36-230 03114/2005 14:55 978-345-2766 ROME INSURANCE PACE 02
AIt bF� #•�, > ,.. '*t:• r x ,' ,'~ Re•. . ICE t.s.k'3d,•'cb y 9 EEC'i, sa LG4 #JR �VAI(:(MM1G{Ri>t) s.
as A lrs& s# I.� t.c
PRODUCER ONLY AND CON ERS 1 O RIGHTS UPON THE RT FICATE
ROME INS AGENCY HOLDER THIS CERTIFICATE MRS NOT AI�AEND ND OR
769 MAIN $T ALTER NE COVERA6IE AFFORDED BY THE POLICIE$BELOW.
f TTCHAURG MA 01420 COMPANY COMPANIES AFFORDING COVERAGE
A
INSURED COMPANY
CORMIER, YVON DBA IVAN B
CORMIEA CONSTRUCTION COMPANY
225 BETTY SPRING ROAD C
GAR.DNER MA 01490
COMPANY
D
7a=N. r �, !'Y"'b i
L i. k, .,�,:3., .),ky r$.,.. h
rR
THY$IS TO CERTIFY TFW7 TIME POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO 714E INSURED NAMED ABOVE FOR�THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REOUIREMGM, 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 Y4 ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMIT'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
00 TYPE OF INSURANOR POLICY NUMBER POLICY EFFECTIVE POUCT EXPIRATION LIMITS
LT GATE(WOMYY) DATE(MN1dI]NYYI
GENERAL LIABWTY GENERAL AGGREGATE 1
COMMERCIAL GENERAL UABILrTY PRODUCTS-COMP/OP AGG,
CLAIMS MADE F-1 OCCUR. PERSONAL d ACW INJURY i
OWNERS A OONTRACTOR'$PROT. EACH OOMRRENCE 5
RRE DAMAGE(Any one fire)
MED.EXPENSE(Any one pdrson)
AUTOMOBILE UABIUTY CouBINEb SINGLE $
ANY AUTO uMrr
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Par Parson) 11
141REDAUTOS 00014Y INJURY
NON-OWNED AUTO$ (ParAoddsmf 6
PROPERTY DAMAGE 4
GARAGEUABIUTT AUTO ONLY.EAACCIDENfT S
CsT8FR THAN AUTO ONLY;
ANY AUTO
_ EACH ACCIDENT g
AGGREGATE s
EXCESS LIABILITY EACH OCCURRENCS I
LOA SHE LLA FORM AGGREGATE 6
OTHER THAN UMBRELLA FORM
1M R'S
ORxEOPE
DMN"TIONAND
A
EMPLPYERSUAEILrrr (UB-79Ox625—A-05) 09-20-05 09-20-06 STATLITORYUm"
EACH ACCIDENT i
THE'rNERSr
PARNERVEXIETOA C-c�J'TIVE INOL DISEASE-POLICYLDAT i a
OFFICERS ARE CXCL DISEASE-EACH EMPLOYEE ;
OTHER
DESCRIPTION R aPEPATIONSILOOXMUKS;VEIVCLMNESTIIMON&SPECIAL ITMS
JOB LOCATION 40 WINTERBERRY [SANE
FLORENCE, MA OiD62
T I5 RE E3 ANY T>R ERTIF CAT SUED TO THE CERTI I AT DER AFFECT RS C GE.
q ,9n aA'.� ..,. I I ,,..r ?.....sr:3 � ., :.� rii. �., •.. .o.,... 33),,.....a .,....a;a,,,.,,F,i, I' '.ti..,K).'b�.,,,,.�s�..�'} ,,...�.f 1.zb
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BBPORE THE
EXPIRATION DATE THRRBOP, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDFR NAMED TO THE
CITY OF NORTHA14PT014 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGIATION OR
212 14AI N ST. UABIUTY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVE&
NORTHAMPTON MA 01Dr;�0
AUTHORZPD REPRESENTATIVE
... .. .... ';3,::F�'"t6'< li >.b ?s3 ..",H } k'. yr: wx.'i,ts bx. xxa §, {t�,'£ ,.ax.ng�•.r „w
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¢(t1AA1P)O
zt-p of XarthanYptan s
` � �1 83E8it�iiStttE -
DEPARTMENT OF BUILDrNG INSPECTIONS /=
INSPECTOR '212 Main Street • Municipal Building '
Northampton,MA 01060
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supc;-,,isor. The state defines "Homeowner" as, "Person(s)
who owns a parcel on which he/she resides or intends to be,a one or t vo amz y -------
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 boil ing department for"tlie City of Northampton wants any persons)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 r'.egulations. The inspection process requires that the building department be called
to inspect work at various stages, which include foundation/footings(before backfiIl),
sonotube holes (before hour) 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.
kilome owner resident's signature requesting exemption)
I. 4ii caii to schedule all required buiiding inspections necessary ror u1C Uu1uI116 pciliiii
issued--to me.
Date-
Address of work
location
r
I
k}0 Jaf �\To fIl3111]Jtoil -
A J � �lc�shcflnsr(le' _
u. v DEPARTMEWT OP BUILDING INSPECT 101, -
212 Main Strcet Nfunicipal Building
i
j Northampton, Mass. OIOGO
I
WGRfCEI *S COIATENS, ' TO.N L`zSUI NCB :�I'I'II)�'�VI�'
I
' y (]iccasxlperrnittcc)
\111Ith z principal place ofbusiness/residence at: -
ke-
- (sac-t/city/na>_cfa p)
do hereby cerdi -, under tic.pains and penalties of perjury:, hal
{ ) I am an employer providing the following,workcr's coincoverage s-ndon coverage for 1ny
etuplovccs wor>ong on this job:
a 0/0
(Issarn= Comm) (Polies:Nt-mgr) (r, irrjor. D21e.)
I ;
I 2QI z sole propr,ctor, general contractor or omeoiw-ner (cc:z one) and have hired
ne coairaCprs listed below T-lho have the folloLvmq worker's compen_czoon pokiest
A— 616
Corin I-C V,C0115
(NamC OT Co. =Cio") (Instranc: C roan)-Pi OUc-, (r':J;'I'jo D SIC)
1
-- (N=r-of Coniraor) (In.st ca : Compazyl?oum NtutcCr) (La�irdon Dale)
(Name of Connaao;) (Insuratc—z C.ompazyfPolicy Numb r) (Expir-,6oa Date)
I -
(N2me of Contactor) (Insu== Company/Policy Numbr) (E pirdtioa Date).
(.11 :dais-d,-YMCC�-V to iac>scE iartxm oo pctaiaia6 to.1)occr-tv�)
j O I am a sore proprietor and have no one worL-iDg for me.
�1
( ) I am..a home owner performing all the-work myself.
NOTE:p(cx be cw-N�Lfii K�-�'}c 6cmv�-nc:�.�to employ pc-wcs w�c sir.••••. cs.:c�oo c rrna„roric oa.d.•�L^C of
oot Mort Lh_a �e__tetra in why the bomoouvc rzado oc oe the aou� c -d. d w he
eitploycs uaG=the t uk&i e=,•,�m qtr(GUI 52,=1(5)) pptL-L6oa by n bomco=a=fc a!ice-or pe-mrt cLy e»dsx ebC
lepl r-4—of as 4ioyec ua&e da W ock.ola Compamatioa AoL
I
!aiadctz�ad tha a oopy of tbi.cml® 1 o y bo for-,.srd<d to tba Dcp„tmcoa of Indstraicl Acddev CHLoo oC la -�for the
�i cavca�-c reirasioo cad ttu L-iltac w sewrc�:ovca-ab-e t�^ta soevon 25A of}.{QL!52 an led to the i�cssilim of eimiasl pea�ia
ooav tag of a fiat of up to S 1300.00 arWor of up to oar yur cad c vif pm.t is in'x fo al or a Stop Work Ordc cad
F,=of S 1 t dty.ptiast�
-
� � j-er$li Nt3IDtKS --
i�natuYt of
aU- ,,_,PCM-LiU= e
SECTION 8-CONSTRUCTION SERVICES f
8.1 Licensed Construction Supervisor., Not Applicable ❑
Name of License Holder: 516-n l CR()1(C'jZ . c)a5L(7Acn7:N 4J/p2
License Number
,)a6 ,3e#�, s'oal't-ri Ravi &r4I r r0A /o/J110(,
Address Expifatiori Date
Signature Telephone
grew ..x a .n-ux� ems: ,. raT'-• 3 ,,` $" ra".ae�k'
9ea�s Jere" orne Ir»proweme t or rac or R Not Applicable 13
00Rh /,f/P_ / JU�Uc�p, 02
Company Name Registration Num er
, A QNLIQ
Address Ex ira ion Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G L.s.152,§250(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......
C�
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.
AIso 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 AiL;otated,.ou my be lsble fer Person(S)
you hire to perform work for you un er this permit.
The undersigned"homeowner" Pies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,Sta Local Zo �ng Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
r
i
SECTION 5-DESCRIPTION°OF'PROPOSED WORK(check all applicable)
New House Addition []. Replacement W' doves Alteration(s) I Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding[0] Other[o]
Brief Description of Propose a / (0,bo eb C Lc.'1#
Work: �='
✓ tY �W
Alteration of existing bedroom Yes I, No Adding new bedroom Yes _ -1/ No " J r
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa New o se 6 H"J M11 naplet+r�#l�e r�IQ rtxlna: r /�
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-TOMBE.COMPLETED WHEN`
OWNERS AGENT'OR C,ONTRAGTOR APPLIES`FOR BUILDING:PERMIT
1, �a I Q Yl OS G 11'r 0—Y1 i j -()Cdr I't S - as Owner of the subject
property /�
hereby uthorize L YCc h C c�rY►� P r �c�►>`Sfi2iC >`l fig
t0 n my beh f i all matters rei tie to work a h ' ed by this building permit application.
lop
S' ture of O—WAP Date
1,� I��n� �1, nf_ X7.11 SC CC) r'f as Owner/Authorized
Agent eby declare that the statements and information on he foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
r
Pri a e /'
ign re of ner/Agent Date
Section 4. ZONING All Informatibli 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
i
Side L: R: 'L: R:i
Rear
Building Height
i
Bldg. Square Footage
01,11
Open Space Footage % f '
(Lot area minus bldg&paved
parking)
#of Parking Spaces }
Fill:
volumes&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT 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
IF YES: enter Book Page? and/or Document#':
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ® Obtained Date Issued:
C. Do any signs exist on the property? YES i NO
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 0
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 r NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
City of Nortf ampton t Perfru '
Building Department
212 Main Streetwve , '
Room 100 r _ �
Northampton; MA 01060
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
This sect�o_n to be code#ed boff"�ce
1.1 Property Address:
11Ifa Lot . knit
'� b)1r')4Crbcffy LznL
�loren�e, Mq Ol per- Z rle�,� OyerlayA�stnct
�E�m-S'�District '� Wr GB.D,�.stnct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
i Ct►1 c� u ! v C-Ord; '/D Q nAt'41CIVYi4 ar�t�jf kenc e MA 0/0(,1--
Na (Print) Current Mailing Addres
Telephone
S' n r
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED-'CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building {a)Building Permit Fee
CDO
2. Electrical ;(b)Estimated Total Cost of
3,ao Construcfiion.�rom 6
3. Plumbing ! / Building Perm it.Fee
4. mecnanicai(rlviAG) O
5.Fire Protection
6. Total=(1 +2+3+4+5) ,3. Check Number
This Section For Official'Use Only
Building Permit Number Issued
Signature:
i
Building Commissioner/Inspector of Buildings Date
File#BP-2006-0912
APPLICANT/CONTACT PERSON SCORDILIS STYLIANOS P&GAIL E
ADDRESS/PHONE 40 WINTERBERRY LN FLORENCE O 586-5540 O
PROPERTY LOCATION 40 WINTERBERRY LANE
MAP 36 PARCEL 230 001 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 WWO
Typeof Construction: INSTALL KITCH CABINETS,COUNTERTOPS&WINDOW &FAMILY ROOM
WOOD FLOOR
New Construction
Non Structural interior renovations
Addition to Existing,
Accesso1y Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9XMATION 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 Commissio
/6 ,�OtJIJ
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-2006-0912
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0912
Project# JS-2006-1393
Est. Cost: $35000.00
Fee:$155.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): 117612.00 Owner: SCORDILIS STYLIANOS P&GAIL E
Zoning: SR Applicant: SCORDILIS STYLIANOS P & GAIL E
AT. 40 WINTERBERRY LANE
Applicant Address: Phone: Insurance:
40 WINTERBERRY LN O 86-5540 ()
FLORENCEMA01062 ISSUED ON:311712006 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL KITCH CABINETS, COUNTERTOPS &
WINDOW, & FAMILY ROOM WOOD FLOOR
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 si nature:
FeeType• Date Paid: Amount:
Building 3/17/2006 0:00:00 $155.00102
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo
40 WINTERBERRY LANE BP-2006-0912
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:36-230 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0912
Proiect# JS-2006-1393
Est. Cost: $35000.00_
Fee: $155.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class_ Contractor: License:
Use Group:_ Homeowner as Contractor
Lot Size(sq. ft.): 117612.00 Owner: SCORDILIS STYLIANOS P&GAIL E
Zoning: SR Applicant: SCORDILIS STYLIANOS P & GAIL E
A : 40 WINTERBERRY LANE
Applicant Address: -
40 WINTERBERRY LN _ 0 586- 540
FLORENCEMA01062 ISSUED ON.-311712006 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL KITCH CABINETS, COUNTERTOPS &
WINDOW, & FAME'-Y ROOM WOOD FLOOR
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Piumbing Inspector of Wiring D.P.W. Bidloii►g Inspector
Undergror,ad: Service: Meter:
j'� Footings:
Rough: - J6 ��ti �Rough:y/3J6b House# Foui►dation:
driveway Fioal:
Final: ��Q� Final:
e=r--t ,��,�L Rough Frame:
Gas: Fire Department Fireplace/Chimney:
_a
�'t�?Oil- Insulation:Rough: .j/-C
Final: G�`O�- f1, Smoke: Final: (�7k -7_ 1 7 ,G�, A47,
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF TI'S RULES AND RE'GULLAATION -'
4
Certificate of Occupancy -. _ �- si nature:
FeeTyne: Date Paid: A.moupt:
Building 3/17/2006 0:0:;:00 $155.00102
212 Main Street,Phone(413)587-1240,I�ax: (413)587-1272
Building Conunissioner- t\athony Patillo