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23A-005 (15) BP-2024-1189 36 MEADOW ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23A-005-001 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-2024-1189 PERMISSION IS HEREBY GRANTED TO: Project# TEMP TRAILER Contractor: License: Est.Cost: 24000 AMERICAN MOBILE HOMES INC 081119 Const.Class: Exp.Date: 06/18/2025 Use Group: Owner: PATRICIA KYLE, Lot Size (sq.ft.) Zoning: URB Applicant: AMERICAN MOBILE HOMES INC Applicant Address Phone: Insurance: 51 MOORE RD (781)331-0333 WCC-500-5022645 EAST WEYMOUTH, MA 02189 ISSUED ON: 09/12/2024 TO PERFORM THE FOLLOWING WORK: TEMP MOBILE HOME DUE TO FIRE 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: fffr, Fees Paid: $75.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner �-'n1Gt i 1 sE�' 2 REc, r------_„LL,:,---5- The Commonwealth of Massachuset 2024 Board of Building Regulations and Stan rdsnF'?of nvi I IOPA ITY h�o tn�,i Massachusetts State Building Code, 780 CMrNa.t�,,Torw�r"• �� FCTION SE Building Permit Application To Construct, Repair, Renovate Or Demolish a a°1 b0' d Ma 2011 One-or Two-Family Dwelling !� This S c ion For Official Use Only Building Permit Number: 6�'�'7' it f Date Applied: /Zvi.-)4 /l& 61'1Z-70zy Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 1S4, tr1424PJ 5 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: pa -Ti t c a Ky l 4 d�I d r'eN. l4,4.,,`ro,.� vn n. 44136,& me(Print) ity,State,ZIP aCe P1 c.ocid,0 s r sos- q 7'1-Ca4-1 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) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other �Specify:_'r-e015 Alp jv14 t& Brief Description of Proposed Work': +'a 4 t 4.. 1L(#V t — ' N+043Lt,4 likes-C. Li't NA'e FQ4- ll!r) 4,1--CN 7 c 4t.!€ TJ ,Fk/t f. c A*' A.ICE-E t-ks."64-- SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ ou. 660---- 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ i G GL ._ 0 Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ A — 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No.3t)�theck Amoun1:11/16 Cash Amount: 6.Total Project Cost: $ 02`'1 060 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) gilil l�ak. G4(2 R ,/` License Number Expiration ate Name of CSL Holder List CSL Type(see below) R A & ` Type Description No.o.and Street Street U Unrestricted(Buildings up to 35,000 cu.ft.) LE iJki 0 of t-t wt/1 6 a ( R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 7 " (. 53 i. 633 S I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) I 4 /-l � ra6 .2� -I �1-1141. C M t'- - M d b i 6 p"e S HIC Registration Number Expiratio Date Company Name or HIC Registrant Name ^ • �t M n614- - Ae lc(...8/4r-t do(.4-1 I1OSE,14 t+)►n 5 No.and Street Email address F , ,i-' .i v-l( �l 7Vl -,3c-4,353 - CO✓'A- 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 8"-- No 0 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 to act on my behalf,in all matters relative to work authorized by this building permit application. 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. W LI `A^" C?�'t`ltk.l ,l TbliZY 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 3. "Total Project Square Footage"may be substituted for"Total Project Cost" I HE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Supplement Card Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 106386 07/22/2026 Boston,MA 02118 AMERICAN MOBILE HOMES INC. WILLIAM GARRITY 51 MOORE RD J ' 4/✓!//,,4'1- ��",�' �_ E.WEYMOUTH,MA 02189 Undersecretary Not acid without signature U Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards Constructio i'ipenrh�gr..1 & 2 Family CSFA-081119 i pires:06/18/2025 WILLIA25KIMMJ -BEACH 25 KIMBALL BEACH RD HINGHAM MA:02043 ...; ri,,15111 Commissioner The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 wow mass.go4'/dia 11inkers' Compensation Insurance Affidavit:Builders]('ontractorsIElectriciansfPlumbers. 14)HE FILED WITH.[HE I'ERMIITINC A(THORI'1'f. Applicant Information i Please Print Le�tibly Name Il3usincsslthganizatiun''Individual):�/'t L,'t Y''7O •7l 4 / f Address: 5 t ?v dam tl-Z City/State/Zip: �LJvy P- GLt g, Phone#: 7 1 -3 3 t'-43 3 33 — Are you au employer?('Peek the appropriate hay Type of project(required): 1.041n a emplawx with 1.L employees(full anikor part-time]_• 7_ 0 New construction 2.10 I am a sole propnetur or partnership and hav c no employees working for me in 8. Q Remodeling any capacity.No workers'comp.insurance nxlurred.l 30 I am a homeowner doing all work myself.iNo workers'cony_insurance it -j' 9. ❑Demolition ne 4.01 ant a hurntuuw ter and will be hiring contractors to conduct all work un my property. 1 will 10 0 Building addition moon:that all cwntrteturs either hate workers'co mprasrtrun insurance or arc sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 51 I ant a emend contractor and I have hired the sub-contractors listed un the attached sheet. 13.0( '"i Roof repairs These sub-contracture es have employe and have workers'comp.insurance.: 6.0 We are a commotion and its officers have exercised their nght of exemption per MUI..c. 14.a O[]ter 152.§t(41.and we have no employees.[No workers'cutup.insurance required.] 'Any applicant that checks box a I must also fill out the section below showing their workers'compensation policy information. +Homeowners who submit this aft-tda%it indicating they arc doing all work and then hue outside contractors must subnut a new affidas it indicating such. C'untruetors that check this box must attached an additional sheet show ing the mime of the sub-contractors and state w hotter or nut those entities lave employees. lithe sub-contractors hate errgslu)Lccs.prey must pro%idc their workers'comp.pulley number. i am an employer that i_s providing Workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AS5O1/4. — ".11.)/oy<r /S �-' 0 Policy#or Self-ins.Lic.#:Vet. COO 5 b.1L Log��Z d.1� Expiration Date: (14 q.t. Job Site Address: V(e P&(4c4 5 t City,State+Zip:NOr V-ist.n(� deg.2- Attach a copy of the workers'compensation policy 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 fine up to S1.500.00 andror one-year imprisonment.as well as civil penalties in the form of a 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. I do hereby eertif i' the the pains and penalties of perjurr that the information provided above is true and correct. Sit:mature; ` K� /`� Date'_ q//2. / Phone#: � ` 3 l'-0�3 3 Official use only. Do not write in this area.to he completed by city or town ofic-ial_ City or'I'oss n: Permit/License!f Issuing Authuritr "circle cue): I. Board of Health 2.Building Department 3.('its Town Clerk 4.Electrical Inspector g. Plumbing Inspector b.Other Contact Person: Phone#: AMERICAN MOBILE HOMES INC. 51 Moore Road Weymouth, MA 02189 (781)331-0333 1-800-232-9991 PROPOSAL f Fax(781)335-0707 Date lj/10� al y Name PAT r 1 L l A Li Est.delivery date Address 3 (o y✓LCA.SO'-u.) 11 57 p3cseclA Ikr4,4A1�'71ri ,' ✓- 6iOCa American Mobile Homes,Inc.hereby propose to furnish the materials and perform the labor necessary for the completion of installing ( l,'(,0, leased mobile home containing: Refrigerator,stove,dining set,living room set,curtains,bedding 1st( ,;.t,2ndl(4.1 ,3rd FayPry ,washer and dryer,air conditioning. 11;ymporary Plumbing installation to mobile home Lpplying for building permit for mobile home 0/temporary Electric installation to mobile home ❑ Remove necessary trees,tree limbs or shrubbery ❑ Remove any necessary fencing 0 Other: Any resulting damage to said property as a result of the installation,removal and existence,of mobile home and its its utility connections shall not be the responsibility of American Mobile Homes,Inc.,specifically driveway,fence, stonewall,septic system,trees,lawn or any other type of landscape items and/or. American Mobile Homes,Inc.,is not responsible for the re-installation of any of these items. Costs: — The monthly rental of the mobile home at._S�3i mos. The delivery and pick up charge of Air conditioning 5"Z - Pet fees 5Qt,'— other There will be additional charges for utility connections,permits,fees,site preparation. There will be a profit and overhead charge of 10& 10 for all sub contractors and fees paid out. Any applicable sales tax.A 5%carrying cost will be billed and payable on all invoices not paid within 45days of billing. A$1,000.00 security deposit is due on delivery of mobile home.Uwe agree to sign a lease for the mobile home rental at delivery. Projected job cost:,1,1,n al) --- Fkr g r /-7 d LA) C./el --Se ! kA Payment Method : Idled directly to insurance company with a signed assignment of payment. ❑ Other: Any alteration or deviation from above specifications involving extra costs, will become an extra charge over and above the estimate. All agreements Respectfully submitted/(....//41,17 on contingent up strikes,accidents or delays beyond our control. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. If insurance company is not willing to honor assignment of payment,Uwe understand Uwe will be responsible for full payment of all services. NOTICE OF RIGHTS TO CANCELLATION You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the Seller,which may be his main office or branch thereof provided you notify the Seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing agreement. See attached notice of cancellation form for an explanation of this right. ifK(-.4.-- SignatureDate '7/ill Signature 1 Client/:23090 AMEMO ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(M VDVTYY) 8/092024 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 pollcy(Ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the temhe and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder In lieu of such endorsement(s). PRODUCER NAMEeCT Matthew M.Bryan Sullivan Insurance Group, Inc. PHOONr E,r,): (-508 791-2241 - ,tyC eI— ,508 797-3889 1 Mercantile Street E-MAIL ADDAEss: mbryan®sulllvangroup.com Suite 710 Worcester,MA 01608 IIS R(S)AFFORDINOCOVERAGE -- KIX _ INsuRER A:Westchester Surplus Lines Ins.Co. j10172 INSURED INSURER B:Associated Employers Insurance Company 11104 American Mobile Homes,Inc. -- — 51 Moore Road INSURER C: East Weymouth, MA 02189 INSURERD: INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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. OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DDLUBR TYPE OF INSURAtiCE BNB 8 POLICY RIMIER_ AM9PWilISw4% 17 0 8Di LIMITS A '"�X CONHFACIALGtNCERALLIABILITY X X G74451482001 03/15/2024 O3/15/202S pEAAC�HpOECCUURRRENCE S1,000,000 I CHUMS-MADE X OCCUR PREM ES{Eno ner el S1001000 MED EXP(Any ate person) sExcluded PERSONAL&ADVINJURY S1,000,000 GENL AGGREGATE LIMIT APPLIES PER_ GENERAL AGGREGATE S 2i000,000 PAO- POLICY JECT I LOC PRODUCTS-COMP/OP AGO S2,000,000 OTHER AUTOMOBILE LUU3IuTY I COMBINED SINGLE UNIT (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 accident) S A _ UMBRELLA LIAB I X OCCUR X G74451524001 03/15/2024 03/15/2025 EACH OCCURRENCE s5,000,000 X D(CESS LAB CLAOAS-MADE AGGREGATE s5,000,000 DED RETENTIONS B WORKERS COMPEMPLOYERS AUAaTIONILIT WCC50050226452023 D8/122023 08/12/2024 X s�rATurE °R ANY PROPREETOR/PARTNER/EJ(ECUTNE Y/N WCC50 05022645 20 24 08/122024 08/122025 E.L EACH ACCIDENT S1,000,000 OFFICER/MEMBER EXCLUDED? ' N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S1,000,000 II yes._DESCRIPTION OFFOOPERATIONS below _ E.L.DISEASE_POLICY LIMIT 511000LO00----_ DESCRIPTION OF OPE ATIONS/LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached II more space le required) General Liability receives Additional Insured status If required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE l•ataAige ID 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2018103) 1 of 1 The ACORD name and logo are registered marks of ACORD #5534290/M528762 MBM City of Northampton / O YMM. "4: `5 s••..S'. "`` Massachusetts A. �'<< al t 1��,. I ����C� �' DEPARTMENT OF BUILDING INSPECTIONS S; .. i � 212 Main Street • Municipal Building ti. OD r' Northampton, MA 01060 s'1* ,"� 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: N b d r( The debris will be transported by: Name of Hauler: Signature of Applicant:!'" ' lt4 t, Date: T/(h./z1 Po )'-' , . .. ...•-'''. I '"' ...---- L'''.-, • 1 ....''' • • '. ‘.. ' . . -. • .....• ' 4 • Ay,. . . < -• 4.,., . '-- .4 \ .. i• . 4 , ....,. ..... . -Pt - ' ' • , - •-- _ t •0.` ' ...,-..,.., ‘41 __----"--- * 44 , ...b g° i a , I - '' 'I 1 . • gtes6°44 • :••• * 4;1.1:' • 401) , ii • ". '- ' .., a/ we 1 .." ,.• • . . > . • . 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" i ' • -,. 4 't I i - }' • „ _ , R I . . a ' 4.‘"* .•*, .11,11,.. • ....- . ..0 V• ,A, ••1."V*•.4•1• ••r 4-j- I ' ' „". , 111111..iimiimum4m,uiv.aJ1ir4eOmii...''p'_ '7* ., II 1 , ..• . _A.-, , .', .-... *-••f Alt1,,e, #4-•-".,,-0_.-,,. 61)r " i # 4 ,., . 0,4••1‘ A j -V Fr : , •S 4. . _ ?441 • * . s • _JlI 1 * * 4 . , • Ir• i . A** ', t .i. .010111 • _ 4,... 44141P - ,, it _ _ .4 , .0. Pr , ..,„,. ' #.**4 kilt - 4 3ai , . , , ' -------_ . 4. . 11. Illittlib __ • - . h . . , .,,' iso)". - . , - -- - Allik 0• Mat Wow CONN Email Client Phone Client Sqtnattes CopyrloM Stolmeent Nonmetal by Phone SAMS DINS LA,no. SM.Plsn Rds plen Amos romMn No copyrlohl cd destrof d NO noI No used other Nan for An MON sock Intended wOhovt woke Newly.No /Om PAW. AN4)Fl MN ANY be VONNed by any other exclustoe tont be conned without I:mm.4mm Noel enforcement NS be uken on copyngN mfrlesernent Idn.onsmicenmeNtehotnessorn Diselalmec Properly Details MAN SOON This et rot en NNW documen*end may not seemly wiN current lews of Musky StellftedS.You Road TA*your own ermines one seek 36 M•o&n.St.Noltompten.MA 010132 USA Men: IAIT Independett*OAP from Wessel MOustly poSesslonels Intone Nets o•'Mop NI to contents of tne doarnent AMERICAN MOBILE HOMES INC. APN 23A-0054301 Deb Wed Sep II 2024 W- AU_DIMENSIONS ARE IN FEET.00 NOT SCALE FROM PLANS. OS ION RE