024 AGGREGATE $ li j DED X RETENTION$ 10,000 Aggregate: $ 2,000,000 B WORKERS COMPENSATION PER !OTH- AND EMPLOYERS'LIABILITY STATUTE___ ER Y/N WMZ-800-8006546-2023A 7/1/2023 7/1/2024 500,000 ANYIPROPRIETO�XRLNERDED EXECUTIVE N/A E.L.EACH ACCIDENT $OF /MEMBE 500,000 (Mandatory in NH) E.L_DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ required) OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more spacer is eq uired) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Proof of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE f ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD �....,IN CONSTRAS01 CDANDY ACORO" DATE(MM/DD/1'YYY) �- CERTIFICATE OF LIABILITY INSURANCE 6/29/2023 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 AXiA Insurance Services :PHONE - — FAX 84 Myron Street (A/C,No,Ext):(413)788-9000 (, ,No(413)886-0190 Suite A pDDRIE$5,info@axiagroup.net West Springfield,MA 01089 INSURER(S)AFFORDING COVERAGE NAIC# --_. INSURER A:Arbella Mutual Insurance Y Com an 17000 D — INSURED INSURER a:A.I.M. Mutual Insurance Co. Construct Associates Inc. INSURER C 36 Service Center Road INSURER D: Northampton,MA 01060 — 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 TYPE OF INSURANCE ADDLJSUBRI POLICY EFF POLICY EXP I LTR INSD WVD POLICY NUMBER I(MMIDD/YYYY)1 IMM/DDIYYYYI I LIMITS I A X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,000 7-+ CLAIMS-MADE X OCCUR ':8500071119 7/1/2023 7/1/2024 DAMAGE TO RENTED 100,000 .- PREMISES(Ea occurrences $ MED EXP(Any one person) $ 5,000 ' PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 2,000,000 POLICY X PR� r� LOC GENERAL AGGREGATE $ 2,000,000 JE J PRODUCTS-COMP/OP AGG $ �1 OTHER: EPLI $ 25,000 X 'AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO 1020098280 7/1/2023 7/1/2024 _BODILY INJURY(Per person) 1$ 20,000 'AUTOS ONLY D X AUTOSULED 40,000 E p BODILY INJURY(Per accident) $ X AUTOS ONLY X'1 AUOTOS ONLY PROPERTY accident�AMAGE $ 1 ' $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAR CLAIMS-MADE RETENTION$ ,OOO 4620098565 7/1/2023 7/1/2024 AGGREGATE $ DED X 10 'Aggregate $ 2,000,000 WO KERS COMPENSATION ' B ANY ANPROPR EMPLOYERS' /PA LIABILITY EXECUTIVE PER OTH- FFICER/MEMBER EXCLUDED? Y N I A — WMZ-800-8007507-2023A 7/1/2023 7/1/2024 EL. ACCIDENT 500,000 andato /N ELDISEASE-EA EMPLOYEE'$ (Rig m NH 500,000 I If — $ 0, ry i DESCRIPTION OF OPERATIONS below describe under 500,000 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 Y 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 1 i....... 9, 7i i P A "1----- 6'-2 1 /2" ''''441*".',, TO REMAIN TO KMAIN IC)RtI:MA IN I )R I',Al,It4 TO i),I Ntok 1t4 ...,1 , -1- —4 Mgt 1 I , I . .... • 1 DI I 1 0 ---F; 1111 z ib _. I tar) .,...: :3... . \ c4 0 A,, ..- ' ... 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