17C-148 (8) 08/02001 09:23 4135679105 S G SIMONS PAGE 02
..... :..; DATE(MM'OEMI
CQRL7 E �' .�•�;�•�: '�� � ,�::'.::;= 08/07/01
: :
PRROOMER THIS CERTIFICATE IS ISSUED AS A WkTTER OF INFORMA T ION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
S G N3im=a Co., Inc HOLDEP..THIS CERTIFICATE DOES N(:T AMENO,EXTEND OR
95 Ashley Avenue ALTER T H5 COVERAGE AFFORDED BY THE POLICIES BELOW.
West SpringEield DSA 01081 COMPA.MES AFFORDING COVERAGI=
Joan 0. Kavanagh LCl.7PANY
PttoneNo. 411-281-7000 F,m 13-733-9545 A Zurich-AInericaa T•:laurance Co
INSURED COMPANY
B
Paul Davie Systems if H=Pden COMPANY
County Inc O —
141 Main Street COMPANY
Indian Orchard MA 0 .151-1143 i p
1C V
da~PG
..
THIS IS TO CERTIFY THAT THE POLICIES•OF NSURaNCG LISTED BELCVI HAVE 6EEN ISS:JED TO THE INSURED NA14tED ABOVE FOR THE POLICY N'r_R107
INDCATEO•NOTY11TH$TANDI\G ANY ZQU ZEAIENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER OOC:JMENf Y!?H RESPECT TO VIHIC H THIS
GERT+FICATE M.4Y BE GSUED OR MAY PER aC4.THE II:SUR4NCE AFFORDED BY THE POLICIES DES"BRIBE'D HEREIN Z SU3JECTTO ALL`HE WIMS.
EXCLUSIONS AND CONDITIONS OF SUCH P LOiS.LI`l,ITS SHOWN SIrY HAVE'6PEENI RZOUCED EY FAIC CLAi.15.
CY
CO ' = IN9URANGE POL-YVUMBER EX°iR4TQ UV(TS
LTR
LATE(aAMJOD" i G4TE(Fda'uu'i")
+ IGFNERAL UABILITY !C NERAAL—GSREGhTE s2000000
b ce:rnEYcwL�-r:Eru_I,wB.!T� j iGT36c536G9 os/O1;O1 11 08/01/02 FE;RS d' DCT;-C0VF!C>AW $ 2000000
CLAIVSMADE aOCCURI i tir,vIruuR'r $10CC000
OVdNE�<3 8 CONTRACTOR'S PROT i URSiENCE S 10 0 0 0 O O
„E(Any one ore) S 3 00 0 0 0
tn;'p Uptacr( S10000
AUTOMOBILE LIAB(LITY i I lX7t.Dll SINGLE LIM'.T $
ANY AUrO
ALL OWNED AUT06 BODILYIN.IJRN' 3
SC•4;:DULEO AUTOS (Per pew-)
HIRED AVTDS
BODLYINJJRY
NON-OWNELAUTO3 i I(PCraoSdr.0 s
! PROPERT`•UWAGS $
GARAGELMLi Y AUTO ONLI''EAACCIDENT $
ANYAUTO I OTHER TH4 AUTO ONLY:
—^
FINCH ACCIDENT $
AGGREGATE 3
EXCESS LIABILITY F1.CHOCC(JRRENGE t1000000
A X uMRELLAFORM SCP36653609 08/01/01 08/01/02 A GGPECAI S1000000
OTHER THAN UMBRELLA FORK. 3
WC.°,fATtl. 0TH•:.::..•.•.•.•.•.•.•.•••.•:••.•.•.•.•.
WORKERS COMPENSATION AND I I TORY,:IMTG ER .•.•.•.•.:.;.:.:.•.•.:.:.:.:.:
EMPLOYERS'LIABILITY EL EACHAjXIDENT $500000
A THEPROPRIEYORI INCL KC5834243901 08/01/01 08/01/02 ELDISFA I.-PPOUCYLIIJIT f 500000
PARTNERSFXECUTNE
CFFICERSAR_: RUCL EL OI SEAS H•EA EMPLOYEE f 500000
OTHER
I
I
DESCRIPTION OF OPERATIONSILCCATION,&%rJ CLESrSPECYAL ITEMS
!....Y- IGA.1 1�Ld
EFf
C4NCELL ?►QN:
TO WHOM SHOULD ANY OF THE ABOVE DESCRIBED POIJ IES BE WI CELLED 89FORETHE
E\'PLRAT.'ON DATE THER7F,THE ISSUING CO OFANY VOLL ENDEAVOR TO NAIL
20 DAYS WRITTEN NOTICE TO THE C ERTI!=TE HOLO&P.NAMED TO THE LEFT.
BUT FAILURE TO ra'a.SUCH NO DICE•S IN'OSE NO CBLIGATION OR NAB LITY
To Whom It May I oncern
OF A D UPON YHE CC'MPAh ,1TS CENT:i OR REPRES'eNi'.4TNE .
AUTHORIZED P AnV= �1
s avaaag
2
:PC
fi
0 8
I
,May 14 02 09: 30a P•6
I;EVARiMCN! OP
�. __
212 !,.lam Strict Municipal ?iilild r.r;
N3ULlicmptori, At
\Y()ll'llll.,W,.', C0,1MITENSATION
C'/ x%(74 7-1 6ji
MY
do hmuQ mah, urno the PITS ad pauXes of peTign M:
providins l,11'2 Follo%vin \vor4:cl-s Iry
s v u -I �u 0 -'.I i S}L"1)
--7
(P o L
—'Qd
use Coll--3C.Drs Lnc,,H Lelcv,, --to h?w-, Lb°_ 'I(Anmq pCN:w's
Onaray, campm5mos" &Won) jymmo Dow)
Co!lu-xicr) (LLsul-a-a(z CouipjY[PoLcy Nl-moL'
sole pro �)Flctuf Crd have :10 CDC wor�:-uig
"L:l hook mVI)en perfoln',ills aL. I-bc work rnysctf
u e—
"FY of L"—`—c Y b- W'a.
--"j a" W�— so Qq 7,A ,i K(Oi. Cw 1,J L',Jx
c is cf I—0r up t,<!ticc.&O cr UP to ci of n Sk,
rim 0( 100.00 y t
-May 14 02 09: 29a p-5
SECTIONS-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: I Not Applicable ❑
Name of License Holder
License Number
Address Expiration Qate
. i ature - Telephone
isteedsl lsmellLlfRl►or�lR�lltContrae ' 'i., ti " Not Applicable ❑
ComlI- Name —� Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,125C(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.......46-� No...... ❑
.....................................................
.....................................................
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 108.3.3.1.
Definition of Homeowner:Person(s)who own a parcel of land an 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"homeommee,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 Massachuscus General Laws Annotated.
Homeowner Signature
May 14 02 09:28a P. 3
•
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: <i_R: R:_ _
Rear
Building Height n
Bldg. Square Footage f 5 %
Open Space Footage % T�
{Lot area minus bldg&paved
atkin )
of?arking Spaces
I
Fill:
vuiume&Location) �r,4
A, Has a S cial 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 t. a site contain a brook, body of water or wetlands? NO DON'T KNOW
YES _
�C-
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained_-_Obtained Date Issued:�_r
C. Do any signs exist on the property? YES NO _7 .-
IF YES, describe size, type and location: _
D. Ar there any proposed changes to or additions of signs intended for the property?YES
No
IF YES, describe size, type and location: _.
_
BOARD OF BUILDING REGULATIONS It
t License. CONSTRUCTION SUPERVISOR !
Number—CS 052369
Blr#hddte;.1212111953
Explres, i?J21i2002 Tr.no: 6051
' d
RwIrIcted Tq. Ot3
DAVID R LESSARD
20 HASTINGS ST -�.
FEEDING HILLS, MA 01030 Administrator
e
HOME IMPROVEMENT CONTRACTOR
Registration. 113865
TYPe x ZINDIVIDUAL.
Expira�t!ion 07119M-
.DAVID✓`CRR LESSARD ^x'
fir: t> s< ce�.r�o 13 NEW BROADWAY
-if tWSTFIELD MA 01085
ADMM'STRATOR ... ...
May 14 02 09: 29a p• 4
SECTION 5•DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition Cl Replacement Windows Aiteratian(s)O Roofing c
Or Doors 11
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ J Siding[ J Other[ ]
Brief Description of Proposed Work:_
Alteration of ex;sting bedroom__YYes No Adding new bedroom---Yes No
Attached Narrat've r- Renovating unfinishad basement Yes _,No
Plans Attached Roll C- Sheet r_I
�g<:�'�����#141t�1��i�1#d���K�����lxt'���'�i fa#�$��t0�►`�f��;��A��. $�thl�='#t17�4�11Fft1$'
a. Use of building: One Family _ Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
e. 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. Masoheck Energy Compliance form attached?_
f1.. Type of construction
i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain__—_Yes No
I. 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 C ONTRACTOR APPLIES FOR BUILDING PERMIT
i, - (-,I /
1 i I(eJ i � �Cr as Owner of the subject property
hereby authorize _ ____ ___ to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Cwner Date
as Owner/Authorized Agent
hereby declare that the statements and information on the foregoirg application are true and accurate,to the best of my
knowledge and belief.
Signed under the pairs and penalties of perjury.
Pri Mme
_._
—
Signature of O%vrer,'Agent Date
May 14 02 09; 28a p.2
City of Northampton ,
,, tait�ltWepartment
17 +,r
x;
2 ?'�~in Street . Vs .
Qm 100 Wafrarl `1 , t � :r
a
ort,'' on, MA 01060
Phon; 3.5 7= 40 Fax 413.587.1272 '
APPLICATION TO CONSTRUCT,'ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Property Address: This,section to be completed by office
Map _-- Lot Unit
Zone Overlay-Rlct
Elm Si.Disf"ai'c't_ iyt04 4.je(.;
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Narne Jhrmt) Current Ma' .
1`!t—=`.t
_ _.till Telephore
Signature
?Authorized Aeent:
Name rint) Current Mailing Address:
<7�- J�f
u -
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item ^ Estimated Cost(Dollars)to be Official Use only
completed by ermit applicant
1. Building (a) Building Permit Fee
2. Electrical 1J (b)Estimated Total Cost of
_ Construction from ro
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 Permit Number: 7pate Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
33 KEYES ST BP-2002-0992
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C- 148 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:roofmu BUILDING PERMIT
Permit# BP-2002.0992
Proiect# JS-2002-1606
Est.Cost:$4589.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: PAUL DAVIS RESTORATION 1173865
Lot Size(sq.ft.): 10890.00 Owner., HARPER KAREN&THEODORE HARPER
Zoning:URB Applicant. PAUL DAVIS RESTORATION
A27.3a yE-S=1
Applicant Address: Phone: Insurance:
141 MAIN ST (413) 543-5001 Workers
Compensation
INDIAN ORCHARDMA01151 ISSUED ON:545Z02 0:00:00
TO PERFORM THE FOLLOWING WORK:R E R 0 0 F
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: OI: - Insulation:
Final: Smoke: Final: OX C'/ •O liz�v
THIS PERMIT MAY BE REVOKED BY THE CITY.OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. /
Certificate of Occupancy Si nature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 5/15/02 0:00:00 14798 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo