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23A-021 (2) AL 10Peerless �lnsurance. Mcmbcr of Ubcny Mutual Group FECTIVE DATE: 10/26/2012 Policy Number: CBP 1005077 Prior Policy: 1005077 Billing Type: DIRECT BILL Coverage Is Provided In PEERLESS INDEMNITY INSURANCE COMPANY Named Insured and Mailing Address: Agent: JOHN MARCUS WESTMASS PROFESSIONAL INS LLC 123 SHAWINIGAN DR 35 CENTER ST LUDLOW MA 01056 CHICOPEE MA 01013-2692 Agent Code: 6201203 Agent Phone: (413)-592-4316 COMMON POLICY DECLARATIONS In return for the payment of premium, and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. POLICY PERIOD: From : 10/26/2012 To: 10/26/2013 at 12:01 AM Standard Time at your mailing address shown above. FORM OF BUSINESS: INDIVIDUAL BUSINESS DESCRIPTION: HOME IMPROVEMENT CONTRACTOR This policy consists of the following coverage parts for which a premium is indicated.This premium may be subject to adjustment. PREMIUM Commercial Property Coverage Part $ 242. 00 Equipment Breakdown Coverage Part INCLUDED Commercial General Liability Coverage Part INCLUDED Total Premium for all Liability Coverage Parts $ 1 , 707. 00 Terrorism Risk Insurance Act of 2002 and 2005 Coverage $ 40. 00 Total Policy Premium $ 1 , 989. 00 FORMS AND ENDORSEMENTS Forms and Endorsements made a part of this policy at time of issue: Applicable Forms and Endorsements are omitted if shown in specific Coverage Part/Coverage Form Declarations Form Number Description IL0003 -0907 CALCULATION OF PREMIUM IL0017 - 1198 COMMON POLICY CONDITIONS IL0952 -0108 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM CG2170 -0108 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM 17-57(06/94) INSURED COPY In»aII)n1l) 1nns(177 NPCRSnP 9onA P!_r)hAnrnr1 I'MAGn PRAFPPN nnn.)7ArQ Paae 17 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: �!-fr1 /' /I10472 c u'j e 117 7 7 License;7- r �2 5i.�✓r.✓ G ✓ �.c i r/r:� Lc �c� 0;70 Address Expiratidh Date Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Num er Address !! Expir ion D e TelephoneW3 ,5&,3 J WE 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 s SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House F_� Addition Replacement Windows Alteration(s) Roofing EJ Or Doors M 1 0 Accessory Bldg. ❑ Demolition New Signs [0] Decks [Q Siding[O] Other[EA Brief Descri ion of Proposed ((( Work: c�hau�t�z. w7 e `t GI/.�- 1,511fj_,74�r/�_ 7/t'i�r .¢r�/� , Alteration of existing bedroom Yes T No Adding new bedroom Yes N 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, '?' d(//-a� 7 z as Owner of the subject property hereby authorize to act on my ehalf, in II matters relative to work authorized by this building permit applica' n. ignatur Owner Date 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. f U Print Name r � � 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 ® DONT KNOW ® YES IF YES, dat((e issued: IF YES: Was the permit recorded at the Registry of Deeds? NO F DONT KNOW © YES IF YES: er Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW ® YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , 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: 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 ® NO a IF YES,then a Northampton Storm Water Management Permit from the DPW is required. s Department use only ty of Northampton Status of Permit: ilding Department Curb Cut/Driveway Permit 12 Main Street Sewer/Septic Availability iJ Room 100 Water/Well Availability Uas In 18 ampton, MA 01060 Two Sets of Structural Plans clectri Pirmbt�- 7-1240 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 17 ��X A S 71t Map Lot Unit y� r /144 616� � Zone Overlay District r Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: S C i 7 0`7i Name(P Current Mailing Address: Telephone Signature 2.2 Authorized Aaent: To ° / e - / 51� /i�rr`G ✓ '. �td��d�� f�1 Name Print)°• Current Mailing Address: roz S 6Z; s Signature Telephone SECTION 3-iSTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building �y �S (a)Building Permit Fee 2. Electrical C� (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee U 4. Mechanical(HVAC) �V 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number L/ G� 4-1 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2014-0781 APPLICANT/CONTACT PERSON JOHN MARCUS ADDRESS/PHONE 123 SHAWINIGAN DR LUDLOW (413)563-5999 PROPERTY LOCATION 17 PARK ST MAP 23A PARCEL 021 001 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 �/y' O � Fee Paid rr Typeof Construction: REMODEL FRONT ENTRYWAY New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 099777 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO 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 De mot ' Delay Signa re 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. 17 PARK ST BP-2014-0781 GIs#: COMMONWEALTH OF MASSACHUSETTS MU:Block: 23A-021 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-2014-0781 Project# JS-2014-001334 Est. Cost: $8950.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JOHN MARCUS 099777 Lot Size(sq. ft.): 7187.40 Owner: QUIGLEY STEPHAN&KATHY Zoning:URB(100)/ Applicant: JOHN MARCUS AT. 17 PARK ST Applicant Address: Phone: Insurance: 123 SHANINIGAN DR (413) 563-5999 LUDLOWMA01056 ISSUED 0N:T1812014 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMODEL FRONT ENTRYWAY 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 1/8/2014 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner