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38D-013
BP-2024-0926 26 CHARLES ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38D-013-001 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-2024-0926 PERMISSION IS HEREBY GRANTED TO: Project# 2024 WINDOWS Contractor: License: Est. Cost: 0 MATTHEW FABRY 118003 Const.Class: • Exp.Date: 12/20/2026 Use Group: Owner: WOOD ROESSLER MARK M&HAYLEY Lot Size (sq.ft.) Zoning: URB Applicant: ROOTS CONSTRUCTION LLC Applicant Address Phone: Insurance: 98 PLAIN ST (413)667-7424 ROWC579433 EASTHAMPTON, MA 01027 ISSUED ON: 07/22/2024 TO PERFORM THE FOLLOWING WORK: REPLACE 21 WINDOWS 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: $60.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner The Commonwealth of Massachusetts • Board of Building Regulations and Standards FOR Massachusetts State Building Code, 780 CMR MUNICIPALITY USE o Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011 A One-or Two-Family Dwelling This Section For Official Use Only BuildingPermit Number 3P—202g-oct Date Applied: //%�- 7 Z7 7, Building Official(Prim Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 2& ChArles ST 3 h -61,E- o° 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Uf23 ,2_3��-� 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.40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private❑ Zone. — Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 4y(c y W 0012 //o t1i4,01-(Y1 M v, b 6)6 Name(Print) City,State,ZIP 26 C I4 S4t". 'l It/3 — 570 4307 ilegi'LWOec e9MAc',CoM No.and Street Telephone Email Address SECTION 3:DESCRIPT ON OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 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: Rep/196e 2.1 !fI Ad1acvs LJI ti ete L✓ ,*f s u Fay -= 2-7 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: 2.Electrical $ CIStandard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (1-IVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $6 a r ^ Check No/Ns Check Amoun �. Cash Amount: 6.Total Project Cost: $ �0vw, !1() 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) /T gU43 /Z/ Zv/2 L ,/1/4 e- , (Z(C/I4KO Fr4/. Z)< License Number Expiration Date Name of CSL Holder U List CSL Type(see below) No.and Street Type Description FA-S� Yh /1 t.A1 A o Id 2 7 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 ` '-if 3)662-75/Zy 4X-414014I Ng yM,.)1.eo, I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 'L $�'J-r 6 3 Zv goofsn i'/' rv�S 'l C & HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name C] PM-in c4 gootSCan5frac-4'k-'n 9,360 /•Cv"'► No.and Street /� Email address ernitw ;A4 4 o i 027 (-030 7-7471Z 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 Iqr No .O 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 /4,7045 Cc.)/1 Sfr ch'cy1 L L C to act on my behalf,in all matters relative to work authorized by this building permit application. Ay/ea,/ Diva 7//V/Z( P mt Ow er's N e(Electronic Signature) ate 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. /1'141`4Cf J�Al3/Z 7�/Z/ZV Print Owner's or Authorized Agent's Name(Electronic Signature) e 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.cov/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 i'= , 1 tl Department of Industrial Accidents i 1 Congress Street,Suite 100 ►= - Boston. MA 02114-2017 +,,:ii wwx:mass.gol/dia 11„rkers'Compensation insurance Aflidasit: BuildersJ('ontractors/Eketricians/Plumbers. TO BE FILED N I I li I HE I'k:RNII I I I\t;.'tl I HORIII'. Aptilicant information Please Print Lreibls Name I liusane Or anitation Individual): Address: f g P/A"4 5 f City''State/Zip: 4i9S24 leif. Ww E.7 Phone#: '/l3 — 66 7-7yzr tic sou an employer?Cttieek the appropriate bean: Y),pe of project(required): i 70/1/arn a employer with 2._, employees(full andl'ar part-tins).• 7. CI New construction '0 I am a sole proprietor or partnership and hate no employees working for me in 8. 0 Remodeling any capacity.[No wurken'comp.insurance roquuat.p ;.a I an svw d a tunt net doing all work myself [No workers'critic.ubotaner required]' 9. ❑Demolition 10 O Building addition 4 El 1 am a hwmeuw net and a ill be hiring contractor,to conduct all work on my property. I a ill ensure that all corm:utora either hate workers'compensation insurance or are sole 11.O Electrical repairs or additions proprietors w ith no employees. 12.0 Plumbing repairs or additions ,..EI I airs a general contractor and 1 but a hired the sub-contractors listed on the attached abee9_ i 30 Roof repairs so These b-contractors hare employees and hate worker,'comp-insurance 'P " � 14.VOther foot elde•CcJ 6.0 we arc a corporation and its officer,hare ex.:m sed their Hybl of cxempltom per MGL c. I c2_.;114I.and we hate no rmployecs.[No workers'comp Insurance required.) 2<f)�/3-( 'Any applicant that checks box al must also till out the section below showing then worker.'compensation policy information- ' I lona:0a run w too submit this affidavit indicating they are doing all w ork and then hire outside contractors must submit a new affidavit indicating suck 't untractors that check this hot must attached an addttiorul sheet show mg the name of the sub-contractoes and state whether or not those entities hate employees, lithe sub-contractors lase cntclo!recs.they must pros ide their worker'crimp policy number_ I am an employer that is providing worAers'compensation insurance for my employees. Below is the policy and job.site information. Insurance Company Name: 5(/Z.kSirre.e._ t -_-- - --- — Policy#or Self-ins.Lie.#: e7U) C 5 7'y 3 3 / Expiration Date: ////2S— Job Site Address: 46 CLIAr/-es 57 Ci1y StateiZip: f /`1/04 6 4 4- vl o6 a Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under IMGL c. 152,§25A is a criminal violation punishable by a fine up to S1.500.00 and/or one-year imprisonmtnnt,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 Inse.tigations of the DIA for insurance cot crage verification. I do hereby certif..under the pains and penalties of perjury that the information provideedd above is true and correct. Signature Dote ///2e- Phone#: 1-#3— 6 7 7 - Zy Official use only. Do not write in this area.to he completed by city or town official ('its or Town: Permit/License# Issuing.tuthorits lcircle one): I. Board of Health 2. Building Ikpartment 3.( its/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other ( ontact Person: Phone#: AoRCP CERTIFICATE OF LIABILITY INSURANCE DATE(MAVDD✓YYVY) 7.'19'2024 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 LONTALT NAME: Jessie Tatro Dale A.Drank Insurance Agency Inc (q/c p p ): (413)665-8324 FAx No): E-mAn. 2 Amherst Road ADDRESS: Jessweumcrrankinsurancc.com BISURIR(8)AFFORDING COVERAGE NAIC Sunderland MA 01 17 c INSURER A: MAIN ST AMER ASSUR CO 29939 INSURED INSURER B: Berkshire Hathaway Direct Insurance Company 10391 Roots Construction LLC INSURER C: vs PLAIN ST INSURER D: INSURER E: EASTHAMPTON MA 01027-2512 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. INSRLTR TYPE OF INSURANCE AUULaDtlli POLICY tFF POLICY XPt INSD wvo POLICY NUMBER (MWDD/YYYY) (MWDO✓YYYY) LIMITS X COMMERCIAL GENERAL LIABILnY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 500,000 MED EXP(My one person) $ 10,000 A MPJ4855Q 04/13/2024 04/13/2025 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 X POLICY JEtT LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER AUTOMOBILE UABILITY C.OMSINEU SINGLE LIMI f $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY UAMAGE AUTOS ONLY AUTOS ONLY (Per accident) S UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTION$ S WORKERS COMPENSATION PER Utt+ AND EMPLOYERS' ABILITY STATUTE ER LI ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L EACH ACCIDENT S 100,000 B OFFICER/MEMBER EXCLUDED? n N/A ROWC579433 05/11/2024 05/11/2025 (Mandatory In NH) E L DISEASE-EA EMPLOYEE $ 100,000 If yes describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ 500,000 XINMR A INMRC MPJ4855Q 04/13/2024 04/13/2025 Tools 10,000 MSIME 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 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DEUVERED IN ••••FOR INFORMATIONAL PURPOSES ONLY ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD City of Northampton p "6 L. Massachusetts w?. -b.- !ee ' .1 ! a • DEPARTMENT OF BUILDING INSPECTIONS � ,� : ..'X -'i r/ 212 Main Street • Municipal Building SJ ct. ! Y,r_ate Northampton, MA 01060 .r4Y. `,‘o 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./)- I( C X le, CYC`'u! Location of Facility: 2 14 EA-5112W%, st /t' 4-A i ,rM old ca The debris will be transported by: Name of Hauler: nZPZs [ t S/ T1d 41 l L t ( Signature of Applicant:( 4frie(-1 Date: �Z /