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28-026 Massachusetts Electric A National Grid Company April 13, 2005 Evelyn Towne 26 Church St. Easthampton, MA 01027 To Whom It May Concern, This is to verify that Massachusetts Electric has removed the electric service and meter at 680 Ryan Rd., Florence, Massachusetts, Meter# 099019039, effective April 12, 2005, for Building Demolition. Sincerely, f, d /Jim Nichols Supervisor Distribution Design JN/ekp 939 Southbridge Street Worcester,MA 01610-2293 508.860.6000 S jr ounce com A nr�s any� ?.025 Roosevelt Avenue RQ. Box 2025 Springfield,MA 01102-20255 April. 29, 2005 EVELYH TOWNE 26 CHURCH ST EASTHAMPTON MA 01027 Dear EVELYN TOWNE, The address listed below has had the gas service(s) disconnected and is now ready for demolition. ADDRESS: 680 RYAN RD TOWN. : FLORENCE STATE : Massacbmuetts Sincerely Terri Mines Workforce Planning DATE(1AMiL JIYYYY) ACORP. CERTIFICATE OF LIABILITY INSURANCE 03/04/2005 PRODUCER (413)586-0111 FAX (413)586-6481 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Webber & Grinnell Ins. Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 8 North Kin Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR King ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 538 Northampton, MA 01061-0538 INSURERS AFFORDING COVERAGE NAIC# INSURED Theodore D Towne, Inc. INSURERA: National Grange Mutual Ins. Co 14788 75-M Parsons Street INSURERS: American International/TPA Easthampton, MA 01027-2529 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 1S SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE fmmIDDIYYI LTR GENERAL LIABILITY MSF67106 05/26/2004 05/26/2005 EACH OCCURRENCE $ 11000,000 . X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,000 CLAIMS MADE FX OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,0001 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY M P JECT RO LOC 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 EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC7686357 05/20/2004 05/20/2005 I WCSTATU- OTH- EMPLOYERS'LIABILITY EACH ACCIDENT $ 100,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. _ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 L_i7 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I 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, Theodore Towne BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 26 Church Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, Easthampton, MA 01027 AUTHORIZED REPRESENTATIVE Jenna Rodri ue ACORD 25(2001/08) ©ACORD CORPORATION 1988 Ctyx#y ofoz#1�tt11ttolt z r $ � �!'ilssaAChusetts DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR '2112 Main Street • Muuicipal Building Northampton,MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as i:is/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 two famlty- - ' 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 eegulations. 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 ti J.. E (rzf of "ICINTorillai)tpfoil — g "' E �Z+ssirritnsrlte' DEPARTMENT OP BUILDrNG INSPEMO1.'S - 212 Alain Street ' Municipal Building Northampton, Mass. 01060 WORICER'S C06QENSATTOlei MSUTZA-NCF AI"I17��1.�11`T" (]i ccusx/pertn�tfcc) \I.rith a principal place of businesslresidencc at: - — �� C�u.-�'� ,� ��1<��-�, (phoney') ��7•—`j(/�� (sttr_..t/ri y/siatdap) do hereby certify, under thc.pa_ins and penalties of perjury:, thai ( ) I am an employer providing the following worker's comocnsadou cove�zge for my etoplovecs wo6ang on dlis job: (layu-r n=Comps (Policy?:u--Zb-cr) (r: ir.UO.DaL.) O I am a sole proprietor, general contractor or homeowner (c cie oee) and hzve hired the coniractors listed below who have the worker's coCBensallon pakies: (Mgmc 0f Con- I cior) (Inn rantx COInOaJI)-/PGUCi ?gti1II1LGI) D11C) (Name of Coatractor) (Lis-w-'cncc ComoanviPol cC Numcsr) (-E-,-Dir Lion Date) (Name of Conu-aclo,-) Gzsurancc Compzuy/PoUc}• Namber) (Expiraoa Date) (Name of Contractor) (Iasuraac-- Comcaay/Pobcy Numb•r) (Expiration Dalr) . (.a-ch addi-�ocal dccc.Iacc�u�•to atc?u�infortn.-ioa periAiain6 to.11 ccc=-to a) O I am'a sale proprietor and have no one working for me. ( ) I am.a home owner performing all the work myself. NOTE:plc==be ew-im t1,,wt le 6emeo.+vm .•bo ,=ploy pcz.oas to do =_--=jao c reps r work oa a d%•elL•-F of not mete th:n t'.1-oe t�r�is the bomoo+wc read.or oa dc F3-ouod3 zppajjcc.=tbe= a<-r as ac:d.7n!to be enploycs and the..vci d cexp�-.,m Aa{GIJl SZn l(S) =Ppliaow by.bomcoQaa far-tics_«pezai:r=y c.-idmce tre lcpl n'^.•of eo<-ePloyor aodc dto Wa,+c .Compomat Act I and—I—d rb.e a oopy of thi.=I=mam m.y be f---,ded to ttw OW ..... ar Acrid—&OQo0 or Irr—for U. coverage va'ifelioa and the U- tac t.o secure)ovrrnse undcr soetioa 23 A of MOL 132 m Icd to the imposition of eimics Pcaaltia coasi,ag of a fioe orup to S 1 500.00 and/or 6rgri-%(� of up to ooc ycr end aNil Pas.ltia is 6e roan Ora Stop Wort ordc+rid+ - f=o(S 100.00 a d_y LFpinst me For dW^ 1,t u,c only .� \�. Pcrviit Nuinbcr " c ^'V'� --- - (J N,a P=_- Lot Signau,n of Li crmiucc e SECTION 8-CONSTRUCTION SERVICES "I 8.1 Licensed Construction Supervisor: Not Applicable ❑ , Lam' J Name of License Holder: i 4"-e tai .+� �'��"k ns N Number License Number A, Address Expiration Date Signature Telephone Not Applicable licable ❑ �R+eaeser"e�"t�'o'fn��n`rarrernen��c�ai ". PP Company Name Registration Num er -_-— Address Expiration Date Telephone SECTION 10-WORKERS'"COMPENSATION INSURANCE.AFFI©AVFT(M 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...... ❑ hs''2\ �5'L'4"�i'"' ' Rtl'aFE4 �vFl�.•�a.S.,.` .«.� fi 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 BBuilding Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature r I SECTION 5-DESCRIPTION OF PROPOSED WORK(check alkapplicabtel New House [] Addition ❑. Replacement Windows Alterations) ❑ Roofing Or Doors Accessory Bldg. ❑ Demolition New Signs [o] Decks [p Siding[0] Other[O] Brief Description of Proposed �L' � !✓ Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No . Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6'a.L�Flevw�tovseaf�' +ate ci�iotlstlnciaaslrtc�,Ca�b ef�l` c><C�.��g: 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`Ta-,OWNER.AUTHORIZATIO14 TO"BE COMEtETED,;WHEN. OWNERS AGENT:AR CONTRACTOR APPLIES 611 BNILDtN°Pz ERMIT as Owner of the subject property hereby authorize '}-c � - zK• 't to act on my behalf,in alf matters relative fo work authorized by this building permit application. I-"c31�L Signature of Owner 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 under the pains and penalties of perjury. s 72 �Tc- <v Print Name Z4 •1) a A Signature/6f wner/Agent Date ' ° ~ Section 4. ZONING All Informati6h 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 Setbacks Front Rear Building Height Bldg.Square Footage Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces Fill: F- ' A. Has a Special Perm it/Vuhonce/Fndi ng ever been issued for/on the site? ' NO 0 DONT KNOW 0 YES 0 � IF YES, date issued: IF YES: Was the permit recorded otthe Registry of Deeds? �� NO �� DONTKNOVV 0 YES IF YES: enter Book Page; and/or Document#; , �� B. Does the site contain abrook, body of water orset|onds ��NO v�� DON'T KNOW �~� YES v�� IF YES, has permit been or need to be obtained from the Conservation Commission? ' Needs tobaobtained x��~� Obtained �x��~� Date' � C. Do any signs exist on the pruperty �� YES v�� NO v�� IF YES, describe size, type and |onodun: 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, ur filling)over 1 acre urisd part ofa common plan that will disturb over 1acre? YEGK > r NO 0 _ / _ IF YES,then o Northampton Storm Water Management Permit from the DPW isrequired. ` ' _ A City of Nort f ampton G ",building Department \ 212 Main Street ;Room 100 e �,Torthampton; MA 01060 e r a pl�onk-413-587-12 0 Fax 413-587-1272 r a APPLICATION;') CQNSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION"'' SIT :INFORMATION ` � �� This sectron to he{com�let�d?nbyroffice d 1.1 Property Address: x r Co �� P Y G n Nla 1_ot' w „ Dntt Zone. � OverlayDistncf El`ntzSt�Distncf r"' � C�D�str�ctw � � ti SECTION:2-PROPERTY'OWNERSHIP/AUTHORIZED AGENT: 2.1 Owner of Record: 'O'n !—1 'n&0 �r y '�. - Name(Print) Current iling Addr ss: w'—Telephone nature 14 1,3 ;; - - CIO U 2.2 Authori zed Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMA7ED'CONSTRUCTION COSTS- Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a).Building 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 Sectiaft,dO Official Use Only Building Permit Number. Dsued; Signature: r i Building Commissionedlnspector of Buildings Date File#BP-2005-1071 APPLICANT/CONTACT PERSON THEODORE D TOWNE ADDRESS/PHONE 67 DIVISION ST EASTHAMPTON (413) 527-9060 PROPERTY LOCATION 6 O'DONNELL DR MAP 28 PARCEL 026 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildinia Permit Filled out Fee Paid Typeof Construction: REMOVE TRAILER New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 000724 3 sets of Plans/Plot Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION 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 Stre ommission �- 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. 6 ODONNELL DR BP-2005-1071 G1S#: COMMONWEALTH OF MASSACHUSETTS Map:Block:28-026 CITY OF NORTHAMPTON Lot: -001 Permit: BuiidinQ Category: demolition BUILDING PERMIT Permit# BP-2005-1071 Project# JS-2005-1170 Est. Cost: Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: THEODORE D TOWNE 000724 Lot Size(sa. ft.): 17772.48 Owner: TOWNE THEODORE&EVELYN M zoning: SR Applicant: THEODORE D TOWNE AT. 6 O'DONNELL DR Applicant Address: Phone: Insurance: 67 DIVISION ST (413) 527-9060 WC EASTHAMPTONMA01027 ISSUED ON.5116105 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE TRAILER 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 Occu anc Si nature: FeeType• Date Paid: Amount: Building 5/16/05 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo