Loading...
17A-183 6/15/2006 4:42 PA FksM: The Jarrett Agency The Jarrett Agency TO: +1 (413) 5871272 PAGE: 002 OF 002 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) rn, 06115!2006 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE The Jarrett Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 657 Enfield Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O.Box 1195 Enfield CT 06083 INSURERS AFFORDING COVERAGE NAIC# INSURED Stefanos Aluminum&Vinyl Siding,LLC INSURER A: Travelers Insurance Company 112 Post Office Rd INSURER B INSURER C Enfield CT 06082 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 D'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION irjqpn TYPE OF INSURANCF LIMITS-DATE IMP M1DDfYYI GENERAL LIABILITY EACI-I OCCURRENCE $1,000,000 DAMAGE TO RENTED A X COMMERCIAL GENERAL_LIABILITY I-680-3403A902 081092005 0810612006 PREMIS- -a occurencel $300,000 CLAIMS MADE n OCCUR MED EXP(Any one person) $500,000 _ ---- PERSONAL&ADV INJURY $ 1,000,000 GENERAL-AGGRFGATF $2,000,000 GEN'L AGGREGATE APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $500,000 A ANY AUTO 1-810-3404A020 08106/2005 08012006 (Ea accident) X ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR E] CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ X WC STATU- OTH- WORKERS COMPENSATION AND AML -EFL A EMPLOYERS'LIABILITY 6KUB-7533A66-805 05/08/2006 05/0812007 EL.EACH ACCIDENT $100,000 ANY PROPRIETOR(PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? E .DISEASE-EA EMPLOYEE $100,000 It yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 OTHER 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 City of Northampton Massachusetts DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN Department of Building Inspections NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 212 Main Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Municipal Building REPRESENTATIVES. Northampton,MA 01060 AUTHORIZED REPRESENTATIVE � �MLM> ; ACORD 25(2001108) ©ACORD CORPORATION 1988 Y SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address ffll Expiration Date V ) Vr !\i E Telephon 2 - f 7 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 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 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. f Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors ❑ le Accessory Bldg. ❑ Demolition ❑ New Signs Decks [Q Siding[ Other[ER Brief De 'pti0Q of Proposed Work: 1—G�— \' a 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 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject propel �l f hereby authorize to act on m behalf 7A'nII matters relative to work authorized by this building permit appli tion. !�' Signatufe of Owner Date l 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 Spe al Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW Q YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW Q YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained 0 , Date Issued: C. Do any signs exist on the property? YES Q NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O 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 O NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only -Gity of Northampton Status of Permit: �lding Department Curb Cut/Driveway Permit 12 Main Street Sewer/Septic Availability f 'I Room 100 Water/Well Availability NotAmpton, MA 01060 Two Sets of Structural Plans phone 413,587-1240 Fax 413-587-1272 Plot/Site Plans ' Other Specify APi(i, ATION'Td CbiS`MCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Prooerty Address: This section to be completed by office I gs- Map Lot Unit Zone Overlay District F/-0 l C Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 'v Name(P'nt) Current Mail' g Addres Signature 4L 1 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com feted by ermit applicant 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 Section For Official Use Only Building ermit Number: Date g Issued: Signature: Building Commissioner/Inspector of Buildings Date BP-2006-1368 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-1368 Project# JS-2006-2019 Est.Cost: $17500.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: STEFANOS ALUMINUM & VINYL SIDING LLC 131405 Lot Size(sq. ft.): 7187.40 Owner: HAHN KENNETH M& Zoning:URB Applicant: STEFANOS ALUMINUM & VINYL SIDING LLC AT. 185 NORTH MAPLE ST Applicant Address: Phone: Insurance: 112 POST OFFICE RD (860) 253-9583 WC ENFIELDCT06082 ISSUED ON.611612006 0:00:00 TO PERFORM THE FOLLOWING WORK.-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: FeeType• Date Paid: Amount: Building 6/16/2006 0:00:00 $25.002067 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo