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31B-162 (5) AT-11'"7IC FRAMING PLAN } S9 C_ s_�' ------ Beam & Ledger Material ------- Type Qty. Product Lenotn B6 3 1-3/4x12-7/8 VERSA-LAM 2.0 310 16' 0' B18 2 v v 6' 0' Total length: 60' 0' G1 1 Spruce-Fine-Fir #2 2 x 8 6' 0" Total length: 6' 0" G2 3 1-3/6x9-1/2 VERSA-LAM 2.0 3100 78' 0' Total length: 54' 0' G3 3 1-3/4x7-1/4 VERSA-LAM 2.0 3100 18' 0" Total length: 54' 0" G4 2 Spruce-Pine-Fir #2 2 x 3.0 1-2' 0' G5 2 v v " D" Total length: 38' D" All product names are trademarks of their respective owners rk Miles Inc. q 21 West St. t West Hatfield Ma. Sc*:,W_, } VII = _ IM a� i I J k A l c _ ��� ��� ;� �. ���>� _ . -_____�ro__..._.._:: ��:4 � �� x����. `' �; s � k�, ge l is 3 �s ter• ..... BY EXISIPING WALLI STUDS r: " G3 3 ply 3EAR I NG WALL �------___ p,, G2 f/I 3 ply �st B6 CD 04 3 pl i Ie Conk T/NQV S o ® TE(MM/DDIYYYY) DA ACCOR" CERTIFICATE OF LIABILITY INSURANCE 8/6/2015. 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 NAME:CT Christine Wallin, CISR PHONE 413)323-9611 F (413)323-6117 Bell & Hudson Insurance Agency Xt; ( A/c No: 119 N. Main Street ADpRIESS:cwallin @bellandhudson.com INSURERS AFFORDING COVERAGE NAIC# Belchertown MA 01007 INSURERA:Main St. America Assurance Co. INSURED INSURER B:NGM Insurance Company, Inc. Michael Flynn, DBA: Flynn Electrical -INSURER C: 110 Kennedy Road INSURER 0: INSURER E: Selchertown MA 01007 INSURER F COVERAGES CERTIFICATE NUMBER:MASTER 15-16 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 CON tRACT 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. A DL POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 G T R 500,000 A CLAIMS-MADE X❑OCCUR PREMISES Ea occurrence $ X $250 PD Deductible MP063005 5/28/2015 5/28/2016 MED EXP(Any one person) $ 10,000 Per claim PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 JECT X LOC POLICY PRO- F PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED INGLE LIMIT $ I BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON OWNED PROPERTY DAMAGE $ Per accident HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ _ $ WORKERS COMPENSATION X STATUTE EERH AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 NIA A OFFICER/MEMBER EXCLUDED? B (Mandatory in NH) WC063005 10/24/2014 10/24/2015 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $_ ,_- 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) ELECTRICIAN- NO ALARM WORK SOLE PROPRIETOR IS EXCLUDED FROM THE WORKERS COMPENSATION COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Kris Thomson Carpentry THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 362 Kennedy Road ACCORDANCE WITH THE POLICY PROVISIONS. Leeds, MA 01053 AUTHORIZED REPRESENTATIVE ,�/ M Tetrault CPCU, CIC/ ,Vff O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) 362 Kennedy Rd. Leeds,MA 01053 (413) 695-6487 December 3, 2015 Mike Flynn Electrician One Employee Chris Salva Plumber No employees Mark Ricciardone Tiler No employees 1 City of Northampton r'. Massachusetts ?S �- 'rr 3" DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building vy ' Northampton, MA 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which -- - -he/she resides or intends 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 home owner." The building department for the City of Northampton wants any person(s)who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work(electrical, plumbing & gas)the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made - - I, understand the above. (Home owner/resident's signature requesting exemption) will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations -A 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.R�\I am a employer with y 4. H,,I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp.insurance.T required.] 5. ❑ e are a corporation oration and its 10.KElectrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.gPlumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 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. " 1 Insurance Company Name: �Atti.1r k�or l� \A&C;Y' 1,.1 r ;-'e t'S Policy#or Self-ins. Lie.#: (p S (D y 1 3 -0 G 0 © 9 1 5 Expiration Date: S 3 0 1 1 6 T - Job Site Address:_1 55 F-1 yyn 54 City/State/Zip:/Yorf�ah2PtoK J,4t-0 1060 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 Investigation of the DIA for insurance coverage verification. I do hereby c der s and penalties of perjury that the information provided above is true and correct. Si iature: C �i Date: Phone#: ` �� -- --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#: SECTION 8-CONSTRUCTION.SERUICES 8.1 Licensed Construction Supervisor: � Not Applicable ❑ Name of License Holder: � S I �QVLt 5 Q License Number Address Expiration Date Si at Telephone 9'ReQiste�ed Not Applicable ❑ S Comp ►1 ! _5:1 any Name Registration Number Z7 I Address 3 Expira ion D to Telephone SECTION_10-WORKERS'COMPENSATION INSURANCEi_AFFIDANIT(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 J .I SECTION 5`DESCRIPTION'OF PROPOSED-WORK(checkall.applicable New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding[0] Other[0] Brief Description of Proposed Work: C rP f, C X1/1 cif,-t_z r �,)i L-e Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet saRlf New>house~and or addfion to existing houslng comp ete the followtng: 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:F OR BUILDING PERMIT, WeiI, as Owner of the subject prope hereby authorizer] S �' '��'50 to act on my be , i tters relative to work authorized by this building permit application. 11 Z3 � 5 Signature of OV4&1 Date 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 ains and pen Ities of perjury. Print Name Signature of Owner/Ag t Date ^ ' ^ . Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by tning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Rear 7-1 Building Height Bldg.Square Footage % - of Parking Spaces (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? AtTN NO C) DON'T KNOW Z>L,, YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO �� YY DON7KNO YES�,/ IF YES: enter Book Page; and/or Document# ` B. Does the site contain abrook, body of water or wetlands? NO 0 DON 7KNOY ~ / "YES 0 IF YES, has permit been or need tnbeobtained from the Conservation Commission? Needs to be obtained /�� Obtainmd vr-` Date ' �~� \_� , C. Do any signs exist on the property? YES 0 NO 152) ` /F YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES /-� NO C) IF YES, describe size, type and location: E. Will the ng, grading,excavation, filling)over 1 acre nrisd part ofa common plan that will� � dis��m�r1ao*? YES k ] NO _—_—_—_-- IF YES,then a Northampton Storm Water Management Permit from the DPW is required. ^ Department use only City of Northampton Status of Permit _ Building Department Curb Cut1Dnveway Permit -� 212 Main Street Sewer/Septic Availability DEC _ 3 Room 100 Water/Well Availabil�fy GN 2��5 orthampton, MA 01060 s Two-Sets of Structural Plans { 7 77 pho e 4 3-587-1240 Fax 413-587-1272 Plot%SItdplans °er oNS Other Specify _ APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORM_ ATION - Thrs section to be completed by office 1.1 Property Address: - IM Lot Unit Overlay District _ EIm St.District GB District SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED.AGENT 2.1 Owner of Record � Name(Print) Current Mailing Address: ge Telephone Signature 2.2 Authorized A ent: y--Y t nM5b v1 3U2 4oaxY%�cl h i . 1_-e_ecN Na (Print) Current Mailing Address. Signature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed b permit applicant 1. Building t O /�jo�j (a) Buil Ii g PeimitFee. ; 2. Electrical 1 —7 (b) Estimated Total Cost of _ Construction from 6 - 3. Plumbing �U Building Permit Fee 4. Mechanical (HVAC) _ 5. Fire Protection Z/0� _ 6. Total=(1 +2+3+4+5) 1 ZI brio Check Number::,,,-:_._. _ This Section For Official Use Ohl Date _ Building Permit.Number = Issued: Signature Br uing Commissioner/Inspector of Buildings ; Date File#BP-2016-0763 APPLICANT/CONTACT PERSON KRIS THOMSON ADDRESS/PHONE 362 KENNEDY RD LEEDS01053 (413)549-1027 Q PROPERTY LOCATION 159 ELM ST MAP 3 1 B PARCEL 162 001 ZONE URB(60)/URA(39)/URC(l) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildin-Permit Filled out l Fee Paid Typeof Construction: CREATE MASTER SUITE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildin<, Plans Included: Owner/Statement or License 084152 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO TION 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 m ' ' n Delay `t5 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. 159 ELM ST BP-2016-0763 COMMONWEALTH OF MASSACHUSETTS Map:Block: 3 1 B - 162 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cate(orv: renovation BUILDING PERMIT P'!1.1 11it ; BP-2016-0763 Project 4 JS-2016-001270 Est. Cost: $128000.00 Fee: $832.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KRIS THOMSON 084152 Lot Size(sq. rt.): 44431.20 Owner: WEINSTEIN PETER J & KATHERINE /onim,,: U1W(60)/URA(39)/URC(1)/ Applicant: KRIS THOMSON AT. 159 ELM ST Applicant Address: Phone: Insurance: 362 KENNEDY RD (413) 549-1027 O LEEDSMA01053 ISSUED ON:121712015 0:00:00 TO PERFORM THE FOLLOWING WORK.-CREATE MASTER SUITE 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: trough: 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 si nature: FeeType• Date Paid: Amount: Buildin� 12/7/2015 0:00:00 $832.00 212 Main Street, Phone(413) 587-1240, Fax: (413) 587-1272 Louis Hasbrouck—Building Commissioner