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30B-073 (4) 1 1 I ssiAcHusErrs Board di Building RegLo.iti w DRIVE ( ,,n,1$1.1,11.0, ‘,011(1,, ,w: ift -A4-,:"g:,..k.44*...:',-•, 'Tr' ,,, CS-05287 0 alkit c, ..., - ,: t■'- 15,4, %tem) 44 MAW , '4 t. :afli'h, "'': ." 5''z' NONE S89358928 KERRY A FOURNIER „, 4'44" ,,—M.—1 , ,t6f.4b4.,i',t"AA, , 72 fIADLEY ST ',.. 414 ., i` . ..."--11F:-:: ' , 01''',: 4, ' 05-IA61 -..*114,,,,,, .- „, .,._,:„,...,.,, 7 SO HADLEY MA U1075 '.., 171. . *INRER 72..„ 05112/2015 e 72 HAMEY ST S HADLEY,MA 01075407 I, L.4.f.,,..,.-.....„.„., e(517/t 67 / -_ , 0 )404z/a 0, tyletz6.1.6zcolueoei6 1--T_-, - Office of Consumer Affairs and gusiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 ,,, Home Improvement Contractor Registration Registration. 171789 Type: Individual Expiration: 4/24/2014 Tr# 224194 KERRY FOURNIER KERRY FOURNIER 72 HADLEY ST — .. SOUTH HADLEY, MA 01075 Update Address and return card.Mark reason for change. Address Renewal r- Employment — Lost Card 14,,-CAI (,) va.i.o.1,-)4 Ecei216 /e#, l'e,,eirk.sie f v.'s/1 , ei, li,,s. ,/,,,,wve., • Office of Consumer Affairs& Ihfsiness Regulation License orxr,egiStrlion valid for individul use only before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration: 171789 Type: 10 Park Plaza-Suite 5170 Expiration: 4/24/2014 Individual Boston,MA 02116 ' - KERRY FOURNIER -,- , 4 r KERRY FOURNIER 72 HADLEY ST ,..,' : .e....--,,,,-9,....6,, __ ' _.... SOUTH HADLEY, MA 01075 U ..ndersecretary Not valid it6out signature • -OW ACo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 41...------- 06/12/2013 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 NAME: Metras Insurance Agency, Inc. PHONN.FXt1: (413) 536-1491 A/C No): (413) 532-8522 2030 Memorial Drive E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Chicopee MA 01020- INSURERA:Travelers Indemnity Insurance INSURED Kerry Fournier dba Fournier Building INSURER B: 72 HADLEY STREET INSURERC: INSURER D: INSURER E: SOUTH HADLEY MA 01075- INSURERF: 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/OD/YYYY) LIMITS A GENERAL LIABILITY 1680001C067701-IND-12 07/11/2013 07/11/2014 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY / / / / DAMAGE TO RENTED PREMISES(Ea occurrence) $ 300,000 CLAIMS-MADE X OCCUR / / / / MED EXP(Any one person) $ 10,000 / / / / PERSONAL 8 ADV INJURY $ 1,000,000 / / / / GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: / / / / PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- / / / / .IFCT LOC $ AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO / / / / BODILY INJURY(Per person) $ ALL OWNED SCHEDULED / / / / BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED / / / / PROPERTY DAMAGE $ AUTOS (Per accident) _ / / / / $ UMBRELLA LIAB _ OCCUR / / / / EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE / / / / AGGREGATE $ DED RETENTION$ / / / / $ WORKERS COMPENSATION / / / / WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS - ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N / / / / E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A / / / / (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below / / / / E.L.DISEASE-POLICY LIMIT $ / / / / / / / / DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) 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. Evidence of Insurance AUTHORIZED REPRESENTATIVE 8v'uc&p /91,q/ uett' ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD 10... • , 0 o w 2 0' V C' C 11 a- PO 3 :_. s. _ -±- ...< v i 0 • T 2 v 0 S b t 7zi tfl 0_ a- a a 1 c)___, __, › _t. 7__ T. 1.__ _._... ,. • ii . ki J , Ibli4 1 Q +7 W , c....:-1:: _ 411111k .4: '; o• Y- ..-0,c1, w c. . I,) Li ,...., ft 0- 7t1, _ 0) o (... --D -Z._ ilk ,-ci tri Q PA 0 r L\ N PJ . ` e.":. •r 1 o x t D 9-) c r- R r 0 tr 1 5 7. tb i d c. cr i 6. 1 I! r r) ,..,,, \ -' Nb X d CD ;C) . 77"111111111111111111111111111111111111111.1111' / S N .,_, p r_ x r 7-----7\ w -6 E o _ l b �d 9- b E I --1 -_,,--- __-' t,' 1 ? 11•11111■.. -mob \.. irgio.............0, _ b � 1 a 1 4 1 1 •■••°. 1 1 7--- A .. C , , ____ Iwo Q ,_ 7 cT ‘.\\ ,-, r ..„:_______ ;_.. �►�e V,ICA .60 '\ - 13 THIS PLAT NOT FOR RECORDING PURPOSES 3k. 13 474, } ,Z G / B1 .lo32) PG, 130 2 c:#9.9 9,0 Lit Lars 2 fi 3 CC 14 Q W � 1— v #/34 (2 ...r. r qA- /2$.4- ra,' Soui cE c hit' Mo2TGAGt°spt?RVtccES CARP, $rFIRS-r. AMERtcAN `r1TrLE tNS • Go. t HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES,AND BASED ON EXISTING MONUMENTATION,ALL EASEMENTS,ENCROACHMENTS AND BUILDINGS ARE LOCATED ON THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT UNES. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED IN A FLOOD PRONE AREA AS SHOWN ON FEDERAL INSURANCE MAPS FOR COMMUNITY NUMBER Z S 0 t C+1 DATED: _5 -9C, NOTE i THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY AND DOES SURVEYOR: er s.. . NOT CONSTITUTE A PROPERTY SURVEY. MORTGAGE LOAN INSPECTION PLAT OF RICHARD !�d R,T H A lit P To N , MASS J. vt N ER LABAR�S /' I ST. of RuTH Gr. $ La-r`'oN z e=�ea ., a `*#a SCA Le, t"r: 3 a' Richard J.LaBarge,Sc.,Registered Professional Land Surveyor 110 hang Street,Northampton, Massachusetts 01060 The Commonwealth of Massachusetts Department of Industrial Accidents �;. a. Office of Investigations , ttir �= 600 Washington Street „ :"J,z," Boston, MA 02111 .+r Me www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): (1('V ; e-r- _ Address: `? ;-- (4iNiC ,5., City/State/Zip: _ , w_ , i, k A-Phone #: /t 3 (o S-? d'6 D Are you an employer? Check the appropriate bo '. 1 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.K I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. n Building addition [No workers' comp. insurance comp. insurance. required.] 5. 7 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0.9ther P,2t y,�2 comp. insurance required.] U *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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u de the pains and penalties of perjury that the information provided above is true and correct. Signature: .-- Date: /0/ T Phone#: /3 (0C el e'630 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 p❑ Name of License Holder: k4'r_y FLO()r h Q_c D ? O O ( License Num er Address 7 !-C7rd �S j S o t 4-6v) � ��l( - c�I O S 5 Ex p iratio Date V ( 6 S e e(o U D Sig ature Telephone 9:Registered Hots} Iriiproven�ent Coi ractor:`. r., " .. Not Applicable ❑ • er Or • Ka orn, l7/ 7 ( Company Name Registration Number Le) cue_ y/a�' i Address Expirat on Dat Telephone SO--4-)-\..e._ 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 X No ❑ ;,„ 7t 1 i emwnertAertin 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 El Addition ❑ Replacement Windows Alteration(s) 0 Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [C7] Decks [p Siding[0] Other[co .. •#4 _All _ r Brief Description of Proposed _ ,(� 1 ‘1.-- d-4 ,Work: 1 S c i.�t.� I n�c. r Q-f ti c Alteration of existing bedroom Yes No Adding new bedroom Yes o Attached Narrative Renovating unfinished basement Yes .✓14o Plans Attached Roll -Sheet 6a.If New house and or addition to existing housing complete the following: S a, Use of building : One Family Two Family Other /r� tn.. y/rl el 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 tilJ DI)cite,y, -u t e (PdA i. Is construction within 100 ft of wetlands? Yes No. Is construction within 100 yr. floodplain Yes !/10 j. Depth of basement or cellar floor below finished grade V° 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, ViEk )OA) 1 l"1 //r/ , as Owner of the subject property hereby authorize P.f"r •v' �-t;�.'(`(\;,,t',x" to act on my behalf, in all matters kelative to work authorized by this building permit application. Signature of Owner Date I, 'ke.„4--f- Li 1----0\.,r A i e , 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. K{fr i (=ot-1A;Q.r Print Nam 2�,-. 9-eSUA'vs-&—, (� t )-013 Signature of Owner/Agent 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 ���j( � Building Department Lot Size P ,)(.2't)'' l Frontage .tY- Setbacks Front [17614 7 1 Side L:L....____: R:---_._.._. L.1 ad R.,__ Rear Building Height Bldg.Square Footage ; % ' _ Open Space Footage (Lot area minus bldg&paved i j t. ... .___s parking) #of Parking Spaces L____1 1 r Fill: (volume&Location) -,---1 A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO er DON'T KNOW 0 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 Or. DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained I Obtained Date Issued: C. Do any signs exist on the property? YES 0 NO OV 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 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 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. r— ,`, fi�'."„r✓ s Dp,_rt __ , .s ks� <k atr fi t ity of Northampton Sta`f-s f t' 1 uilding Department Cur)a Gutll)nvevv,y �, 1. ' OCT 1 h , Li �l 2013 ; 212 Main Street SeerlSecia ti �/ Room 100 1lUatef/V1fe11Ava�btli��`' N rthampton, MA 01060woctsf5# cfatn� , Electriclo/harhp1on, r A 1t Q -587-1240 Fax 413-587-1272 Plot/ tte Tans x , may ' 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 <3 7 1l l°Ile T S i Map Lot Unit Zone Overlay Distnct 1U r-i-/iN u,,,p f (MA Elm St.District "CE District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Val n CA 13c/ Rivers, a.2- br, /Op r-4-44,4110t°n Name(Print) Current ailing Address: 171/3 Telephone- Signature 2.2 Authorized Agent: r-u tt l-n ;�� I e St, .3-'01 /Ad ley ()I/)- O/07.5 Name(Pri t) Current Mailing AFess: •11" IA A_ rIIIIAt Ili/3 Signature Telephone SECTION 3-ESTI ATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building S 9.0 (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) ) 9 O.9 , - Check Number /CI.7 f 5 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Data `� 4- File#BP-2014-0418 to fJt'U APPLICANT/CONTACT PERSON KERRY FOURNIER ADDRESS/PHONE 72 HADLEY ST SOUTH HADLEY (413)658-8600 PROPERTY LOCATION 134 RIVERSIDE DR MAP 30B PARCEL 073 001 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 /� Fee Paid /(J sti Typeof Construction: CONSTRUCT 12 X 24 PERGALA New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 52870 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQRMATION 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 Demolition R elay Signature of 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. 134 RIVERSIDE DR BP-2014-0418 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30B-073 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: shed BUILDING PERMIT Permit# BP-2014-0418 Project# JS-2014-000711 Est.Cost: $3900.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: KERRY FOURNIER 52870 Lot Size(sq.ft.): 22389.84 Owner: MCKITRICK MARY C&VERNON H FATH Zoning:URB(100)/ Applicant: KERRY FOURNIER AT: 134 RIVERSIDE DR Applicant Address: Phone: Insurance: 72 HADLEY ST (413) 658-8600 SOUTH HADLEYMA01075 ISSUED ON:10/16/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 12 X 24 PERGALA 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 10/16/2013 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner