16B-048 '10 NN TI4 MAIN ST BP-2011-0471
GIs #: COMMONWEALTH OF MASSACHUSETTS
MW:Bloc 16B - 048 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 -0471
Project# JS- 2011 - 000765
Est. Cost: $592.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: LOW E'S 96999
Lot Size(sa. ft.): 10149.48 Owner: LACROIX DONNA E
Zoning: URB(100) Applicant: LOWE'S
AT: 221 NORTH MAIN ST
Applicant Address: Phone: Insurance:
282 RUSSELL ST (413) 588 -0270 WC
HADLEYMA01035 ISSUED ON :11/18/2010 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT DOOR
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 Sienature:
FeeType: Date Paid: Amount:
Building 11/18/2010 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
The Commonwealth of Massachusetts FOR
Board of Building Regulations and Standards MLrMCIPALITY
Massachusetts State Building Code, 780 CMR, 7 edition USE
Building Permit Application To Construct. Repair, Renovate Or Demolish a Revised January
One- or Two-Family Dwelling 1, 2008
This Section For Official Use Onl
Building Permit Number: I Date Applied:
Signature:
Building Commissioner/ inspector of Buildings Date
SECTION I: SITE INFORMATION
1.1 X Add ress: 1.2 Assessors Map & Parcel Numbers
& �n ` h s i -
1. a Is thi an accepted street? no Map Number Number
1.3 Zoning Information: i.4 Property Dimensions:
Zoning District Proposed Usc - - Lot Area (sq ft) — Frontago (R) - —
1.5 tuilding Setbacks (ft)
Front Yard Sidc Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Wnter Supply; (IvI.G.L c. 40,§54) 1.7 Flood Zone Information: 1.8 Sewage ;Disposal System:
Public O Private d Zone: Outside Flood Zone? Municipal ❑ On site disposal ;system ❑
Check if es❑
SECTION 2: PROPERTY OWNERSHIP' r
2. ,own�r' of i �- ,il l / Y / 2& �J'
t J ff ;
Narne (Print) `� A I ss for Service:
Signahttt elephone
SECTION 3: DESCRIPTION OF PROPOSED WORK (cheek all that apply)
New Construction ❑ Existing Building D Owner - Occupied ❑ 1 Repairs(s) V Alteration(g) C1 Addition 0
Demolition ❑ Accessory Bid$, 4 Number of Units Othor la Specify:
Brief Description of Proposed WOW: f
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Vse Only
Labor and Materials?
I. Building $ 6 q h l . Building Permit Fee: $_ Indicate how fee is determined:
2. Electrical $ 0 Standard City/Town Application Fee
❑ Total Project Cost' (Item 6) x multiplier
3. Plumbing $ 2. Other Foes: $ _
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Su ression Total All Pecs: $
Cheek No, _ Check Amount: Cash Amount;
6. otail Project Cost: $ � p Paid in Full ❑ Outstanding Balance Due:
LA d OSI 9W saMol
PAGE 82/02
08/o3/2�l8 11 07 4l32673390
SECTION 5- CONMUCTION SERV(Ca
Naft of CSL- Holder
ddresl� - 2 U U
Telephone M Ra Window and Siding --
6.- WORKEPS COMPENSATION INSURANCE AFFIDAVIT (M.G.L c. 152, V 2SC(6))
Workerx ComPen'-Won Inturance affidavit MtL';t be 0011 VIOW AAd 'u4miltCd with thi$ appli=ion. Failure to provide
thi affWav't will ftlWt in the denial of the 1,% of Iding P=1L
IN Owner of the subjoct property hereby
to act on my behalf, in all mmem
M to WQrk,2Uth0ri7Ad by this building permit upplicadon.
UTHORIZED AGENT DECLARATION
on arc true and u%urasc, to the best of my lawwltdgc and
that Laments information on tk foregoi
NOTES-
(not regi-vew;d in the Home Improvelmnt convactor (HIC) Program). will M have accom to the arbintion
progtAm or guamty fund vadcr M.G.L. o. 142A, Other importwst information o4 the faC Prog= and
Construction Supervisw Licensing (C$L) cu be found in 730 CMR Rcgukitions I 10.R6 and I 1O.P.S. rcspcctively-
work is planned, provide the informati4o Wow
Total floors aren (Sq, FQ (including gaiage, finished bmenteattattics. decks or porch)
Gross living am (Sq. Ft.) HXINT,;ible room co=t
Number of fireplaces Number of bedroorns,
Number of bAthrovrns Number of half/baft
3. "Total Pmj&t St1wwc Footage' =y be substituted fbr'TotW Project CoW
` `
` -
�
�
PAGE 01/02
4 i. 2 U,
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•e COMMO-dweaft'h of lvas=hfaetu
Department of Industrial Accidents
Office o, f' , nvesfigado"S
600 Wathingjonqireol
Boswr4 MA 02111
VWWJ1WU-g0V1di4
Workers' Compensation- lastwance Affidavit'. BuUders/ContractoirAtectrickus[PlumbM
AgRagnt IftrM Pim
_afion �t Print &Mk1j
Ze-
Qty/state/zip; Mj4i Phone #:
Are yplfi mployer? rl Check h appro priate box; Typo orprojed (required);
employees
1. F am 4 employer with 4. 1 am a general contmetov and r 6, Ntw codmuction
V411 and/or pact -fim4t have hired the soh- contractors
istcd on the attac heel keo t. 7. Re modr&&
2. C1 I am a sole proprietor or pafter-
l
ship . have no emplaytes Thesc sub-oummctors have S. ociziorldon
working for me in any capaoity. Unployces and W6 Work-S, 9. Suilding addition
[No workers' comp, immnce comp. insummtJ
vaquiral Wc are a corporation and its 10.❑ Eiecwcal Mrairs of additions
I = a homeowner doing all work officers have wmised their 11.[3 Plurab4 rqaITS Of Additions
myself. [No workers oomp, right of exemption per MGL 12.[3 Roof rqx6rs
insumucc rCqW1cd.j1 c. 112, $1(4), and we pave U9
aroplayces. [No worle= I I other
come, insurance imquired.) J I
"rltry nppticam tbar cheeks tsox �!! mwt also Silt am ttx seulotf bdkno s►towln$ thelrtivotn�` cOtripChtitian policy infomtndoa
HOMOW-M who submit ft., ftuvit i"4C.Ulft they W d64 pal V/6f* MA #" hW 4OUJAU 40aftqfM fM'.7 SWW* it W W AffidaVtt W&ehjjfi su ch.
4 COD►Aftm that check tU b09 must aftchm tA addkival s1to shwk$ ft x= of the tub-wMmcvr. and mo wboba or am *0W offlilwS hm
OmPl"= Ir the ub-oamcws bryt employees, th-q inva promz their workers" COW, policy =MbW,
dat an employer that is providing worWV compensation imunwceformy omoyers. Bekw is the policy acrd job site
Insurance Company Name t7 It
Policy # or Sclr-ins, Lic, M Expimion Daw
Job Site AddtCSS' 0A
72Vi4-
1---' - —
Attach a copy orthe ;0(e;e c ompensation policy declaration page (showing the policy number and expiration date).
%UuTr to se4mrc coverage as rcqui=d under Soction 25A of MGL c. 1526wlead to the imptultion o$ oimt W penalties of a
:ruir. up ;* $ 1 ,. 500.00 and/or one-year impxisQnmw, is well as civil paWtics io the fom of a STOP WOOS ORDER and a foo
of up to $250,00 z day ago:= the violator. Ar, advise4 that a c opy of this statoment may be forwarded to tho Office of
Investigations of the DIA for insurance ommSc verification.
I orp herrity i: —
11 MI
afthenaltles o p erjury that th'a information provided above is true and Wrrom
r ITP 419 pe D z
:! M
Otmiol use only. Do not write in Wx am#, to be completed by My or town offidd4
City or Iowa; 0
L Authority (circle om
L Bw rd of Health 2. Widing Department 9. CitytTown Clerk 4, Otetrical Wpector S. Plumbing Itaspen
G. (kher
Contact Per%..n
<< Wo 081 9W Samol 1 :OL 0-90-00-,,
021.
aCat ,� CERTIFICATE OF LIABILITY INSURANCE
Pita>uCl�c THIS CEftTWICATE M ISSUED AS A MATTER OF INFORIMAT
Richard R Green insurance Ag en cy, ONLY AND COMFLR$ NO RM fM UPON THE Cg�N17,
HOL.DER. THIS cERTIFACATE DOES NOT AMEND, EXTEND
11 Allen Slr+eet ALTER THE COVERAGE AFFORDED BY THE POLICIES SELL
H ampden, MA 01036
INSURERS A RDM
FFONO COVERAGE
NAfC tF
3NsLS� munm& Travelers Insura.rrGe
KortekanV GOnoftix lOn U.0 U Mutual
B"n KoFtek2�rnp iwauxr:c: Commence tn9uratxx
27 Butler Road rrsurm�o
Monson, MA 01057
COVERAGES
THE POUCI OP NWaANCE L wq-o HAVE SEEN wsuW TO T NiSURW HAM A OVE FOR THE P OLICY POW INDICAT WOTWFM
ANY MAY PERTAIN. T HE AFFORDED BY TM POMMS MMM SIS MJECT TO ALL TM 7ER W LSKM AND COND M OF SUC
POLICIES.A meGATELIMrrSeHOMM AY MV99MREDl10EDBYPAIDCIAW.
MW MWIL POUCYMIAMEJt P°" Los" nnn
O��n iACiiOC�CtJ�@10E f 1000.000
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cxnwsMnotl 91 MOM upew on "w ) s 5.000
d non d � 6808565P31A 02/05/ 2010 0210 /2011 PERa0WL&AOVw,MW $1.000,000
trir�d auto a+erw wowear+ae s 2,000,000
c,�rrL reLrrrrA�lfear� nwmium- col+mapA~# s 2.000,000
pvucr LOC
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AnrAVM COMMMSMMZLDArr $
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C s BBMV1.107 0211512010 02/0512041 800 o,-y -A s 300,000
f NON -OMq WAUTM
1 �rRr,°R°s�raraen OAMA°E $ 100,000
GARAA4S:IJAM.r1'Y AVrOONLY- rbAACC10�Tr i
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Auraon.Y Aoa s
EXORMAJUMMAUTAMM 0040CCUARP" s
o MOAN AGGROMME
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aFlracluom► a c. a- �.eMw�av�ae: :100,000
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LQwys CO mpardes, im- and "MY and all Suhliidiades of named as addWord Insured as respect w
General Wbility Ind Automobile Lla6ility"
Non- Owned/Hired Auto Is Included on Travelers P06W 6806585P31A
CERTIFICATE HOLDER CANC
SElou►oAfnnF TRIMAWWDNBC/M WPOUCU M OARA:BIFDMBPG yUEFEATIM
101�rH's C 11 ies, Ir1C. (Attu: IS fnsurartc e) t— TNe11em Tw MM>1 No~ au ummvva To wuL - oms N
P.O. Box 1111 NOTE TO TIE CW tw4ATe rALOW *MUD TO 7M � —. BW PANAM M Yo no sa ekft4
Norttl Wilkesboro, NC 28M NOTE
fa Os MUM OR UMMM OF AMY MW UPM ME fM AGEMM a
ACORD 25 (280110 0 ADD CGPJNX% .nCM IM
06/2 2 I u o6: 58 4132673390 PAGE C11/01
Board of Buildin Rcgulations a"d Standards
W Office file
Construction Supervisor License
License: CS 96999 HOME ImpRovEmEw CONTRACTOR
Restricted to- 00 Type
Expiration-
_VO12 LLC
T
TODD KORTEKAMP KAMP T0QW,"`--'.
rMp 27 BUTLER ROAD 'An
MONSON, MA 01057 TODD KORTEKA
27 BUTLER RD
Expiration: 6/2&2012 MONSON, MA 01057 Undersecretary
T rX: 27751
Restricted t** OU Lietan or registration valid for individul use only
before the expiration date- V found return to:
00 - Unrestricted Office of Consumer Affairs and Business Rep"on
IG -1 2 Family 111onves 10 Park Plaza - Suite 5170
Boston, MA 02116
Failure to po$se$g a current edition of the
Massachusetts State Building Code
is cause for revocation of this licenW ILV-el�
Refer to: YjWW.Aj=LGoVADpS Not valid without sloaftre
4 - \
— Office of Consumer Affairs & Business Regulation License or registration valid for individul use only
OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
l k" Registration: 148688 Type: 10 Park Plaza - Suite 5170
Expiration: 1011&2011 Supplement Card Boston, MA 02116
LOWE'S HOMES CENTERS INC
JAMIE SPOFFORD
136 TURNPIKE RD. SUITE 100
SOUTH BOROUGH, MA 01772 Undersecretary Not valid without signature
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