Loading...
25-061 RAWCO-1 OP ID:SD ACORO I DATE(MM/DD/YY1'Y) CERTIFICATE OF LIABILITY INSURANCE 05/08113 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the,policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CUNiAgI 860=747-9207 NAME: Susan Dutcher Connecticut Casualty Company 860 PHONE FAX -747-2720 One Whiting Street LAIC.No,Extr (A/C,No): Plainville, CT 06062 ADDRESS:susan @ctcasualty.com House Account INSURER(S)AFFORDING COVERAGE NAIC f INSURER :Endurance American Specialty INSURED Raw Construction LLC INSURER B:Evanston Insurance Company 73 Lucien Road INSURER C:The Hartford 29424 Bristol,CT 06010. INSURER D: INSURER E: _INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADM SUBI7 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR Wvn POLICY NUMBER (MM/DDOMCO (MMlDDMNYI LIMITS GENERAL LIABILITY - EACH OCCURRENCE $ 1,000,001: A X COMMERCIAL GENERAL LIABILITY X CBC1 0001 578 000. 05/05/13 05/05/14 DAMAGE 10 RENTED 100,00C PREMISES(Ea occurrence) $ CLAIMS-MADE ® OCCUR MED EXP(My one person) $ 5,00C PERSONAL&ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,001. GEN'L AGGREGATE LIMIT APPLIES PER: _PRODUCTS-COMP/OP AGG $ 2,000,000 ( � 7 POLICY I I PR7 Ti LOC $ AUTOMOBILE LIABILITY (.0MBINEU SINGLE LIMI I 1000 00� _ (Ea accident) , , C ANY AUTO 02UECZJ8778 05/05/13 05/05/14 BODILY INJURY(Per person) $ — ALL OWNED E,71 SCHEDULED BODILY INJURY(Per accident) $ AUTOS ^ AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS, (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 B EXCESS LIAB CLAIMS-MADE XONJ522913 04/23/13 05/05/14 AGGREGATE $ 2,000,001; DED I X REItNTION$ 10000 $ WORKERS COMPENSATION WC STATU- 0TH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS- I ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yyes,describe under DESCRIPTIONOF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) yprexx Services LLC is an additional insured for general liability per ritten contract. I- : Various jobs in CT and MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD RAWCO-1 OP ID:SD ACORO' DATE(h1MlDDNYYI) CERTIFICATE OF LIABILITY INSURANCE I 11,26112 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER LUNIA-i 860-747-9207 NAME: Connecticut Casualty Company PHONE A One Whiting Street 860-747-2720 (AIC,No,Est): I F INCX ,No): Plainville, CT 06062 ADD SS: House Account INSURER(S)AFFORDING COVERAGE NAILS INSURER A:Acadia Insurance Company INSURED . Raw Construction LLC INSURER B: 73 Lucien Road Bristol,CT 06010 INSURER c INSURER D: INSURER E: ■HNSURERF: COVERAGES CERTIFICATE NUMBER: • REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBM • POLICY EFF POLICY EXP LTR TYPE OF INSURANCE „INSP wiin - POLICY NUMBER , IdM/DDS OYYI IMMIDDIYYYII LIMITS _ GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES(Ea occur once) $ _ CLAIMS-MADE OCCUR MED EXP(Any one person) $ _ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ n POLICY n F7 In LOC $ AUTOMOBILE LIABILTY COMBINtU SINGLE LIMI I (Ea accident) ANY AUTO I BODILY INJURY(Per person) $ A TOWNED n SCHEDULED — - o E BODILY iiv.iuK'Y(Per accident OW ) ; HIRED AUTOS NON OWNED I PROPERTY DAMAG 7 $ _ AUTOS (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION WC STATIJ S I I OTH AND EMPLOYERS'LIABILITY Y!N X I TORY LIMIT ER A ANYPROPRIETOR/PARTNER/EXECUTTVE WC2()2000419600 11!21112 11/21113 E.L.EACH ACCIDENT $ 100 00 OFFICER/MEMBER EXCLUDED? N!A , (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 5'500!,00 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,U more space is required) his certificate is for Workers Compensation Insurance for the State of ssachusetts. CERTIFICATE HOLDER • CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ok,v ,1 ....., ,,,, r ' , i ' - RAISE YOUR STANDARDS May 15, 2013, This letter is to certify that Cyprexx Services, LLC., as acting agent for JP Morgan Chase, on said property: 101 Old Ferry Rd, Florence MA 01060 Otherwise recorded as: Parcel ID #: 25 -061-001 Do hereby grant authorization to: RAW CONSTRUCTION LLC./and their subcontractors, to execute all inquiries, open permits and perform repairs as owner's agent on subject property. Thank you, Cindy Swick Repair Mana!er fo t Cyprexx Services, LLC 813-9 . 4 / Ae ' ■/ f f -II/ l_ � (Signature o'�Authorized Officer/Director/Partner/Manager) State of Florida + County 9 4 illborough e oregoing instrument was acknowledged before me this 15th day of May,2013,by Cindy Swick,as an Authorized agent for Cyprexx Services,LLC. Personally Known ,,//- or Produced Identification Type of Identification Produced C E\`w 1A N I " • ���Yr�o . u� (Signature of N tary Public) z.--/� ;.��'a (Print, ype, or Stamp Commissioned Name of Notary _�:K OFF°•` "m:P-Public) Vic,:H/f,.: • A AA cyprexx.corn SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: . • Not Applicable 0 a Name of License Holder i •LZ.O (A w 5 G rto/l,k l ��.c—/ D Sc)SO License Number . Address Expiration Date 6 .7 _ S - f - 6 o Signature Telephone 9.Registered Homelmpravement Contractor ; Not Applicable 0 IC,os a411I Company Name -RAO Co Registration Number• • N uf-P b a / 013 Address Expiration Date -73 L uGl ' Teel ` e -$411-itoa5- ph 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 0• No 0 • 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 lie/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 El Addition 0 Replacement Windows . Alteration(s) E Roofing E Or Doors Accessory Bldg. 0 Demolition 0 New Signs [L7] Decks [Q Siding[O] Other[p] Brief Description of Proposed Work: ek I '..��.. .IAJ a �y. i Aril.; . �°e I Alteration of existing.bedroom Yes No Adding new bedroom Yes No• Attached Narrative: Renovating unfinished basement Yes No Plans Attached Roll Sheet . 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 , 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, At 1t4 ODA)-702,11-C-P DA) 2,-,t•e---- . , as OwnerfAuthorized 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 pains and penallti.�s of perjury.. 1,0 v" C C K t Signa ure o •w"r/Agent . Date . , Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information • • Existing .. Proposed Required by Zoning • t'hiscolumn.to be tilled 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 minis bldg&paved _..._._ parking) #of Parking Spaces '- Fill: (volume&Locat'ion) ;.:. A Has a,Special.Permit/Variance/Finding ever been issued for/on the site? .• NO �. ' DONT KNOW 0. • YES 0 IF YES date issr,ed IF YES: Was the permit recorded at the Registry of Deeds NO Q DON'T KNOW 0 YES 0 • IF YES: enter Book 's Page, . and/or.. Document#: . B Does the site contain a brook,.body of water or wetlands? NO C) DONT KNOW Q 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 0 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 YES . IF YES,then a Northampton Storm-Water Management Permit from the DPW is required: . n RECEIVED Department use only, RECEIVED City of Northampton Status cif Permit Building-Department : Curb Cut/Driveway Pertn►t ' MAY 2 3 2013 212 Main Street SeyverTSepflc Aua►labtlity Room 100 Water/Wett. vartab►ufy4� ,... ��, . DEPT,OF BUILDNGINSPECTIONS Northampton, MA'.010.60 TWp Sets of Structural Plans '' NORTHAMPTONkMA0lopb on@ i,13-587-1240 Fax 413-587-1272 Piot/Site Plans ` Other SpeQify'- 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 he completed by office u l ©1c� Fe `-- ` Map Lot Unit `F \oe e "cc- . t 0(0 Zone Overlay District Elm St.District .CB District SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT �l 3 2.1 Owner of Record: M M.a22 0- x F3 mkz 5t Name(P lit) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: 16C-14 1 Name(Print). Current Mailing Address: SL-{ -15 Signature Telephone SECTION.3-ESTIMATED CONSTRUCTION.COSTS . Item Estimated Cost(Dollars)to be Official Use Only completed by permit:applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total= (1 +2+3+4.+ 5) Check Number _L? 7 j This Section.For Official Use Only Date Building Permit Number: issued: Signature: Building Commissionertlnspector of Buildings Date • 101 OLD FERRY RD BP-2013-1133 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 25 -061 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2013-1133 Project# JS-2013-001863 Est.Cost: $3750.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RAW CONSTRUCTION LLC 105250 Lot Size(sq. ft.): 13677.84 Owner: J P MORGAN CHASE Zoning: Applicant: RAW CONSTRUCTION LLC AT: 101 OLD FERRY RD Applicant Address: Phone: Insurance: 73 LUCIEN RD (860) 841-1625 WC BRISTOLCT06010 ISSUED ON:5/23/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS & ENTRY DOORS 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 5/23/2013 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Louis Hasbrouck—Building Commissioner