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36-252 (10) 203 MAPLE RIDGE RD BP-2018-1194 GIS#: COMMONWEALTH OF MASSACHUSETTS Mau-.Block:36-252 CITY OF NORTHAMPTON Wt:-W 1 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit. Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:ROOF BUILDING PERMIT Permit# BP-2018-1194 Project# JS-2018-002139 Est.Cost: Fee:$117.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BARRON & JACOBS 60475 Lot Size(so.ft.): 439084.80 OWner.- OTTAWAY ALEXANDRA H&HARRY G NAULT Zoning: Applicant: BARRON & JACOBS AT. 203 MAPLE RIDGE RD ApplicantAddress: Phone: Insurance: 70 OLD SOUTH ST (413)586-8998 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:5/17/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVING DECKING, RAILING, FRAMING AND RUBBER ROOF ON 3RD FLOOR BALCONY AND INSTALL NEW 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: FeeTVDe: Date Paid: Amount: Building 5/1720180:00:00 $117.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2018-1194 APPLICANT/CONTACT PERSON BARRON&JACOBS ADDRESS/PHONE 70 OLD SOUTH ST NORTHAMPTON (413)586-8998 PROPERTY LOCATION 203 MAPLE RIDGE RD MAP 36 PARCEL 252 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST OSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildine Permit Filled out Fee Paid TvoeofConstruction: REMOVING DECKING FRAMING AND RUBBER ROOF ON 3RD FLOOR BALCONY AND INSTALL NEW New Construction Non Structural interior renovations Addition to Existing _ Accessory Structure Building Plans included: Owner/Statement or License 60475 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9RMATION 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 Permit DPW Stonn Water Management molition Delay acme of uia tcia,�i at Note: Issuance o 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 Once of Planning&Development for more information. �26-0 f - F474-3487-1 tG Kwo.,StreetSblledgrtQ18 MA 010 0ph87- 272 PgB3110INSPECTIONS.MA 01060 ..�1/Clbl 1reSt APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO/FAMILY DWELLING SECTION 1 -SITE INFORMATION b v ` _I' �� 1.1 Property Address: This Section to be completed by office 2-0�) Nb\lpti � Map Lot Unit k\oY2vCe MIS D\062— Zone Or"dayDistrict Elm SL Distinct CB District SECTION 2.PROPERTY OWNERSHIPIAUTHORIM AGENT 2.1 Owner of Record: `P�(CA)(-A .i a'11AW dJn 70� (`/\GInO\P_ NL\I,�L Kai .-F�t1JQrj n� Je(Ph Current Mailing AGdr CLLYQD,[�"Q-I�' /)OI `�", ��M l� Telephone Signature ) sT 2.2 Authorized Attend, Name(Print) Curren)Halling Address: 4/� �� Signature Teleptwne SECTION S-ESTIMATED 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 �1 4. Mechanical(HVAC) 11 1 vO 5. Fire Protection 6, Total=(1 +2+ 3+4+5) Check Number of on For Official Use Only Dale Building Permit Number. Issued: Signature' Building C issioner/Inspector of Buildings Data EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING7 All Information Mast Be Compteted. Permit Can ae Denied Due To Inrdnplete Information Existing Proposed Required by Zoning This column to be filled in by l(--� Building Depornent Lot Size Frontage Setbacks Front Side U R: L: R: Rear Building Height Bldg.Square Footage % Open Space Footage (Lot arca minus bldg&paved parking) #ofParking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW © YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO `) DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O ,tDate Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: r D. Are there any proposed changes to or additions of signs intended for the property? YES O NO (Qy IF YES, describe size, type and location: cow E. Will the construction activity disturb(clearing,grading, xcavation,or filling)over I 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. SECTION 3-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) � Roofing ❑ Or Doors O Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [p Siding[C2] Other[OJ Bnef Description of Proposed Or �j/a\ lgOi'1oa\wr..�,(GN.AJas;V dark-uvU,Va.\.w�, {Yowwr�.0�o..J- Nbbcr Work: srtxitC. \v.5�1,\\ w." rumba.! 1m rwvn n9 c\[c k...na ✓uA..rwv Alteration of existing bedroom_Yes—;�—No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement _Yes X _No Plans Attached Roll -Sheet Ga.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 stones? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction 1. 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. 1. Septic Tank_ CitySewer_ Private well_ City water Supply_ SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETEDWHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, EA(lAH`d - O\�twJa.9 as Owner of the subject property hereby authorize t L .�(Tr-7\Ot ✓PYYQ✓� '1' �().CA\QS to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, r �� S �CA(-ObS as Owner/Authorized Agent ereby declare t at 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. V\( . Print Name Signature of Owner) gent Dat SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor. \_ _ Not Applicable ❑ Name of Urease Heider C 1..r S ip yP Y`a( �G[A hs GS ' "I License Number O\& N tPAo obi v � t0 Address 6cpiration Date S nature —T^ Telephone 9 RapIi Rome Improvement Cumraptor: Not Applicable ❑ I�O ��'1 Company Name Regstration Number Py,�,(Wv� h \v.c. Address \- -n^ Emir tion Date NOf�Cv"M'tl�'P"Yelephoneh�- SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT III c.162,§2506)) 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...... ❑ SIGNATURES By signing below,you agree to items A. B and C. DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES. A. Alternative Dispute Settlement(Arbitration Clause): The Seller and the Buyer hereby mutually agree, in advance,that in the event of a dispute concerning this Agreement,the parties shall submit such dispute to a professional,state-approved arbitration service(cost, if any,to be paid by the subminer)prior to either parry proceeding to legal action in the courts. B. By signing this agreement,you,as the owner of record,are hereby authorizing Barton&Jacobs Associates Inc.to act as your authorized agent in all matters pertaining to the building permit application. C. This is a binding Agreement. You may not cancel it except as stated. This Agreement covers and supersedes all conversations,statements and agreements,expressed or implied,between the parties,their agents or representatives. ' ;� 3 You,the Buyer,may cancel this transaction Buyer Dau at any time prior to midnight of the third business day after the date of this transaction. See the attached notice cancellation fore Buyer Date for an explanation of this right. CJ Seller retains an equal right to cancel. e Barton&Jacobs/ epmsemative }YX>}YXitii»YYYliiii>titiii}}fifirt}}Xrt Yrti Xi Ytittiii»ttt Y44i}X}ii Yiitttttti}}fi}YY}iiiii XXrtii>t Contact Information Office Manager: Sandy Scavotto Office:413-586-8998.x100 ® Chris Jacobs,President CT HIS#0554397 Cell phone: 413-250-6677 Home phone:413-665-9113 Office phone ext: 103 ❑ Adam Sicilia,Director of Design Cell phone:413-923-7003 Home phone:413-610-0660 Office phone ext 106 MA Construction Supervisor License 060475 MA Home Improvement Contractor 100809 CT Home Improvement Contractor 518617 Purchase Agreement Page 17 of 17 City of Northampton -:. .� Massachusetts pBPABTN62rr OF BO WIM INSPECTIONS 212 Nein Street a Wnicipal Building4D '\" V •OC4 Northampton, em 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 pm�xisting owner-0ccupied 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:Ifthe homeowner has contracted with a corporation or LLC,that entity most be registered Type of Work: Est. Cost: Addressof Work:2J22 \.L N\12� O\O(aL Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): —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.G.L.Chapter 142A.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: he "� III � ,� Bn rv'Osn i 1"'liot 4,SQLLw l'--a5 "0OSD' Date Contractor Name HIC Registration 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 C�lie o�rrrirr�,o�r�,coea i oe h&kjad mieff, Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 100809 Type: Private Corporation Expiration: 6232018 TO 419291 BARRON & JACOBS ASSOCIATES, Ifs, Cecil Jacobs 70 OLD SOUTH STREET NORTHAMPTON, MA 01060 Update Address and return card.Mart reason for change. WAI o .1 ❑ Address E] Renewal ❑ Employment E] Lost Card ice of C0—mer Again&BuNvas ReRegulation License or registration valid for individual on only ROME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: R691 on: 100809 Type: Office of Consumer Affairs and Business Regulation Evpiretlorc.. V.&2018 Private Corporation 10 Park Plata-Suite 5170 Boston,MA 02116 BARRON&JACOBS ASSOCIATES, INC. Cecil Jacobs 70 OLD SOUTH STREET NORTHAMPTON,MP.01080 Undersecretary Not valid without signature Massachusetts Department of Public Safety Board of Building Regulations and Standards License: p49eO6 Construction Supervisor taMR{TOaa[{OR R 7a tiEO tOY111 A . xoRndwnow w M� Expiration: Commissioner iVM/aatl i d DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit # was issued with the condition that all debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L c. 111, s. 150A. The debris will be disposed of in: Name Wast acility �"t �ASd'lnc4 M�-'(,ZIy�R Address of Waste Facility III 5 Debra: As a condition of issuing a permit for she demolition, renovasioa, rehabili stion or orher elporansn of a building or nmsas,, M G.L.c. 40 s.54 requires that the debris resulting shereRom shall be disposed of in a properly licensed solid waste disposal facility as defined by M G L.c. I 11 s. 150 A.Signature of rhe pennon[applicant dare and msmber of she building permit to be issued shall be indicated on a form provided by the Building Deparbnent and attached to Ne office copy of the building parnit retained by the Building Department If the debris will not be disposed of as indicated, the holder of the permit shell notify Ilss building official,in writing,as m she location where the debris will be disposed. 780 CMR—6"Edition '� Signature of Permit Applicant Date The Commonwealth of Massachusetts Department stria(Accidents I Congressss Street, Suite/00 Boston, MA 02114-2017 www massgov/dia VII.ritters'Compeamation Insurance Affidavit: Builders/Contractors/Eimtricians/Plumbem TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/OrganieetioNlndividuap:Address: .10.}O G\4 City/State/Zip: lvDf 'VxA l.a10EDPhone#: K\'O ' S$1<, Sctii�lg Are you an employer?Chttk the appropriale has: Type of project(required): L®I am a employer w employ ees(hall and/or parr-time).• 7. []New construction 2.❑I..sole proprietor or partnership and have no employees working for me in $. ❑ Remodeling any capacity.[No workers compinsurance required.( 9. C]Demolition }.❑I am a homeowner doing all work myself.INo workers wra,.insannce rcyuircd.l' 10❑ Building addition J.❑Iamehomeownerand milkeither have conamorstoconductall wornon or property,sole . Twill sure met all contractors either have workers'wmperoa[ion imunnce or resole I LC] Electrical repairs or additions porprooms with or employees. 12.E]Plumbing repairs or additions 1.a general conuacter and I have hired the sub<xmtwuam listed on Ae numbed sheer 13.❑Roof repairs ?base sub-commetors have employees and have workers comp.insurance- 6.❑We are a corporation and its otficen have exercised their right of exemption per MGL c. 14.❑Othef 1 i2,§h4),and we have no employees.Mo workers'comp.nor ancerequired( •Any applicant that checks box#I most also fill out the section below showing their workers compensation Wlicy information. 'Homeowners who submit this affidavit indicating they me doing all work and then hire outside contractors must submit a new alBdavit indicating such. :Cmanemrs that check this box run atmcled an additional sheet slowing me name of the suh-comruaors and sure whether or not those entities have employee. If the sub-cennacton have employees.they must provide their workers comppolicy number. I am an employer that is providing workers'compensation insurance for my employees Below is rhe policy and job site information. Insurance Company Name: Policy #or Self-ins. Lic.#: Ww1 ,%OD&'5L;5 2,C) y3 R Expiration Date: '45 1v 12ZIll Job Site Address: 2,D-',y-) MCinANt,_ City/State/Zip: �noanu, M& D\O feJ^ Attach a copy of the workers'compensation poI14 declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certifyrtuneer th p 'ns and penalties oirperjury that the informationt, videddaabove is ue and correct Siicna.0 ' // //" /t/\ Date' `1 /�N//� Phone# Official use only. Do not write in this area,to be completed by city or town offs l City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: A�H CERTIFICATE OF LIABILITY INSURANCE D 3/5I201Y8W1 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 certNlcata holder N an ADDITIONAL INSURED,the pollcyl Ms)must be endorsed. If SUBROGATION IS WAIVED, subject to the lama and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certiflcM holder In lieu of Such endolsemen s. PRODUCER MNTACT NAME: ACLS. edgett Webber L Grinnell PSE (413)586-0111 FAnxc Hoo uvB)se6-fia9v 8 North King Street AW IE :aedget1,13mebberandgri5mell.com INSURE SK FORDING COVERAGE NAIC0 Northampton HA 01060 INSURERANain Street America 29939 INwREn INSUREN B NCHIMSA Herron S JaCObe Assoc. Inc. INEOPERCA.I_.M. Nctnel A.I.M. At=: Cecil R. Jacvba INSURER.: TO Old SCSI street INSSIER E: Northampton t-A 01060-3833 INSURER F: COVERAGES CERTIFICATE NUMBER:Exp 03/19 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 CI-AIMS. INSR nrerypE OF MSIIMXCE AO UBIi pg NUMBER ns ER M Y LIMITS X COMMEIO:ML GEXERK WBLTY EACH OCCURRENCE S 1,000,000 CLAIMS MADE ISI OCCUR SAM EEr q ry EU A MP6 Eax $ 500,000 1¢IB0C9D /9/2019 (An, $ 10,000 _. PERSONAL SAW INJURY f 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE 3 3,000,000 X POLICY[:]PRO E LDC PRODUCTS-COMPOP AGO 1 3,000,000 OTHER EPu 'f 10,000 CMSNEO IN LELMTOlMnOMOME WBLIIY em E B ANY Auro BODILY INJURY(Per Penoo) ' S 1,000,000 ALL OWNED SOHCDULEO AUTO6 X UTOS 6nTBOa9n 3/9/2018 3/9/2019 WDILY INJURY(Per ev+MM) E - NON-0WNEC ROPENTY L MAGE X HINEDAUTW -C AUTOS ,R?P nl E MCE1ul E 5,000 UaBRM1A LIA9 OCCUR EACH OCCURRENCE $ B EXCESS MANS CLAIMS..E AGGREGATE E OED X RETUmON1 10,000 CUTS0490 3/9/2018 3/9/2019 S W ..a CONFFNSILTNm X PER OTX- AND ElfLOYWW&LITY YIN iATUTE Efl ANY OFFICmEWMREMBERPEXCLUOEpASCUTNE O XIA EL FACH ACCIDENT 5 500,000 Q (MSMs"N NH) RB00063652010A 3/1/2018 3/1/2019 E DISEASECA EMPLOYEE $ 500,000 II Pee Memin UPM DESCRIPTION OF OPERATIONS SAM E DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS UOCATp181 VEHICLES sJOORD 501,AEEIUwuI WmeM Sc11MW,nay Be Messed Xmwe spew MregU4tll CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PSOO£ of Insurance Only THE EXPIRANON DATE THEREOF, NOTICE WILL BE DELrvERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORISED REPRESENTATIVE N Grinnell, CPCU, CIC �L.1!- '? `v'------Pn ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025 rzmam) ►t� 1 � r, r. V ��1IR tt j{ A . i Ir11111M� `- 1 tF t y 4 P' �