Loading...
37-104 1 I I Ns existing window 6 c existing gyp finish existing garage J garage door v 1 - door $ track opener I O_ existing existing existing existing switch outlet outlet outlet to ceiling light existing con curb l ill \ A - Section /Elevation - - West Elevation Ice Pond Workshop - Existing Conditions - 3 Bay Unattached Garage Chrobak- Frazer 74 Ice Pond Drive Northampton, MA 0 1 062 j :e = 71-/ ! por, l Gh.w k Ac• ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD /YYYY) 1�.,../ 11/28/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Elizabeth Downie, Rep Encharter -MA PHONN )_ (800) 675 -6695 I C tot: (800)754 -1602 Encharter Insurance LLC AD RESS: edownieQencharter.com 25 University Drive INSURER(S) AFFORDING COVERAGE NAIC # Amherst MA 01002 INSURER A :Travelers Insurance INSURED INSURER B : Thayer Street Associates INSURERC: 8 Coates Avenue INSURERD: INSURER E : South Deerfield MA 01373 -0146 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1172902180 REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) IMM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ A O COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ _ CLAIMS -MADE I I OCCUR MED EXP (Any one person) _ $ PERSONAL & ADV INJURY $ – GENERAL AGGREGATE _ $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ POLICY n !p n LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ , _ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED — BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED PROPERTY DAMAGE HIRED AUTOS ^ AUTOS (Per accident) — $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION I WC STATU- I x IOT AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ 500, 000 OFFICER/MEMBER EXCLUDED? N / A 7/15/2011 7/15/2012 (Mandatory in NH) XAUB7208Y94A11 E.L. DISEASE - EA EMPLOYEE $ 500, 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Kevin Chrobak AUTHORIZED REPRESENTATIVE William Dowd /NO1ED1 C. °A - ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD a t • • ts' • , •• • t • 4 ,•?.:}/ v •.• • p. ; . • '„, SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : I " tiakrir �.J License Number jheter !/I r 1 . ‘C. Il IA •' %t!/ // Addres ! Expiration Date 413'lp64 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone 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. 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 • • Y . I , • f, I . .. 0 •`. ;,!AK:Ufti 44, teei "4. " N . ! * * ' 4.SIA 1 1■ 44 , • • • „ • • et • 1. • • !V•4;‘, SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ® Roofing ❑ Or Doors 0 lnierfOr Accessory Bldg. 11 Demolition ❑ New Signs [0] Decks [q Siding [0] Other [0] Brief Descriptiop of p posed Work: 5 Uti-'div l IK j ekle Dot e.X.t�'� + re `A i v notiliGked l a :v. Alteration of existing bedroom // Yes /, No Adding new bedroom Yes x No Attached Narrative Renovating unfinished basement Yes X( No Plans Attached Roll CD tt)(['r If New house and or addition to existing housing, complete the following: / a. Use building : One Family Two Family Other ��i b. Number of root. each family unit: Number of Bathrooms /� c. Is there a garage attache l - - -,._ d. Proposed Square footage of new constru D' nsions e. Number of stories? '''''s-->C f. Method of heating? FiisejAkces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck y Compliance form attached? h. Type of construction i. Is construction within 100 I wetlands? Yes No. Is construction within 100 y1oodplain Yes No j. Depth of baseme • • cellar floor below finished grade k. Will buildin! onform to the Building and Zoning regulations? Yes No . I. S is 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, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, 1-1 :. 'irA,i . Owner�horized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the besfof my knowledge and belief. Si ned under the pai and penalties of perjury. i NV vtCd T- Print Name - _VAstAdae -VZ,V2A,/ bl /Zz j2oll Sig ature of Owner /Agent D to t • • I. .,„ <, ■,6„ v'4; v.* 11, • . • i . - • . • t4. f•S' 2! t'ocitvic . V4 Ctflalt7q ts::0:,) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning Cno iar 9 e L ‘Ale) This column to be filled in by 7 � l�f Building Department Lot Size • 53 O (, e5 Frontage 17 • Setbacks Front 1301 9Av Side L: 311 Z R: 5 1 L: R: Rear 35' 60Vit Building Height Z'' c iwe S F U Bldg. Square Footage 32a, ly ?„,30 5p. wife Open Space Footage (Lot area minus bldg & paved ! 'O% 7 5 parking) # of Parking Spaces Fill: (vo & Location) AVn A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW ♦44 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW (3 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 14 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 ® NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 2.. N.. 'e •re • ,,,' tr'' • ''... i 4 -; „ •.. - .... .., .. . 1,, 4 '• 4 , i';‘, P., ! ''- Ott 1 . 0 ' .7 4.. .. ■ . V 1 • II . . ' . , ': • Itt,, . 4 %.• `...../ 4 '4. ' !!' f,. ' '. !. ", rt.. . ' , . .0 .e ,‘. i .:... ', '' 4 " , , 4 4 *7. ''''. ' t' • ; '. • •••& . • `.• It ... ' • 4 ! CI '' 44 1 .... : t 4 ',. i • . , N i I, 4 4 I 4 • 41. . 4W A .I Department use only City of Northampton' ` Status of Permit: Building Department REC 4 nve ,y Permit 212 Main Street Sewer optic Av liability Room 100 ay ter/VYeII Ava bifity Northampton, MA 0106 ` ' wo Sets of Structural Plans phone 413 - 587 -1240 Fax 413- 87-Z.. ._.T ' � C _ Plot/Site Plans _ Nom ti Other Specify 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 toe 1'614- X V i v� Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Levitt rose,/ dwobak 1f I ce4cnet Dried , 1 01 Ifor,,P ' otc 0 -- Name (Punt) Current Mailing Address: 4 1 3 .617 (0133 � �.. Telephone ignature 2.2 Authorized Agent: Name (Print) 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 _ 6. Total = (1 + 2 + 3 + 4 + 5) 3 , Check Number / ` This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date . File # BP- 2012 -0526 APPLICANT /CONTACT PERSON CHROBAK KEVIN & LAURIE FRAZER ADDRESS/PHONE 74 ICE POND DR FLORENCE (413) 522 -6133 0 PROPERTY LOCATION 74 ICE POND DR MAP 37 PARCEL 104 001 ZONE SR(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out i 7 3 1 ) Fee Paid Typeof Construction: SUB - DIVIDE ONE BAY IN DET GARAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 045159 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 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.