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24A-133 (5) 397 PROSPECT ST BP-2019-0347 GIs#: COMMONWEALTH OF MASSACHUSETTS MU Block: 24A- 133 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2019-0347 Proiect# JS-2019-000564 Est.Cost: $9776.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor., License: Use Groin D P CARNEY INC 99798 Lot Size(sq.ft.): 22694.76 Owner: WILBUR C KEITH&SARAH WILBUR C/O MARK E ARSENAULT Zoning:URA(100)/ Applicant. D P CARNEY INC AT: 397 PROSPECT ST Applicant Address: Phone: Insurance: 34 HORSE SHOE CIRCLE (413) 967-7124 () WC WAREMA01082 ISSUED ON:9/21/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Deaartment Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy signature: FeeTvpe: Date Paid: Amount: Building 9/21/2018 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner (e'co �- Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-12f -.. to Site Ps APPLICATION TO CONSTRUCT,ALTER, REPAIR, R ENO�ATE OR DEMOLISH A ONE O� TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: DEPT OF GuILDINGTM* 6h to a completed by office NORTHAMPTON�.lMAI!I040 397 Prospect Street Map_ ZT Lot �3 3 Unit Northampton, MA 01060 Zone Overlay District_____ Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Mark Arsenault 397 Prospect Street, Northampton, MA 01060 Name(Print) Current Mailing Address: (.413) 588-4841 dfz�prrl�k /XM- Telephone Signature tz 2.2 Authorized Agent: D.P. Carney Construction, Inc. 34 Horseshoe Circle, Ware, MA 01082 Name(Print) Current Mailing Address: \ (413) 967-7124 Sig ure Telephone SEC 3-ESTIMATED CONS16156TION COSTS7 Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (Re-roof Lower Roof) $9,776.00 (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 6(q O 4. Mechanical (HVAC) 5. Fire Protection 6. Total= 0 +2+3+4+5) $9,776.00 Check Number 7 This Section For Official Use Only Building Permit NumberDate Issued.- Signature: ssued:Signature: Building Commissioner/Inspector of Buildings - - Date c� Coe.r o e � @ �o In 0-a-`- 1 . o f EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER O CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zonitig This column to be filled in by Building Department Lot Size Frontage _ Setbacks Front T Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved arkiu #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW ® YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW ® YES O 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 0 , Date Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO IF YES, describe size, type and location: E. 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? YESO NO IF YES,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 Alteration(s) ❑ Roofing EZ Or Doors t] Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding [tom] Other[Q 1.) Strip off existing roofing and flashing and recycle properly.2.) Remove existing gutter and put off to the side. 3.) Install pressure treated Brief Description of Proposed nailers equal to the height of new insulation,(4.4"). 4.) Mechanically attach two layers of 2.2"Poly-Iso insulation,(R-25)to the wood deck. Work: 5.) Saw cut scrolled wood decor to allow for height of new insulation,wall flashing,and counter-flashing. 6.) Install a Fully Adhered(.060)TPO(white)Roofing System. 7.) Re-install gutter(raising)to just below roofs edge. 8.) Fabricate and install new 24 gauge Kynar coated drip edge and fascia,installing drip edge into gutter. Alteration of existing bedroom Yes X No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: N/A 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? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? 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 COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT j,_ Mark Arsenault _ _ as Owner of the subject property hereby authorize D.P. Carney Construction, Inc. to act on my behalf, in all matters relative to wo orized by this building permit application. Signature of er Date Mark Arsenault 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. D.P. Carney Construction, Inc. Print Name Signature of Owne'bWnt Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable '❑ Name of License Holder: Daniel P. Carney License Number 34 Horseshoe Circle, Ware, MA 01082 _ CS-099798 Address Expiration Date (413) 543-3150 Signature - Telephone 8/19/2019 9. Registered Home Improvement Contractor: Not Applicable ❑ Daniel P. Carney Company Name Registration Number D.P. Carney Construction_, Inc. 1211_78 Address Expiration Date 34 Horseshoe Circle,Ware, MA 01082 Telephone 413-967-7124 4/11/2020 SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152, §25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... X No...... ❑ City of Northampton Massachusetts DEPARTMENT OF BUIIrDING INSPECTIONS S- 212 Main Street • Municipal Building X Northampton, MA 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('THC"). 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 owner-occupied building containing at least one but not mon:than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: Roofing Est. Cost: $9,776.00 Address of Work: 397 Prospect Street, Northampton, MA 01060 Date of Permit Application:C k` O 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 NE -PA17 FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as of the owner: D.P. Carney Construction, Inc. 121178 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 S�5,..•'�..SIC Massachusetts (.. DEPART74WT OF BUILDING INSPECTIONS 212 Main Street • !Municipal Building �vdti a` � Northampton, MA 01060 ssy •.• ��ao 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. C l City of Northampton S�s" • � Massachusetts 1 DEPARTMENT OF BUIZDING INSPECTIONS a T q 212 Main Street •Municipal Building y - Northampton, MA 01060 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: 397 Prospect Street, Northampton, MA 01060 (Please print house number and street name) Is to be disposed of at.- United t:United Material Management, Inc. , 896 Main Street, Holyoke, MA 01040 (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: All Waste Removal Company, P.O. Box 297, Hampden, MA (Company Name and Address) i� Signatur of Pe mit Applicant or Owner Da If, for any reason, the debris will no5TtF6­ isposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. I The Commonwealth of Massachusetts Department of In4ustrial Accidents IR = I Congress Street, Suite 100 Boston, MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): D.P. Carney Construction, Inc. Address: 34 Horseshoe Circle, Ware, MA 01082 City/State/Zip: Ware, MA 01082 Phone #: (413) 967-7124 Are you an employer?Check the appropriate box: Type of project(required): I.®I am a employer with 15 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.M I am a homeowner doing all work myself.[No workers'comp.insurance required]' 10E]Building addition 4.❑I am a homeowncr and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.F1 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.®Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.❑We are a corporation and its officers have exercised their right of exemption per MGL C. 14.®Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must pro-6de their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepo/icy andjob site information. Insurance Company Name: Granite State Insurance Company Policy#or Self-ins. Lic.#: WC009930624 Expiration Date: 11/15/2018 Job Site Address: 397 Prospect Street City/State/Zip: Northampton, MA 01060 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. I do hereby certify un the pains an pen ties of perjury that the information provided above is true and correct. Signature: MJ _Date:_ 9/16/2018 Phone#: (413) 96 -71 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#: DPCARNE-01 ANGELA ACORO CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DD/YYYY) `•-� 09H 312018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONT NAMEncT Angela DiAugustino Phillips Insurance Agency,Inc. PHONE 97 Center Street (A/C,No,Ext):(413)594-5984 lac,No):(413)592-8499 Chicopee,MA 01013 A-p ' .angela@phillipsinsurance.com INSURERISI AFFORDING COVERAGE NAIC N INSURER A:Kinsale Insurance Compgny INSURED INSURER B:Selective Ins Co Of Southeast D.P.Carney Construction,Inc. jNSURER C:Granite State Ins CO 34 Horseshoe Circle INSURERD: Ware,MA 01082 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRA X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR 0100041217-2 08/01/2018 08/01/2019 DA PREM S(.occu $ 100,000 MED EXP(Any one $ Excluded PERSONAL&ADV INJURY $ 1,000,0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY[XI PECT F-1 LOC PRODUCTS-COM P/OPAGG $ 2,000,000 OTHER: BI1PD Deductibl 5,000 B AUTOMOBILE LIABILITY (Ea ac dents LE LIMIT $ 19000,000 X ANY AUTO A9094953 08/01/2018 08/01/2019 BODILY INJURY Per arson $ _ OWNED SCHEDULED AUTOS ONLY AUTOS yyNE BODILY INJURY Per accident $ AUTOS ONLY ATO ONLDY PPeOr aaci 'I AMAGE $ $ A X UMBRELLA LIABX OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE 0100054375-1 08/01/2018 08/01/2019 AGGREGATE $ 5,000,000 DED I X I RETENTION$ 0 $ C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY TAT _ YIN 0009930624 11/15/2017 11/15/2018 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ MFFI darENI EW EXCLUDED? N/A andato In IIJJFHI E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Installation S1985457 08/01/2018 08/01/2019 Limit 107,000 T1 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Re-Roof Lower Roof at 397 Prospect St.Northampton,MA 01060 i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Mark Arsenault THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 397 Prospect St. Northampton,MA 01060 -- --- AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1 Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 • Boston, Massgchusetts 02108 Home Improveme.i' '=Coheractor Registration Type: Corporation '_'- Registration: 121178 D. P. CARNEY CONSTRUCTION, INC. "'''''%` " = •'' 9 34 HORSESHOE CIRCLE Expiration: 04/11/2020 WARE,MA 01082 ` ;^r_ Update Address and Return Card. SCA 1 0 20M-05/17 /rn�C7iE9YLON./,L�RCI.I/�n�C%��aJrcarfiueel1a Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:°Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 121-128:'< 04/11/2020 One Ashburton Place-Suite 1301 D.P.CARNEY CONST4UCTI0N,4:INC. Boston,MA 02108 DANIEL P.CARNEY NQ_C�'� 34 HORSESHOE CIRCLE... b�" WARE,MA 01082 Undersecretary �-- Ot'Valid W'11 ature­ Commonwealth of Massachusetts Construction Supervisor Division of Professional Licensure Unrestricted-Buildings of.any use group which contain Board of Building P.egulations and Standards less than 35,000 cubic feet(991 cubic meters)of enclosed Constructfori SOpervisor space. CS-099798 Ecpires:08/19/2019 DANIEL PCARNEY . 34 HORSE SHOE CIRCLE WARE MA 01082 Failure to possess a current edition of the.Massachusetts State Building.Code is cause for revocation of this license. For information.about this license Commissioner CIL Call(617)727-3200 or visit www.mass:gov/dpt �.