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44-094 (2) ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID CA DATE(MM /DD/YYYY) KLOTE -2 10/27/11 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Dowding, Moriarty & Dimock Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 139 Union Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Rockville CT 06066 Phone: 860- 875 -2523 Fax: 860- 875 -0921 INSURERS AFFORDING COVERAGE NAIL # INSURED INSURER A: PEERLESS INS CO INSURER B: Kloter Farms, Inc. INSURER C: I 216 West Road INSURER D' Ellington CT 06029 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 SUBJEOT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSR., TYPE OF INSURANCE I POLICY NUMBER DATE (MM DD/YY) DATE (MMf D //Yl )N LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 UAMAbt I KtNI tU A X X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) $100,000. CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000 CBP8083948 10/24/11 10/24/12 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE 52,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 `POLICY r--- PRO I LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $$1,000,000. A X ANY AUTO (Ea accident) ALL OWNED AUTOS BA9906944 10/24/11 10/24/12 BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ P . GARAGE LIABILITY i AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC j $ j AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE j $ $ 5 , 0 00 , 0 0 0 . A IX I OCCUR CLAIMS MADE ! CU9907247 '10/24/11 10/24/12 AGGREGATE 1$$5,000,000. $ 7 DEDUCTIBLE $ i RETENTION $ $ WORKERS COMPENSATION AND X WC (TORY LIMITS LIMITS OTH- EMPLOYERS' LIABILITY I E R if A E.L. EACH ACCIDENT $ 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? WC9773633 10/24/11 1 0/24/12 E.L. DISEASE - EAEMPLOYE j $ 100,000 I( yes, describe under ' I � i SPECIAL PROVISIONS below , E.L. DISEASE - POLICY LIMIT j$ 500,000 I OTHER 'i . 'I • I ! I _ DESCRIPTION OF OPERATIONS / LOCATIONS f VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS I CERTIFICATE HOLDER 1 CANCELLATION SPECIME ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 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 "SPECIMEN COPY ONLY IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 10 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE I ED GIZA ACORD 25 (2001/08) n Arnon , • ,,,,„, •.. — Cape Storage Building 2012 with overhead door I< VARIES >I 1< VARIES > I /— 30 YEAR / �� ARCHITECTURAL -- --.., ASPHALT SHINGLES END VENT EACH SIDE I ( h SINGLE HUNG _ -- ,.. II ALUMINUM _ y -7.7.1 — 1I r i WINDOW � IT..__. = i_.... ■ f---- SIDING VARIES: �) — l i 5 /e "DURATEMP® -� - �_ I TEXTURE 1 -11 `J ��y � OR HORIZONTAL \\ / OVER '/2 "CDX , '� __..._...__.-_..___-__..__...._-. _....__...._._.._- _._...___._.. . OVERHEAD DOOR \� — -- --- — _• 9'0" x 6'5" FRONT SIDE '"shown with standard single door and standard windows 30 YEAR ARCHITECTURAL rf I --- ASPHALTSHINGLES ,,,,,. 1 /z" PLYWOOD �`--,.� 1 /2" CDX PLYWOOD ROOF SHEATHING , GUSSETS BOTH .� SIDES .� , 2 "x4 "RAFTERS `,� J 16" O.C. ALUM. DRIP EDGE 0 1 ? _ I 2)2 "x4 " TOP PLATE I; FINISHED SOFFIT �� and FASCIA ti , SIDING VARIES: I • - 5 /8" DURATEMP n TEXTURE 1 -11 OR HORIZONTAL OVER 1/2' CDX 5 /8"13C BC PRESSURE TREATED 5 -PLY PLYWOOD I -2 "x4 "STUDS 2" x 4" PRESSURE TREATED I 16" O.C. FLOOR JOISTS 8" O.C. v PRESSURE TREATED ' 1;• 4 "x4 "BEAMS 4 111 PA ► ;�_ 1D' WIDE:5BEAMS 7l'= I(Ll=l4 = �UL Li ll -- tC(`,41,1,(�Ll= {vlAl(/ y�= lt l(. UC-5 U. ,= -(.((,( 12' WIDE 5 BEAMS SECTION 14' WIDE: 7 BEAMS ,' KLOTER FARMS NOTES: Design meets requirements Designed to resist wind gust of Iq :. 1. www.KloterFarms.com of 2005 CT Building Code 120 MPH for 3 seconds Residential Section 301.5 Design wind force - 34psf 860 - 871 -1048 800 - 289 -3463 Fax 860- 871 -1117 Floor will support 2000# load Design snow load - 40 psf 216 West Road (Rte 83), Ellington, CT 06029 applied over 20 sq. in. Design floor load - 100 psf r y V i I ( -#.4Si I < -ac _id 9/ > ! -- --- - - - - -I 1 1 I z I I 1 I . 