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23D-038
A�°® CERTIFICATE OF LIABILITY INSURANCE 6/18/20 4 Y' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTA71VE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s). PRODUCER CONE: Barbara Van Mourik Finck & Perras Insurance Agency Inc. PHONE . (413)527-5520 FAD .(913)527-5970 6 Campus Lane E-MAIL ADDRESS:bvanmouxik8finckandperras.con INSURERS AFFORDING COVERAGE NAIC A Easthampton MA 01027 INSURERAMain Street America Assr Co 29939 INSURED INsuRER a:NGM Insurance C2LnpanV 14788 Axiom Landscape & Home Improvement LLC INSURER C; 40 Pine Valley Road INSURER D: INSURER E; Florence MA 01062-3600 INSURE COVERAGES CERTIFICATE NUMBER:CL145600787 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR TYPE OF INSURANCE A 0R POLICYNUMBER POLDICDYEFF M,MII)D YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREM ES( a occurrence)nc $ 500,000 A CLAIMS-MADE C OCCUR APF5898Y /11/2019 /11/2015 MED EXP(Any one arson $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEMLAGGREGATELIMIT APPLIES PER: PRODUCTS-COMPIOPAGO $ 2,000,000 X POLICY PRO- JFCT F]LOG $ AUTOMOBILE LIABILITY OMBI D SINGLE LIMIT a c i� nt 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED KIF5898y /11/2014 /11/2015 BODILY INJURY id Per accent AUTOS AUTOS ( ) $ X HIRED AUTOS X AUTOS PROPS tDAMAGE $ ELITE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ B WORKERS COMPENSATION X I WC STATU- WH O AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER0CECUTIVE E.L EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? NIA CF5898Y /17/2014 9/17/2015 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEq$ 500,000 If yes.describe under DESCRIPTION OF OPERAT(ONSbelow E.L.DISEASE-POLICY LIMIT 1$ 500,000 DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Proof of coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORI REPRESEN7ATNE d �- W® h-- ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(2otowpi The ACORD name and logo are registered marks of ACORD SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Al,S 4,, D I/ License Number /� / Address Expiration Date Signature Telephone 9 Realstered Home Improvement Contractor: Not Applicable ❑ o a Company Name Registration umber 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 buildi g permit. Signed Affidavit Attached Yes....... No...... ❑ 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. 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) E] Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[0] Other LK Brief Description of /�fLj Proposedb ) f Work: PfnlacrAi..4 -F ICf�' dv, S%nk 1 4,4.tr,'&/) i INIt��I� //Sw "A &'bet' 1"' sat"' 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 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-TO BE COMPLETED WHEN -F OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Lit II;C,1" M tt,Sc,y) as Owner of the subject property hereby authorize A; to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date I 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 Name Signature of 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 Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Findin ver been issued for/on the site? NO 0 DON'T KNOW YES 0 IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book Page and/or Document# 0 B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , 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 N0 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. Deportment rise only ILJ(� 11 i f Northampton Status of Permit: u ing Department Curb Cut/Driveway Permit JUN 1 2014 2 Main Street Sewer/SeptleAuaiiability U Room 100 Water/Well Availabiltty Electric,Plumbing rt ampton, MA 01060 Two Sets of Structural Plans NorlhamPto, OPO" 7-1240 Fax 413-587-1272 Plot/Site Plans Other Spettify APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: { ,a �,V�rs r` Or r v¢ map Lot y Unit Ffc1-ejjC( O/tlG) Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: 1'411""" ,8e �� Pr !"r4�S�y� �(n /�,r./✓jiGC! lJ�,wC. 81, P&eC 10-4 G�OG Name(Print) Current Mailing Address: L413— A, i3— S' � � Telephone Signature 2.2 Authorized Agent: J� C 0I S h ��1 1�Y 1/-+ Name(Print) if Current Mailing Address: 9 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building s-C�c>U (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of f� V C10 Construction from 6 3. Plumbing l SoU Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) i"v C) Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2014-1362 APPLICANT/CONTACT PERSON ALISHA PHILLIPS ADDRESS/PHONE 40 PINE VALLEY RD FLORENCE (413)586-5986 PROPERTY LOCATION 56 RIVERSIDE DR MAP 23D PARCEL 038 001 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 Typeof Construction: REPLACE ROTTED WALL SECTION, KITCHEN SINK/COUNTERTOP New Construction Non Structural interior renovations Addition to Existing Accessoa Structure Building_Plans Included: 1141E A Owner/Statement or License 106378 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 ay Signature of Bui ding 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. 56 RIVERSIDE DR BP-2014-1362 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D-038 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2014-1362 Project# JS-2014-002294 Est.Cost: $7500.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ALISHA PHILLIPS 106378 Lot Size(sq. ft.): 5793.48 Owner: MASON WILLIAM S Zoning: URB(100)/ Applicant: ALISHA PHILLIPS AT. 56 RIVERSIDE DR Applicant Address: Phone: Insurance: 40 PINE VALLEY RD (413) 586-5986 WC FLORENCEMA01062 ISSUED ON:612312014 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE ROTTED WALL SECTION, KITCHEN SINK/COUNTERTOP - FRAMING AIR SEALING, INSULATION - FINAL INSP 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 6/23/2014 0:00:00 $55.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner now