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A CORD, CERTIFICATE OF LABILITY INSURANCE }" DAT {1uIWg
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213 MAIN STREET
NORTHAMPTON MA 01000 Al r'{:E,,cEr'H -I :;;;A I :'E
Attention:
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ACORD 25 { 411tm b, Ttu+S , r
:•erVir.wile a 4GG94
lfe ACORD CORPORATION 1988
01/26f2 010 15:55 4135966560 f
IITCHEN ENCOUNTERS PAGE 01
--- pChRSrv ttS WI -__- we trf /dents
The Ca � . Mto» i ndust /.ice
DePa rtinC t of 'fives tiBati+ v to
workers' comp- insurance 5 roprietor or P 9
fl W e are corp 60 ;2
Vi 3ostant x4 Q �di a ctf�K S ll ectrlc � a nt ib .
'- � �► w ww.m � ss - � •l d�,rs1C�►�tr a ple p �'
l davit: �'ut
�ompe�s #,*
vV 0 Xkers n t411' a
A is a
�n ►rm� � , iti•
t Rinzsal{Jr�aniza tduai� - _--- --
e ,.- _ J�
?.1at?ie l u � -.0
� �� hilt• � i,'� `'`l � •M_-- - - - -- ulped
C4
Addre5 �}',
t I 0 #: 1 ect i ti
i._ � Type of pra
v: -- _ - C pttStNCti 41 �
Cit Statelt ry Check the a ppt °p I stn a gCne ral con Contractors Renlodeltng
Ax you an tmployer have h ired the su .
ct with _—�-�' * attached s 11t't4Ct
l .� I am a employ rt time) listed on the S- 0 De mta
employees {full a netlor pa contractors ha additlnl�
pole artner Tl1ese sub- 0 Building
_ t tam a • aye nt5 trY►plaemployees. employees and have Worke'r5'
ship and 11 insurance. 10 Electrical repairs Or adtiitio
working fot me in any capacity comp
[No workers' and its plumbing repa or additic
required.] officers have exercised rMGi 12,0 Roof repairs
3. ❑ I am a homeowner doing all work right of exempts p
m yself. INo workers' comp. c. 152, §1(4), and we have no 13.0 Other
insurance required.] t employees, to workers'
r:ornp. insurance requited.3
• Any applicant that checks box #1 must also fill cut the station below showing their workers compensation must information.
t H ,,p�,, nors who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicat ins 5ui it.
:Contractors that cheek this box must attached an additional sheet showing thename of the sub - contractor and state whether or not those entities have
emoiovices, Ti' the sub - contractors have employees; they must provide their w irkcrs' comp policy nurnbcr.
I am an employer that is providing workers' compensation inssurance for my employees. Below is the policy and job site
• information. '
'Insurance Company Name: -
Folic' # or Self -ins. Lie, #; _ j Expiration Date:
• Job Site Address: - Cit}t? tate /Z,i;p' ,
. Attach a copy of the workers' compensation policy declara.ioa page (stowing the nurth er and expiration date
Failure to secure coverage as required under Section 25A of MbL c. 152 can lead to the imposition of earn penalties of
fine up to 51,500.00 and/or one -year imprisonment, as well as iivil penalties in the fornrsn•a STOP'*01 tt, ORCEFt and a
. at up to 5250.00 a day against the violator. Be advised that a cbpy of this statehrmn tt may im, td r'tu Mar Off tee or
• .. Investigations of' the DIA for insurance coverage verification.
—
I do hereby certify u e •
• . an , , enalties of p erjury tit _ -- ' orntation provided above is true and correct
- nature: _ ' t +%
Ph #
one r�f ° - t
Official use only. Do not write in this area, to be completed by city or town officicri
City or Town: l errnit/License #
Issuing Authority (circle one):
•
1 Board of Health 2. Building Department 3. City/Town?Clerk 4. Electrical I nspector 5. Plumbing 1ttsEsrr for
b. Other
Contact Person: . .._ Phone #:_
� VWB2430 M C 1727.24 4) .-,-..
f . atj
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te a,
VSB241834
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TOILET -1
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All dimensions size designations 20 This is an original design and must Designed: 11/17/2009
given are subject to verification on TECHN IO
OGiES not be released or copied unless Printed: 12/5/2009
job site and adjustment to fit job applicable fee has been paid or job
conditions. order placed.
Scagel Sold I All [Drawing #: 1
•
A - 6 2 ..w0404i ot_Ackoaciudoe14'
--
Bo ard of Building Regulations and Standards
ConstructISupervisor License
- I
Licens CS 64950
t ;1010 Tr# 23856
Ro al*- • a
MICHAEL A GAS1VE.13t'
15 RAILROAD AVE '
WILBRAHAM, MA 01095 Commissioner
•
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•
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• „
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. pcilvofivoiretwrrofteig4i6)44,144064(4440
• ff , HOME IMPROVEMENT CONTRACTOR
• P - a t Registratlop: 137000
• . s
- 4". if 4 j Expiration: 6(25/2010 Tr# 273798
Ltd Liability Corpor
• ; RENOVATION CONSyl-TANTS
MICHAEL GASTEYEa
15 RAILROAD AVE ,
VVILBRAHAM. MA 01065 Administrator
a.
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RENOVATION 15 Railroad Ave. Wilbraham, MA 01095 (413) 596 -2919 Fax 596 -6560
consultants
Work Contract
Renovation Consultants, LLC proposes to furnish materials and labor; in accordance with the attached quote numbered SCAGEL-
002 totaling Fourteen Thousand one hundred nineteen and 17/100 and Renovation Consultants, LLC must approve any
changes. Any alteration or deviation from the original estimate involving extra costs will be executed only upon written consent
and will become an extra charge over and above the original estimate (all change /add orders will be assessed at 25% above our
cost, the charge is payable upon signed approval for work to be performed).
Payment Terms:
Upon signing of the contract ($7,009.59), 2nd payment upon delivery of cabinets ($6,009.58) and the final payment upon
completion of work ($1,000.00) please note if there is a specific manufacturer delay or replacement order you may with hold
double the value of the replacement parts. 1 '/2 % interest per month charged to all overdue balances until paid. It is agreed that
any payment not made in accordance with this payment schedule shall be considered delinquent after 10 days. Legal fees
accrued in the collection of any outstanding balance will be charged to customer.
All materials are guaranteed to be as specified. All work completed in a workmanlike manner according to standard practices. All
schedules and agreements are contingent upon delays beyond our control i.e. weather, delivery of materials by suppliers, dealer
delay on special order items, etc.
Our workers are fully covered by Workman's Compensation Insurance and Liability Insurance. Renovation Consultants, LLC
guarantees all workmanship for a period of one year from the date of completion. All materials are covered by the normal
guarantees, if any provided by the manufacturers or suppliers. This guarantee is void if payment is not made as to the terms of
this contract.
All home improvement contractors and subcontractors shall be registered and any inquiries about the contractor or subcontractor
relating to a registration should be directed to: Director, Home Improvement Contractor Registration, One Ash Burton Place, Room
1301, Boston, MA 02108 Telephone: (617) 727 -8598.
Acceptance of proposal: The listed prices, specifications and conditions are satisfactory and are hereby accepted. Renovation
Consultants, LLC is authorized to do he work as specified. Payments will be made as outlined above. This updated contract
supersedes any and all others.
1 -
Authorized Signature: 1 ,,y I Date: November 17, 2009
• V,
I
Job Name: Ann Scagel Date of Acceptance: X7//7/ ?
Job Location: 9 Jewett Street Signature:
Northampton, MA 01060
Phone: 413.584.2870 Signature:
Mondays & Evenings By Appointment
Tuesday thru Friday 10 a.m. to 5 p.m. Saturday 9 a.m. to 1 p.m.
4- 20
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : \ hk, )♦`� �\ Q .v^ SO
� ` \ License Number
` C� v1 512, j 2 � 1-0
Address Expiration Date
Signature Tele•hone
9. Registered Home Improvement Contra.,,or: Not Applicable ❑
�\� ,�O \ C.) � ) 3iono
Company Name Registration Number
15 N.N1 912-S /Z310
Address Expiration Date
3 C
,4 t
f�}1QN �N Telephone���'" /6�,
—
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 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
(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 Q DON'T KNOW Q YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DON'T KNOW Q YES Q
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO Q DON'T 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 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
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing in
Or Doors ❑ 0
Accessory Bldg. ❑ Demolition ❑ New Signs [G7] Decks rirl Siding [D] Other [D]
Brief Description of Proposed " \O&Q_ fit. 1 % \
Work
Alteration of existing bedroom I 'Yes I I No Adding new bedroom I I Yes L I No
Attached Narrative Renovating unfinished basement I I Yes I I No
Plans Attached Roll - Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family] L 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 J
g. Energy Conservation Compliance.' I Masscheck Energy Compliance form attached? I
h. Type of construction I I
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
I, /fJIJ L. S(. n -E , as Owner of the subject
property
hereby authorize IEE kio ) CO.S V rtiCS . L` L
to act on my behalf, in all matters relative to work authorized by this building permit application.
(
Signature of Owner Date
RC-LA./A.6 A - GkSir , 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 nd penalties of perjury.
Nkkc, A, Gal
Print Name AI
AI
Sig . ure of 0 Mr NNW Date
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
„ 212 Main Street Sewer /Septic Availability
,,, 2 Room 100 Water/Well Availability
N prthampton, MA 01060 Two Sets of Structural Plans
phone 413 -1240 Fax 413- 587 -1272 Plot/Site Plan
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: This section to be completed by office
a \ Map I I Lot I Unit I
Zone I I Overlay District I
y � Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
1)ti N ,SUac-5Z_L I H
H
Name (Print) Current Mailing Address:
g9 Li— 7%. 7t7)
Telephone
Signature
2.2 Authorized Agent:
t c; k .€/C. ta . 64 s f t I [ is 4 , 440 ,42 u/ lkof h j mg DIOtr
Name (P ) Current Mailing Address:
AA I [CU«). ces3C
agnature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building I (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) I
5. Fire Protection —
6. Total = (1 + 2 + 3 + 4 + 5) ] Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2010 -0687
APPLICANT /CONTACT PERSON RENOVATION CONSULTANTS LLC
ADDRESS /PHONE 15 RAILROAD AVE WILBRAHAM (413) 596 -6535 0
PROPERTY LOCATION 9 JEWETT ST
MAP 31A PARCEL 120 001 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 �i �
Fee Paid 7 ,LD d
Typeof Construction: REMODEL UPSTAIRS BATHROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 064950
3 sets of Plans / Plot Plan
THE FOLLOWING 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
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.
19 BP-2010-0687
GIS #: COMMONWEALTH OF MASSACHUSETTS
ap if k: Ai- 120 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 -0687
Project # JS- 2010 - 001009
Est. Cost: $14019.00
Fee: $84.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RENOVATION CONSULTANTS LLC 064950
Lot Size(sq. ft.): 9147.60 Owner: SCAGEL ANN
7oninc: URB(I00)/ Applicant: RENOVATION CONSULTANTS LLC
AT: 9 JEWETT ST
Applicant Address: Phone: Insurance:
15 RAILROAD AVE (413) 596 -6535 0 WC
WILBRAHAMMA01095 ISSUED ON:1/28/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: REMODEL UPSTAIRS BATHROOM
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 1/28/2010 0:00:00 $84.00
212 Main Street, Phone (413) 587-1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo