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22-026 (4) 56 SPRUCE HILL AVE BP-2018-1144 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:22-026 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categorv' ROOF BUILDING PERMIT Permit# BP-2018-1144 Project# JS-2018-002060 Est. Cost: $8200.00 Fec: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BRADFORD J MOREAU 1175408 Lot Size(sa. ft.): 14287.68 Owner: BELL VICKI A&RICHARD W RILEY zoo Applicant: BRADFORD J MOREAU II AT: 56 SPRUCE HILL AVE Applicant Address: Phone: Insurance: 9 HARLOW CLARK RD (413) 358-7946 HUNTINGTONMA01050 ISSUED ON:5/4/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF 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: FeeTvpe: Date Paid: Amount: Building 5/4/2018 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only -- pfo Status of Permit ..� " tl�eBuildinDp en Curb Cut/Driveway Permit A 21a S et Sewer/Septic Availability see Room 10 WatertWell Availability �R oic 30 Two Sets of Structural Plans —Al587-1272 Plot(Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION go (} i //Vv 1.1 Property Address: This section to be completed by office S6pev��v�� �il� �/��E' Map_dA Lot G.;' & Unit 7 Zone Overlay District Elm SL District CB district SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2A Owner o7 Record= c E S�SPQa/cF/✓irr <La�F�lr a ame(Print) Current Mailing Adtlress' ✓2 , 1�t F—ane?= 195, - 6S � Telephone Signature 2.2 Authorized Agent: Namee((PlrPring ,Bu tcl T. ///a/!FA/. 7L I/✓A/11IJWCC4/�2D N/1n rni/_� N /fin. Current Mailing Address: 01U� �/Z?- ..352- Signature Signature Telephone SECTION 3.ES M TED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed bpermit applicant 1. Building (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) ly 5. Fire Protection 6. Total=(1 +2+3+4+ 5) 1 .2.00 Check Number 1/0 This Section For Official Use Only Budding Permit Number: Date Issued: Signature: 3 Building 4missioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) i Section 4. ZONING All Information Must Be completed. Permit n Be niedDue To Incomplete Info ma[i Existing Propsed I Bgte irEd"ni ��hh��, hhlumn filto in by Buddin.Department QiMR� Nr 'mnMM'D tV11 Lot Size Frontage ... ... _... _. Setbacks Front Side L R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage % - (Lot arta minus bldg&paved -- rkm #of Parkin S aces Fill: ivalumc&Lacenonl A. Has a/S'�pe(�Ta t Permit/Variance/Finding ever been issued for/on the site? Cl NO DON'T KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW C) YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO �ON'T KNOW ® YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained O , Date Issued: C. Do any signs exist on the property? YES "`���"JJJ O/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. Wil the construction activity disturb(clearing,gredinc, exc abon, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O VO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check II applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing gr Doors O Accessory Bldg. ❑ Demolition ❑ New Signs [[7] Decks [q Siding(0J Other[O] Brief Description of Proposed _ Work'J %L 17r, '7—m ./V,�qA" Alteration of existing bedroom_Yes ✓ No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes Nc 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? J. 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? In, Type of construction i. Is construction within 100 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 PERMIT I,property as Owner of the subject hereby authorize ,6/l.,Q/'FG/u7 /3(/ G(' F/J,S —r/JG to act on my behalf, in all matters relative to work authorized by tKs building permit application. Signature of Owner Data I, /,�2,�1C�0/IQ T, /j'I6//FAl2 as Owner/Authorized Agent hereby declare that the s atement�s and information on the foregoing application are true and and belief. accurate,to the best of my knowledge Signed under the pains and penalties of perjury. SWA'Doan ,T, ('4- Print Name T� Signature of /Agen Dat SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: 15//. .19,7 [,O S7 License Number 9 HqC Lju e«P'A- AeblIVItl 70 A4 lrc a /9 Address Expiaoig6 Date Sign.t.reV Vl Telephone — 9. Registered dHHolme/Improvement Contractor: Not Applicable ❑ Company Name Registration Number a/1frsrr %v;�DFns LNC 8�si �l� Address � r' / Expi anon D to /L/A?L6w eLA/,. 9N///Jjt'E/,-x✓///�. Te ephoney/3-,(rf-/1) b SECTION 70-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....... ❑ No...... ❑ ' City of Northampton ( Massachusetts C A . I DEPMTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building t Northan ton, um 01060 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 owneroccupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: Est. Cost: Address of Work: Date of Permit Application. I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): Job under 51,000.00 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 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PACE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: - `y�a/yADl�t07. Na/ZFGJt fi/!ll�ODrdi�BC;[tK��s /%-� 7W�� Date Contractor Name L HIC Re g1stration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton MasB.acnusetts �- 'I DEPARTMENT OF BDZLDSNG INSPECTIONS 212 Main Street a Hunicipal Building CJs C` \ ., Northampton, MA 01060 Massachusetts Residential Building Code Section 110.R5.1.2 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. Section 110.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner ;hall act as supervisor. 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. City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS i r 212 Mein Sweet •Municipal BDilding NDithamp[Dn, MA 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, 554, 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. The debris from construction work being performed at: (Please print house numb and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: Aa/' Al 5 /70// (Company Name and Address) / LOain;s �ti�Ay F/'srgAmQ7un/, 47� 41��7 Signature c&1 e t plicant or Owner Date If, for any i on, 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 ofMassachuseus r., Department oflndustrialAccidents I Congress Street,Suite 100 7 Boston,MA 02714-1017 rvwly.mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Informationppnn,,,, _ Please Print Legibly Business/Organization Name:�e W,4J j/zo A fIll t, TAc Address: 9 CLA?/l RG_ City/State/Zip: rl 'il <' _ Phone#: ZZ k/ Are you an employer?Check the appropriate box: Busin s Type(required): 1,❑ I am a employer with employees(full aid/ 5. Retail or Part-lime).` 6. ❑Restaurant/Bar/Ealing Establishment 2.El I am a sole proprietor or partnership and have no 7, ❑Office and/or Sales Qnel,real estate,caro,etc.) employees working for me in any capacity. ,,,,��,,II [No workers' comp, insurance required] 8. ❑Non-profit 3.LI We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152,pl(4),and we have 10.❑Manufacturing no employees. [No workers'comp.insurance required]" 4.❑ We are a non-profit organization,staffed by volunteers, I1.❑Health Care with no employees. [No workers' comp.insurance 'eq.] 12.0 Other 'Anyappncantdmchecksbox#Imust also fillom thesection below,hosmiheuwmiwo compensationpolic formsomi. "'lithe ro...is mr.c.have axempred themselves I.the corpoa i a las Mier employees,a workerscompensation policy is required and such an .,—..,am should check box#1 I am an employer that is providing workers'campensatiun insjumnce for my employees. Below is the policy information. Insurance Company Name: _ Insurer's Address: City/State,Zip: Policy#ar Self ins.Lic.# Expiration Date: Attach a copy of the workers'compensation policy declamation 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 c,vil 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 ofthe DIA for insurance coverage verification. I do hereby certify,under the pains and penalties ofperju y that the information provided above is true and correct Signature e s � _ Date z1�3b/1�� is Phone#' y/.f-J3.J�—V Official use only. Do not write in this area,to be compreted by city or town ojlieiak City or Town: _F'ermit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City//Pown Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www x,gMy/dig Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as--every person in the service of another under any contract of hire, express or implied, oral or written" An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However,the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,525C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements ofthis chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply your insurance company's name,address and phone number along with a certificate of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required.Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please bo ame that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number.In addition,an applicant that must submit multiple permu license applications in any given year, need only submit one affidavit indicating current policy information(if necessary). A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant zi proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Departments address,telephone and fax number The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street Boston, MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSA-FE Fax# 617-727-7749 www.mass.gov/dia Pim,Rc,-d02'3-15 HIC 170018 CSL 75408 Bradford Builders, Inc. 9 Harlow Clark Rd Huntington, MA 01050 Tel 413.358.7946 Customer: i Vick* ell �S (� 56 pruce Hill�N.� (,��b� "-- Florence, MA UU Scope of work: Remove existing layer of shingles that are on the roof. If at that time any rotted wood or any problem is detected, Bradford Builders will contact customer and discuss problem and options. This would result in a $55 per man hour. Apply 2 rows of ice barrier along eaves and in the valleys. Apply roof guard over the rest of the roof so in the end you will have 2 layers of roof. Apply a 30 year architectural shingles over the whole roof. Install a continuous ridge vent and cap on peak of roof. Install a new boot over the stack pipe Install a new drip edge (white) Bradford Builders will pull permit Bradford Builders will get a dumpster and have it delivered to site, we make sure that the dumpster company puts guards under it but sometimes the lawn will compress, but not our responsibility to repair. Owner will supply power and access to it for project Bradford Builders loves shrubberies and flowers so we will be as careful as possible to not disrupt any ,of it but some damage could occur. Total cost: $8200 $5,000 due upon signing of contract �C 'J ow $3200 due upon completion _/ J X_-� _Q`---------- x-I�-`i� -------- _r 4Co CERTIFICATE OF LIABILITY INSURANCE 05/02/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement's). PRODUCER CONTACT HANE AdlRa Edgetl Webber&Grinnell PNx"Ea_ (413)588-0111 aG He, (013)5867481 8 Noun King Street ADOFEsE-. aedgett ebew d,nnoII ad. INSURERCH AFFORDING COVERAGE HAIL. Northampton MA 01060 INSURER Main Street America/MSA 29939 INSURED INSURERS. Commerce Insurance 34754 Bradford Sunder$,Inc INSUMENC ART Bradford Moreau INSURER 9 Har[°Clark Read INSUNERE Huntington MA 010509799 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp OD18 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. 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMSHER POLICY NIFF Try . PE OF INSURANCE NED WYa POLICY NUMBER MMNOMYY MMODYE%P LIMITS X COMMERCIAL GENERAL LIABILITY EAOry OOOURRENCE 5 1.000.000 DLAIMS-MADE O OCCUR PREMISE$ E 5 500,000 PCce ME°EXP(Ary one eio) s 10.000 A MPT9550S 08/04/2017 NVGE2018 PERSONAL S ADV INJURY s 1.00a000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 5 Z000 000 X POLICY ❑�Ea' 1-1 U. PRODUCTS-COMPIOP A. 5 2,'C-0 OTHER AUTOMOBILE LIABILITY CEO MBI eEDI SINGLE LI Rl a 1,000,000 ANY AUTO BODILY INJURY(Per,penon) 5 B OWNED x SCHEDULED BCDR20 07/13/2017 07/13/2018 BODILY INJURY ryeremden° $ AUTOS ONLY Aul HIREDNON9WNE0 ANEGIC PROPERn x AUTOS ONLY x AUTOS ONLY P.'='O5 Undenroured motorist S 100,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE 5 EXCESS LIPS GLAIMs-MADE AGGREGATE s OED RETENTION 5 S ROMPERS COMPENSATION PER OTH AND EMPLOYERS'LIABILITY ,.IN STATUTE ER ANY f CEP)MEMPOER EXCf UDEO+Ecu11vE ❑ N EL EACH AGO DENT s niuseorvin NH) E L DISEASE.EA EMPLOYEE $ If Arr once eds OEscwPnoN OF OPERanONs eelpw EL DISEASE POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACONO I.I.Adair anel Remerkn BCRe4un,mry be aNCRed Nmort apace[a repulntl) Regarding_56 Spruce Hill Ave. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 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