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25C-168 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID D DATE(MM/DD/YYYY) XCZUPRY S1 12/20/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE First American Insurance Agy. , HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 510 Front Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Chicopee MA 01013 Phone: 413-592-8118 Fax:413-592-0995 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Arbella Protection Insurance INSURER B: Steven T. CZupryna INSURER C: dba Aldenville Window 178 Wheatland Avenue INSURER D: Chicopee MA 01020 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 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE POLI DATE MM/DD/YY DATE MM/DD/YY GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY 8500030850 05/03/06 05/03/07 PREMISES(Eaoccurence) $ 100000 tAGGREGATME DE x OCCUR MED EXP(Any one person) $5000 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $2000000 GEN' LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2000000 PRO LOC ECT AUTOMOBIL E LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUT!VE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under E.L.DISEASE-POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION O O O O O O O SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR City of Northampton REPRESENTATIVES. Northampton MA THORIZED REPRESE ATIVE ACORD 25(2001/08) ©ACORD CORPORATION 1988 DATE(MM/DD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE )EDGERS S1 12/19/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE First American Insurance Agy. , HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 510 Front Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Chicopee MA 01013 Phone: 413-592-8118 Fax:413-592-0995 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Granite State Insurance Co. INSURER B: Timothy McDonald and Charles Capella dba The Edge Remodelin INSURER C: 69 Suzanne Street INSURER D: Springfield MA 01104 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 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATEYMM/DD/YY E POLICY DATE MM/DD/YY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurence) $ CLAIMS MADE n OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY F7 PRO JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR El CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY WC 8745178 05/11/06 05/11/07 E.L.EACH ACCIDENT $100000 A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100000 Ifyes,describe under E.L.DISEASE-POLICY LIMIT $ '5500000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION O O O O O O O SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. THORIZED REPRESS ATIVE ACORD 25(2001/08) ©ACORD CORPORATION 1988 �S�VJ-t �o 0L " �,' £ }ia7tnchacrtta' - 4 — W`� DEPARTMENT OP DUILDI'�,'C INSPECTION'S 212 Main Strcct " Municipal Building Northampton, Mass. 01060 WOP R'S CO1'C'ENSATION LNSURA_NCT- AF=, A�Tl- - (li cL-msr�l perml ttcc) \.Vlth a principal place of businessJresidence ar: (sa->wt1 c�ty/stal.cJa p) do hereby certify, under the pains and penalties of perJury, ha O I :m an employer providin- the iollowin-, xvorl:e>'s cotnocns-non covcrzgc For Iny elnpiovees %vor�ong on Llus job: CL>s-u --Dw Conr ) rpolic: NtLa�cr) _- Fix-pimion D2.i^) V-ixm a sole proprietor, general coocractor or homeowner(circie one) and have hired the cones actors listed below cgho have the following worker's coCpt,15- l-on policies: (Nam-, Of co:urnaor) (IasuMnc;,•COI DxI)-/Prue-, �tiltIlli4:) (Y:D1iJ ^l (Namc of Cona-ac lor) (Inssran ComDaavJ?OUL-v Ntunccr) 6 6 n Dale) (Name of Coturaclo;) (Lasuaace Compan}•fPot�cy Numb r) (Expir-"6oa Da1c) (N me of Conaaaor) (Ia utau(--ComcaayfPoUcy Numhur) (Et�iraaon Da1sr). . (—Ch z66-D=J rh<�it aeoci.�•a ttrd=iaforayj oa pertaia��to all coo?-rr�:-�) ( ) I am a sole proprietor and have no one work-jog for me. ( ) I am,.a home owner performing all the work myself. NOTE:plesc b awxrc the +1r is bom�rcvcrz wtio cmploy pe-%am t.o da= „-••..•,. ===.=oa c rrns-ark oa.d%-J1_Z of aoe mote ih_,o t'ro pro is cebich the bomoaw,oe rend=oc m the crv=.3 z?p-rlca:C tbern ac ax L--n-r--Uy cc,=.0-cd to be c-Plo)=,an'.e the -=P .stim Act(GL132-z I(S)J appG=L6ao try a bomeoo-ocr fcr r tic m or pa=it rncy n-de LL� 1cgU n_t-Of as csployx-,odor di.Work_oe.Compovs+lioa AcL 1 uadcrsi,,ad t :copy of this CMLLcmc E may bo for-.�t d to tbo Doporcm W of lomsui.l Arc d.=Y omS or lrsa.r,noa for tb. mvcrT vai6c=100 a_•td th1 L-Jum to Lcw=Fsv�,Ge Mdc scrim 23 A of MOL 132 c=ltd to the=posdim of c-imical pca_slti= ooc x,=E of a Gnc of up to S 1500.00 xrw(r t> of tap to ooc yur cnd civil pra,t�o is tSc form or.Stop Word Ord--„d, fb ofS100.00 a d_y api=t ( For �a1 use only Y —---� Pcrm,t NtLmbcr I , 11.fap�— Lot n Lic=ISCrJpc cc Dace } 1 � Versionl.7 Commercial Building Permit May 15,2000 SECTION 1"0-STRUCTURAL PEER REVIEW;(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No SECTION 11 -OWNERAUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT T � l�(Ln l�! �,as Owner of the subject property hereby authorize_ s1 C% . r'Wel�'� =to act on my behalf all matters relative to work authorized by this building permit application. Signature of O er V 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 und�th��and 1 es u Print Name Signature of Owner/Agent Date SECTION 1:2-CONSTRUCTIOM SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Q6 — License Number __ 0 �' fa•�rt��j�•t1/, .A�-4.c �1i-fl[?r1F �✓1�►t�' � � 1 y Addres Expiration Date S� a Telephone SECTION 13-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 buildirjg permit. Signed Affidavit Attached Yes No Nei j �, � /cg e a M I A)6 1:2a-/.2 Versionl.7 Commercial Building Permit May 15,2000 SECTION 9 PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility I Address Registration Number I Signature Telephone Expiration Date f I Name Area of Responsibility i Address Registration Number o i Signature Telephone Expiration Date i Name Area of Responsibility I Address Registration Number Signature Telephone Expiration Date t f i Name Area of Responsibility r Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign El New Signs[:1 Roofng❑ Change of Use El Other&T-1, Brief Description 'Enter a brief description here. Of Proposed Work: �. d�f��?Ak'�° IneC�c-� �1!• �L 3 SECTION,5-USE GROUP AND CONSTRUCTION'TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A 1 ❑ A-4 ❑ A-5 ❑ 16 ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS:SECTION IF EXISTING BUILDING UNDERGOINGRENOVATIONS,ADDITIONS ANDIOR CHANGE IN USE Existing Use Group: ! Proposed Use Group: I Existing Hazard Index 780 CMR 34):' Proposed Hazard Index 780 CMR 34): 'SECTION 6;BUILDING-1HEIGHT AND AREA ar yOFFILOEM"500140 r BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTIONr 3.0 Floor Area per Floor(sf) x St 1st 1 2nd ; y nd 3rd T a 3rd 4th th I i 4 Total Area(so J Total Proposed New Construction(sfl Total Height(ft) Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ I Zone Outside Flood Zone[:] Municipal ❑ On site disposal system[-] Version 1.7 Commercial Building Permit May 15,2000 8. '.NQRTON ZONING Existing Proposed Required by Zoning This column to be filled in by Sm Building Department J�� Lot Size Frontage Setbacks Front Side L. R: L: Rear Building Height Bldg.Square Footage % j Open Space Footage % — (Lot area minus bldg&paved parking) y � #of Parking Spaces --� Fill: ( j volume&Location A. Has a Special Permit/Variance/Findin ver been issued for/on the site? NO Q DON'T KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Regi ry of Deeds? NO 0 DON'T KNOW YES Q _.....___ IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 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 0 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 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,exca ion,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. Version 1.7 Commercial Building Permit May 15,2000 - t ye "t us ok J NOV5'M City of Northampton 'f Building Department 212 Main Street 2 7 - Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SEC'fION'1<-SITE INFORMATION 1.1 Property Address: w T►ts section to be completed I,y office 3v �lzCdf/� IIAa Lq Unit Zone 'cs'laX�D►stnct .5' :•. SECTION 2:-PROPERTY OWNERSHIP/AUTHORIZED AGENT . 2.1 Owner of Record: Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorize QennEt: Name(Print) -'? Current Mailing Address: Signature Telephone SECTIO QMATED�CONS'TRUCTION COSTS Item Estimated Cost(Dollars)to be Qfficial Use Only completed by ermit applicant 1. Building i jaJ-,B ilding.'Per.mitFee � 2. Electrical ! (b)Estimated'Total=Cost of 1 � i Construction from 6 3. Plumbing j --Building"PertnitFee 4. Mechanical(HVAC) 5. Fire Protection ' ! — 6. Total=0 +2+3+4+5) Cheek Number This-Section-'For.:Officlal,Use Onl Building Permit'Nurnber - 'Date Issued Signature: Building Commissionerfinspectorof Buildings Date File#BP-2007-0676 , APPLICANT/CONTACT PERSON STEVEN T CZUPRYNA ADDRESS/PHONE 178 WHEATLAND AVE CHICOPEE (413)594-5678 PROPERTY LOCATION 34 ORCHARD ST MAP 25C PARCEL 168 001 ZONE URB 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 4 X 4 ENTRANCE DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 080726 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN RMATION 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 �+-�-•-`� 41-4-At �6 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. 34 ORCHARD ST BP-2007-0676 GIs#: COMMONWEALTH OF MASSACHUSETTS MM:Block: 25C- 168 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category BUILDING PERMIT Permit# BP-2007-0676 Project# JS-2007-001022 Est.Cost: $1200.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: STEVEN T CZUPRYNA 080726 Lot Size(sq. ft.): 8102.16 Owner: BIAPITA INC Zoning:URB Applicant: STEVEN T CZUPRYNA AT. 34 ORCHARD ST Applicant Address: Phone: Insurance: 178 WHEATLAND AVE (413) 594-5678 WC CHICOPEEMA01020 ISSUED ON:1212712006 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE 4 X 4 ENTRANCE DECK 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 12/27/2006 0:00:00 $50.00MO 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo