Loading...
17C-056 (2) AC0� L , CERTIFICATE OF LIABILITY INSURANCE ioi3iizooZ PRODUCER (413)527-5520 FAX (413)527-5970 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Fi nck & Perras Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 6 Campus Lane ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Easthampton, MA 01027 INSURERS AFFORDING COVERAGE Rebecca Kubosiak INSURED Thomas McCarthy General Contractors,Inc. INSURER A: Blue Ridge Insurance Company 3 Broderick St INSURER B: Masswest Insurance Company Easthampton, MA 01027 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. r A POLICY EFFECTIVE POLICY EXPIRATION LIMITS TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MMIDDIYY GENERAL LIABILITY RT0353741 02/10/2002 02/10/2003 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ 50,000 CLAIMS MADE a OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- AUTOMOBILE 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 LIABILITY EACH OCCURRENCE $ OCCUR FI CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WCM0010642 02/10/2002 02/10/2003 ORY LIMITS I I ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 100,000 B E.L.DISEASE-EA EMPLOYEE $ 100,000 E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL City of Northampton 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Att: Building Inspector 212 Main Street Room 100 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Municipal Building OF ANY KIN ,UPON THE COMPANY,ITS AGENT PRESENTATIVES. Northampton, MA 01060 AUTHORI/ REPRESENTATIVE ACORD 25-S(7/97) ©ACORD CORPORATION 1988 Steve& Jackie Lapienski 586-5290 10/28/2002 174 Chestnut St. Same Florence,Ma 01062 Same Nov. Jackie: 584-1106 Estimate for the following work at the above listed address. The estimate includes the following: Building out 20 windows, remove shutters,gutters& downspouts,install 3/8" insulating backer board, remove side entrance door openings, side with premium Nantucket vinyl siding in Estate Grey, 4" ,wrap all trim in white, open so flits, install 5 pairs new vinyl shutters in the loover style, color Burgundy also, electrical work for siding as needed, and hanging old or new exterior fixfures. Strip entire roof, make necessary trim repairs, install new dripedge and other flashing as needed,install ice and water barrier along eaves and vAeys. Install 151b. felt paper, 30 ear arch shingles install ridge vent'on lower sloped roofs cover entire area with ice and water barrier. Color,Rustic black. Mcludes installin g new white seamless gutters& downspouts. Remove 20 existing windows, supply and install 18 double hung Mastic trimlock,2000,6/6 grids, all with 1/2 screens,& install 2 fix glass 6 lites,for the garage windows. Install 1 new Anderson slider ermashield, white exterior& interior, trim inside and and out as needed. 1-6'0" x 6?8",with screen and all standard hardware. Remove old furnace,install new 1 Comfortmaker GN-075 naturat gAs higkbnv warm air fiirnace SOO/& AFIIE, 1 Comfortmaker chimney kit adapter, I cold air return pgokage-install ver t pipe i&urn rxriiace to chimney, connect new furnace to existing duct work,connect exisiting gas line to new furnace with separate shut-off,remove and dispose offiirnace, humidifyer& electrical included. The estimate includes removing and installing new Therma tru front door,#236,3'0" x 6'8",and installing a new Kaskel white storm door model advan*age crossbuck, 3'0" x 6'8" All rubbish removal is included& clean-up is included. Regular Total: $33,700.00 Mass. Construction Supervisor's License#053221, ex. 05/23/03 Mass. Home Improvement Contractor's Registration 4100364 ex. 6/16/04 See some of our projects on the internet-At Rugglumber.com& http://www.eastahmptonweb.com/mccarthy E-mail address-TCMGCI @AOL.com Thirty Two Thousand and xx/100--------------------------------------------------- $32,000.00 Upon progress 45 0�1 O 9 , 8 �Zf� lCl� �aZ��J�1111�:T�DIT z - d =sexrhnsrtte' m DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 ' WORKER'S COMPENSATION INSURANCE AF A A,VIT with a principal place of business/residence at: `�5 (stye City/slate/zip) do hereby certify, under the pains and penalties of perjury, that: (�4-I am an employer providing the following ,.vorker's compensation coverage for my employees workng on this job. (In=uic- Company) (Pclicy Number) (Expiration Date) O I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers compensation policies: (Name of Contractor) (Insurancc Comparry/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Compam,/Policy Number) (Expiration Date) (Name of Contractor) (lnsurancti Comps}/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Comp:ay/Policy Number) (Expiration Date) (attadi additicail ixd ifnocc ry to iadudc iafocinstion pcftama r&to all � ) I mn it sole proprietor and have no one working for me. ( ) X am a home owner performing all the worm myself. NOTE:ptcssc be awr4rc that wt.do hoar_owixn%Nbo employ paso:s to d�)¢�aintcaancr,co=-ruc ion cr rrpair�xurk on a dwcl g of not mote tll.n three units in which the ho-.ncouvcr raider or oo the gro 4-:,s zprurtcruat thcrcto arc not G-cncrally coasidcrcd to be cmploycra under the veoriccr's ccxnper_4oa Act(GL152,-i 1(5)�application by a homoowrxs for a 6--Ic oc Pcfmit tnay c�Tdcaoc the Icg21 ctatua of an employor under the Wuk'cet cocnpmznt Act I undcnt snd thst a copy of this etatcmccd may bo forwnrdnd to tbo Dtpartaxnt of Inrhtstn d Aocie'W&Offioo of In—r—oa for the coverage va-ific atioa and that fad=to!—ire coverage urxler scctioa 25A of MOL 152 can lmd to tbo imposition of auniml penslfts -alLgiug of a fine of up to S 1,500.00 and/or imprisoamart of up to one year and civil pcnsltics in the form of a stop Work Order and a find of S 100.00 a day IL&Liast me 9 For c-Wrne jw UPC only permit Ntunber mip"{ -- Lot Sigi,ttum of LiccnswJPermittce e . SECTION 8-'CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder 0,3 License Number — Address Expiration D to Signature Telephone 2)- Reg"s'teretliHame;Im rQvement Contractor: �° `� ��.n..• . _ ... a _ � . Not Applicable ❑ Company Name Regist. .,r�n Number Address Expiration Date r- Telephone qr 3 -5 Uj SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted Mtn this application. Failure to provide this affidavit ,Hill result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... ❑ No...... ❑ 11: : omen :caner 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 buildi i 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 fc-which this permit is issued. Also be advised that with reference to Chap-,c r 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 persons) 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) Roofing Or Doors );�- Accessory Bldg. ❑ Demoliti n j _ New Signs [ ] Decks [ ] Siding [�6 Other [ ] Brief Description of Propose Work: Fe '- e �, ���� etiF2�" f S' z��� ��'�'��'�` � ���9"- v'JI-, Alteration of existing bedroom Yes _ No Adding new bedroom Yes _ No Attached Narrative Renovating unfinished basement Yes -'X—No Plans Attached Role Sheet 0 6a If N`euy house a I'd `orf ad"diti6n to bxistinf�:f ousinf7;,:compI6te th`6J611 dwifti7: 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. _ ._ Mascheck 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 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT � 9 as Owner of the subject property hereby authorized� _��,_GC t e��r._�` �_ _ _ ____ ___ to act on my behalf, in all m ters relative to work authorized by this building permit application. r4� �UL' �` __ - c.�- _ �:..•a--.�7� r`��t.�..n Date Si a ure of Owner g r/ L� �-� �, - � as Owner/Authorized Agent et — hereby declare that the statements and infor anon on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Pc e�f Owner/A Owner/Agent Date i Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF 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/Finding ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book _ Page and/or Document # 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 Obtained _ Date Issued: C. Do any signs exist on the property? 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 _ No- IF-YES, describe size, type and location: City of Northampton S t Building Department G. 212 Main Street Room 100 a e Northampton, MA 01060 e phone 413.587-1240 Fax 413-5871272 P o IS�te , O�erSP A jP,ICATICSdN, t 0NS RUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE Oft TWO FAMILY DWELLING SECTION 1 SITE INFORMK,tIJ0N 1.1 Property Add'ressla This sectionAo-;164e eompleted by office � f Map Zone Overlay Dis#rict3 _ r } n re ar e A c>/0 Elm St. District CB'Diste,0' SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record_: I r'' _ fie_ -mac 1- ns15 _�?Ci Name(Print) ent 4vlafhri,Address: qo- �cl2�,Q.��� Telephone Sig ature ` 2.2 Authorized Agent: Cr. Nameri t) Current Mailing Address: A G- Signature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by errnit applicant 1. Building 66 (a) Building Permit Fee 2. Elecirical �� (b) Estimated Total Cost of _ __ Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) /'1© e e 5. Fire Protection _ 6. Total = (1 + 2 + 3 + 4 + 5) 0601 d) 0 Check Number :;zl pZ� This Section For Official Use Only Building Permit Number: _ Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 174 CHESTNUT ST BP-2003.0476 GIS#: COMMONWEALTH OF MASSACHUSETTS Map-.Block: 17C-056 CITY OF NORTHAMPTON Lot: -001 Permit: B u i I d i ng Category: BUILDING PERMIT Permit# BP-2003.0476 Project# JS-2003-0796 Est.Cost: $32000.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Thomas C McCarthy 100364 Lot Sizes .ft.): 15899.40 Owner: LAPIENSKI STEVE&JACKIE Zoning:URA Applicant: Thomas C McCarthy AT. 174 CHESTNUT ST Applicant Address: Phone: Insurance: 3 BRODERICK ST (413) 527-5141 Workers Compensation EASTHAMPTONMA01027 ISSUED ON:1117102 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF, REPLACEMENT WINDOWS, DOORS & SLIDER & INSTALL SIDING 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 11/7/02 0:00:00 1012 $25.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 174 CHESTNUT ST BP-2003-0476 GIS#: COMMONWEALTH OF MASSACHUSETTS Ma :Block: 17C-056 CITY OF NORTHAMPTON Lot: -001 Permit: BuildinE Categoa.L BUILDING PERMIT Permit# BP-2003-0476 Project# JS-2003-0796 Est.Cost: $32000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Thomas C McCarthy 100364 Lot Size(sq. ft.): 15899.40 Owner: LAPIENSKI STEVE&JACKIE zonin •URA Applicant Thomas C McCarthy AT. 174 CHESTNUT ST Applicant Address: Phone: Insurance: 3 BRODERICK ST (413) 527-5141 Workers Compensation EASTHAMPTONMA01027 ISSUED ON:1117102 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF, REPLACEMENT WINDOWS, DOORS & SLIDER & INSTALL SIDING 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 F9repisce/C Inimna-xY Rough: Oil: Insulation: Final: Smoke: Final:pk- .2-11-03 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLA OF ANY OF ITS RULES AND REGULATIONS. J Certificate of Occupancy Fee Type: Receipt No: Date Paid: Check No: Amount: Building 11/7/02 0:00:00 1012 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo