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24D-182 119 PROSPECT AVE BP-2019-0827 GIs#: COMMONWEALTH OF MASSACHUSETTS Map-.Block:24A-018 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2019-0827 Proiect# JS-2019-001362 Est.Cost: $68265.00 Fee: $448.50 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: WRIGHT BUILDERS 106505 Lot Size(sg. ft.): 11238.48 Owner: RAINVILLE JUDY Zoning:URB(100)/ Applicant: WRIGHT BUILDERS AT. 119 PROSPECT AVE Applicant Address: Phone: Insurance: 48 Bates St (413) 586-8287 (116) Workers Compensation NORTHAMPTONMA01060 ISSUED ON:1/22/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-RENOVATIONS ON MASTER BEDROOM AND 2 BATHROOMS, NEW CABINETS AND COUNTERS IN MUDROOM**SEE PLAN NOTES RE FRAMING, WINDOWS AND SMOKE DETECTORS 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 1/22/2019 0:00:00 $448.50 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0827 APPLICANT/CONTACT PERSON WRIGHT BUILDERS ADDRESS/PHONE 48 Bates St NORTHAMPTON (413)586-8287(116) PROPERTY LOCATION 119 PROSPECT AVE MAP 24A PARCEL 018 001 ZONE URB000)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ' Fee Paid Tvpeof Construction: RENNOVATIONS ON MASTER BEDROOM AND 2 BATHROOMS,NEW CABINETS AND,COUNTERS IN MUDROOM 41 -Pt olz 5- IZ,E fRA y tlsy I Wipbows, SrvLoK6 D6TEc�0iZS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 106505 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO,,UMATION 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 4 (..._ �.__ 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. Department use only City of Northampton Status of Permit: . Building Department Curb Cut/Driveway:Permit 212 Main Street Sewer/Septic Availability. Room 100 WaterM all Availability. t Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Site Plans _ —RECEIVED 10thi ir Specify APPLICATION TO CONSTRUCT,A TER, REPAIR, RENOVATE OR DEM LISH A ONE OR TWO FAMILY DWELLING JAN 1 8 2 Q/� n g -/ (a "3 SECTION 1 -SITE INFORMATION (`-�`� 1.1 Property Address: rra7 0=sun.niric ir;sPECTIoNs his section to be completed by office CC1 ni�Tuq"a�TON.MA01060 LvkQ' '] Lot Unit Zone Overlay District f�J Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Ij r --':'5tkt K A • l i ov IM FUSPW 3r NT14MPNM� N e(PW"'zt) Current Mailing Address: Telephone Sig atur 2.?�ulhnrized Agent: (Print) Current Mailing Address: 1 �] 10 I,C t, 413 7lo S 8Mnat a Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS f k K tc.�li�OOU . ' Y�Fg• Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (,t 4 V1 (a)Building Permit Fee 2. Electrical � � , 6qj (b)Estimated Total Cost of Construction from 6 3. Plumbing 3 17, 7r l Building Permit Fee 4. Mechanical (HVAC) ✓ �`>o 5. Fire Protection 6. Total=0 +2+3+4+5) ib Z.t s" Check Number 5 ,� This Section For Official Use Only BuildingPermit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) V. Worv- 4 k close emr hA j7VI'1d(& gQ f prrg f 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 fille by Building Departm 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 Parkin aces volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO W DONT KNOW © YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained © , 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 ® NO 19 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,expavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YESQ 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 l] Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding[[--3] Other[a Brief Description of Proposed Work: 4tNaya:h l dti Makfer Io,drodi" atNd Jig bahiraamf. Mew !C[`mm t GovbgfC4S in wwd ras on • Alteration of existing bedroom Yes No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes K No Plans Attached Roll -Sheet Ga. If New house and or addition to existina'housina, 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. Dimensi 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. wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basemen cellar floor below finished grade k. Will buil ' conform to the Building and Zoning regulations? Yes No . I. eptic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT V I, V&1+4A Rg iyiy k- as Owner of the subject property hereby author e �-]Ono to act o my be n afters relative to work authorized by this building )eArmit application. Signature o Ow er Date I, I G n 1 I �`'�I� �� L�V�►1� �� as Owne uthori Agent hereby declare that the statements and i formatio n the foregoing application are true and accurate,to the best of m�ge and belief. Signed under the pains and penaltigs of perjury. ,Nv) i L� L �uv-) Uameti Y I /1 � 19 caner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor:() Not Applicable ❑ Name of License Holder: Arn n WAA 10 W05 License Number Z31 Wust ,Wlr HA 11 / 1 l I q ddress Expiration Date y l 3 7 2 ig to Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ WK1bk+r SUMERS 1 a t s 3 Company Name 9 Registration Number y �ArTESS sT Nb&7[�MP1bk) MA 01046 6/ ?'s / " Address �p r1 Q 1 Expiration Date Telephone l�/13 J U4 �V D 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...... ❑ The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Vey` Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information (�,f ' j� Q Please Print Lezib Mly Name (Business/Organization/Individual): t f'i f t/I W�/f�S Address: BASS ST `,� r, City/State/Zip:��aR fi f 1 / f `� 0�011t 6 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.[J I am a employer with 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.] 3.E]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.[:]1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10[:]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 4 1 am a general contractor aqd I have hired the sub-contractors listed on the attached sheet. 13. ROOf repairs 14"�T 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:A f H 1VA VW � 3N Expiration Date:#or Self-ins.Lic.#: MCCZOO Z3 t 1 Job Site Address: I(-1 PfO�Ftcr ST City/State/Zip: of 0d 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 c u r he pains and pe ltie of per that the information provided above is true and correct. /� / Q / c� Si ature: C� 1 Date: ( / 16 /1 l 1 ` Phone#• y t3 748 6z2R 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(MMMD/YYYY) ACC)R o CERTIFICATE OF LIABILITY INSURANCE 03/22/2018 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(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 Rodrigue,CISR Elite NAME: Webber&Grinnell actio Ext: (413)586-0111 A C No: (413)586-6481 8 North King Street E-MAIL SS: Jrodrigue@webberandgrinnell.com ADDRE INSURER(S)AFFORDING COVERAGE NAIC III Northampton MA 01060 INSURER A: 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 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 TYPE OF INSURANCE IND WVD POLICY NUMBER MMIDD POLICY EFF APMIDDY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RFNTMT- CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A 8500068268 03/01/2018 03/01/2019 PERSONAL BADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 XPOLICY ❑jEa EILOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ A OWNEDX SCHEDULED 1020070845 03/01/2018 03/01/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS XHIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY Per accident PIP-Basic $ 8,000 X UMBRELLA LIAR 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 X RETENTION$ 10,000 �/ $ WORKERS COMPENSATION /� STATUTE ERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000 B OFFICER/MEMBEREXCLUDED? [N] N/A MCC20020005342018A 03/01/2018 03/01/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yea,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/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 list-,) - -:4 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts ` Division of Professional Licensure Board of Building Regulations and Standards Constrv--,*6r-tupsrvisor CS-106505 4pires: 11/01/2019 ANN MONICA-LE 231 WEST HAEY CHARLEMO 01 i)l� .l-1i�t�` Commissioner C14 Un restricled Construction Supervisor less than 35�0pBuildings t(991 cubic use group which contain meters)of encbsed space_ Fadure to Passes'a current edition of the M State Bulldnng Code is cause for assachusetts Far i on of this license. Call(6 For In" a�this license visit wwwxmss.gov/dpi 3 Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, M usetts 02118 Home Improv fir Registration TYPE WRIGHT BUILDERS,INC. Expiration: 10a6/25l2020 48 BATES STREET NORTHAMPTON,MA 01060 > F •s 4 L'�tir Sys Update Address and Return Card. SCA t 0 2oM-05/17 .� �orr�w.wxaltiPa�✓�aasa�,k�a Office of Consumer Affairs&Business PAguistlon HOME IMPRO ENT CONTRACTOR Registration valid for individual use only before the axpirstiondimts. If found return to: Expiration Office of ConsurnerAffaws and Business Regulation 0612512020 1000 Washington -Suite 710 WRIGHT BUI Boston,MA 0 $ cl JONATHAN A 48 BATES NORTHAMPTON,MA 3060 Undersecretary WCA valid without signature a " i