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12C-128 '7-95-[(' 46 RDALE ST f ,� 0-" T-0 BP- 2011 -0317 GIS #: COMMONWEALTH OF MASSACHUSETTS Map-Bloc 12C -128 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category BUILDING PERMIT Permit # BP-2011-0317 Project # JS- 2011- 000515 Est. Cost: $22500.00 Fee: $135.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: INTEGRITY DEVELOPMENT & CONSTRUCTION INC 059672 Lot Size(sg.1): 80106.84 Owner: MURPHY PAUL Zoning: URA(100 )//RVWSP A p plicant: INTEGRITY DEVELOPMENT & CONSTRUCTION INC AT. • 46 CLOVERDALE ST Applicant Address: Phone: Insurance: 110 PULPIT HILL RD (413) 549 -7919 Workers Compensation AMHERSTMA01002 ISSUED ON :101812010 0:00:00 TO PERFORM THE FOLLOWING WORK .- FINISH BASEMENT AREA (XERCISE RM,BEDROOM,BATH) -SMOKE & CO DET MUST MEET CURRENT CODE IN WHOLE HOUSE 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 Si FeeType: Date Paid: Amount: Building 10/8/2010 0:00:00 $135.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner File # BP- 2011 -0317 I APPLICANT /CONTACT PERSON INTEGRITY DEVELOPMENT & CONSTRUCTION INC ADDRESS/PHONE 110 PULPIT HILL RD AMHERST (413) 549 -7919 PROPERTY LOCATION 46 CLOVERDALE ST MAP 12C PARCEL 128 001 ZONE URA(100) //RI/WSP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T_weof Construction: FINISH BASEMENT AREA (XERCISE RM BEDROOM,BATH) New Construction Non Structural interior renovations Addition to Existing - Accessory Structure Building Plans Included: Owner/ Statement or License 059672 ✓ i -F l Q 3 i N i�`� b ` SF' 3 sets of Plans / Plot Plan PA TI "{'_T C4 rJ L K L U rd THE OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON I RMATION 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 Demolition Delay 1 Signature of Building 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. 9 { City of Northampton Building Department l^ 212 Main Street Room 100 Northampton, MA 01060 Y; 'J0N0 phone 413.587-1240 Fax 413.587.1272 APPLICATION TO CONSTRUCT, ALTEP, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION I - SITE INFORMATION � 1.1 Prop Address TINS sestrS r,to fiE curnpteted by office MaP Lt Unrt 4�2 a i N I a F �" �OfGN. CA Zone "` verlayDistricE Elm St'Qistrrct;_ _ CB District_ SECTION 2 - PROPERTY OYJNERSHIP/AUTHORIZED AGENT i 2.1 Owne Record _ — -- Name nt; _ Cuuer A� t Nailing Address: S gnat ure T efephone 2.2 Authorized Agent : R. vwG Na (Print; 'D �.OIIJfTiR�G• Current Mailing Address: —" 1114 A ?eleprone . ST I ern Estimated Cost (Dollars) to be 1 competed b ermlt applicant 0ff•cial Use Only I. Building -- ra i J 61 S ao ) Building Permit Fee I 2 Etect - -- - Z � (b) Estimated Total Cost of 1 3. Ph robing — - l ding- Pur`icn Fee 51 f l 3� DOO gulld3n� Permit Fee i 4. Mecnanicai HVAC) f t6TUt?j rs Protection - (; 2 +3 +4 +5) -- Z, SOO Lhect'Number 'Phis Section For official Use;Q,6i 1 Bull di gft,. r g plt Nurxr'faer: Date Issued 1 [ 7-8iinure.: - - -- .:, - -------------- Buircing Corrrmis siuner!Inspettor of 8ufid.ings Date Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF TYFOR'�iATION Existing Prcposad Required by Zoning 7 This column to be tilled in by Building Department Lot Size Frontage Setbacks Front Side I.: R: L: R: Rear Building Height Bldg. Square Footage % , Open Space Footage % (Lot area minus bldg & paved erkin # of Parking Spaces Fill: r` (volume & Location.) A. Has a Special Permit /variance /Finding ever been issued for /on the site? NO DON'T KNOW.. '�� YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO D0N'T KNOW � YES IF YES: enter Hook,__ Page anc /or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Date Issued: C. Do any signs exist on the property? YES _ NO IF YES, describe size, type and location D. Are there any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location :_____ • I , a Now House ❑ Addition ❑ Replacamant Windows Alteration(s) b ' Roofing ❑ 4r Doors d Accessory Bldg. ❑ Dernalition%l New Signs [ j Decks [ ] Siding [ ] Other [ ] Brief Description of Proposed Work: 1. {S K 131 5 6 0-044 ' AW-5 Alteration of existing bedroom Yes No Adding new bedroom X Yes No Attached Narrative 0 Renavating unfinished basement - lJo Plans Attached Roll Sheet 0 a. Use of building: One Family 5� Two Family other b. Number of rooms in each family unit: Number of Bathrooms i c. is there a garage attached? d. Proposed Square footage of new construction_. , S Dimensions e. Number of stories ? iS�MMK ( j f. Method of heating? in s ta0 P:replacos or Woodstoves �. flumber of each g. Energy Conservation Compliance, ,aasgheck Energy Compliance form attached? h. Typo of construction 1 I i. Is construction within IOC ft. of weilw; ds? ______ Yes % No, !s construction within 100 yr. floodala n _,_,_Yes No 1 $J j. Depth of basement or cellar floor befaw finished grade k. Will building conform to the Building and Zoning regulations? X Yes NC . i I, Septic Tan:.c City Sewer. x- Private well • City water Supply i 1. . _. �" _ as Owner of the suhject property her author: f ill, — to act on j my be in a I matter relat re to vrork authorized ly this building permit application. Sig atura of her Date I, �L� Iii ~ S� F V 7W ( jw' uthorized Agent hereby declare that the statement and information on the foregoing apphcatior. are true and sdcurate, knowledge and belief. ` Sign o under the pain and penalties cf perjury. PrinA J S'to her /Agent Date r ME t QN$TRU) T10Nd �+lrf{4'lCES u . %:L Licensed Constructio Supervisor Nct Applicable ❑ H ame of License Holder : *Mg� = �C7y I 4 U Lioei�se Number Address Expiratcoii i at> I A 17 t�wc+. X13 •S - 19 Signat r Telephone 1 Mi Not AppFcable ❑ 0_1 _ C .6 t i�panName Registration Number __!�_ " ►� �? lT [tit, A t oLL—_ — Add'ress rxpi tion C)Ety q ,lt)1' i0 WORt(Eft$' CQMPE N S ATfON iN$ I .AE> IDA V I Tj #XiG L. c: 552. § 25C(6)) b�1 orkers Compansatlor Insurance affidavit mast be completed and submitted with this appiication. Failure tc provide, this aNdavit will result in the denial of the issuance cf the bu permit. L Signed ,affidavit Attached `'es....... ...... L 6 arc- 5 , �x��� g s $ a�,�'' 10 , The current examptiontf9r "homeowners" was extended to include Owner - occupied Dwellings of one ;1) or two(2) families and to allow such i otncazvner to engage ar. individual for hire who does not possess a license, provided that the owner acts as supervisor. GMR 7% Sixth 'Edition Section 108.3.5.E 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 c2nstructs more than one home in a two -year period shall not be considered a homeowner Such "homeowner" ahall submit to the Build'urg Official, or a form acceptable to the Building Official that he /she shall be responsible for all such work perfor under the building hermit. As acting Construction Su26rvisor you. presence on the job site will be require9 /ram time to rime, luring and upon cornpletion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Worlters' Compensation) and ^haoter 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 7nu under this permit. The undersigned " homecwner" 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 fr � _ 9 �z� Il[� �riZf�c�Tlt��tl•n : ' � � ,�rsrac�rsttta' �, 'iEPt1RTri2EN7' tJP $UILDITjG INSPEGI'tUNS � 212 Main 8trtMt Municipal Hulloing, Northamptou, Mcus. 01060 WU CONe NSATION IMUTtALINC•T: AFIt'133AVIT — �� y �� l' cznscxJp�rrtiaee} vata a principal piac. of bt>siness/resideuce a;: : (suet /ci tyista :chip) do hereby certify, uLder the pains and penalties of perjury, that. am as employer provi2 rg the, fcilov cg worhrr3 connpensarion coverage for ny ployee s worhog un tll s job: A - T .. M '04A4 w nnz goo 6z 2 ��10 to�lo (insuraart- Cctnpany) (Pota^y Numk.r) (- H-pirat on Dais) () I am a sole p: oprietor, general contractor or honzeowcer (circle cae) and have ) fired the contractors ?fisted beiow who have tae fc DoMilig worker's compeslsatIo:l policies: (N<,.-ae of C;ontra•.�or) ;Lnsvr.:�na, ComFr�m•,Polie; iv'•.irnlx;) (E:cPirudon Date; M zne of Coutrac?er; ',TjLmmnw Co=UyiPoUcy Number) (Explradon Date) (Name of Coauac(or) M -Lusir.�acc Cyompazylfcin Number), (Fapiratian Dalc) ;?3a I e of Contractcrj< (Insumace Company/PoL'cy Nu.Tnbcs) (Expiration Date) (attarit addi*3oeat s:sct i; n�x U ia.^iude infc*�ativa ga tia.c�, '.o ell uro} (} I am a sole proprietor and hive r:o one worldng for me. () I am a hoate owner performing all the viork myself. N'UIT: pl; ", t+c avrztc that wbDe b cxI wixn % cxpl" palow to h� , moo a• rep,& aarl ce a dw:ling cf Sot mx" tbaa L'Ieo units in which the bo ma oct rt4des or oa be ov apps ritnwA thoa tc are rnx g c�.rity tocsidcr�t u be emplcy unctea the wa rch .t�xr xr ire Ao (BL152.ss. (5)). appta_ 6m by a hmoo>% r for a liocrx a txrnit mey e�ideixt �c legsi ttatuJ of as acaploy+r ut5der thn Woracdr C�a�aLiptt Act. r uaeearwa4 thA a oopy of this a u • w y bo fwward*d to tye Dcpartarns of LV—V t+ Icx tLo mvaage vcri&catioa•tcnt; tt:at failttt+e to tecttre ravcrag � wader soeiiaa 25A ar MoL 133 � lord W t5o imgostiaa of ais3a+t ptriaSiid . . °Oq B c[ a Eno of lsp w S 1,500.00 era!!« of ttp w aoe ysat sad Coil panlda in t5e form ottc sw work order' aed a a.-ao of S 00.00 t,c:ty sgniirat mc. i rce dcwe=-W rye ooty f Permit Si t c araaeat ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE( 12/2010 MMIDD010 * 1'�ODU,ER 413. 586. 0111 FAX 413. 586. 6481 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Webber & Grinnell Ins. Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 8 North King Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Northampton, MA 01060 INSURERS AFFORDING COVERAGE NAIC # INSURED Integrity Development and Construction, Inc. INSURER A.I.M. Mutual 110 Pulpit Hill Road INSURER B'. Amherst, MA 01002 INSURER C. INSURER D: INSURER E: 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. INSR DD' POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD DATE (MM$DD GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS MADE F7 OCCUR IVIED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ ri POLICY PRO JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WMZ80062242010 04/10/2010 04/10/2011 X TORY LIMITS X ER AND EMPLOYERS' LIABILITY A OFFICER/MEMBER IETO EXCTLUDEDXECUTIVE Y❑ E L EACH ACCIDENT $ 500,000 (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE J$ 500,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT 1 $ 500, 00 OTHER DESCRIPTION OF OPERATIONS) LOCATIONS I VEHICLES (EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 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 REPRESENTATIVES. - - - -- For Information Purposes Only - - --- AUTHORIZED REPRESENTATIVE Cynthia Henderson CINDY ACORD 25 (2009101) ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD *= Massachusetts - Department of Puhlic SafetN Board of Buildin Rc��ulatinns and titandards Construction Supervisor License License: CS 59672 Restricted to: 00 PETER W JESSOP' 110 PULPIT HILL RD AMHERST, MA 01002 Expiration: 6 /72012 ( nuui —i ,ficr Tr#: 26864 \ Bo ro Ong eguYa o ° rfs a �cCa`na`r HOME IMPROVEMENT CONTRACTOR Registration: 118041 Expiration: 1/20/2011 Tr# 278284 Type: Private Corporation INTEGRITY DEVELOP & CONST INC PETER JESSOP 110 PULPIT HILL RD AMHERST, MA 01002 Administrator