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24D-167 (7)
39 MYRTLE ST BP-2019-0774 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24D- 167 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2019-0774 Project# JS-2019-001276 Est.Cost: $8700.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: WRIGHT BUILDERS 106505 Lot Size(sq.ft.): 6882.48 Owner. DWIGHT WILLIAM&ALIDA LEWIS Zoning:URC(100)/ Applicant. WRIGHT BUILDERS AT. 39 MYRTLE ST Applicant Address: Phone: Insurance: 48 Bates St (413) 586-8287 (116) Liability NORTHAMPTON MAO 1060 ISSUED ON:1/7/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 10 REPLACEMENT WINDOW 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 1/7/2019 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northamr itonLAN 9-0";S' et. Building Department ri yPermit 212 Main Stre ttic vailabflity. Room 100 Filabiliry DEPT.OF[3UILDlNC;IM Northampton, MA 1060 NORTHAMPTON.r aural Plans phone 413-587-1240 Fax 413-587-1272 0 ans - Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 60, /1,, 77 Y `IA Property Address: This section to be completed by office 39 MYRTLE ASE Map �I� Lot Unit NogTN pJDW f MA 01060 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name Print) Current Mailing Address: X � Telephone Signature 2.2 Authorized Assent: WKIST BUILDEKS/ANN LEDWE L y8 6AM LST NibK 4 Mld, Mf1 61060 Name(P t) Current Mailing Address: n%1�h' 3iA 413 586 8287 A 127 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building a 1700 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) �b 5. Fire Protection 6. Total =0 +2+3+4+5) 119,700 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) JVM IIID ae—� -fb gll� 1>0N6 w'4 �' 'rK- 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 fi m by Building Dep t Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved azldn #of Parking aces Fi olume&Location 10 A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW Q YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO �2f DON'T KNOW 0 YES 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: u 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,2xpavation,or filling)over 1 acre or is it part of a common plan 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 apolicablel New House ❑ Addition ❑ Replacemer�ndows I Alteration(s) Roofing Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[0] Other[E] Brief DWork: escription of Proposed I iN Sy'A/ ` //O\ � PErUA AE &*�AA6 T— �l�(�ti lm"' Alteration of existing bedroom Yes�No Adding new bedroom Yes X 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 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. Di sions e. Number of stories? f. Method of heating? ireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. etlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement ellar floor below finished grade k. Will buildi nform to the Building and Zoning regulations? Yes No. I. is 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, as Owner of the subject property � IlNY ' ` ` ��V) t�'�r J hereby authorize to act on my behalf, in all matters relative to work authorized this building permit`applicati Signature of Owner Date I 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. Prin(W t Name Sign a Ow er/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Constructions)Supe�rviisoor::/ / /Not Applicable ❑n Name of License Holder:ANN LGY W�LL Cs T I v(o565 License Number Addr&s ?I� Expiration Date w,4 4B-7� -8 Signature Telephone 9.Realstered Home Improvement Contractor: Not Applicable ❑ R�Gt�T BUILPEgs , INC • 10153 6 Company Name Registration Number `18 Bis sT , IuoRT�AM�TdN, M!� 0��0 06/z6/zb20 Address Expiration Date Telephonelm st� a2t7 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....... JR No...... ❑ City of Northampton Massachusetts I DEPARTMENT OF BUILDING INSPECTIONS i 212 Main street •Municipal Building �a Northampton, MA 01060 sSp 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: 31 MIME AvF- (Please print house number and street name) Is to be disposed of at: VAU.EY R£CYCLI NG (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Amf6�rh — Signature Y Permit Applicant or O ner 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 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 �w1v�t/' Please Print Lesibly Name(Business/Organization/Individual): WR�1 5VIL� 5 / 1WC1. Address: 446 BA u S t p City/State/Zip: �O�'`'1{1�t i�+Nr MA 01060 Phone#: 413 S6(0 84B7 Are you an employer?Check the appropriate box: Type of project(required): 1.E]I am a employer with employees(full and/or part-rime).' 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.F1 I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10❑Building addition 4.[:]1 am a homeowner 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.E]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 PVKWEVr 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.�OtherM 152,§1(4),and we have no employees.[No workers'comp.insurance required.] WINDO ,$ *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. ^ M MMA e Insurance Company Name: MA • ( .1 I • MMA L q Policy#or Self-ins.Lic.#: Y{ CCZOO ZO dO 534 ZO aQ Expiration Date: 03 l d ml t Job Site Address: 31 M 1 111 LF- AVA City/State/Zip,p(��' paj M 000 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 cern nder the nd pena[tie pe fury th a information provided above is true and correct Signature: Date: Phone#: 4 1 3 8Za7 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#: DATE(MMIDD/YYYY) AC40" CERTIFICATE OF LIABILITY INSURANCE 03/22/2018 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLYAND 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(les)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 CONTACT Jenna Roddgue,CISR Elite NAME: Webber 8 Grinnell PA/C No Ext: (413)586-0111 ac No): (413)586-6481 8 North King Street E-MAIL jrodrigue@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA: Arbella Insurance Group 17000 INSURED INSURERS: A.I.M.Mutual Wright Builders,Inc. INSURER C: Attn:Jonathan Wright INSURER D: 48 Bates Street INSURER E: Northampton MA 01060 INSURER F, COVERAGES CERTIFICATE NUMBER: Master 2019 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD MMIDD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 1 OCCUR PREMISES Ea occurrence DAMAGE TO RENTEIT $ 100,000 MED EXP(Any one person) $ 5,000 A 8500068268 03/01/2018 03/01/2019 PERSONAL BADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X ECT POLICY F—]PRO- F LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ • OWNED X SCHEDULED 1020070845 03/01/2018 03/01/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS er X HIRED X NON-OWNED P OPERdTY DAMAGE $ AUTOS ONLY AUTOS ONLY PIP-Basic $ 8,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE 4600068266 03/01/2018 03/01/2019 AGGREGATE $ 5,000,000 DED I X1 RETENTION$ 10,000 $ WORKERS COMPENSATIONX STATUTE ETH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000 B OFFICER/MEMBEREXCLUDED? NIA MCC20020005342018A 03/01/2018 03/01/2019 (Mandatory in NH) E.L.DISEASE-FA EMPLOYEE $ 500,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/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 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Informational Purposes Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts r Division of Professional Licensure Board of Building Regulations and Standards Constr4clibri tupervisor CS-106505 EAa ires: 11/01/2019 ANN MONICA-LE 231 WEST HA EY CHARLEMON IIIA 013` Commissioner d;•. Un restricted instruction Supervisor fess than 3330 � ngs of any use group which contain feet(881 cubic meters)of enclosed space. Far7ure to possess State Build a current edition ofthe Massachusetts Code is cause tar revocation of this license. Call(s o 727-3 a about�license 'vww.nwss.gov/dpi Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Mophousetts 02118 Home Improv dor Registration i /7�, Type: corpwation _ Reg rah°^: 101536 48 BATES STREETWRIGHT 'INC. Eviration: 06125!2020 NORTHAMPTON,MA 01060 AQ �{I L,yM Svc Update Address and Return Card., SCA 1 O 20U-W17 Office of Consumer Affairs&Business Regulation HOME IMPR ENT CONTRACTOR Registration valid for individual use only before the If found return to: E Office of Cores:unw and Business Regulation 06i25/2U2U 1000 Wallington .Suits 710 WRIGHT BUI Boston,MA.0 8t t , JONATHAN A. ,r�---- 48 BATES STRE NORTHAMPTON,MA Y11060 Undersecretary valid without signature