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32A-024 Kitchen Plan r l , i - i,_ ,-yJ N ' CiOsct .- ` 3%7,"z _ \\*--'-----1 ' 5/ -TALe. / J _ b Cap --z ,r I"9el • 1 ti 1 y_ 3"ve H Over 'i I ��_ WI Dkiv 2.4 rl r>>�e4 v�Ptl� I tea" ��,s. (I `fiyz 1 I A., ' jj �� LS ., d•.brt ex's i f1 izr, 60.$ 1 �j_r1 �1� 0 Ups+ /-\11 S 0 • EN1/4/ -t 6� Y SyZ, 8 2 �4 CGb ' 3a,. DDwnska,,,zs 6x153,y\ - mare }vb ,rove 49..-4' 5/ 3 " ��vJ -f 15(si �w-u, u r - 9 a f r `15`011 t% rte t 5' a Client#: 18092 MILLR3 ACORDTM CERTIFICATE OF LIABILITY INSURANCE 07/31/2013�Y) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION King &Cushman, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR King &Finn Streets ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 447 Northampton, MA 01061 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: First Financial Insurance Compa Mill River Co. INSURER B: 15 Willow St. INSURER C: Florence, MA 01062 INSURER D: 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 SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I AD TYPE OF INSURANCE POLICY NUMBER POLICY(MM/DD/YYE POLICY DATE(MM DD/YYIN LTR NSRC LIMITS LTR RD A GENERAL LIABILITY 241 F000400 10/30/12 10/30/13 EACH OCCURRENCE $500,000 DAMAGE RENTED COMMERCIAL GENERAL LIABILITY PREM SESO(Ea occurrence) $50,000 CLAIMS MADE OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $500,000 GENERAL AGGREGATE $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000 PRO- -1 POLICY r7 JECT fl LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) - ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 71 OCCUR CLAIMS MADE AGGREGATE $ __ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- ER TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Northampton Building Dept. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1(1 DAYS WRITTEN Northampton, MA 01060 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED� ' y- REPRESENTATIVE TIVE ACORD 25(2001/08)1 of 2 #S13146/M13145 SMF O ACORD CORPORATION 1988 . . , City of Northampton -'' Massachusetts 4 e.e., aaE Ur, ;w k �.'?j, j DEPARTMENT OF BUILDING INSPECTIONS : ` { "+ - 212 Main Street • Municipal Building rJ� c... ,Ar �mNorthampton, MA 01060 'i S. 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 the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, 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 Address of work location • . . . The Commonwealth of Massachusetts , . Department of Industrial Accidents 71` l Office of Investigations °` 600 Washington Street 111000 A r Boston, MA 02111 WWW.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information u Please Print Legibly Name (Business/Organization/Individual): r I hie..N v I- bu t-•e U _ Address: IC 3 C \ c,S-r tJ 0i0(c--- City/State/Zip: Fl v it A. 1 ,, t /0 Phone #: `I 1 3 .-c5 V Ks---G, (A Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. n I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7.NISI Remodeling These sub-contractors have ship and have no employees 8. [' Demolition working for me in any capacity. employees and have workers' 9. n Building addition [No workers' comp. insurance comp. insurance.t required.] 5. n 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.❑ 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' 13.0 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. 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: 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un i' r th' pains an' i. •naltie ,f perjury that the information provided above is true and correct. 4 Si• attire: ''- '' Date: /�3 Phone#: --- —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#: • . SECTION 8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable (fl / Name of License Holder: M b it IA J • 1W1-001 ., Y/ tJ (Q License N mber E3 cvkc ST�uT, S , rt i ce MA 3 7/1 Address Expiration Date Signature 17 T phone 9'.Registered a Improve rit Contractor , M ..... 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 ❑ 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 f • • s SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing n Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [D]- Decks [D Siding[ID] Other[El] Brief Description of Proposed / Work: /L rc Rkx7H i( i t..eL96"CS// ITFi- =7 /U -s Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes ---k° No Plans Attached Roll -Sheet sa If New house-and'or'add ition 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 1 0 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basemen r cellar floor below finished grade k. Will building con rm 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 C,� L.�.•.tt r�5`�' 2ea 3 '1 A-, 4i• /1r,„5 ao''�v`'^ /4 as Owner of the subject property -T- hereby authorize / eaei �/ .Dv c0 to act on my behalf, in all matters relative to work authorized by this building permit application. !/ 7x31/)3 Signature of Owner D e -17-A-( /4/e-/k V c3 f® , 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 f perjury. Print Name L 7' Signa ure of Owner/Agent / Date 1 Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information y ' • Existing Proposed Required by'Zoning This column to be filled in by Building Department z Lot Si�. !....�____ _ I v — ..__" i Frontage Setbacks Front 1----1 - Side L:L- R: L:;._—_-3 R 4 i Rear Building Height 1 1 I Bldg. Square Footage 1'--1 i % 1-- 1 -- Open Space Footage (Lot area minus bldg&paved l I 1 I parking) #of Parking Spaces F l s Fill: y 1 f (volume&Location) =—A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW 0 YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book i Pagel 1 and /or Document#1 i B. Does the site contain a brook, body of water or wetlands? NO 0 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: 1 C. Do any signs exist on the property? YES 0 NO ep IF YES, describe size, type and location: 1 D. Are there any proposed changes to or additions of signs intended for the property? YES l 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 0' IF YES,then a Northampton Storm Water Management Permit from the DPW is required. P- , . Department use only j�., .�� ..--- -- `} pity of Northampton Status'-of Permit j i uilding Department Curb Cut/Driveway Permit"... 11 j JUL 3 1 2013 1 1 212 Main Street Sewer/Septic Availability" "---.. { Room 100 Water/Well Availability .t;W) ham ton MA 01060 Two Sets of Structural!Plans L ' .;: Electric, i- i-i L ,6,v ..e p tvc l'.011i• = _ 87-1240 Fax 413-587-1272 Plot/Site Plans ,4-4 " t y 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 /!J C/`+'6—/C�y s 7 Map Lot • Unit , No Q, 7-7-/Aft/'t-4/'D TO/v'1 /2,,i/1 Zone Overlay District EIm St District CB District „ - SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED ` _ . _AGENT .<_ 2.1 Owner of Record: Peil;5 e 7114X-cif)r-) /�^i<s-te e OOJ72Lc,r� ,,, A ;,/ S p,,, ,7' Sl-.G' Tf...01 f2 t4, 4tie„1)1 r A/orfih<, f,to,- /OA `liOOO Name(Pri Current Mailin Address: r 3 3 2r�- 2.�S / +^ 'iJ 2 ��jd'' Telephone II// Signature 2.2 Authorized Agent: / fl 4/Z/4 ,,,%, Dr>i-=cG U •-- l c"-2 Cf' S r/JC i- ” s '- Name(Print Current Mailing Address:_V., re; i g I y c."-- -.• a" ,)'-'-' ..S—Le (.(;.' Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be r Official Use Only .. ! - completed by permit applicant , _ 1. Building 00 (a)Building Permit fee 2. Electrical C, ` v (b)Estimated Total Cost of - •_ _ Construction from(6) - 3. Plumbing `_ 5?--,0 0 t 0,b Building Permit Fee - - 4. Mechanical(HVAC) , -. 5. Fire Protection p� 6. Total=(1 +2+3+4+5) 1 Check Number - This Section For Official Use Only - , Date Building Permit Numbe - _d. Signature , �..r f _ Building Commissioner/Inspector of Buildings_ Date (./, ,2E/2 /Oa 0.°4 18 CHERRY ST BP-2014-0106 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:32A-024 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-2014-0106 Project# JS-2014-000207 Est. Cost: $26300.00 Fee: $157.80 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MARIA J DUFOUR 84569 Lot Size(sg. ft.): 3310.56 Owner: KAHN DANIELLE J&DENISE A MCKAY Zoning:URC(100)/ Applicant: MARIA J DUFOUR AT: 18 CHERRY ST Applicant Address: Phone: Insurance: 183 CHESTNUT ST (413) 588-8566 FLORNCEMA01062 ISSUED ON:7/31/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:REMODEL 2 BATHROOMS & KITCHEN 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 7/31/2013 0:00:00 $157.80 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner