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18D-041 19 DAMON RD BP-2016-1323 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18D-041 (CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) CategoEy:replacement windows/siding BUILDING PERMIT Permit# BP-2016-1323 Project# JS-2016-002285 Est. Cost: $28000.00 Fee: $196.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: GENE BOROWSKI 106527 Lot Size(sq.ft.): 22869.00 Owner: BANISTER TIMOTHY P&TRACY A Zoning: HB(100)/ .Applicant: GENE BOROWSKI AT. 19 DAMON RD Applicant Address: Phone: Insurance: 117 SUNNYMEADE AVE (413) 687-3777 WC CHICOPEEMA01020-1780 ISSUED ON.5/1812016 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL 6 REPLACEMENT WINDOWS & SIDING POST THIS CARD SO IT IS VISIBLE FROM THE 15TREET 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 5/18/2016 0:00:00 $196.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2016-1323 APPLICANT/CONTACT PERSON GENE BOROWSKI ADDRESS/PHONE 117 SUNNYMEADE AVE CHICOPEF-01020-1780(413)687-3777 PROPERTY LOCATION 19 DAMON RD MAP 18D PARCEL 041 001 ZONE HB(100) THIS SECTION FOR OFFIgIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Tyneof Construction:_INSTALL 6 REPLACEMENT WINDOWS&SIDING New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 106527 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON TRIS APPLICATION BASED ON INFOR,MAXION PRESENTED: pproved 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 D oli lay 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 authotities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. fr----- t' r" Version 1.7 Commercial Building Permit May 15,2000 Department use only City of Northampton status of Permit: - Building Department Curb Cut/Driveway Permit - 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability J; Northampton, MA 01060 Two Sets of Structural Plans 1 �W phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLIC O CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit az �•z-.4� Zone Overlay District __.._ .. __._._............ ... .. . _._. _ .. Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: Name(Print) tQe.-7,� �% �Ci/'G L�� S Current Mailing Address Signature Telephone /3 SECTION 3-ESTIMATED C NSTRUCTION COSTS 79 Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee Oi (� 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) Check Number —____ This_Section_For_Offici I_Use_Onl Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date Versionl.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other Brief Description Enter a bri f description her . Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A AssemblyElA-1 ElA-2 11A-3 ❑ 1A A-4 ❑ A-5 ❑ 1 B ❑ B Business "4 1-, 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ I F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: ...... M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): .. Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA -F BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1 St 15` 5 3f 5 . . J ...... ... ...:. ...:. ... _,_ 2nd 2nd _.._.: ............................. ..._.._ 3rd 3rd _..: 4th _... ........................._._..........._.........................._..._....._........... ....: Total Area sf Total Proposed New Construction sf) / ..... L Total Height(ft) Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone.,Information: 7.3 Sewage 94sposal System: Public Private ❑ Zone C Outside Flood Zone❑ Municipal �' On site disposal system❑ i r Versionl.7 Commercial Building Permit May 15,2000 S. NORTHAMPTON ZONING 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 ......... parking) #of Panting Spaces - Fill: (volume&Location) _ A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO C) DONT KNOW 0 YES 0 IF YES: enter Book Page and/or Document#' S. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0 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: yC cb D. Are there any proposed changes to or additions of signs intended for the property? YES NO .. IFYES,—describe size'-,-ry-pe 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 O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 1 Versionl.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES -FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant): _ .... ........... Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number i Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number ........._. _... .._...._...... .. .............. ........... .. Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone I Expiration Date 9.3 General Contractor r�A .._, _ .. . ..... ., Not Applicable ❑ Company e — — Responsible In Charge of Construction 1 1.100 Address OW Signature Telephone i i i Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) —7 Independent Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 :a41 ��–r��_ _ as Owner of the subject property hereby authorize 2 o act on my behalf, in all matt r relative to r authori is uilding per application Signature of Owner 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 pains.and penalties of per' unl,___ _........_ _.. ....._..._ ....... Print Name L Signature of wner/Age Date SECTION 12-CopeSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ __. ... .. ...... _ Name of License Holder License Number Address Expiration Date Signature T ephone SECTION 13-WO ERSCOMPENSATION 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 0 The Commonwealth of Massachusetts Department o f Industrial Accidents r Office of Livestigations r r 600 Nl'ashington Street =T Boston, MA 02111 www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information F Please Print Legibly Name (Business/Organization/Indivi(lual): Address: /`7 ✓►n �Ozel_dc° K City/State/Zip:C rC'o' f Phone#: Are you an employer? Ch91k the gKpropriate box: Type of project(required): 1.X I am a employer with 4. D I am a general contractor and I employees (full and/or part-time). * have hired the sub-contractors 6. New construction 2.D 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 workers9. Building addition [No workers' comp. insurance comp. insurance.* D required.] 5. D We are a corporation and its 10.D Electrical repairs or additions 3.D I am a homeowner doing all work officers have exercised their 11.D Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E] Roof repairs / insurance required.]t c. 152, §1(4),and we have no 13.X] Other O�S,dr:,� 7 employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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 isproviding workers'compensation: insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: �^/�t C?y-e Policy#or Self-ins.Lic. #: 2?, %- & Expiration Date: 1 I Job Site Address: �a rn City/State/Zip: . /lef. f� 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 certifyZundthe pains a penalties peijury that the information provided above is true a rd correct. Signature:_ -�� Date: sz� Phone#: Z - -- Of frcial use only. Do not write in this area, to be completed by cit) or town officiaL City or Town: Permit/License# i 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#: Commissioner Hasbrouck DATE Subject: Request for Waiver I requ st that you gr nt a modification to waive the requirement for control construction for the �r project at 1!2 c in !'1���.� a because the work is of a minor nature,will not affect health, accessibility, lif and f re safety, or structural requirements and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work.All work will be completed within the prescriptive requirements of 780 CMR.Thank you for your consideration. "Mass Amendments, sections 107.1 allows for an exclusion from control construction for this project" Respectfully, SIGNATURE NAME C� < COMPANY ` S ADDRESS CITY, STATE, ZIP l ,acoRD® CERTIFICATE OF LIA13ILITY INSURANCE DATE(MM/DD(YYYY) 02/03/2016 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(les) 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 4317817075 4137817076 rcia°r"ne. Eric Fred c Froebel Ins Inc arcCN o Ext): 4317817075 FAX No:4137817076 321 Park Street ADDRESS: West Springfield, Ma, 01089 INSURER(S)AFFORDING COVERAGE NAIC# 'INSURERA: Nautilus INSURED INSURERS:Travelers Eugene Borowski/ Beyond Builders wsURERC: 117 Sunny Meade Ave INSURER D: Ch icopee,Ma. 01020 INSURER E; INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS ✓ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE a OCCUR PREMISES Ea occu TUTTEence $ 100,000 N N 540774 01122/2016 01122/2017 MED EXP(Any one person) s5,000 PERSONAL&ADV INJURY $ 1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2,000,000 POLICY a PRO- JECT LOC PRODUCTS-COMP/OP AGG s2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accent AUTOS AUTOS accident)) 5 NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $( EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION PER I OTH- AND EMPLOYERS'LIABILITY Y/N 1/23/2016 01/23/2017 STATUTE JER ANY B OFFICER/MEMBER EXCLUDED?ECUTIVE E.L.EACH ACCIDE $ 100000 N/A NT (Mandatory in NH) ZE67637 E.L.DISEASE-EA EMPLOYE $ 100 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$50O 000 DESCRIPTION OF OPERATIONS f LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CONSTRUCTION CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AU ORI ED RE SENTATIV ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Number C:-AB641 April 30,2016 PO4 AE-3492 33 Gene Sorov ski LicerSsed S�!,Insured gp rn r+:17 1 NIA 0 CUSTOM DESIGNS NT Submitted To: Job Site: Pacific PrintinQ Tirn/Tracv Bannister SAMF?- 19 Damon Rd. Northampton, Mia, 01061 !Phone (413) 336-1330 IE-Mail w.s � ot anfif` rr_1motion C#�m _ c- SCOPE OF WORK: Install gallen blue steel,idingiroofcup flashtnr.trin'cc?t ter 'drip edge,"baso f7ashing,,gutters and windows, Permits!Insurances/Protections: 1 File demolition and building permit. 2#:i Furnishing a certificate ol'general liability and work compensation insurance;upon request. <b< Provide protection and masking as required. _i= Set tcmporan Butting.,barricades.amllcar tcnnporary 1,anage around worksite ,i- :Hake work site accessible to work_ Provide continuous supervi,ioP over svorker>and suis-contractors. Demolition: i i' Remo%e all sidingJtrim and_utters,(If owner is on able to make startup date) 14 €ZIR windows and ira-n. 4 Supple dun.psters li nisbed by Waste ti4anagemen[. Carpenters/General Tracks: 1* Install metal stud purl in y.4astened .vith tap-cons. 2= Build out hc:hirtcl gutters tt4 required alone with windows and dix>r::. =7 install dual 0axed insut ued white vinyl window,,.with nevi trim. Install Steel Sidinat Accessories: lit Install trintlllashing and corner,.. 2P' Install neck siclint_to manufactures speciFications. Gutters/Downspouts: y I7 Wrap build oats with aluminum coil stuck as net dee 2 Install Dutters and do4snspouts. 1 C O W N, Permits/Filing.Fee S 375.00 CarpentrhlMaterial $ 6,680.04) !SidinglTrirn ,M/L S 16,325.00 Windows MiL S 3.265.00 Gutters/Downspouts ^S 11590.011 TOTAL BID S 28.235.00 We hereby agree to follow all requirements specified in this contract as well as all manufacturers' specifications. The job will be,completed in a substantial workmanlike ruanner. The site will be kept clean at all times and all material kvill be stored properly. The job will be completed within (3) Weeks; excluding conditions beyond our eontrol sitch as: weather, subcontractor delays, back orders, etc. All labor guaran ee t d or one e (1) year. Ykny alteration or deviation turn the above specifications involving extra Costs will be executed only upon written orders. aid will become an extra charge over and above the original contract. J? T 4 TOTAL CONTRACT S 28,23-5.00 12,000M Deposit required to start contract,witli the balance of S 133,680.00 due upon completion of contract. 'T ONT t,i A co The above price. specifications and cosiditions are salisfactoryi mid are hereby accepted. You are authorized to perforin the-,vork as detailed in this Contract. Pa-vinent is outlined in the above Payrtient Schedule. Gene J. Borowski, General Contractor Client SituiatUre