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31A-097 (6) ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1 TM 09/28/2006 PRODUCER (413)S86-7373 FAX (413)S84-0859 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Aquadro & Associates Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 355 Bridge St. , P. 0. Box 357 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Northampton, MA 01061 CHRISTINE M SULLIVAN INSURERS AFFORDING COVERAGE NAIC# INSURED ANATOLY KISHKO DBA AMERICAN CONSTRUCTION INSURER A: TRAVELERS INSURANCE CO 24 WEST SCHOOL ST INSURER& LIBERTY MUTUAL INSURANCE CO W SPRINGFIELD, MA 01089 INSURER C: INSURER D: 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. INSR ADD'LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DA TCEY(EXPI MM/DRDATI LIMITS GENERAL LIABILITY I6807232C783COF06 08/10/2006 08/10/2007 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $ 300,000 CLAIMS MADE Fv OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 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 ❑CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC231S350728-026 08/15/2006 08/15/2007 X I TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 100,000 B ECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/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 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPO NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS fQVT40 EPRESENTATIVES. x AUTHORIZED REPRESENTATIVE CHRISTINE SULLIVAN ACORD 25(2001/08) ©ACORD CORPORATION 1988 PROPOSAL No. e�l ly 14 -,IV 21 Date Aq 1 17-7 1791 Sheet No. 1 Proposal Submitted To: Work To Be Performed At: CName Street Street City State City State 0 Phone Date of Plans Architect We hereby propose to furnish the materials and perform the labor necessary for the completion of a. a /0"n41 _jq ar(i1 1 1 Valy / S, J w / rr t ,r { }.�Gi`'~l�,s�'ifl. '',� '}'.`�/'�, t?t�.:�;� �y �z .si � �fib'/`! . 6 4 r All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of Doll p r s $ with payments to be made as follow S': Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will become an Respectfully submitted extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance upon above work. Work- Per men's Compensation and Public Liability Insurance on above work to be taken out by Note-This proposal may be withdrawn by us if not accepted within days. \1 ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted..You are authorized to do the work as specified. Payment will be made as outlined above. Signature Late Signature 0 FORM 3850 DUPLICATE MADE IN U.S.A. O O �� ti$ (tyz#fir nrfnr#l��ln�rurt Z i x �1835AClTii5tt15 DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street • Municipal Building >o,y S,. Northwnpton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as has/her construction sup,:. •' sor. T he 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 backfill), sonotube holes (before pour), 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. (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 a Crif cf O f1JU111}ifoll J f '51 ao aA ch nrctr a' _ p DEPARTMENT OP BUILDr?\'C INSPPCT101.'S 212 Alain Strcct Municipal Building Northampton, ATass. 01060 �V0 RI2IZ'S COi1TENSATION LNSU_R_AJNCF A17FrnAVII (1;ccnsxJperrn;ticc) \vILb a prb,-icipal place ofbusioess/residence at: (phone-') do hereby certify, under die.pairls and penalties of perjury, hzr ( ) I am an employer providing the following worker's ComocnS_nDon cove ale for my employees worling on tins job: O=Uran=Comp. m•) (PeLic: Nu_ad cr) -- (1 ;-pinion DzL) O I am a sole proprietor, geacral contractor or homeow70er(Cilcie one) a-nd have hired the concraciprs listed below vvbo h2ve the folloVIM, Worlcet's comptn_s ion po!!cies: ('Name Oi co:'.Mcw0 ) Orisumrlcc Company/-Pobci Ntumh-c-) (YXJtTJuo D; -- (N:me of Cootramor) (Lnsaranc;. COMuaz"-1?OLie" Nuobcr) (Lxpi-zuon Date) (Name of Conmaci&) (Inswanc:. CompaDy/PoUq- Namber) (Expim000 Dam) (Namc of Cooaactor) (Insurance Compaay/Pol;cy Numbs) (Hxpi-,;oa Darr). (atI.ar.� i oral v'cct,iracxvl to inch iaform oo pc--ta.iaias to.0 mc1-r_o:n) q { ) I am a sole proprietor and bave no one working for me. ( ) I am.a home owner performing all the wofl` myself NOTE:ple be awlrc of +1 to boo=r vm u'bo cu ploy pc o,=m do cs c,ao r rapair work on.d­crl_;:of aoc mcct th_n latr_—j is ubicb the bomrwwnc hider or oa the p"o6 z�purtcvss t&-_a a.-c ox�.--ally occuid=cd to Lr c>nployc^r unr c the o==P�on Aa(G L1 S2=1(5)1.apptia.600 by.bommaw fm:lice or pcmn r=y c%id—LL- 'CVJ ctayc of ea cgloyec wader tlto WOrkr ec COCVI, .Lida Ad. I uadcnaad th¢a copy of lhia mt®mt may be fo.-+nrded In tbo Degeltmm¢of 1n�aLrial Acadc Off o0 of L'zx .D a for the oovcraSc Yeif alioa,aZd Uu L IILM W cecurc tovcry;�uodcr IccUon 23A of MOL 151 da led to the m pcm600 of cr=iasl prn+lEc3 00misi�of a fine of up to 51500.00 andlor of up Lo ooc year Lod c ail p upjc.in tS_form of-Slop Wort Order and a rim of S 1 00.00 a d_y aPjaa me For 6�. --,I u-only . Pctmrf Numb= Si�zZ�of Licrosctlperrniucc �� __ .� � SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: �WJr4y-j � �� �'�� License Number ' i Address 7� Expiration ate vl 4 1 C) Si re V Telephone 9� Not Applicable ❑Reiisreh�orn Im � �' Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION 1 INSURANCE AFFIDAVIT(M:G.L.c.152,§-25q-(16)) 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...... ❑ Nt 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-owna._parcel_ofland 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 Alterations) Roofing n Or Doors 0 `+^� Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [E:] Siding[l]] Other[O] Brief Work:Description of Proposed r"N f_ Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa;�'New f ous a d ti- "X- 3S LUC :OUSM, t2COM e: .o to t°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=OWNEF2 11lhTHOR1ZATION rf0 BEGQMP6 14 OWNERS.AGENT..OR=CONTRACTOR APPI-!ES FOR°.'BUILDING PERMIT r � L'&i�t?1/1 � ,as Owner of the subject property L hereby orize C nr( �� Gt �v"�I� Gd'D�f to act on behalf,in all�tter lative to work authorized by thi building p&rr6it application. Sig twe o Owner Date I, as Owner/Authorized Agent herehy 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 Rear Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (volume&Location) A. Has a Special Ponnit/Vahonoe/Fndi ng ever been issued for/on the site? �� �� NO �~� DON7KNOVV �~� YES x��� � IF YES, dotwissua& IF YES: Was the permit of Deeds? NO � 9 DON7KNUVV YES~-^ IF YES: ' enter Book ' Page' and/or Document#! B. Does the site contain a brook, body of water orwetlands? NO 0 DON7KNOV 0 YES 0 IF YES, has permit been or need tobe obtained from the Conservation Commission? Needs to be obtained v~~� Obtained '~~\ Date Issued: �~� ��' ' . C. Do any signs exist nn the pruperty �� ��� YES \_� 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 . grading,excavation,or filling)over 1 acre nris it part ofo common plan that will disturb over 1acre? YEG ���� NO C } �� IF YES,then a Northampton Storm Water Management Permit from the DPW is required. ` -City of Northampton Building Departments 212 Main Street a tcatit �' r Room 100 a � Northampton, MA 01060 phone 413r587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1,=SITE=INF.ORMATIONr' , 1.1 Property Address: This sectiort<"W1611-e com{�[e a IN 'K T�`V\ Zone�� � � � 4)ierlay�Dtstn.cts= s SECTION 2'-PROPERTY-'OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: �c�r�vi- Name( C +k C' T U�: Wit ` r' ) Current Ma" Address- _ _ ;j( Telephone Sig a ure 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone C r LUU�B SECTION-3-ESTIMATED CONSTRUCTION COSTS Item -- Estimated Cost(Dollars)to be Official Use Only completed by perm it-applicant - 1. Building ;(a)Suilding 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) Check Number This Section-,For Qffictal Us`60ril - -Building Permit Number.: Date:, Issued: Signature: Building Commissioner/inspector of Buildings Date 63 VERNON ST BP-2007-0364 GIs#: COMMONWEALTH OF MASSACHUSETTS MU:Block: 3 1 A-097 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-2007-0364 Project# JS-2007-000533 Est. Cost: $8900.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Edward T Corbett 119488 Lot Size(sq.ft.): 34804.44 Owner: CARTY SHARON Zoning URB Applicant: ANATOLY KISHKO AT: 63 VERNON ST Applicant Address: Phone: Insurance: 24 WEST SCHOOL ST WEST SPRINGFIELDMA01089 ISSUED ON:912912006 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF 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 9/29/2006 0:00:00 $25.00MO 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo