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Structural&Civil Engineering NIGROSH REV DWG NO rleet@wildblue.net , 21 BATES STREET,NORTHAMPTON,MA SK-2 P.O.B. 881 WENDELL MA 01379 TEL/FAX: 978-544-800C 1 I -o 73 0 5 m 0 co H > 0 -1 < 0 m x 1 < < z > 1- m r- -< (1) 0 030 I () rZ • 0 m IV X NkN 1X1 -0 73 < 1-- 5 < M M-< x r- -o m 0< r -0 U) 0 Z H ul co m H 0 > 2 2 c) i > r- I> z r- r- - ,., 44';'' h'•N -< • Qv- co ....N•-•,•- • 4 -3 XI c\-- • -V 4,, x 0 e fo‘ to r. 41 10'1 i , 1\1 „i, DES BY RTL SCHEMATIC PLAN DVVN BY RR (1 „,..,- ,--r----",,,,,,.„1. • SCALE 1 ' i 3/16”=1 , Aii,••:, , ROOF BRACING DATE 06/17/13 ' r ;f,, '..,ii.,, , .... ;. , PROJECT NO. 13072 , NIGROSH REV ", „ Structural&Civil Engineering k DWG.NO deet@wildblue.net 21 BATES STREET, NORTHAMPTON,MA SK-1 P.O.B. 881 WENDELL MA 01379 TEL/FAX: 978-544-800L. 105/01/2013 08:27 FAX 1 413 283 2556 Crimmins Graveline 0]0001 ■ _ : °R°I CERTIFICATE OF LIABILITY INSURANCE /1/2/OD/VYYY) • 5/1/2013 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 "CONTACT Debra Grassetti NAME: Crimmins/Graveline Insurance Agency, Inc. PAN/OONNo Ertl: (413)283-8378 FAX NOC (413)283-Z556 1382 Main St. EMAIL ADDRESS: g d rassetti @cgins.com P 0 Box 905 INSURERISJ AFFORDING COVERAGE NAIC M Palmer MA 01069 INSURER A:Preferred Mutual Insurance 15024 INSURED INSURER B:Liberty Mutual Fire Ins.-ARWC 16586 Nathaniel Messier INSURERC: 11 Conant Street INSURER CI: INSURER E: I Palmer MA 01069 INSURER F: COVERAGES CERTIFICATE NUMBER:CL135100599 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 SUBR POLICY EFF POLICY EXP UNITS LTR TYPE OF INSURANCE INSR wvn POLICY NUMBER IMMIDD/YYYYI (MM/DD/YYYYI GENERAL LIABILITY EACH OCCURRENCE S 300,000 DAMAGE TO RENTED 1 COMMERCIAL GENERAL LIABILITY PREMISES(Es occurrence) S 100,000 A CLAIMS-MADE n OCCUR CPP0170586050 3/9/2013 3/9/2014 MED DIP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 300,000 GENERAL AGGREGATE $ 600,000 GE''L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 600,000 ( X POLICY PRO. "LOC S AUTOMOBILE UAB1I..ITY COMBINED SINGLE LIMIT(Es accident) $ ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTDS _ AUTOS NON-OWNED PROPERTY DAMAGE S � , HIRED AUTOS AUTOS (Per accident) _a S UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEO RETENTIONS , II ` S 3 WORKERS COMPENSATION [TORY LIMITS] I FR I AND EMPLOYERS'LIABILITY Y/N —=; ANY PROPRIETORIPARTNER/EXECUTIVE • EL.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N IA H38702 11/15/2012(11/15/2013 (Mandatory in NH) • WC531S36 11 E.L.DISEASE r-(=A EMPLOYEE' If yes,describe under To be issued by Carrier DESCRIPTION OF OPERATIONS below Y -E.L.DISEASE• iOLICY LIMIT:;• ,^, DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,B mom space is required) , f . , ■ t'1 1 CERTIFICATE HOLDER CANCELLATION (508) 790-6230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. Jack Raczkowski , 46 Babbleing Brook Centerville, MA 02632 AUTHORIZED REPRESENTATIVE I T Gravelin CPCU/DJG / ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. . . -S •..#+nn . The Commonwealth of Massachusetts Department of Industrial Accidents II + I= Office of Investigations -e'r�[� 600 Washington Street Boston,MA 02111 \� www.mass.gov/dia -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information J ^/ Cl /Please Print Legibly Name(Business/organization/individual): Nxi 3.an/C/ / less I L I /v i L Cc f4 ,6ni- Address: // (gin 0-if— Jr , City/State/Zip: Pa/mom t M A-- 0/64 1 Phone.#: 4i�3 - 336 ` '?6 3 ' 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.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These subcontractors have g. ❑Demolition M working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.t 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.ri Roof repairs insurance required.]t c. 152, §1(4),and we have no /13.X Other/ (404 4fiC0j employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. ■ T 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: L/ Lea-6 1111RC* �� Policy#or Self-ins.Lic.#: Y"/e.c3) 5 3883 $`j Oil 2 Expiration Date:-V/S/�3 Job Site Address: Al Bear., S'r= City/State/Zip:Norrifr i 11* • 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert• under epains and penalties of perjury that the information provided above is true and correct. Signature: Date: 7/c�&//' 3 _ Phone#: L1/3- 330 ^976 3 !!! Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other ,. . Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: /�'� Not Applicable `9J pplicable ❑ �,+ ,(� Name of License Holder: Nat'l 1-G( / Tessier C .5- 09i License Number / C c,c -f sr, R/mr, /'14- D;CGK S /`/x//$ Addre Expiration Date 4/i3 - 336 - 9763 Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ N. Pt Gofisr/uarioA /S J 6 Company Name Registration umber /1 Con zwr Sr , Pa/crr1 /`7'4- 3/06 9 -5-/ Y//5/ Address �,/ Expiration e Telephone /�`3 G-4.x3 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 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors l] Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[D] Other[ I] Brief Dej ript�ion Proposed /s Work: r> Kt 4n 14P149 v —vr !A Sala, pQ4t ( Plot eGT Alteration of existing bedroom Yes k No Adding new bedroom Yes X 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 I, `j n (._'( NA(44,0c(,f as Owner of the subject property ^/ /Vf , /V hereby authorize a-rh VI r{r I net f r 'e t to act on ehalf,( ' 'e s relative to work authorized by this building permit applic tion. � o)�i? /60 Signatu a of Owne Date I, Akcrileoel rt; I H&c's-1 er , 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 of perjury. NOCrh/WA iLt, ( ,/`i-{MS'S to Print Na • AZ'L 7/4(9/13 Signature of Owner/Agen Date 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 0 DONT KNOW ■ YES 0 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 Page, and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW (2) YES Q 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 Q 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: 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 Q NO • IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: ) Building Department Curb Cut/Driveway Permit Li 262013 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability DEPT o e',ii i5ii, wEP=cTioNS orthampton, MA 01060 Two Sets of Structural Plans NORTHAMPTON,MA•_�•: _ _ _587-1240 Fax 413-587-1272 Plot/Site Plans 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 I 3a-rts STS Map Lot Unit NorT owtrT&t 1 MA Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 O ner of Record: 1\91G✓�05 p ovzit-i_1zA r4 17b ) Name(Pri,e- Current Mailing Address. , Telep e Sign.iire � � ic ( Ts 3 7 ivt O`t 1 041°1° 2.2 Authorized Agent: Na-rhan,c 1 ticss(c( it Ca►na►�-�r �a I*/' �i� 0/(16q Name r ) Current Mailing Address: &/3) 330 - `/76 3 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 (� / �Lr 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2014-0095 APPLICANT/CONTACT PERSON NATHANIEL MESSIER ADDRESS/PHONE 11 CONANT ST PALMER (413)330-4763 PROPERTY LOCATION 21 BATES ST MAP 25A PARCEL 128 001 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 c�Fee Paid Z09/ V � Typeof Construction: ROOF REINFORCEMENT FOR SOLAR PROJECT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 91995 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOjA `TION 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 'tio Delay / Signature of Bui ing Of cial 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. 21 BATES ST BP-2014-0095 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25A- 128 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-2014-0095 Project# JS-2013-002027 Est. Cost: $2700.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: NATHANIEL MESSIER 91995 Lot Size(sq.ft.): 19209.96 Owner: NIGROSH BARRY J&ELLEN EMERSO NIGROSH Zoning:URB(100)/ Applicant: NATHANIEL MESSIER AT: 21 BATES ST Applicant Address: Phone: Insurance: 11 CONANT ST (413) 330-4763 WC PALMERMA01069 ISSUED ON:8/16/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:ROOF REINFORCEMENT FOR SOLAR PROJECT 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: 1 Final: Smoke: Final: 4 iVi 0 t Li THIS PERMIT MAY BE REVOKED.BY THE ITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REG ION Certificate of Occupancy // ' �F f Signature: al" h .io.t4vrw FeeType: Date Paid: Amount: Building 7/26/2013 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner