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23B-079 (10) A/IL•�'�• Mutual j u���y A.I.M. Mutual Insurance Company 1"r 1 ] Massachusetts Employers Insurance Company �Ilirll�_. New Hampshire Employers Insurance Company INSURANCE COMPANIES Associated Employers Insurance Company A.I.M. Mutual Insurance Company INSURANCE BINDER This binder is a temporary insurance contract subject to the conditions shown below. PRODUCER ISSUE DATE 04/22/2014 EFFECTIVE EXPIRATION Webber&Grinnell Insurance DATE TIME DATE TIME 8 North King Street Suite# 1 07/01/2014 12:01 AM 07/01/2015 X 12:01 Northampton, MA 01060 AM PM noon CODE 818-1 SUB CODE 1 DESCRIPTION OF OPERATIONS/VEHICLES/PROPERTY(including location) Stephen Ross Carpentry—Detached One-or Two-Family Dwellings 36 Service Center Road#202 Northampton, MA 01060 INSURED COVERAGES POLICY NUMBER All liability limits in thousands STATUTORY MA $ 500,000.00 (each accident) WORKERS COMPENSATION To be assigned. $ 500,000.00 (policy limit) $ 500,000.00 (each employee) SPECIAL CONDITIONS/ RESTRICTIONS/OTHER COVERAGES 1 NAME &ADDRESS AUTHORIZED REPRESENTATIVE 1 CONDITIONS This company binds the kind(s) of insurance stipulated. The insurance is subjected to the terms, conditions, limitations of the policy in current use by the company. The binder may be cancelled by the insured by surrender of this binder or by written notice to the Company stating when cancellation will be effective. This binder may be cancelled by the Company by notice to the insured in accordance with the policy conditions. This binder is cancelled when replaced by a policy. If the binder is not replaced by a policy, the Company is entitled to charge a premium for the binder in accordance to the Rules and Rates in use by the company. 54 Third Avenue• P.Q. Box 4070• Burlington, MA 01803-0970•Tel: 781.221.1600/800.876.2765 • Fax: 781.270.5599 BRIDGEWATER• BURLINGTON e CONCORD, NH • HOLYOKE• MARLBOROUGH sponsored by Associated Industries of Massachusetts City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: 2 The debris will be transported by: The debris will be received by: Building permit number: Name of Permit Applicant Date Signature of Permit Applicant SECTION 8-CONSTRUCTION SERVICES 7 8.1 Licensed Construction^[Supervisor: Not Appliccabblle/❑ Name of License Holder: License N tuber (� 551,r'v Address Expira ion Date Signature Telephone S,Re latered Home Improvement Contractors Not Applicable ❑ CdrpanjtName Registration Num er Address Expirati n 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...... ❑ 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. Derinition 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.AAperson 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ ition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors 0 Accessory Bldg. Demolition ❑ New Signs [O] Decks [Q Siding[O] Other[O] Brief Description Qf Prop Work: /Gc Alteration of existing bedroom Yes No Adding new bedroom Yes No 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 ttach d. Proposed qua a foot e f new construction. Dimensions e. Number to ies? f. Method h ting? Fireplaces or Woodstoves Number of each g. Energy on rvati n Compliance. Masscheck Energy Compliance form attached? h. Type cons ruction 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, �?( ��iy'�U'�y"t'� , as Owner of the subject property her9by authorize t ct n my behalf, in all mattefs relative to work authorized by this building permit application. Signature of Owner Date as Owner/Authorized Agent hereb 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 ains and penalties of perjury. Print Nam Signak Rof Owner/Agent 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 ICS 2{4 .10 �0t214 Frontage -1.41 -7 41 Setbacks Front 6d Side L: R:' L:'A0(-4 R: Rear 27 lit Building Height (.,( Bldg. Square Footage 11q1-7747 10 % 0 Open Space Footage % (Lot area minus bldg&paved Wit t 8 Z, 2 G"?04 1"370 parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW � YES Q IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW YES 0 IF YES: enter Book Page and/or Document#' B. Does the site contain a brook, body of water or wetlands? NO Q, DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the property? YES NO Kh IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES l NO VY 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 0 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only fit of Northampton Status of Permit: buil ing Department Curb Cut/Driveway Permit V MAY 2 7 2014 ,:, 2 Main Street Sewer/Septic Availability Room 100 WaterANell Availability Electric,Plumbing&Gas Insp@fti mpton, MA 01060 Two Sets of Structural Plans Northampton. MA 0106 -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 Z 5 ©t,L lt�-Nl--" " t-� Map Lot Unit e--t, 0 Zone Overlay District Elm St.District C13 District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: / c �/ ���- lClt}r � "U NaA(Printf Current Mailing Address: Telephone /3 .-7 Z-7� 3 Signature _( 2.2 Authorized Agent: . rte. '. Name(Pr' t) Current Mailing/'ddress: gna a Telephone ! S tj'`{ SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com feted by ermit applicant 1. Building -- (a) Building Permit Fee 2. Electrical / ct) (b) Estimated Total Cost of ` Construction from 6 3. Plumbing _ ,/\ Building Permit Fee 4. Mechanical(HVAC) (� 5. Fire Protection 6. Total=0 +2+3+4+5) jj. &zyO: Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date dk File#BP-2014-1251 APPLICANT/CONTACT PERSON STEPHEN D ROSS ^ ADDRESS/PHONE 36 SERVICE CENTER RD NORTHAMPTON (413)584-1224 Q PROPERTY LOCATION 62 SOUTH MAIN ST MAP 23B PARCEL 079 001 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 Fee Paid Tyneof Construction: CONSTRUCT 15 X 30 DET GARAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildiniz Plans Included: Owner/Statement or License 079160 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 Demo ' ' Delay 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. 62 SOUTH MAIN ST BP-2014-1251 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23B-079 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: GARAGE BUILDING PERMIT Permit# BP-2014-1251 Project# JS-2014-002106 Est. Cost: $46000.00 Fee: $90.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: STEPHEN D ROSS 079160 Lot Size(sq. ft.): 10585.08 Owner: FERRON ALEX Zoning: URB(100)/ Applicant: STEPHEN D ROSS AT. 62 SOUTH MAIN ST Applicant Address: Phone: Insurance: 36 SERVICE CENTER RD (413) 584-1224 O WC NORTHAMPTONMA01060 ISSUED ON:611212014 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 15 X 30 DET GARAGE 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: FeeTyne• Date Paid: Amount: Building 6/12/2014 0:00:00 $90.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner MW