29-114 (4) 71 FOREST GLEN DR BP-2017-0736
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29- 114 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-2017-0736
Project# JS-2017-001222
Est.Cost: $13500.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RICHARD PARADIS 100245
Lot Size(sq. ft.): 13982.76 Owner: HAYNES CHRISTOPHER A&ANNE
Zoning: Applicant: RICHARD PARADIS
AT: 71 FOREST GLEN DR
Applicant Address: Phone: Insurance:
322 FORMER RD (413) 535-7006 WC
SOUTHAM PTONMA01073 ISSUED ON:12/1/2016 0:00:00
TO PERFORM THE FOLLOWING WORK STRIP & SHINGLE ROOF - 23 squares
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 ft 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 12/1/2016 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
-_- City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit_„--
r""'�z 212 Main Street Sewer/Septic Availabllity
f "i Room 100 Water/Well AvaiiabSly
1. Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 PloVSite Plans
Other Specify
w
�AP$UCATION TO CONSTRUCT,ALTER,REPMR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION I SITE INFORMATION BO- 17 +736
1.1 Property Address This section to be completed by office
71 rayforet+Le 1n o to& . Map Lot Unit.
Zone Overlay District
Elm St.District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: t `-� t^ \ ,.,
r5f.ss . i. Ayt s / t rcct 6-ie Lxr.
Name Print) Cu nt ilinaAdyy++r ss
I ?,c2r4- 5577
• 2 �� Telephone CF
gnature
2.2 Authorized Agent:
Name(Print) Current Mailing Adtlress'.
Signature Telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS J
item Estimated Cost(Dollars)to be OMutat Use Only
completed by permit a..licani
1. Building d O/ goo (a)Building Permit Fee 111.1.11. Electrical 7 / J t.�' (b)Estimated Total Costof
Construction
from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
6. Total=(1 +2+3+q ( 5) % ) 3, co° Check Number mitt a I
This Section For Official Use Only
Date
Building Permit Number ,,,{{{/// �, issued:
Signature: lam`/ ,/e
....... .......... .........
building Commissioneranspector 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 flied in by
Building Department
Lot Size
Frontage
Setbacks From
Side L: R: L: R:
Rear
Building Height
Bldg Square Footage STs
Open Space Footage
esh area minus bldg ek paved
parking)
#of Parking Spaces
Fill: _ ....
volume&tocadmp
A. Has a Special PermitiVariance/Finding ever been issued forion the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date Issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW ® YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO (PA DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained fl Obtained Q , Date Issued:
C, Do any signs exist on the property? YES Ll NO
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
IF YES, describe size, type and location:
E. Win the construction activity disturb(clearing,grading,excavation, or filling)over I acre or is it part of a common plan
that will disturb aver 1 acre? YES O NO
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 n Addition ❑ Replacement Windows Alteration(s) ❑ Roofing 01
Or Doors 0
Accessory Bldg. n Demolition ❑ New Signs [D] Decks [p Siding[0] Other[D]
Brief Descri. on of Proposed
Work: a .. - • •`t . s SS - ' /'1
Alteration of existing bedroom Yes )c No Adding new bedroom Yes `L No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa. 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
I, ('/iri'skc i _t— A- (-L, N✓S ,as Owner of the subject
property
y P S I In^^�CiiA ? I� iidi U
hereby auth ze e I V. A
to act or�my b half,in all i a es relative to work authorized by th' building permit app ication.
A. / jam /^1� X // z-3 /G
Signature-67 er Date
I, /�.I c L p✓,4 ( A✓c j, S ,as Owner/Authodzed
Agent et'
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.
,P, PARCci
Print Name
�}( //-2/—//
Signatureof
of Owner/Agent Date
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
' 100245 _ 09/24/2017
Richard Parodic License Number Expiration Date
Name of CSL Holder
List CSL Type(sea below).
164 Valley Road
No.and Street Type Description
U ./ Unrestricted(Buildings up to 35,000 cu.fl.)
Southampton.MA 01073 - R Restricted l&2 Family Dwelling
City(Towib State,ZIP NI Masonry
RC _ Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-535-7006 dcpatadteyahoo cam I Insulation
Telephone Email address D _ Demolition
5.2 Registered Home Improvement Contractor(HIC)
17
Paradis Remodeling and Building LLC HIC Re04 OExpira0on
NIC'Registration Number Expiration Date
HIC Company Name or IBC Registrant Name
164 VatHY Road _.....___ ._ ncparadis(ayahoocom
No.and Street Email address
Southampton MA 01073 413.535-7006
Cit /Town,State,ZIP Telephone
SECTION 6: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 0 No 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property, hereby au •Aze Richard Paradis of Paradis Remodeling and Building LLC
to act on my behalf, in allr matters relative to 'oauthor+=• by this building permit application.
t-Owner's�van. i (Electronic�( I�fJ Cf ) 1 P%-- Z 5
Print
( tronic Signature) Dat.
SECTION 7b: OWNER' OR AUT' O' !ZED AGENT DECLARATION
By entering my name below, I hereby attest wider the pains and penalties of perjury that all of the information
contained in this L
application is true and accur o'the best f p knowledge and understanding.
�C ( 4A1s 44"1 �c . - 6 � � 1112- 1J,
Oar's on Ath ized Agent's Name(Electronic Signature) Det
NOTE :
I. An Owner who obtains a building permit to do his/her own cork,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will gal have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can he found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage,finished basemendattics,decks or porch)
Gross living area(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"
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: 7/ Forec- (r/en jr, IL-en c e
L-ence /Wt o )bGa.
The debris will be transported by: Pei rags ,5 'uyno/p /,i ,/cil;ti-c�
The debris will be received by: ley 'PecyC/1h �J
Building permit number: c)171/c)171/ Vu c�g k f ler�(> 44,-Thanyloyi
111, 6/6
Name of Permit Applicant , i ; - ,,�`., ,/ci )
, a -
I
Date .n.ture of Permit Applicant
I
n>- The Commonwealth ofMassachusetts
lit
l Department of Industrial Accidents
i` Office of Investigations
I. i0 600 Washington Street
Boston,Mass. 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (BtsinesvOrganirdionnndividual)Paradis Remodeling and Building LLC
Address: 164 Valley Road
City/State/zip:Southampton, MA 01073 phone#:413-535-7006
Are you an employer?Check the appropriate box: Type of project(required):
1.01 am an employer with 4 4.Q l am a general contractor and I 6.0 New construction
employees(full and/or part time)." have hired the sub-contractors ;_{]Remodeling
2.0I am a sole proprietor or partner- listed on the attached sheet. g
ship and have no employees These sub-contractors have 8.0 Demolition
working for me in any capacity, employees and have workers' 9.0 Building addition
(No workers' comp. insurance comp.insurance. f
required) 5.0We are a corporation and its 10.0 Electrical repairs or additions
3.01 am a homeowner doing all work officers have exercised their I I.0 Plumbing repairs or additions
myself [No workers' comp. right of exemption perm MGL
insurance required]it c, 152, § I(4),and we have no 12.0 Roof repairs
employees. [no workers' I3.0 Other
comp. insurance required.]
L
'Any napplicant that checks bm#1 must also fill out the section below showing their workers'compensation policy information.
;Homeoweowners who submit this Affidavit indicating they are doing all work and then hire outside tracto eon must submit a new othose
affidavit indicating such.
;Contactors that check this box most attach an additional sheet showing the name ofthe umber.-mNractors and sole whether or not those entities have employees. If
the sub-contractors have employees,they most provide their workers'comp.policy number.
I am an employer that is pronging workers'compensation insurance for my employees. Below is the policy andJob site
information.
Insurance Company Name:Acadia
Policy#or Self-ins.Lia d.WCA-5154474 Expiration Date:06/20/2017
Job Site Address: 7/ toYecf 64/. Nr CityState/Zip:1-%r a2 /734/ Oy 6
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 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
$250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the
DR for coverage verification.
I do herby certi/fy uncle to pairs and penalties of perjury that the in_formation provided above Is true and correct.
Signature: l" - Dae: /1-2f4
Print Name: Richard Paradis Phone a: 413-535-7006
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):
[Board of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact person: Phone ft:
^'1 PARAREM-01 HOLERI
AC.1C)RC) CERTIFICATE OF LIABILITY INSURANCE °A"1'""°°"r"
�.-- 8/26/2016
THS CERTIFICATE IS ISSUED AS A MATTER Ort r:_RMA tO' 0N>AND CONFERS NO2IOiTS UPON THE CERTIFICATE HOL DER 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
I REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:a: conditionsIf the oosiof the holtly, a to ADDicima require tee dorsemes)n must ae me t on If SUBROte eN Io co tE D,shs tot toh
the [cane andrileof the policy,curtain policies may require an endorsement. A statement on this certificate does not collet rights to the
I_ certificateholder in ho4 of such endorsement s-
I P sRaBa
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Insurance Center of New England,Inc o FAX
we
1
107ura0 Suffield Street 1 , ,1,(000)263-8174 luxvl (413)771-8539
,Agawam MA 01001 CRr.,
INSURER1SaaaatO110 COVERAGE NAICIt
' I wsuRERA;Atadia Insurance Company
INSURED .INSURER1'.
Paradis Remodeling&Building LLC 1INSURER c:
164 Valley Rd INSURER 0: I
Southampton,MA 01073 I INsuRERe:
COVERAGES CERTIFICATE NUMBER' REVISION NUMBER
E i0 GERT'F II L FOLUW rF ` JR:. ( JS . 6F'.4 I P `4J''. 1 N•IUFE r V1FJ b0A. FlIL�4 PE Rl0D
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[ LLL, ION= ANDY v 1 Sl GR A/WY da n i , .:F - a ,. t iG ALL TIRE TERMo
EXCLUSIONS AND 60N41pN OFSUC F ,_CES IIMtT-n ONl uF'M.E GeLN-[De!Y E a .EXP
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NFE OE INSURANCE anMat SUM PCU Y auMS R POLICY F f terms LtkfS
m m-sO.wan _ :vnrr. 1 Smxo°rrerr!_ _..
A X COMMERCIAL csNEaawaeEm EACH orcuRRerr.e 1 1A00,90
CL?IMS ort` X I P X BOAS154468-12 06/2012016 06/20/2017 r U IUen 50,00
EL E.=mor my j,,,,,,I S 5,00
Lamm-a._Iau<r 1,000,00
Eo,t.E t r B ES PER ER e s 2,000,
'
1 X r _ ur ti F 2,000,001
ca,i. 1
AUTLmIORILE LIABILITY _._..—... ,, • ,. i I S 1,000,004
A Mn AUTO X MAA5214412-11 06/20/2016 061201201? e<wIV'Nara,a1.1„anal, 3
At40Yk8^_ X SOiEOU_EJ eooir PLu of RVrxT,derA T.
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LI A teens UAB P, L X CIJA5182600-12 06120/2016 06/2012017 c r 1,000,00
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RIPTION Or OPERATIONS I IOCATONS I Valla ES(ACORn 101,Au4Rlpnal eam.w SryeuNe.mer he atm nal it mom spare II rvnuxeul 10 Show alvtd ence Of co,,orae
CERTIFg;ATE HOLDER CANCELLATION
SHOV LO ANY OF THE ABOVE,DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DA r6 !HEREOF. NOTICE WILL BE DELIVERED IN
Rick Parade. ACCORDANCE WITH Tee POLin'Y PROVISIONS
164 Valley Rd
Soulhamptun.MA 01071
Ai : cRaro RI,,,,-dy`ar,„Iu- ,
1 @11988 2014 ACORD C RPORATION All rights reserved.
ACORD 25(2014/01) The ACORO name and logo are registered marks of ACORD
License or registration valid farndividul use enlyYr YS,,,,, ,.di/,�-ft rt
Wren the eapiratwu¢ate. tf foundFetnr5t6- Office ofC mer Affairs&Business Regulation
Offceatronss dr Affairs and Business Regulation 'r HOME IMPROVEMENT CONTRACTOR
10 ParYC Lslvev-.Suite 9770 -- '- ' [tegistra0on: 176404 Type:
Boston,MA02116 3= Expiration: 8/20/2017 LLG
_ ar
PARADIS REMODELING&BUILDING LLC.
RICHARD PARADIS
322 FOMER ROAD
Not valid without signature - ---
SDUTHAMPrON,MA01073 Undetsarctaq
Massachusetts Department of Public Safety
111 Board of Building Regufabons and Standards
License' CS-1O0249
Construction Supervisor
RICHARD 0 PARADIS
164 VALLEY ROAD
SOUTHAMPTON MA X01073
NI e. CA,,..- Expiration'.
Commtissioner 0412412657