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18-030 (4) BP-2024-0653 14EMILYLN COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 18-030-001 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-2024-0653 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2024 Contractor: License: Est.Cost: 14800 AGELESS CONSTRUCTION INC 039566 Const.Class: Exp.Date:09/20/2025 Use Group: Owner: SMITH RONALD R &DARA M ADAMS-SMITH Lot Size (sq.ft.) Zoning: RI/RR Applicant: AGELESS CONSTRUCTION INC Applicant Address Phone: Insurance: 676 STEVENS ST (914)525-3022 WCM000092503 MARLBOROUGH, MA 01752 ISSUED ON: 05/22/2024 TO PERFORM THE FOLLOWING WORK: STRIP AND REFOOF 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: ji/ti Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner I 1 MAY 2 1 2024 IL., The Commonwealth of Massachusettsr-p7 of - FOR BUIIOING INSPEC' Board of Building Regulations and Standards9RTHnymTON r^go,�nIONMTIN IGIPALITY WMassachusetts State Building Code, 780 CMR "----- USE Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling ..22 is Section For Official Use Only Buildin Permit Number: L71 c' '1 Date Applied: Crt 1 i•Jal Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Properq Address: 1.2 Assessors Map&Parcel Numbers 19 ErnIfi [An t, ,NOr /4601pfOn 1.1a 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 ord: • ara air 5— rnram► Worfham;p -6n , Mfl OIDC0 Name(Print) City,State,ZIP 1 (-1 6(7111ki l a+u- y-13 2-09 +3 dadarAS5onc++t&a s. No.and Street Telephone Email Address_ d SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building" Owner-Occupied 0 Repairs(s) 0 Alteration(s) E( Addition 0 Demolition Cl Accessory Bldg. 0 Number of Units Other Ili Specify:4).lltd:l? Vt>( Brief Description of Proposed Work': SfYYD cs,rarrt 5hi rvi k5 a rta vq\Orr w t#ii ot.rc,h ricctua l ois 1a t 611 tr1 (cs SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ ►y Sop 1. Building Permit Fee: $ Indicate how fee is determined: , 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire Suppression) $ Total All Fees: 41)40 Check No.11 Check Amount: 6.Total Project Cost: $ t 9 00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Zraditrd E� 51vwe.. l -03�5� 9 �ZO License Number Expiration Date GA Name of CSL Holder List CSL Type(see below) C rt th'U 61.0 ft w No.and Street 4' Description // r Unrestricted(Buildings up to 35,000 cu.ft.) COOra-fi 3 r (AN - V 1�OZ Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonr y RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 71q-y1- 2 3 9�Or9CCsMa.rKopou(0S- I Insulation Telephone V Email address l'Oo('y ,con_ D Demolition 5.2 Registered Home _Improvement Contractor(HIC)'/ 2.01 502407(202'� Gle`5 `c t)e-t10�l i"c-• HIC Registration Number Expiration Date HIC pany Name or HIC Registrant Name Co-up WG1't5 � -• /wtov V c rv.yKl�ot� O�orco�ir,• CA"(VI' No and Street J Email address City/Town,State,np ' 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 .......... oY No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT/ I I. , 1,as Owner of the subject property,hereby authorize � ibVt•S �`�I 117ci.cJ�wz/ es�",tI to act on my behalf,in all matters relative to work authorized by this building permit application. bity-G. 4 S Sty. 5-- /1-ay 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. 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 wF^ww.mass.govioca 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" 114 . The Commonwealth of Massachusetts Deportment of Industrial Accidents 1 Congress Street,Smite 100 1.•es .4,::::41 e Boon, MA 02114-2017 4, .....• •-"x `t%, • Witlit init0.01ViiM Vi>t)rkere CONtipnoktibttketa 1ftglIrAtla3)4ttlidakit:BalidttrtiCOatrutorVEktrtrieTanalPlornitera. TO BE VILE)WITH THE:PERMITTING AUTHORITY, Auttlicant I it forma tioa Please Print I...Mil& Name(141.1i$K,.,...,...kkg.;:sniz;iti.,:mf.hattividt : /4 gek,,,., ......cono-frockto 0 I Adiarts6-:._62,:ga_sf-rAirx, . -1.-- CityiStatelipaproi)/h. t1/44.11 01/5 1 Phone#: 7 7'I 937 ..................,___, t4:re I•evi an rlitialstprO•MO fin stmomn!n Ian: 'T'ype of pfttlect(required): t. .aaar..,otivkqn with r4 ......4............0„,,,..0,gt antVorrat.sitn4.*1 7. 0 Now(.ahlaret.letitvtt lit.i... t orn.o wk.paqtritnxi•nt initinmbin,sollisssvz nes staspioym vilichilv tar no.:io IL ri Remodeling b.m.y z,ztogily.i's.•Ne workein`onto.irMititniV tegaioaQ 9, E,,I Demolition 1E1 i zit 8.izonztvvious-doing;tii>Ault sizyia.qt. 11..6 wiN.4;.rsi:`eintr.'mum=axpnteiiii 1 1:1 rj Badding addition Aritirrs.r.:waioavitier and wilt kv•kiting s.-ni•nsw.tianr§o oontiott 8£i wink ott ttt•Invite:1y. I wilt L,...1 ' V...8iikt 68.t a tonthk:sor8 Atha Iwo worloox'on8tix:iiontiott insiotonix xe on •i.xin 1 .0 Elechical reimits or additions witpriinsii8 with tS0 er.100,4:41.$. i 20 Pio Mg ix-pairs or add:dims Nfl i ama gawk}imaracter arta 1 1....we i.litta:lit ialb-e.c'xita,a\kni Will os tin ottotittx>Age. 1:1t -,,. ixsisvpilipx — Th.,.,:,,t wia.,,x.tue.t6ri ht„„titipirsyiiiA2M iiVi4 Wattets,t‘tiiirsp.if...4.iinkiliX. b,..—.$ 14.I—ID:titer .•1".1 W., , • • ft '''4.1.'"."Ise•••• • .. • I t1W. ' ke•f• • ' w VC' • sAV:4,1..zi Jaz.ft:4 Ski'M.., .r..::c . .1..,i.V.ir...M.•$. f2 Cii$ ..› Vs.t.tir.,Ska N.... is.k.. 1,11,§U4..and we 118,,,e nil esntioyeex iNe*oda&vsanp.io.sittameiequitatil .„ L.,....„...., thii77114:oks box 3a8 itZ1:Zfig oat It*.wsiox beio187;iWiTttlICin en-Am'xnentt8Zslioa‘0.....fiey•..s.,:distkatkxl. 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Site,Address: I(--f m 0.(4, (.-ztn..c. city:Rattail,:tkv p(t‘pckyytyh?mtPyr Attach a copy of*1st worter 'I.Vill lithii£41 policy deelartHion page(showing the polk.,y number and expiration date), Faikee lo goetae coverage as nautirtA under:VIOL it. 152,f 23A i„s a criminal violation puilishabIo by a fine tip to 5.1,500.00 aialto r ow.-year inqtrisonment,as.well as civil penalties in the form of a STOP WORK ORM aad a fine of up to day aping the violator.A‘...-opy of this.statement nray be forwarded to the Mee of haw:4406(31u of the 1)11A for insurance eoverage vorificatien, Ida&reit,reify),tt der the pain*hod pettatties tb i rperjory that the ittjOrnuthott posith4 above it tree oh 4'come e.t. ' • ..C. - / 7— Y Phone ft; 1 1 4( i;7 e3 I ) MT Cid itte only, flo rwi*rile in this amo,to he tootplemi 4 aty or town offictoi City or Towirft: Pertnisil.itewse# 'suing Authority(circle one): I.Board of iitaltil 2.Btliitthig DipArtnitt1.1 3.Cityttown Clerk 4.Elearkal Inapt *or 5 !loathing Inspector 6>Other • Contact Person: Phone 4: . . . City of Northampton ,S ,Za. c,� ski; �, �. •yt, Massachusetts `ec� , ` DEPARTMENT OF BUILDING INSPECTIONS i �e� 11 212 Main Street • Municipal Building W$ •, ., Northampton, MA 01060 •.s i 4:?' 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: !°7 Cr grit keg • AL /LA The debris will be transported by: Name of Hauler: $eI,Jl c., elvS 1, ori, I Signature of Applicant: 7 Date: / / Licensee Details Demographic Information Full Name: BRADFORD P STOWELL Owner Name: Licensie,Address Information City: Worcester State: MA Zipcode: 01606 Country: United States License Information License No: CS-039566 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 9/26/2023 Issue Date: 9/20/2011 Expiration Date: 9/20/2025 License Status: Active Today's Date: 9/26/2023 Secondary License Type: Doing Business As: Status Change Reason: License Renewal Prerequisite information i No Prerequisite Information E No Available Documents } .;•.'/'J%:::% :F'/. 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CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YVYY) 06/15/2023 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 NAME: Monica Swaida MONICA INSURANCE AGENCY INC PHONE (A/C,No,Exp: (978)454-2577 FAX No) E-MAIL monicainsurancel@aol.com ADDRESS: 11 V I L L ST Suite 2 INSURER(S)AFFORDING COVERAGE NAIC n LOWELL MA 0185? INSURER A: PENNSYLVANIA MANUFACTURERS ASSOC INS I 12262 INSURED INSURER B: AGELESS CONSTRUCTION INC INSURERC: INSURER D: _ 676 STEVENS ST INSURERE: MARLBOROUGH MA 01752 INSURERF: COVERAGES CERTIFICATE NUMBER: 903279 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. INBR TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LIMBS LTR INSD WVD POLICY NUMBER (MMIDDNYYY) IMMIDDIYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S __ DAMAGE TO RANTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) S N/A PERSONAL&ADV INJURY S GEM.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY n JECa LOC PRODUCTS.COMP/OP AGG S OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ea acadenl) ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS N/A BODILY INJURY(Per accident) S ~ HIRED ^ NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Pet accldentl S UMBRELLALIAB _ OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE NIA AGGREGATE S DED RETENTIONS $ WORKERS COMPENSATION X PSTER I ERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT S 1,000,000 A OFFICER/MEMBEREXCLUDED? 11 WA WA NIA WCMA000092503 06/18/2023 06/18/2024 --- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 It yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached rt more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN GM PROPERTIES LLC ACCORDANCE WITH THE POLICY PROVISIONS. 347 CHANDLER ST AUTHORIZED REPRESENTATIVE WORCESTER MA 01602 Daniel M.CroHvl;ey,CPCU,Vice President-Residual Market-WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AC>it..)wL5 CERTIFICATE OF LIABILITY INSURANCE DATE citiMfOot YYY) 88125123 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. it 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 t9 hts to the certificate holder in lieu of such endorsements. PRODUCER CM At, »» NAME: .__.._ MONICA INSURANCE AGENCY Vag oss), 078 -2577 FAX 9780441-iZ82 19 Mill St ORli: monlcainsuranceltttaoLcam Lowell, MA 01862 IRSJREt(RAFFORIN3 O COVERAGE MAIL S INSURER A: ATLANTIC CASUALTY INS CO _._..».. INSURER 8: _ AGELESS CONSTRUCTION INC INsuRERc: 676 STEVENS ST INSURER 0: MARLBORO MA 01752 ennnamF: _ ». I etsul F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS ES TO CERTIFY THAT NE POLICIES OF ENSURAt'JCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM CR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VCTTH RESPECT TO WHICH THIS CERTIFICATE MAY SE £SSI!ED OR MAY PERTAIN; THE INSURANCE AFFORDED SY THE POLICIES DESC R BED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDmO.N8 OF SUCH POLICIES.UMITS SHOWN MAY HAVE.BEEN REDUCED 3Y PAID CLAIMS. AM$A' RISIi1:ST:f33. PDIECS$RF • POUCYEh i I:. TYPE or te$tuRANCE usa BIT POLICY NUMBER ilaxfyYYYY;jag��iXXl; LIMNS X 1 COMMERCIAL GENERAL L3ABILDY I i EACit OCCURRENCE It 1,00%000 £YAN•f 8i f0 PF7d°Kit I CLAIMS—MADE X CA^n:UR i PREAE,45 as sco e+vviL 1$ 10%000 --1i MED EXP(A^t area 0>sn^) $ 5,000 A _...,j E.307002723 06116122 06116123 }t'E:rx'v:NJR:&Anct WAY t.$ 1,000,000 OVA AGGREGATE L IMIT ARIAS PER: i GENERAL,AGGREGATE i$ 2.000>000 PQt.:CY f i e cT I OC PRODUCTS-COL PIOPAO:3 a$ —22„000,000 OTHER: $ AtITOMOatLE L.kefl.Yr » �,u�uslvtu SltlO:.I::.IMB' $ --, ... AGV AUTOAUTOi30D8Lr,cEY INJURY( c") $ ----.CiVNED : ;SCI-EDLiLED 3ODt:Y INJURY tsar Ustitifir4$ t0.OS f ONLY ?—i ANiX+t CYe�TJ=D PROPERTY DAMAGE AUTOS SNRY i. ... Airtos ONLY 3 8 s --- i _....».» S U$SSR.E LlA(ERA I S UCCLJR 1 5*01e OCJ.,i:t3 OX1.c $ FXCr.$$13A13 i C 9S-MACIE A3CiREGATE $ • :DEO r RETENTION $ wots es COMPENSATOR :PER : 004. ARO4I PLCYelorLASH-TY Y13t iI -�3A.V.E i —. AtrdPROPR•nT::rd'AR11lrR•EXEMTwa r : N. t .E_i,EACRACCIDENT - $ 0 P1C5RR4rM33ER XC :eno? i '" tt�tran tsfory n N*I • , E,i..3ISFRSE-EA EMPLOYEE$ :t l tS,6c:be:vim wxMr »»» DI<&iRiP110M OF OPERATIONS he•Tm E.L.DISEASE_PoucY:j*' $ i 1 DESCROTION OF OPERATION8I LOCATIONS i VEHICLES(ACMES ICI.AdsJJ3nna3 Rsisserta Schasieeto.may Lw sttact os3 N m:xx sps,*La:squints) REMODELING AND ROOFING CERTIFICATE HOLDER CANCELLATION —I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE GM PROPERTIES LLC THE EXPIRATION DATE THEREOF, EOOTECE WILL SE DELIVERED IN ACCORDANCE WITH THE PoWty PROVISIONS. 347 CHANDLER ST i WORCESTER MA 01602 ARTtlORLTED REPRESENTAT:YE !I : I » ," .)1988-2015 ACORO CORPORATION. All rights resented. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD