32C-232 (4) BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Numb6i. 045975
85 1948
7 Tr.no: 10212
LAWRENCE A B
PO BOX 1473
GREENFIELD, MA 0135)2
Commissioners
00-35,000 d enclosed space
WGL C.112 S.eol)
1A-Masonry only
1G•1&2 Family Homes
Failure to possess a current edition of the
Massachusetts State Building Code
Is cause for revocation of this license.
y
I ;!
DIG SAFE CALL CENTER: (888)344.7233
.�i STPAIIL
ri TRAVELERS One Tower Square, Hartford, Connecticut 061e3
BUSINESSOWNERS COVERAGE PART DECLARATIONS '
CONTRACTORS PAC POLICY NO.: I-680-4654A96A-TCT-06
ISSUE DATE: 12-21 -05
INSURING COMPANY:
THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT
POLICY PERIOD:
From 01 -28-06 to 01 -28-07 12 :01 A.M. Standard Time at your mailing address .
FORM OF BUSINESS : CORPORATION
COVERAGES AND LIMITS OF INSURANCE : Insurance applies only to an item for which a
"limit" or the word "included" is shown.
COMMERCIAL GENERAL LIABILITY COVERAGE
OCCURRENCE FORM LIMITS OF INSURANCE
General Aggregate (except Products-Completed Operations Limit ) $ 2,000,000
Products-Completed Operations Aggregate Limit $ 2,000,000
Personal and Advertising Injury Limit $ 1 ,000,000
Each Occurrence Limit $ 1 ,000,000
Damage to Premises Rented to You $ 300,000
Medical Payments Limit (any one person) $ 5,000
BUSINESSOWNERS PROPERTY COVERAGE
DEDUCTIBLE AMOUNT: Businessowners Property Coverage: $ 500 per occurrence.
Building Glass : $ 500 per occurrence.
BUSINESS INCOME/EXTRA EXPENSE LIMIT: Actual loss for 12 consecutive months
Period of Restoration-Time Period: Immediately
ADDITIONAL COVERAGE :
Fine Arts : $ 25,000
Other additional coverages apply and may be changed by an endorsement . Please
read the policy.
SPECIAL PROVISIONS:
COMMERCIAL GENERAL LIABILITY COVERAGE
IS SUBJECT TO A GENERAL AGGREGATE LIMIT
MP TO 01 02 05 (Page 1 of 02)
0'5324
VDAC
ZURICH WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
TYPE AR INFORMATION PAGE WC 00 00 01 ( A)
POLICY NUMBER: (6ZZU6-906X722-3-06)
RENEWAL OF (6ZZU6-906X722-3-05)
INSURER: AMERICAN ZURICH INSURANCE COMPANY
NCCI CO CODE: 80012
1.
INSURED: PRODUCER:
BEAUDOIN GROUP, INC A H RIST INS AGCY INC
PO BOX 1473 159 AVE A
GREENFIELD MA 01302-1473 PO BOX 391
TURNERS FALLS MA 01376
Insured is A CORPORATION
Other work places and identification numbers are shown in the schedule(s) attached.
2. The policy period is from 07-17-06 to 07-17-07 12:01 A.M. at the insured's mailing address.
3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers
Compensation Law of the state(s) listed here:
MA
B. 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: $ 100000 Each Accident
Bodily Injury by Disease: $ 500000 Policy Limit
Bodily Injury by Disease: $ 100000 Each Employee
C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here:
COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A
D. This policy includes these endorsements and schedules:
SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE
4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating
Plans. All required information is subject to verification and change by audit to be made ANNUALLY.
DATE OF ISSUE: 07-10-06 'CC ST ASSIGN: MA
OFFICE: ZURICH-ORLAN 809
PRODUCER: A H RIST INS AGCY INC 26LTL
_c3471
C
I of Nart4a mptan _ Z
�RSSRCh IiStttB
Y
DEPARTMENT OF BUILDI)j, INSPECTIONS /
INSPECTOR 212 Main Street • Municipal Building
North,uripton, MA 01060 ,
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 78OCNlR 108.3.4 to
act as iris/her construction sups. -':sor. 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
fi0 Q7t TO //rr
F 61if ,3 of �\To rfljullipjoll
A � f ?ic�aRrhacrlla• — =_
DEPARTMENT OP BUILDING INSPECTION'S
212 Alain Strcct Municipal }3uilding
NorthampLon, Mass. 01060
j
Nor 0lua IZ'S C O i\'fP EN S A TZO N [_N S UR1-N CF A I - A VI
(Ii cCnsxJpcTm�ttcx)
\%rILh a principal place of business/residencc at: / /� 3 G -2 c/ 7 3
D y
();honey-) �-7a - CU a o Z
tylst=/Z)'p) r--�y -7 7
do hereby cent --, under LhC.pP-ins and penalties of perjury; hzl
( I am an employer providing the follo%vinL %vorl:C�5 COI DCrlS�UO, cove age for in),
-etnplovecs worldng on this job:
d`z-Z /3 U s 9-0 2
l ('insure Conr._cy) (Pcbc-, Numbcr) (!,-pirdon i)2i--)
( } I art a sole proprietor, general contractor or homeowner (c cie one) aDd have hired
the con-actors listed below crbo h2ve the iollo%VlnQ workers coi oen-sauon pokier:
I -.
(i1am-, o; Co:lt:?!c-,Dr) (Insumnc: Col c)a,-i '/PoUCi N'ulh_Cr)
—
(Namc of Con tractor) (Lnsuzac Compaa�iPo!ie lancer) (��virilon D te)
(Name of Coanactd;) (Insurancc- Comp`a-o)•/POUC)- Numbzr) (Expirden Datc)
(N?-mc of Contractor) Gm uran= Comcauy/Pobcy Numb r) (E\pin60n DatL).
(eaaGh�c'�1 tuxz if accairt to c�cvt`irsftxm,.�on pctaizuas u.0 tact-�a:�) -
( ) I am a sole proprietor and bave no one worii3ng for me.
( ) I am.a home owner performing aB the work myself.
NOTE:pica be awtut fs, ,tJc ,bo c,,p j,7y pe-,om u do rtpQz-,a&-cz.d.c(1_;,of
aot Mort tb-c a Toe-tMfa to u.�I ch Lbe boa,., c r=d-,or Ca tbC gln6 tbC' LT DCK
amployca unc'.e the---kcez o=,r-- ca Act(GL15Za 1(5)�=;>p Gca.6cm try a bomnoavc far-bc=--.c or permit rty nidmoc tbe
IcvJ naau of a-a c=ployer under rho Workzea Coazpom it Ad
I uadcs d tha a oopy of thia mt®am m y be for-—ded to the pcp� Om—of in—r*om for th.
eovQx�;c verirecioo and that Uu m to tca='Covera:se tmdrt=C6 a 25A of MOL 152 na ltd to the L'=Pmoa of air i peaa =
oo=i5z ag of-rite or up to S i-moo-rtd/or of up to oue yezr eZd ci,11 p..-hia is tie form o(-Sup Work Orjcr`�a
fish or 5100.00 1 dry aPja•1 tnc,
For& —.t.-only -
j l Pcrmtt NumbcJ _�--
.tM Lot :
Sigv-tturr of Lic=scclPctmiucc �� -
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑0
Name of License Holder: C�r �m 2J-
/► License Number
Address 013 o 2-1 y'73 Expiration Date
natur Telephone o�� j�3 _ 7 7 _ C)a t1 'Z
Sea steredlommpa<rrementanraoto zit 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...... ❑
17 P twn.
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
7
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors 17-1
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding[0] Other[0]
Brief Description_of Proposed
Work:
Alteration of existing bedroom Yes�_No Aiding new bedroom Yes _No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
", xt;�
sa-� I eWNEG W-aan F-ia lore#o:exls#incrfia a om ►e��ie��o� �n rrig:
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
L 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 AGENTOR CONTRACTORAPPLIES FOR BUILDING PERMIT
as Owner of the subject
property
hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Own Date 16W as Owner/Authorized
Agent ereby 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/.�
07 6k V
Pri
Date
ure of Owner/Agent
Section 4. ING 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
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&payed
#of Parking Spaces
(volume&Location)
A. Has a Special Perm it/Vahanco/Rndi ng ever been issued for/on the site?
/T� DON7NOV YES NO 0 0
IF YES, date issued:,
IF YES: Was the permit recorded at the.Registry ofDeeds? '
��
NO �� DONTK0OVV 0 YES
IF YES:� entor Book Page/
and/or Document# /
�� ��
B. Does the site contain abrook, body of water orwetlands? NO K�J DONTKNOVV �~� YES «��
r+~
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs tmbmobtained �~�Obtained Date Issued:
x~~� �~� ' _ '
C. Dn any signs exist nn the property? YES K j
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES K 3 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,gradingexcavation,or filling)over 1 acre orini1 part cia common plan
that will disturb over 1acre? YES ���� NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
^
City of Northampton
Building Department �
f
a
212 Main Street
3r �4
Room 100
Northampton, MA 01060 e
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE.INFORMATION
1.1 Proaerty Address: 7fiis section to be completed byv lice
k'
t
�y 1Y P 1
Zones Oferiay t7istnct
�Efrn�tnD�stGrct. � ,` .z ,_:`` CBilisi
SECTION 2-+PROPERTY'OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
'2 ry
Telephone
Signature
2.2 Authorized Agent: P 05 C 7 S
Na a(P• ) Current Mailing Address:
/3 -- ��.� - U� D -Z
ignatur Telephone
SECTION 3--ESTIMATED CONSTRUCTION COSTS-
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building J?j- (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) Check Number ,
This Section For Official Use Only
,-Date _.
Building Permit Number. Issued:
Signature:
Building Commissioner/inspector of8uildings Date
File#BP-2007-0229
APPLICANT/CONTACT PERSON LAWRENCE A BEAUDOIN
ADDRESS/PHONE P O BOX 1473 GREENFIELD (413)772-0202()
PROPERTY LOCATION 15 HANCOCK ST
MAP 32C PARCEL 232 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REPLACE ROTTED SILLS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 045975
3 sets of Plans/Plot Plan
THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN�F 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 S eet Commission
Signature of Building 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.
ff� BP-2007-0229
CIS#: COMMONWEALTH OF#,!-KARL— 3zc-232 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2007-0229
Project# JS-2007-000348
Est. Cost: $5000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin: LAWRENCE A BEAUDOIN 045975
Lot Size(sq. ft.): 7013.16 Owner: GONZALEZ SOPHIE A&
Zoning. URC Applicant: LAWRENCE A BEAUDOIN
AT. 15 HANCOCK ST
Applicant Address: Phone: Insurance:
P O BOX 1473 (413) 772-0202 () WC
GREENFIELDMA01302-1473 ISSUED ON:813012006 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE ROTTED SILLS
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 8/30/2006 0:00:00 $50.002116
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo