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" m op n I:T1 to (A D im (AEI )J.13 TI 71 R� �.'�e CLiij of pot-thump ton 1- Sit V•'i � _MR36AC{InLrf(o DEPARTMENT 01' DUILDrlG INSPECTIONS 212 Main Street • Municipal Building; Northampton, Mass. 01060 «'O12IQ 1Z'S COMPENSATION INSURANCE AIYl'LIMVIT I ��► V-t r 1 ge (li ccnsIperrni ttec) with a principal place of business/residence at: 317 ,ref 1 6_ '710— none:- I/(> -SrV (scrc deity/natcrzlp) do hereby certify, under the pains and penalties of perjury, that ( ) I am an employer providing the following worker's coinncns:aJo:: coverm^e for Ind' employees worlong on tins job. (Insurm Company) (Policy Ntn or) (rMir aon Duly) ( ) I am a sole proprietor, general contractor or homeowner (circe one) aald have hued the contractors Ilsted below who hzve the following worker's comaensadon policies: (Name of COnrncror) (lnRJranG COII1pinyt?cLic ' I)itc) (Name of Contractor) (Insurance ComoanviPo!i )' Number) (Ey-oiratlon Date) (Name of Contractor) (Insuranc: Company/Policy Ntimbx_r) (Expindoo Date) (Name of Contractor) (nsuran Compatry/Policy Numbs) (E.vpu-2tioo Da ..) (attxcrt�.d-!icoc:al c'R-Q tl❑c^cv.ry to rndu.d-infocrni_i oc pain tiu,c to ail occarcas.of-1) ( ) Ian a sole proprietor and have no one working for me. ( ) I am.a home owner performing all the work myself. NOTE. [t,,.‘,;._Jc txoarouvcn'abo employ pjzoru to 63 c-_a_o_Tca-a;c, rc--ta woric oo a d",-1-1-13F,of o x EDOCt Lan Lbro: the bo:noouvcr rro da a oa the ro waits zip ,rn r tbcro trr o-t ecx :Uy ocrsc'..-rcd to b c;r loycs uoc.c (Ix..aid ccl c•;ica Ao(GL152.ss1(5)},npplir,tion try a homco,acr fc r t :.._a lx-/nut m_y idzx t:x IepJ rtn.t3u of to ca. Ioyoo under rho Wor{cole Coonpoo..' j rid I undk^rtand tut a Dopy of this a>t may bo focwnr<ted to rho Doc a of 1 grid Modm,tj OU oo of l'""-°°o for thn oovm.sc vtn6c4roo mad that f`iitat to sccurt covcia c under soction 25A of IdOL 151 can Icd to Ih.:u�-rxuitioc of criminal ixo-+Bien 000iutz-rs of a fine of trp to S 1_500.00 and'or 3.«. --n.of up to one year rid a\il pavlLo o thc fcxut of a Stop Work Order and e (im o(S 100.00 thy R ptinA roc // 7 6( +�1 �J For S LV�I u,c only ----__ _ 1/4a Ntilt p;; Lot Signature of Lica>_sc il'crmittcc 1T��e AUG-07-2012 14:38 AIM HOLYOKE 1 413 535 5001 P.01/01 • ' WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Industries of Massachusetts Mutual Insurance Company 54 Third Avenue,Burlington,Massachusetts 01803 (800)876-2765 NCCI NO 26158 POLICY NO. WMZ 8006547012012 PRIOR NO, NEW BUSINESS ITEM 1. The insured Oliver Iselin III Mail Address: 36 Service Center Road#202 Northampton MA 01060 Street No. Town or City County State Zip Code FEIN xxxxx9526 ®Individual ❑Partnership ❑Corporation ❑Joint Venture ❑Association ❑Other Other workplaces not shown above: 2. The policy period is from 07/01/2012 to 07/01/2013 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the states listed here; MA 8. Employers Liability Insurance:Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident$ 500,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 500,000 each employee C. Other States Insurance:Coverage Replaced By Endorsement WC 20 03 06A D. This policy includes these endorsements and schedules:SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications,Rates and Rating plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTRA 370700 SEE EXTENSION OF INFORMATION PAGE Minimum premium$ 500.00 Total Estimated Annual Premium $ 550.00 As indicated interim adjustments of premium shall be made: Deposit Premium $ 553.00 ® Annually ❑ Semi Annually ❑ Quarterly ❑ Monthly MA Assessment Chg. $301.65 x 4.2000% $3.00 This policy,including all endorsements,is hereby countersigned by _ 08107/2012 Authorized Signature Date GOV GOV KIND PLACING ' CLAIM NAME ' SAFETY Webber&Grinnell Insurance STATE CLASS AUDIT OFFICE OFFICE CHECK GROUP Agency MA 5645 7 802 1 8 North King Street Suite#1 , Northampton,MA 01060 WC000001 A(7-11) Includes copyrighted maternal of the National Council on Compensation Insurance, used with its permission. TOTAL P.01 1 Licensed Construction Supervisor: 0) Not Applicable El of License Holder: l ve.r' i Se 7 11_, .79Q7 '{\� License Number 2 to 1,e,J . C t CC.l.t.+�..r y.--, , I w`. --�-o n . tJ — I3 Address Expiration Date _-____, sTki - /2-l'i Signature Telephone �_3 Cx �E r �� aa.ae��l� � . .� �t v � �'a �a �� , gia � � � � � � � Not Applicable ❑ fay /0 sc Company Name Registration Number Address Expiration Date Telephone Y; '4 r t , I x,, :, f a •; s ,v,,,,,,!,;;4,,, ra y , ., b x _ s . „ . n=I : ' ,,, 1 F . 4 aa�r 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 113 7 No ❑ 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. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF 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 DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO ✓ DON'T KNOW YES 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: ,, sz... = 0 , , ,wa ,. .t7%. .., to ,.4,,2. 7u . ,,hrx ,.tea: / New House ❑ Addition ❑ Replacement Windows Alteration(s) l3 Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: iZ?pt 6 02-- ,-'d owl 0 c.r,.t do c , 20%Id ne,,° ,y-1.vi v q.R.- Alteration of existing bedroom Yes 1."---No Adding new bedroom Yes V No Attached Narrative❑ Renovating unfinished basement Yes ✓No. Plans Attached Roll❑- Sheet t� ‘5 ''''7','-'. >t �,.: J .x ta�{'�„,=,:.:' »n.,, �-..,'a £ t, ...�,��` �,��.i „aad m4� �. �k. 1.1.=<: mom., ... ... .. ,. �. 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. Mascheck Energy Compliance form attached? . 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 liy ;wi :.: E'`vy�`l` d .d ' Yea 43 v+, t, t ° -,� s i �� 6 ial k. 6 �e 3,6 � � i . Pe tea n J ✓Q ,it{ 1, � , as Owner of the subject property 1 lo hereby authorize �''r Sz ”" to act on my b , ' I ..a...tte2n. relative to work authorized by this building permitfpplication. it-, ." Z)3)J Signature of Owner Date 1 I01a' i Q V I . ''"� , 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 t pains and penalties of perjury. 4 Print Name G-%'9G Signature of Owner/Agent D 1,()2,53/J o . ' r-.�._.. _ _ C ty of Northampton � ,. B i(din Department �' ,��; ' �� � .�� � JUN 5 20(3 212 Main Street � : ',- � Room 100 �� DEPT.OF BUILDING INSPECTIONS No thampton, MA 01060 r „„� ` ` NORTHAMPTON, A 01060 • - - 587-1240 Fax 413.587-1272 x APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING T 1 ,h Ni;;iii ,... �' }}`t . . ,t41. 4 Z,1 Property Address: 1 ` ii< a ,q e � � t Si0 g' 't 4.4tr.t4e.'4,‘f4„ / el‘A'''JL :14':',-,:fi'''''f(34AtlYitt.■^;,ir.,6`,4";,,,,:4,015!‘,:14,,,,IA,,-;t?tki;',30-fiA.:Irii,SkV.,4,. -k,.,;,4.,,,,,,' ,, .1 2. ,mr , s� w / let';,;.' F r g,4 C �` ' M$; xa it 2.1 Owner of Record: ,...r , ,, k .,&__. ,.), is,Ltr ,t,c_.0.-- (IP/ /,);YN ier L-e_r_r.•I 1°-.- Nam: (Prin• Current Mailing Address: 1.,s-7_,_ 5�33,_ Telephone oignature 2.2 Author'aed Agent: r✓, c4— C c a 7` �l Q /``t-iv' � r e ti,.S Name(Print) ,, Current Mailing Address: 44 ____ ,f ' ( 2Z�(el Signature Telephone ,� T-A ': s 0 .. 2 Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant i. Building 7 (°).8 Irtg Purl+t Fee (b) sI t 1rr'1; a�ed Tct �of 2. Electrical r ..r7'6°,.m ,Ccstit ructiohi7,6k ': 3. Plumbing Building Permit Fee ro 4. Mechanical (HVAC) 5. Fire Protection 6 Total (1 + 2+ 3 +4+ 5) /,S- ©�`1 check ;r"4rhber ---f 4 4h , ,. t, ?` ` J r"r.t'liZtav 6' •, � �� rOfhctal IJ',-",'`3ttly f ��re� xtauY 1. & oto�� ,> � >ji ,, _....r -eats „ File#BP-2013-1167 APPLICANT/CONTACT PERSON OLIVER ISELIN ADDRESS/PHONE 36 Service Center NORTHAMPTON (413)584-1224 PROPERTY LOCATION 81 WINTERBERRY LN MAP 36 PARCEL 221 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out n/ l( Fee Paid OC(�1`Z gD Typeof Construction: INSTALL REPLACEMENT WINDOWS/DOORS&NEW STORAGE ROOM IN GARAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 039073 3 sets of Plans/Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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 �e��o ' ' Delay Ieddi /3 I°nture o 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. 81 WINTERBERRY LN BP-2013-1167 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36-221 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2013-1167 Project# JS-2013-001908 Est. Cost: $15000.00 Fee: $90.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: OLIVER ISELIN 039073 Lot Size(sq.ft.): 94525.20 Owner: GARRETSON ADAM D&STEPHANIE D SILVERMAN Zoning: Applicant: OLIVER ISELIN AT: 81 WINTERBERRY LN Applicant Address: Phone: Insurance: 36 Service Center (413) 584-1224 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:6/7/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS/DOORS & NEW STORAGE ROOM IN GARAGE 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 6/7/2013 0:00:00 $90.00 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Louis Hasbrouck—Building Commissioner