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36-116 (4) 4 OVERLOOK DR BP-2019-0130 GIS#: COMMONWEALTH OF MASSACHUSETTS Man-.Block: 36- 116 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category-window replaced BUILDING PERMIT Permit# BP-2019-0130 Project# JS-2019-000208 Est.Cost,$3981.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: NORTH EAST SPECIALTY CORP 081031 Lot Size(sp. tt.): 16596.36 Owner: CONNOR RICHARD E&KATHLEEN M&M CONNOR-THOMAS&P CZARNIECKI Zoning: Applicant NORTHEAST SPECIALTY CORP AT.- 4 OVERLOOK DR ApplieantAddress: Phone: Insurance: 148 DOTY CIRCLE (413) 739-4333 WC WEST SPRINGFIELDMA01089 ISSUED ON:8/2/2018 0:00:00 TO PERFORM THE FOLLOWING WORK INSTALL 3 DOUBLE HUNG WINDOWS 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: 911; 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 82/2018 0:00:00 $40.00 212 Main Strcef, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use Only 0 City of Northampton Status of Permit Building Department Curb CutlDrlrewayPaml� 212 Main Street SeweriSeptio Avaryelrillty Room 100 WataNWell Availability Northampton, MA 01060 Two Sets of Structural Plena phone 413-587-1240 Fax 413-587-1272 Pion"Plank- Other Speciy APPLICATION TO C ALTER REPAIR RFNOVJ TE OR DEMOLISH A�ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMA j ON " 0— j `"{ - 13t) 1.1 Properly Address' JUL 31 2018 �TTJhiss�stiction to be completed by office wap_ Lot II ILA UnS 4 Overlook Drive DEPT OF BUILDING INSPECTIDNB ne Overlay DlsMet NORTHAMPTON.MA 01080 Elm SL Diselct CS Distril SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Kathleen Connor 4 Overlook Drive Florence MA 01062 Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Name mn Current Mailing Addres I�-7?�t—y ERS Sig Telephone S CTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed bermit ap licanl 1. Building 3981.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) 3981.00 Check Number This Section For Official Use Only Date Building Permit Numbe ' Issuetl: r Signal 0 Building Co Issionerllnspeclor of BullDale EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Mort Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning na,column to be filled In by Building Department Lot Size Frontage Setbacks Front Side L R: U R: Rear Building Height Bldg.Square Footage Open Space Footage (Lot area minus bldg&paved parkin,) #of Parking Spaces Fill: volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page 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 O 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: E. Will the construction activity disturb(clearing,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 YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5.DESCRIPTION OF PROPOSED WORK(check all applicablet New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[0] Other[[:� Brief Description of Proposed irrsP 3 douNe hung windows in existing frame work Work'. Alteration of existing bedroom_Yes_No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement _Yes No Plans Attached Roll -Sheet Ga.If New house and or addition to existing housina, complete the following: a. Use of building :One Family Two Family Other Windows b. Number of rooms in each family unit Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? I. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction I. 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. I. Septic Tank_ City Sewer_ Private well_ City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETEDWHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 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 ;e—P. lS r as Owner/ Ihorizetl 'Age ereby declare that the statements and information on the foregoing application are true and accurate,to the best of y knowledge an belief. Sired under the pains and penalties of perjury. Ph a e Q r Sign ure of Own Agent ata SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Nam..f Lies...Holds: Matthew Harrison License Number 148 Doty Circle West Springfi Id MA 01089 cs-081031 Address Expiration Date 09/06/2019 S' a Telephone 413-739-4333 9.R1 �teeciis �mHHoo_me�IImmprovement Contreptor: Not Applicable El 1\ X-d'7..0 J/ Company Name Registration Number 103713 Address Expiration Date Telephoney/3-7�9'y33 07/13/2020 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(e)) 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 it. Signed Affidavit Attached Yes....... No...... ❑ City of Northampton »- s, [Massachusetts ;6 ' DEPARTNBNT OF BUILDING INSPECTIONS 312 Main Street •ewnicipal Building BottMmptw, MA 01060 "-gijla 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 MA. The debris from construction work being performed at: (Please print house number and street name) Is to be disposed of at: L= 1�1$ and ti P4 W ` -CL6 h�c�olGSq (Please print name and Iota ion of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 4watu—r6 of Permit Applican r wner 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 Department of IndustrialAccidents c I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contrastors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name (Busineas/Organi alion/Individuap:Nescor Address:148 Doty Circle City/State/Zip:West Springfield MA 01089 Phone#:413-7394333 Are you an employer?Check the appropriate boa: Type of project(required): 1-E✓ I am aempm,u with 30 employees(hill and/or puh-uhan 7. ❑New construction 2.❑Iamasola proportion or partnership and have no employees working formein 8. ❑ Remodeling anycaprany.Mo workercompinsurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required]' le 4.❑I am a hommg cantractors m conduct and will be hiring cuct all work on moI will 10 Building addition ypr everm that all contractors insurance cover have workers'compensation sinsurancear mnce or e sole 11. Electrical repairs or additions pmpdetors with oo employees. 12. Plumbing repairs or additions 5 1 am a general contractor and I have hired the sub contractors listed on the attached sheet. These sub-constrainrs have employees and have workers'comp resurar¢eJ 13.ElOffe,Roof inti 6.❑We arcawmoratahand o oircer base exercisedthewm in r[exemprion per MGL e. 14.❑✓ Other Windows 152,41(4),and we have no employees.IN.workers'comp.insurance required.] *Any apphyannhat cheeks box dl must also fill out the section below showing Nair workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contmctom must submit a mac affidavit orchestra,Inch. :Contm<tors that check an,W.most attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employ.. If m,ar,ormomm have employees,they mol provide than workers reap.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy coal site information. Insurance Company Name:A.I.M Policy#or Self-ins.Lia#:VWC6003962-2017 Expiration Date:07092019 Job Site Address:4 Overlook Drive Florence MA 01062 City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date)t 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 certify re pains on l pe I 'es of perjury that the information provided above is true and correct Signature Phone#: 41 .,`(36-0333 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 one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone 0: NORTHEAST SPECIALTY CORPORATION dlb)a NESCOR All home Improvement contractors and subcontractors MA License 1103713 engaged in horns Improvement contracting, Won speele- 148 DON Cilde • WEST SPRINGFIELD,MA 01069 W ly eaampt trom,ogstrauon by Provue W Chep 1142A 1.888-NESCOR-1 1-888-537.4871 of the general laws. must be registered win the 413-739-4333 Commonwealth 01 Massachusetts. Inquires about regiatrs• nescornow.eom hes HM status sMum be made to me Director o/Consumer Artems and fiuskess Regulation, Tin Park Plata,Su9a 5170 Bromides / Boslan,MA 02116-Plan(617)973.8703 S_L'Sf-7�.. 7/o lisllMLigH_LSL(1_ W.MnM wb..Ybrn4P»v4 pMub.b w�Ab W pfil'm,ra'W nuM1Wr b b uaN / 1 _Arad S� c/off_LQA ....e> � .._w).tZ.Ufa• —S_u�enF �,(/G—S7C—o— lr _[e.•ryt _ Z' pp rq N Cme^rt4`n r.b`M•p(alm} ��N.(a P 4M/MRW/,r.V qIT M EW M k.w.'V F.C^Y d MH'.InM"4 W!a W 1T��4YJP rI Mpn M K•4T a Yl. .roea«4 ta,.wwa�.n rw..w.am..aaw aa�+ eaay.+.wrpVnur.hs�wem enbergbein bww.aTMm aim.wvw , a..�a.res Pe d awaa.w e.vaa bsPvm w.ra«,vwP.a«.ween.a M ee.00w wraw+m ry �<o M riP.rebl.e,Mb NlMw.bnNN Mr.unsr aunb 4w 1pn OYW nmu.ruM1 4e.mnWwpb epreea� �' -kb«,p Pw{W Wa/(PRIr .w,MrWawvsa M1eMMn1 w w n.n,.n)wl.[I n wawn.^gP r+iu^+e.n Ea.»p.V�er M CpuMx.a rt<Pmalm,vrags«P pMr,.6cawN .Ox Meean tl Mr/A.vRMbnpi4.nW.MCMncbrpW,a ban..gw.IT4T nmP/,nMltlnR1.PaY,Pu,n.bb,YMPN.,bW PbdMe.W Yr- er e ffOp058 trereW b wrrvan geiebe arse b ale m pip da -p wM eoo4e apacdiwem�s�•ar Ina sum d. fl�le� 1/i, ,S�.ol A o A •rt�or7 e•a.IJ vrc — donaats pgmrnl a a mea a bwPe J �x,s 3 a 1 uwm aenvwawr NORTHEASCSPECIBLTY CORCQM40tl.dVAHESCOR- 4a.a cbweaam..osaro wp•ua.. 1/3 sot a r,am m.ou4P.a �•��/ WEST SPRINGFIELD,MA010B9__—._41.3739:<333. —_ ce"sua n,P,e _xd .rlwamw blmn Torn 103713____. amelamel. vneavvii %gw•wvo J'Jp, J�� /N sees, ND.WMmetl MrbTe YrpIP«abeC 4eaW K,kYW•p,MeaeTM N.rMd$WWI, �(�f_//" _ p.ymw.lwwM1.a.wwlamabaw P,.+bro olMlaa mesa acePM wwma�w�� fi� rL^^ I«aa*enaoeeos«awrM^b.wa,MaW,ecKK Pw�rIv44aearer,vl, yv.—_.. .. � _--•^ bf/Eer Y6P dNrw•N min 6lMM1dsCmaGArMbrW.erb MR M1. e1TMdM➢OY'ilCt'aa'Y_ Accontends of Proposal: I have read both sides of this document and accept the prices,specgaatiars and carldrtipns Ueted. I uMerstand Chad upon signing, this proposal becomes a binding contract. You are authorized to do the wok es apedled. Payment will be made as oWmed above.You may cancel this agreement If It has been signed by a party thereto of a pace tiger than an address Of the Seller,which may be his main ohlce or branch theley the Sonar provided you nolltSonar N=14 et nis f11aO1 once branch by erd+nmy mail Posted, by telogram sent or by delivery,M Wer than midnight of the third bussi day fdepwing fhe signing of Mrs agreement. Please refer to the Notice of Cancotedicn. DDO`NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. an �l.L)4iseL_oa. A��q_i 9 syuur,s _ou srw — Scanned with CarnScanner NESCO-1 Acorzo CERTIFICATE OF LIABILITY INSURANCE onlmzota 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: Ifthe certificate holder Is an ADDITIONAL INSURED,the policyiles)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certaln policies may require an endorsement. A statement on this certmcate does not confer rights to the certificate hostler h Uses ofsuch endorsemen s. PRODUI 413-7373359 hkW.IT J Raymond Lussier ins Agcy Inc J Raymond Lussler Ins Agcy Inc Paol>E q13-7373359 IS- 413-732-2027 181 Park Avenue,Suite 8 Wc,rve,EI,tl. lac,Npl. PO Box 499 I ss:ln o usslerinsumnce.com West Springfield MA 01090-0499 J Raymond Luss{er Ins Agcy Inc INS SMFOCOVERAG NAIC/ wsuRERA'.COLONY INSURANCE CO INSURED Northeast Specialty Corp INSUREMB:A.I,M. Mutual Ins.Co. 1as 48 or Doty circle M,auclEP r Safety Insurance Company 39454 West Springfield,MA 01089 INSURER o'. INSURER E' INSURER F'. COVERAGE CERTIFICATE NUMBER, R VISION UMB R: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY RERI00 INDICATED. NOTW THSTAN DING ANY REOU IREMENT, 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, EXC WSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS. INSRTYPE OF INSURANCE IADMNS POLICY NUMBER 1OAbaLICV EFF POLKV EXP LIMITS A TXCOMMERCIAL GENERAL UABIJTYEACH OCCURRENCE $ 1,000,000 CLAIMSMADE OOCCUR 101 PKGOON179-00 03/1812018 011812019 DAMAG E TO RE N T E D S 100,000 MED Ew 1.,11.1151000 PERSONAL a ADV IHILMY f 1,000,000 GEN'L AGGREGATE LIMIT APPU ES PER GENERAL AS GREGATE $ 2,000,00 X PODc ❑jPeT [::]L.' PRODUCTS-COMPIOPACG 2,000,000 THAI FQ9'EED SINGLE LIMIT 1,000,00C gUTOM001LE LIABILIT( t ANY AUTO 2433825 0311112018 031172019dJUR Pe- arOWNEp SCHEDULED son AUp7p0pSONLY X AUTµOpy� p NJUP Per eccd XALTOS GNLYXAUTVS ONY Bdl AMAGE $ UMBRELLA LAB OCCHR EACH OCCURRENCE 4 E%CESSLAB CLAMS-MADE AGGREGATE $ DED RETENTIONS $ B WORKERS LOMFENSATLN X PER OTH- ANDEMPL YM LAS TY C6003962-2017 OL09r2018 07/092019 100,000 ANY PRCPRIETORPARTNER/E%ECU-IPE YIN EL EACH AC6pENT } AFFIL 1�lnQEUCHNED'r N� rvlA 100.000 gonEaE Dry InINHI EL DISEASEEAEMPLOYEE £ 1 yes describe under 500,000 res ON OF OPERATION$below D15EASE-POLICY LIMIT DESCRIPTION OF OPERATOM 1 LOCAnONS IWHCLES (ACORD 101,AdditanalRemu s Scbdule ms,be Attached K mon apace Is"dred) CERTIFICATE HOLDER ANCELLATION ENFIETO SHOULD ANY OF THE ABOVE DEIM MEED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF ENFIELD ACCORDANCE WITH WE POLICY PROVISIONS. 820 ENFIELD STREET ENFIELD,CT 06082 AUTHOR¢EDREPRSSENTATIVE ACORD 25(2016103) ®1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 3)2Tl2oie Details The ORclal Website of the F_xecutive Office of Public Safety end Semvlty(EOPSS) Moss-GovHmae Slate A9endes Wr,ensee Details emographic Information Full Name: MATTHEW S HARRISON O er Name icense Address information City: Becket State: MA ipcode: 01223 CounW UNtedStates License norma ion License No: C -081031License Type: Construction Superyisor Profession: Building Licenses Date of Last Renewal: 10/20/2017 Issue Date: Expiration Date: 9/6/2019 License Status: Active Today's Date: 3/27/1018 /no B-e AVrien Secondary License Type: Doing Business As: tus Chancle R as n: License R ewal Prerequisite n orma i n No Prere uisite Information Close Window ©2011 Commonwealth of Massachusetts i Site Policies Contact Us htmualinen.cnchsstatn.ma.usNerificationll)etails.asox7eoencv itl=lUcense itl=270018& 111 Vie �o�nvnu�Y�ea,��i o�C-iG�czc�uulel�i� �'� Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Corporation NORTH EAST SPECIALTY CORPORATION Registration: 13 Expiration: 0711 07/13/2020 DON CIRCLE WEST EST SPRINGFIELD,MA 07089 Update Address and Return Card. SCAT r; -¢M-05M17 officeHOME I s mer IMPROVEMENT TR Regulation HOME IM TYPEM ENTOONTRACTOR Rsters ationviraflor individual use only TYPE CcmaaOon before theonsu er data afountlines, to: Registration Ex i 02 Office of Ash Consumer ,-Suite u ie 13 Business Regulation 103]13 0]/13/2020 One Ashburton Place-Buite 1301 NORTH FAST SPECIALTY CORPORATION Roston,MA 02108 SHARON M.TARIFF _y,�� 148 DOTY CIRCLE (� WEST SPRINGFIELD,MA 01089 Undersecretary Not valid without signal