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11-011 (3) 106 MORNINGSIDE.DR BP-2017-0777 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Bloekt I) -011 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:Deck BUILDING PERMIT Permit 4 BP-2017-0777 Proiect d JS-2017-001289 Est,Cost: $25165.00 Fee: $163.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Crop._ SCOTT CALLAHAN 97309 Lot s_ze(s.8.): 30012.84 Owner: JAKUC MONICA M Zoning: Applicant: SCOTT CALLAHAN AT: 106 MORNINGSIDE DR Applicant Address: Phone: Insurance: 33 WESTVIEW TEAR (413) 320-6269 EASTHAMPTONMA01027 ISSUED ON:12/12/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:DEMO EXISTING DECK AND POSTS/NEW SONATUBES & DECK 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: Fee'Tvpe: Date Paid: Amount: Building 12/12/20160:00:00 $163.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017.0777 APPLICANT/CONTACT PERSON SCOTT CALLAHAN ADDRESS/PHONE 33 WESTVIEW TERR EASTHAMPTON (413)320-6269 PROPERTY LOCATION 106 MORNINGSIDE DR MAP 11 PARCEL 0 1 1 001 ZONE THIS SECTION FO$OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST .NCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Pgjd Building Permit Filled out 10 3 Fee Paid TypeofConstruction: DEMO EPiSTIN4 _ - '_DpOSTS/NEW SONATOBES&DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner!Statement or License 97309 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO}R�1ATION PRESENTED: fpproved 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 Demoliti in Dela Siy_r. - ofBud gOfc'. 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. C City of Northamptonivtnkrts 2' `t. , DEC I C Building Department4elithttkenrit i tea` . _ 212 Main Street gxd fit.. :I `z `r+.3't"' - xk Room 100 " airti' IY�a"ji . 1.. .- `aw t Northampton, MA 01060 , it t�� i'.Mer phone 413-587-1240 Fax 413-587-1272 :jt1€ i.t - ° -�• ;Ft a"` fir; r ltr E APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address This section to be completed by office I CDC, ( Q t .oacts h C,t. T1. C` Map Lot Unit 1 ,O CC.anICC- N\101" o k cif,-1 Zone Overlay District Dm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: tho ..)itcc1 3$KUC. c&vE:CfbL „I.tS �� 1-10Te c N-tie(Print) Current Mailing Ad Qs /fl "< >�/L `p`,ru'r"-ny'%�' Telephone ^ �} K _ Signatur- �i?4 r f rY •ML4.t1 , 2.2 Authorized Agent: i ,, • Name Print) Current Mailing Address: S:: ature Teiephane SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building r'S3 /1 (o� "1� (l 0 (a)Building Permit Fee 2. Electrical I0l (b)Estimated Total Cost of Construction from (6) 3. Plumbing !,'�/° Building Permit Fee �6 4. Mechanical(HVAC) 5. Fire Protection / r,.■ ".r- 6. Total= (1 +2 +3+4+5) Uct-( _ -}0 Check Number /7ff 7f./ f This Section For Official Use Only Budding Permit Number: Date Issued: Signature: Building Commisslonerfrspectar of Buildings /� 77 ''y` Date C�kC"—t0 �i ItlyyIr er-5 4Wei W deck Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due Ta Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department — Lot Size I __ ._:-J J 1 �.� Frontage L I - ---_ 1 Setbacks Front r_^'I [_ I Side I L - 1_R:r."--1 L:I 1 R:EL I L i Rear L ) Building Height t_ I Bldg.Square Footage '11 , — Open Space Footage °� — r--, (Lot area minus bldg&paved r ( i__1 LJ j parking) #of Parking Spaces 1 I co_.—� — Fill: — IL I —. i (volume&Location) �� -- A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES IF YES, date issued'I IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES IF YES: enter Book L_ I Page ( and/or Document k1. B. Does the site contain a brook, body of water or wetlands? NO a DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs Co be obtained O Obtained 0 , Date Issued: !fI C. Do any signs exist on the property? YES O NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO O 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 plan that will disturb over 1 acre? YES © NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required, SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House 0 Addition O Replacement Windows Alteration(s) U Roofing EJ Or Doors ❑ Accessory Bldg. El Demolition New Signs (D2 Decks Siding(D) Other[DI Brief Description of Propose Work: '%Oc.in^+J t4-'S' l ice. C C q.&j {"^^�cies / tuts,) Sacs -Leael C0,4 picaIC- Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet pa:if New fiouse endrar addition"to exiBtina hausing,comoletethe follawinq: 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? f. Method of heating? Fireplaces or Woodsioves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within WO ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes __No I. 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 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING 1 VBBUILDING PERMIT / i Mtn tv S C-4. 1 A At—--� (7'F-,t/ P EC E-7-7-- , as Owner of the subject property hereby authorize C-N" G- Ni‘-etkA'"K--- tn my behalf, in a alters r lative to work authorized by this building permit application. ty Wye Signature Owner / Date II, r, ,as Owner/Authorized Agent - -by declare t5 a sta omen's and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the painssand'�� p /nalties of perjury. ^/t /{ i I� Printame If idt ' L..wt \ ��. �'�)" n J 1 (,1 Sign- re'd• . -rfAgent Dale SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor Not Applicable ❑ r Name of License Moid¢r (C) / Cr.rit u Ls}-, 7 09 License Number 3 L 't41 &5 it a2 VASIfikk pfon NVk Addreor Expirahon Date e it �/ �_ . - 0- Ca Si.nature Telephone 9t Reaistered Hama Improvement Contractor (; , . _ Not Applicable ❑ �Corr -��st.6ro Company Name Registration Number 33 4.sirr+ re> r-r.ti-- t` + rtra n (2(c2re? Address Expira ion ate Telephone�.f t�" 20-Frulo� SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 15Z §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 IC No 0 11:- Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied DweIlin2s 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 acts hs supervisor.CMR 180, Sixth Edition Section 108.3.51. 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 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 aeceftable 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,duringand 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"homeownercertifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,Stale and Local Zoning Laws andState of Massachusetts General Laws Annotated. Homeowner Signature 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 150k Address of the work: KCC MoRLI ks-C r - t— F*o 4-ccr-A- The debris will be transported by: CC)r.,PteJ(c wu e (sSAL The debris will be received by: Building permit number: Name of Permit Applicant Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations -iztE 1 Congress Street, Suite 100 f.,.!SITE'*�(,"rr Boston,MYL4 02114-2017 m www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly 1f( Name(Business/Organization/Individual): {}on/indiv:dua3): ep —� s,.�,C i LCs kV* 'C. Address: 33 ‘s-re ?_1 ii 4Z ... _ City/State/Zi.: '-Ci hWt (c/A L. • cosem ) -.say 6?9. Are you an employer? Check the appropriate box: �r Type of project(required): 1.❑ I ani a employer with_ 4. y_y l 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..x[�]5 Remodeling K`t ship and have no employees These sub-contractors have A. Demolition working for me in any capacity, employees and have workers' [No workers'comp. insurance comp.insurance j 9. Building addition required.] 5. [l We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MOL I 2. Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other __ comp.insurance required.] *Any applicanttat checks box%i must also fill out the scclion below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they an doing all work and then hire outside contractors must submit u new affidavit indicating such. tConttactors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities hive employees. If the sub-contractors have employees,they must provide their workers'comp.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: F\c\ -'.aa,r ra+--[- icu.•-has‘,, 'it Cavtktti C JuFFaµ..fC. Policy#or Self-ins. Lie. #:SOD -(I 87 �Ck Expiration Dater:: —7 '- ti Job Site Address: iQL 'ff\tyn2$ J,+ +tk' bC City/State/Zip: I\Un.."-CC MI} G+ o(1,,, 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 certif under the pains and penalties of perjury that the infirrrnmion provided above is true and correct. Spature: ( ,lU-.. Date: / - —16 Phone#: ("i(Jai 3�-11.E-h4 _.._...._ _ 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other _, Contact Person: Phone a: Poicy Number: MPT14O1X MAW' STREET THIS ENDORSEMENT CHANGES THE POIJCY AMERICA PLEASE READ rr CAREFULLY GROUP BUSINESSOYINERS POLICY CHANGE ENDORSEMENT MAIN STREET AMERICA ASSURANCE COMPANY Endorsement No. 001 Named Insrsed: OGC, LLC Endorsement Elective Dan: 08-17-16 Agent Name KING & CUSHMAN INC Agent No. 201429 This endorsement will not be used to decrease coverages, increase rates or deductibles or alter any terms or conditions of coverage unless at the sole request of the insured. BUSINESSOMINERS POLICY CHANGE DESCRIPTIONS THE POLICY IS AMENDED AS FOLLOWS: THE INSURED BUSINESS TYPE HAS BEEN CHANGED FROM INDIVIDUAL TO LIMITED LIABILITY COMPANY. THE INSURED NAME HAS BEEN CHANGED FROM: MICHAEL DALE TO: OGC, LLC. A DBA / AKA NAME: 2GC HAS BEEN ADDED TO THE POLICY. ALL OTHER TERMS AND CONDITIONS REMAIN THE SAME The charges deserted mutt it a stage n penmen as follows IN No Changes fl To be Adjusted at Audit Additional NO CHARGE Return NO CHARGE Charges in Taxes, Fere and S..Jaya Additional = p Countersigned By: N I4MAN A-BY , . ,ati T/ BPM CHANGE 0197 mune)caw mrrn A�s, CERTIFICATE OF LIABILITY INSURANCE au union 2/9/2016 THIS GERM-MATE 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: I the certificate holder is an ADDITIONAL INSURED,the policy/pas)must be endorsed, If SUBROGATION IS WAIVED,Subject to the terms and conditions of the policy,ce.tain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement/a). PRODUCER CONTACT Sultan Fleury NAMe nrY. CLC CIO, _ King S Cushman Inc. PNONEL sea (413)584-5610 I pANj,,. NeL i 1D)5ed-aux F.O. Bax 447 17,1ftsrlemry@KIngcushman.com 176 KingStreet .,,. INSURFAI6/riRFOPOPIG COVERAGE NNCa........._ Northampton NA 01061 INSURER A AceAnerican In¢urance CO INSURED INSURER e: OGC, LLC - _ .�_ __..—. .. - INSURER 07 3 Adams Court INSURER'S: INSURER E: South Deerfield NA 01373 INSURER F: COVERAGES CERTIFICATE NUNBER:CL1612901816 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED RF[OW 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 roe 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 MD CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WOR— —MESCRII POLICY OF POuCY EXP .. LTR TYPE OF INSURANCE INSO YND FULICY NUMBER IMWODNYVYI IMMIOOITYYY) LIMITS COMMERCNL GENERALLW&UTY EACH OCCURRENCE ___� tuwARELOGERTAW CLAaISNADE I I OCCUR Es.w_R3SSAITITE) 9 ._. .W_._ MED EXP[Any a*person) L PERSONAL BA[W INJLNYf__ _ GEN'L AGGREGATE Jilt APIGG rPLIES PER: I I LGENER AGGREGATE II t�hCT POLCY I'. PR0. , LOC PRODUCTS COMPXIPA00 5 I1 1 _ .._ S ` AUTOMOBILE MAMMY 14MBRRD.6INPRE ILMI $ IES accident) ANY AUTO BODILY INJURY IWMperson) $ .ALL OAHU) SCHEDULED BODILY INJURY(Per accident)!f ■HIRN}AU as ITU ED IiPR«P r A I$ _ S UMBRELLA ULB OCCUR EACH OCCURRENCE $ H ._ MESE UM- CLAMS-MADE AGGREGATE S OED I TRETENTIONS S WORKERS COMPDRSARCP V L 'PERiV[E ER Gni AND EMPLOYERSVASHfl ANY PROFRICTORNPATNERFXEOtmVE YIN 1 IEL EACH ACMMENT {S 100 ODOR OFFICER/MENDER EXCLUDED [ N IA A (ML 99RI' CCCeumm In NM 6S62UT5JT2616 10/28/2016I10/28/20171EL DISEASE;EA EMPLOVEyf 100,000 O N teuntler 1- OEBCWPIR}N(JFOPERA¶ONSbnMx LEL.gsELSE�POUCV LIMITi 500,000 I i 1. DESCRIPlON OPOPEMnONS ILOCATORS/VEHICLES(ACORO 101,A6au4ne Remarks schedule,may be enacMa N mere apace Is rintafi ) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE Monica Lovett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED W 106 Morningside Drive ACCORDANCE IMP/THE POLICY PROVISIONS. Florence, t9 01062 I AUTPDRRED REPRESENTATIVE Scott King, CIC/SAI �� - �� @1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD )NSODScreo@ 714 " // / ( 1 � ` �/ ° ����c�t a s CYC c��y , '9044( ,�` ( d ( or,, - 7 ae,---0 ,-; ‘, \Lc_ City of Northampton / Building Department �6y)v)i � Plan Review / 212 Mein Street 1 i Northampton, MA 01060 /� I— l/ /eoki t� IL'_11�1 I lir Vo0 ityt • Zo q ao SK ESN-T`3 !ccC �� 7e�D — S r'c��L � Jj I t b / Lc ow ��,^L Lit ��jo�� i o DM ' \s)y-out^ �KS rot/e- lyr;Cil( /O(46friV,,r (33d fro.frAq 41 04/fir Ca q S1v-rte., Ci-t. .i .1 0 L `.ri