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35-118 (8) PROPOSED FRONT DECK 49 DREWSEN DR NORTHAMPTON, MA 01060 O'CONNELL CONSTRUCTION LLC CHRIS O'CONNELL 413-539-1521 A FRONT OF HOUSE FRAMING TYP 2"X6" PT JOISTS 12"O.C. DBL 2"X8" BEAM 10"CONCRETE PIERS W/FOOTING GUARDS& RAILS TYP TREX DECKING& RAILS +/-24"OFF GROUND 3 STI�IN&�K-S � X ZxS 2x 2xl A T Act To AL ,0LJ WATER b((-A (NA�,6 a � 76 ('2E VFivT &,ATE 12 ACC ��LuG�TI�N C-6NNE0CL6N Ta tjovSE HAND"kL-5 1269'.9 For,— QK MORE 9-lS6N5 � Ca\AAiLD P,41 LS 30 , E dg' i !!!r /�Ir ■ INSURANCE DATE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONPEM wO 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 CONTACT NAME: BANAS&FICKERT INS AGCY PHONE IF X. 63 MAIN ST E-MAIL EASTHAMPTON, MA 01027 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:TRAVELERS PROPERTY CAS CO OF AM INSURED INSURER B: OCONNELL CONSTRUCTION LLC INSURER C: 24 PLEASANT VIEW DRIVE HATFIELD,MA 01038 INSURER D INSURER E: INSURER F: V 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 RESP-ECT 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 CLAIM$. EFF POLICY INSR TYPE OF INSURANCE ADDL SUB POLICY NUMBER MOM/DD/YYYY MMIDDNYYYYY LIMITS LTR INSR WVD GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGETORENTED $ D PREMISES =rrence CLAIMS-MADE D OCCUR MED EXP(Arty one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PEO- LOC N $ AUTOMOBILE LIABILITY O a�I SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED rFFO P Y AMAGE $ HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ TH- WORKERS COMPENSATION X I WC STATU- or AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOWPARTNER/EXECUTIV N/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? 07-28-2015 07-28-2016 (Mandatory In NH) 013 196372 E.L.DISEASE-EA EMPLOYEE $1,000,000 It yes,describe under DESCRIPTION OF OPERATIONS low E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space Is required) CERTIFICATE HOLDER CANCELLATION CITY OF NORTHAMPTON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE BUILDING INSPECTOR CANCELLED BEFORE THE EXPIRATION DATE THEREOF, 212 MAIN ST NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE NORTHAMPTON,MA 01060 POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE JOHN J.LUPICA,President 1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Nil Christopher O'Connell 413-539-1521 O'Connell Construction 24 Pleasant View Hatfield, MA 01038 Y,,HWe,,,,,,,,iii _...�ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: gistration: 179785 Type; Office of Consumer Affairs and Business Regulation am ;expiration: 9/8/2016 Individual 10 Park Plaza-Suite 5170 Boston,VIA 02116 CHRISTOPHER O'CONNELL CHRISTOPHER O'CONNELL 12 PLEASANT ST asa.6� 64.-t �HUNTINGTON,MA 01050 Undersecretary valid without signature 1 Massachusetts -Department of Public Safety �, Unrestricted-Buildings of any use group which Board of Building Regulations and Standards contain less than 35,000 cubic feet(991m)of (umtruction SuperN iwr Lcense: CS-108508 enclosed space. CHRISTOPHER O'CONNELL P.O.BOX 176 Huntington MA 01050 Failure to possess a current edition of the Massachusetts cam „ -x rat!o n State Building Code is cause for revocation of this license. Commissioner 06/24/2018 For DPS Licensing information visit: www.Mass.Gov/DPS The Commonwealth of Massachusetts Department of Industrial Accidents = v Office of Investigations M d 1 Congress Street,Suite 100 Boston,MA 02114-2017 �M www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name (Business/Organization/Individual):©,( c n /�zzz/ 2 f /a' , f l Address: Z �S�a� > �3 f 15'� Y b 3� City/State/Zip: 1- 4 raen,��✓� � ►�' Phone#: Are you an employer? Check the appropriate box: Type of project(required): 1.O aam a employer with Z- 4. E] I am a general contractor and I have hired the sub-contractors 6. E]New construction employees (full and/or part-time).* 7. Remodeling 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have g. Fj Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.* required.] 5. We are a corporation and its 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.E] Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.n Other comp. insurance required.] *Any applicant that checks box 41 must also Fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: 0 6—( 1 Expiration Date: � ' � `c`� ` 2-01 � Job Site Address: ��/ Q' �v.F Pn '''^'� City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby u r the pains and penalties of perjury that the information provided above is true and correct. Sig natur Date: e: Ph ne#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• 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. �,� Efe-w�'� The debris will be transported by: The debris will be received by: Building permit number: at Name of Permit Applicant CL" z;3 Date Signature of Permit Applicant SECTION 8-CONSTRUCTION SERVICES 7 8.1 Licensed Construction Supervisor: Not Applicable ❑ \ Name of License Holder: ���v�J�� 0 C% k0 License Number :gat iR Ad -� Expiration D to Signature Telephone 9.Renistered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address �i3 Expiration D to Telephone �2,>-(I 13 rA l 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. Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all awlicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [C]] Decks 9§. Siding[0] Other[CJ Brief Description Propose Work: ® 1 �oti c� 9 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 I, L,e0, as Owner of the subject property hereby au rize l� �1 �C�lt��'1 to act my ehalf, inQ matters relative to work authorized by this building permi application. Sign re of Owner Date I, t11 Ire ('1�f C�` ✓Li�`��f as Owner/Authorized Agent hereby deeclare 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. L Print Name — V Signature o wner/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 clan #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ® DONT KNOW ® YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW ® YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 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 Q NO 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 0 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: I ' AUG ( 2615 j Building Department Curb Cut/Driveway Permit u i 212 Main Street Sewer/Septic Availability. Room 100 Water/Weli Availability Electric F Pections o N rthampton, MA 01060 Two Sets of Structural Plans phone 413=587-1240 Fax 413-587-1272 Plot/Site Plans Other Speci fy 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 D few Jev\ Map Lot Unit I 141A ow Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: _L Lox &,oi e!z r. 4 UACU Name(Pent) Current Mailing Address: Telephone Signature 2.2 Authorized Aaent: �CL J��a,o�eT G'yf,; N—u Pc �v` t 7(, �ljttiv�► �'"�d� Name P Current Mailing Address: 1S�1 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 3, (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=0 +2+3+4+5) 3i So() Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File# BP-2016-0193 APPLICANT/CONTACT PERSON CHRISTOPHER O'CONNELL ADDRESS/PHONE P O BOX 176 HUNTINGTON01050(413)539-1521 PROPERTY LOCATION 49 DREWSEN DR MAP 35 PARCEL 118 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid it Building Permit Filled out Fee Paid Typeof Construction: CONSTRUCT FRONT 7 X 5 DECK W/ AIRS rwNl 5 New Construction Non Structural interior renovations Addition to Existin¢ Accessory Structure Building Plans Included: - Owner/Statement or License 108508 3 sets of Plans/Plot Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF MATION 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 Demolition Delay 1 Signature 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. 49 DREWSEN DR BP-2016-0193 GIS#: COMMONWEALTH OF MASSACHUSETTS MaR:Block: 35 - 118 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Deck BUILDING PERMIT Permit# BP-2016-0193 Project# JS-2016-000328 Est.Cost: $3500.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CHRISTOPHER O'CONNELL108508 Lot Size(sq. ft.): 10018.80 Owner: GRIPPIN LEA A Zoning: Applicant: CHRISTOPHER O'CONNELL AT. 49 DREWSEN DR Applicant Address: Phone: Insurance: P O BOX 176 (413) 539-1521 HUNTINGTONMA01050 ISSUED ON.812612015 0:00:00 TO PERFORM THE FOLLOWING WORK.CONSTRUCT FRONT 7 X 5 DECK W/STAIRS 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 8/26/2015 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner