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36-357 °X /3Y' A" a INSURANCE BINDER DATE THIS BINDER IS A TEMPORARY INSURANCE CONTRACT SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM AGENCY COMPANY BINDER# Bell S Hudson Insurance Agency Peerless Insurance 81412309879 19 N. Main Street DATE EFFECTIVE TIME EXPIRATION DATE — TME- X I AM X 12:01 AM Belchertown MA 01007 12/2/2014 12:01 n PM 1/1/2015 NOON JA/C,NO Ext: (413)323-9611 a No l: (413)323-8132 THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY CODE: SUB CODE: PER EXPIRING POLICY# TBD AGENCY L 00009476 DESCRIPTION OF OPERATIONS/VEHICLESIPROPERTY(Including Locstlon) CUSTOMER INSURED Loc# 00001/Bldg# 00001 Hampshire Property Management Group 83 Emerson Way aka Lot 8 P.O. Box 686 Northampton, MA 01060 Attn: Russ Jopson .Northamptop MA 01061 COVERAGES LIMITS TYPE OF INSURANCE: COVERAGE/FORMS DEDUCTIBLE COINS% AMOUNT PROPERTY CAUSES OF LOSS Job Specific Builders Risk New 100 325,000 BASIC D BROAD Cr:.]SPEC Job Specific Special form GENERAL LIABILITY EACH OCCURRENCE $ DAMA E T COMMERCIAL GENERAL LIABILITY RENTED PREMISES _$ CLAIMS MADE []OCCUR MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ RETRO DATE FOR CLAIMS MADE: PRODUCTS-COMP/OP AGG $ VEHICLE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS MEDICAL PAYMENTS $ NON-OWNED AUTOS PERSONAL INJURY PROT $ UNINSURED MOTORIST $ $ VEHICLE PHYSICAL DAMAGE DED ALL VEHICLES SCHEDULED VEHICLES ACTUAL CASH VALUE COLLISION: STATED AMOUNT $ OTHER THAN COL: GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE: SELF-INSURED RETENTION $ WC STATUTORY LIMITS WORKER'S COMPENSATION E.L.EACH ACCIDENT $ AND EMPLOYER'S LIABILITY E.L.DISEASE-EA EMPLOYEE 1$ E.L.DISEASE-POLICY LIMIT $ SPECIAL Please refer to your policy for terms and Conditions of coverage. FEES_ $ CONDITIONS/NOTE: Contruction of this home is being done by Benchmark Custom TAXES $ OTHER COVERAGES BOMB. ESTIMATED TOTAL PREMIUM $ NAME&ADDRESS MORTGAGEE ADDITIONAL INSURED LOSS PAYEE LOAN# AUTHORIZED REPRESENTATIVE ----�-.-� M Tetrault CPCU, CIC/M ACORD 75(2010104) Page 1 of 2 ©1993-2010 ACORD CORPORATION. All rights reserved. INS075(2010041.02 Thu ArC%Rn namo anri innn 2m runiclnrurl marlrc of Af C%0n 3 `'n DEPARTMENT Or BUILDDtiG INSPECTIONS 212 M<dn Street ® •Muuicip31 Builduia JNSPECT(N Northampton,NIA 01060 LOCATION SQUARE FOOTAGE AMOUNT BASEMENT @ :20 0 1"FLOOR.@.50 2ND FLR @.30. .. V.FLOORS, FINISH ATTIC,GARAGE @.20 en DECKTORCHES @ .20 TOTAL. / 35.0 33K 6A / 3y2 / G a s 3y;•35 / 0 p N / Z F 3�3 g gtl.•S 83 EMERSON WAY NORTHAMPTON MA COSTA CONewnri0 ENOINEERO,INC. 104 M0ODY 8T. LUDLOW MA 01038 *CALM 1."mm sv QLC a^n Xx4m a MA"" =20' emm gr oLc DnTu 144 - ow�wwo wo. GRADING PLAN 0001 MUNICIPAL SEWER/AVAILABILITY APPLICATION Northampton Streets Department 125 Locust Street Northampton, MA 01060 587-1570 A Department of Public Works Trench Permit and Sewer Entry Permit shall be required prior to any construction or connection activity associated with this application. Location: 83 Emerson Way - Lot 8 Inquiry Made By: Donald Besancon 413-478-9528 Date of Inquiry: 11/13/14 Reason for Request: Hook into City Sewer New Construction Municipal Sewer Main in Front of Location: Yes No Municipal Storm Drain Available: 5 '/2 deep Yes No Size of Sewer Main: Material: Age: Depth of Sewer Main: Length of Sewer Main: Size of Service Connection: Type of Service Connection: Tie-in to Sanitary Main Tie-in to Sanitary Stub Comments: I V/9-J6 City Requires 6" cleanout installed at City Property Line Note: If this availability is for new construction, this form must be hand delivered to Building Inspector. A corresponding"sewer entrance fee"shall be paid prior to making any connection to the municipal sewer system.Arrangements of such installation shall be made with the Northampton Streets Department with a minimum of 5 working days notification. All work shall conform to Northampton Streets Department specifications. John Hall Sewer Department cc: Ned Huntley, Director DPW O,Al Louis Hasbrouck, Building Commissioner U MUNICIPAL WATER AVAILABILITY APPLICATION Northampton Water Department 237 Prospect St. Northampton, MA 01060 587-1097 A Department of Public Works Trench Permit shall be required prior to any construction or connection activity associated with this application. Location: 83 Emerson Way- Lot 8 Inquiry Made By: Donald Besancon 413-478-9528 Date of Inquiry: 11/13/14 Number of Type of Single Family X Type of Private X Units: 1 Unit (s :� Apart. Comm. Ownership: Condo Multi-family Rental (Annlicant t� _fill_�i�t the above) Municipal Water Main in Existing service to Front of Location? Yes: No: X site? Yes:X No Size of Water Main: 8" Material: Ductile Iron Age: 2010 Approximate Static Street Flow Test Conducted: Yes: No: X Pressure: 60psi If done attach results Size of Service Connection 1" Suggested Meter Size: 5/8" Comments: The Water Department cannot guarantee adequate water pressure during peak demand times at elevations above 320 feet. • A corresponding water entrance fee shall be paid prior to making any connection to the municipal water system. • Arrangements of such installation shall be made with the Northampton Water Department with a minimum of 5 working days notification. • 11 c 1 conform to Northampton Water Department specifications. l� go .Nuttelman, Superintendent of Water Dept. Water Entry $ 200 Meter$ 100 Radio $ 100 cc: Ned Huntley, Director Note: If this availability is for a new construction,it must be hand delivered to the Building Inspector. / r 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: The debris will be transported by: ;�i, 42 The debris will be received by: Building permit number: Name of Permit Applicant /Z/ ice Date Signature of Permit Applicant City of Northampton . Massachusetts5 ._,.. DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building ' Northampton, MA 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The 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 r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations } 600 Washington Street Boston, MA 02111 x www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name (Business/Organization/Individual): /�1i',iy.���✓ /��'fr9N�° Address: 5?0 �' ;S �,y s� ✓��'� ��L�`�'t,✓.,., /,-�ir�. ®/off) City/State/Zip: Phone #: Are you an employer? Check the appropriate box: Type of project (required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I ,�.�/�mployees (full and/or part-time).* have hired the sub-contractors 6. ['�ew construction 2.EV l am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.❑ Other employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: I z Date: Z"sz Phone#: ly — - �- Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable £ Name of License Holder: z2� Ww/l ����'� e*J li —®57!J Z('S— License Number 3D -�e S 2- 12- llc2 /P ^7 30)4 Address Expiration Date Signature Telephone 9..Reoister4Home Improvement Contractor: ;_ Not Applicable £ Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§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. 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 buildine 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 Ef Addition [] Replacement Windows Alterations) ❑ Roofing Or Doors 171 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[OT Other[a;�" Brief Description of Proposed Work: e /.vt e Alteration of existing bedroom Yes ✓No Adding new bedroom Yes y No Attached Narrative Renovating unfinished basement Yes L/ No Plans Attached Roll -Sheet 6a. if New house and or adtlition o ezistinq housinct, complete the foliowing: a. Use of building : One Family_� Two Family Other b. Number of rooms in each family unit: f1 Number of Bathrooms c. Is there a garage attached?f— Z Y36 d. Proposed Square footage of new construction. Dimensions G G e. Number of stories? / f. Method of heating? /1/9�✓lt r � !�. Fireplaces or Woodstoves �Number of each g. Energy Conservation Compliance, Masscheck Energy Compliance form attached?. h. Type of construction 1-a®0 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 3L,962a 10,16 a4544 as Owner of the subject property hereby authorize /r�v/a�� ��✓`d-'✓ to act on my behalf,in all matters rel v w u by this building permit application. Signature of Owner I,,/, /�'�/��,r�/ �j�}���NL ter✓ as Owner/Authorized Agen ereby 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 / L /� Signature of Ow r/Agent Date ' V � Section 4. ZONING AR Information Must Be Completed. Permit Can Be Denied Due To Incomptete Information Existing Proposed Required by Zoning 71iis column to be filled in by Building Department - ' Lot Size Frontage Setbacks Front r--=, I F3-67 Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) V #of Parking Spaces (volume&Location) to Has a Special Permit/Variance/Finding ever been issued for/on the site? �� �� NO ��n DONTKNOV� �_y YES �~� |F YES, date ioued: IF YES: Was the permit recorded at the Registry ofDeeds? NO �� D � ��' un � �nu� /c IF YES: enter Book Page' and/or Document# �� �� 90 Does the site contain e brook, body of water o/wedands7 NO ��� DONTKNDVY v�� YES ��' IF YES, has permit been or need to be obtained from the Conservation Commission? Needs tobeobtained v~� Dbtained «�\ Date ' �~� t_� ' �� C. Do any signs exist on the property? YES v�� 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: ^ x E. Will the construction activity disturb(clearing, grading ion.or filling)over 1 acre orioit part ofa common plan ' that will disturb over 1acre? YES NO Ka IF YES,then a Northampton Storm Water Management Permit from the DPW is required. ^ '- � } r x Department use onlx ' k City of Northampton Status ofPermr�t A _ Building Department Ggurb cuvDnc�eway Petrrtlt V li 212 Main Street Sewer/SepticA�airabtll{y ` Room 100 W6 tec/We1lAriailablllty { SEC , ,4 i hampton, MA 01060 Two Sets of S#r�rcturai Pians w phone l 3 587-1240 Fax 413-587-1272 PIo JSite Plans bons Otner5pec�fy 'APPLtCATf T CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be com leted by office 1.1 Property Address: - / p� =Zone � Overla District L Elm St District CB,Dlstnct _ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name Print Current Mailing Ad r / Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: - y --? 9J-zf Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Buildings—� P D (a) Building Permit Feb 2. Electrical JaC�o (b) Estimated Total Cost of �3 Construction from 6 3. Plumbing t/ppv Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection f��OO 6. Total=(1 +2+3+4+5) 31'J-d U'd 1 Check Number A0 AAA This Section For Official'Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings. Date File#BP-2015-0632 IJ APPLICANT/CONTACT PERSON DONALD R BESANCON Pea, ADDRESS/PHONE P O BOX 520 BELCHERTOWN (413)478-9528 PROPERTY LOCATION 83 EMERSON WAY-LOT 8 MAP 36 PARCEL 357 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildina Permit Filled out Fee Paid Tyneof Construction: CONSTRUCT SFH W/ATT GARAGE/2 PORCHES New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 94265 3 sets of Plans/Plot Plan j?5 e-t'P yeI :, THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFffRMATION 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 moliti ela 4 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. 83 EME SON WAY-LOT 8 BP-2015-0632 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36-357 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) New Single Family Cate�ory � v House BUILDING PERMIT Permit# BP-2015-0632 Project# JS-2015-001213 Est. Cost: $325000.00 Fee: $947.60 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: DONALD R BESANCON 94265 Lot Size(sq.ft.): 11412.72 Owner: HAMPSHIRE PROPERTY MANAGEMENT Zoning-: Applicant: DONALD R BESANCON AT. 83 EMERSON WAY - LOT 8 Applicant Address: Phone: Insurance: P O BOX 520 (413) 478-9528 BELCH ERTOWNMA01007 ISSUED ON.112112015 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT SFH WATT GARAGE/2 PORCHES 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 1/21/2015 0:00:00 $947.60 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner