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25A-047
gw43 BATES ST BP-2017-0267 GIs 4: COMMONWEALTH OF MASSACHUSETTS Map:BBlock,25A-047 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-2017-0267 Project# JS-2017-000457 Est. Cost: $3300.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: use Grouo: GENE BOROWSKI Lot Size(sq.IL): 8494.20 Owner: HARRIS JUDITH A& FREDERICK C HARRIS Zoning: URB(100)/ Applicant: GENE BOROWSKI AT: 43 BATES ST Applicant Address: Phone: Insurance: 117 SUNNYMEADE AVE (413) 687-3777 CHICOPEEMA01020-1780 ISSUED ON: TO PERFORM THE FOLLOWING WORK:ROOFING SOUTHERN SIDE ONLY 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: FeeTvpe: Date Paid: Amount: Building $40.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner I— Deoa Te un?<n1 I Gr OACIThafpI3r t,_c n ss= r - - ? I PiLIIIGLn CJ Ce.2rC'rL!TI ( ux t;tt rt inv F_tm _ i 212 Main SI:'es": 15 z ro Fr ai[re�t "' ;TATd Room 190 d b r' 1 u J Illi � bicarb rraton MA C 106C ,rc 'a s c S rc i t P o I phone 213-58, 12 .E <713-587-1272 OtS'.a r :1 r ' +:.i� I lOr r�r ay e8 APPLICATION TO CONSTRUCT ALTER, REPAIR,RENOVATEOR JOLia A ONE v.R TWO FAMILY DWELLING il SECTION 1 -SATE INFORMATION i t.t Erpoer^r Address: L This_ecrmn tc be,.ccnpleretl by once 1 L/ 1 Si- PiI P La - Ln l li AV �lqA Cvr ar Dr n -� 71.j7 .t/r7e-. 0/060fm roeer2>. _ � c�oern�t 1 SECTION 2.PROPERTY CWN_R. HiP1AUTHORIZED AGENT 2.1 Op.en ottiord: i J[l//4 . G-LijJ.'Va /Ct.�t.T E'7 I N Ior Curet Mating y gdtlress: lI/� s (! ) . ..,-,----2 -7_,, i . —J Authorized Anent: Cir e 6 - - — f. L 'Vr ii7(ie j -s 4 7 n. / _ • tse !t . 1 Name(Ain' /? C::rr 'e::..- I 7 I 7 1 Signature 000 Teleoilone ISECTION 3-ESTIMATED CONSTRUCTION COSTS ( item E=_+ioated Cost(Dam?A be Gffo>ai Use Only mo wb by permit antcant I. 7 Building q j (a.) Bunning. Petri rt Fee "%) �. sr�r r. - 1 2 "' ctecai I ( (b)Estimated ";m Cost of I I i Coretruciion front'Tl 1 3. Plotting g i i 6ulldmg Permit Fee iI 4- .Mechanical (HVAC) 1 i. rite PmtecJon I 1 5 To'ai=(t +2to_zon) ( 1, Check Number This Section For Official Ilse Only 7 M I Sv ktins Pe mit Nureer flair C ote siert T fr 1 r attire: i .1-1/7' EulIdi y Comm:;sio nettinsoecar et eu:icings 1a I a `til ' e X I Sector Z. ZONWG ALT Aformanon ALAI Be CArn:leced fArmif Can 3e Denied Due Ts Inconel x ItArITI2ZiO7 1st g FAcposed I r` a ireb 1 I =uiie " ar ! ;crsz. e Footage., I ... L-`a- _ Setbacks Front. �7 S.i4e r / .. Ri. - 1. ,._ -_ ?tiding Height I . .. :/ I „. .__... Bldg Squane Foctage I ,r— 1 . ,._ ._.. IOpen paces F c age ._ — P<eb n I � r._ ..._ I A. Has 5 3,ecial Perm.A.:Plaffr,ncelFilc':ng. rah beet Issued `or/on the site? NO 0 DONE? KNOW =, U IF YES, date issued �- - IF YES: Was the permit recorded ed at C e Fe tsayref sr NO 0 DONT KNOW CV YES Cj IF YES: enter Book Pa .� .d(cr Document E. )I B. Does the slte contain a brook, body or water or wetands' NO . DONT KNOW 0 YES 0 IF YES, has a permit beer or need to be obtained;rem the Corservation Commission? Needs to be obtatneo CD Obtained 0 , Date Issued: C. Do any signs exist on theproperty? YES 0 NO IF YES, describe 'Ze, type and Location: : - - __"'"" 3, Are there any proposed changes to or ad i t r_ ger signs me ded for she property ? YES N=✓ IF YES, descrIbe st•e, gyve and location: B WE the constructor acfMfy r -rine grad n exca eon oe filling)osyef 1 acre or is t p Y of ,Troon plan tat !B aist over acre' YES 0 NO .ES,ter,a Nodfrintone rn Water Man-ardentPcct te DP !f usrequre I I i Boa'i:SON 6-DESCRIP4IDk' CE PROPOSED WCRrV!check all auniicebia) 1 New House Lel r Addibion [ f I Repfacismont Windows ri Alfecatiorifs) r [ i P.co Smg :� Or Doors Lel I 1 Accessory Didg. E l Demolition I , New Signs [ ] Decks Zap' Siding l03 Other l_J _. 1 BriefD e cicdon ofProposed yn /� .// i Work: /<e .,ler y(Pl. e est FO& /44 _i LC 7 I I Alteration cf isfng bedroom Yes I . R ^ o Adding new b donom Yes No Attached Narrative, k r va ing unfinished'casement Yes No Plans Attached Roll -Sheet 6a New house and or addition ezidtrra nousirici. othidieteithe foirowriac_ a Use of building One Family TwoffFamily Other b_ Number of rooms in each family unit: V Number of Bathrooms ? _ c. is there a carate attached? L-7 "` d. Proposed Square rootage C1:flew construdien_ Dimensions a. Number of stories'? Me:hod or heating? Fireplaces or Woodstoves Number of each_, g. Energy Conservation Cortolience fiffeascheck Energy Cc-tall ya fichmatached? .� F,.. Type of construction_. 1 Is construction within i00 ft of welands? Yes No is constracha milin:n 100 yr floodplain Yes No i. Depth of:casement or cella:ricer below finished grade k. Wei building conform to the Building and Zoning regulations' Yes No 1 i. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR EUILOING PERMIT 11pc,A A /"v as Owner the subject G" Y //�} hereby authorize to 9.s..1/4, &..'"G0M0 toactoncry/ =_tae,in il ma .s fele:hie' -work authorized by This building rermit eopycatl I /'��' Y sign um of Ov. et Fv p'{V Date a I s OwnerrAuthoriz d Agent hereby s _lore: at The statements and iinformation on the foregoingaooiication are true and accurate, to the best cf my ko owledge and belief ISioned under the Pans and nenaliies c`perjury. fibre Name II -. -.. —..- Signs:yrs cf Cvme:rsgent Deete SECTION E-CONSTRUCTION SERVICES €1 L - Cors a 'on Sucerviscp 72 INott ApeIica;ble = I/,ry '`'� N nee 6('1 (.P a^s - 1 S ._./ o5 /6 :�_ / License:Neter fieGffies w Expiation D'J:e lir 5Nea,„a Telephore 0 ) � 7 75c7 9 R_c3steied Home Improvement Contractor:. _ _ r No.Applicable Sekno,-- / 73 Company None j RecIetralion Number f 4V/ A�rass Expiration Date Tele hone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152, §250(6)) Waters Compensation Insurance affidavit mug:be competed ani su mi ed with This application,Failure to provide this affidavit AN result ) in the denial of the Issuance of ihe bultl .g permit. 1 Signed Affidavit Attached Ts= Nn The os en.exetpdon for"homeowners"was extended to ntdude Owner-occupied Dwellings of one(1) or :wo(2)rmales and so allow such hone-ovmer to engage an indindual for hire sego does not possess a license,urovtded that the owner acts as supervisor. CMR 780 Sixth Edition Section 10 .51. Definition of Homeowner Perron f )who own parcel of land on which r /s e resides.or intends to ide.on which there is, or is i,t_naed In be,a one or non family dwelling,abashed or detached Salnattleea accessory to such use and/or farm s;ccn_ss. A person who constructs more than one home hi a two-year period shall not be considered a homeowner. Such"homeowner"shall sibmif to the Building Official,on a form acceptable to the Building Oficial.that he/she shall be responsible for all such work nerfo.-rued under the building,permit. As acing Construction Supervisor your presence on the jab site will be:gulled from time to:tmq during and upon completion ofthe work for which this permit is issued. Also be advised:hat with reference to Chapter 152(Workers' Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)ofthe Massachusetts General Laws Annotated,you may be liable for pamo:n(s} you hire to perform work for you under this permit. The undersigned'homeowner"certifies and assumes responsibility for compliance with the Stare Building Code,City of Northampton Ordinances,State.and Loco Zoning Lai.:and -. a of Massachusetts General Laws Annotated - 1 Et+meawner SignaH,re i� _ id rt t =tY vvv YYwWeut __ St`::,reg .7' - Betflarau _ifel 021.¢« D wY✓.t%O.w gtv "e8 Wt rr_ra' Conape. anir osr r,agrari ace E.,.., !_arc. afloerr/C. c a _A., t er re--ca.a _iuddir,:hr ADoi:deg:rat l'itic m ©a 2Ptase P#Lrit Leaiiirdv Name (EvsiussiO p m dors di ideal): 6,e:Jo rrt. "/ r �> an . Address: // 7 —>(ice'-r P /74, / /{ ^�_ Cit "atate'Zip:_L--4 r e ( r ,{ejl 0 Phone #: 1 �f 3 )lod —:7 /`-� / � Arrevvon employer? Check to apo p late box: D,n .. c: t(r ree): Are Y t r a a employ ' With h ' -_ ". O S .i a genera; contractor and I o. _] New wns'_lvc c:. employees (f_rl and/cr part-time).* have hired the sub contractors 12.I7 Z z'.. a a proprietor or uar.ler- hated c,me attached.sheet. ?. JRemodeling mnodetisg ship and have nen ea_n]ityees These sub-contractors have g. 7 Demolition woridaa for se in nY capacity. employees and'have workers' 9. I Bu riding addition [Bic workers' comp isurance comp. insure. ce+ i required. 5. 7 We are a corporation andzts 10 El Electrical repairs or addc'.ons 13_0 I arn a homeowner doing all work officers have exercised their '_l.❑ Plumbing"e a. or additions myself. [No workers' comp. right of exemption per MCI tc t _.0 Roof repairs I insurance required.j t c. 152, 51(4), and w have no ployes. [ eorke13 r" Other 1J 1r comp. rd.] 1. Any applicant that cheeks box#1 must also ill cut the secu cc below ahowing their 'orke_s'coma easahon policy information. tHo avww,rs nem submit this davit indicaum they are dour all work and then-tie cutwde umnactes most submitnew art dawn indicating such TCortracors that Gawk the box attached an I i, al sheet sho ing the namo ci the sob-contactors nd state whether cr col those entities have employees If the sub-contactors have onployees,they must provide their wo2sers'cesuppricy=Wit Iam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. l//-^ //' Insurance Company Name: //�d e/E'... Policy f or Self-ms. Lie. 44 E . 71.['� _/� Expiration Date: / ,/j�,aS/7 Job Site Address: 9Z , c-4,, ✓/_ City/stzte.zip:�/4 17c.,,i 4-7 ,r.OW/(e Attach a copy of the workers' compeusaaon policy declaration page(showing the policy nwuber and expb-a 7012 date). Failure to secure coverage as required under Section 25A of MGI, c. 152 can lead to the imposition of arimi al penalties of a fine up to$i,500 00 an 'or one-year i.'rp ison.0 ent. as well as civil penalties in the form.of a STOP WORK ORDER and a Lone 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 DLA,for insurance coverage verification, I do hereby cera/der the a airs dpen .es ofperjuty that the information provided above is rue a dd correct `<i mature: it - Data: 4 Phone Q-77,- t.. .7-- '-_77 1 Official arrt only. Do not write in this area, to be completed by city or town official i` Cry or Torun: Permit/License f _.... i' _issuing Authority (circle one): i 1. Eoa_d of Health 2. Eatidlag Department 3ry Tena Clerk 4.Electrical inspector 5 Plumbffg inspector � 11 6. Other i 7 Contact Person: Phone x: II y arp oza Dilereseichrreetts � �.. ✓If EruC7i __ s 212street C_2—.� Buildtr5 NcrthaaptOn, C1050 21s?3CTGK Louis Hasbrouck Chuck Miller 3uilding Commissioner assistant Commissioner H_OI_M-EOWNER EXEMPTION ACKNOWLEDGEMENT i The State of Massachusetts allows the homeowner the right under 7800MR 105.3.4 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 dwredltog, 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 responsibue for compliance-with state bui[ding codes and regulations. The inspection process requires that the building department be called to inspect work at various states, which include foundation/footines (before backfill). sonetube holes (before Dour). a much buiidinc inspection (before work is concealed). insulation inspection (if required) and a final buitdina 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 occuoancv until the work can be inspected. ,r The Homeowner hires other trades to perform work (electrical, plumbing &gas)the homeowner will be responsible to make sure that the ttrades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections, Failure or 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 understand the above. (Home owner/resident's signature requesting exemption) will call to schedule all required t)uildino inspections iicessary for the building permit issued to me. Date /� Address of work location City of_Northampton 217 Math Street. Northaninton. TvLA 01.050 Solid Waste Disposal Affidavit In accordance of the provisions of MOL 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: The debris will be transposed by: % sLr :kr-7 _ The debris will be received by: Building permit number: Name of Permit Applicant of � / Date Signature of Permit Applicant Number C-43321 July 12,2016 PO# AZ234 Gene Borowski Licensed&Insured GeneralContractor MA lie.CS-106527 117 Sunny Meade Ave. PCI II MA 01020 t � I (413)687-3777 CUSTOM,ESIONS NEW HOMES•AODPONS•RENOVATON$ CONTRACT SUBMITTED TO: JOB SITE: Judy Harris Same 43 Bates Street Northampton, Ma.01060 Cell (413) 320-7749 RE: North Street SCOPE OF WORK: Complete the following repairs at the above named adress. Permits/Insurances/Protections: 1# File building and demolition permits as required. 2# Furnishing a certificate of general liability and work compensation insurance,upon request. 3# Set temporary fencing,barricades,and/or temporary sirmage around worksite 4# Make work site accessible to work. 5# Provide continuous supervision over workers and sub-contractors. Permits/Filing Fee $ 250.00 Insurance Fee $ 100.00 Sub Total $ 350.00 Roof: (Install east side only 17'x35') 1# Strip lower edge of roof and cap. 2# Install new 5"drip edge and new flashing as required. 3# Install ice and water barrier on bottom 3'of roof edge. 4# Install(6sq)of asphalt fiber glass shingles which carry a 30 year warranty pro-rated. 5# Clean up and remove all waste. Demolition/Material $ 1,165.00 Labor $ 1,000.00 Sub Total $ 2,165.00 Basemen/Waterprooling/Exterior Grading: 1# Clean up soil in basement: 2# Apply hydro cement on bottom 3'of west cellar wall. 3# Install Lock Tile waterproof over entry wall. 4# Grade and compact soil along exterior wall install culvert drains. Material/Labor $ 785.00 TOTAL Bid $ 3,300.00 APPROVED AND ACCEPTED: C-cIL/G A f7a ui., DATE: OF�w' �6 • Payment terms to be negotiated. 6_ _JUDITH A. HARRIS • We look forward to the possibility of working with you on this project.Should you have questions regarding this project,please contact me at(413)687-3777. Sincerely, Gene Borowski (Owner) BEYOND BUILDERS /� 4 .Act3KL3 CERTIFICATE OF LIABILITY INSURANCE DATE CAMYn .S----- 02/28/2016 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 EY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TBE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pclicyliesl must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require en endorsement. A statement on tis certificate does net confer rights to the wCertificate holder in lieu of such sndorsement(`3). I PRODUCER 41377817075 4137817076 wicIcONT`T Eric Froebel t Fred c Froebel Ins L 'No Batt 41377$117075 Nan 413;817076 321 Park Street 521.aEs:efroebe@comcasf.net West Spiingfild, Ma- 01089 INSURERISI AFFORDING COVERAGE NAIU INSURER A: Nautilus Insurance : INSURER INSURER B:Travelers Eugene Borowski/DBA Beyond Builder's IN3URERc, .117 Sunny Meade Ave USURER,: �l IShicopee. Ma. 01020 INSURER Et INSURER F: COVERAGES CERTIFICATE NUMBER; REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED SELOW HAVE BEEN ISSUES TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOiWITHSTANDINC 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. MAR TYPE OF INSURANCE ' POLICY EPP POLICY EXP / AINW tWQ' POLICY NUMBER I IMM/DOIYYSO (MM/OB/YYYYI' LIMITS Li COMMERCIAL GENERAL UABILITt .EACCHOCCURRENCE 32040000 A LA STADE '✓I-cmR 1 `i5RS is TGJ ( IARFM IS 5 E gPmt e Stf.O(U Es I NN540774 01/23/20160 /23/2017Mal)EXP y one pa won; 155,000 [PERSONAL a ACV INJURY I s 1.000.00 GENT AGGREGATELIMITAPPLIES Pr;e GENERAL AGGREGATE i $2.00,000 cLcr =° LOC0DU sCOMP'o'tAGO,s 2.000.000 OT F1 5 I AUTOMOBILE LIABILITY Iv r$MED SINGLE Ha $ kdkrOl eenl EsANY AUTO ' SOUILY'Nl R P pardon) $ ALL OWNED, ' ISBMEOuLED BODILY INJURY(P;r accaenl'a _....... IAUTOS 1= N.S0& PROPERTY DAMAGE HIRED AUTOS (AV -0J + qxmidoon tE ._ UMBRELLA LIAU 1 OCCUR !EACH OCCURRENCE 5 — EXCESS LAO ;CLFIMa-MADE AGGREGATE S [OED i 'RETENTIONS F i I5 1ORR RS COMPENSATION I r PER I 6TH- . O R6 LI 8 YIN: USTATUTE NR N' Ec R :PA R x 1urvh I EEACH ACCIOENY 3100000 8 OP ICES BE XC OEC? I L.y IIN/A I 2E67537-2-16 (M ory tip EL DISEASE' EA EMPLOYEE 3 500000 :Mies.desc.Bev 1/23/2016 . 1/23/201, IloESCad RIFnoN CP OPERATIONS Sic•n ! I BI.DISEASE-POLICY LIMIT 3100010] DESCRIPTION OF OPERATIONS I LOCATIONS I PERICLES (ACORI'01.Additional Romarlda Schedule,may be attached if more spaces required) CERTIFICATE HOLDER CANCELLATION HAP Inc • SHOULD ANY OG THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 327 Main $[ THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Springfield. ma-01105 /1 ADT XIZEIREPREBENTATIVE � Lei, i (' ©1988-2014 ACORIYCORPORATION. All rights'reserved. ACORD 25(2014/01) The ACORD name and loge are registered marks of ACORD