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17D-081 (17) I GARFIELD AVE BP-2018-1276 GIs#: COMMONWEALTH OF MASSACHUSETTS M=Block: 17D-081 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Ca[eeorv'New Sjnele Family House BUILDING PERMIT Permit# BP-2018-1276 Project# JS-2018-002275 Est.Cost:$100750.00 Fee' $376 00 PERMISSION IS HEREBY GRANTED TO: Const Class: Contractor: License: Use Group: PIONEER VALLEY HABITAT FOR HUMANITY 046013 Lot Size(sa. fol 22346.28 Owner: CITY OF NORTHAMPTON CITY HALL zoning, URB 100 Applicant: PIONEER VALLEY HABITAT FOR HUMANITY AT. 1 GARFIELD AVE Applicant Address: Phone: Insurance: P O BOX 60642 (413) 586-5430 0 WC FLORENCEMA01062 ISSUED ON.711012018 0:00:00 TO PERFORM THE FOLLOWING WORK.BUILD NEW 1 BEDROOM HOME 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: FeeType: Date Paid: Amount: Building 7/10/20180:00:00 $376.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2018-1276 APPLICANT/CONTACT PERSON PIONEER VALLEY HABITAT FOR HUMANITY ADDRESS/PHONE P O BOX 60642 FLORENCE (413)586-5430 0 PROPERTY LOCATION l GARFIELD AVE MAP 17D PARCEL 081 001 ZONE URWI00" THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLO QUIRED DATE ZONING O FILLED OUT Fee Paid Building Permit Filled out Fee Paid T_voe f Constructiom BUILD NEW IBEDROOM HOME_ New Construction Non Structural interior renovations Addition to Existine Accessory Structure Building Plans Included, Owner/Statement or License 046013 3 sets of Plans/Plot Plan THE LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INrMATION PRESENTED: _AAAAAA 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 PmofEnclosed 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 Ehn Street Commission Permit DPW Storm Water Management Demolition Delay mmS,ite.fBajdgoffictaj Date Now: Issuance of a Zoning permit does not relieve a applicants 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 ` Status of Pe unit. Building Department Curb Cut/Dnveway Permit ♦r, #AT fi Sit Sevrer(Seplic Availability Room 100 Water/Well Availability 0 Two Sets of Structural Plana ph ne -%11-00-987---587- 272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Progertv Address: This section to be colleted by office Map ._L0 Lot / Unit 1 Garfield Ave Florence, MA 01062 Zone overlay District Elm SL Dlstict CB Distinct SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Pioneer Valley Habitat for Humanity,Inc. PO Box 60642 Florence,MA 01062 Name(Print Cument Mailing Address: q13-586-5430 /-" !� Megan McDonough, Executive Dir ctor Telephone Sign re 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 82750 (a)Building Permit Fee 2. Electrical 7000 (b)Estimated Total Cost of Construction from 6 3. Plumbing 5000 Building Permit Fee 4. Mechanical(HVAC) 5, Fire Protection 6000 6, Total=(1 +2+3+4+5) 100750 Check Number Q This Section For Official Use Only Date Building Permit Number: Issued: Signature' Building Cammissionerlimpector of Buildings Date Megan @ pvhabitat.org EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete In{brmation Existing Proposed :Reggrr d by Zoni g `nus Umnto beflll in by Building nepgnmem Ic q 5 Lot Size 5160 sq ft 5160 sq ft Frontage 25 25 Setbacks Front 10 Side L:_R: L: 10 R: 10 Rear 20 Building Height 0 18' Bldg. Square Footage 0 % 672 13% Open Space Footage (Int area minus bldg&pavid 5160 4288 83% ,kin #ofParking Spaces 0 2 Fill: volume&Location) unknown A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW O YES O IF YES, date issued: 7/18/14 IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'TKNOW O YES O IFYES: enter Book 11782 Page . 252 and/or Document # B. Does 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. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: temporary construction sign E. Will the construction activity disturb(Gearing,grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YE$then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑✓ Addition ❑ Replacement Windows Ahemdonls) ❑ Roofing ❑ Or Doom El Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding(0] Other[01 Brief Description of Proposed guild new I bedrwm home Work: Alteration of existing bedroom_Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes _No Plans Attached Roll -Sheet ea.If New house and or addition to existing housing, complete the following: a. Use of building :One Family yes Two Family Other in Number of rooms in each family unit: 3 Number of Bathrooms 1 c. Is there a garage attached? no d. Proposed Square footage of new construction. 672 Dimensions 24 X 28 e. Number of stories? 1 f. Method of heating, electric mini-Split Fireplaces or Woodstoves no Number of each 0 g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? HERS h. Type of construction wood frame I. Is construction within 100 ft.of wetlands? x Yes No. Is construction within 100 yr. Floodplain_Yes_No j. Depth of basement or cellar Boor below finished grade k. Will building conform to the Building and Zoning regulations? x Yes No I. Septic Tank City Sewer x Private well_ City water Supply x SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 1 as Owner/Authorized Agent hereby 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. Print Name Signature of OwnerlAgent Date SECTION 8-CONSTRUCTION SERVICES 8.1 t.ieansad CmaWeaee Suoeevifer. Not Applicable 0 Name of UmmeNor4x: Michael Broad Uoense Number PO Box 94, 36 Briggs Rd Shutesbury, MA 01072 046013 Addn as Expiration Date 4/14/19 Si p 'ke _ Telethons (� 413-636747 Not Applicablex C mmm Nome Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT tS1.G.L a.132,$Z8C481) Workers Co npansation Insurance affidavit must be complsted and submitted with this application.Failure to provid itds sflltlavl Wil result in the denial of the iswance of the building permit. Signed Affidavit Attached Yea....... 0 No...... 0 City of Northampton s - - _ Massachusetts M1 s -Y `qct i DEPARTMENT OF BOILDING INSPECTIONS \ 212 rain Street • Municipal auildi� NorNv ton, MP 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 ownerbccupied building containing at least one but not mom than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Nate: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 mason(s): _Work excluded by law(explain): Job under$1,000.00 Owner obtaining own permit(explain): _Building not owneroccupied 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 perj ury: I hereby apply for a building permit as the agent of the owner: 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 _ City of Northampton � Massachusetts ' t�( DEPARTMENT OF BUILDING INSPECTIONS 2 fe YSY main Street a Municipal Building Jb l eurther,ton, ma 01060 O 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 shall 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 r-"-' Massachusetts P? >- 1 \ � DEPART!ffiNT OF BUILDING INSPECTIONS i 212 Min Strut •auniaipal Building Northav¢ n, !A 01060 r -cyjA'0 Debris 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. The debris from construction work being performed at: 1 Garfield Ave Florence, MA (Please print house number and street name) Is to be disposed of at: Valley Rel', (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: Duseau Trucking 9� (Company Name and Address) 5125118 Sign Lure 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 ulfDepartment ol"Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-20177 www.mass.gov/dia porkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aoolicant Information Please Print Legibly Name(Business/Organizatiim/ndividua0:Pioneer Valley Habitat for Humanity, Inc. Address: PO Box 60642 City/State/Zip:Florence Phone#:413-586-5430 Are you an employer?Check the appropriate box: Type of project(required): I.O l am a amployerwith 6 employees(full aM/orpan-time)• 7, ❑✓ New construction 2.E]I am a sole proprietor or partnership and have no employees working for me in g. Remodeling any capacity.[No workeri comp.wormnce required) 3 l am a homeowner doingall workm myself No workers com insurance 9. El Demolition a yse [ p required 4 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workwe'compensation inaumnco or are sole I IQ Electrical repairs or additions proprieties with no employers. I2.[]Plumbing repairs or additions 5 r7 I am a general contractor and I have hired the sub orkersctors listed on the attached sheet tra . I3 E]Roof impairs These subcontractors have employees end have workers e comp_insurance: 6.❑we are a corporation and its officers have exercised their right ofexampron per MCL c. 14. Other 152,§I(4),end we have no employees.[No workers'comp-mauranae racermi.] •Any aphound that checks box al must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this atFd wit indicating they are doing all work and then hire monde contractors must submit a new atfldovit indicating such. [Contractors that check this box most attached an additional skew showing the name of the subcontractors and sale whether or not those entities have employees. Ifthe sub-contractors have employees,they must provide their workers comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name:Lockton Affinity, LLC Policy#or Self-ins.Lic.#:C48747401 Expiration Date:4/1/10 Job Site Address:1 Garfield Ave City/State/Zip:Florence, MA 01062 Attach a copy of the workers'compensation policy 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. 7 do hereby certify under the pains andpenalties of perjury that the information provided above is true and correct. Signature &W-- D t - 5/25/18 Phone#:413-5 5430 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 me): 1.Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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 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 in do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall net 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,§25CO 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 of this 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 sub-contractor(s)come(s),address(es)and phone number(s)along with their certificam(s)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 be sure 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 pennio'license number which will be used as a reference number. In addition,an applicant that must submit multiple pennio'license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under`Job Site Address"the applicant should write"all locations in_(city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as pmof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Depa nnent's address,telephone and has number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Information and Instructions Massachusetts General Laws chapter 152 requires all employersto provide workers' compensation forth eir 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 ofthe foregoing engaged in ajoint enterprise,and including the legal representatives ofa deceased employer,or the receiver or trustee ofan 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 ofthe dwelling house of another who employs persons to do maintenance,consmiction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because ofsuch 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,§25C(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 of this 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 ofinsurance. 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 be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom ofthe 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 permit/license applications in any given year,need only submit one affidavit indicating current policy information(ifnecessary). A copy ofthe affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proofthat a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner 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 Department's address,telephone and has number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street Boston, MA 02114-2017 Tel. # 617-727-4900 ext 7406 or 1-877-MASSAFE Fax# 617-727-7749 www.mass.gov/dia Form Revised 02-2115 ACO-Ra CERTIFICATE OF LIABILITY INSURANCE 04/11/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RHRITS UPON WE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EMND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING RISURER(S), AUTHORRED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the earBRcate holder is an ADDITIONAL INSURED,the policyges)musl Be eeCorsed. H SUBROGATION IS WANED,su6jeel to Ike temTs and conditio,of Uro Policy,$mein Policies my regLA a an endorse nenf. A sfalemeW on His cartl6caM done net confer nods,to Me eer4FinM holder in Neu of such arMoroemenl(s). N M¢ Lockton Affinit , LLC Lockton Affinity, LLC RHOIE ,BB-553-9002 x0:913-652-396] LL P. G. Box 873401 POG1F85: Fanaaa City, MO 64187-3401 INBUP9i8 PFFORtlNO WVBIAOE NPRY INS MPA:Ma.wc BAA EL H&B6 B: Pioneer Valley Habitat for Humanity, Inc PO Box 60642 INSURER o: Florence, 14A 01062-0642 INSLeB1 a: WBU F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THS IS TO CERTFY THAT THE POIJOES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TIE INSURED NAILED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWIHBTANONG ANY REQUIREMENT,TERM OR COM]ITION OF ANY CONTRACT OR OTHER DOCUMENT WW RESPECT TO WNICH THIS CERTIFICATE MAY BE ISSUED OR BAY PERTAIN, WE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, FXCLUSIONIS ANE,CONORIONS OF SUCH POLICIES.UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CILIUM. IMBA 1 TYPswIMRANCE WILW NNrt61 Leas, A XGdAMEM]PLBENEAAL LM,LITV GL1066966-18 (</0=/]018 04/01/2019 EALH p_CCUMENCE $1,000,000 j C"INSMACE ��w.n RVBAISES}EF r�¢unercel 51,000,000 MEDEID My Uw x—) EO PERSONRLAWV.IJ I $1,000,000_ GEM L A-.—ATEUMrt A-LIES PBi. GENERAL AGGREGATE E2,000,000 X —cu -1 LOC PRCdJCfS-CCHPAIPAGG $2,000,000 OMS $ AUSJ TOSLE LIARLJry E ANVAUTO EOfNLV INJVRV(Perpersonl $ ALL GIN® SCHWVIEG AUTOS AUTBCgLV INJVRV{Pva¢Itlenp S G ER XIREDHRPS AVT0$ E E U"- LAB OCCUR RICH O,^,CVRRENCE E ELAS CLAIMSMAx ACA REG ATE E C,nE En RET£NTIXJE $ CPRLFeIEfPIITNERE% MIA C46]a9401 /O1/R018 OL/02019 . OOH- ANDEMROStt _ VO GflLIAML, EL J0,000 BeMIn Xp ELCISEA.E EA.MOYE051,000,000 Iyy��,,NllM luxlx �1£9CtiplIGN CFOPHtATIONSkebw EL.CIBEAEPd1CY LINT I ES 000,000 WtlnFTmN OF d£IIPTIONSILOCATXM81 VEHICLES AEON)101.MNNMYI PMwFL Sex4J Ery behdlM RmnA q%.Ix pU I CERTIFICATE HOLDER CANCELLATION 1.64911 erMf of Coverage SHOULD ANY OF THE ABOVE DEBE SCRIPOLICIES BECAME.I.BEFORE THE EXPIRATION NATE THEREOF, NOTICE LULL BE DELIVERED IN ACCORMNCE WITH THE POLICYPPONSIONB AUIINMI/r��ITA HD 1SS8-E14 ACORD CORPORATION. All fights reserved. ACORD 25(201/101) The ACORD name and logo aro raglslaned marcs of ACORD 26691081 1064964 Home Energy Rating Certificate Rating Date: 2018-04-13 Projected Report Registry ID: Unregistered p Elootrope ID: yLOaBEpd HERS* Index Score: Annual Savings Home: Your home's HERS scow Is a relmlv: 1 Garfield Ave, Northampton, MA performance score.The loviner the umber,4 • 01060 • the more energy efficient the home.To 5 Builder• verage US.home PV Habi tat For Humanity Your Home's Estimated Energy Use: This home meets or exceeds the Use [MBtul Annual Cost criteria of the following: Heating 6.0 $317 Cooling 0.2 $11 Hot Water 1.1 $60 Lights/Appliances 9.8 $519 Service Charges $60 Generation(e.g.Solar) 0.0 -50 Total: 17.2 $967 Home Feature Summary: Rating Completed by: ,w.u... Home Type.. Single fam.'l.y detached Energy RateeAdin May nard ConmConed f loon Area: 672 sq.It RESNET ID:9463452 Number of Bedroom, 1 Primary Heating System. Air Source Heat Fpmp•E'xhic125 HSPF Rating Company:HIS&HERS Energy Efficiency .Mailing:12 Perkins Ave.Northampton MA 01060 e " " N Primary Cooling System. Air Source Heat Pum p-E'ectiic.26.1 SEER 4136588784 ro toa Primary Water Healing. Water Heater•Electn,•3-55 Energy Factor House Tlghtness. 3 ACH50 Rating pmvider.Energy Raters of Massachusetts Duct Leakage to Outside. Untested �. Above Grade Wails. R-30 Ceiling'. Attic R-56 as" W'.ndow Type. U-Value:0.280.SHGC 0.310 Foundation Walls: N/A •n,r Adl in Maynard.Certified Energy Rater Digitally signed.4113118 at 12:53 PM • • • 3 City of Northampton Massachusetts c s \ t SA212 B ISNT OF By Mni G INSPECTIONS L b` 212 Hain rkr • lNnici 010 Building Nertl�empton, !P 01060 'r " Fee Calculator for Residential Properties Location : 1 Garfield Ave Florence, MA 01062 Square Footage Amount Basement @ .20 1sT Floor @ .50 672 $336 2nd Floor @ .50 % Floors, Finish Attic, Garage @ .20 80 (shed) 16 Deck / Porches @ .20 120 24 Total : $376 Permit No. W37-18 Date Approved:'b—I flat Exp. Date:�SlIB CITY OF NORTHAMPTON,MA RESIDENTIAL OR COMMERCIAL BUILDING WATER ENTRY PERMIT A Department of Public Works Trench Permit Shall be required prior to any construction or connection activity associated with this application. To the City of NORTHAMPTON, MASSACHUSETTS: The undersigned,being the OWNER of the property (Owner,Owner's Agent) located at 1 GARFIELD AVE.,FLORENCE ,does hereby request a permit to install and (Number and Street) connect a I" Water Service to the RESIDENCE at said location. (Size) (Residence,Commercial Bldg.,etc.) 1. "Owner"shall mean the person holding title to the property served or to be served by the water service. 2. The person or firm who will perform the proposed work is: THEROUX BROS., INC. , of 622 GRANBY RD, SOUTH HADLEY, MA (Name) (Address) 3. Plan/sketch and specifications for the proposed water service shall be attached to permit. In Consideration of the granting of this permit,the undersigned agrees: 1. The Water Department shall make all taps to the water main. 2. WATER ENTRY PERMIT FEE IS$200.00 3. Additional work performed by City forces from the water main to street line shall be paid at the prevailing labor rates and cost of material. Water Meters 5B" $130.00 Water Meters 3/4" $140.00 Water Meters I" $180.00 Radio Read N/A $135.00 *•*Water Meters 1.5"and above shall be purchased by the owners using City som.•"•' 4. A fee of$150.00 for the Radio Read Fee with the purchase of a new meter. 5. The Water Superintendent shall be notified for water line inspection prior to backfill of trench. 2orS- 5so 533-18 SEE ATTACHED UTILITY CONNECTION REQUIREMENTS Pennit No. W37-18 CITY OF NORTHAMPTON,MA RESIDENTIAL OR COMMERCIAL BUILDING WATER ENTRY APPLICATION DATE: 6222018 SIGNED: q 'IONEER VALLEY HABITAT FOR HUMANITY, IN( (Name of Applicant) P.O.BOX 60642,FLORENCE, MA 01062 (Address of Applicant) 413-586-5430 (Telephone No.of Applicant) $ 200 Entry fee paid Check No. 8833 $ 130 Meter fee paid Check No. 8833 $ 135 Radio Read fee paid Check No. 8833 Application approved and permit issued: DATE: / �6 �C SIGNED: vector ment of Pu Works) Fee Schedule: Water Entry Permit Fee: $200.00 5/8"Meter Fee: $130.00 3/4"Meter Fee: $140.00 1"Meter Fee: $180.00 Radio Read Fee: $135.00 SEE ATTACHED UTILITY CONNECTION REQUIREMENTS Permit No. W37-18 WATER CONNECTION INSPECTION REPORT Northampton Sewer Department 125 Locust St Northampton, MA 01060 (413)587-1570 Date: 6/22/2018 Domestic: X Fire Line: Irrigation: Type of Service: New X Renewal_ Repair_ Pipe: Size 6' Material AC Age 1955 Water Entry Fee Paid: Yes X No N/A Meter Fee Paid: Yes X No N/A Meter Sin: 5/8" Radio Read Fee Paid: Yes X No N/A Check# 8833 Cash Money Order# Location of Installation: 1 GARFIELD AVE.,FLORENCE,MA 1713-081-001 (Number and Street) (Parcel ID) Contractor/Developer Installing Service Connection THEROUX BROS., INC (Name) 413-534-6544 (Telephone Number) This service connection at this location was inspected by the undersigned on (Date) at and approved by: (Time) (Water Superintendent) 1 have instructed of that the installation can be backfilled. Measurements for all installation shall be documented by the Water Department. The information shall be on file at the Public Works Department office. Copy to Supervisor: Date: Copy to Utility Billing: Date: SEE ATTACHED UTILITY CONNECTION REQUIREMENTS Permit No. S33-18 Date Approved: Exp. Date: CITY OF NORTHAMPTON, MA RESIDENTIAL OR COMMERCIAL BUILDING SEWER ENTRY PERMIT A Department of Public Works Trench Permit Shall be required prior to any construction or connection activity associated with this application. To the City of NORTHAMPTON, MASSACHUSETTS: The undersigned, being the OWNER of the property (Owner,Owner's Agent) located at I GARFIELD AVE., FLORENCE ,does hereby request a permit to install and (Number and Street) connect a building sewer to serve the RESIDENCE at said location. (Residence,Commercial Bldg.,etc.) 1. The applicant and/or owner shall fumish upon request of the Superintendent the estimated quantity and characteristics of waste to be discharged to the public sewer. 2. "Owner" shall mean the person holding title to the property served or to be served by the building sewer. 3. The person or firm who will perform the proposed work is: THEROUX BROS. , of 622 GRANBY RD., S. HADLEY, MA (Name) (Address) 4. Plan and specifications for the proposed building sewer are attached hereunto as Exhibit"A". In Consideration of the granting of this permit,the undersigned agrees: I. To accept and abide by all provisions of the Code of Ordinances, City of Northampton, Massachusetts, Section 22.41 through 22-52,and all other pertinent ordinances or regulations that may be adopted in the future. 2. To maintain the building sewer at no expense to the City. 3. To notify the Supertintendent when the building sewer is ready for inspection and connection to the public sewer, but before any portion of the work is covered. 2-018—rb a (k)37-/S SEE ATTACHED UTILITY CONNECTION REQUIREMENTS Permit No. 533-18 4. The City shall not be held liable for any open plumbing fixtures below street level. 5. The applicant and/or owner herby agrees to pay the City any sewer use assessments or charges as may be established under city ordinance. 6. City requires 6" cleanout installed at City Property Line. DATE: 3IG SIGNED: PIONEER HABITAT FOR HUMANITY (Name of Applicant) P.O. BOX 60642 (Address of Applicant) 413-218-0683 (Telephone No. of Applicant) Application approved and permit issued: DATE: SIGNED: (Director of the 15epartment of Public Works) Code of Ordinances Section 22-41 through 22-52 available upon request. Tie-in to sanitary main $200.00 Tie-in to sanitary service at street line $500.00 Tie-in to existing PRIVATE line N/A SEE ATTACHED UTRTIY CONNECTION REQUIREMENTS i uu VARIES N< B'PVC.PIPE. =x-'r6•WYE INCREASER IF NEEDED 6• m - FERNCO PVC. TEE NTE ul COUPLING 8•BEND (SIZE VARIES) EXIST SEWER SERVICE (SIZE VARIES) + 2 S MIN. SLOPE PLAN �� e•GAR 6 MST GROUND HM FOR CLEANOUTS WON TERMINATE WTHIN PAVEMENT AREAS CONTRACTOR TO SUPPLY THE TOP OF A STANDARD WATER GATE BOX TO PROVIDE ACCESS AND TO PROTECT THE PIPE REDUCE CLEANOUT PIPE SZE FROM 6• TO ♦' WTHIN THE GATE BOX TOP. 6 I{. VARIES 4T; SEWER MAIN (SIZE VARIES)ic . -'r6'WYES - 90, 6'BEND P TEEPJC. TEE PROFILE EXIST SEWER SERVXJE 75 TYPICAL 6"PVC.SEWER SERVICE NOT TO SCALE SEE ATTACHED UTILITY CONNECTION REQUIREMENTS Permit No. S33-18 SEWER CONNECTION INSPECTION REPORT Northampton Sewer Department 125 Locust St Northampton, MA 01060 (413) 587-1570 Date: 622/2018 For Billing Only/Private: Type of Service: New X Renewal_ Repair_ Existing_ Sewer Entry Fee Paid: Yes X No N/A Check# 8833 Cash Money Order# Pipe: Size 8" Length 20' Material PVC Age Location of Installation: I GARFIELD AVE., FLORENCE (Number and Street) Contractor/Developer Installing Service Connection THEROUX BROS. (Name) 413-534-6544 (Telephone Number) This service connection at this location was inspected by the undersigned on (Date) at and approved by: (Time) (Sewer Supervisor) I have instructed of that the installation can be backfilled. *City requires 6" cleanout installed at city Property Line. Measurements for all installation shall be listed on the back of this form. The information shall be attached to the permit on file at the Public Works Department office. Copy to Supervisor: Date: Copy to Utility Billing: Date: Copy to W WTP Date: Jim Zimmerman SEE ATTACHED UTIUTY CONNECTION REQUIREMENTS Home Energy Rating Certificate Rating Date: 2018-04-13 Projected Report Registry ID: Unregistered p Ekotrope ID: yLOa8Epd HERSO Index Score: Annual Savings Home: Your home's HERS score I a relative performance score.The [(me,the rurnbner, • • 01060 46learnthe more energy efficient the home.To $ 1 , 5 Builder: Your Home's Estimated Energy Use: This home meets or exceeds the Use[MBtul Annual cost criteria of the following: Heating 6.0 $317 Cooling 0.2 $11 Hot Water 1.1 $60 Lights/Appliances 9.8 $519 Service Charges $60 Generation(e.g.Solar) 0.0 -$0 Total: 17.2 $967 Home Feature summary: Rating Completed by: xm+r Home Type: Single family detached Energy Rater.Adin Maynard ,v Conditioned Floor Area: 672sq.ft. RESNETID:9463452 Number of Bedrooms 1 Rating Compa ytHIS It HERS Energy Efficiency Primary Heating System: Air Sou rce Heat Pum p.Electric•12.5 HSPF Mailing: 12 Perkins Ave.Northampton MA 01060 RHn ^e ,a Primary Cooling System: Air Sou rce Heat Pum P-Electric•26.1 SE ER 4136588784 Home coo Primary Water Heating: Water Heater•Electric•3.55 Energy Factor ao ..,; . House Tightness: 3ACHS0 Rating Provider.Energy Ra[ers of Massachusetts / 3 ro Dud Leakage to Outside: Untested _ ,_ +^ •� Above Grade Walls: R-30 .. . , IICeiling: Attic,R-56 6F mi+came Window Type: U-Value:0.280,SHGC:0.310 o Foundation Walls: N/A Z.Enmermpe � Ado Maynard,Certified Energy Rater Digitally signed:4/13/1 Sat 1253 PM • rope- The Home Energy Rating Stanclard Disclosure for this house Is avallable from the rating provider.