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36-243 (8) 46 SOVEREIGN WAY BP-2017-0386 GIS ft: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36-243 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: demolition BUILDING PERMIT Permit# BP-2017-0386 Protect# JS-2017-000635 Est. Cost: $500.00 Fee: $30.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: COMPLETE RESTORATION SOLUTIONS 103014 Lot Siae(sa. ft.): 60374.16 Owner: WILSON AMANDA L&CATHLEEN 0 Zoning_ Applicant: COMPLETE RESTORATION SOLUTIONS AT: 46 SOVEREIGN WAY Applicant Address: Phone: Insurance: 30 HAYES CIRC (413) 592-2772 WC C H I C O P E E M A 010 2 0 ISSUED ON:9/22/2 07 6 0:00:00 TO PERFORM THE FOLLOWING WORK:DEMO OF CONSTRUCTION DEBRIS DUE TO STRUCTURE FIRE 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 sianature: FeeType: Date Paid: Amount: Building 9/22/2016 0:00:00 $30.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File 4 BP-2017-0386 APPLICANT/CONTACT PERSON COMPLETE RESTORATION SOLUTIONS ADDRESS/PHONE 30 HAYES CIRC CHICOPEE (413)592-2772 PROPERTY LOCATION 46 SOVEREIGN WAY MAP 36 PARCEL 243 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT FeePaid Building Permit Filled out Fee Paid Typeof Construction: DEMO OF CONSTRUCTION DEBRIS DUE TO STRUCTURE FIRE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 103014 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ON 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 Demolition De ?— 971/6 Signature of Bm ding O'trial 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. Department use only City of Northampton Status of Permit: Building Department Curb Cul/Driveway Permit 212 Main Street Sewer/Septic Availability , Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING §4CTION t -SITE INFORMATION 1.1 Property Address: This section to be completed by office '945BVtrt,cn LU/i a , Map Lot Unit liana, Ma /J^'/'f'0/Y)) Zone Overlay District q !' L 110 Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Amanda Wilson 46 Sovereign Way, Florence, MA 01062 Name(Print) Current Mailing Address'' Telephone Signature 2,2AuthorizedA//gg nt: ,30410. ,;y (jy . Chlc);stc,t HA ui0?u z. Cpmplete Re6tor tion Solutior •c. Complete Restoration Solutions, Inc. Name(Print) - ' / Current Mailing Address 103'5,)-02-27}- ,.--- Signature I p Complete Restoration Solutions, Inc. 1 3'2 Y)-n2 7 7}- Signature ' ' - ' Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS (tern Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (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=(1 +2+ 3+4+5) 5(2O . Check Number /:Q /o? '" This Section For Official Use Only Building Permit Number: Date Issued: $ignalure: Building Commissioner/Inspector of Buildings Date Section 4. ZONING AU Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning Mk column to be filled in by Building Department Lot Size Frontage Setbacks Front _ T Side L: It: L: R: Rear Building Height Bldg.Square Footage Open Space Footage (Lot area minus bldg&paved parkingl #of Parking Spaces Fit: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW O YES 0 IF YES,date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW O YES O IF YES: enter Book Page and/or Document 4 B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW O YES U 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 lJ 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 V 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 pleb that will disturb over I acre? YES O NO O IF YES.then a Northampton Storm Water Management Permit from the DPW is required. SECTIONS-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑ Or Doors O Accessory Bldg. ❑ Demolition New Signs le] Decks I= Siding(Cl Other[O] Brief Description of Proposed Work:derno or,w,E ion dm,a,mo o,,. ]our lift Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Pians Attached Rd1 -Sheet 4P.11 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? L 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 Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ,}-an{r'1 (l, Lai ISXI ,as Owner of the subject prgpertY jq .} ` hereby authorize l AC,0 aaiitte__ q d(G..' .Se .kl I0+4) to act on my behalf, in all mrs relative o work authorized ty this building permit application. Signature of Owner Date I. ,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 perjury. Print Name Signature of(honer/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction `Supe((rviiser / � Not Applicable 0 Name of license Holder 1CJK..L�h (-71// .4-t S-/7)3,014 License Number G Sh cx Lafq Lod- Sm�hlr.� ( g DV— _ �1 h7 Address ` ` Expiration Date r -590?-271 Signatureelephone f 9.Re.': --d Home Im*rove —nt . rector: Not Applicable ❑ 1 mPI� a,SdhCc:�iSn StSIUhDfS l6Lf127 Company Name Registration Number 36 I t; n2 S or. (/2iCul p _J4d ti62o Address _ )) Expiration Date Telephone' � 27P SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.152,§25C(81) Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavil will retie( 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(I) 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 act4 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 stmctures.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 he responsible for all such work performed under the bnlldin2 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 dICOfiti CERTIFICATE OF LIABILITY INSURANCE DA1StMlaDDANYSI 8/29/2016 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 acL2W. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPQRTANT; N the certificate holder Is an ADDITIONAL INSURED,the poi cyliea)must be endorsed. If SUBROGATION IS WAIVED,subject to Rs Wins and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the Cerdreate holder in lieu of such endorsementls). P9ANDuR ICWrAE Gail croaks RAS rstt _.. Bprawski Snsuranee 'E, Frtl, 1413)596-5011 Fax _ LAx,wry 14131506-79n BB King Street, Suite B N•..1 :Reroakeeborawskiinsuramoe.com WSHRERISIASPORDING OnVFAAor _,- NAI .. Northampton MA 01060-3257 msu En_Capitol Speci.altY jos Corp _ 10328M INSURED - MsiouRe2urich Insurance Services ZLR003 ZE Complete Restoration Solutions Inc. Fxsuiwtc Hanover 22292 'a-Yea. 30 Haynes Circle ixanto:to -��_-- mlata t:........ _._.__....._. __. r. Cpieopee MA 01020 COVERAGES CERTIFICATE NUMBER16-17 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PLR CD 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 SUCiI POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. RHR aOSLEU —" VOlIC1 p0.Cv�3'D ._ —... __... Lir TWE OF INSURANCE OOP MD PCSICYNUMBhP ( MM2XMWYr1EFF 11MWUP'YYYYI uMIFs I X I COMMERCIAL GIINEW R Lumen 11 AC IX. V R@NL'E 5 1.000,090 I-CLSIMSMYO- X OMR OAM LIQ FMS A REM) 54 OOWgr 4z S 300,000 X Prof 5551 1 Llab{}Sb ` iM0150520-02 0/28/2016 8/26/2017 MED SY (Any ow Moor S 5,000 I PFRSctALd.ago IHJORr 5 1,000,000 GEN A ACCESS:ATEL 0 I I APPLES PER GENERAL AGGREGATE S 2,000,000 POND(x JEO' 'u PRODUCTS COMMA S 2,000,000 •.OTHER. NLabia S 1,000,000 1 �I e ...--I & AU14M0LE LIAEsun DOWNED aRCIE LIMIT 3 1ELP4kk 1 ANY AVM yBOODIIL+INAmY cpnm p nl .3 l ALL "scrveouLEO W TWOS r 6YINJURY Pxxa09n1 S HIRED AUTOS 'UTOS �tF'eR DAMAGES AUIP•�.Wa�i 1_ � _..__ X I OMENS}A UAe XI rot 9R I [EACH OCCURRENCE S 9000,000 I—n EXCESS rwe -' A ! cisam.mF I 1 I MRFLGHTE 5 5,00(1,000 X'RISAtOONS 10,OOP IRv00035119-tl2 0/28/2016 8/2E/2019 I3 "aa IWOAKERS ANOEMPLOY $EUAStlllI PPP GTv.. ^ere IAXDENPLOYEAS'uABR)tt alX •4 TUTE..._ER... .. -_ '^� Y e?OZPA W, EC nI/E — 1 E1 EACH CGGENT 5 1,000 000, OPPOEPAIENDER EXCAJDEESI 1 NIA B iMrdece, NH) IOs062S308-6-16 9/1/2016 9/1/201'1 �E L DISEASE.EU EMPLOYEES _x_000,000 DRfSCFGCON0;O.ERAI,M Cetus 1 I EL DISEASE.POLICY UMC S 1 006,000 C Bailment Coverage i RmI965954 02 A/28/2016 ' 8/2S/2011 $35060001,151000 A C2t PV2Ul50526-02 a/26/2016 4/28tno ? A,0t as Ea EaI DESCRIPTION OF p+EMTOlsI LOCATIONSI VEHICLES IACgiD101,gtlebnal ibilorta smash,my bragged 0 moo Apace a nlmicd] CERTIFICATE HOLDER CANCFI I ATION 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE MTh THE POLICY PROVISIONS AWITIORIZEOREPRESENTATVE R R<.ra..skiiBOGG.l R2' - aLte.....'•I'G . , 01988.2014ACORD CORPORATION. All rights reserved. AN ACORO 25(2014/01) The ACORO name and logoare registeredmarks of ACORD r INBDZAnmam, -.deMl i Massachusetts-Department of Public Safety Board of Building Regulations and Standards Cpm ,ru,,,,,n Supen knr License: CS-103014 JOSEPH M CILI.gY'g••i^ / 6 GI ISE JJ�2lG WEST SSH$BUMV V %,�.-11�6t 'i,°•., Expiration • Commissioner 01/30/2017 c9/ CiriMonet/ea/de el 47'icediceektielT Office of Consumer Affairs and Business Regulation t3 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 164927 Type: Private Corporation COMPLETE RESTORATION SOLUTIONS, I Expiration: 12/2/2017 rra 273106JOSEPH GILLETTE 30 HAYNES CIRCLE -- _ CHICOPEE, MA 01020 - Update.Address and return card.Mark reason for change. SCA 0 =ou 05." Address ni Renewal - Employment -. Lost Card Once ofcoasemer.Affairs&Business Regulation License or registration valid for individul use only y HOME IMPROVEMENT CONTRACTOR aetore the expiration date. If found return to: q Registration: 164927 Type: Office of Consumer Affairs and Business Regulation Expiration: 12/272017 Private Corporation 10 Park Plaza-Suite 5170 COMPLETE RESTORATION SOLUTIONS,INC. Boston,MA 0 JOSEPH GILLETTE4L-- 30 RAYNES CIRCLE CHICOPEE,MA 01020 Cndersecretary Not valid without signature The Commonwealth of Massachusetts Department of Industrial Accidents i E l Office of Investigations t '�°�'l_� = 1 Congress Street, Suite 100 to Boston,MA 02114-2017 "�''_••` www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Complete Restoration Solutions, Inc. Address:30 Haynes Circle City/State/Zip:Chicopee, MA 01020 Phone #:413=592-2772 Are you an employer? Check the appropriate box: Type of project(required): L 0 I am a employer with 15 4. ❑ 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. [i Remodeling ship and have no employees These sub-contractors have y, Q 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 Ill.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.17 Roof repairs insurance required.f ` c. 152, §1(4),and we have no employees. [No workers' 1 13.0 Other comp. insurance required.] 'Any applicant hat checks box p I 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 sab.contractors and stoic whether or not those entities have employees If the sub-contractors have employees,they must provide their workers'camp_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;Zurich Insurance services Policyr4 or Self-ins. Lie, #:UB0G26388.6-16 Expiration Date:09/01/2017 Job Site Address: 46 Sovereign Way city/state/zip:Florence, MA 01062 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 Wit,c. 152 can lead to the imposition of criminal penalties of a tine up to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the Efor insurance coverage verification. I do hereby certify S Date: r t .,,•in. Aoiallies of perjury that the information provided above is true and correct 'i_ attire: - / „ 0945-2016 Phone#: 413>542-2772 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permil/License# --- Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspectbr b.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: Li& &Wri ; h I l0 rn. pp oleo- The debris will be transported by:' `nm(�.� to -L;e�Skta+f°n S4 /d-hinS W The debris will be received by: &Sfire h1Gl,lCC� VY}Q/tf- Building permit number: UU ((�1� Name of Permit Applic a fill '�� "fdY ' lX��Li-iG/Ud' iv Date Signature of Permit Applicant