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06-022 CASELLA DESIGN ASSOCIATES, LLC Date: January 06, 2012 DRAFT COPY — DRAFT COPY To: Mr. Louis Hasbrouck Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 Re: Complete Restoration Solutions Fire Damage Repairs Yankee Hill Condominiums. 48 Evergreen Road Building #5,Unit #113 Leeds, MA 01053 Mr. Joseph Gillette, President Complete Restoration Services 30 Haynes Circle Chicopee, MA 01020 Dear Commissioner Hasbrouch: Mr. Joseph Gillette, President of Complete Restoration Solutions has requested that you grant a modification to waive the requirement for control construction for the project at Yankee Hill Condominiums, 48 Evergreen Road, Building #5, Unit #113 in Leeds. The anticipated scope of the work at this time appears to be of a minor nature, and is not anticipated to affect health, accessibility, life and fire safety, or structural requirements, and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work. If the scope of said work changes beyond the anticipated limited work above, and falls under any portion of required Control Construction, Mr. Gillette or his designee shall contact your office, as well as this office before proceeding. Thank you for your consideration. Respectfully submitted, Raymond C. Casella, A.I.A., J.D. DESIGN FOR EDUCATIONAL, MUNICIPAL & RELIGIOUS STRUCTURES 200 SHOEMAKER LANE AGAN'AM, MA 01001 T 413- 7E6 -0318 F. 413 - 726 -0286 E. INFO'2CASELLA,ESIGN. CASELLADESMIZ A kei... c „ ° R D CERTIFICATE OF LIABILITY INSURANCE 9A�i2o11YYY) 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 Gail Croake NAME: Alexander W Borawski Inc IA/C. (413)586 -5011 1n/c, No): (413)586 -7973 88 King Street, Suite B ADD : gc r oake @borawskiinsurance. INSURER(S) AFFORDING COVERAGE NAIC # Northampton MA 01060 -3257 INsuRERAAmerican Safety Indemnity Comp INSURED INSURER B : Liberty Mutual Complete Restoration Solutions INSURER C :Peerless Insurance 24198 30 Haynes Circle INSURERD:Chartis Specialty Insurance INSURER E : Chicopee MA 01020 INSURERF: COVERAGES CERTIFICATE NUMBER :CL1181500179 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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR INSR WVIZ POLICY NUMBER (MM /DD/YYYY) (MMIDDIYYYYI GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE EMI TO ( aEc X COMMERCIAL GENERAL LIABILITY occurrence) PREMISES (Ea occurrence) $ 50,000 A CLAIMS -MADE X OCCUR ENV0266591001 8/28/2011 8/28/2012 MED EXP (Any one person) $ 5,000 _ PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY PRO- $ PRO- LOC .IFCT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ A ALL OWNED SCHEDULED ENV0266591001 8/28/2011 8/28/2012 AUTOS AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED PROPERTY DAMAGE $ _ AUTOS (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 ENUO266711001 8/28/2011 8/28/2012 $ B WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY i TORY LIMITS ER ANY PROPRIETOR /PARTNER /EXECUTIVE N N E.L. EACH ACCIDENT $ 1,000,000 OFFICER /MEMBER EXCLUDED? W C1 - 318 - 374704 9/1/2011 9/1/2012 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Bailment Coverage 1M8857812 5/18/2011 5/18/2012 $250,000 Ded $1000 D Pollution D- CPL11785371 08/28/11 082812 Pollution Liability $1,000,000 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. Insurance Purposes AUTHORIZED REPRESENTATIVE R Borawski /BORGC1 .__ ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. INS025 nnlnnst nl Tha Arnifl nnma and Irwin nra ranic8arad mnrlrc of A C(1Rfl ,_ The Commonwealth of Massachusetts Print Form Department of Industrial Accidents , Office of Investigations i. ` 1 Congress Street, Suite 100 Boston, MA 02114 -2017 J ``` www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organizati /Individual): / " �� f i f I i ) '� /t'h. � / / /zis Address: r 0 + / -C /// =J ( i�� e k- Cit /State /Zi 1 - Y p r�l / , �i� /020 Phone #: ( - i G/7 Are ou an employer? Check the appropriate box: Type of project (required): 1. 1 am a employer with 2.0 4. ❑ 1 am a general contractor and 1 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 any aci employees and have workers' y ca p 9. ❑ Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions 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' 13.0 Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 1. 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: Z' IS grity 1 Ili if / Policy # or Self -ins. Lic. #: hie/ j — 3/ cc 371 70 1 / - 0671 Expiration Date: q8pl(!/ Job Site Address: "/ 0 fejt (i1) l2t City /State /Zip: ie.ros .c i //I1 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. 1 do hereby cer t under the • ains and enalties o I er'u that the in ormation provided above is true and correct. Signature: �I /% Date. .2 `"�i Phone #: •'i/' - s -4. - - L7 77---- 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 #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supe LI /71- Not Applicable ❑ Name of License Holder : .� y f7 e, /o ✓ 0/i f License Number ,,.1/ All v.es (r e k— eke.eri.e_ ie #0 0% 20 /.'7iov 3. Address Expiration Date Signature Telephone 9. Regis ed Hom 1 • ro vem 1er.47-,7A-4.1 ent Contractor: Not Applicable ❑ ( ' � 1 /e r ��, s -7),4 (Z f6 ,l 9 Company ame Registration Number ' i f Z,) / f ff e , , , e ,s ( A r 7 ,-et r _p_„./-"fri--- 0 /0 zo 4. 2 - - A-16 / . Address i / i Expiration Date t,^ • .Alt Telephone //, :.�7.L 2 77Z Pr i SECT • 10- WORK: S' 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 i SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing n Or Doors 0 Accessory Bldg. ❑ Dem New Signs [0] Decks [Q Siding [0] Other [0] Brief Description of Propose fi //,�I gg Work: GaPn ofr I!`'L, /7 140 A t- ,4 9,,4,+ ti- -, Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes / No Attached Narrative Renovating unfinished basement Yes ✓ No Plans Attached Roll - Sheet 6a. If New house 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 attached? Ai 0 d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform 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 APPLIES FOR BUILDING PERMIT ? I, i - S � 1 _6 ...., Ae % i - " , , as Owner of the subject property / /' " hereby authorize e rs� 4 J f ( /cif) Sobel e %py S to on my behalf, i II matttrs relative to work autho . ed by this building permit application. - / at0 J f 7 ? Date /2 /✓ of Owner 1 I, /4 X ,tt • 6: / /r79 , as Owner /Authorized Agent hereby dclare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed und: r the pains and penalties of perjury. ��0i' eit Print Name , 11 ik'` P. /�' 20 2,9 Signatur= . • -er/ ∎: 1 1 Date It Section 4. ZONING AU 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 R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW 4� YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO (3 DON'T KNOW 0 YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Date Issued: C. Do any signs exist on the property? YES NO i IF YES, describe size, type and location: cX G - fa-f .4- Co X D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 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 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 1111 CC (5? Department use only City of Northampton Status of Permit: �� Building Department Curb Cut/Driveway Permit DEC 0 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability „R►tDta iii orthampton, MA 01060 Two Sets of Structural Plans o�°N phone 413 - 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans 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 A Y -Lt'�1 t� 4 l/ an 3 Map Lot 00 Unit 1'7711 Zone G Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: W /frii / aSitikt Name nt) % Current Mailin Address: / /3 °�P' • war r ■ — � 49 " Telephone Sig,r;re / 2. Authorized Agent: �. // /� .� 4f M, (> /r / ( ' 0 (� ��'L� /k /►" -GJ �� v (, r si e� � 4-7/9 Name (Print) Current Mailing Ad ess: . [k e •2 `fie_ « '? 7 Signature ‘ Telephone SECTION 3 - STIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building y0P/ (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) Check Number / This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2012 -0592 APPLICANT /CONTACT PERSON JOSEPH M GILLETTE ADDRESS/PHONE 30 HAYES CIRC CHICOPEE (413) 592 -2772 PROPERTY LOCATION 48 EVERGREEN RD - UNIT 113 MAP 06 PARCEL 022 035 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 164111 /.QC) Fee Paid l/ Typeof Construction: REMODEL FIRE DAMAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 103014 3 sets of Plans / Plot Plan THE FOL WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON I FO 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 a •' • lition Delay 0 00 gnature 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. 48 EVERGREEN RD - UNIT 113 BP- 2012 -0592 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 06 - 022 CITY OF NORTHAMPTON Lot: -035 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit # BP- 2012 -0592 Project # JS- 2012- 001017 Est. Cost: $50000.00 Fee: $300.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JOSEPH M GILLETTE 103014 Lot Size(q. ft.): Owner: HAMPSHIRE PROPERTY MANAGEMENT Zoning: URA Applicant: JOSEPH M GILLETTE AT: 48 EVERGREEN RD - UNIT 113 Applicant Address: Phone: Insurance: 30 HAYES CIRC (413) 592 -2772 WC CH I COPEEMA01020 ISSUED ON:1/19/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: REMODEL FIRE DAMAGE 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 1/19/2012 0:00:00 $300.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner