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24D-149 (2) May. 4. 2015 3:49PM No. 0475 P. 1 ! zq goo 4if CC) ✓1 A �I To g V, Pilo Lam P c1 �- s j _ r cc�" \A)/ 0"L�/ c i ` � Z 299 May. 4, 2015 3:49PM No, 0475 P. 2 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Su ervlsor: Not Applicable ! � f Name of License Holder License Number 1Jgt / �or ►. �,� n ; re-JT lam s o8' Address Expiration Date Syr l/ /Y11r Signature Telephone 9 Rmistered Home Improvement Contractor: Not Applicable ! Company Name Registration Number wIP , l ;r7r( Address y Expiration Date zmi44 vn,OTGI') S7 Teleph ,3 �OL/ .-3 17 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.1S2,§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 Osaner-occulaied 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 109.3.5.]L Detwtion of Homeowaer: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 fore acceptable to the Building Official,that he/she shall be responsible for all such work per[ormed under the building permit. As acting Construction 5upetrrisor 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(g) 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 Cenral Laws Annotated. Homeowner Signature oil May. 1. 2015 4:25PM No. 0469 P. 1/2 D', cr n I/ May, 1, 2015 4; 25PM No. 0469 P. 2/2 Carolyn L. Porter From: Sheryl Monfreda {sheryl.monfreda @pratttrucking_com> Sent' Friday, May 01,2015 2:30 PM To: . Carolyn L. Porter;Info Subject- RE:Which solid waste facility do you dispose your debris into? Good Afternoon Carolyn :} Most likely your dumpster will be disposed @ the Oxford Transfer Station 200 Leicester Street North Oxford, MA 01537.Any other questions,Please let me know Thanks Sheryl Monfreda Senior Customer Service Representative 22 Town Forest Road Oxford, MA 01540 508-987-1187 Sheryl monfreda@ pratttrucking.com MONDAY MAY 25TH WHICH 15 MEMORIAL DAY--ALL TRASH PICKUPS WILL BE RUNNING ON A 1 DAY DELAY FOR THE ENTIRE WEEK -----Original Message----- From:Carolyn Porter Imailto:cporter @chicopeema.gov] Sent: Friday, May 01,2015 12:45 PM To: Info; ryan @massachusettswebdesigns.com Subject:Which solid waste facility do you dispose your debris into? From:Carolyn Porter<c orter chico eerna. ov> Subject:Which solid waste facility do you dispose your debris into? Message Body: I need info for my building permit solid waste affidavit. my contractor is using on of your dumpsters.Thanks This e-mail was sent from a contact form on Pratt Trucking(http://Pratttrucking.org) 1 Adam Moulton POTSmodeml ( 1/1 ) 04/30/2015 09 : 09 : 29 AM -0400 ACC>Rn= CERTIFICATE OF LIABILITY INSURANCE DATE (M1201 YYY) 04!30!2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone (413)967-3327 Fax 413-967-4607 CONTACT Moulton insurance Agency,Inc. NAME'. _ -_ --_..--- MOULTON INSURANCE AGENCY,INC. PHONE 413 967-3327 FA 413-967-4607 143 WEST STREET E-MAIL o Ext ( ) ]r A/C lvo EavI P 0 BOX 90 ADDRESS INSURER(S) AFFORDING COVERAGE NAIC# WARE MA 01082 INSURERA Penn America INSURED INSURER B JOSEPH STARKOFF DBA UMBRELLA ROOFING INSURERC 80 HITCHCOCK STREET INSURER HOLYOKE MA 01040 INSURER INSURER F COVERAGES CERTIFICATE NUMBER: 29566 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, IN ADD'L SUER POLICY EFF POLICY EXP LIMITS SR TYPE OF INSURANCE POLICY NUMBER MMIDDIVVVV MMIDDIYYYv NSR WVD A GENERAL LIABILITY PAV0057575 04/18115 04/18116 EACH OCCURRENCE $ .. 1,000,000 _ DAMAGE TO_REIJTED _ 100,0 00 X COMMERCIAL GENERAL LIABILITY PREMISES Ea Dcnuence] $ CLAIMS-IvfADE -" OCCUR MED.EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENE AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPlOP AGO $ 2,000,000 PRO- $ POLICY J£CT LOO X AUTOMOBILE LIABILITY Not Provided COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED BODILY INJURY(Per accident) $ AUTOS pSCHEDULED AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Pet ac CI X UMBRELLA LIAB OCCUR Not Provided EACH OCCURRENCE $ EXCESS LIAB CLAIMS-IAADE AGGREGATE $ DIED RETENTION$ $ WC STATU- OTH X WORKERS COMPENSATION Company To Issue TORY LIMITS ER $ AND EMPLOYERS' LIABILITY YIN E.L.EACH ACCIDENT $ ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMEER EXCLUDED? NIA E .DISEASE-EA EMPLOYEE (Manciatory In NH) - — - tyes,descnbeunder E DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below - - -- X Not Provided DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) ROOFING AND HANDYPERSON COVERAGE SUBJECT TO ALL POLICY CONDITIONS AND EXCLUSIONS CERTIFICATE HOLDER CANCELLATION City of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 212 Main St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Northampton,MA 01060 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Attention: 413-587-1272 & C. Adam C. Moulton,Account Executive ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Rightfax C3-2 5/1/2015 6: 16: 49 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) T j IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE A IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: MOULTON INS AGCY INC PHONE FAX P.O.BOX 90 (A/C,No,Ext): (A/C,No): E-MAIL WARE,MA 01082 ADDRESS: 233RS INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA STARKOFF,JOSEPH DBA UMBRELLA ROOFING INSURER B: INSURER C: INSURER D: 80 HITCHCOCK STREET INSURER E: HOLYOKE,MA 01040 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TD CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADD SUB I POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MM\DD\YYYY) (MM�DD\YYYY) LIMITS GENERAL LIABILITY ACH OCCURRENCE Is COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE [—]OCCUR. PREMISES(Ea occurrence) ED EXP(Any one person) Is PERSONAL&ADV INJURY Is GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY 0 PROJECT O LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ A WORKER'S COMPENSATION AND WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-56957625-15 04/30/2015 04/30/2016 Y LIMITS F ANY PROPFRITOR/PARTNER/EXFCUTIVE M N/A E.L.EACH ACCIDENT $ 100,000 OFFICERIM EMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR STARKOFF,JOSEPH. CERTIFICATE HOLDER CANCELLATION CITY OF NORTHAMPTON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 212 MAIN STREET IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE NORTHAMPTON,MA 01060 re istered marks of ACORD 1988-2010 ACORD CORPORATION.AII���� .. ACORD 25(2010/05) The ACORD name and logo are g rights reserved. May. 1, 2015 2:02PM No- 0468 P. 6 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: S7 NDA"Ohql . fM � of c60 The debris will be transported by: ?r-c �-( 7ro c.k'nq `" Ll�ps The debris will be received by: Building permit number: Name of Permit Applicant C k XO tkYx 19 115— Date Signature of Permit Applicant May. 1, 2015 2; 02PM No. 0468 P, 5 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ ' C N apse Holder: -J D�4i -J�C�I�y(� - -' o c ;/1 LJCgnse Number IS I lye ke 01 A o l a Vo 105-5-(.9'9 Address Expiration Date slgnalura Telephone -r'ro chN w �� �d i., liis 9.Registered Home Improvement Contractor: i S 5�g/' O-/w . Not Applicable ❑ g Company Name Registration Number t//I — Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(B)) 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 afone(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 E Lion 5ecti n 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-rear period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a farm acceptable to the Building Official,that he/she shawl be iwoonsible for all such work performed under thy bpi ins 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)ofthe Massachusetts General Taws Annotated,you may be Gable for person(&) 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 May. i 2015 2: 01 PM No. 0468 P. 4 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all avplicabfe) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing y f� Or Doors ID Accessory Bldg. ❑ Demolition ❑ New Signs [[I Decks [M Siding[p) Other[GI) Brief Description of Proposed j, I� - �� Da J„ . 1. 12—o Work: wl 1 ►"�'lril� 1 Alteration of existing bedroom Yes . No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes .. X .. No Plans Attached Roll -Sheet sa.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 7- c. Is there a garage attached?1.0 d. Proposed Square footage of new construction. Dimensions e. Number of stories? 7— f. Method of heating? T&a Fv-r 0) zA,� f=ireplaces or Woodstoves Number of each g. Energy Conservation Compliance, Masscheck Energy Compliance form attached? h. Type of construction i- 1s construction within 10Q R.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 AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property art hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. -1 o ,: g129 - Signature of O&er Date I as Owner/Authorized Agent hereby deciare 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 Oyvmr/Agent late May. 1. 2015 MIN No. 0468 P. 2 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 -... b.d,q 3 fntAA . Frontage Setbacks Fron Side L: R• L R Rear Building Height Bldg.Square Footage % Open Space Footage ° (Lot area minus bldg&paved #of Parking Spaces �1 " Fill: volume&Location i..._... .. A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES,date issued:'. IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW 1;Z1 YES and/or Document!#', IF YES: enter Book ; � Page!! I B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES 0 NO `aV 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: E. Will the construction octivity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acne? YES a NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. May. 1. 2015 2 01 PM No. 0468 P. 1 Department use only 7 City of Northampton Status of Permit: uilding Department Curb Gut/Driveway Permit 212 Main Street Sewer/Septic Availability t MAY — !'I J Room 100 WaterMell Availability ' ( + rthampton, MA 01060 Two Sets of Structural Plans - ho 'e 41 -567-1240 Fax 413-5671272 Ploi/Site Plans c Eians Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING i SECTION 1-SITE INFORMATION 1.1 Property Address: This section to be completed by office Map - Lot Unit M ck of u6 o Zane Overlay District Elm St District CS District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: C�MOy yk Por,�C"' 610111 ► Name(Print) Current Mailing Address: C* M Telephone 3 -STz -619� Signature 2.2 Authorized Ascent: 705 . Act, Name(Print) p Current Mailing Address: Signature 7 Telephone SECTION 3-ESTIM NTeP CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed b ermlt a Ilcant 1, Building .� R � (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 B. Total=(1 t2+3+4+5) Check Number This Section For Official Use Only_ Date Building Permit Numbe Issued: Signature: Building Commissioner/Inspector of Buildings Date 18 FINN ST BP-2015-1088 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24D- 149 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2015-1088 Project# JS-2015-002063 Est. Cost: $1800.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: WILLIAM LYLE 105508 Lot Size(sq. ft.): 4051.08 Owner: MASON INVESTMENT PROPERTIES LLC C/O JOSE M GONCALVES PORTER Zoning-: URC(100)/ Applicant: WILLIAM LYLE AT. 18 FINN ST Applicant Address: Phone: Insurance: 1851 NORTHAMPTON ST (413) 533-6012 HOLYOKEMA01040 ISSUED ON.511112015 0:00:00 TO PERFORM THE FOLLOWING WORK.STRIP & SHINGLE PORCH ROOF 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 5/11/2015 0:00:00 $35.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner