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24D-048 (8) 32 STODDARD ST BP-2019-0357 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24D-048 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:demolition BUILDING PERMIT Permit# BP-2019-0357 Project# JS-2019-000583 Est.Cost: $16360.00 Fee: $110.50 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BARRON & JACOBS 60475 Lot Size(sq.ft.): 13547.16 Owner. FULLER SARAH JANE Zoning:URB(100)/ Applicant. BARRON & JACOBS AT. 32 STODDARD ST Applicant Address: Phone: Insurance: 70 OLD SOUTH ST (413) 586-8998 Workers Compensation NORTHAMPTONMA01060 ISSUED ON.9/20/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMOVE ADDITION FROM SIDE OF GARAGE. FIIL IN OPENING WITH NEW WINDOW AND INSTALL NEW SIDING AND GUTTERS 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 9/20/2018 0:00:00 $110.50 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0357 APPLICANT/CONTACT PERSON BARRON&JACOBS ADDRESS/PHONE 70 OLD SOUTH ST NORTHAMPTON (413)586-8998 PROPERTY LOCATION 32 STODDARD ST MAP 24D PARCEL 048 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T eof Construction: REMOVE ADDITION FRO SIDE OF RAGE.FIIL IN OPENING WITH NEW WINDOW AND INSTALL NEW SIDING AND New Construction Non Structural interior renovations Addition to Existing_ Accessory Structure Building Plans Included: Owner/Statement or License 60475 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFqRMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit _ Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay Signatur�ouildin� 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 City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 'A 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability f Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALT R, R I E V�VR DDMOL H A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION i� F7, I 1.1 Property Address: Thi section to be completed by office `�u Lot Unit DEPT.OF GUILDIPJ , - NORTHAMPTON,MA 01060 Overlay District N Elm St. District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: GwGAr, Z Sr1 o � J � o Name(Print) Current MailiAddrPq--- n Telephone Signature 2.2 Authorized Aqent: q ��(�Skv►��a( S iTi-��S � �Id. ���-r- 0(-� � �� Nom' 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 6 5(.0 (a) Building Permit Fee 2. Electrical gio C) (b) Estimated Total Cost of O Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) l 5. Fire Protection 6. Total = 0 +2 + 3+4+ 5) 'J(o 0 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by C-' . �L UON Building Department Lot Size Y��' Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DON'T KNOW ® YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © 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 17 DON'T KNOW 0 YESyy 0 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 © NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO (Q� 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 ISU that will disturb over 1 acre? YES © 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) V�l Roofing ❑ Or Doors E] Accessory Bldg. ❑ Demolition New Signs [O] Decks [M Siding [I;I] Other[O] Brief Description of Proposed V-e o\Je, S►.AA C Y 0�-)vaq'Jc Work: ✓\Dw „i,v,�r 51�\\ Atw AAv--, avNk qU Alteration of existing bedroom Yes__)Q No Adding new bedroom Yes —)(._No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? 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 I, So(4' &I1 Q( as Owner of the subject property hereby authorize 6'VV_l1S_DPV1'Gl O1�7 2$ �a� `r :yO'�aS to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of O er Date I, ckc&�)S as Owner/Authorized Agent hereby declare 1hat 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 61IL-1 OA,,,� a.o Signature of Owner/Agent Cbte SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Constructions Supervisor: �" 1 Not Applicable El Name of License Holder: ( C s���nor �Mt��S G S 0(ofjl License Number Addressss1 Expiration Date c/ , v O Signature Telephone 9. [Registered Home Improvement Contractor: Not Applicable ❑ J tT�'�n X ��0•c.-�LiS �O l���Y�L. � 0��1 Company Name Registration Number Address Expiration D to Telephone 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....... No...... ❑ II� City of Northampton Massachusetts r r DEPARTMENT OF BUILDING INSPECTIONS �* 212 Main Street • Municipal Building 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("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 owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note: If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: AQyho Qavo�c ' Oh• KAVh66W Est. Cost: Address of Work: , Date of Permit Application: n i?—O)I S( I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): _Job under$1,000.00 Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A. SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT. SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I here y apply for a buildin permit as the agent of the owner: l � CJ,f k Soca, b0 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 i DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building 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: (Please print house number and street name) Is to be disposed of at: A G` (PI se prin am a d location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) L/ Signature of Per it 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. SIGNATURES By signing below,you agree to items A. B and C. DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES. A. Alternative Dispute Settlement(Arbitration Clause): The Seller and the Buyer hereby mutually agree, in advance,that in the event of a dispute concerning this Agreement.the parties shall submit such dispute to a professional, state-approved arbitration service(cost, if any,to be paid by the submitter)prior to either party proceeding to legal action in the courts. B. By signing this agreement,you.as the owner of record. are hereby authorizing Barron&Jacobs Associates Inc.to act as your authorized agent in all matters pertaining to the building permit application. C. This is a binding Agreement. You may not cancel it except as stated. This Agreement covers and supersedes all conversations. statements and agreements.expressed or implied,between the parties.their agents or representatives. You.the Buver. may cancel this transaction Bu,,er Date at any time prior to midnight of the third business day after the date of this transaction. See the attached notice of cancellation form Buver Date for an explanation of this right. Seller retains an equal right to cancel. � ld Ba on&Jacobs R presentative D e Contact Information Office Manager: Sandy Scavotto Office:413-586-8998. x100 El Chris Jacobs. President CT HIS 0554397 Cell phone: 413-250-6677 Home phone: 413-665-9113 Office phone ext: 103 MA Construction Supervisor License 060475 MA Home Improvement Contractor 100809 CT Home Improvement Contractor 518617 Purchase Agreement Page 19 of 19 Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-060475 Construction Supervisor CHRISTOPHER R JACOB 70 OLD SOUTH ST NORTHAMPTON MA Expiration: Commissioner 11/10/2018 OSHA 001Q16943 :.� ,tkdfia • ;�ai!fineg f;��� y � - ZZ .. [,j Salary � 2 �1K.aineKt � C)4 � Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Corporation BARRON &JACOBS ASSOCIATES, INC. Registration: 100809 70 OLD SOUTH STREET Expiration: 06/22/2020 NORTHAMPTON, MA 01060 Update Address and Return Card. CA 1 0 20M-05/17 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 100809 06/22/2020 One Ashburton Place-Suite 1301 BARRON&JACOBS ASSOCIATES, INC. Boston,MA 02108 CECIL R.JACOBS - 70 OLD SOUTH STREET .� NORTHAMPTON, MA 01060 Undersecretary Not valid without Signature \ The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/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): bG1r(>('dn p,�� `�-a�,S5,� c,. `YAC.' Address: 1-G G tC3Q ky C-� City/State/Zip: o060 Phone #: !:Ak3 ' i�T�5-L mag Are you an employer?Check the appropriate box: Type of project(required): I.®I am a employer with��employees(full and/or part-time).* 7. E] New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. rQ Remodeling any capacity.[No workers'comp. insurance required.1 9. Demolition 3.F1 I am a homeowner doing all work myself. [No workers'comp.insurance required.]� 0 10 E] Building addition 4.F1 1 am a homeowner and will he hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 1 I.Q Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑t am a general contractor and I have hired the sub-contractors I isted 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 are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors 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 provide their workers'comp.policy number. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: M = �Q {,`'JL�'� Zl7 �`� Expiration Date: ?2 JU19 Job Site Address: City/State/Zip: t7( DkD6C2 Attach a copy of the workers' compensation policy declaration page(showing the policy number and ex iration 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 forth 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. Ido hereby certify under the pyi sand penalties perjury that the information provided� � `�above . t ue and correct. Signature: Date: ! Phone# 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#: ACORO0 DATE IMWDD/YYYY) �, CERTIFICATE OF LIABILITY INSURANCE 3/5/2018 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 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 CONTACT AME:__ Ad1na Edg ett N _____ Webber & Grinnell PHONE (413)586-0111 FAX.No,:(413)586-6481 I'a 8 North King Street aDOA's aedgett2webberandgrinnell.eon INSURER(S)AFFORDING COVERAGE NAIL• Northampton MA 01060 INSURERA;Main_Street America/MSA 29939 INSURED INSURER B:NGH MSA Barron b Jacobs Assoc. Inc. INSURER CA.I.M. MutuAl A_.I.M. _ Attn: Cecil R. Jacobs INSURER D: _ 70 Old South Street INSURERE: Northampton MA 01060-3833 INSURER F: COVERAGES CERTIFICATE NUMBER:Exp 03/19 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. (NSR - - IADDL�,SUBR POLICY NUMBER MM ICY EFF POLICY EXP LTR TYPE OF INSURANCE LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE OCCUR PREM( E occurrence $_ 500,000 MPT8049D 3/9/2018 3/9/2019 ME D EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEWL AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE S 3,000,000 X POLICY a JECT LOC PRODUCTS-COMPIOP AGG S 3,000,000 OTHER: ! EPLI S 10,000 COMBINE5TAUTOMOBILE LIABILITY j Ea a.d.nt IN TLE LIMIT S B ANY AUTO BODILY INJURY(Per person) $ 1,000,000 ALL OWNED X SCHEDULED MlTS049D 3/9/2018 3/9/2019 BODILY INJURY(Per wadellt) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED I PROPERTY DAMAGE S AUTOS I Per accident Medical payments S 5,000 UMBRELLA LIAR HOCCUR i EACH OCCURRENCE $ B EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I X RETENTIONS 10,000 CUT8049D 3/9/2018 3/9/2019 S WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY TAT T R ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N1 N' I E.L EACH ACCIDENT $ 500,000 C (OFFICER/MEMBER EXCLUDED( FN NIA j (Mandatory in NH) WMZ80063652017A 3/1/2018 3/1/2019 iE.L.DISEASE-EA EMPLOYE1 S 500,000 If yes,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Proof of Insurance Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE W Grinnell, ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(20'40/ nj r why � 4 w, ly y� S s xr' R --— �ti! S