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11C-066 (7)
83 FLORENCE ST BP-2019-0794 GIs#: COMMONWEALTH OF MASSACHUSETTS Map.Block: 11C-066 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:Bath reno BUILDING PERMIT Permit# BP-2019-0794 Project# JS-2019-001321 Est.Cost: $5000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor. License: Use Group: JIM R BOYLE 107689 Lot Size(sg. ft.): 20865.24 Owner: KOLODZIEJ PETER J&MAMLYN J Zoning:URA(100)/ Applicant: JIM R BOYLE AT. 83 FLORENCE ST Applicant Address: Phone: Insurance: P O BOX 241 (413) 586-8010 WC HADLEYMA01035 ISSUED ON.1/15/2419 0:00.00 TO PERFORM THE FOLLOWING WORK:RENO 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 Occupancy Signature: FeeType: Date Paid: Amount: Building 1/15/2019 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck--Building Commissioner File 4 BP-2019-0794 APPLICANT/CONTACT PERSON JIM R BOYLE ADDRESS/PHONE P O BOX 241 HADLEY (413)586-8010 PROPERTY LOCATION 83 FLORENCE ST MAP I IC PARCEL 066 001 ZONE URA(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildina Permit Filled out Fee Paid Typeof Construction: RENO BATH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 107689 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 Si re 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. t [ airtnWat use only City of Northampton Status of Permit Building Department Curb CAfiiorwway Permit �r 212 Main Street Sewrerl3sptloAvail Room 100ltfi`Blt mel Aso, 11it, Northampton, MA 01060 Two, ofso" 4. �1�"larrs phone 413-587-1240 Fax 413-587-1272 Plot7aie glans Other Specify E D APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMIL f D LLING SECTION 1 -SITE INFORMATION .IAN 1 1 2019 1.1 Property Address: P^ Th n to be completed y b r�) C � off ce Ma �t D��(�I/ D OF BUILDING NSPECTION9 b AMDING MA 01060 Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: a-A3 Floren« Qi053 -T Name(Print) went Mailiq dyes TelepficAe Signatur 2.2 Authorized A ent: E )C- 0 Ar5)e a Name(Pri ) Current Mailing A dress: i 9f/- )6RL-'�5u2 Signatur telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building2 �. (a)Building Permit Fee ..J i 2. Electrical 35 co- (b)Estimated Total Cost of Construction from 6 3. Plumbing 4 i 5th Building Permit Fee D r 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) 5 Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissionedlnspector of Buildings Date @ �� men C�nc�(J . nk--k7- 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 Building Department Lot Size Frontage Setbacks Front Side L: R: L: R.- Rear :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 ® 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 © DONT KNOW ® YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained © 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 O NO ID 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 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 Alterations) Roofing Or Doors t] Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[O] Other[E3) Brief DWnptio of Proposed Q r remote -exis w1 J,,S1 n S ower MI Work:�I nc�A)n UO�n � IUIY)OAeA Jd��tQO>' `.- �(� acIi 4ont-- Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.W New house and or addition to existing housing,complete the followinfa: 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. MasAheck 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 J_ OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, PC--ye-y- - r y�. a t" 1 14O Z i as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to k authorized by this building permit application. al Signatur Owner Date I, 6_i as Owner/Authorized Agent hereby declare that the atements 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. okJ Print Name 41 Signature o wner/Agent Da e SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction nSSupervisor: Not Applicable Ix` / (fi n Name of License Holder: CJ I m R- yu )�'. CU r��4,2l5 `T License Number ox X40 'I"a�Iuj , m ,9-- c) 1C)3 /O /-'i� Address Expiration Dalie _ 64/3),�8 �- 5 Signature Telephone 9.R ist Home I rovement ctor: Not Applicable 9 C&mpany Name Registration Number Address 1 Expiration Date Telephon 41 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...... !n KdxhewConcept38r WItchen 117 Rutsel.LSbwr t t houzz oncepts P.0.80%,24140 801 EII01 . 1 DREAM DESIGN DELIVER Hadley, MA 01035-0241 I I FI 1 I 17 ACMDI CONSTRUCTION SUPERVISORS LICENSE Recognized by the Commonwealth of Massachusetts as a Supervisor. Superior knowledge of Massachusetts laws and code are mandatory. Testing and years of experience are required to receive this license. Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction'Supervisor CS-107689 E,tpires: 10/25/2019 JIM R BOYLE PO BOX 241 HADLEY MA 01035 Commissioner License#- CS 107689 HOME Il"ROVEMENT CONTRACTORS LICENSE Required for remodeling existing property. office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:LLC gedis"tiRn Expiration "f9335D - 10/10/2020 KITCHEN CONCEPTS&DESIGN CENTER LLC JIM R.BOYLE 117 RUSSELL STREET C� HADLEY,MA 01035 Undersecretary License#-180308 All licensing information can be obtained through government agencies. Insurance coverage binders and references are furnished upon request. • Office: (413)586-3506 • Fax. (413)586-8051 • Email. design@kitchen-concepts.net City of Northampton �5 S� -�' Massachusetts m ; "t DEPARTMENT OF BUILDING INSPECTIONS y JD 212 Main Street `:q Municipal Building vp•.,, OD Northampton, MA 01060 rs •,• `�a 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 ith a corporation or LLC,that entity must be registered Type of Work: d�hC'oc cry �o e. Est.Cost: 5 , )0 Address of Work: \ v C E e d S Date of Permit Application: \ �10 © � -1 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 hereby apply for a building permit as the agent of the owner: 1 `a � -")C)-")C) iq ► 17 nPt1 �Q« A 5� 1 Ci 33 0 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 l DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street .funicipal Building Northampton, MA 01060 42 06 44 OC OB OD 42 OB d0 d6 4R 4D 43 49 4� 81 07 4B 45 03 QF PH OE 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: K) rl oren(e, <- *, re4 (Please print house number and street name) Is to be disposed of at: It )6 Rd, (P ase prinVname location of facility) O n I nl �— 0161/_O Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signature of Permit 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. The Commonwealth of Massachusetts Department of Industrial Accidents s 1 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 Lesibly Name (Business/Organization/Individual):ASAP Painting Inc. Address:117 Russell Street/PO Box 241 City/State/Zip:Hadley, MA 01035 Phone#:413-586-8010 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓❑I am a employer with 12 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. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition IFJ I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition 4.C]I am a homeowner and will be hiring contractors to conduct a]I work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.Q 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.: 14.E]Other Bath Remodel 6We are a corporation and its officers have exercised their right of exemption per MGL c. .❑ 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. 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 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:Main Street America Policy#or Self-ins.Lic.#:WCB49466 Expiration Date:01-31-2019 Job Site Address:83 Florence Street City/State/Zip:Leeds, MA 01053 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 fy under the pains and penalties of perjury that the information provided above is true and correct Si ature: Date: a C>1 Phone#:413q- 86-8010 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#: ACOROr DATE(MM ODIYYYY) CERTIFICATE OF LIABILITY INSURANCE 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(les)must have ADDITIONAL INSURED provisions or be endorsed. N SUBROGATION 18 WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on We certificate does not confer ri is to the certificate holder In lieu of such endorsement(s). PRODUCER NANIC CT Barbara Van Mourik Finck a Perras Insurance Agency Inc. P . (413)527-5520 Art No. (413)527.5970 6 Campus Lane ADDRESS: bvenmounk@fincyandperras.com 013URER(S)AFFORDING COVERAGE MAIC N Easthampton MIA 01027 INSURER A: Main Street Arneaice Alar Co 29939 INSURED POURER 8: NGM Insurance Company 14788 ASAP PAINTING INC INSURER C: PO BOX 241 INSURER 0: INSURER E HADLEY MA 01035-0241 INFER F: COVERAGES CERTIFICATE NUMBER: CL1851703579 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. LTR TYPE OF INSURANCE POLICY NUMSER MY ,9Dt YYY LINSTLIMIT'SMrbDIYYY COMMERCIAL GEIMMLIABILITY EACH OCCURRENCE S DAMM,. CLAIIS•AUOE DOCCLq PROAS£5 Its0XUrraraa'- f IAED EXP tAny cm Mrsaml S A MPS4%66 05+0512018 05/0532019 pE,SONAI.d ADV INJURY f GENLAGGREGATE LNATAPPUESPER GENERAL AGGREGATE E RGCUCY EITC D SOC PRODUCTS•COGIPrOP AGG I OTHER, DATAC s 25.000 AUTOMOBILE LIABILITY COW E amoval LIMIT S AMY AJTO HUOILY INJUHY I Par Iwrscr,l S 100,0111} B VANED SCHEDJLr-7 MgB49466 %-&2018 0612012019 SOCILY Ik1URY Wer accderx, S 300,000 AJTOS OILY AJ?OS xr ARED M4�AUI N314NFs AUTOS ON-Y AUTOS ONLY iper HNTBI S UMBRELLA LAAB OCi:UN EACtI CCC'JRcI"CE s EXCESS LIAR C-„AIrdSNUDE ACGRkC,AIt- 3 DED I rtETENnot.E S WOWER3 COMPENSATION R AND EMPLOVER3'L"L(TY Y 1 N S'A'UTE ER _ ANY PRG"RIETOMPARTVER'EXEvJrIVE E.l. EACHACCt(}EN? = 100.,000 B NIA WC849466 0113112018 113112018 U1i311�019 "rWatory to NH) F DSEASE-EAEW1 CIYEE S 100•0w t42�tdssunbe w4ar RIPCION OF ODERATICAVS tiMow El DSEASE-,PC:tICY LIMIT S 500.000 DESCRIPTION OF OPERATIONS 1 LOCATWNSI VEHICLES IACORD 101,Additional Remarks Sclwdale,may be attached if moa space Is required) Proof of coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ASAP Painting,Inc ACCORDANCE WITH THE POLICY PROVISIONS. AUT ES£NTATIVE yy 1®1—s•2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ;?VREAM itchen Kitchen Concepts&Design Center, LLC .1 houzz ncepis P.O.aox 241 V is UN ,U� VER Hadley,MA 01035-0241 -s ..• Bt)SII1C55 G�Newsf January 8, 2019 City of Northampton Building Department 212 Main Street, Room 100 Northampton, MA 01060 Subject: Building Permit 83 Florence Street, Leeds To Whom It May Concern: Enclosed please find our Building Permit Application and payment for a bathroom remodel at 83 Florence Street, Leeds. Please contact me at (413) 586-3506 with any questions. Thank you, 1-aa� L r3/-3/ Luann L. Brown Executive Administrative Assistant :llb • Office: (413)586-3506 • Fax: (413)586-8051 • Email: design@kitchen-concepts.net