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38B-174 (3) BP-2024-0838 192 SOUTH ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-174-001 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-2024-0838 PERMISSION IS HEREBY GRANTED TO: Project# REN BATH/ADD RAMP 2024 Contractor: License: Est. Cost: 49900 MICHAEL POWELL 093015 Const.Class: Exp.Date: 10/31/2025 Use Group: Owner: BYRNES PATRICIA C Lot Size (sq.ft.) Zoning: URB Applicant: MICHAEL POWELL Applicant Address Phone: insurance: 149 POMEROY LANE (413)374-0963 WC5-315-619610-013 AMHERST, MA 01002 ISSUED ON: 07/03/2024 TO PERFORM THE FOLLOWING WORK: RENO BATH AND ADD TEMP RAMP 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: (:72. Fees Paid: $374.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner R, a'i,ii / vt.- i/E*C osx4461 c° '''' �, 'The Commonwealth of Massach i settiiri JUL Board of Building Regulations and .tan• I "OR V1Massachusetts State Building Code 7895 US ALITY Building Permit Application To Construct, Repair,, prof ona .. Revi.'d Mar 2011 One-or Two-Family Dwelling T°N•MAoo This Section For Official Use Only Building Permit Number: 3I 21„, y31 Date Applied: -.2 g-Viii4Z) / 7- 3-may Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers i41 s.v-14, s�-rt.0 + 11 a ,i If - 60 ( 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Ref Z, 3s4 Zoning District Proposed Use Lot Area(sq 11) 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❑ Private❑ Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ _ SECTION 2: PROPERTY OWNERSHIP' 2.1 ( wner'of Record: Parr c :i. C. B y F. ni) 11 a Sv1-.1i SIB /14,14.7 ,m4 6/c,id Name(Print) City State,ZIP if-2 So 41 S ('to)Scf 71f0 pki y rn e5 a e gmuz.«-1► 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) ID' Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: /✓P t.✓ QA , �.t1dAL'�-t'S �D[" Qt et 5, - ^rIr4(019 r 4tiewip SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 3 1. q • ^ 1. Building Permit Fee:$ Indicate how fee is determined: 2. Electrical $ y. e . s ClStandard City/Town Application Fee Cl Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 6, 2. Other Fees: $ 4. Mechanical (I-IVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fces � Check No.`r Check Amount:2 Cash Amount: 6.Total Project Cost: $ y 9, I Q O Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Constructions Supervisor License(CSL) CS 09 30 J /D-3 1-)6 a M: c a.t / Poi"(e G/ License Number Expiration Date Name of CSL Holder ' 7List CSL Type(see below) p iyne,,uy L,i,,,,, No.and Street Type Description J N-r) k 44 5 4- A A,¢ 0 -L Q Unrestricted(Buildings up to 35,000 Cu. ft.) City/Town. State,ZIPV V Q c a R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering - WS Window and Siding SF Solid Fuel Burning Appliances / /3 Y- J__ A4MieN 1 i Pijr" I Insulation Telephone Email address D Demolition 5.2,/Registered Ho Improvement Contractor(HIC) i 7 0 s/ 5" 2-2 C- ?e /V(/ owe GI 15 HIC Registration Number Expiration Date HIC Company Name or HICRegistrant Name �l�L NhandS+t_Po-L6 / M /VIA00WVI/fT #J ` t-n n•fie! ) i '" 4 1 010, 1 l00Z (iton...07,j Mail address 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 Nr No .0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,is Owner of the subject property,hereby authorize M I C ka t 1 M. povie t i to'act on my bchall in all matters relative to work authoriz by this , . ',Ig permit application. e1VL ,A G . j'1 f &s 5 6,,,, i6� jv� I 2 Y Zp Print Owners 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. M„o,. .( P° r1( lr2' fR )-i---7 1�LI to ly Print Owner's or Authorized Agent' ame(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 half7baths 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" 398-079-001 / / eLS 388-078001 vv�/ 38B 160-00t �� J /SO hb " T VSTEP Enos 46) / 368 1/400t fief • 38B-175-001 3®-176-001 38B-186-001 3*B-1n-0o, 007' :01J 8 Tphe6 e... 4 192 South Street 6/16/2024 9:30:36 PM .f --� Scale: 1"=20' Scale is approximate "'`ir The information depicted on this map is for planning purposes only. It is not adequate for legal boundary definition,regulatory interpretation,or parcel-level analyses. 'co_ So•v 44n S' • C3,lc, @ 3) -36 kq 4' h445 New 6e4 ' 4 CeC4err) �,6" 1 6 oX� - - h t P S if 3a y CuS►. • . 7 .Tp l• 1i Gam.'r I -I, rr- .__ -jai.r• 4 �y ;1 / i tom/ • . ..„Pcs.r:41. - I "77 47)da k _P6., - e 2 po►c tk T=I cs o r �`—__� Powell Family Home Improvement,Inc. it i Michael M.Powell.Builder,Designer,CS p i CSL#093015 HIC#170515 C t 157 Pomeroy Lane,Amherst Ma 01002 l' f 1 1 ' b T t_ - S 4 -- -- T.P.Mpor4r* is-yl z r.c t G r le z r k c-,iih.or tio.,l f . Y Rip e.J94 prr,kc*'fi Ow lr400, 141.,d xi?'ed.rk.,,s;w, • n k YCarg, 1 JW,.G,1g S ov:s hay )r 3or Ia..del r Cray, j... _ r � : V41 IM ,�OA h _`'P""i^ o.rCyys __ , sjmpiona it: reltr., ,rife -Its' Z,r 1. �. _ ga. ' r r Cb�stc•4A✓r, , n Tr 0eau:,' . • Powell Family Home Improvement,Inc. Michael M.Powell,Builder,Designer,CS CSL#093015 HIC#170515 • 157 Pomeroy Lane,Amherst Ma 01002 • '\ C,ILAA-70\J v(3-1/0(4 -ktio J06.v•kr-et kiQ).Hill 3 Q-7 4 I a6uw! . . . JP • • ,-.-,•4,4 t .• • •;,,,..„ / :. . . , ••• 4. Is i-iod . . i - ls tioA ,... ... . ! f .. 1.• 44. 10 % .4. ilk 464. •-. 441., " ile i _ i. IGO . ... . i ..i.:...... , • . -. " L :;•.-").:..-. ' ‘41 . _......-____---------- , ar __....,—.„... 4 __._ _............--- al , _ . -------- , - • 41 _-........----^ 4- .............:.--4.---— . . -t .-. . ! :. . , . .. ..._— ' ti: i. i . ..........._ .4.010104 ....-- ,. , . ..., t• rm ..: ., ., ... _. . • .,4.1 „. I••,1; ID_if ...... ..._ ...,.. ,........ _ . _ -} ••.• ...., --_-___ _____ , 1, /ail Jill -- lied Loi• _.... III 111 • ,.., — -•••, Mk , *'` ` . iiMmuminiallInii ___ _ . -'-'..•',.,, ''.. — _ _ • . .':.- , ..------ __ - -..„,..._. ..... ________. : / 1 /.....-- . , — .. . . . - soleIS PaPufl'CzOt, _-- if' X -09010 V1N‘uolduiewoN Is Ilinos !--,.. _,.„------- •, ,..„----- : i . , / , _ • ., • ....0 .,• . . i ,, . ... City of Northampton Massachusetts ��? �_ c� t ,. , r 1 I DEPARTMENT OF BUILDING INSPECTIONS y� 212 Main Street • Municipal Building O _ .Cam `y� Northampton, MA 01060 '"sy ......W. 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: V 7 ) Gt S 4 .( Rr G l( , ''`/ 77 (A)e , t S.V . f-t'ttd J o , Pgf The debris will be transported by: Name of Hauler: V .cA W + çLe Signature of Applicant: , Date: li I‘,6) I 1 Zo d2 9 r . Commonwealth of Massachusetts .0. Division of Professional Licensure Board of Building Regulations and Standards Cons r t*iLAiipe.rvisor CS-093015 1,; Expires: 10/31/2023 MICHAEL M POWELL ,, !. , 1_ . . 149 POMEROY LANE .r; AMHERST MA1�01002 !..11% l'y 'C , Commissioner a 1. b�cmclL& AFRO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 03/14/2024 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 Samantha Babilonia NAME: Alera Group.Inc. HONE Extl: (413)586-0111 FAX(A X,No): (413)586-6481 N8 North King Street EILSS: samantha babilonia©aleragroup.corn A-MADDRE INSURER(S)AFFORDING COVERAGE NAICU Northampton MA 01060 INSURER A: Main Street America Assurance Company 29939 INSURED INSURER e: Liberty Mutual WC Assigned Risk Michael Powell INSURER C: 149 Pomeroy Lane INSURER D: INSURER E: Amherst MA 01002-2908 INSURER F: COVERAGES CERTIFICATE NUMBER: Updated Master:2023-2024 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 ADDL SUBR POLICY NUMBERPOLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DDIYYYY) (MMIDD(YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X DAMAGE TO RENTED 500,000 PREMISES tEa occurrence) S MED EXP(Any one person) S 10,000 A MP087548 11/10/2023 11/102024 PERSONAL SADVINJURY S t,000.000 GEN'LAGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE S 2.000.000 POLICY n JE n LOC PRODUCTS-COMP/OP AGG S 2.000.000 OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY __, AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY .—� AUTOS ONLY (Per acodent) S UMBRELLA LIAR OCCUR EACH OCCURRENCE S —^ EXCESS LIAR CLAIMS-MADE AGGREGATE S DED RETENTION S S t WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN 100,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA WC531 S619610013 07/27/2023 07/27/2024 E L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED (Mandatory In NH) E L.DISEASE-EA EMPLOYEE S 100,000 It yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS I 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 Greenfield Savings Bank ISAOA/ATIMA ACCORDANCE WITH THE POLICY PROVISIONS. P.O Box 3024 AUTHORIZED REPRESENTATIVE Coppell TX 75019 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of 1 fassachusetts Jo.sue` l Department of Industrial Accidents 1= 1 Congress Street,Suite 100 tree kV: 6 Boston, MA 02114-2017 www.mass.gor/dia 1lutkers'Compensation Insurance Affidavit: Builders/('ontractors/Ekctricians/t'lumbwrs. 10 BE TILED 1%I III I llE PERM!11 IM: 1U f11ORl h1. olicant Information /'` Please Print I.eiihh ne Name lBusiss.Organtz.tion'IndividuaiI:A c ( pfiw`r YI . Address: 1 / 1)0/vv cry o_vj ,tom City/State/Zip:" rl' S}J AAA at oc1 Phone#( i 1�� 3 7'1 0 91 3 ► Are inn an amrpluer?("►eck the appropriate)sees: Type of project(required): t.®I am a employer with —Z- employees(furl andiur part-tines).• 7. 0 New construction 20 i am a sole proprietor or partnership and have nu empluvits wutking for me in M. a'Retno deling any capacity.[No wurken'comp.insurance required] 30 I am a h ineowner doing all work myself.(No wurkets'comp insurance n quuerl 1' 9. El Demolition I0 Q Building addition 4.0 I am a homeowner and will be hiring cvnttucton to conduct all work on my property. I will ensure that all c nuractiurs tither have workers'compensation insurance or are sole I I.0 Electrical repairs or additions proprietors with no employees. 12.[3 Plumbing repairs or additions 50 I am a general contractor and I law c hued the sub-contractors lisle)on the attached sheet. 13 a Roof repairs These sub-contractors have employees and hay a workers'comp.insurance.: 6.0 Vic an:a eorpvrratiem and its officers have exercised their ngM of exemption pa4K.l.c. 14.0(Mier I'2.11141.and we have no etripluytes.)Nn workers'coup.insurance required.) 'Any apphrant that cheeks box PI meat also fill out the section below showing their workers'compensation policy information. +Iloineowrwrs who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this bus must attaebed an additional sheet showing the name of the sub-contractors and state whether or riot those entities rwv e emnployee-s. If fly;sub-euatractaxs have employees.they must prwv isle their wumken"heap_policy number_ l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. r _ Insurance Company Name:l.-b �(L4')&1 .3_(// 1G 4- Policy#or Self-ins.Lic.#: 14.)G5--3 1 5-6 i q6/0 013 Expiration Date: 7—a 1— 2 Q. Y Job Site Address: 14 1 SO',)41 S T, City/State/Zip:/e'•r K► ft/Il f )/Q60 Attach a cope of the workers'compensation police declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152.*25A is a criminal violation punishable by a tine up to S 1,500.00 and'or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine 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. I do hereby certify under the pain and penalties of perjury that the information provided above is true and correct Signature: Date) { 2 a, y Phone#: 1fl3 ) 374(- 04 t 3 Official use only. Do not write'in this area, to he completed by city or town official (-it v or Tow n: i'ermit license 4 Issuing.Authorit) (circle one): I. Board of Ilealth 2. Building Department 3.Cite i'ovsn Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone 4: WORKERS COMPENSATION AND EMPLOYERS LIABILITY ;02 INSURANCE POLICY 'WI(Liberty Mutual. INSURANCE AR INFORMATION PAGE ns Brawls.,e...I Soaon,IAAYti1• Issued by TM INSURANCE CORPORATION 27243 Policy Number WC5-31S-619610-013 Issuing Office 016C RENEWAL OF: WC5-31S-619610-012 Issue Dale 06-26-23 Account Number 1-619610 Sub Account 0000 1. Insured and Mailing Address MICHAEL POWELL DBA POWELL FAMILY HOME IMPROVEMENT RISK ID 000026275 149 POMEROY LANE. AMHERST,MA 01002 Status 01 - INDIVIDUAL Other workplaces not shown above: SEE ITEM 4.PREMIUM-EXTENSION OF INFORMATION PAGE 2. Policy Period:The policy period is from 07-27-2023 to 07-27-2024 12:01 A.M.standard time at the Insured's mailing address. 3. Coverage A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance:Part Two of the policy applies to work in each state listed In Item 3.A. The limits of our liability under Part Two we: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance:Part Three of the policy applies to the slates.if any,listed here. SEE END WC 20 03 06B D. This policy Includes these endorsements end schedules: SEE EXTENSION OF INFORMATION PAGE 4. Premium: The premium for this policy will be determined by our Manuals of Rules,Classifications,Rates and Rating Plans. All information required below is subject to verification and change by audit. Code Premium Bass Total Rate per$100 Estimated Annus/ Classifications Number Estimated Annual Remuneration of Remuneration Premium See Extension of Information Page Mnimum Premium $ 500 (MA) Total Estimated Annual Premium$ 10,998 Premium will be billed ANNUAL Producer 0004-132151 ALMA GROUP INC 8 N KING ST STE 1 NORTHAMPTON MA 01060-1151 WC 00 00 01 A 01967 National Council on Compensation Insurance,Inc. WC 00 00 01 B(CA) Ed.07/01/2011 All Rights Reserved Page 1 of I