38B-080 (2) TO :924511 ' •
APR -30 - 2009 0B:56 FROM:MORIN INSURANCE 4132456559 — ! _
•
{ �+ �+ (MNI+QDlYYYY)
�4CDR_D,� CERTIFICATE OF LIABILITY INSURANCE E , DATE 04/30 /2009
PROD IC
UCER (413) 245 -6864 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTW1CATE
Morin Ins. Agency HOLfDER. TNfS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 140 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
7 Main Street
Brimfield MA 01010- INSURERSAFFORDINGCOVERAGE HAIG*
INSURED mSURERA:Nattilua Ins. Co.
Scott Ai,key -Steel eed Renovations INSURER B: — T
PO Box 323 INSURERC _
INSURER D:
j $X i mf'ira7.d MP, 01010- INSURER E: -
COVERAGES
THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY
I REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IN$R ADD% POLICY EFFECTIVE PCUCY EXPIRATION LIMITS
).T - •,! TY _ OF IHSURAKE POLICY NUMBER ,_DATE 1IMA DDITT) DATE IMM1D KY)
A CF-NERALI IASItJTY NCB16218 06/34,(200$ 06/30/2009 HOCCuRRENct S 1,000.000
fl DAMAGE TO RENTED
Ell COMMERCIAL GENERAL LIABILITY FREMISER (Eaae 3
tur[encel
CLAIMS MADE I X I GccuR / / / 1 MED EXP ( one person) $ - —
� � - PERSONAL & ADV INJURY - S
• / / / / GENERAL AGGREGATE $ 2,000,0017
dEETL AOoREGATE LL APPLIES PER: PRODUCTS - COMPRPP AGG $
POLICY _ 1T Loc / / _ / / _ _
AUTOMOBILE UARLU Y 1 / / / COMBINES] SIN31 LIMIT S
(Ea accidelB
III ANY AUTO — - —
III ALL DIM'iPA AUTOS / / / / BODILY INJL #RY $
{Per p4s7Ati)
SCE ,RULED AUTOS –,— - _
HIRB AUTOS / / / / BODILY INJURY $
(Pet aceiel nt)
III NPN•CMNEO AUTOS
/ / / / PROPERTY DAMAGE $
:..r --+— - (Pict ecciclenl)
GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $
■ ANY AUTO / / / / OTHER -WAN EA ACC $
AUTO ONLY:
AGG $ .
----,--. EXCESS/UMBRELLA LIABILITY / / / / — EACH OCCURRENCE $ _
■ OCCUR LI CLAIMS MADE AGGREGATE $ .
• $
III DEDUFTIRLF / / / / -- $ ._
RETENTION s / { / / ITlIMTf ° a
EMPLGYERS' UAA1Idt , E.L. EACH ACCIDENT $
ANY PROPRiSTOR/PARTT'lFR/EMECUT)VE / 1 E.L. DISEASE ". EA EMPLOYEE $
OFFICER/MEMBER EXCLUDED? / /
H yes. dehalbn mire ,L. DISEASE -POLICY LIMIT $
SPECIAL Pl�OVII�7N3 (Xlgrr - / / / /
OTHER
/ 1 / /
/ / / / —
ESCRIPTTON OF OPERATKAISA.00ATioNsivENICLESFExcLustONS ADDED BY ENDonst ENTtSPECIAL PRCriHS ONA
ER HOLM CANCELLATION -
- ( ) - SHOLuLB ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE 155UING 1NSL1Rl:R WILL ENLIFAVQR TO MAIL
20 DAYS WRITTEN NOTICE TO THE ceaTIFlCATE HOLDER NAMED TO THE LEFT, BUT
T AILURE TO Da SO SHALL IMPOSE. NO OOLIGATIQN OR LIABILITY QF ANY KIND UPON THE
Northampton Building Dept INSURER,TTSAGENTSORREPRESENTA .- . _
Main Street AunwaRRessostsseNTAT>'
North —ton MA 01060- `- ACO RD CORPORATION X8818
;ORD26(2001108) Palle aTa
M fNS025 (voq.aa ELECTRONIC LASER coRMS., inc. - TV:1)327AS15
t 4 'ltt� tttr - D at°tiaciit tr1 Public .ata °l s
Hoard d ttt Bui Rettulationi. and 'st<tntlar3.t-
Construction Supervisor L cense
License. CS 69147
R4.7 taacts +o. 00 ;
WILLIAM R CANTELL x
1230 DUNHAMTOWIV BRIMFLD
BRIMFIELD, MA 01010 p
Expiration: 7/31/2010
--- l =kt{iso-ii'*tigray�d' k' Tr#' 161
!loan! of Building i.,.gilkili n s and
F'OME IMPROVEM _ NT
Registration. 124556
Expiration: 7/16/2009 Tr r
Type: Individual
th, +l >iam R. Cantell
;�r,lliam Cantell
1230 tau?4t m!Dwn
Aft 001(} tAti,iCtr, t " „
7.'"zeow Of registratio l t', 114 fort iividttl:use caile a
before tilt: cxliiratioln date. rp found return to:
tioittil of Banding Regu:aia s and Sandftrds
£ �
As! .Ia r cc n Place R m 1301
..frste}:a, ?s a. 02108
Not a11d s►itl.uail Sayr,: <Rt.?
•
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supergsor: Not Applicable ❑
Name of License Holder : �0- ' ['� Q 4(-7---v-1-
License Number
/c 3C) bi :ti�� - 7 "7 (CA' 152 -taw) afo/o (1.5 9 / y 7
Address Expiration Date
x{13 4.37.. -� 3--- 7 _ 3 f
Signature Telephone
9. Registered Dome Improvement Contractor: Not Applicable ❑
Company Name Registration Number
is 0 60/49 ritY( 'it- r? 9t l .K/ tir4r Az I l a /0R v6 5 6
Address Expiration Date
Telephone N0 43 7o y 5 - 7 ,/6 °-' 0°7
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
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ID Replacement Win s Alteration(s) 0 Roofing El
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [E:j Siding [0] Other [0]
Brief Description of Proposes / ` / , _
Work: TO .?.d. TA� ( 6 3 8Feti3 C�77'ie 1 / Cwt GVs
Alteration of existing bedroom Yes 1:- Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes �
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 budding 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 APPUES FOR BUILDING PERMIT
I, t S v c trt' n , as Owner of the subject
property , ..
hereby authorize SCer ;� nn 7/ k iP1. l) ail 'l9,TgZ
to act on behalf, in all matters relative to work authorized by this building permit application.
(~
Signature of Owner Date
e
I, SC e77 r L ,4 key , as Owner /Authorized
Agent hereby declare that the staterhents 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.
eo / e ' l f
Print Nam = /
Signature of Owner/Agent Date fi !i - .
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) f
# of Parking Spaces A — /
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO er .--- DONT 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 #
B. Does the site contain a brook, body of water or wetlands? NO T KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO e''y
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO
IF YES, describe size, type and location:
E. WiII the construction activity disturb (clearing, grading, xc n, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
City of Northampton Status of Permit:
Bu Department Curb Cut/Driveway Permit
212 Main Street Sewer /Septic Availability
i�U Room 100 Water/Well Availability
C North mpton, MA 01060 Two Sets of Structural Plans
phone 413 -58 -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 Progertv Address: This section to be completed by office
-1 " . 3- t- 6rr Map Lot Unit
ird.T°' '' Zone Overlay District
0( OW
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: _
1EX;' l l 7 60-7A s i ,A ,4
Name (P ' ) Current Mailing Address: ! f? -6-86 - 6 -Zt3
Telephone
Signature
2.2 Authorized Agent;
Seth kip/ - (La Cg T iL /.?0,4 &q B 11YFCt-2I /4550100
Name (P tht) Current Mailing Address:
, 9 �3 [ 76t
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building , r 7 (a) Building Permit Fee
r
2. Electrical (b) Estimated Total Cost of
it_90 Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection /t. e
6. Total = (1 + 2 + 3 + 4 + 5) Check Number /770 x,35
This Section For Official Use Only
Permit Number: Date
Building Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
179, OMPt 1 BP- 2009 -0900
GIS #: COMMONWEALTH OF MASSACHUSETTS
- i} eiCr B = 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 -0900
Project # JS- 2009 - 001315
Est. Cost: $4760.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WILLIAM R CANTELL 124556
Lot Size(sq. ft.): 161172.00 Owner: BERLIN - CHAVEZ STEVEN & REGINA CHAVEZ - BERLIN
Zoning: URB(100)/ Applicant: WILLIAM R CANTELL
AT: 179 SOUTH ST
Applicant Address: Phone: Insurance:
P 0 BOX 324 (413) 219 -7642
BRIMFIELDMA01010 ISSUED ON:4/30/2009 0:00:00
TO PERFORM THE FOLLOWING WORK: INSTALL 17 REPLACEMENT WINDOWS
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 4/30/2009 0:00:00 $35.00MO
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo