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35-126 (5) 45 CAHILLANE TER BP-2018-1250 GIS#, COMMONWEALTH OF MASSACHUSETTS Mao'Block: 35- 126 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categmry�shed BUILDING PERMIT Permit# BP-2018-1250 Project# JS-2018-002226 Est.Cost$7900.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Group: HOMETOWN STRUCTURES98186 Lot Size(so.ft.): 10541.52 Owner: GABRY STEVEN I tonin : Applicant: HOMETOWN STRUCTURES AT. 45 CAHILLANE TER Applicant Address: Phone: Insurance: 627 SOUTHAMPTON RD (413) 562-7171 WC WESTFIELDMA01085 ISSUED ON:5/30/2018 0:00:00 TO PERFORM THE FOLLOWING WORK PREASSEMBLED 13.5X24 SHED 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: HouseFoundation: 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 Occuoancv sic t re• FeeTyBc: Date Paid: Amount: Building 5/30/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2018-1250 APPLICANT/CONTACT PERSON HOMETOWN STRUCTURES ADDRESS/PHONE 627 SOUTHAMPTON RD WESTFIELD (413)562-7171 PROPERTY LOCATION 45 CAHILLANE TER MAP 35 PARCEL 126 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST SED REQUIRED DATE ZONING FORM FILLED OUT /10771Q\ Fee Paid Building Permit Filled out Fee Paid TvaeofConstructiom PREASSEMBLED 13.5 24 S D New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 98186 3 sets of Plans/Plot Plan TH FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IF(ORMATION 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 Arcla tecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management DemolitionDel�ayy / yn Signature of 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. Department use only HEULIVED and On Slaws of Permit: Building De art ent Curb CWDriveway Permit " �(py 2 32ygigain Stre f Sewer/Septic Availability yt i f' Room 00 Water/Well Availability 1060 Two Sets of Structural Plans 13-587-1272 Plot/Site Plans Other Specify APPLI ATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -sr E INFORMATION 1.1 PropertyAtl cess: This section to be completed by office i n Map G Lot � Unit 45 Cahilla ie Terrance, Florence, MA 01062 zone Overlay District Elm St.District CB District SECTION 2-PF OPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Steven Gabr} 45 Cahillane Terrace, Florence, MA 01062 Name lPdnp, Current Mailing Address: 413-522-5662 Te epM1ona 4A-th�.retd Glenn metown Structures) 1p,? 7 Name(Print) Current Mailing Address: 1413-so� -7�71 Signature Telephone SECTION 3-ES (MATED CONSTRUCTION COSTS Item Estimated Cast(Dollars)to be Official Use Only completed by permit applicant 1. Building 7900 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee /n 4. Mechanical( AC) y p 5. Fire Protection 6. Total=(1 +2 3+415) 1 7rfc Check Number /pZ This Section For Official Use Only Building Permit moor: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date Ste,,, 6W'- @ /v"-?ad . EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) �� ann v ' k'"L +0UJ, S �rG�CfU rLS. Cour Sect 1 ❑ 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Requiredby Zoning Tbia column to be filled in by Building Department Lot Size 10542 Fron ge 104 Se[b cks Front 80 Side L: R: L:27 R:55 Rear 7 Buil d1i ng Height 11 5' Bldg.Square Footage % 324 Open Space Footage (Lut ar a minus bldg&pav<d p.,kinx) #of Il.king Spaces Fill: ".1rar &1nw�ion7 A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF ES, date issued: IF ES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O 1 YES: enter Book Page and/or Document# B. D es the site contain a brook, body of water or wetlands? NO O 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 , Date Issued: C. Do any signs exist on the property? YES O NO 0 IF YES, describe size, type and location: D. A e there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: E. ill the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan t at will disturb over 1 acre? VES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-D SCRIPTION OF PROPOSED WORKfRe�� applicable New House ❑ Addition ❑ placement Windows Altera[lon(s) ❑ Roofing ❑Doors 0 Accessory Bid . ❑D Demolition ❑ New Signs [C31 Decks [0 Siding=J Other Im Brief Description of Proposed delivery ofpreessemblM accessory svucwre(13.5'x 34.) Work: Alteration of existing bedroom_Yes XX No Adding new bedroom Yes XX No Attached Nanm i a Renovating unfinished basement Yes * No Plans Attached[toll -Sheet ea. If New ho se and or addition to existina housina. complete the followin a. Use of build ng:One Family Two Family Other IF, Number of r oms in each family unit: Number of Bathrooms c. Is there a g rage attached? d. Proposed S uare footage of new construction. Dimensions e. Number of ones? f. Method of h ating? Fireplaces or Woodstoves Number of each g. Energy Con ervation Compliance. Masscheck Energy Compliance form attached' h. Type of con [ruction i. Is wnstructi n within 100 ft.of wetlands? Yes No. Is construction within 100 yr. Floodplain_Yes No j. Depth of be ement 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-0 NNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGE OR CONTRACTOR APPLIES FOR BUILDING PERMIT I. >:-• �� S(BL.L� c r �J Lr�>'7 as Owner of the subject property Hometown Structures hereby authorize ' to act on my beh in all platters relative to work authorized by this building permit application. o Signa-of .1 Data 1. C ( �otve{a�J. S''}w c+��� ,..Owner/Authorized Agent hereby de lare 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. Print Name Signature of Owner gent Det, SECTION 8-C NSTRUCTION SERVICES 8.1 Licensednstructlon Supervisor. Not Applicable ❑ Name o/License Holder: Andrew Kurtz License Number 295 Brornk y Road, Huntington, MA 01050 CS-98186 Address - Expiration Date 8-3-2019 Signature Telephone 413-562-7171 9.Registered Home Improvement Contractor: Not Applicable ❑ Company Nam A Registration Number (c a h -5.-J 159772 Address Expiration Date ln19 6/0FFS Telephone j- -71 5-27-2018 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§2SC(6)) Workers Compe isation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of it a issuance of the building permit. Signed Affidavit dflached Yes....... FT No...... ❑ ® ,Ontrtwnweexh vt MasaaceYsettd Dmi won oI Prmessmnal Li4enmrd BPdrO u!BlYltlle(j RegYldUens iOtl 6bnUdrtlS CS-098186 __ Expires M103 2D19 ANDREW 0KURT2 �= ,1 ¢BS BROMLEY RD HUNTINGTON MA 0/100550 M. CRmmbsloaer �^" w �-�' 11s3C i Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 03116 Home Improvement Contractor Registration Registration: 159772 Type: Ltd Liability Corporation Expiration: 5/27=18 TS1 419291 HOMETOWN STRUCTURES ANDREW KURTZ 627 SOUTHAMPTON RD WE TFIELD, MA 01085 - Update Address and return card.hark reason for change. Address Renewal Employment Lost Card Olri<e of luounerAfLirs.i Business Resolution License or rr„i9ration valid for individual use only HOME MPROVEMENT CONTRACTOR before the expiration date. If bund return to: Reglstnation: 158772 Type: Office of Consumer Affairs and Business Regulation Expi on: 5/272018 Ltd Liability Corporati 10 Pork Plaza-Suite 5110 Boston.MA 02116 HOMETOWN STRU CTURES ANDREW KURTZ 627 SOUTHAMPTO q RD _ WESTFIELD.MAO 085 fuWerseo-eun' Not valid without signature The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Worke s' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant nformation Please Print Legibly Name (Busin(:ss/Orgmizadowlndividual): Hometown Structures Address:62 Southampton Road City/State/Zip: Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.21 1 am a employer with 15 4. ❑ I am a general contractor and 1 employee (full and/or part-time).- have hired the sub-contractors 6. E] New construction 2.❑ I am a soI2 proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and I ave no employees These sub-contractors have g. ❑ Demolition working or me in any capacity. employees and have workers' [No work rs' comp. insurance comp, insurance: 9. EJ Building addition required.] 5. ❑ We are a corporation and its l0.❑ Electrical repairs or additions 3.❑ I am a hoi neowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. Plo workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] x152, §1(4), and we have no employees. [No workers' 13.❑✓ Otheraccessory, structure comp. insurance required.] 'Any applicant that c iecks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who a ubmit this affidavit indicating they are doing all work and then hire outside contractors must submit a new aRidavit indicating such. =Cma acmrs that the k this box must attached an additional sheet showing the varve of the sub-contractors and nate whether or not those entities have employees. If the su con racmrs 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. Insurance Comp ny Name: Berkshire Insurance Group Policy#or Self-i is. Lic. #:AWC-400-7028459-2017A Expiration Date:11/27/2018 Job Site Address 45 Cahillane Terrace City/State/Zip:Florence, MA 01062 Attach a copy ell the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure overage 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$250.00 1 day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. do hereb cern under the ains and ertaaies a er'u that thein ormation provided above is true and correct. Si nature: --$` G Date 5-1-2018 Phone 4:413-562-7171 Oficial use only. Do not write in this area,to be completed by city or town official City orTown Permit/License# Issuing Auth rity (circle one): 1.Board of I, alth 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Pers n: Phone#: I WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803.0970 (800) 876-2765 NCCI NO 25158 POLICY NO. AWC-400-7028459-2017A PRIOR NO. AWC-400-7028459-2016A TEN The Insured Hometown Stuctures LLC DBA Mailing addr ss: 627 Southampton Road FEIN: ""'6332 Westfield, MA 01085-0000 Legal Entity ype: Limited Liability Company ger workplaces not hewn above: See Location 2. The policy p riod is from 11/27/2017 to 11/27/2018 12:01 a.m.standard time at the insured's mailing address. 3. A. Worker Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states tied here: MA B. Employ rs'Liability Insurance: Pan Two of the policy applies to work in each state listed in item 3.A. The Iimi s of liability under Part Two are: Bodily Injury by Accident $ 100.000 each accident Bodily Injury by Disease S 500,000 policy limit Bodily Injury by Disease S 100,000 each employee C. Other S ates Insurance: Coverage Replaced by Endorsement WC 20 03 06 8 D. This Po icy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premto for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. Ail informed n required below is subject to verification and change by audit. Classification Premium Basis Rates Code Eliboral Annual Per$100 EAnnu l No. Total Annual ne Annual I Remuneration Remuneration Premium INTRA 337 67 INTER SEE CLASS CODE SCHEDULE 'jr,mcm Premium $�00 Total Estimated Annual Premium $16.806 COV GOV - Deposit Premium $17,549 iTATE CLASS MA 2802 State Assessments/Surcharges $16.303.00%4.560090 5743 Tis policy, including all endorsements, is hereby countersigned by ` — 11/28/2017 Awno(etl Signature Date �m,,ce Office: Berkshire Insurance Group Inc is Third Avenua P O Box 4889 ahington MA 01803 Pittsfield, MA 01202 'i0000001 A(7-17 xedit.coDYrightetl met al of the national Council on compensation Insurance, 'KE tvthna pettnisslon. t i i �6 :-��� � . . h , � � L , r7 ' ;, I �i I ����� ;��� I, � t '' � �.� �� � `� 30-year architectural 2 x 4 rafters 16" on shingles over 1/2" CDX center with collar plywood roof sheetin ties 4' on center 5 exclusive detailing, painted eaves, ' and wood corners A double 2 x 4 top wall plate, 2 x 4 wall studs double 2 x 6 16" on center header over doors e pressure treated floor 5/8" DuraTemp T1-11 fastened withi f, system, 4 x 4 rails, joists 12" _. gaI.vani7p nails exter o acrylic latex paint - or 1/2" CDX with vinyl . ; \\��2 2 ��• ��{ HOMETOWN STRUCTURES 627 Southampton Road Westfield,MA 01085-1329 (re-..st a S'J y-s 8 (413)562.7171 Order Date -S - )-1k www.HometownStructures.com stimated Completion Dow 4 u,ez k n 0"-) Cis+- e— 9L++: 3 p�..-;i. Rrxay BIII ts G¢�1�/ Notes Address Ua ,Jla.w- Ttrr-x..t .See o4c,kcsol oT io}u Ric,r,,oc; MA Nvfoa (Tone iiCel l Phorto#.__ 5a 7 -Sb b.2 Email Address q eareTemp T1-11 U U Moil J In-stook Display Shed To Be Custom Built Body Color Body color Rim Cola nor,Color. M'Bit Delivered Fully Assembled teub r�:e8mmamnayro+evrwrarvu rxrm.a<.s umaamdsrauu.rMnW J ModularA J Modular Door Colm Oew Celor J Built On-site comers Comers W k.$c J.3 rra % aY SOFFIT CHOICE(For N.FnpbM SMe brryl $12e SOFFIT (For New EiyaiN Style only) JYendnp Vinyl wnro J New England Series U Solid DureTemp T1-Il kgda UYears vinyl awn U &poead Peder Tek mrymu Sok Keystwte Series J Bowline Series W AlumNum Stop Vemma�rau Base Price $ —1,(, �U SW, �kCy�SCK` DoorAdjustment $ Code 6 Y 'S Window Adjustment $ — 3L) Shingles Windows Ramp ❑ 6x it ❑ 5'x 4' D.54'x 4' )O T x y' $ ) 8 U U Dual Black U 18•06' U Farthtone Cedar _U .24'x 38` 04'x8' ❑ 4'x10 ❑Sx12' ❑ $ U Dual Gray —© 30'x36' Laft U Dual Brown ° 36x36 Window Boxes I] Wood ❑ 16' ca 30, $ U 'Weather nuod _O 36x40' I Harwrd Slate ❑ Vinyl O 24' ❑ 36' U Charcoal Gray •1r' o Calor Shutters O Wood Calor/Detail $ Drip Edgo:..91W JB Grids: UW JB I] Vinyl Single Door }t Boor a� s g" Vc $ } l4U Width ul*^+^r Width c.ncl (;nSk=2 o4 1a) $ Type Type Gnld, r-. 'renscm SJ e $ Grit-: UW UB 6iitls: JW ❑B. 11111- Wild. Wsnap Hrees:Word US-P V Site Preparation-pad size ti x 2-6 Iwuiere ask evalwuml $ R-—o &r- Jig Ovmxridth Road Pernik In $ VU .uT Lading llluahadao �ir a " d, - ),Isla. S9 suhtoal $ -7,559.41 Leler rmrx Sales Tax $. yo 9. 3Y E Tom $ 1,5b $-iS ' - Deposit $ S :Below@ $ 'SS Dustamei 5ieidrve G Salesperson signature