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10B-015 (2)
REMINDER _ J aL Ly o1)5 II C4 Bill No. 5691 Parcel I.D. # 10B- 015 -001 0 0' 00 Dear Homeowners(s): ‘\ Your FY2010 real estate bill has an overdue amount of $ 4,942.95 w 'line es interest and demand . Please remit payment by August 5, 2011, to avoid t: di our property put into Tax Title. Once in Tax Title, interest will accrue at 16 % nd of late 1, Zall fees will be added to your bill. vEC�c If you have any questions, contact the Collector's office at 587 -1294. TOF O ovri Sincerely_ • • 1 Workers' Compensation and Employer's Liability Policy NSURANCE NorGUARD Insurance Company - A Stock Company Policy Number JAWC224435 GROUP of NEW N CCI No.[25844] Policy Information Page [1] Named Insured and Mailing Address Agency James D Ross FINCK & PERRAS INS AGENCY PO Box 66 6 CAMPUS LANE Whately, MA 01093 Easthampton, MA 01027 Agency Code: MAFINC10 Federal Employer's ID 061 - 55 - 9981 Insured is Individual Additional Names of Insured (N2) JDR Builders Locations on Policy (L2) 177 State Road , South Deerfield, MA 01373 (01/29/2011 - 01/29/2012) [2] Policy Period From January 29, 2011 to January 29, 2012, 12:01 AM, standard time at the insured's mailing address. [3] Coverage A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation Law of the following states: Massachusetts B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed in item [3]A. The limits of our liability under Part Two are: Bodily Injury by Accident - each accident $100,000 Bodily Injury by Disease - each employee $100,000 Bodily Injury by Disease - policy limit $500,000 C. Other States Insurance - Part Three of this policy applies to all states, except any state listed in item [3]A. and the states of North Dakota, Ohio, Washington, and Wyoming. D. This policy includes these endorsements and schedules: See Extension of Information Page - Schedule of Forms [4] Premium The Premium Basis and, therefore, the premium will be determined by our Manual of Rules, Classifications, Rates, and Rating Plans. All required information is subject to verification and change by audit. (Continued on another page) Total Estimated Policy Premium $ 3,126 Total Surcharges /Assessments $ 189 Total Estimated Cost $ 3,315 INTERNAL USE GT Page - 1 - I ormation P_.e MGA : 3AWC224435 (dC 0001 Date : 01/28/2011 MANOTE � k- 16 South River Street • P.O. Box A -H • Wilkes- Barre, PA 18703 -0020 • www.guard.com The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations - 600 Washington Street ;° Boston, MA 02111 r ; ° ` ? www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Legibly ,,,,,J Name ( Business / Organization /Individual): J.J2-- [Lb � ` /� S Address: k k City /State /Zip: Cj in A b 10 C3 Phone #: Cis - 7 - 2 Are you an employer? Check the appropriate box: er with Type of project (required): 1. [ ° I am a em io ith 1 4. 111 I am a general contractor and I p y 6. ❑ New construction employees (full and /or part- time).* have hired the sub - contractors 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. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. ❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. ❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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: 6U Pk-I- Policy # or Self -ins. Lic. #: fltr -.)' C- -4 3 C Expiration Date: ( 1)--o / 2--- Job Site Address: S7 J elf- ,a-,- City /State /Zip: L 6 , / ' 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 coverage verification. I do hereby certify der a pains d enalties of perjury that the information provided above is true and correct. Signature: Date: ' 7 - 7 -7c• 1 / g Phone #: .5 ( — 7q s3 Official use only. Do not write in this 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 #: +9. CITY OF NORTHAMPTON Construction Debris Affidavit In accordance with the provisions of MG.L. c. 40 § 54, all debris resulting from any work covered by a Building Permit shall be disposed of in a properly licensed disposal facility, as defined by M.G.L. c. 111 § 150A. Address of Work: 5a 1 ' 1 6/ 1 - The debris will be transported by: { SflFS C The debris will be received at: C ‘T o F N a - 7 - d i,44 /0 6A� I �- Signature of Permit Applicant IC i Date 7 - - 7 - 3 = 5 1 / Building Permit Number: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable / ❑ Name of License Holder : �pp/k E5 �) 07 -I ` Q p /k License Num er le"Ct- 4,)t) et-ttw--rc-tb mi1/2 l Address Expiration Date 3 CC 3 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ -; �2 _e (30 3 7 Company Name Registratio Nu ber Address // Expiratio Date Telephone l� SECTION 10- 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 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. CM 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 . SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) I Roofing n Or Doors El Accessory Bldg. ❑ Demolition g New Signs [D] Decks [p Siding [D] Other [D] Brief Des otion of Proposed Work: to LiS•44" STD"A' 1)04 &GL- -• S1 - . A/ % +'C'ri 1b Lkt57) AJ 6/1- 0- Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. If Newhouse and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage a -ched? d. Proposed Square footage • ew construction. Dimensions e. Number of stories? f. Method of heating? e.laces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Ener. , _ .mpliance form attached? h. Type of construction i. Is construction within 100 ft. = wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement • cellar floor below finished grade k. Will buildin. - .nform 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 1. APPLIES FOR BUILDING PERMIT --7-04-1/ 1/ L-- LO /V , as Owner of the subject property i� _ hereby authorize -/ P " '' S s--()- 55 to act on my beh atters relative to work aut zed by this building permit application. Signature of Owner Date r Y N ' - as S l , 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 erjury. j p4 - CI 5 Print Name Signature of Owner /Age 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:' ' Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Space Fill: (volume & 'cation) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES O IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO c IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO 0 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 O NO e IF YES, then a Northampton Storm Water Management Permit from the DPW is required. - • .. . f as......=,.. . - --,,,� ._ _ .1.4.17.1., ,,,, City of Northampton a �P l Building Department CurtxC ray Per t ¢ " 6.14, , 212 Main Street Sewe,�/SeptipAvall s DEFT. OF 81.'-iraING Room 100 vvitg,ll t 11 :'• !: ° * ,� r � � = +•.:u,. ;� N orthampton, MA 01060 1'i, a i s . . _ 13- 587 -1240 Fax 413- 587 -1272 Pi0t1 (te Flag 0 ' , '° Of,epe9lfy., ,. APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office D 2 2 2__ Map Lot Unit - d ?Z,ey.,G.l .1 d Zone Overlay District I' 7's /4 ) , Q/0 _s 3 Elm St District CB District • SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Rprnrd: Name Oxe n M ailing dress: Le ir L L e HS I le a 3 Telephone Signature y/ 3 " ;7D/ - a / 2.2 Authorized Agent: Name (Prin Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection T� 6. Total= (1 +2 +3 +4 +5) Vb ©O '' Check Number /1/2- This Section For Official Use Only Date Building Permit Number: Issued: Signatur / - '7.---7.--.// Building Commissioner /Inspector of Buildings Date s , File # BP- 2012 -0112 APPLICANT /CONTACT PERSON JDR BUILDERS ADDRESS /PHONE P 0 BOX 4 NORTH HATFIELD (413) 665 -7587 PROPERTY LOCATION 50 RIVER RD MAP 10B PARCEL 015 001 ZONE URA(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 1 - 77 1----2 00 20 Typeof Construction: DEMOLISH STORM DAMAGED ANNEX STRUCTURE TO GARAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 074105 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF TION 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 S re 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. 50 RIVER RD BP- 2012 -0112 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 10B - 015 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: demolition BUILDING PERMIT Permit # BP- 2012 -0112 Project # JS- 2012 - 000168 Est. Cost: $1000.00 Fee: $20.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JDR BUILDERS 074105 Lot Size(sq. ft.): 25134.12 Owner: LYONS PAUL J & JANE Y Zoning: URA(100)/ Applicant: JDR BUILDERS AT: 50 RIVER RD Applicant Address: Phone: Insurance: P O BOX 4 (413) 665 -7587 WC NORTH HATFIELDMA01066 ISSUED ON:8/2/2011 0:00:00 TO PERFORM THE FOLLOWING WORK: DEMOLISH STORM DAMAGED ANNEX STRUCTURE TO GARAGE 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 8/2/2011 0:00:00 $20.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner