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31B-014
Ill PROSPECT ST BP-2017-0310 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:31B-014 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-2017-0310 Project# JS-2017-000515 Est.Cost: $12000.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: WILLIAM APONTE 086481 Lot Size(so. ft.): 8799.12 Owner: PATEL DEEVIA C Zoning:URC(1001/ Applicant: WILLIAM APONTE AT: 111 PROSPECT ST Applicant Address: Phone: Insurance: 71 GREEN ST (413) 883-1646 WC SPRINGFIELDMA01109 ISSUED ON:9/8/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:ROOF 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 ' 1 i/ji'/: Certificate of Occupanc / /� Signature: FeeTvpe: Date Paid: Amount: Building 9/8/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner !7vn1 v„m.a.wnpwu © Building Department Curb Cut/Driveway Permit �J• Hca212 Main Street sewer/Septic Availability G QqO Room 100 WaterNyell Availability - , / Northampton, MA 01060 Two Sets of Structural Plain ��, • rhbne 413-587-1240 Fax 413-587-1272 Plot/Site Plans E,./__ other specify • • ION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION -SITE INFORMATION 1.1 Procerty Address: This section to be completed by office /7 fJyo3 j14r cA 1". MapLot Unit 1 Zone Overlay District ,o0r/4 *.rpJa Elm St District Ce District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT r ttpmpitytHA- Name(Print) Current Mailing 'dress: 1 01Ot O �j� e2 : coelephone �� „ / ` I Signature (,�. J! Name(Pri no7A / Current Mailing Address: 6a 32 ir5 Sign. • Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building /4 G q 08 0 (a)Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) u 5. Fire Protection ,,f� f 8. Total=(1 +2+3+4+5) Check Number .0 , `C(/ This Section For Official Use Only I Building Permit Number: Data issued: Signature: /� _ %„ft,'" ( ` r/c Building Commissioner/Inspector of Buildings Dale $E.CTtoN 5-DESCRIPTION OF PROPOSED WORK Icheck all ami icable New House ❑ Addition ❑ Replaceinenirtdows Atteratlon(s) ❑ Roofing Or Doors Accessory Bldg. 0 Demolition ❑ New Signs irp Decks CI Siding 01 Other[q Brief Description of Proposed s /l /1/../44 / f Work: Zoog., /41f h r;t2p(tf Alteration of existing bedroom Yes/ No Adding new bedroom Yes �o Attached Narrative Renovating unfinished basement i,•.. Yes No Plans Attached Roll -Sheet 6a.If New house and or additi 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 7_ c. Is there a garage attached? /NP d. Proposed Square footage of new construction. 2{,,.+ SQ t-'A re_ Dimensions a. Number of stones? sl--^ f t 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 1MflSIMIWI NIPNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT V • D.E�vi 19 C. (-17C L ,as Owner of the subject proPeer1Y hereby authorize to act on J alt rs relative to work authorized by this building pe .t application. mic //6. ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing appbcation are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name .. Signature of Owner/Agent Date 45c nt1 CERTIFICATE OF LIABILITY INSURANCE i oarsmWLMWm 04/14/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIMlATI ELY OR NEGATIVELY AMEIW, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. TNS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING NISURERTSI,AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIRCATE HOLDER. IMPORTANT: H the certMoste holder Is an ADDITIONAL INSURED,the pollcy(tss)must be endomed. I/SUBROGATION IS WAIVED,eu4JoGt to the temp end conditions of Rs policy,certain policies may require an endorsement A stat stent on this ceruNcete dor not confer rights 1st le tertMoste Rader in Sr of such ewe} PRODUCER CZARIST IRIRII COWS MARTIN J. CLAYTON INSURANCE AGENCY INC ,„,. (413)5384804 Fj,"uEc,top fT- .Mm _......... 1649 NORTHAMPTON ST,RTE 5 RMURPRICIANORONS ADRAM RACI HOLYOKE MA 01041 Bimt.A - ATLANTIC CHARTER imp CO 4432e WILLIAM APONTE Mme! IILEItc; WILLIAMS HOME IMPROVEMENT sa D: 71 GREEN STREET INW E; SPRINGFIELD MA 01109 MMmmP_ COVERAGES CERTIFICATE NUMBER: 45052 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 IMTH RESPECT TO WHICH IRIS CERTIFICATE MAY BE ISSUED OR MAY PERTAW, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 5 SUBJECT TO ALL THE TERMS B%CLUSIONS NW CONDITIONS OF SUCH POLICIES,LINTS SHORN MAY HAVE BEEN REDUCED BY PAIDCIAa4S _ SM TYP$�BIWRRYCE ADOISSUEFF ,Mar POLICY RUDDER IM4iUMYYY1141 TAM -•— _COWINCMLerBNLMANIIY DWI OCCURRENCE .__GAm&MME i I CCCUE �1M iRTORIXIEO a .-_ SED EDP WIT m.PSOn) • — NDA PERSONAL SMTV ewM GEE}}}NtAGGREGATE 1WAIT APPLIES PER. tENERALA.T#GATE El JE I POLICY CT IOC PRC UCTe.CDMPTCPMG _T— °TN5& Cry�SINGLE vieAUMAIM'SLAWN ' . EG4aMFO S ma AUTO WORT WJIMY¢lrpenom S P'".'"'ALL OWNED SCEixnkDWADODDS AWRYtherwnnl S _ xN(T� AUTOS mW NQMED PROPERIYDNMGE S NOWMROS S UMBRELUAWO OCCUR EACNOCCURRENCE 1 E%CESStM((e CMItehMOE WA HmREG&TE S _ CFO IRETENTIONS S .ANO AGCY VUUIETT HIT TOTE " ANO IOPRET1VLMrm' ANYMOPtaterr AnumecrSYCUIH[ IY�/x EL EACH ACUD NT f 100,900 A wandans to Lim AOImEOT 1 1 NIA WA VYCV00874000 93/122018 03/7717017 IYWypmeht• EL@BPPSE-EA EMPLOYED f 195.990 RaGu+ W. a.ia.YDId+Y EL DEFACE-POLICYLIMIT € .599.909 WA DEPDTIPTION OF OPERATIONS?LOCATIONS IYOWLED p,COIm SE.1ArawW Muem sulfas hos Ma1MNWem»4ryre aneYMl YNkHt c neneako tonastan Se Lathe lettachnelts WMbremmla P,txw%m EMemMR NC 20 MOS&,t IS eeee Deem"be PT dan!or bees to tyuS,— aeaetea Mnmwaetlr if tie Ewen NM,a Ma Neatlms employs Wag*MMuteawns. }LM rod15c*e of humus mores as carry In One co to aft BM at aNSwn Win Sus(utn SMWPam an W the Mon Fag PnUMM r a a a Wd Sw W h a WWMII'). The Dieu el nu meSle m he mantes'My by wmaY,Eme Prof of ammo*.Come venation seers)aid et WYW.Mini OM,MMatmaCOMpeilltillbhoirMIPIflcI J. said pwSut ha ml DODO corps. Ca1YaLL'eoeon AWM tweet C84 WEL.WB WEE IMPROVEMENT CERTIFICATE HOLDER CANCCU.ATION sHOULD ANY OF THE ABOVE°ESCR OED POLICIES SE CANCELLED BEFORE TOE ESRRATON SATE THEREOF, NOTICE NN. BE oawERED W CITY OF SPRINGFIELD ArnRDS REEK THE PCUCYPROVIBIONS. 10 TAPLEY STREET AUUa(Z OREPREWBrTATIYE SPRINGFIELD MA 011141DanielM.CIENg y,CPCU.Vice PmsMml1-Residual Market-V.CRISMA 1 0151164014 AGGRO CORPORATION. Ail rights reserved. ACORD 25(201401) The AGGRO Earns and loge are of (red marks of ACORD 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(Ns)must be endorsed. If SUBROGATION IS WANED,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 Nancy Daher Martin 1 Clayton Insurance Agency, Inc. P" Emjc (413)536-0804 F^r 41BJ SS4-leis 1649 Northampton Street EMAIL'Em - two No):( P. O. BOY 989 S3ESS -- -'" INSURER/Si AFFORDING COVERAGE NAIC Holyoke MA 01041-0989 INSURER A:Travelare Cas Ins Co of Americ 19046 INSURED — INSURER8: Williams Rome Improvement INSURER C: 71 Green street INSURER O: INSURERE: Springfield MA 01109 INSURERF: COVERAGES CERTIFICATE NUMBER:CL166201615 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. NSR AODL Sean POLICY EFF POLICY ESP LTR TYPE OF INSURANCE Will.?ND POLICY NUMBER IWWODIYYYYI IMMIDD YYTI LINTS X COMMERCIAL GENERAL LWNUTY 1,000,000 EACH OCCURRENCE i A CLANS-WOE I X I OCCUR PRE / o x,e S 300000 6006185N445 5/27/2016 5/27/2017 MED EXP(Any vqperson) $ 5,000 PERSONAL S ADV INJURY S 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: AIDI f AUT01M)BNF uAmuty COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per Senora ALL(PANED SCHEDULED BODILY INJURY(PM accident) SAUTOS AUTOS NON-O NEO PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accWNl UMBRELLA LAB OCCUR EACH OCCURRENCE S EXCESS MAS CLAIMS-MADE AGGREGATE DED RETENTIONS $ WORKERS COMPENSATION PER 0TH- ANDEMPLOYERS'UAWUTY YIN STATUTE ER ANY PROPRIETORJPARTNERB%ECUTIVE EL.EACH ACCIDENTS OFFICER/MEMBER EXCLUCtVe NIA - IMUMeOgy M Nm E L DISEASE-EA EMPLOYEE S n yes,&IM MO Under -' DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT F DESCRIPTION OF OPERATIONS/LOCATKKISI VEHICLES IACORD 101,Adana/W ROIN,b Schedule.nay he Weaned N ape Ewe M ngind) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SPRINGFIELD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING DSPT. ACCORDANCE WITH THE POLICY PROVISIONS. 70 TAPLEY STREET SPRINGFIELD, la 01001 AUTHORIZED REPRESENTATIVE Daniel Sullivan/KAITYGli�w-"" ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025Haulms ?&esack'ssaitsepa!Cntax't:cc 9ubRo Secsiv ..:ctv`of Soil,.. eieccl:isac,ns n .. 2a_ee;ds L?cense CS aftc: , WAddAM '.----71 GREENE AS T.' 9—. ">....., 71 AA • f'p SPRINGFIELD Sit BA.,. . comoiss!oner 0812.W2017 Office of Consumer MTUtrs a Bu �R ul°Hon FL;, �"s Ie•a. NAPRIV ENT CON `nom istretton 1-1!P5 *NW ,Expiration: kTAt28 DEA await HOME IMPRC3VEME-i WILLIAM APONTE 71 GREENE S7- SPRINGFIELD,MA 01109 - '- Undersecretary Section 4. ZONING AU Information Most Be Completed.Permit Can Be Denied Due To Incomplete Information _® r r Requng D Thio colud mn py ho be Gllyd in by Bwldin6lRpanmerit mwt MEIN_-� Setbacks Fmni S� llarni Rear Bldg.Square Footage 111.1111111111111.1111.111111.01111 Open Space Footage --_-_ (Int area minus bldg&paved -_- Fill: vdwiw&Wration A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES a IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page and/or Document N B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading, xcavation,or filling)over 1 acre oris it pan of a common plan That will disturb over 1 acre? YEE O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. stn:taxi is-CUPS I HUC HUN StHYIUtb S1 Licensed Construction St/�//,e raiser: Not Applicable U Name of License Polder !/I'e'r Aeon fel /��q"" � �/ -vr /A license Number�/ / _... �/ "' QYfrr� �� ,5'iJY.+F.a�r(,/'l4 lro//09 _/j 66 < ? / .......... Address 77 ExpirationVDate VC; 5593 /6 rid j Sign..,-. / Telephone f7/y31,7()) 7 iD/ 9.RealstHome Improvement Com r: Not Applicable O kiffjirli7M5A0ceacik:14-re-#4.14--1-- ‘7- Company Name Registration Number _.... / /900 % Address jj .�J Expiration Date ) )}n "')(C9 Slrr.rc- �Jf Telephone `//i f/ ifir'✓,o /1/ / 90/7 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAIDT(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 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 10835,1. Definition of Honwowner.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 he,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 wort 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 Lent Zoning Laws and State of Massachusetts General laws Annotated. Homeowner Signature rru+s\ trig t,tnnrnmr Weaart Uj wiasstartusett] Department of Industrial Accidents = O--5L Office of Investigations a =lamb, € ; .r_ ] Congress Street,Suite 100 ird-1 Boston,MA 02114-2017 ;"+ www.moss.govldia Workers'Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information ( //f/ Please Print Leaibtx Name(Business+Organi>atiodtndividuai): ji/f// i ✓ r . 1.1e inpvcvC'n "Cr Address: 7/ availN'E' J7' City/State/Zip: /(r:sv7141V-&WV Phone#: 4f/3 y/fJJIfl Anon an employer?Check the appropriate box: Typeof project(required): 1.0 I am a employer with 4. 0 I am a general contractor and I e employees(fug)and/or part-time)." have hired the sub-contractors 6. New construction I am a sole proprietor or partner- listed on the attached sheet. 7. Q Remodeling ship and have no employees These sub-contractors have g, Q Demolition working for me in any capacity, employees and have workers' y Building addition [No waiters' comp.insurance comp. insurance.: required) 5. 0 We are a corporation and its I0.❑Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 110 Plumbing repairs or additions myself. '1 o workers' cora . right of exemption per MCiL Y ' P 12.0 Roof repairs insurance reyuired.l r c. 152,§I(4),and we have no employees. [No workers' on Other (1.00,�'-1✓diI-C comp.insurance required.) _ *Any applicant ata[checks box ql must also fin out the section below showing tel[workers'compensation policy information. t Homeownns who submit this affidavit indicating they are doing all work and thou hire outside contractors must submit anew affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the nave of the subccmtttors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. nem . ._.. - _. .__. _.... ......... ._. .._. I am an employer that is providing workers'compensation insurance for my employees Below is the policy andjob site information. .� // �� Insurance Company Name: (w /in, '&fl( d✓ "'tt% _ Policy#or Self-ins. Lie.#: 9'I/3/SeeExpiration Date: -<-1 /. 7/I 7 Job Site Address: di //,'ac/. e c7' V//!A414etu' City/State/Zip: 0/42‘• o 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 S1,500.00 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. zoo I do hereby certify pairs and penalties of perjury that the information provided above is true and correct. Sipnemre: /.1 ' I )late: Phone#: 422/3 .883 /4.544 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.Cityfown Clerk 4.Electrical Inspector S.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: /// Q„oirelsT The debris will be transported by: Z'o,tifi,+e / The debris will be received by: £e, It r'-/eel al fiv // Building permit number Name of Permit Applicant , 21 v Date r Signature of Permit Applicant