1 1 I I ! k !II/ . 1 I ! ! I I I \ 4 d Nr , j r � �� I t i f f 1�.�oY 9 9 (�aU 7 C ash 1 ■, I I I " i I (. 1 i 13 ft 1 i i 1 . IP 1 r ue,f 2_5e ce eize- f C40.:. 5-1c VJI togi i I ) < ) 1 , , . I , ■•■■•f dem.. —......■ ■.......... ..m... ...ea ...■■• pa■■■■ ...m.o..... ,.......... 4........ - ................. - ..... f eye..4,7 City of Northampton w - ,, . Massachusetts g r ,. , w - ski 0 t DEPARTMENT OF BUILDING INSPECTIONS � , x 1,5 212 Main Street • Municipal Building y;, *■ , g `" Northampton, MA 01060 `P 4 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his /her construction supervisor. 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 structures. 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 backfill), sonotube holes (before pour), a rough building inspection {before work is concealed), insulation inspection (if required) and a final building inspection. 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 th permits and inspections as required can DELAY the project until such time as the proper permits d inspections are made I, �y !Soave f 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 y/o /lZ Address of work location ysD JZc 441/ ,,ZQs j cb 4ce. / ,4t4 0/ cm, Z The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street "°' !L.= Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name (Business /Organization/Individual): icktM ! .1N t Address: 0 2 / 6 tics (244 City /State /Zip: FM a y / J 1 G r c ) 6 0 2 -1 Phone #: 86 o - ?-1 - p y FS Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. I am a general contractor and I employees (full and/or part- time).* have hired the sub - contractors 6. New construction listed on the attached sheet. 7. Ei Remodeling 2. 111 I am a sole proprietor or partner - ship and have no employees These sub - contractors have 8. Demolition working for me in any capacity. employees and have workers' 9. n Building addition comp. insurance. - _.. [No workers' comp. insurance p' 10. ❑ Electrical repairs or additions required.] 5. n We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their 11. ❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. ❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13. ❑ Other comp. insurance required.] *My 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. 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. Insurance Company Name: AA t . l et S Z sj Ca . Policy # or Self -ins. Lic. #: r„ f c 19-F 6 37 Expiration Date: / Job Site Address: City/State /Zip: 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 certi under the ains and penalties of perjury that the information provided above is true and correct v natur l"' Date: Phone #: yiT — SAY - s .c 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 #: w , SECTION 8 - CONSTRUCTION SERVICES 1 . 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : License Number Address Expiration Date Signature Telephone .. «,r*s�rn!��m+n . rwn +ss° -�> ..,.'"� -: x ��m 2 "';' :^, .^5. m� tYkaistered,iloine: mprovemenrContriaii � 7, , � �r F , , a Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone 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 ❑ ii 7 T O wner. leinp ion 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 Zonin_. aws and State of Massachusetts General Laws Annotated. / Homeowner Signature r1 • , M ► a SECTION 5- DESCRIPTION OF. PROPOSED WORK (check all applicable) „ New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing in Or Doors CI , - Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [(] Siding [D] Other [D] rief Description of Propose Work: /07a Lo p► d - t-b C,4►oe Si140 a _got id I g Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa 1f - Newhouse:a or.additi to. e xisting, housinch .compl 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'P.ERMIT I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, 7G4. !e , 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 . L The ivy 'eiz / e_ yame ,f i.nature ...../... ...:. of r /Agertf 'S Date 4 Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information , . e Existing Proposed Required by'Loning This column to be filled in by Building Department Lot Size l.. , ' a l i Frontage - Setbacks Front Side L: R: L:: _ iv Rear I 'f Building Height Bldg. Square Footage % Open Space Footage (Lot area minus bldg & paved j I parking) # of Parking Spaces Fill: , 1 I (volume & Location) I • 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 Q IF YES: enter Books Page and /or Document # I B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? - YES Q NO 0 IF YES, describe size, type and location: 1 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 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. r De a rtrileFi t tle 4 ` N ��- f -3 n 1',",...•,':4- ^'�{ �`"� q -- -- -� City of Northampton s ta #us of Pe ml ''�' ,°� . t. Building Department C u r U'4 -e ay a ;. it s 212 Main Street ''' - ep Ic,7Auaitabitity e a i� ? w " q APJ ) 0 2012 Room 100 11Ua oll�Ayallab liter Northampton, MA 01060 T e ct alF* OF BUILDING e 4 3- 587 -1240 Fax 413 587 -1272 t/5� an ' ' : � NORTHAMPTON MA 01 ,. „ , ga., k °s° t 4 na ' - . APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAM DWELLING SE TION 1 -SITE INFORMATION This section to be c omplete d by office 1.1 Property Address: 4 1-r° l� o y /2 // a,� b Ma i , ' t)nit 7 vn e Overlay District N __Etm Sf Dis tri c t CB Disinct ` � SECTION 2 - PROPERTY OWNERSH /AUTHORIZED AGENT Owner of Record: i,/ (S o` 7fe,'-ii e ySo Aoik: f /fj // liar'. f% /asw�, /4' Name Name (Print) rr Maili Address: 3 � Y/�ent - zng ry -yy Telephone ___7.....4._ cigaature 2.2 Authorized Agent: Name (Print) Current Mailing Address: Signature Telephone SECTION 3 '. ESTIMATED CONSTRUCTION. COS TS': Item Est Cost (Dollars) to be Offic Use Only completed by permit applicant Building it Fee s 6 s. 7s 1. (a)`Bullding Perm 2. Electrical (b Estmated Total Cost of," b) Construction from (6) ..> 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection , + I 6. Total =(1 +2 +3 +4 +5) Check Number � '�, - . - This Secti For Official Use Only 2h Date Building Peilnit Number Issued. ' Signature: - Building Commissioner /inspector of Buildings pate • • File # BP- 2012 -0879 APPLICANT /CONTACT PERSON BERUBE TAMMY J & STEPHEN C ADDRESS/PHONE 450 ROCKY HILL RD FLORENCE (413) 214 -4463 0 00 46 PROPERTY LOCATION 450 ROCKY HILL RD MAP 44 PARCEL 094 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 1 �/� Fee Paid / 4 Tjf Typeof Construction: ERECT 12 X 20 STORAGE BUILDING New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 127530 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF_ OI MATIO ' SENTED: PA-0 rik jzzt pproved 14 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 W !1J !00 4 Other Permits Required: 8 villa- { Curb Cut from DPW Water Availability Sewer Availability ik k frcivt (`jexd Septic Approval Board of Health Well Water Potability Board of Health �l /t. r6 Permit from Conservation Commission Peunit from CB Architecture Committee S ' Permit from Elm Street Commission _ Permit DPW Storm Water Management Vii " Demolition Delay /1" Li Z7 I 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. 450 ROCKY HILL RD BP- 2012 -0879 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 44 - 094 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: shed BUILDING PERMIT Permit # BP- 2012 -0879 Project # JS-2012-001546 Est. Cost: $5966.00 Fee: $48.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KLOTER FARMS 127530 Lot Size(sq. ft.): 32670.00 Owner: BERUBE TAMMY J & STEPHEN C Zoning: Applicant: BERUBE TAMMY J & STEPHEN C AT: 450 ROCKY HILL RD Applicant Address: Phone: Insurance: 450 ROCKY HILL RD (413) 214 -4463 () WC FLORENCEMA01062 ISSUED ON:4/30/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: ERECT 12 X 20 STORAGE BUILDING 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 4/30/2012 0:00:00 $48.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner