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24A-226 43 PILGRIM DR BP-2012-0033 GIs #: COMMONWEALTH OF MASSACHUSETTS Map - Bloc 24A - 226 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Bath reno BUILDING PERMIT Permit # BP- 2012 -0033 Project # JS- 2012- 000058 Est. Cost: $29183.00 Fee: $175.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BARRON & JACOBS Lot Size(sq. ft.): 11020.68 Owner: CRAWLEY SARA Zoning: URA(100) / Applicant. BARRON & JACOBS AT. 43 PILGRIM DR Applicant Address: Phone: Insurance: 70 OLD SOUTH ST (413) 586 -8998 NORTHAMPTONMAO1060 ISSUED ON :7115120110:00:00 TO PERFORM THE FOLLOWING WORK.- Renovate 2 Bathrooms Air barriers behind tub /showers! 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building $175.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner A File # BP- 2012 -0033 p APPLICANT /CONTACT PERSON BARRON & JACOBS ADDRESS/PHONE 70 OLD SOUTH ST NORTHAMPTON (413) 586 -8998 PROPERTY LOCATION 43 PILGRIM DR MAP 24A PARCEL 226 001 ZONE URA(100) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Paid (/ Building Permit Filled out ee Paid uotqo < Typeof Construction: Renovate 2 Bathrooms New Construction Non Structural interior renovations Addition to Existin Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans / Plot Plan THE FOL NG ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN O ATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management M AI �- ,5 -� Si re of BuiTdir6 Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. RECE 0 epartm use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit JUL Z 2011 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability DEPT. OF BUILDING INSPECTIONS N orthampton, MA 01060 Two Sets of Structural Plans NORTHAMPTON, MA 01060 -587 -1240 Fax 413 -587 -1272 Plot/Site Plans Other Specify- APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 PropeEU Address This section to be completed by office 4 3 1 I ��rlh1 Dr1x Map Lot Unit N ari w� u n m A o l b G b Zone Overlay District Elm St, District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record I I / 5 c' c rti. C r in, w'2,�1 43 i a t I A DrtvL crth�m�un �� (jIOCZ Name (Print) Curr nt M ilin dress: s I ��f 5 $C- 5306 QR Q/ cQVhth (� S e- G �0►1 Telephone Signature 2.2 Authorized Agent: / 2 C�1 I o y l J wT11 sT / VGr�hww��G, AL 0 6() Name (Pr! Current Mailing Address: 13 5c66 — `6`(u�S Signature Te ephone SECTION 3 - ESTIMATE N TRUCTION COST Item Estimated Cost (Dollars) to be Official Use Only completed by ermit applicant 1. Building '7 3 DQ (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of n '�� • © 6 Construction from S 3. Plumbing ' d O Building Permit Fee tp --7 4. Mechanical (HVAC) 1,s ) • " 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) �/ , Tg3 , ©C Check Number b L( U �- This Section For Official Use Onl Building Permit Number: Date Issued: Signature: Building Commissioner /Inspector of Buildings Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg & paved arkin # of Parkina Spaces Fill: volume & Location A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO O DON'T KNOW • YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES C) IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO �' DON'T KNOW C) YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained ® , Date Issued: C. Do any signs exist on the property? YES ® NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO . IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES V NO . IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5- DESCRIPTION OF PROPOSED WORK (check all annlicablel New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [E] Siding [D] Other [O] Brief Description Qf Proposed Work: e C �.C. C CU ti� ,� i ✓ _ Alteration of existing bedroom Yes _ No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family X Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, f C L as Owner of the subject property J Q hereby authorize c.P ru L mA C. A A 55 OG ice' E5 . a to act on my behalf, in all matters relative to work authorized by this building permit ap lication. CA Ile 4L M , Signature of OwnerJ Date I, C Q C 1 (� . C C _c)�S as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print N Signature of Owner /Agent Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Constructions Supervis Not Applicable 0 Name of License Holder l� E.G11 1 \ �.L� IJ-� 30 — 1 J II 11 I n,� n /1 License Number 1 1 0 ��d S o�-k� Si re -c '/ Noc-7L I L o". /11 �I060 101.1 ]X101 Address U Expiration bate _ Signat � Tele one 9. Re istered Home I ovement Contractor: Not Applicable ❑ cnrrY� (k" — c,b A55 0L�c.�25 � Company Name Registration Number S OS h A - ' U6o 61131aO, Address Expiration bate Telephone �6 �( � SECTION 10- WO RS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(8)) 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....... 0 No...... ❑ 11. - Home Owner Exemption The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official that he /she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature Narrative of Construction Sara Crawley Residence 43 Pilgrim Drive Northampton, MA 01060 First floor Bathroom — Remove existing none load bearing walls between bath room and first floor office. Reconfigured first floor bathroom and office as shown on plan to allow space for the relocation of washer and dryer from basement to first floor bathroom. Remove existing wall tiles and finished floor and replace with new. Install new ventilation fan. Second floor Bathroom — Remove existing wall tiles and finished floor and replace with new. Relocate bath exhaust vent on roof, install new fan unit. Frame in, insulate and sheetrock existing window. Install sun tunnel skylight. Clean all gutters and reattach existing leader pipes to house. SIGNATURES By signing below, you agree to items A, B and C. DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES. A. Alternative Dispute Settlement (Arbitration Clause): The Seller and the Buyer hereby mutually agree, in advance, that in the event of a dispute concerning this Agreement, the parties shall submit such dispute to a professional, state - approved arbitration service (cost, if any, to be paid by the submitter) prior to either party proceeding to legal action in the courts. B. By signing this agreement, you, as the owner of record, are hereby authorizing Barron & Jacobs Associates Inc. to act as your authorized agent in all matters pertaining to the building permit application. C. This is a binding Agreement. You may not cancel it except as stated. This Agreement covers and supersedes all conversations, statements and agreements, expressed or implied, between the parties, their agents or representatives. You, the Buyer, may cancel this 7 transaction at any time prior to Buyer Date midnight of the third business day after the date of this transaction. See the attached notice of cancellation Buyer (' Date form for an explanation of this right. Seller retains an equal right to cancel. Z_ Barron & Jacobs�6Ztative Date/ ************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Designer /Salespersons Registration Numbers Cecil R. Jacobs MA HIC 100809 ❑ Christopher R. Jacobs MA HIC 100809 CT HIC 0518617 CT HIS 0554397 Barron and Jacobs - Key Personnel Contact Information: Office Cell Home Office Manager: Sandy Scavotto 413.586.8998 President: Cecil R. Jacobs (Jake) 413.586.8998 413.250.2357 413.584.4447 Purchase Agreement Page 11 of 11 �la,,:►chu,ctt, - Dcp:u of Public Safct� Board of Building, Rc,ulatiows and �t:ui►larcl, Construction Supervisor License License: CS 30739 Restricted to: 00 CECIL R JACOBS 70 OLD SOUTH STREET NORTHAMPTON, MA 01060 Expiration: 9121/2011 ( nuni,.i , nw Tr=: 2429 91te .r- Office of Consumer Affairs and uslness Regulation t� 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Reqistration: 100809 Type: Private Corporation Expiration: 6/23/2012 Tr# 296962 BARRON & JACOBS ASSOCIATES, INC. Cecil Jacobs - - -- -- - - - - -- -- - - - - -- 70 OLD SOUTH STREET -- - - - - - -- - - -- -- -- NORTHAMPTON, MA 01060 - -- Update Address and return card. Mark reason for change. _I Address Renewal IJ Employment Lost Card ✓/ t umer c A ffairs ss Regina [.1et`1J License or r valid for individul use only Office of Consumer Affairs & Business Regulation g Y f� HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 100809 Type: Office of Consumer Affairs and Business Regulation `10 Park Plaza - Suite 5170 Expiration: 6/23/2012 Private Corporation ` Boston, MA 02116 BARRON & JACOBS ASSOCIATES, INC. Cecil Jacobs 70 OLD SOUTH STREET NORTHAMPTON, MA 01060 Undersecretary Not valid w' o signature The Commonwealth of Massachusetts Print For = Department of Industrial Accidents Y : Office of Investigations I Congress Street, Suite 100 Boston, MA 02114 -2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization /Individual): Address: C v �. �. � YJ �� i� 1Mc,) i o co City/State/Zip: ty ��� � G�•ati1 �r � � j Of, c; Phone #: ie -\ Are you an employer? Check tO appropriate box: Type of project (required): l .;K I am a employer with IS 4. ❑ I am a general contractor and I employees (full and /or part- time). * have hired the sub - contractors 6. New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub- contractors have 8. F Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.* ° required.] uired. 5. F We are a corporation and its 10.0 Electrical repairs or additions 3. El I am a homeowner doing all work officers have exercised their 1 I. F Plumbing repairs or additions myself. o workers com right of exemption Y � ' P• per MGL 12.❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13. El Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. ` Homeowners 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 box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If the sub - contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: � �� j(�r; j, J(� j ,,1\ Expiration Date: G Job Site Address: 43 P i 14Tlm Dr oe City /State /Zip: 'f' X060 1i Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and /or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance cove e verification. I do hereby certify u er the pains and enalt s qfperLua that the in ormation provided above is true and correct. Si nature: � � L Date: 7 7 / l Phone 4: 3 ,s - Official use only. Do not writ in is area, to be completed by city or town officiaL City or Town: Permit /License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City /Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Ate- !!T" DATE(MM/DDIYYYY) r�f`�vA CERTIFICATE OF LIABILITY INSURANCE OP ID 05/06/11 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION IRM Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Barry M. Stephens, CPCU HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 75 North Main St . -P 0 Box 564 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. East Longmeadow MA 01028 Phone: 413- 759 -0010 Fax: 413- 759 -0017 'INSURERS AFF COVERA NAIC # INSURED INSURER A: EMC Insurance Cos. INSUR B: A. I. M. Mut Insurance Co. I Barron & Jacobs Assoc. Inc. IN C: 70 Old South Street _ Northampton MA 01060 INSURER D: INSURER E: 1 COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �(jL�Y EFFE IVE 61�Y EXPIRATI N LTR INSR TYPE OF INSURANCE POLICY NUMBER DATE MM /DDS DATE MM /DDIYYYY T LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY 4X4998012 03/09/11 03/09/12 PREMISES (Ea occurence) $ 300000 CLAIMS MADE X - 1 OCCUR MED EXP (Any one person) $ 5000 PERSONAL & ADV I NJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OPAGG $ 3000000 — PRO - POLICY JECT f� LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 A ANY AUTO 4Z4998012 03/09/11 03/09/12 (Ea accident) — ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY $ X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN 1 AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY j EACH OCCURRENCE $ lOOOOOO A OCCUR 7 CLAIMS MADE 4J4998012 03/09/11 03/09/12 AGGREGATE $ 1000000 DEDUCTIBLE _ $ X I RETENTION $ 10000 $ WORKERS COMPENSATION X .TORY LIMITS ER AND EMPLOYERS' LIABILITY $ ANY PROPRIETOR/PARTNER/EXECUTIV� f, 12( ,'1 (','+ '"(' ;, ' ^`.� z, _ E'L. EA ACCIDENT $ 500000 OFFICER/MEMBER EXCLUDED? 1 - (Mandatory in NH) � E.L. DISEASE - EA EMPLOYEE $ 500000 yes, describe under S PECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT I $ 500000 S OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECUIL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION PROOFOF DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Proof of Coverage REPRESENTATIVES. AUTHORIZED REPRESENTATIVE IRM Insurance Agency Inc. ACORD 25 (2009/01) ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD vvNu the provislons of NIC-L c 40, C I ackmovA-adge, as a condition of the Building pefm)it, at'i debris resulting fro! cc, aC-TVVEY governed by this Buihdini.j Permit shall be disposed Of as 0 AP-AE OF FAICI�Ll nil a F'�Cpedy IiceT solid waste fa1ifiiv, as defined by C; to it C F - D TYP HI E 0 L L DYWIE N G 1I NF D FRI N T C, 1 f S Z:7 (NA. 0,F,--;RAgff A. PPL- I CA.N7) (T YF DF M4 T�Rt.A L T0 D!SPDSE=E) r-F,,' i- L . C� 43 ?d Dpi%/(-- 01M A D DR ESS L-d Barron & J acobs DESIGN . BUILD . REMODEL 6 / /dzw A Dear Code Official, Enclosed please find an application and related documents and information for a requested building permit. Our client will be out of town. I am enclosing a self - addressed, stamped envelope for your convenience. Please mail the building permit to our office. Thank you. Sincerely, i ecilcobs President A Tradition of Building Satisfaction 70 Old South Street, Northampton, Massachusetts 01060 411586.8998 www.barronandjacobs.com O to ":a N CD to o vc rD APO C I D I CD CD