24A-128 t ., 156" — —.
Pull -out
–434-" %111 35 " , 63" /
Spice rack
WFPO630
r
M iN W3012BD D ' [_ W183009L �1 1� W 3030BD W3030BD
,11 N s_i_iii
RANGE DB1821 24 .DISHW B36FWDRO I
3 -31
B09FHDL SB36 -BD
CO cliv
In
: ,-ice
8
B06FHDR
v I, 1 ( W Y \
d 0 4
RW3712BD o ) , ,, L' c,
00�
i
■
o 00 o
a 4 Roll-outs
3 , rr ' 0
/
z
TF3 -84
26z" 354" 354"
4
1044" --
PDF created with pdfFactory trial versa n www.pdffactory.com
ACORD E ` CERTIFICATE OF LIABILITY INSURANCE 10/05/2009
PRODUCER 41.3. 586. 0111 FAX 413 . 586. 6481 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Webber & Grinnell Ins. Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
8
North King Street ALTER T THE THIS COVE ICATE AFFORDED BY AMEND, PO B
N
Northampton, MA 01060
INSURERS AFFORDING COVERAGE NAIC #
INSURED Craig Marney INSURER A NGM Insurance Company 14788
DBA: Harney Builders, LLC INSURER e: WCAR- Liberty Nutual
57 Ashfi el d Road INSURER C
Williamsburg, MA 01096 INSURER D:
( INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWIIMSTANDING
ANY 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.
INSR LIR ADM TYPE OF INSURANCE POLICY NUMBER POLICY DATES LIMITS
GENERAL LIABILITY MPI71914 10/01/2009 10/01/2010 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ 500, 000
CLNMS MADE X OCCUR MED EXP (My one person) $ 10,000
A PERSONAL & ADV INJURY _ $ 1,000,000
GENERAL AGGREGATE $ 2, 000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
POLICY I Imo- IOC
AUTOMOBLE 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 I UMBRELLA LIABILITY EACH OCCURRENCE $ —
OCCUR I CLAIMS MADE AGGREGATE $
—
$
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION WC1315374627019 09 /19/2009 09/19/2010 ToaY UMI s 1 ER
AND EMPLOYERS' LIAa LITY ANY B AFYIC IE CUTIVE Y / N E.L. EACH ACCIDENT $ 100,000
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ 100,000
It
SPECIAL PROVISIONS bobs/ describe under
YES E.L. DISEASE - POLICY LIMIT $ 500,000
OTHER
DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
No members are covered by the worker's compensation policy.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING NISIARBt WILL ENDEAVOR TO MAIL DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SWILL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
* * * * * For Informational Purposes Only * * * * * AUTNORJED REPRESENTATIVE
Cynthia Henderson /CINDY
ACORD 25 (2009101) 019@8 -2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
. The Commonwealth of Massachusetts
7 .; Department of Industrial Accidents
. ;, Office of Investigations
.=1 600 Washington Street
..A Boston, MA 02111
ls www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual): 66- PA.."/ Address: ld ice
City /State /Zip: /eels" liA• v /Oct Phone #: `7y T -(- 54 a
Are you an employer? Check the appropriate box: Type of project (required):
1. ❑ I am a employer with 4. fl I am a general contractor and I
employees (full and/or part- time).* have hired the sub - contractors 6. ❑New construction
2,0 I am a sole proprietor or partner- listed on the attached sheet. 7. g Remodeling
ship and have no employees These sub - contractors have 8. 0 Demolition
working or me in aci employees and have workers'
g any capacity. 9. 0 Building addition
[No workers' comp. insurance comp. insurance.: 10.0 Electrical repairs or additions
required.] 5. LI We are a corporation and its
3. ❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, § 1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their 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.
1 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 workers' compensation insurance for my employees. Below is the policy and job site
information. / 1
Insurance Company Name: j, + e 2� t7J1 r.1Ao
Policy # or Self -ins. Lic. #: % ( / i33'7 d;,,/ 70/9 Expiration Date: l 9 ; a
Job Site Address: 1 S �, - >.;5 e • ,, City /State /Zip:144°1 h /IA ace?)
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 $1,500.00 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 against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cent under the pains and penalties of perjury that the information provided abo a is true and correct.
Signature: 7/110") Date: /e -r`' c'
Phone #: .5/ KW .%r.,
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction upervisor Not Applicable ❑
Name of License Holder : f a) HArzt,e 05 7/3",
m
License N b
r?a &- rag /Id�sJA, Diotj //7/1
Address Expiration Date
Signature f Telephone
9, Reeistereci ' Home imprttverment Contractor. Not Applicable ❑
C1A /1AP'ke / /L%7 /a
Company Name Registratio Number
PO ' Zee/ km,e'arr d v
Address Expira on Date
Telephone s7 -s3
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(8))
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 A' No ❑
11. — Rome Owner Exemption
The current exemption for "homeowners" was extended to include Owner- occupied Dwellini s 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 buildine 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 p Replacement Windows Alteration(s) Et Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition ❑ 1 New Signs 10] Decks [p Siding [D) Other 101
Brief Description offropo ed/'� r" gf� JI h/5.- '`- -- — " , C,h,. ,.(' y- ; ,j.s-�," � ti fP,a7`-
Work: fil.�p✓Jod r' � ,:To, ,-:a. /,vvie o4 . /
Alteration of existing bedroom Yes /_✓ No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes !/ No
Plans Attached Roll eet
sa., If New house and or **Rion to exiStino holmium comoletee 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 .
1. Septic Tank City Sewer Private well City water Supply
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APP. • IES FQR BUILDING PERMIT
4/ I, - „... ii !J / , as Owner of the subject
property
hereby authorize 6/T�'/ Qi.” I/
to act on my be - in . 3,_ - Ia ' , - to . f thorized by this building permit application.
I, l'''
Signature o • er / Date e.
I, dr; 1 � At 7a e , as Owner /Authorized
al Agent hereby dere that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed der the pains and penalties of perjury.
ei
ed 5 14M ve
Print Name
r4 A ' . 1
Signatur Owne gent Date
I
Section 4. ZONING Alt 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)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 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 0 DONT 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 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO Q
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 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.
brit use only
\`‘ �� � ,` '-' \ City of Northampton Status of Pe�nntt
�, > Building Department Curb Cut/Dnwe ey porn
r, c.
21,2 Main Street Sewer 8 A abthty,
\�`� r\'
— 1 oom 1 ��� r
rthal ipton, M A 01 060 its o 5 � # ns
phone' 240 Fax 413- 587 -1272 PIOUS l*'lan
Other p
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address:
This section to OR t►e completed by office
Map Lot Unit
i / O. A v(
Zone Overlay District
Elm St, District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1
Own of Record: ,�
5 / w a C�Q14 % )c , it �s' 6 v�,Q'/�; �a ;/y,,4. 0 /0(0
Nam z< /�� nt aili g A dr ss:
- Telep
k Sign
2.2 Auth zed Aaent
Ai �it /� ®, k" jP �S; ,/t'Jid DIOS
Name (Prin Current Mailing Address:
Signature Telep
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cos (Dollars) to be Official Use Only
completed by permit applicant
1. Building 6� o D (a) Building Permit Fee
2. Electrical �Dd 4 1` � (b) E stimated Total Cost of
3. Plumbing
i Construction from (6)
od ry Bui lding Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5)�,��' "" Check Number /3 ?4( l
This Section For Official Use Only
Building Permit Number: is
Signature:
Building Commissioner /inspector of Buildings Date
•
File # BP- 2010 -0481
APPLICANT /CONTACT PERSON CRAIG MARNEY
ADDRESS /PHONE P 0 Box 128 LEEDS (413) 586 -5512
PROPERTY LOCATION 45 PROSPECT AVE
MAP 24A PARCEL 128 001 ZONE URA(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out � ��/‘3�
Fee Paid L[Q
Typeof Construction: REPLACE KITCHEN CABINETS & COUNTERTOPS,UPGRADE PLUMBING & ELEC
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 057159
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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
20 #
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.
P ROWAT BP- 2010 -0481
GIs #: COMMONWEALTH OF MASSACHUSETTS
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 -0481
Project # JS- 2010 - 000664
Est. Cost: $25500.00
Fee: $153.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: CRAIG MARNEY 057159
Lot Size(sq. ft.): 7056.72 Owner: WOODRUFF STEPHEN & CHRISTINE M MOLLOY
Zoning: URA(100)/ Applicant: CRAIG MARNEY
AT: 45 PROSPECT AVE
Applicant Address: Phone: Insurance:
P O Box 128 (413) 586 -5512 WC
LEEDSMA01053 ISSUED ON:11/4/2009 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE KITCHEN CABINETS &
COUNTERTOPS,UPGRADE PLUMBING & ELEC
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 11/4/2009 0:00:00 $153.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo