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24B-001 (5) 99 BARRETT ST BP-2008-0169 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24B-001 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2008-0169 Project# JS-2008-00.025. 2 Est. Cost: $44500.00 Fee: $179.50 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Thomas C McCarthy_- 053221 Lot Size(sq. ft.): 14984.64 Owner: MURRAY MARGARET M Zoning: URB Applicant: Thomas C McCarthy ,}T. QQ BARR:TTT S 1T Applicant Address: Phone: Insurance: 3 BRODERICK ST (413) 527-5141 Workers Compensation EAST HAM PTO N MA01027 ISSUED ON:8/22/2007 0:00:00 TO PERFORM THE FOLLOWING WORK:REMODEL BATHROOM & KITCHEN 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:-1 —( 7 oughtNouse# Foundation: � Driveway Final: r Final:n-07Final://- 9—t77 Ip' Final: `� ��/ Rough Frame:o K 6 972 $ 6ulc /oi Gas: Fire Department Fireplace/Chimney: Rough: (1i1: Insulation: Final: Smoke: Final: di C/a /2-‘1:b 7€0117,-- THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIO_ .. Certificate of Occu•an signature: FeeType: Date Paid: Amount: Building 8/22/2007 0:00:00 $179.502532 212 Main Street, Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 11111111111111. 111011111101111111. BP-2008-0169 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit 4 BP-2008-0169 Project# JS-2008-000252 Est. Cost: $44500.00 Fee:$179.50 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Thomas C McCarthy 053221 Lot Size(sq. ft.): 14984.64 Owner: MURRAY MARGARET M Zoning: URB Applicant: Thomas C McCarthy AT: 99 BARRETT ST Applicant Address: Phone: Insurance: 3 BRODERICK ST (413) 527-5141 Workers Compensation EAST HAM PTO N MA01027 ISSUED ON:8/22/2007 0:00:00 TO PERFORM THE FOLLOWING WORK:REMODEL BATHROOM & KITCHEN 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: FeeType: Date Paid: Amount: Building 8/22/2007 0:00:00 $179.502532 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo i • File#BP-2008-0169 APPLICANT%CONTACT PERSON Thomas C McCarthy ADDRESS/PHONE 3 BRODERICK ST EASTHAMPTON (413)527-5141 PROPERTY LOCATION 99 BARRETT ST MAP 24B PARCEL 001 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid r q(3 d- *M5-D T peof Construction: REMODEL BATHROOM&KITCHEN New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner%Statement or License 053221 3 sets of Plans!Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO TATION PRESENTED: Approved 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 2//40 Signature of Building Officia 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 r�....�...� ,6 rthampton Status of Permit: E Q t �Btdi "'Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability AUG 1 6 Northampftn, MA 01060 Two Sets of Structural Plans phone 413-587112401 Fax 413-587-1272 Plot/Site Plans I T —� Other Specify ; .�rz;1143'1$ APPLICATION TO V �fiyR,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: q96arr Map Lot Unit LjfL'y ! Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Rec• : 99 l71 //, ��r� aria S kiezip4v Na •- Current Mailing Address: t� 922—jf Telephone 7/` 3 Signa re 2.2 Authorized Agent: • TivA411 S C fikeoC Ai . aul• JA06o 2'ck Name ) K a, Current Mailing Address: g-457. -"ft✓ 11 a/d Signature Telephone 1/13- 5a? 5,yi SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 3 S 9q. (a)Building Permit Fee — 2. Electrical c /� (b)Estimated Total Cost of ��w/,•f�Q Construction from(6) 3. Plumbing f J4s .a& Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2 +3+4+5) 7 7/ �O,Q© Check Number c)57, -- This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date • • Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L:_ R: Rear Building Height Bldg.Square Footage Open Space Footage (Lot area minus bldg&paved ___- parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Findin ever been issued for/on the site? NO O DONT KNOW YES C) IF YES,date issued: IF YES: Was the permit recorded at the R-vstry of Deeds? NO 0 DONT KNOW ►4 YES C) IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO C) DONT KNOW 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 C) NO 41 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 Vf. IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,gradin• e r vation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO ►4 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New HouseAddition ❑ Replacement Windows Alteration(s► Rooting ED Doors I] Accessory Bldg 1 I Demolition ❑ New Signs [El] Decks [❑ Siding ID] Other[tel Brief Description of Pro•ose• Work, . 77 y Cif/i10�(,� / i ' .L" ✓ .'"Ye: .d 7 ,. Alteration of existing bedroom Yes No Adding new bedroom YesV. No ��77�j-tq� Attached Narrative Renovating unfinished casement Yes ,/ No Plans Attached Roll -Sheet 6a. If 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? f. 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 7a -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT r I, 'L1 A'�4'R �l r(^ H ,as Owner of the subject property A/ /�/� /hereby . th. ize /JJ i X V 6'en/ 67//7/WOWS 1�C. act • i'n behalf,in all m."ers rela e to .rk authorized b this building permit application. ip f 7-/ ,' Slgnatu -rofOwner! f 1 Date I. /VW-5 C. . as Owner/Authorized Agent hereby declare that the statements and informat n the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. yfe/IMS c /!fr�Ae- y Print Na Si§e: 6-‘ , 06 n re of wrier Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor. Not Applicable 0 Name of License Holder )f/1QDIA )e t ad Cc5.3 ,2 / License Number 3 � /114/ sa.3k Address Expiration Date y/3-.5at 9 frW Signature T- -.hone C •.Re•is'-red Home I •roveme C•ntractor: Not Applicable 0 M,70 _ eA (1;11 2‘)1 Company NameRegistration Number ,j1/4fide cae.d' 414 Address Expiration Date/ Telephone 9�?.c—e77c/ -411111, SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(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 A/ No 0 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(l) 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 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 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 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 The Commonwealth of Massachusetts -. Department of Industrial Accidents 1r Office of Investigations .::die 600 Washington Street _ el 1 = Boston,MA 02111 'f.,t• www.rnassgovldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print 'blv Name usm 'on/Individual): • S L�11,' e hi*--/ZATTfaelor65 P , e . Address: j inifidUited / 4City/State/Zip:Z;elf //It /e /oY Phone.#: 3. f.51 / _ - Areyou an employer?Chec c the appropriate box: Type of project(required): 1p11 am a employer with � 4. 0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction listed on the attached sheet 7. 0 Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employes These sub-contractors have 8. 0 Demolition workingfor me in anycapacity. employees and have workers' p ty. z 9. 0 Building addition [No workers' comp. insurance comp•insurance. required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 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 MGL 12.0 Roof repairs insurance .]t c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required_] *Any applicant that checks box MI must also fill out the section below showing their workas'conspestisstiaa policy info/gm:ion. 1 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new tfffjdivit iodizing such. tCentrsetors Out the&this box must attached an additional sheet showing the nam of the subcontractors and state'whether or not those entities have employees. lithe 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. ( 5/€A ' Insurance Company Name: 0M/ — Policy#o Self-ins.Lic.#: (kL I ' ? 549 9 Expiration Date: 0 0 Job Site Address: / / ;y7 S City/atter-Lip: j#hi gietC 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 Investi•ations of the DIA for insurance covera•e verification. Ido hereby c • - •ext the pa s a penalties of perjury that the information provided above: is true and correct. Signature: �! 4/f— DataL '/ 'C t7 phone#: /i%''v/7,2/ .- 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.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: .Rc:UK0, CERTIFICATE OF LIABILITY INSURANCEI 03i%200� � (413)527-5520 FAX (413)527-5970 I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION r4.neli L Perras Insuranee Aageney, Ina. ONLY AND CONFERS NO RIGHTS UROW TME CERTIFICATE 6 Campus Lane HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Easthampton, MA 01027 ' Rebecca Kubosiak INSURERS AFFORDING COVERAGE NAIC# INsuREo Thomas McCarthyGeneral Coti-ractors,Inc. 'INS RER*: General Casualty 24414 3 Broderick St 'INSURER B: Easthampton, MA 01027 'INSURER C: ' 'INSURER D: 'INSURER E: COVERAGES 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 AFS.ORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SR TR ;WO V TYPE OF INSURANCE PORGY NUMBER rvtx.T tPTt611v2 rUIUI.1 11.AY11 A 1,can LRAM LTR NERC DAT!(MM/DD/YY) DATE(PAM/DOM) GENERAL UABIUTY LC103 95169 OL/10/2OU7 ' UL/10/200( EACH OCCURRENCE 'S 1,000,000 COMMERCIAL GENERAL LIABILITY L,A1YPl[3C TVTCCIs?cv 3 50,000 PREMISES(Ea oceuronce) CLAIMS MADE 'T OCCUR MED EXP(Any one parson) S 5,000 A PERSONAL&APV INJURY S 1,00U,OU0 ` — GENERAL A(UGRREGATE S 2,000,000 PRODUCTS-CUMP/CP AGG S 1,000,OLHi POLICY JECT 7 ''_OC AUT TY COMBINED SINGLE LIMB S ANY AUTO (Ea sc dMI) ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS (Per Panora) ---' HIRED AUTOS BODILY INJURY — NON-OWNED AUTOS (Pot amaaa) S II PROPERTY DAMAGE S (Pet accident) UARAUL UABIUIY AU IIJUNL1'-t/ AI,LIULN1 S ANY AUTO OTHER THAN to ALA, ) AUTO ONLY; Acaca•7 l A J LIIIMM If10LLA LIAZI•,I t Lvrvrervc.T- i OCCUR El CLAIMS MADE raAa.ccw�e r ^—,DEOUCT'BL 11: RETENTION S 1 CltiC0 N4 4007 02-/-10/2008 TORY u EMlt.OYERS•LU1lILm 1.e,r,Ii e -0 100,000 A ANY PROP RIETORIPARTNERJEXECUTTVE OFFICER/MEMSER EXCLUDED? I CL.Dlcr<!!-00.=MPLCfee 5 100,000 daaCtlDa,%IdSt-D !A t-PCL CY LIMIT _ -- — - rm, e0ICAL PROVISIONS below muss ,- . . - - . . ._- - ',BiCk WOMB tM& . EXPIRATION DATE THEREOI,THE ISSUINO INSURER WILL ENDEAVOR TO MAUL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUOATION OR LIABILITY City of Easthampton OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRESENTATIVES. Easthampton Building Inspector AUTHORIZED REPRESENTATIVE _. . l `K 'L �� �iX OAD Coe_OOR/1Ti0N WS