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23D-087
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TYLER BERGERON 7 SCHOOL STREET — GRANBY, MA 01033 Administrator Asmossommannummanunnomaimilanlaiow - AU a. "I.a°'GtF{„i7 40 :JC. VT% TE t1k1LITU 1I1813T'B31Ce 1 s +s • ACORD CERTIFICATE OF LIABILITY INSURANCE Sl_� -1 �`� ,,�° " - THIS CERTIFICATE IS ISSUED AS AMATTER OF INFORMATION peoouce ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Remillard Insurance Agcy, Inc HOLDER. THIS CERTIFICATE DOM NOT AMEND, EXTEND OR 79 Lyaan Street ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW. South Hadley M! 01075 Phone: 413-538-7662 Taxa413- 538 -7179 POURERS AFFORDING COVERAGE NAM # 'INEINED ENEMA Safety Insurance Company 39454 NEARER& Western World Ins., Co. Hergarcal Builders Imo n®LNItIRC: Hartford Ins., Co Ty Granby ILIA 0 3 B a BC E railaikain THE POUCSM OF INSURANCE USED MOW HAKE BEEN MEMO TO THE BEEPED N M1ED ABOVE FOR THE 1 ROD INSICATED. NOTNXTl5TAIMIK3 ANT RECIUMEMENT. TERM OR COSIOnme OF ANY CONNECT ONETHEROOCUMENT WITHERIPECT THE C6ftTIrICATE ELYSE SEED OR WAY PERTAIN, THE INSURANCE AFFORDED BY THE PLY.IC'E6 sacrum rates W mow TOW. THE TE 1 . ENCLUMONS AND C0NDITAINS OF SUCH POU . AGGREGATE LBWS SHOWN MAY / AVE NEN REDUCED WPM CLAM LTR BERQ TYPE OF INSINIAIICE P0L CYNENIER '"^# 7S ways OWERALLMMSLRY EACH OCCURRENCE $ 500000 H Q C0 IMETICIE GENERAL LINNUTV NPP1063865 -2 09/12/OS 09/12/09 '°x ., $ 50000 :� .LB cLAWADE OCCUR BEOEEV (Any ant pn.an) $5000 PERSONAL 'saw SNJURY s 500000 maim AGGREGATE s 1000000 GEML AGGREGATE LENT APPLIES PEE PRODUCTS -COMP/OP AGO $ 500000 POLICY ! i teCr fl ►OC AUT0MOBILE LMii UTY COSNINNEO SINGLE UNIT A III ATMAUTO 2432163 07/14/0S 07/14/09 (21 $ II ALL mosso A TOS SOOS.Y INJURY $ 100000 ri SCHEDULED AUT0$ PMrMnN HIED AUTOS N0N0WNITO s 308000 BODILY INJURY I PI1OPERTY DAMAGE '* 10O00O (Per soridlytI 6A AG LNSNJTY ' AUTO ONLY - EAACCIDBIT s . ANY AUTO , OTHER MAN EA ACC S AUTO ONLY AGG S EXCESSMISBRIILLA LIMIT( EACH OCCIRIREME S ■ OCCUR ED CLAIMS MADE AGGREGATE S s . DEDUCTIBLE RETENTION s $ WORKERS COMPENSATION AND x Vic / si L 1 S L EMPLOYERS' LMINUTY C ANY 6060035126C36408 07/23/08 07/23/09 EL EACH ACCIDENT S 100000 ANY PROPRIETORIPARTNERIEXECUINE OFFICE ER EXCLUDED E.L DISEASE - EA EMPLOYEE $ 100000 SPECWI Dhow EL DISEASE • POLICY war $ 500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS CIIIMIFICAIE141311.8MR CITYNOR SHOULD ANY M THE ABOVE DESCRIBED POUCH BE CANCH.LED BEFORE THE EXPIRATION City of Northampton DATE THEREOF, TIM ISSUING SOURER VLL ENDEAVOR TO MM. 10 DAYS WRITTEN Ps 413-587-1272 NOTICE TO THE CERTIACATE HOLDER MANED TO THE LEFT, BUT FAILURE TO DO SO SHALL Electrical Inspector moss NO OBLIGATION OR LIABILITY CF ANY Kam tram THE INSAJRER, ITS AGENTS OR 212 Main Street Northampton MA 01060 REPRESENTATIVES. 7 ACORD 25 (200110 0 ACORD CORPORATION 1988 SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Su rvisor: Not Applicable ❑ Name of License Holder : - 1 - 1 Cr bet e rU r) 7? © 1 License Number 7 , �. r oo l 51 ie, J- GI,A,i Mk 0043 7 -,)B- £ ( Address r Expiration Date '/)3 - *7 -993 Y Signa Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ is Company Na Cv /I g to i Vil e fi S L VA r'_ Regis f 7 N 7 1 7 6 <1 64 leei - brv►I 40 0/033 7-deo, Addreg's / Expiration Date Telephone y / 3 )7 0 °3y 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 [J Addition [J Replacement Win ws Alteration(s) ©' Roofing ❑ ,� ,/ Or Doors Accessory Bldg. [ Demolition ❑ New Signs [0] Decks [['J Siding gar Other [0] Brief Despription of Proposed �II / ( i Work:, e I r r°>. i S 7 J at c� �� +.c� " ��P�[t t w : •.•/1?w%/rinn t- j h « 1 ' t t►t—'{ Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet ea. 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 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR A - PLIES FOR BUILDING PERMIT R / l , as Owner of the subject t property �!` hereby authorize I \ Jt' r 13r (O to act on behalf • • all m- i - relative to , • rk authorized by this building permit application. s —s /Ll ✓` ' �• - Sig :t 're of • Date I, 1 r ) *C,,.. ( tt��,,pp � }�h , 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. 456) Print Name 5- /I-07 Signatu !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 0.7 0. eeerns &pawed # 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 0 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 1 DONT KNOW 0 YES 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 I NO ec IF YES, describe size, type arid location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO Cr IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, ex tion, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO 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/Driveway Permit r 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability , yV J i 2 2-N Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413 -587 -1272 Plot/Site Plans Other Specify, APPLICATION TO COftTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: i This section to be completed by office ;, 0.0∎x∎ t f`' s j C'f PP 1- Map Lot Unit { Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: R06 (.11Marl F Z L � s Se I �°� tri � ��aY�t Name (Print) f Current Mailing Address: 5e 6 Telephone Signature 2.2 Authorized Agent: TIA P 8e .e 1 7 ��k01 s tye+ G t- M) Ui 3 Name (Fir Current Mailing Address: y)..7.- 9o3 y 1 Signatu J T elepho ne 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 �(� (b) Estimated Total Cost of Construction from (6) _ 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection `, �y 6. Total = (1 + 2 + 3 + 4 + 5) Check Number i /J r 5 y G� /go This Section For Official Use Only Building Permit Number. Date Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2010 -0169 APPLICANT /CONTACT PERSON TYLER BERGERON ADDRESS/PHONE 7 SCHOOL ST GRANBY (413) 427 -8034 0 PROPERTY LOCATION 29 WARNER ST MAP 23D PARCEL 087 001 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 4(5 5 /0 -.- Fee Paid 4C 4 Typeof Construction:_REPAIR GARAGE, REPLACE WINDOWS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 080274 3 sets of Plans / Plot Plan THE FO ,OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO C 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 ASO # , <6 A( 0 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. F ^ BP- 2010 -0169 GIS #: COMMONWEALTH OF MASSACHUSETTS i : iuc1C: 23D • owl 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 -0169 Project # JS- 2010 - 000209 Est. Cost: $30000.00 Fee: $180.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TYLER BERGERON 080274 Lot Size(sq. ft.): 49658.40 Owner: CILMAN ROBERT & SUSAN P CASSEL Zoning: URB(100)/ Applicant: TYLER BERGERON AT: 29 WARNER ST Applicant Address: Phone: Insurance: 7 SCHOOL ST (413) 427 -8034 0 WC GRANBYMA01033 ISSUED ON:8/19/2009 0:00:00 TO PERFORM THE FOLLOWING WORK:REPAIR GARAGE, REPLACE 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 8/19/2009 0:00:00 $180.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo