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23A-232 (3) 4 y Board of Building Regulations and Standards 1 —MAIM L HOME IMPROVEMENT CONTRACTOR V _II Registration: 153197 � Expiration: 11/3/2010 Tr# 283923 Type: DBA ALLAN JARVIS CARPENTRY ALLAN JARVIS 2 JACKLYN CIRCLE -)--..f., GRANDY, MA 01033 Administrator • g7t.e ervomoneesealeg o1✓t act BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR, Number: CS 094928 Birthdatce 1=4/1967 Expires 1,2/24/2010 Tr. no: 94928 i Restricted 00- ALLAN JARVIS 16 SENATOR DRIVE '' [LAST. LONGMEADOW MA_ 01023_ _ Commissioner P o Allan Jarvis General Contractor ,, 2 Jackielyn Cir • Granby, MA 01033 • 413.262.1065 • aljarvis @charter.net Finish Schedule: A Finish Schedule is a detailed list of all owner selected--- (allowancedor mmer.._selected.'._inctud& &)finish items. The schedule should contain wall and trim paint color selections and all manufacturer /model information including specifications (not directions!) for installation of each owner selected product. The purpose of this schedule is to ensure all sub - surfaces have been modified or prepared properly to accept selected finishes and to ensure efficient construction progress. If applicable, a completed Finish Schedule shall be submitted to the Contractor by it's due date. The due date is one week prior to the longest `owner selected' material delivery lead time in your project. Any delay or changes in finish schedule may cause removal of installed materials at an additional cost and /or delay the projected completion date. Contractor requires 24 hrs to review finish schedule after receipt. General Provisions: If conditions are encountered at the construction site which are subsurface or otherwise concealed physical conditions or unknown physical conditions of an unusual nature, which differ naturally from those ordinarily found to exist and generally recognized as inherent in construction activities, the Owner will promptly investigate such conditions and, if they dyer materially and cause an increase -or decrease in the Contractor's cost of and/or time required for, performance of any part of the world will negotiate with the Contractor an equitable adjustment in the contract sum, contract time or both. Hazardous Materials, Waste and Asbestos: Both parties agree that dealing with hazardous materials, waste or asbestos requires specialized training processes, precautions and licenses. Therefore, unless the scope of this agreement includes the specific handling, disturbance, removal or transportation of hazardous materials, waste or asbestos, upon discovery of such hazardous materials the Contractor shall notify the Owner immediately and allow the Owner to contract with a properly licensed and qualified hazardous material contractor. Any such work shall be treated as a Change Order resulting in additional costs and time considerations. Total of Contract: Including all materials and labor to complete. The cost for remodeling the project as specified in this contract shall be set at the sum of $18,250.00 (eighteen thousand, six hundred and fifty dollars.) This price is subject to additions and deductions pursuant to authorized change orders and allowances and valid for 30 days. Payment terms: $500 with signed contract, $5917.00 material deposit with permit, $5917.00 with framing completed, $3800.00 with sheetrock completed, balance upon completion. Time to complete: Estimated time to complete, weather permitting- 4 -6 weeks C Owner initial/ date: M. J-J i ' 30 c] (' 11.TTP ACT Doer. A of G Cnntra -fnr initial / data- a - / 0 o a 1 .! 1 --_---; _ill - // 0 0 0 1 i 11 i="1:1--_ 0 =1 T 1 11 """ - v � Lila • . ( (' El a - 0 0 , rv r PI 'J • ACORD,„ CERTIFICATE OF LIABILITY INSURANCE 10/1/20 9 ' PRODUCER (413) 214 -7474 FAX: (413) 214 -7447 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Foley Insurance Group ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE y p HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 37 Elm Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. West Springfield MA 01089 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A Travelers Property Al Jarvis INSURER B: 2 Jacklyn Circle INSURER C: INSURER D: Granby MA 01033 INSURER E: COVERAGES 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 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. LTR SRD TYPE OF INSURANCE POLICY NUMBER DATE MUMMY) DATE ( MIDD/YYY) N LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ - 50 , 000 A I CLAIMS MADE IX IOCCUR 16804399N206 4/28/2009 9/28/2010 MEDEXP(AIN one person) $ 10, PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2 ,000,000 POLICY n JE& [ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ I OCCUR I I CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND 1 TORY L1MRS J J TRH EMPLOYERS' LIABILITY E.L. EACH ACCIDENT S ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERJMEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $ tf yes, describe under SPECIAL PROVISIONS below E.L DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 587 -1272 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Northampton EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Building Inspector 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT 212 Main Street FAILURE TO DO SO SHALL IMPOSE NO OBUGAT1ON OR UABILITY OF ANY KIND UPON THE Northampton, MA 01060 INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENT ;e A .- ACORD 25 (2001/08) © ACORD CORPORATION 1988 ,s cnec.......,.,. Pape 1of2 • HOME OWNER EXEMPTION ACKNOWLEDGEMEIN'1 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 picess_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 permits -in- conjunction. to_thebuilding _permit -.issued,_ 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 me. Date . Address of work location The Commonwealth of Massachusetts _,_ Department of Industrial Accidents A ►mi Office of Investig,ations • w =i— 1� 4 600 Washington Street ti Boston, MA 02111 m. www.massgov /dia . - Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ADalicant Information Please Print Legibly Name ( Business /Organization/Individual): O -R-Y 7 4 "..._Yll • Address: 2 a _ 14- /i', 14 . .3 City /State/Zip: Phone #: /.. - Z e e 2 - / 1 , 5 --- Are you an employer? ;-Check the appropriate box: _ Ji Type of projecf(required): 1. I am a employer with 4.. fiji I am a general contractor and I 6. ❑New construction employees (fu11 and/or part- time).* have hired the sub - contractors 2.I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and . no cloy ees These sub - contractors have. g. ID Demoli capacity. employees and have workers' working for me in any Y P ty 9. 0 Building addition c insurance.$ [No workers ' . comp. msurance ° 10. Electrical repairs or additions required.] 5. E We are a corpo ration and its � eP _ _ cers_have:eAezcas d their _ 1_1 RImnbin repairs �. 0 I -am a- �iomeo-�aer- demg�ll- �+efk- -- - - -- _ -- ;_ - — �- g or additions myself. [No workers' comp. right of exemption per MGL 12.0. Roof repairs c. 152, 1 4 , and we have no 13.� O insurance required.] t § ( � employees. [No workers' vi (46, comp. insurance required} *Any applicant that checks box #I must also fill out the section below showing then- workers' compensation policy information. t 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 worker' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip:' 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 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 ag. ' , e violator. 13e advised that a copy of this statement may be forwarded to the Office of Investi . . uations of the DIA I . ce coveraze verification. I do hereby ce u , er e p , ' and penalties of perjury that the information provided above_is_true and_correct. Si . • ature: _ . ral� a� Date: 4 2 Zo Phone ##: I y/ 3` -. � 2 /6 - Official use only. Do not write in this area, to be by city or town offc aL City or Town: Permit/License f Issuing Authority (circle one): I. Board of Health 2. Building. Department 3. City/Town CIerk 4. Electrical Ins. ector 5. Plumbing Ins. ector 6. Other _ Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction 9 // Supervisor: Not Appppliccablle ❑ Name of License Holder : f"7ZL� 0 � L"t �+ v / / / z/ License Number / /� / 2 1- ..4,1 rl �. t r 6ra-vh , 40 L � 5te e, y /co 10 Address / Expiration D Signature Telephone 9. Recti ee tratfOii.F a ..:. � . A i g A,F :,. ., Not Applicable ❑ 4L M/ 2vfl die, rrrrer / S3 /i'7 Company Name �+ / Registration Number 2 �ct e S L -/ - C�ra� -� z b fri01 er033 l //3 /Zd /D ' Address Expira n D e Telephone T/✓ -&,� 40 _ 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 bui ding permit. Signed Affidavit Attached Yes No ❑ Th i5II 9, t f a n The_current_exemption for "homeowners" was extended to include Owner 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 NoftEampton - Grdi iffiaST State rd`Lcreaf tinting Massaehusetts-General- Laws - Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows � Alteration(s) ❑ Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ I New Signs [0] Decks [C] Siding [D] Other [Z Description of Proposed Work: � � -� 6�, �/ � o — ,- 1 Brief Alteration of existing bedroom Yes Pc No Adding new bedroom Yes X. No Attached Narrative Renovating unfinished basement X Yes No Plans Attached Roll - Sheet ea f o - N e i e o lsse; i i t j r z a d d l t i rrltci,e c f t t r e i hoi > r Lei, ?9ampYete the'f Ioii iri a. Use of building : One Family I/ Two Family Other b. Number of rooms in each family unit: .6 Number of Bathrooms -/ -7 L ---- /L c. Is there a garage attached? AVD e , / e5 / 7 X lZ , d. Proposed Square footage of new construction. J • Dimensions _�,_ e. Number of stories? / g fireplaces or Woodstoves Number of each � f. Method of heating? it €k • < < ' 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 1, , 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. A Signature of Owner Date IIiliiip _ , as Owner /Authorized Agent t�-- • • =r' rl at the statements and information on the foregoing application are true and accurate, to the best of my knowledge and b- r . Signet, un• -rthe pa .nd penal : of perjury. , • /1-1-1-44/ off-,& »s Print fir I ............. al,&4147.q__ Signature of 0 r /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 i Frontage Setbacks Front Side L.'._ ....... R. L.. R .,.__.. __w 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 DONT KNOW el.. YES IF YES, date issued:. IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW 1►�, .�`4 YES IF YES: enter Book ' Page,_ and /or Document # B. Does the site contain a brook, body of water or wetlands? NO .J 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 Oil IF YES, describe size, type and location: D. Are there any proposed changeSTO or afidit ons of signs intended for the property ? YES 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 P ®/ IF YES, then a Northampton Storm Water Management Permit from the DPW is required. M City of Northampton a r� Building Department Cuup'e 212 Main Street Room 100 ev.. ®� Northampton, MA 01060 Tz olS a n � p �_ _.__ .An ro A2A F AAn co A •1 77 Z �,.r h�� -. � ; . IVI u 1 J-00t- I cy r`QJl Y I �7 V ! - 1 L / L „, iP. cU ' txwa �s , „ fr? ��. APPLICATION TO CONSTRUCT. ALTER, REPAIR. RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: 1 '1 A.J0/t0 C Map Lot Unit 1 ) Zone Overlay District :EfrSt District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: _ 6 ' r� -� - _ L1 1 / cie.�c.Q , Mfg Name (Print) Current Mailing Address: Telephone Signature 2.2 _ Ag Authorized Agent: a, -. z ��G4 / of 4, Name (Pri Current Mailing Address: 26 2- /66 S Signa • - Telephone SECTION 3 - ES I 1 ATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building ' j 6 C � • (s - (a) Building' Permit Fee ✓ / 2. Electrical ''�� �� ��n) VV • (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection ie 96 1 6. Total (1 + 2 + 3 + 4 + 5) Check Number , W q This Section For O Use Only Date Building Permit Number: Issued: Signatures Building Commissioner /Inspector of Buildings Date File # BP- 2010 -0362 APPLICANT /CONTACT PERSON ALLAN JARVIS ADDRESS /PHONE 2 JACKIELYN CIR GRANBY (413) 262 -1065 PROPERTY LOCATION 139 NONOTUCK ST MAP 23A PARCEL 232 001 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 #7° �j/ J — Typeof Construction: PARTIAL FINISH BASMENT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 094928 3 sets of Plans / Plot Plan THE FOL ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO 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 Demolition Delay ,z .- Lo. 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. ,i,D0?/,‘? )/ 139 NONOTUCK ST BP- 2010 -0362 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A - 232 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERNIIT Permit # BP- 2010 -0362 Project # JS- 2010 - 000483 Est. Cost: $18500.00 Fee: $ 109.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ALLAN JARVIS 094928 Lot Size(sq. ft.): 11499.84 Owner: STREHORN KREGG C & MOLLY RYAN STREHORN Zoning: URB(100)/ Applicant: ALLAN JARVIS A f . 1.:58 N(.1,:37 !Cr, 3T Applicant Address: Phone: Insurance: 2 JACKIELYN CIR (413) 262 -1065 Liability GRANBYMA01033 ISSUED ON :10/8/2009 0 :00 :00 TO PERFORM THE FOLLOWING WORK: PARTIAL FINISH BASMENT 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/ 0,A, ( -0 9 House # Foundation: p . Driveway Final: Final: Final: _ d cq P Rough Framefc/o Lz o7 !fit Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: i. Final: Smoke: Final" O t< I2/ —(Q THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. i c 4 2102/6 Certificate of Occupancy Si gnature: FeeType: Date Paid: Amount: Building 10/8/2009 0:00:00 $109.00 :) 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo