The URL can be used to link to this page

06 C��.,.L��j ! ..._ _./„�•_—_ ;+�- __._- --�--_.____.�_.�,..._...� Ic � Inc AI J� • b f JOELZIM-01 WAR CERTIFICATE OF LIABILITY INSURANCE D 11 228/208120 8 11/ 18 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 endomement(s). PRODUCER WITVcT Valerie Carrier Whalen Insurance Agency PHONE FAX 71 King Street ac,No,Ext):(413)586-1000104 A/C,Na:(413)5854)401 Northampton,MA 01060 Ip ' .valerie@Whaleninsurance.com INSURER(S)AFFORDING COVERAGE NAIL S INSURER A:Utica First Insurance Company 15326 INSURED INSURER B: Joel Zimmerman DBA Joel Zimmerman Carpentry INSURER C: PO BOX 225 1 INSURER D: North Hatfield,MA 01066 INSURER 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 LTR I TYPE OF INSURANCE ADDL SU POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 11000,000 CLAIMS-MADE FX OCCUR RT-5089597 02 08/13/2018 08/73/2019 DAMAGE TO RSESE.ENTED $ 50,000 MED EXP(Any one y 5,000 PERSONAL&ADV INJURY E 1,000'000 NG N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2'000'000 X POLICY 1-1 jpa El LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: b AUTOMOBILE LIABILITY COMBINED accident)SINGLE LIMIT ANY AUTO �� BODILY INJURY Per person) AUUTOS ONLY ED AUUTNOSSWULNEDp BODILY INJURY Per accident E AUTOS ONLY AUTOS ONLY P 08ERS MAGE $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE E DED RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/NUTE] ER ANY PROPRIETOR/PARTNER/EXECUTIVE (�ICS�FMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ ( NN) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate issued as evidence of coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 210 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Northampton,MA 01060 AUTHORIZED ,REPRESENTATIVE ACORD 25(2016/03) Y 0 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD �„-...'' . � h Y� ,�� * �-� � �� . r;n �� ` r,, � .,k. •: �,; .N ��Ia to 6 `� i, � ';+ �y1��n t a`�rlt'`�t�� ll.�.. � Nat��F �r��' �� © � �� 4�. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 r www mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lezibly Name(Business/Organization/Individual): �Y02 i zImod1.eziofk, C4.1 Q1-0miry/ Address: 790 We5-t 57 ZAreCity/State/Zip:lll 74 hg7&, 14 Mq, O/o d! Phone#:_013 ,► 9,57-- 7 7 12- Are you an employer?Check the appropriate boa: Type of project(required): 1.[:]I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.n I am a sole proprietor or partnership and have no employees working for me in $, Remodeling YY++rr any capacity.[No workers'comp.insurance required.] 3.[__11 am a homeowner doing all wprk myself[No workers'comp.insurance required.]t 9. Demolition 4.E]I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.� p 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#1 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. I 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.#: Expiration Date: Job Site Address: City/State/Zip: 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. Ido hereby cert under the pains andpenalties ofperjury that the information provided above is true and correct Si nature: .� — Date: Ido Phone#: 7 7'--/Z 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 M City of Northampton JMassachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building Northampton, MA 01060 s y 4 `14 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: 2-71 HAY 4v, v. i 1fy (Please print house number and street name) Is to be disposed of at: low trey R eye' 11.1 1 (Please print n me and ocation of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) r Sinature of Prermit 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. City of Northampton ? Ns ay • • Massachusetts urs ; L r I rIMPAR229CUT OF BUILDING INSPECTIONS 212 Mnin street . lhmicipal HnildingIQ moi_ NortbMwton, MR 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("IRC"). 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-exishing 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 corpo wdoon or LLC,that entity amw be registered Type of Work:k;16 ken rt w) n d e I g n ci a del 7 &-74r-o,-,n Est.Cost: 6 3 9, OOc'• 0 D Address of Work: 2-'7/ ftAydyny,Ile, L e-ecf s f`14 Date of Permit Application: 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 RESPONSIBHdTES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: 11 -2 9- /-16 7OR I z:,�'I.rr��'.�A.-� /i's 919 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 SECTION 8-CONSTRUCTION SERVICES 81 ur ensed Cogatructlon Suaervrlsor Not Applicable 0 �Jy 2 f P✓►�►yn`Q%rr►a�� c S ~ 47 If 3 j�b License Number 3�/d i.�-e57 �i'P�'7yr'r�l Kg7 •-e(c� f�g. 0lGd 2-- t — ,gyp /q Address F*ffation tate Signgofi Telephone 9Registered Nome hn Contractor_. Not Applicable 0 To-e_1 e'4rAP.r7ry t 21h 121 Company darns — Registration Number 3410 100 fc,� ',71-fY7 �cr-r6 Harp-eld Mg v1dG6- i-- ,-o / 9 Address Expiration Date z-*" Teiephane-"//y 6?�5-7 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.ML 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....... .III No...... O SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Akeration(s) Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[[ ] Other[C]] Brief Description of Proposed t Work: X,-fz ;.rn Te mpd e [ anC otdcl 1367h /'ay n Alteration of existing bedroom Yes_X No Adding new bedroom Yes A Nq Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll -Sheet 6a. If New house and or 4ddition 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 constructio 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 r I, P.7-ei /9 i5 ho 0 as Owner of the subject property hereby au^~rize ' J e j i * a yi to.A �b�eh all matters relative to authorized by this building permit application. za nature ner Date I, To-e 1 t M^1 •n 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 ofAgent Date 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 Building Department Lot Size 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 O DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW © YES 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 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? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. t Department use only City of Northampton Status of Permit: - ° Building Department Curb Cut/Driveway Permit f 212 Main Street Sewer/Septic Availability '�. Room 100 WaterArVell Availability Northampton, MA 01060 Two Sets of Structural Plans, phone 413-587-1240 Fax 413-587-1272 Plot/Site Pians APPLICATION TO CONSTRUCT,ALTER, EPA SH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION NOV 2 9 2018 Co'^ 09 1.1 Property Address: Th js"ec on to be completed by office DEPT.OF BUILMW INSPECTIONLot Unit NORTHAMPTON,MA 01 065 Q Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: P-e-T,-.e ,S h o 9. 7 / &,d,/i Ville k J. L t A0 Nlq Name(Print Current Mailing Address: Telephone Signature 2.2 Authorized Agent: J a P,0, (3©k IV, H,ke id Mil. deo � Name(Print) Current Mailing Address: Signatu Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1-. Building fi �cf 0 p 0'U-� (a)Building Permit Fee 2. Electrical ,►t l/ O 0U� 0 p (b)Estimated Total Cost of 'f{ Construction from 6 3. Plumbing HOZ, , Z, Building Permit Fee 4. Mechanical(HVAC) v 53 5. Fire Protection 6. Total=(1 +2+3+4+5) '3 % 000 . O O Check Number a03 This Section For Official Use Only Building Permit Number: Date Issued: i Signature: I IA Building Commissioner/inspector of Buildings Date Z"M 3 t'O @ e"Oty? ,C 7- EMAIL EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) File#BP-2019-0644 APPLICANT/CONTACT PERSON JOEL ZIMMERMAN CARPENTRY ADDRESS/PHONE 340 WEST STREET NORTH HATFIELD (413)695-7742 PROPERTY LOCATION 271 HAYDENVILLE RD-Route 9 MAP 06 PARCEL 043 001 ZONE SR(100)/ THIS TION FOR FFICIAL USE ONLY: RMIT APPLICATION CHECKLIST ZONING FORM FILLED OUT ENCLOSED REQUIRED DATE � Fee Paid Building Permit Filled out Fee Paid iyl2eof Construction: K TCHE B REM L AND 1/2 BATH New Construction Non Structural interior renovations— Addition en vationsAddition to Existing AccessoEy Structure Buildine Plans Included: Owner/Statement or License CS-074318 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9KMATION 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 Demo ' 'on Delay /2-7-/6 Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. 271 HAYDENVILLE RD-Route 9 BP-2019-0644 GIS#: COMMONWEALTH OF MASSACHUSETTS MV.-Block: 06-043 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category KITCHEN&BATH RENO BUILDING PERMIT. Permit# BP-2019-0644 Proi ct# JS-2019-001053 Est.Cost:$39000.00 Fee:$253.50 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Group: JOEL ZIMMERMAN CARPENTRY—CS-074318 Lot Size(sg.ft.): 30622.68 Owner• CHAPIN-BISHOP CATHERINE A&PETER E BISHOP Zoning: SR(100) Applicant: JOEL ZIMMERMAN CARPENTRY AT. 271 HAYDENVILLE RD - Route 9 Applicant Address: Phone: Insurance: 340 WEST STREET (413)695-7742 — Workers Compensation NORTH HATFIELDMA01 066 ISSUED ON.-1211012018 0:00:00 To PERFORM THE FOLLOWING WORK.-KITCHENB REMODEL AND 1/2 BATH 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 Occupangy Signature.. FeeTyve: Date Paid: Amount: Building 12/10/2018 0:00:00 $253.50 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner