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24C-064 (6) 88 MASSASOIT ST BP-2017-1488 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24C-064 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categorv: ADDITION&RENOVATION BUILDING PERMIT Permit# BP-2017-1488 Project ft JS-2017-002484 Est.Cost: $100190.00 Fee: $650.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ROBERT WALKER 034783 Lot Size(sq. ft.): 17031.96 Owner: EPPSTEINER ROBERT&ENN Zoning:URB(100V Applicant: ROBERT WALKER AT: 88 MASSASOIT ST Applicant Address: Phone: Insurance: 36 Service Center (413) 584-1224 Workers Compensation NORTHAMPTON MA01060 ISSUED ON:6/23/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:REMODEL KITCHEN AND BATHROOM, ADD MUDROOM - 8X9 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 OS 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 6/23/2017 0:00:00 $650.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner I,y� (t1 � File#BP-2017-1488 to �' J APPLICANT/CONTACT PERSON ROBERT WALKER Zl ADDRESS/PHONE 36 Service Center NORTHAMPTON (413)584-1224 LOW"' ,"'�A ' t PROPERTY LOCATION 88 MASSASOIT ST MAP 24C PARCEL 064 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST NCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid �\ Building Permit Filled out Fee Paid Tvpeof Construction: REMODEL KITCHEN D : lir ROOM,ADD MUDROOM-8X9 New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 034783 // 3 sets of Plans/Plot Plan f(2e7iO4/tc qq(g THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO RMATION PRESENTED: t--"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 Permit DPW Storm Water Management molibon Dela ���� 101.-12 Sign ure o Building Official 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. of Northampton - te11)1W ilding Department ( � 212 Main Street �. t "' Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 •SITE INFORMATION 1.1 Propal'tLAddress: Be (mass A-So Cr 4-r. SECTION2--:PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Enn A QoA c.r 'r E\Aas n• r S)% h-lcssaso�4 S l�.csr�Ik�u C rens M ing Atltlress'. /we Y1 r�OB U-lr'I -CP Z-CCS ! i� _� tu.. {d� Te phone ..tare 2.2 Authorized Agent: <Qy\At (�zn+�ar- f"°p'S4-0*+.w�D•— Name(Print) Current Mailing Address: - Signature Telephone SECTION T-ESTIMATEDCONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Offidal Use Only completed by permit applicant 1. Building 2'7 (a).Goading Permit Fee 2. Electrical 55 / (b).Estimated Total Cost of (s 7 1-1 Construction from(6) 3. Plumbing Building Permit Feeel 4. Mechanical(HVAC) 5 Fire Protection 2 , L..)14.) 6. Total=(1 +2+3+4+5) VO/ i GI U, Check Number MO This Section For Official Use Only Date Building Permit Number: i d. • Signatirce: Bmg.Commissioner11nspemor Of Buildings Wld t5, EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed ! Required by Zoning This column w be tilled in by Building Department Lot Size to Kb 4' 1i 1 SG d- 1 , Frontage F--- I1 St r 1 Setbacks Front 1401 1 3d1 1 1 Side L: ZS 1 R:L.7A-11 L: z.0 J R:1 2. I (— 1 I I Rear . it t; I I i14 1 I . Building Height ,''- f/{at'� I Bldg. Square Footaget:P, : .iL,, °fo 2 Tis 5/e . Open Space Footage (Lot area minus bidg&paved '. z�r� r /8 1 I tt 1 parting) 1 3Mbo 13 1- Ip' t #of Parking Spaces Pili: (volume&rm tion) A. Has a Sped I Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW 0 YES 0 IF YES, date issued:L IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW 0 YES Q 1 IF YES: enter Book Page- and/or Document N, 1 B. Does the site contain a brook, body of water or wetlands? NO07 DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained Q , Date Issued: C. Do any signs exist on the property? YES O NO V 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 07/ 1 IF YES, describe size, type and Location: E. Will the construction activity disturb(ciQaring,grading,ex tion,or filling)over 1 acre or is it part of a common plan that will disturb over I acre? YES NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. —NOTE— THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED. BUILDING LOCATION ACCURACY IS NOT GUARANTEED 84.5't NOTE: PROPERTY LINES SHOWN ARE APPROXIMATE. A FULL FlELO SURVEY IS REQUIRED TO ACCURATELY BOOK 4602, PAGE 21 DETERMINE THEIR LOCATION. SEE: BOOK 264, PAGE 170 LOT g29 ftEa2 Cear- 11 ItCO o ' * N C N O pi -H. NE.W E r-+,ay ser- P,kc aPC)MON • 2S 2° 4111101 L__ Ra ,t setga�. 2z1g „ FRarr csr4Ack O 86't • MASSASOIT STREET TO: BERKSHIRE BANK & FIRST AMERICAN TITLE INSURANCE COMPANY TO THE BEST OF MY INFORMATION. KNOWLEDGE AND BELIEF I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES, EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR COMMUNITY #250167�n-�..a.�z 7. y -AOTE- SURVEYOR; THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY OF -MORTGAGE I OAN INSPECTION PIAT- s+ rtrs\ e�� NORTHAMPTON, MASSACHUSETTS RANDALL PREPARED FOR !' ; ERIN E. & ROBERT W. EPPSTEINER SCALE: 1"=40' JANUARY 4, 2016 4 suR,R.S HAROLD L. EATON AND ASSOCIATES, INC. -- REGISTERED PROFESSIONAL LAND SURVEYORS SE.G t06LSBESbTRP!NON OF PROPOSED WORK,(check all aoolicabte) New House ❑ Addition [EReplacement Windows Alteration(s) Roofing C Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs ID] Decks C Siding IDI Other IDI Brief Description of Proposed 1 r I1 Work: e& e %L k 2 tl#&r paP n ,ge twtkov' 1 AOevtuD4Oca l 3 Y9 Alteration n of existing bedroom Yes ✓ No Adding new bedroom Yes r^ No / Attached Narrative Renovating unfinished basement Yes ✓ No Pians Attached Roil/Sheet a. Use of building One Family VlVl Two Family_„ Other „ b. Number of rooms in each family unit: _ Number of Bathrooms c, Is there a garage attached? iiia r0 0 1 d. Proposed Square footage of new construction. —7 1 p c/ x e Dimensions e Number of stories? 1 , -_ �/ f. Method of heating? t1 ?- 4-.n-.x / k) C'v Fireplaces or Woodstoves /' Number of each X g. Energy Conservation Compliance. ha 15,- Masscheck Energy Compliance form attached? h. Type of construction elf- Le L,.069 cA_A- lr i. Is construction within 100 ft. of wetlands?!-Yes 1�,l No. Is construction within 100 yr floodplain Yes Nn j. Depth of basement or cellar floor below finished grade tJ k. Will building conform to the Building andeningregulations? ✓ Yes No. I. Septic Tank_ City Sewer V Private well City water Supply 1// SEOITON'Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERSAGENt'OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, en Yl7 p.cos tilt r- �` .as Owner of the subject property 1 ^�,, 1, hereby authorizeV)Q'( N�� } 0 to on my behalf in ail matters relative to work authorized by this building permit application. �q �D �Z O 1 Si a ure of Comer r Da I, P?P[ _. WAY^IN%C'L,/--- ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,tome best of my knowledge and belief. Signed under the pains and penalties of perjury. ç2_,c ln„4-�,1/44 Print Name • 0 4I7.4, i t Signature of Owner/Agent Date 8.1 Licensed Construction Supervisor: Not Applicable 0 -r Name of License Holder: ..17 -T S Wart.Y+E(L CS - owlO3 License Number 3 L. S fetvtcv. C¢.•otR ,soerM a-...Prom! OAS t o l t S/ zo i 1 Address�t � w5� 1 ^11 r Expiration Date 144.411.7�.tC� ¢n - riS4 - tat it Signature Teiephone Not Applicable C Q rt.X- 3 WS.LAW R fl 2 0 ( 6 Company Name Registration Number 3L. Sct.0 cs &v i-eatte s/ 14. / 7—ot8 Address Expiration Date h-bt'tV AcwW M.a1 %AA4 Ottt.O Telephone 5L —1224 Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit Mit result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes 0 No 0 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 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 City of Northampton � s- Massachusetts :Act, Massachusetts 7^f . DEPARTMENT OF BUILDING INSPECTIONS 212 Main Ntreet •ttnicipal Building Northampton, ✓'�t 1 MA 01060 44;:dir Debris Disposal Affidavit In accordance of the provisions of MGL c 40, 854, 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 ill, S 150A. The debris from t��construction work being performed at: a., p_,, e (Please print house number and street name) Is to be disposed of at: VAel-.L-C-4 R- Cy N (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: 41444.1.<ft sT `'M)Ottt f�JCA (Company Name and Address) Signature of Permit Applicant or Owner Date If,for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts t= A� CERTIFICATE OF LIABILITY INSURANCE °A"' ","n 6/20/2017 i` 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 POUCIES 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 POlcylies)must be endorsed. If SUBROGATION IS WAIVED,subject to the teems and conditions of the policy,certain polices may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endersement(s). PRODUCER CONTACT Barbara Grpnkievier Webber 6 Grinnell PHONE P+,I (413)586-0111 • PAX peal,(115)596-6491 8 North King Street n�S:bgryakiwicz@Mebberandgr±unefl.corn INSURERS)AFFORDINGCOVENGE NAJCC Northampton HIS 01060 usuRERAlixcelaior/Liberty 11045 INSURED INSURER a A.I.N. lhitual I Robert Walker INSURER C: I Attn: Rim Clairemont 04SUReR D: 1 36 Service Center Road NSURERE: Northampton NA. 01060 INSURER F: COVERAGE CERTIFICATE NUMBER 3/1/18 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTW THSTANDING ANY REQUIREMENT.TERM OR CONDNION OF ANY CONTRACT OR OTHER DOCUMENT IMTH 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 SUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS'', TYPE OFINSUMXCE ALOLSUBRI PDYLY yr i PWCYEW ' LAMS JtlBp WVO POLICY NUYBER NWOD'IWY1 1Melee'IWYI. 1, 8 'COIMrEWALGENERAL UAWIITY EACH MT,RREYOE I5 1,000,000 A I CLAMS-MADE '`!OCCUR DAMAGE TO RENTED 100,000 REMISES IEC Or cRl 5 Ca%S9B29e ! 3/1/2017one 3/1/2016 MED EXP penin) 'IS 5,000 — ' PERSONAL BADV IWURY I$ 1,000,000 GEN':AGGREGATE LIMIT APPLIES PER'. GENERAL AGGREGATE 1$ 2,000,000 78,7-POLICY C ' Loc PRODUCTS-COMP/RAGG I $ 2,000,000 •AUTOICSILE UABEIn !. •• IED NI N • S ANY AUTO . BOGEYIU BOGEY INRY(Per person) 15 •A" OWNED —SCHEDULED BODILY INJURY(Per accident)I5 i AUTOS HIRED AUTOS ^.NON-OWNED PROPERTY DAMAGE $ J AUS (PAT acodedl I I IS I U16RE.IA We ! •OCCUR I', EACH OCCURRENCE S — • EXCESS LlA9 ILWMSMPDE AGGREGATE 'S ' •DEC ' I RETENTIONS I $ I WOMEPS COWSISUNM • IC PER IfTE I MR- 1 AND EMPLOYERS WBWtt :ANY PROPRIETOWPARTNME(ECUPVE Yltl . E.L EACH ACCIDENT 'I $ 500,000 • B !IOFF) ,BERIXCLUOm] I N/A 41.80080065482017A 7/1/2017 7/I/201E EL pICFnSE-EA EMPLOYFE $ 500,000 I1ITS ResateurPer DESCRIPTION OF OPERATIONS bekw I E.L DISEASE-POLICY LIMIT I5 500,000 • • DESIWPIpN OF OPEMTNMIS I LOCATONE I VEHICLES(ACORD 101,AdBbnal Ren SCMLN,may S teacMS Smelt Waal b,puired) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE **For Insurance Info Only** THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ANHIXRDEO REPRCSENTA1lW t^� -� e /I� R Webber, CIC CBIS/EA i/`� AS[Nc"Y'c."-_ ®1985-2014 ACORD CORPORATION. All rights reserved. ACORD 25(201401) The ACORD name and logo are registered marks of ACORD INS025(r1401) A RLA CERTIFICATE OF LIABILITY INSURANCE wirs 6/20/o"ir' - HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS JERTIFICATE 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: H the certificate holder Is an ADDITIONAL INSURED,the policyllos) must be endorsed. N SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the Lerdfiadu holder in lieu of such endorsement$). PRODUCERI NAiIEACT Barbara GYynkiewicz Webber & Grinnell ImgaP Ewajj, (413)585-0111 !i FAX(611)566-6691 _ a North Ring Street bgrynkiewicz@wabberandgrinnell,con INEUREP(W AFFORDING COVERAGE WC a Northampton MA 01060 LNstRER A BrealaiotJLibArtY 11045_ INSURED INSURERS Petberlands/Liberty 124171 Construct Associates, Inc. mwRER e:Peerless/Liberty Attn: Rim Claire/tont MEURERO NEI Lmploters/A.I.M. 13083 36 Service Center Read NsopEQE: Northampton MA 01060 INBUREn F: COVERAGES CERTIFICATE NUMBERBzp 7/1/18 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTMTHSTANDING 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS ILTR TYPE OF INSURANCE IMTIX est FOAMY ROAMER �M � Haff• �1 GISTS Z. I COMMERCIAL GENERALuAaRRY ( I EACH OCCURRENCE $ 1,000,000 E MRENT A _iiiCLAMS-WOE I OCCUR I jpawl MaMorrrival 5 100,000 ®e8895898 3/1/2011 13/1/2018 MED EXP( or*Foram) i5 5,000 : :PERSONAL 9%W INJURY i5 1,000,000 i GENt AGGREGATE LIMIT APPLIES PER:PPLIEGENERAL AGGREGATE iE 2,000,000 • , • I POLICY R jECT LOC PRODUCTS-COMP/OPAGG i5 2,000,000 ^-OTHER 5 . 'AUTOMOB4a GAMUT, COMMOVE SINGLE'LIMIT ',IS 1,000,000 '1`-e accent B :' ANY AUTO •;SODILY INJURY(Pe C fl '5 A60NNED 'BCXEOULED _AUTOS 8 NONE 185889669@ 3/1/2019 3/1/2018 BODILY INJURY(Pttawbn0 E NON.OWNEU PROPERTY OAMADE I R__ HIRED AUTOS I R AUTOS (PeraNhnil 5 Meamlpemenss 5 5,000 IR 'V5®RT;LU UAB :X .00CUR IEACX Ol1CURRENCE 5 1,000,000 c EXCES511A9 1 I CWMSNADE: : AGGREGATE IS 1.000,000 CEO X RETENTIONS 10.000 Ct1889729e 13/1/201.7 3/1/2018 pp E jPOWERS CORPENSATION 1 Rlay' 10TH. • AM)Li L f RSt MJtt a LER I ANY pROPWai0GPARTN8VIXECunVE TINI ' 'EL EACH ACCIDENT 5 500,000 OFFICERS/EMBER OFFICERBER EXCLU0 'TNI A D INA4woryy h NSI I BCC6000000780201.7A 17/1/2017 7/1/2018 E LOSEASE EA EMPLOYED S 500,000 oesCR9>rTION OF OPERATKK:S ttlw : . EL.DE=EASE-POLICY LIMIT 5 500,000 • 1 DESCRIPTOR OF OPERATIONS I LOCATIONS/VEHICLES IACORO 101.Adatimol Renetta Sd,.4a may In a1McM M nwra space N rpuhS) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE **FOM Insurance Info Only** THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUMORG'ED REPRESENTATIVE ll � -. n R webbe_, CIC ORIS/BA �f , R+A�03-4-i-Y^�- 401888.2014 ACORD CORPORATION. AN rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS0281201401) City of Northampton Csr Erik. ,. Massachusetts � 'y 8i1' DEPARTMENT OF !WILDING INSPECTIONS 212 Main Street • Municipal Building r. �. Northampton, MA 01060 �'Cg7YYr AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes, Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units..,.or to structures which am adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a prporatiion or LLC,that entity must be registered Type of Work: Vt-to^t . ... Via S.cQE ✓` Est. Cost:4r\00 004-) Address of Work: % '1�-l.GS u i .Ca ( t C flA 'QTt ', !AAA Date of Permit Application: U) Z.4 t'? I hereby certify that: Ij erration is not required for the following reason(s): (/ i (}- /' ICI , IIFT York excluded by law(ekplain): 4fi t“ j- Job under$1,000.00 Owner obtaining own permit(explain): Building not owner-occupied Other(specify): -. OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.C.L.Chapter 142.A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: j /`7 U76/ b l ( L-1 V v:16VV(LT VI. tirvw.YL I j Date Contractor Name HIC Registration No. OR: Notwithstanding the above noj'ce,ee,,, I hereby apply,for a building{ �lpermit as the owner of the above property: pp Date Owner Name and Signature