Loading...
38A-021 ACGRD C ERTIFICATE OF LIABILITY INSURANCE DATEIMM,DDITYYYI 4/160 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Wedgwood -Crane & Connolly Ins ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 19 College Ave HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR g ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Box 440313 Somerville, MA 02144 -000 INSURERS AFFORDING COVERAGE NAIC # INSURED 1NSURERA Western World Insurance Co. SUNBUG SOLAR LLC NSURERs Liberty Mutual Insurance Grou 411A HIGHLAND AVE INSURER c Arbella Protection Attn; Cheney Brand 1NS•URERD Associated International Ins SOMERVILLE, MA 02144 , INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITI-6TANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WfTH RESPECT TO WHICH THIS CERTFICATE 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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR AD 1 TR INSRIk TYPE OF I ADM URANCE POLICY NUMBER � ..D DATE YYhh n LIMITS GENERALLUABILITY EACH OCCURRENCE $ 1,000,000 A X Cc rtERCIALGENERAI.LAHL;TY NPP1203662 4 /1 /10 4/1/11 PR Mos DAMAGE TO RENTED . � Es I Ea ocartAnca.L _$ 50 CLAIMS MADE X OCCUR MED EXP ,Any one person $ 5,000 -.. PERSONAL BADV INJURY $ 1,000,000 j GENERAL AGC,REGATE $ 2, 0 00, 0 00 GEN1 AGGREUA •PP LIE SfER PRODUCTS COMP -OP AGG $ 2 _ POLICY PRO IP f T LOt AUTOMOBILE UABI UTY r - COME3INED SINGL E LIMIT $ C X ANY AUTO 22194400004 1/21/10 1 /21 /11' ace dent, AL L OVINE D AUTOS BODILY INJURY $ 250,000 SCHEDULED ALTOS Per parse HIRED AUTOS BODIL Y l 4 URY 500,000 NON.{ 'OWNED AU Pe' acc,dent PROPERTY DAMAGE. $ 250,000 ; Per acc,denU GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC y 1 $ . OTHER THAN AUTO ONLY AGG $ ■ EXCESS? UMBRELLA LIABIUTY EACH OCCURRENCE $ 2,000,000 X OCCL. CLAIMS MADE AGGREGATE $ 2,000,000 ''. $ D DEDUC CUBW2863309 10/29/09 10/29/10 $ RETENTION $ $ WORKERS COMPENSATION ‘ STATU OTH AND EMPLOYERS' LIABILITY - __RY AI LUM1TS __ DEB B ANY PROPRIETOR/PARTNEREXECUTt$ Y' - " WC31S372506 -019 4/1/10 4/1/11 E1 EACH ACODENT $ 1,000,000 ' OFF IC;E RAE MBER EXCL X E ^^ (Mandatory in NH) E L DISEASE • EA EMPLOYEE $ 1,000,000 SPECIAL PROVISIONS , .w E L DISEASE POLICY LIMIT 51,000,000 OTHER i DE SCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES 1 EXa.USIONS ADDED BY ENDORSEMENT r SPECIAL PROVISIONS All work performed by the insured for the certificate holder. All policy have been renewed and are up to date. CERTIFICATE HOLDER CANCELLATION S HOULD ANY OF T HE ABOVE DESCRIBED P OUCIES BE CAWELLE 0 BEFORE THEE XPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN The Insured NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL SunBug Solar IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR 411A Highland Ave REPRESENTATIVE ` / Somerville, MA 02144 AUTHORIZED RE * -,- 41"„t fitt. (1, r ACORD 25(2009/01) 0 1988-2009 ACORD CORPORA ' • • N. All rights reserved. The ACORD name and Logo are registered marks of ACORD 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 constniction 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 backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (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 jermits 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, understand the above. (Home owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to Date Address of work location , . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investig,ations a =.- t.-... ....... =zi!P..= ,-.. = 600 Washington Street ---- - --Tift---- # ( Boston, MA 02111 . ‘ -..-...- - ,,.4 'k!ir:""-prio a. • - I www.mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legiblv Name (Businesi/Organization/Inciivirhini): ..Ctii L.1 Iv • • Address: Li 1(4 H 6 h it el 4,,r. 5re ) 1 City/State/Zip: 50 / /fr - V). / ti Phone .#: Are you an employer? Check the appropriate box: Type of project (r uired 1- -. - - . 1 1 7 CV° 3 4 7 1 W - • eq): ,.., • , 1E1_1 am a emp w i t h li 4. 0 I am a general contractor and I 6. 0 New construction su employees (full ancVor part- • ).* have hired the b-contractors 2.0 I am a sole proprietor or partner- listed 011 the attached sheet. 7. 0 Remodeling • These sub-contractors have ship and have no eoloyees 8. 0 Demolition employees and have worke rs' • working for me in any capacity. 9 -0 Ruildin i addition [No workers' comp. insulin:me :- required.] - 5. 0 We are a corporation and its 100 Electrical repairs or additions 3. 0 I am a homeowner doing all work officers havexercised their . 11.0 Plumbing repairs or additions -, myself [No workers' comp. right of exemption per MGL 1/0 Roof repairs insurance required.] t ' c. 152, §1(4), and we have no • .1=1 employees. [No workers' 13 Other comp. insurance rect.:tired.] • *Any applicant -that checks box #1 must also fill out the section below showing their workers compensation policy information. t Hcrmeownera who submit this affidaVit indicating they are doing all work and then hire outside (=tractors must submit anew affidavit indicating such. 1 1 Contractors that check this box must attached an additional sheet showing the name of the sub--contractors nid state whether-or notthose entities have employees. If the sub-contractorshave employees, they must provide their workers' comp_ policy number. I ant an employer that is providing workers' compensation insurance for my OnPloYees- Below is the Policy and job site information. ci21? 4 (Tr)ctie d . . • Insurance Company Name: • Policy # or Self-ins. Lic. #: Expiration Date: . . . I Job Site Address: City/Stafe/Zip: - • - , Attach a copy of the workers' compensation policy declaration page•(showing the policy number andeapiration date). Failure to secure coverage_ as required Mid& Secti6il 'of N1GL c. 152 can lead to the iMPOsitirni of iimin41' penalties of a fine up to S1,500.00 and/or one-year imptisonme4 as well as civil penalties in the form of a STOP WORK-ORDER and a fine of up to 5250.00 a daY against the vio - for Be advised that a copy& this statement may be forwarded to the Offfee of Iiiireitinations 'of theDIA ger . ..•...., e coveraze verification. __-,—.....,_..-.:.- ....._____ 1ter..b_y ceril , .4" .and penalties ofperjray that the information providedabov.eisinte_andcorrect. _ / Simiature: , Date: ( -/ I al ( 0 . . , Phone #: 617 Sb0 7)S` - ' Official use only. Do not write in this area, to be completed by c•ity or townOffzcial • City or Tovvn: ' Permit/License # ' Issuing Authority (circle one): .1.. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inv ector 5. Plumbing Inspector 6. Other . . . Contact Person: Phone #: l • a .......,,--.. • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : C tiiJ V( 13 RA N'r) CS 990 3'+ License Number II Ma r-1-1soN 0.7- 2117-/1O12- Address Expiration Date Signature Telephone L- 9 Renistered•-Hom iiimia em8nt CorAtiao1 ZERSIZZEli Not Applicable ❑ 5ti r•S ) G Sot f.i- (4 16 3091 Company Name Registration Number i f I I A tha tk-,W p AV E S 3f Z 51 l /2o 11 Address / Expiration Date So m0?-4f it�c.E M A a Zl 11 Telephone 6(71003 94 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 ❑ 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all aaalicable) New House [J Addition ❑ Replacement Windows Alteration(s) ❑ Roofing 0 Or Doors 0 Accessory Bldg. D Demolition ❑ New Signs [0] Decks [Ca Siding [0] Other [tar Brief Description of Proposed p Work: . A2 — f v ft ND 14 wNi - "it, Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6i,: tf.Nernr ©hill tc r dditi t ka iriitii gi.110: I q aimpi i tho iiiiiiWI n : a. Use of building : One Family Two Family Other b. Number of rooms in each family unit _ Number of B- hrooms - c. Is there a garage attached? d. Proposed Square footage of new constru ': 4. Dimensions e. Number of stories? f. Method of heating? Fi • aces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck iergy Compliance form attached? h. Type of construction i. Is construction within 100 of wetlands? Yes No. Is construction within 100 • 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, PAM E 1.1c Mkc-e-W J k' ��1► t4 GE LLY as Owner of the subject property hereby authorize Soo 3 J G So��4 - f&. to act on my hal� al�tters relative to rk authorized by this building permit application. t1+ . 4 • , is Signature of Owner ) Date 1, Cte&te y t 1, % f S,,l~ 11 4j •10 (01 , 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. C ehey 11 JA Print Nam • / Y . , G ( Signatu - e of 6: -PC { n Date Ali • o 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 1 ` - " / _ .., Lot Size Frontage 1 1 1 b Setbacks Front E Side L:` 1 R:` 1 L: A A i Rear 1 1 � 4 I Building Height 1 t 1 Bldg. Square Footage 1 t% F-1 " 1 1 Open Space Footage , % f I N. (Lot area minus bldg &paved # L. ' 1 " parking) ,, ,, # of Parking Spaces Fill: �.�.....,��,.�...._ .,.� �..�.v ���,.w .....�. �.,�. _�.a..N�m �.,� �. ��. (volume & Location) i r i A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 1 k YES 0 IF YES, date issued:1 1 • IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book P age l f and /or Document # i B. Does the site contain a brook, body of water or wetlands? NO p DONT KNOW 0 YES 0 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 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 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 0 NO s e IF YES, then a Northampton Storm Water Management Permit from the DPW is required. City of Northampton ei 4 � Building Department . - , u tia- W 212 Main Street gs. . E � N% Room 100 3.E� 1 _ - 1orthampton, MA 01060 �� y phone 41387 -1240 Fax 413 - 587 - 1272' 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 3S tZJST A Map Lot Unit Ao R- '[fithy & PTV r 1 1 MA- 0 lb 60 done , Overlay' District Elm St. District r ___ C D istract SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: - rP- MEt-(� tApic,FtrJM1 * 'M . QEPte∎Eta Y 3c I�JST k%JE � o P[a N MN c to6e Name (Print) Current Mailing Address - -..i 1.1 (3 586 - s7 g ` Telephone Signature 2.2 Authorized Agent: .54 0To) 6. Sokkgz u-C- / - NeY 155- /vt-n) 411 It thGt�th•►O �•/E� 5r 317. fn�ERJi� / MA Name (Print) /// Current Mailing Address: 02 r t j �/ G! 7 Soo -3 t36 Signature Telephone SECTION 3 - ES MATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building C,! /� (a) Building Use Permit Fee 2. Electrical /4/ �'' 7 (b) Estimated Total Cost of 44 1 / Const from (6) 3. Plumbing 4. Mechanical (HVAC) i Building P ermit Fee 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) � 7 �, /, Check Number J /j/74, 0( 07)/- This Section For Official Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2010 -1025 APPLICANT /CONTACT PERSON SUNBUG SOLAR ADDRESS/PHONE 411A HIGHLAND AVE SOMERVILLE (617) 500 -3936 PROPERTY LOCATION 35 RUST AVE MAP 38A PARCEL 021 001 ZONE URB(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 1/76O Odd Typeof Construction: INSTALL SOLAR PV HOT WATER New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 99037 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 /ziJ 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. r, BP- 2010 -1025 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block .315A:4)„,4 . 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 -1025 Project # JS- 2010- 001513 Est. Cost: $35200.00 Fee: $211.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SUNBUG SOLAR 99037 Lot S ze(sq. ft.): 7884.36 Owner: PENGELLY FRITHA A & PAMELA T MACEWAN Zoning: URB(100)/ Applicant: SUNBUG SOLAR AT: 35 RUST AVE Applicant Address: Phone: Insurance: 411A HIGHLAND AVE (617) 500 - 3936 WC SOMERVILLEMA02144 ISSUED ON :5/21/2010 0 :00 :00 TO PERFORM THE FOLLOWING WORK: INSTALL SOLAR PV HOT WATER 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: g' ,4.0 fa r e Final: C -30- j O 2 � Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: OK 0 4 C .. THIS PERMIT MAY BE REVOKED BY THE CITY OF THAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGU T 49:04:r #04 400 Certificate of Occupanc , �/ bignature: FeeType: Date P , i : Amount: Building 5/21/2010 0:00 :00 $211.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo