24C-058 CERTIFICATE OF LIABILITY INSURANCE OP ID SF DATE(MMIDDIYYYY)
CONSA50 l 07/15/09
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
IPM Insurance Agency, Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Barry M. Stephens , CPCU HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
75 North Main St . -P O Box 564 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
East Longmeadow MA 01028
Phone: 413- 759 -0010 Fax: 413- 759 -0017 INSURERS AFFORDING COVERAGE NAIC
INSURED INSURER A: Central Insurance Companies _ 20230
INSURER B:
Construct Associates, Inc. INSURER C:
36 Service Center Road INSURER D:
Northampton MA 01060
I _ 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
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.
1NER ADDT., POLICY EFFECTIVE POLICY EEXXPRApTION
LTR INSRE TYPE OF INSURANCE POLICY NUMBER DATE (MMIDDIYYYY) DATE (IAIMIDO/YYYY) OMITS
GENERAL LIABILITY EACH OCCURRENCE $ 500000
A X COMMERCIAL GENERAL LIABILITY CLP7834317 07/01/09 07/01/10 PREMISES (Ea o urence) $ 100000
CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5000
PERSONAL &ADVINJURY _ $ 500000
GENERAL AGGREGATE $ 1000000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ 1000000
XX POLICY JEa LOC
AUTOMOBILE LIABILITY
A ANY AUTO BAP8614614 07/01/09 07/01/10 COMBINED (Ea SINGLE LIMIT $ 1000000
CO accident)
ALL OWNED AUTOS BODILY INJURY
X SCHEDULED AUTOS (Per person)
$
X HIRED AUTOS
BODILY INJURY $
X 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 $ 1000000
A X OCCUR CLAIMS MADE CXS7834319 07/01/09 07/01/10 AGGREGATE $1000000
$
DEDUCTIBLE $
X RETENTION $ 0 $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY TORY LIMITS ER
A ANY PROPRIETORIPARTNER /EXECUTIVI WC783431819 07/01/09 07/01/10 E.L. EACH ACCIDENT $ 500000
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ 500000
If yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500000
OTHER
DESCRPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
PROOFO0 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Proof of Coverage
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
IRM Insurance Agency Inc.
I
ACORD 25 (2009101) ® 1988 -2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
- IVV I C.
THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT
TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED.
BUILDING LOCATION ACCURACY IS NOT GUARANTEED
C7ASZ
• 't 'dam , .
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TO: FIRST AMERICAN TITLE INSURANCE COMPANY
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT UNES,
EXCEPT AS. NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY if 250167
-NOTE-
SURVEYOR SURVEYORM1/4431. T THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
- MORTGAGE LOAN INSPECTION PLAT-
44 %
NORTHAMPTON, MASSACHUSETTS
RANDNI N, PREPARED FOR
E.
2 u PAUL F. & GAYNELLE K. WEISS
IZER
SCALE: 1 " =30' FEBRUARY 12, 2002
• HAROLD L. EATON AND ASSOCIATES, INC.
REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET - HADLEY - MASSACHUSETTS
1
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: r Not Applicable ❑
Name of License Holder : ..crc , C� �' 0 7T/4 C ``.
License umber
Address Expiration Date
1�N i" - ` , p 4 e-- ee 6
Signature Telephone c
7� . . - / 5t/ ...'! 2 -
/
9. Registered Home Improvement Contractor Not Applicable ❑
w j, -.... S W - v..r.
. ! i �-fit re. ..A. // a e." - r—�"
—. / pl v 1 el 7
Com ny Name Registration Number
34 S14_,,-- / -- /---- r 0 - �,, 5 y�r�
Address Expirhtion Date
Telephone _ "°-t
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 permit
Signed Affidavit Attached Yes fi ldin No ❑
i I. - 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 ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [0] Other [L9]'
Brief Description of Proposed /
L / �
Work: C
� / �-
l t /i. {
S't cC J� J �-t� � j c-4 R , d f .. �T'0
Alteration of existing bedroom Yes No Adding new bedroom !/ Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet 7
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 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
6 R e e- L 1 4 ( , as Owner of the subject
property !!�
hereby authorize SI (�-'i� `�" O s c
to act on my behalf, in all matte relative to ork authorized by this building permit application.
S ignature of Owner Date
05 , as Owner /Authorized
Agent hereb eclare 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
.e . re of •., er /Agent Da e
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 / 0 7 2 C') / Q 7 L_ c)
Frontage
Setbacks Front 7 6t gd
Side L: / R: / G L: / .S" R: /S
Rear is U - '7
Building Height 2 5 S '
Bldg. Square Footage r4 3o C 3 % /6 C/e) / S
Open Space Footage /" +-� C
(Lot area minus bldg & paved 7/ '/ (# 7 l 1 e f G 2
parking)
# of Parking Spaces �—
Fill: G, 7(/
`volume & Location)
A. Has a Special Permit /Variance /Finding e - ' been issued for /on the site?
NO 0 DON'T KNOW C'' YES
IF YES, date issued:
IF YES: Was the permit recorded at the Regis of Deeds?
NO 0 DON'T KNOW YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO V KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Q , Date Issued:
C. Do any signs exist on the property? YES NO
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
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, exc tion, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 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
t 212 Main Street Sewer / Se p ticAvailaby H :i �„
�L Room 100 Water/Weil Availab
Northampton, MA 01060 Two Sets. Plans
of Structural
phone 41 ?- 87 - 1240 Fax 413 587 - 1272 Plot/Site Plans
---J Other Specify
A Pt ATION TO ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
`t, i-
SECTION 1 SITE INFORMATION
This section to be completed by office
1.1 Property Address: 4 t i — 7 5 1 4- 1
c v 1,1. - M ap Lot Unit
r le e- . /� 62 Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: / 1
l� e Gismo /' 2-4 k /'� 1 ri <1 < 1 7`i 4n °(�e.E�)�,}rl -t. /1 - ) � ,Lvs. / !/I 4
Name (Print Current Mailing Address
4( t .l( tr -��" Telephone G �
Signature S� (t
2.2 Authorized Agent: /'
'./ ,.gfi- .-(- l' I 36 —,e.._ tili 4 C --C.. t --f..4.--
Name (P t) Curr t Mailing Address:
na�/e Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building &p (a) Building Permit Fee
2. Electrical .— (b) Estimated Total Cost of
S Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection ilz/—
6. Total= (1 +2 +3 +4 +5) / 4 / ( , Check Number a9/
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2010 -0279
APPLICANT /CONTACT PERSON STEPHEN D ROSS
ADDRESS /PHONE 36 SERVICE CENTER RD NORTHAMPTON (413) 584 -1224 ()
PROPERTY LOCATION 79 WOODLAWN AVE
MAP 24C PARCEL 058 001 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 j 1/ Fee Paid
Typeof Construction: ENCLOSE EXISTING REAR PORCH & ADD LANDING /STAIRS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 079160
3 sets of Plans / Plot Plan
THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO 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
APO
Signature of Building Official" .te
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.
79 WOODLAWN AVE BP- 2010 -0279
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24C - 058 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 -0279
Project # JS- 2010 - 000359
Est. Cost: $14000.00
Fee: $84.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STEPHEN D ROSS 079160
Lot Size(sq. ft.): 10715.76 Owner: ROZARIO KEVIN L & AMBREEN HAI
Zoning: URA(100)/ Applicant: STEPHEN D ROSS
AT: 79 WOODLAWN AVE
Applicant Address: Phone: Insurance:
36 SERVICE CENTER RD (413) 584 -1224 () WC
NORTHAMPTONMA01060 ISSUED ON :9/18/2009 0:00:00
TO PERFORM THE FOLLOWING WORK: ENCLOSE EXISTING REAR PORCH & ADD
LAN DI NG /STAIRS
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: Roughq... ? , a - 1 House # Foundation:
ri Z2 v Driveway Final:
Final: Final:
/ge / Rough Frame: 04' r
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: ,CJ
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. ®
s 4 Zoarre
Certificate of Occupancy __ ___ Si ! nature: !'
FeeType: Date Paid: Amount:
Building 9/18/2009 0:00:00 $84.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo