38A-028 (4) RUST AVE BP-2017-0640
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38A-028 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: chimney rebuild BUILDING PERMIT
Permit# BP-2017-0640
Project# JS-2017-001040
Est. Cost:$3903.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BRUCE FARIA 106039
Lot Size(sq.ft.): 4443.12 Owner: SPENCER BENJAMIN P&MARTHA J EBNER
zoning: URB(100)/ Applicant: BRUCE FARIA
AT: 8 RUST AVE
Applicant Address: Phone: Insurance:
19 SPRING ST (413) 568-6488 WC
WESTFIELDMA01085 ISSUED ON:11/7/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:TEAR DOWN OLD BRICK CHIMNEY & REPLACE
WITH NEW CLASS A CHIMNEY
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: O1: 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 11/7/20160:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
The Commonwealth of Massachusetts
-
- - ---02 -• a Board of Building Regulations and Standards FOR
7414 I' MUNICIPALITY
ri,Ir;r4 Massachusetts State Building Code, 780 CMR USE
�
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Dar 2011
tiOne-or Two-Family Dwelling
1 IThis Section For Official Use Only
j I .8 ildiug Permit Number: Date Applied:
I •uildin i e m- Signature ��- Ute
SE TION 1:SITE INFORMATION
I 1*opertylq d essr 1.2 Assessors Map&Parcel Numbers
I.1 a Is thi�s�an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(0)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard .
Required Provided - Required Provided Required Provided
1.6 Nater Supply:(M.G.L c.46,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Reyc 5d:
'Y41Y+i13. ehrler kbri-IOOIPITM Tor OloloO kr
o)
Name(PIA) City,State,ZIP I
(XuSf CVP 413-5&g•,292g
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction Existing Building Owner-Occupied.Xl i Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition N Accessory Bldg. 0 Number of Units Other 0 SpecSpecify:if
Brief Description of Proposed Work': (jr gm, in alel nat. ('41 Ar)/ :].
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item I Estimated Costs: Official Use Only
(Libor and Materials')
I.Building S g969,�/, I. Building Permit Fee:S Indicate how fee is determined:
2.Electrical S 7 ..JJ - 0 Standard City/Town Application Fee
- — -- — 0 Total Project Cost3(Item 6)x multiplier
3.PlumbingS 2- Other Fees: $
4.Mechanical (HVAC) S I List: f.
5.ivlechanical (Fire S
Suppression) Total MI Pee
Check No.l Check Amount Cash Amount:
6.Total Project Cost: I S rJry)•-7 O(s) 1 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
-- License Number Expiration Dale
Name of CSL Holder F
�✓ I List CSL 1 ype(see below/
YcrNo.mudd Stc,mct I Type I Description
tet,,ss
/ I U I Unrestricted(Buildins up to 35.000 cu.f.I
l �r(`p / h )i ' _ _ I R I Restricted I&2 Family Dwelling
City/mw .Stare. I (k0 Masonry
II I. `-4 elf OA 610E�i RC Roofing Covering
'C/Z- -j'* [ i ) r. 4' r urs I Window and Skiing
l SF t Solid Fuel Burning Appliances 1
4l -SIL '6V I I Insulation
Telephone Email address i D I Demolition ,
5.2,Registered Home improvement Contractor(FRC) jkl/7 3 3�fp /zo/
/"i/Uu/, /t-�� C'/i.once_ z2S�"Afi
cif t�.+�y'K-_ MC Registration Number Expiration o l
HIC Com i ErNamaor H[ R ra`RVmne
r
L I
td SueE t 'I address
1ik ?#,�t 1�� /inkOMRS H17-S(ak-bvfrk I
City/Town,State,'ZIP Telephone I i
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) I
J
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. I
Signed Affidavit Attached? Yes No ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I
YYYtYth )y-lid
I,as Owner of the subject property, hereby authorize L . I I i_ .'yr,Ari-, L, I, • ...1-
to act on my behalf, in all matters relative to work authorized by is building permit ap ii at ion. 1
v-I-h £bho '
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is Rve and accurate to the best of my knowledge and understanding,
Print Owner's or Authorized Agent's Name(Electronic Signam re) Dare
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will 2 have access to the arbitration
program or guaranty find under M.G.L.c. 142A. Other important information on the HIC Program can be found at
yytpt 'i6 Information on the Construction Supervisor License can he found at ye, a llt goy'dos
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living arca(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths _
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. 'Total Project Square Footage'may be substituted for"Total Project Cost" I
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: 8 Bits five /uo/4-11074-fr /yy4 d/616'6
The debris will be transported by: /lie& ,Ciij7% Chtkrinej cid 0.. -1-
-47-c
The debris will be received by: 20gal Ror,i6rzc2 &yitu _
(j 0
Building permit number
Name of Permit Applicant Brace c- r;& /I/vr, . fK I% vs/ /twnn c &'-QED d-
11/7/20/67
Date Signature of Permit Applicant
Q\ hie Cor)uttatrweteitlt ref Manual melts I Pint Forrn j
cr //„ Department of Industrial, ecidenty
c,
Office oJ'frncsttgaweet
NW) Workington Street
Boston, MA 02111
10 www.hntl.sAgo ✓fella
Workers' Compensation Insurance Affidavit: General Businesses
Apidieant Information // Please Print Legibly
Bu4htesstfl attitmiral ''t!!Inlet J1.iL.t._bis/ILt / C it Li'el L-i� fir. i'.,t-b1.f i)Ise... d - , c._
/� c„ - . c �— t - U
_Li
( fl viSUlcdip )C eta / riPhone t 5(fi (e'/SS� . p ._.
Areson an employeCheek the appropriate Inn: rBusiness Type(required)
I
/ I nn a employe! wilh� employees Ll and'
a tat it
mpari-tine ). 1 (. 1J It taur nt Itar lt.alai Establishment
'_!_l I ante solo p re pn'nnr o a pat ntuothip and have no
1 (_(Uflieu arra m'Sales(incl.real estate wart,etc.)
employeev rk >.foi vc in e.Paellat
. I X ❑Nun-profit
iS ;;o kers' comp insurance required]
i 1_1 We ale a cepanHim and Hs officets have ct ,CI.erl I ) I itnterlimnent I
Ihcu z!ale cl exemption per c52 81(13 and we have I1 tot imatiu tunny.
In l:mlrlo;eec. [No 13orkerst comp.in5uranceequired! - i , licaiti=tate
_I We arc a nett profitorh mv,mon,started by wale ee[
uith nn employees.I No workers' comp. insurance rent 12.0 Oilier F
rain (Tehran an I I ,x innta gni also lilt(liLt he ea tellw sli(W.Inn tlicir“others.onaneasanan Dula a'initanythea
mews ant.ett owe etoinetailea rte. Tori nrrr ult>* 1. ull , .a u�.;'co.r.m” itou pole]' .,Y efwhea. ,_ , y0 an
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lam an employer that is providing workers'compensation insurance for an emplagees. Below ix the policy information.
t
IIi II:PICO (l,mpoov Nana: jyC\V \0
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(i - -Li, ep f aIrt.7``.A__ ._
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hootory Add;_'..I ,' 'C /
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la ¢; ' or Self us Lr[ 1/9 ji(1 ; t Gl1 71i-1 -_.d i(p__. - _ _Lspitatiun f>any 3 _'11i-j.G/ 1'7
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Attach a copy of the s orkers'compensation policy declaration page(showing the policy manatee and expiration dole).
it;ilurer to xeure coverage as required raider Section 25A of MGI. e. 152 can pend to the imposition of criminal penalties ofa
I e up to l81.5110 00 and/or one-year imprisonment.as;cell as civil penalties in the iron of a STOP WORK OI*DI:R and a Cmc
ui op to 5250.00 a day against the violator. lie advised that a copy of this statement may he forwarded to the Office of
low:Alp:Pleets of the DIA I'or insurance coverage Verification.
I da hcrekr cert/u,under the pools and penalties of MAIMS that Are ht/nrmafon provided above k true nod carnte't
Si ull'c__ V!/jh_c-".__ 'E_sf'^— ... _ _ . _ __ bate /I_.--2014,.
frac ^;: 1/13 ' jf,J:.( /r& '+.
IOfficial use orale. Do not write in this urea, to he cwnpkrr<i ht cite or town official
City or Town: permit/License#
Taring Authority'(circle.ane):
I. Hoard of Health 2. Building Department 3. City/Iowa Creek 4. Licensing Board 5.Selectmen's Office
II 6.Other
rr
r Contact Person: ['hone#:
nun art: e.. dn ....:
fis
MassarP c t s ieparrne 'oI°.ib c sa{e[y 1t
iker Hoaro _t 3 l 9 Rel 0^5 a-a r a ,flares
cense CSSL-106039
1 (A
BRUCE FARIA
19 SPRING STREET
Westfield MA 01085
•
10106/2018 -t
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fr 71,.Y,33,3 33,331; f 7(;,,,.../3./1.
sa-\ Of8<e of Coessimer AO's s&Besiness Rtgaiation
ME IMPROVEMENT CONTRACTOR
stration: 181173 Type:
• apiration: 3(10!2017 Corporation
r•
NEW ENGLAND CHIMNEY$WEEPS&MASONRY,INC
BRUCE FARIA
19 SPRING ST
WESTFIELD,MA 01085 Vadtrutretary
VUNL
TRAVELERS WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
TYPE AR INFORMATION PAGE WC 00 00 01 ( A)
POLICY NUMBER: (7PUUe-2E09314-2-16)
RENEWAL OF (7PJU8-2E0931 A-2-15)
INSURER: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA
NCCI CO CODE; 13579
1.
INSURED: PRODUCER:
NEW ENGLAND CHIMNEY SWEEPS AND COAKLEY PIERPAN DOLAN
MASONRY INC 26 UNION STREET
19 SPRING ST NORTH ADAMS MA 01247
WESTFIELD MA 01085
Insured is A CORPORATION
Other work places and identification numbers are shown in the schedules) attached.
2. The policy period is from D3-19-16 to 03-19-17 12:01 A.M. at the insured's making address.
3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers
Compensation Law of the state(s) listed here:
MA
ere
B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in
item 3.A. The limits of our liability under Part Two are:
Bodily Injury by Accident: $ 100000 Each Accident
Bodily Injury by Disease: $ 500000 Policy Limit
Bodily Injury by Disease: $ 100000 Each Employee
C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here:
COVERAGE REPLACED BY ENDORSEMENT WC 20 03 068
sisa
D. This policy includes these endorsements and schedules:
SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE
oEie
4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating
- Plans. All required Information is subject to verification and change by audit to be made ANNUALLY.
DATE OF ISSUE: 03-05-16 WC ST ASSIGN: MA
OFFICE: DIRECT ASSIGNMENT 701
PRODUCER: COAKLEY PIERPAN DOLAN 22ULW
0044+e
DNYVI
;CORO CERTIFICATE OF LIABILITY INSURANCE SATEi5lzDl6 '
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(fes)must be endorsed. it SUBROGATION IS WAIVED,subject to
the terms and Dominions 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),
'ROOUCER CONTACT Nick). Creer
NAME:
:oakley Pierpan Dolan & Collins Insurance Agency &No,enp (413)664-9366 FAAX No):(<1b 664-472
26 Union Street A'�pES$_ncreer(anpdcinsurance.com
INSURER(S)AFFOnmNG COVERAGE NAM 0
forth Adams MA 01247 mums Falls Lake National Insurance Co
NSURED INSURER B:Travelers Property Casualty 36161
Pew England Chimney Sweeps and Masonry, Inc INSURERC.
t9 Spring St ;USURER D:
INSURER E:
fiestfield MA 01085 !SUMER Fl
:OVERAGES CERTIFICATE NUMBER:2016-2017 REVISION NUMBER: _
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOP 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 I5 SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
ISA TYPE ICF INSURANCE AOD4 SIAM POLICY UP POLICY EXP LIMITS
mil MD POLICY NUMBER IMMIDDAMYYI IMMIDMYYYYI
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000
DAMAGE TO RENTED 100,000
A CLAIESMAOE X ODOUR PREMISES(Ene;_v05E0E) $
CPP1200/1/ 4/15/2016 4/15/2017 MED EXP(Any*Epperson) 5 5,000
PERSONAL&ADP INJURY $ 1,000,000
GEN I AGGREGATE LIMIT APPLIES PER'. GENERAL AGGREGATE S 2,000,000
X POLICY SECT LOQ PRODUCTS COMP-OP AGO $ 2,000,000
OTHER S
AUTOMOBILE LI401VTY COMBINEDSIN('I.E LIMIT S
(Ea aYtle
ANY AUTO BODILY INJURY(Per parses) 5
ALLON'NED SCHEDULED BODILY INJURY(Per accienll 5
AUTOS AWOL;
NONOAUTO
HIRED AUTOSAUTOSWNED PROPERTY DAMAGE a
AUTOS {>'a+xcdbM4
S
UMBRELLA LIAR OCCUR EACH OCCURRENCE S
EXCESS LIAR ClAIMS-MADE AGGREGATE S
0E0 RETENTIONS S
WORKERS COMPENSATION PER DTH.
STAIlRE ER
AND EMPLOYERS'LIABILITY' Y,N
ANY PROPRIERER EXOLUOED CUTIVE NIA EL EACH ACCIDENT 5 100,000
B (MendaR-MEMOER EXCLUDED?
(Mes,describey In NN) TPdUO-2W N314-2-16 3/19/2016 3/19/2010 E_L.DISEASE-EA EMPLOYEE S 100,000
II
y DESCRIPTION OFO
OF OPERATIONS below EL DISEASE POLICY LIMIT S 5004000
1E$CRIPT10N OF OPERATIONS I LOCATIONS,VEHICLES (ACORO 101,A4dItIonal Remarks Schedule,may be anachRd II more space is roqulred)
2ERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESEHMATIVE a
D'Ibki C1eec/NICCRE G�
.I C_'. e -
O 1988-2014 ACORD CORPORATION. All rights reserved.
%CORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
N5025(2014011
— rnpnsa! i��z2�a
The Place to Call England Engla„ NO.:
/or Complete
Chimney Service Chimney Sweeps (413) 568-6488
Bruce Fano, President
FULLY INSURED andMasonnr�y P.O. Box 2083, Westfield, MA 01086
PROPOSAL s11@AmEb ro DATE MIME IN
STREET - DATE Off PIANS
i TIME OUT
crrY STATE AND nP CODE "r�HE
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— .� .,.. _ y _ _ ,euvlovEEa
PHONE CELL FHCNE ,FAx _
We hereby Newel spa0ratiens and Kpmald fo
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mak- ws the cL'✓ 1��gvV:e ,d«4'yr . .moi: -�{. ---
apa I h.r< 1.-‘,, I i 1.14, '4t_ , tt$h. €'Hr`94'.04 "13 1 - . l �_-
The Provost hereby to furnish material and labor—complete in accordance with above specifications.for the sum of.
•
-
Payment to be made as foNows . 1 /a. .. .. 1. r • - •• r%..
Any alteration or deviation from above specifications involving extra New England Chimney Sweeps and Mammo IInp,
costs will be executed only upon written order,and will become an extra -_.
charge over andabove the estimate.Atlagreements contingent upon strikes,
accidents,or delays beyond our control. By:Bruce Fan$Resident and Treasurer
Contractor shall be entitled to colledbom Owner all expenses incurred
incollecdng any amounts due undermis agreement,including but not limited Note:This proposal may be er_
`to costs of collection and reasonable attorneys fees. Ymhreawn by us it not accepted within -- days.
Ck
Acceptance ofllropnna(—mealwvemcee,spe cafmsandconenons signature`s .
ale satisfactory and are hereby accepted.You are authorized to do the work as specified.
Payment will be made as outlined abovy
.fr1 / r)/ I Ii_ Sienature