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I>> zoo o r I I I v�C �•�morn NO Dm c ' (n n m oD +z ?tm 0 N A z I i I �n W \ �m N O �� m zlnm om A n I i I �Dr =oo m n ODZ oo m3- > �o D = I m N D m m _� v I I I Cj� n rrnnr"D D r- 0D� Wo0 cZMO �m r z Inz O r-K: z r �z 0 -{ O D �,f,,o ° TI-i o D O C C O raj I,�, O Z < �. �ODO rOD m Om A� mOZ Dr mZOO cN z m Ooh Nx ; -j F- m� �� �D =1 o Ol A D = m m c) m N U) ;;u 2 -1 i w i to w 1 � lu 0 � X Fill_ KITTREDGE INSURANCE AG Fax:5083936983 Mar 8 2007 09:40am POOdgd ACRD CERTIFICATE OF LIABILITY INSU NPE OP ID x �^ �kMP" ANDREWS 03 0$ 07 PRODUOER 5 0 8 3 9 3 6 9 8 3 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Kittredge Insurance Agency Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 1555 Otis St. , P.O. Box 1129 ALTER THE COVERAbE AFFORDED BY THE POLICIES BELOW- Northboro NA 01532 Phone: 508-393-7744 Fax:508-393-6983 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER A: Acadia; Insura]]QO Company 31325 INSURER B; Firela ' '» Iris. Co. Andrews Guni to Co. , Inc. INSURER C: 6 Republic Road INSURER D: North Billerica MA 01862 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 CERTIKICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EJCCLUSICIN$AND CONDI'T'IONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, POLI LTR NSR TYPE OF INSURANCE POLICY NUMBER FFE TIV BATE MM/DD/YY) DATE MMIDD/YY LIMITS G6N]RAL LIABILITY EACH OCCURRENCE $1,O D O r 0 0 0 Z� X COMMERCIALGENERALLIABILITY CPA0136208-11 03/01/07 03/01/08 PR EI�IISEB(Eaoccureme) 5250r000 CLAIMS MADE D OCCUR' MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY S 1,O D O,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS,COMP/OP AGG $ 2,000,000 POLICY 7L I gp'e LOC. )ISnp Ben. 1>bI/2M AUTOnnOe1LE LIABILITY COMBINED SINGLE LIMIT $ 1000000 B ANY AUTO MIaA01362J 0-11 03/01/07 03/01/00 (Eaeecldent) ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Perper=6) X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per sccidenl) PROPERTY DAMAGE $ (Par accident) ®ARAQE LIABILITY AUTO ONLY-EA ACCIDENT NY AUTO $ ANY THAN EA ACC $ AUTO ONLY. AGG S EXC)=SS/UM DRELLALIABILITY' EACH OCCURRENCE 31000000 A X OCCUR CLAIMS CUA0136211-11 03/01/07 03/OT/08 AGGREGATE S 1000000 DEDUCTIBLE $ IX RETENTION $10000 g WORKERS COMPENSATION AND - EMPLOYERS LIABILITY ITS TORY LIM ER A ANY PROPRIETOFJPARTNER)EXECU7IVE WCA0136213-11 03/01/07 03/01/08 E.L.FAAC14 ACCIDENT $ 1000000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1000000 S"E',deePROVISIO E.L.DISEASE-POLICY LIMIT S 1000000 SPECIAL PROVISIONS 6elaw OTHER i DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT(SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SMALL SAMPLE CERTIFICATE IMPOSE NO OBLIGATION ORLIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPR NTATIVES. AUT D REPRE$kN*NE ('��c.�, reS, ACORD 26(2001108) ©ACORD CORPORATION 1986 MORTGAGE LOAN INSPECTION THIS PLAT IS FOR IDENTIFICATION PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY 1 250 ALONG BROOK w LOT 22A o 0 C. N- 0 0 0 o �` lv4t `986, i ti ��2 f S rn w \ H- \ l f / J I A1N AGE EASEMENT os 20 W1D II WINTERBERRY ° LANE-f- THE PREMISES SHOWN ARE SUBJECT TO AND/OR TOGETHER WITH THE BENEFITS OF ANY AND ALL EASEMENTS, RIGHTS, CONDITIONS, COVENANTS, AGREEMENTS, RESERVA11ONS_AND-RESTRICriONS OF RECORD. TO THE SOURCE ^NE MORTGAGE SERVICES CORP. fop THE LAWYERS TITLE INSURANCE CORPORATION — ONLY To nay knowledge, information and belief, from information supplied to me, I hereby report that the premises have been examined end that this inspection plat shows the improvement or improvements as located on the premises described, that the improvement or improvements are entirely within lot lines, that there are no encroachments upon the premises described by the improvement or improvem n s of any adjoining premises, end that there are no easements o` record affecting the tract shown hereon, except as shown. 4y. PAUL OF 4fS,� cy I further report that the promises shown on this elan is not located within a Flood Hazord Area as shown on PARUL 4}' Department of H.U.D. Federal Insurance Administration Maps, LUSSIER No.29648 Community Number 250167 0001 A _ ti Identification Date APRIL 3, 1978 P.l.5, Lo HUNTLEY OWNER WALTER E. BAK & CLARISSA G. BAK ALMER HUNTLEY, JR. €c ASSOCIATES, INC. LOCATION 85 WINTERBERRY LANE Surveyors • Engineers • Landscape Architects NORTHAMPTON, MASSACHUSETTS 30 industrial Drive East Northampton, MA 01060 JOB NO. DATE SCALE voice(413)584-7444 fax(413)586-9159 97-727 11/19/97 1"- 80' 3 � �f1833a�Cf�l13Cff4 � 1 DEPP?zTbfENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Buildinv INSPECTOR Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as l,is/her construction supe_ So r. 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 back-fill). sonotube holes (before pour) a rouzh building inspection (before work is conce.tled) insulation inspection (if required)and a_fnal_buildina 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 occupancv 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 In dustrial Accidents (' Office of Investigations 600 Washington Street Boston,AL4 02111 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): _OCI Address: REPU B u c_ RA City/State/Zip: Phone.#: (-'iT-o(:3') c�7.). - 7T 4:(o Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with ?c7 4. Q I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have S. Q Demolidon working for me in an ca act employees and have workers' g addition g y P ty 9. ❑Building [No workers' comp..insurance comp. insurance.$ required_] 5. Q We are a corporation and its 10.Q 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'ger MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.[Z Other comp.insurance required.] 4xny ap—ptican mat checks oox 4 1 must a so 511 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 indicting 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. Iam an employer that is providing workers compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ,q 7 I f9 ti7 S c > — Policy#or Self-ins. Lic.#: r r t� 13 6 L 3— l 1 - Expiration Date: � / )az—`- Job Site Address: '3S nJT�2t3E(ZR'/ LA N,P-- City/State/Zip:pooR:ri4AMP7Zr J,1 010 6 0 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 ,ne of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DLk for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Phone#: r8 007 z�L 7a — 7g4 c. Gfficiai use only. too not write in this area, to be completed by city or town offieiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone T: SECTION 8-CONSTRUCTION;SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder:- R 0 D/.1 G y C S Q`Z 7 � License Number b T2 alPuJ[�Li� fZD r- LF 6ZILA /f , m,4 a �8`� la a Address Expiration Date -7a- 744 x Telephone elephone , z PP Not Applicable ❑ �n��iQt_-rL ku i — io 77� U �i t Company Name Registration Number 6 R:P)r-'1 �C RDA 1�ItL RAGA �'YIR UlBI�� ��l��ag Address Expiration ante Telephone(f$as-)a7Q-7�0 SECTION 10 WORKERS'COMPENSA:T.ION-INSE IRAN"CEAFFI'DAVI (M.G.L.c-f52_§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...... ❑ 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-vear 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 D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding[O] Other[) Brief Description of ProposedC Work: C 1c�9 Atj7a ln,�?5T/1r��i Rn] �s7�- e211 r,J7A71 Si17�m�11d?G- y°aaL No Adding newtedroom Yes ✓ No Alteration of existing bediom Yes Renovating unfinished basement Yes ✓ No Attached Narrative 9 Plans Attached Roll -Sheet sa Li New.-,housezr ara€TdMod is 16W OUSUICL CO MPtet��h��o'�tai�iz,rg: 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 o. is cons ru on within 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?WHER- OWNERS AGEg-T--OR CONTRACTOR APPLIESs FOR B€11C171NCs PERMIT /C 73 19 K as Owner of the subject prop rty he a authod e — i ,C D i_ S �S o b II matters fat a to ork authorized by this building permit application. ig ur fiek/ 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. Print NamQ e Signat a of Owner/Agent Date . . . - Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information This column to be 11 in by Lot Size xi Setbacks Fr�nt Rear 10 Building Height Bldg.Square Footage Open Space Footage % #of Parking Spaces (volume&Location) A. Has a Special Perm it/Variance/Fi nding ever been issued for/on the site? IF YES, date issue& ---'-'-- IF YES: Was the permit recorded at the Registry ofDeeds? NO 0 DON7KNOW 0 YES IF YES: enter 8uoh ! / Page� and/or Ducument# �� �� �� B. Does the site contain a brook' body of water or wetlands? NO «~�� DON7 KNOW x_� YES �~/ |F YES, has a permit been or need tobe obtained from the Conservation Commission? Needs tobeobtained �~� Obtained ��\ Date �~� �~� ' � �� C. Do any signs exist un the prope�y? YES �~/ NO |F YES, describe size, type and location: D. Are there any proposed changes tou,additions n signs intended for the property? YES NO Vy IF YES, describe size, type and location: E Will the construction activity disturb grading, o,filling)over 1 acre oris it part ofo common plan that will disturb over Iacre? YES � > NO �)� ~� X� |F YES,then a Northampton S^onn Water Management Permit from the DPW is required' +fy a Northampton statrts of Fer>x -� ° 1I , Baldlmg pepartment 21�L M$in Street Sewe>-lSept�cxAyailabrlit � R60 100 Wafe, fEttelLA a�Iabrl 2 5 ( harnpt MA 01060 �rro se of t acl ra€PCans *� --' phone 413-5871240 'Fax 413-587-1272 Ptasife l?tan - APPLIWION T© '� J LTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION°t SITE INFORMATION ry This section to f5e complefed 6y bifiee 1.1 Property Address: l�a 2TH�n�I�� /'h�`1 C��a 6 0 �a�rse j QveafaYr k]rs#r►ct _ ESf Distrscf _._ _ CS Disfrrct - - - SECTION 2-PROPERTY OWNERSHIPIAUTHORIZEDr,AGENT 2.1 dwner of Record: Na Current Mailing Address:' X Tele hone ig to 2. Authorized Agent: l�E L t !„ TREPOF?Ldc 27 B E L1 6oZC-4� Z44 0 4 cR- Name(Prp'K Current Mailing Address: / CSG�,C;�) Q7.2— 794 _ Signatur Telephone SECTION 3-ESTIMATErY CONSTRUCTION COSTS- Item Estimated Cost(Dollars)to be Official Use Only completed by ermit 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 6. Total=(1 +2+3+4+5) O©o Check Number S� This Section-For OfficiaFUse Only ` Building Permit Number.- Issued: Signature: Building Commissionerlinspector of Buildings- Date 53 — Ca R, File#BP-2008-0337 APPLICANT/CONTACT PERSON ROBERT BLAIN ADDRESS/PHONE 6 REPUBLIC RD BILLERICA (800)272-7946 PROPERTY LOCATION 85 WINTERBERRY LN MAP 36 PARCEL 222 001 ZONE SR 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 Typeof Construction: CONSTRUCT 20 X 40 INGROUND POOL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 027999 3 sets of Plans/Plot Plan THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO 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 Street Commissi 1,2161zv� 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. ,. BP-2008-0337 GIs #: COMMONWEALTH OF MASSACHUSETTS } .0> CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category BUILDING PERMIT Permit# BP-2008-0337 Project# JS-2008-000482 Est. Cost: $63000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ROBERT BLAIN 027999 Lot Size(sq. ft.): 169884.00 Owner: BAK WALTER E&CLARISSA G Zoning: SR Applicant: ROBERT BLAIN AT: 85 WINTERBERRY LN Applicant Address: Phone: Insurance: 6 REPUBLIC RD (800) 272-7946 WC BILLERICAMA01862 ISSUED ON.9/28/20070:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 20 X 40 INGROUND POOL 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 9/28/2007 0:00:00 $50.005553 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo