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Y'..4 . +� s, 363 L� VPE4 ` * . `v i As. tut t , , t6 AAP �` 1.6 A � . •3D S3ef 0.a i..*.itg yJ kJ* .. •• '^.,,t» '#l. 16.4 � • 4,4 I ,t� � a�: 0 470- ' Training conducted by: 'Y a • � ' ATC Associates, Inc. ,, ) � 73 William Franks Drive t -• ,.-?1 MA 01089 ` ' `i ce r ' West Springfield, ; k j 0:1 - (413) 781 -0070 ', • (4)*1-,..- C ertificate of Attendance and Successful Completion t i - .4) Renov Initial -- English ( , Pe 40 CFR Part 745.225 ' )` 4:0 J R x / 1,11 /i,l K W. Lynds .1, ►, j PO Box 448, 71 Reservoir Road, Leeds, MA 01053 • „t Certificate Number: NAT - RV - 966 - 10 - 02172 '1/h r� Course Date: May 1, 2010 \ o� - Exami Date: May 1, 2010 ,; 4 . s �' . 1 Expiration Date: May 1, 2015 T R ^ v It 41* (0 -1 , ., 10 , .4: - zj ii... ,, 2 ,../ ziceet.x.e. 4 _.-- / sf-", ( , - ..:.k , :. 4, oN: ' '‘) ' 1 \ Principal Instructor ' — r j -- (). ) . /./e7,,,c40417...e.4 > .,,.. Or" • 4 t � Regional Manager / • �'' J ' -- - - ^a _� — .� ^ � -- x. �� u a a an; ►a � �. ?t . yl` q A ��• a ; >, ,xy� a s z < . <> j9 , k� l �i r �� y? a j +a 8 : + ' . bhc 'Apt, 4 . P' je 'fit r . t�` q P , 4 , 41 �'l w; sli.. ♦ 1 �„ . 4 ,o� o • ,. r ir> 'w, q p °4 y ', f` °° �` ""'M r, �. �►�� A+ de ' 4 �� ,4 rr ' AN rl �4^ /i F , A � � � / l �d /i t� '. .off i ;'•� tW� � � /, �Mtl � s� r � A►R' � m v 4 l a�l+a" -� M � tnw`^ �' 4 p�,�'cM...• u�,M� ,� .w•, r. � �' vn,. <f s� •�.n'"'�i�> �rA� `� ,;,a"0�a A�'� E av �., i • ..*: ►t ° A ar.: t. ,pN- ..+w,w'>1�4�F� 1 t0' , � ,b te, .„-" % +a► v47 ., ew- «ar.'h - ,,�.� '•> �YM�OyW.��� > i �� a/ '�y,' -•-ti. - < `MO� I+ ,� wY � ���{�' .�'�RM�, J " 0 �:>�< y ",ti �ti� > <• ` .., �,���p/�y > t� .: y "' t .p�'> i �r� s �� > ! �Y ,. � �� � �1. I yiS.■ 1 `'` . c V � /M1•. Y•W A.', 1. '1y, � . „.... .0 MM 'e : , ; ,... 4 1 ,,�� J +' A / ,t f .. �l Y I...4..a�./1./ h1y�. IY �.{,,(, � � ,....? ) . - ,r „ Y M�d F ,. r Y v; � n JN,.M� °+1� J• , .,w� q�nl. .�:� � ; .w- w,"«,�`0w.. , , 1� .w' d _ .� '` /f ,....', � d.".;. , i . `Y►- w„ y0 rs `tlw~04,,, ,,4 , a► 1 , 400 . , �•Y�. �iL�Mry ,4.4R.. / .4 n, 4e ^ � ,p;1,A S'.l� �w? . ,447E a� �"w ,?110 *� . "'1W.4. ..' ,.. '. ' "`91N' y. _> '.�� lla�• ,•�.. NWM' �.� " •qA ' al�' " sr '�_Y'rtl.�.A License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 Not valid without signature Restricted to: 00 00 - Unrestricted 1G - 1 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: WWW.Mass_Gov/DPS OSHA recommends Ouireach Training courses as as orientatiw to eccopatitmal safety and health for workers. Participation is voluntary. Workers must receive additional training on specirtc hazards if their job. This course completion card does nit expire. For further informalioo see our web site at w. oslu.=evipulrrarh.hsml • SAFETY ', OSHA 10 EQUIPPED Q Fall Protection Training & Consulting Services Tel.: 508- 332 -8959 Bill Kershaw 61 Eisenhower Road Safety Consultant Swansea, MA 02777 Member of ASSE SafetyEquipped(dcomcast_net O11kc of( ousuhnr Aft;tirs 4 li t(siness Rc atatiors Ti ; HOME IMPROVEMENT CONTRACTOR �� Registration: 136677 Type: „' Expiration: 8114/ ?_0 Ind /Vtduat KENNETH WILLIAM LYNDS KENNETH LYNDS 71 RESERVOIR RD., LEEDS, MA 01053 t1I1(ter re tars \1a.0aChu,rtis - Dep.11ittu.nt ,.t i'uhlir �airt? Rrtartl tII Bttiltlin_ R antl `tatttiartl� Lccense- GS 13668 KENNETH W LYNDS 71 RESERVOIR RD LEEDS, MA 01053 E'xp +ratt<,rt: 7/24/2013 Tr- 21283 „;tturi..i 7 irr ,-, n, " �. OSHA _ ' ' C� ; Department of labor Cfcc,paliona; Satety aua Heart) Ao■Mis;raLOn has successtutty completed a 10-hour Occupat,onat Safety and Hearth Tra +Whig Course in Health Construction Sates & Pale) • (T *a,ner ertificate of Completion NEB a 1 Hour OccuPational Has successfully com plete d in Coostructioft 4 111 nd Health Tra► Course Safety & Health J06 ( Date Trainer L?'r 1 ; . ,:-.7,:::".. . 'fir ...''....;;,,,,'L--- _ ( ,R \_ t to y . � i� T . j � ^ _ _ j , ,.. ,„.,,,,.....-.........„--,;...- . I._ . 9... f /` p2_� .. il s k-ri 4irq--1(Z.44 ' -,'--- .: (---)4.1 0,tf... re-t,..-a ) F .., g _5-0 3 9 w t i t f'F . , AS le " ° J ( 4 ! ,/' ,SFr -- ..., M.,«.. J F /po /�-�/� -111 Y ✓ �Dr P 5 e.... (-cm . S f 0J .. ,..s r'2 Lp : u 7 Zs o '� y �w r 4' , i t I' ' c- 7 w A -, L 44 ell A�! t P . 144 ry �~ 1 r✓ a( 4 f ..." ,r w.t ` r 4 '� a.-"' _v° s 4. 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ISD p yc4.4 o ©/d Z f & " fl---- f47; 44-1,5e_ !n h t.A 40 r ca .,..dL P-Iti A.-//,‘, (3) C.o Kc_r doer s.-r,.,-'--s CZJ = /b'cOtto 7 y , O/ II aWN Frew fdd 1 ,,,,d... got- 6 X `'. ,r far 71 - a--'— 14,r art oit, r ' to-c4, S Ai— FA •✓ (yw r` coy , w e' p 0.3T o I , ,rc.�. -1- 7 fie o u,, -J Iu° J e h, o / 7 - 6"4 44 r;11,41- p 4 .1+ / a,`�■ a .s r Y / rf e N 10 6.4 /; G • Gc io o O f h._ f ; 6 ,..4.104 - 4.- 2�' 8 p ✓ 4'4 /0 ' ,4, j cA /, w di Gt._ 4„,a...,,...41. P5 64.41... u. it 'bf^.L-- 4ii. Llti e:6 /A..., . y/s- £ .1793 City of Northampton Massachusetts } DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building \ No Northampton, MA 01060 st' X 1 6 `, INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massach allows the homeowner the right under 780CM" 08.3.4 to act as his /her construction supervisor. The -te defines "Homeowner" as, " Person(s) o owns a parcel on which he /she resides or intends to be, - one or two family dwelling, attach:: or detached structures accessory to such use and /or farm ructures. A person who constr s more than one home in a two - year period shall not be considered a ' ome owner." The building department for the City of No ampton wants a person(s) who seek to use the home owner exemption, to act as their own constru , ion supervis. , to be aware that by doing so you become responsible for compliance with st. e buildi • codes and regulations. The inspection process requires that the building department be . ailed o inspect work at various stages, which include foundation /footings (before backfill), sonotube 1 o _s (before pour), a rough building inspection (before work is concealed), insulation inspecti • if required) and a final building inspection. The building department requires these inspectio► be' the work is concealed, failure to secure these inspections can result in failure to ob : in a ce ' icate of occupancy until the work can be inspected. If the homeowner hires other trades to pert m work (electric: I, plumbing & gas) the homeowner will be responsible to make sure that the trades ' ired secure their proper permits in conjunction to the building permit issued, and that they get their - quired inspections. F - lure of the individual trades to secure the permits and inspections as requir- d can DELAY the project u 1 such time as the proper permits and inspections are made und- stand the above. (Home owner /resident's - ignature requesting exemption) I will call to schedule all req ed building inspections necessary for the building permit issued to me. Date Address of work location • The Commonwealth of Massachusetts Department of Industrial Accidents 3 = _ Office of Investigations 600 Washington Street •.._� Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): f( V' ��]�t ' 2•i is Address: PD • Po/ 4 i 4 a 7/ 4b -yr y)c- , City /State /Zip: L Q ,24- , o s'-1 Phone Phone #: 1 S - �� d' 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 2.1 I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub - contractors have 8. n Demolition working for me in any capacity. employees and have workers' 9. n Building addition [No workers' comp. insurance comp. insurance.$ _ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. _ I am a homeowner doing all work officers have exercised their 11.17 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.n Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.1 1 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. Insurance Company Name: ,A//15P Policy # or Self -ins. Lic. #: 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: ) A 4 Date: b Phone #: 4 -S3.• g 798 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Insp 5. Pl Tnep 6. Other • Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 4, 8.1 Licensed Construction Supervisor:: • Not Applicable ❑ Name of License Holder : ee. vvn-e- r / 'o 44) L y N' d . /34L $. P a pvuv yg License Number 7/ lees - - 1 K , Ge e-es ► phis. or 7 -. Z y --t 7 Address t Expiration Date � gi/J -4,30 - 87Q , L ure Telephone 9'itei iste ed.Home,lmprovement'Contractor �M , �, _ : , �- No )6Ah 0 II ae.t /.2. , . a Not Applicable ❑ /.3‘( 77 Company Name ,, Registration Number P. gyp)( 4 /Y8 7/ /LYUO 1 N- gel . , g '—/ c "Z Address 9 1j Expiration Date 7 L,Q. 4 "+ l N,JJ . o / °SJ Telephone 530 - 87 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. 7 Signed Affidavit Attached Yes No ❑ 11. :— Home; O?�vner%Exemption The current exempti. , for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families and to allow such home. . er to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, • h Edition Section 1083.5.1. Definition of Homeowner: P - on (s) who own a parcel of land on whic• e /she resides or intends to reside, on which there is, or is intended to be, a one or t , • family dwelling, attached or d- . ed structures accessory to such use and/ or farm structures. A person who construct • ore than one home • • . two - year period shall not be considered a homeowner. Such "homeowner" shall submit to the :. •lding Officio •n a form acceptable to the Building Official, that he /she shall be responsible for all such work performed • • er • • building permit. As acting Construction Supervisor your pres- - on the job site will be required from time to time, during and upon completion of the work for which this pe .' is issu... Also be advised that with reference to apter 152 ( . kers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resultin . • Death) of the Mas : husetts General Laws Annotated, you may be liable for person(s) you hire to perform work for yo • nder this permit. The undersigned "homeown- • certifies and assumes responsibi • . for compliance with the State Building Code, City of Northampton Ordinances : ate and Local Zoning Laws and State o ' assachusetts General Laws Annotated. Homeowner Signature • vs SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) or nett( New House n Addition n Replacement Windows Alteration(s) ) I Roofing I Or Doors D Accessory Bldg. I I Demolition n New Signs [D] Decks [ Siding [D] Other [1!1 1! Brief Description of Proposed R; {d( 13 ► / 2 G r, n Work: 0 S L ! 9 � (*' KA" ✓'may Died d504.16" , • Alteration of existing bedroom Yes X No Adding new bedroom Yes x No Attached Narrative Renovating unfinished basement Yes No C.t ) Plans Attached Roll - Sheet - ed At e Ga If- .New -douse and or ad dition to existing housing; c m'aae -the following: a. Use of building : One Family Two Family X Other b. Number of rooms in each family unit: Number of Bathrooms I t • c. Is there a garage attached? )SLS d. Proposed ar age of new cons ruc ion. 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 an 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 ' 5 ,4 r• AN P •.Y , as Owner of the subject property hereby authorize icev%h.�l� '' S /" * 2 'Z' �C to act on my behalf, in all r ttatters relative to work authorized by this building permit application. Signature of Owner Date 11KA. '14 4 ' ) 14 t Lv d, S , as Oar /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 1 penallties of perjury. 1l �► A W , L..G r✓Gvr Print Name Signat' of 'Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by 'toning 1 1 This column to be filled in by'' !llvvv ,( /) n J 61 1 / Building Department l s 1 a 1 Lot Size _ _.. _ �_.. — Frontage . � _- —. ._._.__,. _ — - — �_.__.�.._._.__.� ___ Setbacks Front t , k t Side L:- __._..J R:.. L: _ R: ? _ Li Rear • ``. ---- Building Height ff rg C� Bldg. Square Footage - �� —°--_ % --I _r__- Open Space Footage % ---- (Lot area minus bldg & paved __ !', ! __ n parking) # of Parking Spaces Fill: bbl.)--- (volume & Location) A. Has a Special Permit/Variance/Finding ever been issued for / on the site? NO 0 DON'T KNOW ‘„,10 YES 0 IF YES, date issued:i IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page f and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 35 DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 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 it/'N AO 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 it* IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Departmewt use on ly !f I City of Northampton s t a t u s of P , Building Department Ceb CutfD P rmtt / k, pk � �L JUN , 6 2012 212 Main Street Sewe / ept Availability i� Room 100 W Availability t fir , , ,ii, � 4 Northampton, MA 01060 Two Structural P lans vy � - fione 413 587 -1240 Fax 413-587-1272 Pio 5 e `P( `ns � ,,' ` '�'� ':� x. 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 b office 35 5,,,Itv..4.s AJ.c. M ap �pY Zone" � Ove rl�a y D i strict �� Elm St. District CB District ^ i SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: SusA^l A • o 3.$ roc s +e , ��, d ra La Name (Print) Current Mailing Address: r`� Lf f3 —.S v 89 (t °I a.t rte Telepho S ignature 2.2 Authorized Agent: P.o. ___•6 „L. ,1,,,1 4j A a • 2 C' C 0, I4r, Lted s A4 is.s . ofaS 3 Name (P int) Current Mailing Address: —............/ -,'✓ • ►`.. 1../ 4J 3 -vr3 b - d' 7 J' Si.na ure Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only co mpleted by permit applicant � A GO � � (a) Bu ilding "Permit Fe 1. Building ( e" 2. Electrical _ (b) Estimated Total Cost of ...—...........\ ` Construction from (6 ) 3. Plumbing Building Permit Feel ' 7 ..r 4. Mechanical (HVAC) .n ip 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) / y o --- Check Number 7 This Section For Official Use Only Date Building Permit Number: � Signature: Building Commissioner /Inspector of Buildings Date 35 GRAVES AVE BP- 2012 -1169 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A - 085 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- 2012 -1169 Project # JS- 2012- 001998 Est. Cost: $14000.00 Fee: $84.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KENNETH LYNDS 013668 Lot Size(sq. ft.): 4051.08 Owner: PARKER SUSAN A Zoning: URC(100)/ Applicant: KENNETH LYNDS AT: 35 GRAVES AVE Applicant Address: Phone: Insurance: P 0 BOX 448 (413) 584 -9282 LEEDSMA01053 ISSUED ON:6/27/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: Rebuild 1st FLR Porch 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 6/27/2012 0:00:00 $84.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner