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18C-098 (3)
Sep -25 -2008 04:16 PM Remillard Insurance 14135386010 1/1 ACORD CERTIFICATE OF LIABILITY INSURANCE , � " � `"""'°°""' 0 C�1 -iM 09/26108 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Remillard Insurance Agcy, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 79 Lyman Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. South Hadley MA 01075 Phone: 413 - 538 -7862 Pax:413- 538 -7179 INSURERS AFFORDING COVERAGE NAM # INSURED INSURER A• Safety Insurance Company 39454 INSURERS: Aaaoaiatad Rgplayara ma ae Tomlinson Builders Inc INSURER C: Patrons Insurance Group 14923 Greenfi d 01330 a Rd. INSURER Cr .__,. INSURER COVERAGES THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONORTON 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 MO CONDITIONS OF SUCH POLICIES. AGGREGATE LENTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. C PORE E TYPE OF INSURANCE POLICY NUMBER D (� P l D A�TE y (IWiMA LENTS TRW (RJR% GENERAL LIABILITY EACH OCCURRENCE $1,000,000 C X COMMERCIAL GENERAL LNABtLITY CTR0002030 05/12/08 05/12/09 P s"(Ea'�'"' h9m S 50,000 I CLAIMS MADE © OCCUR MED EXP (Any one person) $ 5 000 PERSONAL &ADVINJURY 61,000,000 X snow plowing GENERAL AGGREGATE $ 2 , 000, 0 00 OEN'L AGGREGATE LIMIT APPLIESPER: PRODUCTS • COMP/OP AGG 6 2,000,000 POLICY n i'a floc AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A ANY AUTO 2209112 12/29/07 12/29/08 (EaacddenR} — ALL OWNED AUTOS BODILY INJURY $ 500 r 000 X SCHEDULED AUTOS (Per Person) X HIRED AUTOS BODILY INJURY X NON -OWNED AUTOS (Per seeldenQ S 500,000 PROPERTY DAB s 500,000 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCF.SSAIMBRELIA LIABILITY EACH OCCURRENCE _ S — 1 OCCUR U CLAIMS MADE AGGREGATE S S DEDUCTIBLE _ 6 RETENTION S ) S WORKERS COMPENSATION AND ITORY N LJbAIU I ° ER s EMPLOYERS' PROPRIETOR/PARTNER/EXECUTIVE wCC5004320012008 04/09/08 04/09/09 ELEACHACCIDENF $ 100000 ANY OFFICER/MEMBER EXCLUDED? E.L DISEASE • EA EMPLOYEE $ 100000 SPECIAL PROVISIONS bebw E.L. DISEASE - POLICY LIMIT $ 500000 OTHER C Property Section CTR0002030 05/12/08 05/12/09 C Equipment Floate CTR0002030 05/12/08 05/12/09 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Northampton DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS wetrreN 1r:413-587-1272 NOTICE TOTES CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Building Inspector IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 212 Main Street Northampton MA 01050 REPRESENTATIVES. AUTHORIZED REPRES Ste hen B . :; w a " w. ACORD 25 (2001J0S) 0 ACO • - - • • - TION 1988 HOME OWNER EXEMPTION ACKNOWLEDGEMENT • The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation /footings (before backfilfl. sonotube holes (before pour), a rough building inspection (before work is concealed), insulation infection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, ; , ' • u. derstand the above. (Home owner /resident's signature requ • • ti 1g exe pt'. n) I will call to schedule all required building ins. - ions eces for the building permit issued to me. Date 1 11) /at Address of work location — ��:�'� er 14� � ftn. rA ! • 01 0_11 SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ k Name of License Holder : 'II ► t) it O `I' W 'J License Number /-1 5Zk Address Expiration Date U 1 - V .17 L Pc 4L • — ?.5(o -O491 Signature T elephone 9. Registered Home Improvement Contractor Not Applicable ❑ -" bt"t\ (.1 ‘,\._‘20‘‘4, - V7tAt v i t � . /117 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 Exempt The current exemption for "homeowners" was extended to include Owner - occupied Dwellints 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 Z ng Laws and State of Massachusetts General Laws Annotated. Homeowner Signature • • SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacemenndows Alteration(s) ❑ Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [C] Siding [D] Other [D] Brief Description of Proposed Work: 17(A I t . tom f t P9911‘614- 11- LZ : 4 ,1j44 Alteration of existing bedroom Yes No Adding new bedroom Yes X 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? 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 Ta - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT , 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 , 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. Print Name Signature of Owner /Agent 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: 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 /Findin ever been issued for /on the site? NO 0 DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW At YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO i „..4 DONT KNOW 0 YES C) 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 0 NO IF YES, describe size, type and location: 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, ex - vation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 4 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. • Department use only City of Northampton Status of Permit Building Department Curb Cut/Driuevray Perm 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans 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 Pro Address: 7 This section to be completed, by office 0 f c ' Map Lot Unit R CAL ATCTC (; Zone Overlay District 0I, OleD. Elm St. District CB District SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: I TtaL44fAi k ' fi ll IP_ 4 tjti• Name (Print) Current Mailing Address: of ' * Telephone l 2.2 uthorized 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 I ( • 6 (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) Ab 2i p • (p Check Number 4/ This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner /Inspector of Buildings Date • File # BP- 2009 -0342 APPLICANT /CONTACT PERSON TIERNEY AELAN B & ADDRESS/PHONE TAMLYN K MAGINNIS NORTHAMPTON (413) 584 -8706 () PROPERTY LOCATION 30 FRANCIS ST MAP 18C PARCEL 098 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid 49 4/0 6 Typeof Construction: ADD 2 SKYLIGHTS, REPLACEMENT WINDOWS & ROOF INSULATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 017965 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF3 RMATION PRESENTED: V 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 cad 0 V2_9/0 y 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. �j4(6(,,y //q re/ v ,`' 2 f 9 eia 7t l�v�r fir / p n/� - / ~ l-,L v / / 30 FRANCIS ST BP- 2009 -0342 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18C - 098 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- 2009 -0342 Project # JS -2009- 000464 Est. Cost: $21000.00 Fee: $126.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TIM TOMLINSON 017965 Lot Size(sq. ft.): 7492.32 Owner: TIERNEY AELAN B F Zoning: URB Applir.unt: TIERNEY AELAN B & .47": 30 FRANCIS �T Applicant Arirrre s_ Phone: Insurance: (413) 584 -8706 () Workers Compensation NORTHAMPTONMA01060 ISSUED ON :9/29/2008 0 :00 :00 TO PERFORM THE FOLLOWING WORK ADD 2 SKYLIGHTS, REPLACEMENT WINDOWS. & ROOF INSULATION 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• 1rsib8 � House # Foundation: 4, - /- ousa) Driveway Final: Final: Final: ' 4 /44 4 Rough Frame k( . " - •) fiVelogv II 'rep r ; Gas: Fire Department F P Fireplace /Chimney: Rough: Oil: Insulation: y_) v�__" I J Final: Smoke: Final: On 02 / 0 4/o9 1 .ot415 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. �. 4L--4---() 7 Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 9/29/2008 0:00:00 $126.00698 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Conunissioner - Anthony Patillo •