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23D-002 I S/ Tim,° _ 8:52 =iM To: G NETTE P 536 - 835: h 2/:5 14-CQR CERTIFICATE OF LIABILITY INSURANCE j D i 10 ` i � PReDIJOER (4i7` 53n -0804 ' 34 -7874 FAX (4�3) 5 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Martin 1 Clayton Insure Agency, Inc- I ONLY AND CONFERS NO RIGHTS UPON 71 CERTIFICATE 649 Northampton Street I HOLDER_ THIS CERRTIHCATE DOES NOT AMEND, EXTEND CR E. u . Box 989 + ALTER THE COVERAGE AFFORDED BY THE ?CLiCIES BELOW. Holyoke, MA OI041 -0985 I , ! INSURERS AFFORDING' COVERAGE NAiC I sue S E. 5 lensui Roo ± =ng & Siding ■ 'ro: -Q F- ATt AIYC CASUALTY INSURANCE CO 103 South Street Ho' yoKe, HA 01040 I 'NSuR.? E! Safety Insurance Co. any ;0014 I :NSuRS c NATIONA' UNION FIRE INSURANCE COI I :NSLiFE, O ! -- COOIERO ,PS ! INSUP�- E I -- i i THE POLICIES OP INSURANCE C E LISTED 'B_i.,�,h HAVE q=_�; _SSUEC TO THE INSURED NAMED A8O E FOR THE POLICY PER :OD ;NDICATED, NOT.vi i HST4 DING I —� .Y REQUIREMENT. TEPM OR c OF ANY CONTRACT OR Gr NER DOCUME+T'J1i!m RESPECT TO WHICH .}iIS CERTIFICATE MAY BE ISSUED OR I MA'Y PERTAN. THE I'JSURANCE AEFORDEU BY THE POLICIES DESCRIBED HEREIN iS SUBJECT TO ALL THE TERMS. EXCLUS,ONS CONCIT!ONS OF S ;�H ■ POLICIES. AGGREGATE UM i7 = S SHOWN MAY uc c BEEN REDUCED BY PAID CLAIMS. !,rasa .�^: _J •.''q �, a - TYPE OFjNSUPANCE P� „ _;CYNUMBER r ?CUM'EFFE'~NE I POLICYE7(PIPATION i I GENERAL ;.:,cai, H � . d1M1�6r D, L�MIOD�'>^ _ • I I DATE C MSS c . ,.�,. L081000533! 06/04/2009 1 06/04/2010 ! .%C� DcCuPRE'c'E IS 1,000,000j 5C , 000i A � _ _,, I i ED EYP , - ' cm' pa ;,n j ! - 5.000 -- 1 • PER ?Or•GL s F0•: 'mJ!1F: 1 1, (1 00, 00e ` : ?zC _ _. =�. -.��� i I I - I GENCD.,ti GC.:” S 2,000,00$ ` 'JL _ ---` ca- -C-007S - CG :AP :;) R :-.C.3 15 1, ON , 001 1610306; 01/01,`2009 I 01/01/2010 I coN.INEo s,wG1c I ' CH_Dls_=0 -J7CC ?ODI_ •r.JL -.. ! I��rpE�s :nl I X 1 3'.0,_ - Ir.,�rr I ? ?r _C GC9.T . 1j n ;CAP cti t:S, i GARAGE I s;(.r, i = O ONLY - SF C rosrvr I S - CC 15 i E'' h,, I f I ! ; ALTO Ora:,` ?6 1 - 5 EXCES$JME.Z_ --L FA ..,' i ! Al:-ELATE H s I j 5 u ERs uo.KP =\ 1 4 �0 05015t�49j ■ i LO'ERS L Ag SATiON AND 1 12/31/2008 i 12 /31/2009 ! :� - -'' , 1 I o Y � , y,Y So ! E OSE DISESE - = �' P O = =f g 10(j, 71_;1 OTHER ! =SE FOLIC', LI11, ? .S 500, u01 I 1 f i I C P ESCRTICN OF OP_FA7DNE I LCCA : VE.,- ICLEE: EXCLUSIONS' ADD:D BY =NDORSEMENT/ SPECIAL PROV1S4ONS I I j I SHOULD Atv't OF THE ABOVE DESCRIBED POLICIES EE CA.NrELLED BEFORE - i E EXPIRA 3N DATE THEREOF. 7HE ISSUING I.NSJRE Y ENDEAVOR TO NAIL_ 1S JAYS NfbTlzi: NOTICE TO THE CERTIRICATE H .OL CEE NAMED TO THE LEFT. BUTT FAILURE TO MAIL SUCH NO7C= SHALL :.tiPOSE NO OBLIGATION OR Li:,3uUrr i OF ANY N NJ UPON THE INSURER. ITS A G2!TS CR REPRESENTATIVES. AtJTI- �OR:ZEDRF9RESENTA;zVE _� ^ ` r ?� 1 aCORD (20C-1)08:: Harold Cla or Jr.i�EC I 2� ACORO CORPORATION 1982 _, B oar• o . ui • mg ' egula V s ant tans are s ,l s :� One Ashburton Place - Room 1301 Boston_ Massachusetts 02108 Home ImprovementContractor Registration Registration: 101718 - Type: Private Corporation ,•- ` Expiration: 6/29/2010 Tr# 267344 S.E. SULENSKI ROOFING & SIDI ,- {}_ -_' - John Rigalis _ __._-_. 103 South St - - - --- - -- Holyoke, MA 01040 = - -_ __ -. _ _ - -. _- - - - -__ _ - _ , Update Address and return card Mark reason for cbange- o =s -o C> 5061- 07 /07- PCE49O Li Address ❑ Renewal ❑ Employment Li Lost Card _ _T Board of Building Regulations and Standards License or registration valid for individul use only "_ .. _- `'° HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to . (— =-/ Registratign- -, 101718 Board of Building Regulations and Standards o .6 49/2010 Tr# 267344 One Ashburton Place Rm 1301 ; Tjipe: Private Corporation Boston, Ma. 02108 S. E. SU ENSKI ROO SGScS115ING, CO John R!galis n - 103 South St CC.,_-_4-...,(1:2.4......., l _ hO!yoke, MA 01040 Not valid without lid witht re Administrator ;-/ g a-71� )x t:cta city / / ' i I F; _ • '= • Board of Building Regulations One Ashburton Place, Rm 1301 '± Boston, Ma 02108 -1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 06/22/1945 • • Number: CS 022840 To: 00 --- Massachusetts - Department of Public Satet� 9 Board of Buildin? Reulations and Standards Construction Supervisor License JOHN R RiGALIS License: CS 22840 103 SOUTH STREET Restrictedzo. 00 HOLYOK.E, M.A 01040 . JOHN R :R3.GALIS 103 SOUTf i =STREio 1 HOLYOKE, `MA 01040 _ change of address notification _-. ACM -0= 105X5695 c — - - � Expiration: 6/22120 < "ommi_ Toner 7r=. 26956 . ..° 40;04 go o ti O. of XIIxil!a nptzm —'� :3 `.., )' ry e g .. a T'+ sli �1 s () • f1Ii assacbttsefis _ L= DEPARTMENT OF BUILDING INSPECTIONS _ 4= / I NSPECTOR 212 Main. Street • Municipal Building '; ,,Y - Northampton, MA 01060 1' HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108 -3.4 to act as his/her. construction sups: •.sor. 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 struct 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 . any 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 backfiIl) sonotube holes (before ' pour), 'a r building inspection (before work is concealed , insulation ins 7 ection if re • uired and a -final buildi I .• ins t ection. 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, . 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 • • 451W4 is?. - ( A r t.i r7 CI �.�rrrdI7al)1pI oil 1 - i. 2 D . 1 i A ......... s E �1ts1.clintrlls" • '_ l��i t_ i • , �' DEPARTMENT OP BUILDING INSPECTIONS • •— ' 212 Main Street - Municipal Building — Northampton, D4ass. 01060 • r ' :a WORKER' S COKPENSA • NSUA R"tCE ' I FEDA\rIT I, o•kii) R" 1R194,lt.o o S• Su_ zit)Skc Smi,iti's . (lioc s . -- ∎vith a principal place of business/residence at: 18 S: kat s Le dta L& iti_ h•, . C JvL /D (phone =.') 4/3 -5 -3 Ls (s—t /city /suuda p) • ` ,: • do hereby certify, under the. gins and penalties of e that Y �)', P P perjury.; • ( ) I am an employer providing the following worker's compcns_ ion cover for In) . • employees wor>hng on this job: Zze Co ir�rior. Dan) " (Insur -ac Coar,any) (Policy • )'ice r) ( ="P I am a sole-proprietor, enera] contractor 'or homeowner cis t. e one) and have hired the consactors listed below who hzve.the folio vioz worker's co- pe,nsanon policies: • (Name of Co cior) (Insurance Coinoarlyi?o Ci N (t= 7ir : o Date) • • _ (Name of Contra no or) (ir_sara Comaa,- iPo!ic Nt:.mc_•r) (Lipirdoo Dale) • (Nlame of Conuacid) (Insivan Co mpa"u } Nuxebc.r) • (t"cp doe Dale) • (Name of Contractor) (Insurancc Cbmr iy/Policy Number) t���tratlon Dale). • (teat oditiocaJ anent if noncnoxy to into& informs-ion pc.-t&i to .11 ooc - -o ) 1 • . •( ) I am 2 sole proprietor and have no one woridog for me. ( ) I am:a home owner performing all the work myself. " Pl i...-.:3,. bomao•ivct ubo i to do r. : - .--, • c� ro c- rz .-ork o . e -o or NOTE: es e Dc ews� t , not mote th ne tai: is .Aaici cbe bon000woc nos do or on tb.o grow)r'3 a p•utea>� th o c D' cm..: _11y aect."Od to be c4) - =dm" the' kg c — ••.* AA (GL152 l (S)). a gliatiw try c bomm ve fa a ki r _ a PCZ>< 7 e i&Doc t "- 1cpi tna.r of ca .xploy.r uod.r M. Works:!. Coo>pa ..jion Ad • 1 .sod nyazti *LA a Copy or ea. a teccursn cosy b. f r.rd.d to M. rsoo rcmma of Ind..r i AoO4 ' Oo. of iccumocc. roc IS. my - c n_riGcsiaa and that L-iltac to toasn:'covei ,, suction 25A of MGL 1S can s 1 c4 to the i osas 'I oo of cio m p""It coosillimE oft floe of tap to S1,500,00 .oGlor iapra.oancat of up to ooe yrsr end a.-1l pcachia +o tt4 form of .S109 Wore Or `od rc of S 100 "O0 . day 'viral For dcryna' ='! u.c only . Permit Number /'V P= Lot = --- Signature of Lic se fPcrmiuc Bate P • t ... SECTION •8 - CO>![StJG(3[EH_ES 8.1 Licensed Construction Supervisor. n Not Applicable ❑ Name of License Holder: OL nl `IZ . 1{ 1 ( 0 02 8 go License Number • iO3 & ulk, S'tI4 t - a aro Address Expiration Date a. Li. AL h a✓ 1)10 (10 Signature Telephone �vt,�.� �,f�Q IRR - a. - 3630 :, _ � -� ` . • _ = '� Not �. �o� =� ,. . ,,_ , , �,_ Vii_ _ - ,� _ _ - .:4__ Applicable .❑ S. E . St:..i'_.i1L' ? d e y iw13 ti- Slcli wv.S (In - )0/9I0 Company Name Registration Number /o 3 Sc k`th. STi .Z�` 6 - Q9 - 0/0 Address +- Expiration Date be k rC ._ k'Yi a., ©l0 t/o Telephone 2 I /3 -53 a- 3b. 1? SECTION:1- 07WORKS S C O M P - E t i t S k , t 1 S U 1 n 9 a? ' t ' : , . . ' ' ' ' ' ' ' - . o' 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 IR' 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. Aperson 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 -tune 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, von 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- _'DESCRIPTIONe.OFRROPOSEQ I'l ORK4checkalt applicab e) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ ' Roofing 1 1 Or Doors ] >/ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding [o] Other [0] Brief Description of Proposed Work - Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet e . -÷ J. W,,.':_,'.w_e a ; E : v � "a 7. -- 'h k e1 7. `'-�. . 1 - �"t.a T1.. 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 buildir conform to the Building and Zoning regulations? Yes NO . L Septic Tank' City Sewer Private well City water Supply CI ''90:9:N1•40.• C1 „ 9 i p v C.- :i I r r 7 � Y 4 7r� I. l ` ip iry 41nUdLVA , as Owner of the subject property hereby authorize .r _ Sr...Lf i)S/Ci.. ooF1w. J Si dtwq eil • to act on my behalf, in all matters relative to work authorized by this building permit application. Signature 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 I : ' Frontage i H Setbacks Front Side L:I i R:' I.,: i R' • Rear • H • .' Building Height Bldg. Square Footage . ; % �- - Open Space Footage % r--- (Lot area minus bldg & paved i 1 i I 1 ' parking) # of Parking Spaces Fill: • I (volume & Location) 'r ;I ' A. Has a Special Permit/Variance /Finding ever been issued for /on the site? • • NO 0 DON'T KNOW 0 YES. 0 IF YES, date issued:? l IF YES: Was the permit recorded. at theRegistry of :Deeds? . NO 0 DONT KNOW © YES 0 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 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 0 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 Q 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 Q IF YES, then a Northampton Storm Water Management Permit from the DPW is required. City of Northa s � Budding Department ate" � 212 Main Street n om Xa + " Ro 100 ' gy=- - 7" �.�,� _ � .x \T -) Northiampto , MA 01060 -, — � - phones. �a a - Fax 413 -587 -1272 `� APPLICATION TO C ONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOUSH A ONE OR TWO FAMILY DWELLING , r< - ; .Olit • 1.1 Property Address: _, ' �_ �„ ;9 rs f [ee . .� r,">'„` "T "m b 7-Luk sr . s_ U 3 rum - - J ��, f 1...0 "(Au C S_ Q. a ® " c i- ,c* —..ca '4 s -: ,,ate SECTI ©N.2 PROPEft'EY LORIZEt3,. T • 2.1 Owner of Record: �A�y 1J •t ndi i3 1 / 4 • II Name (Print) Current Mailing Address: / Iii ,•.A.,—i. -.J / / t , �. it • Telephone 7y $86- /poi Signature , 2.2 Authorized Agent: S•C . .u.l$.rt.'SK! Rcerlrv°1 Sid/ /ai3 (o _ ) D3 Sao:. 1. Sr: tLiL.1vKz, h c, Litt-JD Nam - (Print) Current Mailing Address: Silture • Telephone SECTIOit _=ES$Ilfif e s s e Item r (Dollars) • _ Official Use Ordy 1. Building itta-Otiird 2_ Electrical o a 0 tOr S 'a 0. 0 1 0 0 6-,) 3. Plumbing 4. Mechanical (HVAC) 5. Fire Protection 6. Total= 11 + + 3 +q +5 ,- — _ � 6 Ap • - C kieck Number Building;P._errnifNumber, : . . -:: ` Issued: • Signature: Building Commissioner1lnspedtor of Buildings Date 43 NONOTUCK ST BP- 2010 -0513 GIS #: COMMONWEALTH OF MASSACHUSETTS }4ap:I ock: 23D - 002 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 -0513 Project # JS- 2010 - 000717 Est. Cost: $2680.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: S E SULENSKI 022840 Lot Size(sq. ft): 36938.88 Owner: HARDING MARY J TRUSTEE Zoning: URB(100)/ Applicant: S E SULENSKI AT: 43 NONOTUCK ST Applicant Address: Phone: Insurance: 103 South Street (413) 532 -3630 Workers Compensation HOLYOKEMA01040 ISSUED ON:11/9/2009 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 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 11/9/2009 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo