24D-003 ; C DATE (IaIIPDDfYYYY)
C ERTIFICATE OF LIABILITY INSURANCE OP ID SF
ROSSS50 07/15/09
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
IRM Insurance Agency, Inca 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 0 Box 564 ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
East Longmeadow MA 01028
Phone: 413- 759 -0010 Fax: 413- 759 -0017 INSURERS AFFORDING COVERAGE NAIC i
INSU1tED INSURER central Insurance coe 20230
INSURER B:
N te� hen Ross 1! INSURER C:
orthampton 0 Center I NSURER D:
{ . INSURER a
COVERAGES
THE POUCIES 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. p��,
tri INSRD TYPE OF NSU pp
RANCE POLICY NUMBER DA II�Cyy IINDD/YYYY) ST S EFFECTWE
GENOPLIJABILITY EACH OCCURRENCE 5 1000000
A X COiIMERCIAL GENERAL IJABIUTY CLP8123544 07/01/09 07/01/10 PRE "�"'"`'`waSF.4(Ea $300000
CLAIMS MADE I X I OCCUR MED EXP (Any one person) $ 5000
PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE $ 2000000
GENT. AGG, REGATEUNITAPPLIESPER PRODUCTS - COMP/OP AGG $ 2000000
TI POUCY ( J P LOC
AUTOMOBILE LJAB L TY COMBINED SINGLE UNIT
ANY AUTO (Ea acddent) $
—
ALL OWNED AUTOS BODILY INJURY
(Per person) a
_ SCHEDULED AUTO
HIRED AUTOS BODILY INJURY
—
NON -OWNED AUTOS (Per acddent) 5
—
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS I UMBRELLA LJABIUTY EACH OCCURRENC $
OCCUR CLAIMS MADE AGGREGATE S
$
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION
AND EMPLOYERS' mown, X ITOR LIMITS I I R
A ANY CUTN — WC812355915 07/01/09 07/01/10 E.L. EACH ACCIDENT x100000
(Mandatory lntell Et DISEASE -EA EMPLOYEES 100000
SPECIALPROVISIONS b E.L. DISEASE - POLICY LIMIT $ 500000
OTHER
DESCRPTION OF OPERATIONS / LOCATIONS / VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION
CONS001 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FALURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR UABLLJTY OF ANY KID UPON THE INSURER, ITS AGENTS OR
Construct Associates REPRESENTATIVES.
36 Service Center Road AUTHORED REPRESENTATIVE
Northampton MA 01060 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
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :54 f4 - k - 5g 67 9/et D
/ License Number
34 5 wv, c C f. / / ., - 4 6 /0G a 72/1/
Address F ation Date
� .�'y -
Si. - - Telephone
x ` q Not Applicable ❑
.�. p. too /rd e
7 -i,
v Name Registration Number
I> la cf (- eh,/ �v /2
ddrrss ,r Expir Lion D to
34 �i/ /C Ra ��trc � -�+r� `v � s. f Telephone 1 '_�ZZ
1 01tANCE° OWL. 182, 7
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 ❑
The current exemption for "homeowners" was extended to include Owner - occupied Dwellines 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 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 0
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [[J Siding [El] Other [D]
Brief Description of Proposed ,�/�� /z ,� / ` / /�
Work: G� d C v(��_ C'c ��i,,l S
Alteration of existing bedroom Yes No Adding new bedroom Yes No /
Attached Narrative Renovating unfinished basement Yes f No
Plans Attached Roll - Sheet
sa.Jf New house and or addition to existing housing, complete the following:
a. Use , buil ing : • e • amily Two Family Other
b. N m er f ro. s ins- - h family unit: Number of Bathrooms
c. t e a rage- ttached?
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
r {�-
I me /?« 0 ` ..cf, ' b S'C 4 , as Owner of the subject
property
hereby authorize 7'—C '"- P ' ?T 5'
to act on my behalf, in all matt relative _ to work authorized by this building permit application.
/
c.
Signature of Owner Date 5 < e
I, , — t - c • - - ?6 f ' , as Owner /Authorized
Agent hereby clare 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.
S , / -j .� j 7. r205-c
Print Na
•■••• - / e
c _
Signature % Owner /Agent Date
t
I/ ` ,, c r-- -- C , , or '' f
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Lot Size /
1 Existing Proposed Required by Zoning
' 7
This column to be filled in by
Building Department
Front e ,r
Setbacks r t
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 e -r been issued for /on the site?
NO 0 DON'T KNOW et YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Regis of Deeds?
NO Q DONT KNOW 0 " / YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO I DONT KNOW 0 YES 0
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 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES ® 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.
City
et of Department use ly
Northampton status Permit:
Building Department Curb Cut/Driveway Permit
MAY 2 5 2010 212 Main stree Sewer /Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plant
phone 413587 -140 Fax 413 - 587 -1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT, 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
2-3 l ) �U'i,p 4 'Si ` e. 4-- Map Lot Unit
A 1060 Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
fT.2-J7 /ids 65 (fi_c '<J'(' 4 p
Name (Print) Current Mailing Address:
6
-- ? Telephone
Sig ture + Y( 3 v a 7 gl
2.2 Authorized Agent:
Name (Pri ) Current Mailing Address:
res
k fi e. n✓L4 £ /o 6
Signature Telephone 5-94/-/
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building z7 o j C/V (a) Building Permit Fee
2. Electrical J ut% (b) Estimated Total Cost of
�,���� Construction from (6)
3. Plumbing 2c o -cJ , cx Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 +2 + 3+4 + 5) 6 0 t `� Check Number 30 1 19�'
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2010 -1067
APPLICANT /CONTACT PERSON STEPHEN D ROSS
ADDRESS/PHONE 36 SERVICE CENTER RD NORTHAMPTON (413) 584 -1224 Q
PROPERTY LOCATION 231 PROSPECT ST
MAP 24D PARCEL 003 001 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 ( � j �
Fee Paid 30 ( �f, l �
Typeof Construction: REMODEL KITCHEN
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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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
Signature of Building • fficial 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.
231 PROSPECT ST F BP- 2010 -1067
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24D - 003 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 -1067
Project # JS- 2010- 001568
Est. Cost:531900.00
Fee: $191.40 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STEPHEN D ROSS 079160
Lot Size(sq. ft.): 9583.20 Owner: OHLENBUSCH HENNING W & LISA BEZO
Zoning: URB(100)/ Applicant: STEPHEN D ROSS
AT: 231 PROSPECT ST
Applicant Address: Phone: Insurance:
36 SERVICE CENTER RD (413) 584 - 1224 O WC
NORTHAMPTONMA01060 ISSUED ON: 6/1/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: REMODEL KITCHEN
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
t , E Footings:
Rough:7' I ° 1 +� Rough: f /� � House # Foundation:
d • � ` Driveway Final:
Final: .- f -3 1 : Final: I
40 — Rough Frame: 0 t � l 1 0 cm
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation: CK r , . 1 '10 C: IYAA,
Final: Smoke: Final: _ � ( 6
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGUL • . - ONS.
Certificate of Occupancy '6"
gtt‘d'
v
FeeType: Date aid: Amount:
Building 6/1/2010 0:00:00 $191.40
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo