18C-063 Apr, 30. 2015 9:44AM Brlgar Express Stns 518-438-0224 No, 5962 P. 1/1
Atft�>R& 74/30/2016 CERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE 15 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 endorsements.
CONTACT
PRODUCER NAM
Association Benelits Insurance Agency PHONE FAX No
299 Ballardvale Sir Suite 1 IL
Wilmington,MA 01887
INSURERS AFfORDINOCOVERAOE NAICS
INSURERA; MA Retail Merchants WC,Group Inc.
INSURED IN5VRER B;
Kitchens of Distinction Inc. IN6URERC:
PO Box 1225
Southwick,MA 01077 INSURER D:
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: 08779 REVISION NUMBER: OOOOi
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 THP POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLCIES-LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
AWL s eR POLICY EFF PD
LTR TYPE OF INeVRANCE POLICY NUMBER MwoDJYyY MMl04'Y�'Y LIMITB
GENERAL LIARILITY EACH OGGVRRENCE S
EO S
COMMERCIAL GENERALLIABIL(TY PREMISES Ea
CLAIMS-MADE F OCCUR MEOD(P(Anyone reon) S
PERSONAL A ADV INJURY S
GENERALAOGREGATE S
GEML AGGREGATE LIMIT APPLIES PEA: PRODUCTS-COMPIOPAGG S
POLICY PR LOC $
COMBINED 5NUISTIVIf
AUTOMOBILE LIABILITY E accden
BODILY INJURY(Per persm) S
ANY AUTO
ALL OM ED SCHEDULED 130DILYINJURY(PeraQodenq $
AUTOS NON-OWNED PROPER AMAGE $
HIRED AUTOS H AUTOS Pef e
S
UMBR0.LALIAB OCCUR EACNOCCURRENC£ $
EXCESS LIAR CLAIMS-MADE AGGREGATE 3
DEO RETENTIONS $
WORKERS OOMPENSAi11 X STATU- O -
YlJMIT
AND EMPLOYERS'LIABILITY
ANY PROPRIETOWARTNER/EXECUTIVE YIN NIA E.L.EACH ACCIDENT $ 100+000
OPACEPJMEMBER EXCLUDED'!
(Mandatory In NH) 0114000501867115 1/01/20J5 1/01/2016 E.L.DISEASE-EA EMKOYEE $ 100,000
If desreOunder E.L.DISEASE-POLICY LIMIT $ 500,000
0 -RIPTION
OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOOATIONbIVF}ACLES(Attach ACORD 101,Additlonal RGmarlrs Schedule,N more space la required)
Fax 413-687-1272
CERTIFICATE HOLDER CANCELLATION
City of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
212 Main Street ACCORDANCE WITH THE POLICY PROVISIONS-
Northampton,MA 01060
AUTHORIZED REPRESENTATIVE
0 1 98 8-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name And logo are registered marks of ACORD
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SECTION 8-CONSTRUCTION SI RV'`..E:S
8.1 Licensed Construction Surwrviscir ' 7
Name of License Holder:
i t ar
i
I
Address
I
Signature Tole oci,, _
i
i
9,Re LStered Moon-7Im iroveiineilw CivwiL
Comp ani Name k: i ii.,mber
-ERR _
Address
SIDDTAM
SECTION 10-WORKERS'(01VIFIFI C-3 Z:',t°i�.r}� i
,r,r. ir)liae this affidavit will result
in the denial of the issuance=of
Signed Affidavit 4ttached Yes ...... ❑ Jc_.. . ❑
1 .. dome Owner ExurgJ11jw :
The current exemption for')ovic'm-. -
� � i. . l�... :��' ?}' _ r �3;e={1) or two(2) tamp ies
and ii si, i, !i r idod that the obi ner acts
as suflel visor C lki, ''0 a i, i ti
Defiinition of I I C,n-,0ovvile, i 1 'eside,on which there
is,or is intende(i to oe. a cnc'or Gl -I J anC'k/or t2nn
Stvucti.zes.f� )ei'�tln OV'ho ConStl alts Z ,�tnr t 17z t l dF N'1'-:P E� ! D� .t�.;l�.� ' 2,'C' !cd a homeowner.
Such"homeowner" shall sul-,mit to the Bt;ililin .Ol'i(°i I) ; dr, B; i �alz that he/she shall be
respoltSible for all salchorv.arl4�SLlfotrrc±!�i �'r r � '�L r .?iti.
As acting Construction Supelvisol`voi} pi-es( Jc:(.�lJ, e „t' � .'1`s 11,-�, 1 ! 1� ��` :, t�uring and Upon
completion of the work for whirl h:,, ,x ;,i I i
.
Also be advis�d r.n t '-;. ibs'.it, of Employers to
Employees for injuries not re<.i Iti;,Ll: f,: i;,U* be liable for person(s)
you hate to perform,"Volk fo
'h(,' undersia Cod'L,, _'ii)'of
"onico,°['tiel'siol {il.m-e
May.04.2015 11:59 KITCHENS OF DISTINCTIn 4135691152 PAGE. 3/ 3
LNG �dr3
SECr.1�It7N 8.CONSTRUCTION SSRVi W L S
Name of License Holder., N:, .'1I . 0
8.1 Licensed Construction t visor:
� .��_l�w,. �_ ..... ���t„�,.`�If.............. . .. �.�..�
{} 6n yA yp
Address
SI azure , 7
w
Company Name I':::,Is,l ,tc)„ Nurnber
Address Fiz6 i rir:rl r);1tn
't 10-INIfO1 KERS"CONIPENSA [ON
Workers Compensation Iqsurqnc:e africi,p '1 '.1c,<.!6t: :ur:1 ",i V. , q. it liu . : .' ur i.;o*de this affidavit will result
in the denial of the issuance of the building hermit.
Signed Affidavit Attached Yes....... 0 No...... C
1 1 f
4 k' ktlN o ' iw� .ar,✓Muur"�ary•.�(' ^ � N_M
The current exemption loi i 7 ,ol,(Mu(1) or two(2)families
and to allow such 1)olnio�a,1":r lu r,',, ;•,,, •: 16 , „ + ovided that thw.owlier_gets
as su ervisor•t M 1 7110 .1,iini`.E1 V di,ioii '1:
Definition of illt�m�c?�wntir lyt,sr,=! ,, lIS a ,r ; ;;;', ; u'i 'w'li .,r,4 !.,,icE 1' ';tovu4;to reside,on which there
Is,or is intended to b1 ,a one oi,iNvo ialnily Uvr 1. "' 1'"1 i' ''• 1C1't': P.C'.i r,:5'a"� 'i til)Gh IISC 111d/01"term
111FrI'YBCtti w1 Vil' d�l I' •14' ...'il 1, V15111 )I lil c � ;-�-.,gs
strllctrlres.A�71Crtitin Who
.
C(�._.W._......,, idered a homeowner..,,•...��
Such"homeowner"shall suhmil to tl,c Riiiltii, n %:,•1 a lu'. 13("il 1,, iit it:i,that he/nc�511�N��e
resnoydble for aNl such wo t(��ert Qi,11 laa.'rl a 1•,r
As '`.. ;I 1�•, l';..'d ii )n,I''10' !inrc,dur-in('and upon
completion ul'the work fin•which -his pt n+, 1
Also he advised ih�tt with r't:'', ;;r, '[ia[,I;:I ;;:ability of Employers to
Employees for injuries not r r l; I ,' nuo!• I, 0411V be liable'for person(s)
you hire to perforn work film.!:u:rl;'; ,ii
The undersigned rd.iilding Codc,City of
Northampton Ordin;;niucs.S;1. ;m! 1,o:,I t c ;rw ;I Annotated.
Homeowner Si>)u:awre
SECTION 5-DESCRIPTION OF PROFOSED V1 FX sghf c !r Gz.«
New House [-J Addition ?hoofing
Or Do o r'c,
Accessory Bldg. [-1 Demolition Nr vw Sk 7 Other ice]
Brief Description of Proposed
Work: -- 1iY1C?32L..._.P1T�1!tL°d\8... 1n1t1._.. . 0 .1�f1N.QEGJb. trz� Zt'i��L
Alteration of existing bedroom Ye:> _ hic ��`0 7 r 1r �.rr :s ✓ '.o
Attached Narrative tF nc.✓f r. ' t.�,_:r i/ No
Plans Attached Roll -Sheet
5ar f New house and or addition to ia s,!inn� �-O u.d
a. Use of building One Family f wo Fa-i-i;'v is ar
b. Number of rooms in each famil �unit: �,: i:;::�`�:a��I
1 _
c. Is there a garage attached?
d. Proposed Square footage of new c,n t "•T
e. Number of stories?
f. Method of heating? or mt>er of each
g. Energy Cenoreat'o:. C, r;:li
h. Type of construction
i. Is construction within tor'ft. of wa
.,' n ''ds? 'Ye.::,. No
j. Depth of basement or cellar floor be ow fir,ish& ,g':ac
k. Will building confo.-m to the Euil& . i ' .
I. Septic Tangy: City Sewer z _
SECTION 7a -OWNER AU fHURILAJ M,4 • f a: rA— C GM
OWNERS AGENT OR C01'lTRA,,,*7'R,f PP �: :.tz., :3 i.:..,.
I, hiN_- i..' s Ovmer+-3f the subject
property
hereby authorize �
to act on my behalf, in all matters relative to ,pork ai thori7
Signatur of O"ner
it irt ,
�by I, �� ��N ;� K' o � � S � irON 1 LVC- -is Owner/Au.horized
Agent hereby iterre, s n
t e ..esi of my knowledge
and belief.
Signed under the pains and penalties
-___.----------------
Print Name
Signature of O✓✓nar/.Agent I
Section 4. ZONING Att Informatio;i Must I,�, i ^1, :'D -i; r,;r-nation
Existing
_ <<,
_._.._..l_
Lot Size
Fronta-e
Setbacks Front
I � i
Side
Rear I _
Building Height
--
Bldg. Square Footage i _._ ..
i
Open Space Footage
(Lot area minus bldg& paved d p
r
#of Parking Spaces
s
Fill:
(volume&Location)
A. Has a Special. PErrnit/\/ari�n� e/F-ir
NO ) DOIV"E KNOW �C .3 YE:'s 1
F YES, date issued:;
IF YES: Was the purnit r F c(:je or,1 at t �t
NO 0 D0,147 KNO\rr !
IF YES: enter Book . .sPn'.#
o
B. Does the site conta`T a brook, b,)cly cA, ' ` YE S
�.,
IF YES, has a ?Pr,,-r?it be -
Needs to be obtaiied
C. Do any signs exist or the r coe s-v? r i..; u
IF YES, describe si7,2, typt-anrs iocaii�, �
D. Are there any proposed charges lu o,' a-,J NO
IF YES, describe size, type aci6 ltocUtir,,,:
E. Will the construction activity oisturh zar r ", .,riat of a common plan
that will disturb o,rera.r<''
IF YES,then a Northampton Storm Water Ma ian, --': unit`ror-.J. 0 Cal rrr
1 V t_ i�af, .iE.•netit usp only
City of Northampton Estatus f P6nflit:'
APR 3 0 2015 J, ' Building Department Curb CA/Driveway Par, it.__—
212 Main Street Avattab1Ir.11 _
-�. Room 100 Waterh1letl Availability__r,.__
;ctric Plumbing&Gas Inspections
orthampton, MA 01060 Northampton, MA 01060 TWO 5r1s of Structural Ilan,
phone 413-587-1240 Fax 413-1587- )72 Plovt, Plans
C7ther' :t��clfy ',
APPLICATION TO CONSTRUCT,ALTER, REPA R Itir 1LGf91Af Tc OR DEIdI0 l,`;H A ONE OR WC FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: i ,ev-dc-rt to i:, c o,nipreted by office
I � ?R ?r;_r_T Nve- MaP__ for - -Unit
I\1(�tZTt4 m i�7d►J. MAX O l'Di4n Zane
Ehn St.Ws b ict __. A District__– —
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT i
2.1 Owner of Record:
M"zL• iAivN Knm& 0_00N& IN Lf-:Name(Print)(Print) curr nt A- iilii,a
-----------
l � �'sphore
Signa re
2.2 Authorized Accent:
_ R
077
Signature Id, f le pfia e
SECTION 3-ESTIMATED CONSTRUCTION COSTS l
Item Fsnmated t c-st ,Do r ) Lo k ("Illy
conFleted by permit d�iT
1. Building E P._._ _
2. Electrical (b) E s iiw atr ' c cal
3. Plumbing Rt�ilai � i1
4. Mechanical (HVAC)
5. Fire Protection
6. Total :: (1 +2+3+4+ 5)
i 1115 �.�ti�r7 F-,�r Off,r:.al U-�t.
Building Permit Number:" I
!
Signature,; —
Building Commissic 7erllnspe,:to
File#BP-2015-1045
APPLICANT/CONTACT PERSON KITCHENS OF DISTINCTION
ADDRESS/PHONE P O BOX 1225 SOUTHWICK01077(413)569-1100
PROPERTY LOCATION 165 PROSPECT AVE
MAP 18C PARCEL 063 001 ZONE URB000)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: EXTEND&REMODEL KITCHEN INTO GARAGE SPACE&ADD 4 WINDOWS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 081778
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INIF "ATION 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
Demo ' o lay
n e of Building Official 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.
165 PROSPECT AVE BP-2015-1045
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18C-063 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2015-1045
Project# JS-2015-001993
Est. Cost: $61000.00
Fee: $366.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group:— KITCHENS OF DISTINCTION 081778
Lot Size(sq. ft.): 9452.52 Owner: MILIANN KANG&CUONG N LE
Zoning: URB(100)/ Applicant: KITCHENS OF DISTINCTION
AT. 165 PROSPECT AVE
Applicant Address: Phone: Insurance:
P O BOX 1225 (413) 569-1100 WC
SOUTHWICKMA01077 ISSUED ON.51512015 0:00:00
TO PERFORM THE FOLLOWING WORK:EXTEND & REMODEL KITCHEN INTO GARAGE
SPACE &ADD 4 WINDOWS
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 5/5/2015 0:00:00 $366.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner