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18-004 285 NORTH KING ST BP- 2008 -0212 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18 - 004 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- 2008 -0212 Project # JS- 2008 - 000330 Est. Cost: $475.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: DAVID DULONG 064581 • Lot Size(sq. ft.): 8407.08 Owner: DULONG DAVID I & PAUL A LABBEE Zoning: — - Applicant: DAVID DULONG AT :,285 NORTH KIN(G ST Applicant Address: Phone: Insurance: 189 PANTRY RD (413) 320 -1195 WC WEST HATFIELDMA01088 ISSUED ON :8/29/2007 0 :00 :00 TO PERFORM THE FOLLOWING WORK: REPLACE FRONT WINDOW & 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: Anal: oi< d 3d - d/ <�"'� THIS PERMIT MAY BE REVOKED BY THE ITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGUL • IONS/ Certificate of Occu. anc � / Si. nature: FeeType: Date Paid: Amount: Building 8/29/2007 0:00:00 $50.00427 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo 285 NORTH KING ST BP-2007-0692 COMMONWEALTH OF MASSACHUSETTS ;r7',;:= ` = Map:Block: 18 - 004 CITY OF NORTHAMPTON • Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS eA Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A) Category: Non structural interior renovations BUILDING PERMIT Permit # BP- 2007 -0692 • Project # JS- 2007 - 001044 Est. Cost: $1000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO Const. Class: Contractor: License: • Use Group DAVID DULONG 064581 Lot Size(sq. ft.): 8407.08 Owner: DULONG DAVID I & PAUL A LABBEE Zoning: SR Applicant DAVID DULONG AT: 253 NOM.-: , .`ci 1`V 11 aJ i Applicant Address: Phone: Insurance: 189 PANTRY RD (413) 320- 1195 WC WEST HATFIELDMA01088 ISSUED ON :1/5/2007 0 :00 :00 TO PERFORM THE FOLLOWING WORK: REPLACE CELLAR DOOR & WINDOW & CONSTRUCT OUTSIDE STAIR 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: Ro„e l: O? Insulation: - " - -- Final: Smoke: Final: OA 47-.3 -of THIS PERMIT MAY BE REVOKED BY THE TY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIO S. Certificate of Occupancy _ si. nature: FeeType: Date Paid: Amount: Building 1/5/2007 0:00:00 $50.00390 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo • • • AR WCIP Liberty ISSUING OFFICE 181 r1 � Mutual Workers Compensation and INFORMATION PAGE Employers Liability Policy ACCOUNT NO. SUB ACCT NO. Liberty Mutual Insurance Group /Boston 1 - 371520 0000 LIBERTY MUTUAL FIRE INSURANCE CO 16586 POLICY NO. TD /CD SALES OFFICE CODE SALES CODE N/R 1ST WC2 -31S- 371520 -019 XX X WESTON 102 REPRESENTATIVE 3000 1 YEAR ASSIGNED 2009 Item 1. Name of JAMES D ROSS DBA JDR BUILDERS Insured FEIN 06- 1559981 Address PO BOX 66 RISK ID 147592 WHATELY, MA 01093 Status 01 - INDIVIDUAL Other workplaces not shown above: SEE ITEM 4 Mo. Day Year Mo. Day Year Item 2. Policy Period: From 01 -29 -2009 to 01 -29 -2010 12:01 AM standard time at the address of the insured as stated herein. Item 3. Coverage A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident 100,000 each accident Bodily Injury by Disease 500,000 policy limit Bodily Injury by Disease 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE END WC 20 03 06A D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE Item 4. Premium - The premium for this policy will be determined by our Manuals of Rules Classifications Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Rates LINE 110 Per $100 Estimated Code Estimated of RE- Annual Classifications No. Total Annual Premiums muneration Premiums SEE EXTENSION OF INFORMATION PAGE Minimum Premium $ 500 (MA ) Total Estimated Annual Premium $ 3,462 Interim adjustment of premium shall be made: ANNUAL This policy, including all endorsements issued therewith, is hereby countersigned by Authorized Representative Date 02 -26 -09 Loc. Code Term. Oper. Audit Basis Periodic Payment Rating Basis Pol. H.G. Home State Dividend 02 -26 -09 NR MA NEW to R1 Copyright 1987 National Council on Compensation Insurance we o0 00 01 A Insured Copy The Commonwealth of Massachusetts Department of Industrial Accidents 1=1. #1011.11MNI Office of Investigations - SRN ,_ 600 Washington Street Boston, MA 02111 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): I(Y `t t eg -S Address: p0 ' TT& ‘ City /State /Zip: (,(i il'[EL` j l AAA- Phone #: ES '7 E Are you an employer? Check the appropriate box: Type of project (required): 1. I 1 I am a employer with 1 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. ❑ Demolition working for me in capacity. employees and have workers' g any p >y 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11. Plumbing re 3. ❑ I am a homeowner doing all work g airs or additions P myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.E Other P , rI tZSi f?c( , comp. insurance required.] -71 H4tvO c )l *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: J_ ■ Policy # or Self -ins. Lic. #: W. a 31 S '3 7 /SD 0 —6 j Expiration Date: / " a 9 — Z O l 0 Job Site Address: 2E6 K I iv& ST City /State /Zip: NC ZTR '€CI, ht4 . 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 cer ify under th pains and penalties of perjury that the information provided above is true and correct. Signature: C 1 Date: 't c Phone #: ll' &ss - 07 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 #: Versionl.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes O No SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 'PA\►\ Q dot.? 1'v �T ' as Owner of the subject property hereby authorize 3 P T' S 1 0 0 A- Qi i -0 L 7 to act on alf, in all matters 've to work authorized by this building permit application. Signatu a of Own r Date Z s — SS , 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. - 3 - Ptr( 0. '20 -SS Print Name - -/1 - 6 Signature of0 ner /A ent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : "F�^cr� (� ^ License Number i /7 3 l3/NNu. — 014 Address Expiration Date Signature Telephone SECTION 1 - 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 J � ' Versionl.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name (Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor . 5D - iLoc- Not Applicable ❑ Company Name: - •T'aPc∎C -% 0 , Z°'S S Responsible In Charge of Construction Address Signature Telephone Versionl.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size 76 L{c.) 5 Frontage 2 Ci ce t' Setbacks Front 76 SC> Side L: /w_ R: R: Rear 2 D Building Height / 6 /Ca Bldg. Square Footage , 0 Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces 1 Z-- 11 Fill: 1-4 6 MC 1NJ (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO DON'T KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page and /or Document # Does the site contain a brook, body of water or wetlands? NO DONT KNOW O YES O 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 tp NO IF YES, describe size, type and location: 1 PW+ D. Are there any proposed changes to or additions of signs intended for the property ? YES © NO y) 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 ZP5k IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Version1.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition [8. Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ix Brief Description Enter a brief description here. Z EPR'' - WAZ45t D 603 S i3 T tz&t. g_, Of Proposed Work: C C 1 N s CAp " R r ' r - N f ? O1T C)(I s j(f SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C _H High Hazard ❑ 3A ❑ I Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B I J U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: Proposed Use Group. :_....._ Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1 e, "6 Q 1st s ;-r7 2 nd f Ode, 2nd SA1h 3 rd 3 4 4 Total Area (sf) , 4 a Q Total Proposed New Construction (sf) NIA- Total Height (ft) JO Total Height ft 6.0 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Private ❑ Zone Outside Flood Zone Municipal C4 On site disposal system y Version1.7 Commercial Buildin& Permit May 15, 2000 Department use only City of Northampton Status of Permit; Building Department Curb Cut/Driveway Permit - 212 Main Street Sewer /Septic Availability 1 Room 100 Water/Weij;Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413 - 587 - 1240 Fax 413 - 587 - 1272 Plot/Site Plans Otl a 'Specify U APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILYiDWEL1 iG SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office za:s (V. JCWU& - Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Print) Current Mailing Address: 4 / Zf35 N,kfYbG 3T. ` +ri& MA Signature ii/ �'��� /` /� Telephone 3 Z C, 0r I 2.2 Authorized pent: ZAmcs Name (Print) Current Mailing Address: Telephone (y v � SE'"? 3 3 7 7 ' f( 3 c' fit" SECTION 3 - ESED 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 J 6. Total = (1 + 2 + 3 + 4 + 5) /L_.G U- Check Number 3J59 This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2010 -0165 APPLICANT /CONTACT PERSON JDR BUILDERS ADDRESS/PHONE P 0 BOX 66 WHATELY (413) 665 -7587 PROPERTY LOCATION 285 NORTH KING ST MAP 18 PARCEL 004 001 ZONE HB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ��� y� Fee Paid Tvpeof Construction: REPAIR WATER DAMAGED SHEETROCK & CONSTRUCT HANDICAP RAMP New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans / Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: pproved 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 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. . BP- 2010 -0165 GIS #: COMMONWEALTH OF MASSACHUSETTS 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- 2010 -0165 Project # JS- 2010- 000204 Est. Cost: $1200.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JDR BUILDERS Lot Size(sq. ft.): 8407.08 Owner: DULONG DAVID I & PAUL A LABBEE TRUSTEES & PAUL A LABBEE Zoning: HB(100)/ Applicant: JDR BUILDERS AT: 285 NORTH KING ST Applicant Address: Phone: Insurance: P 0 BOX 66 (413) 665 -7587 W HATE LYMA01093 -0066 ISSUED ON :8/14/2009 0:00:00 TO PERFORM THE FOLLOWING WORK: REPAIR WATER DAMAGED SHEETROCK & CONSTRUCT HANDICAP RAMP 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 8/14/2009 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo 285 NORTH KING ST BP- 2010 -0165 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18 - 004 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- 2010 -0165 Project # JS- 2010- 000204 Est. Cost: $1200.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JDR BUILDERS Lot Size(sq. ft.): 8407.08 Owner: DULONG DAVID I & PAUL A LABBEE TRUSTEES & PAUL A LABBEE Zoning: HB(t00)i Applicant JDR BUILDERS A'': 285 NORTH KiNci ST Applicant Address: Phone: Insurance: P O BOX 66 , •. (413) 665 -7587 WHATELYMA01093 -0066 - ISSUED ON :8/14/2009 0:00 :00 TO PERFORM THE FOLLOWING WORK: REPAIR WATER DAMAGED SHEETROCK & CONSTRUCT HANDICAP RAMP 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: Q / � — �D — Qg THIS PERMIT MAY BE REVOKED BY THE CIT i F NORTHAMPTON UPON VIOLATJ-ON OF ANY OF ITS RULES AND REGULATI S ¢ Certificate of Occupancy si nature: FeeType: Date Pai s Amount: Building 8/14/2009 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo