35-181 4 PINE VALLEY RD BP-2019-1153
GIs 4 COMMONWEALTH OF MASSACHUSETTS
Map-.Block: 35 - 181 CITY OF NORTHAMPTON
Lot .001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categom renovation BUILDING PERMIT
Permit k BP-2019-1153
Project JS-2019-001872
Est Cost $2500.0
Fee $65.00 PERMISSION IS HEREBY GRANTED TO:
Const Class: Contractor: License:
Use Group MATTHEW TORTORIELLO 103521
Lot Size(sa.ft.): 32103.72 Owner: EMERALD CITY RENTALS LLC
o in : Applicant: MATTHEW TORTORIELLO
AT: 4 PINE VALLEY RD
Applicant Address: Phone: Insurance:
2033 WILBRAHAM RD (413) 218-0311 WC
SPRINGFIELDMA01129 ISSUED ON.411912019 0:00:00
TO PERFORM THE FOLLOWING WORK.MISC INTERIOR RENOVATIONS & REPAIRS -
SHEETROCK, WINDOW, FLOOR JOISTS, SUPPORT COLUMN
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$0 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 Simulate:
FeeTvoe: Date Paid: Amount:
Building 4/19/20190:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-1153
APPLICANT/CONTACT PERSON MATTHEW TORTORIELLO
ADDRESS/PHONE 2033 WILBRAHAM RD SPRINGFIELD (413)218-0311
PROPERTY LOCATION 4 PINE VALLEY RD
MAP 35 PARCEL 181 001 ZONE
THIS SECTION FM OMCIAL USE ONLY:
PERMIT PLICATIO HECKLIST
ENCL SED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
T of Construction: MISC INTERIOR RE OVATION REPAIRS- SHEETROC WINDOW FLOOR
JOISTS SUPPORT COLUMN
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included
Owner/Statement or License 103521
3 sets of Plans/Plot Plan
THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INNFATION 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 9 Registry of Deeds Proof Enclosed
Other Permits Required:
_Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Bond of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Z/�l
mol' ' n Delay
_ 11-/8-W9
Signa a of Building Official Date
Now 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.
—— The Commonwealth of Massachusetts
q,h Board of Building Regulations and Standards FOR
Massachusetts State Building Code,780 CMR MUNICIPALITY
igJ USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One- or Two-Family Dwelling
This Section For Official Use Only
it Number: — / D e Applied:
Epr.s �i<as3 4-)6-2nIq
cial(Print Name) Sigature Date
SECTION I:SITE INFORMATION
Addres : 1.2 Assessors Map& Parcel Numbers
vaufe., 2�ad 3s y/
1.1 a Is this an accepted street?yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq R) Frontage(it)
1.5 Building Setbacks(it)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L a 40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'o(Record:
Cme ra l cl CcFra R�a f��5 { LL_ I w�ie�drw 4 0/139
Name(Prim City,stat ,ZIP
PO 60g 4119% `688-dib,`)035 {off uPi bnck orc,
No.and Street Telephone Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building Owner-Occupied ❑ Repairs(s) ❑ Altera[ion(s) Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Prop ed Work': in f—Q t t-
10 i S C J
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ - SCSI 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard CitylTown Application Fee
❑Total Project Costs(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire S
Suppression) Total All Fees: $ , {�
Check No. Check Amount: Cash Ans unT.
6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction_Supervisor License(CSL)
_ `/`_ I_� cs )o -ai a a
� 7ea ')! jC(TRIPF. /6 License Number Expiration Date
Name of CSL Holder q � V
,A&3 t) 1 haham
fill List CSL Type(see below)
No.and Street
/� "' I e Description
SQrI(I ,ne-IJ mR U Unrestricted(2 Famidin su loin cu.ft.
-'S Restricted I&L Family Dwelling
Ci�, [ale,ZIP M Masonry
RC Rending Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
-YO -,90 c3i) Zen/keyed �� (LVVt I Insulation
Telephone ailail address D Demolition
5.2 Registered Home]inlot (HIC) )�3S — shh0
04+61C7z7 1 o HIRNumber
Expiration Date
HIC�C a;ny Name o,1,11 Registrant Name / h
h ,wl (lrygcri( ZPnnocle mar. ' (cv✓1
No.end Slheer /,1I / m�' y,3_a)s-0311 �1 address
C y,afo Ywn,,L*at'tle,ZIP
G1 Tel hone
SECTION 6: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........... 11SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
L as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Fuel Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is time and accurate to the best of my knowledge and understanding.
emeral d Crime Qe� l s L.LL,
print Owner's or Authorized gent's Name(Electronic Signature) ate
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.X2v/oca Information on the Construction Supervisor License can be found at www mass. og v/dos
2. When substantial work is planned,provide the information below:
Total Floor area(sq. ft.) (including garage,finished basemontootics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. `"total Project Square Footage"may be substituted for"Total Project Cost"
A`I ® CERTIFICATE OF LIABILITY INSURANCE X0411172019
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 INSURERS), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the cartificats holder is an ADDITIONAL INSURED,the policy(les)must heve ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,sub)ect W the terms and conditions of the policy,certain policies may require an endorsemerd. A statement on
this certificate does not Confer rights W Me Certificate holder In lieu of such entlorseme S).
PRODUCER MME; David R Jerry
Neill&Neill Insurance Agency Inc
662 Riverdale Street PHONE 413-7321137 xo.4I3-731-0829
West Springfield,MA 01089 ame tlj@nedlandrieillmm
IXBURE 8 AFFOROIND COYERAOE XAICR
INSURERA: Northfield Solutions NOF
Ix&IREO Build It Right, Inc. INSURER a: The Travelers TIC-00
PO Box 91199
Springfield,MA01130 MauRER c:
IXBURER O:
INSURER E:
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 REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MY 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 TYPEOF INSURAIICE A UBR MUOY EFF POLICY IXP
R POLICY HUMBER I LIMITa
A CQ MEKC GEXER UARIR WS354680 06/29/2018 /29/2019 EACHOCCURRENCE $ 1,000,000
OLAIMBMAOE 57 OCCUR
PREMISES EeARn $ 100,090
M EOEXP(Myorcmna3 5,900
PERSONALA ADV INJURY f 1,000,000
OENL ASSREGAM LIMIT APPUES PER: 2,000,000
RO GENERAL AGGREGATE S
POLICY [7] P
JECT [�]LOC PRODUCTS-COMPIOPAGG S 2,000,000
OTHER'. $
AUTOMOBILE LIABILITY MBINED SIN LELI $
ANY AUTO BODILY INJURY(PBr Penes) 3
.ED
ONLY AUTOS
ACHEDLEO
AUTOS BODILY INJURY IPeraaMenp 3
HIREDNON-OWNED PnOPERry DA GE 3
AUTOS ONLY AUTOS ONLY (Pin a
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UMBRELIALUB pCWR EACH OCCURRENCE $
EXCESS LIAR CUCUR.KADE AGGREGATE 5
DEO I I RETENTION E 3
B WORREW COMPENSATION 7PJUB-1H24103 03/13/2019 031732020 N6 P STM'
AND EMPLOYERS'LMBUTYANY YIX STAID R
OFFIOEFNEMBEREXCLODEED ECVTNE O NIA EL.EACH ACCIDENT 3 100,000
Ilan W4 Inxp E.L.DISEASE-EA EMPLOYEE 3 100,000
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DESCRIPTION OFOPEMTIONSBebw EL.DISEASE-POLICY LIMIT S 500,000
DESCRIPTION OF OPERATIONSI LOCATIONS I VEHKAFe WORD Im,Ads..Ra..D.ftivRuie,mry Ba Mbd1e411monepG Is ul.)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE BONE DESCRIBED POLICIES BE CANCELLED BEFORE
City Of Northampton THE EXPIRATION THEREOF, NOTICE WILL BE DELIVERED IN
212 Main Street ACCORDANCE WITH E OLICY PRO ION&
Northampton,MA 01060
AIITHdUZEO REPREB
A
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®1989-2015 ACORD CORPORATION. All Tights reserved.
ACORD 25(2016/03) The ACORD name and logo ere registered marks of ACORD
C\ The Commonwealth ofMassachuselts
Department ss StreInduet,
Suite
100 nts
I Congress Street,Suite 100
Boston, MA 02114-2017
www.massgov/dia
Workers' Compensation Insurance Affidavit:General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leaibly
Business/Organization Name: o- ejelrrt IKe
Address: c3q(0 lits-FS- �r
City/State/zip: i"J &—kL- M& COIC Phone#: 11/3 -dlk'D3/I
Are you an employer?Check the appropriate box: Business Type(required):
1 1 am a employer with J5 employees(full and/ 5. ❑Retail
P
or part-time).* 6. ❑Restaurant/Bar/Eating Establishment
2.❑ 1 am a sole proprietor or partnership and have no 7, ❑Office and/or Sales(incl.real estate,auto,etc.)
employees working for me in any capacity.
[No workers' comp,insurance required] S. ❑Non-profit
3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment
their right of exemption per c. 152, §1(4),and we have l0.❑Manufacturing
no employees. [No workers'comp. insurance required]'
4.❑ We are a non-profit organization,staffed by volunteers, 11.[]Health Care
with no employees. [No workers' comp, insurance req.] 1 12.0 Other
•A,applicam that checks bon#1 must also puma the section below showing their workers'compensation policy infaraeamn.
—Ifthe eoryorateofficen have exempted Themselves,bunhe em,somtion has other employees,a workers compensation policy is mquind and such an
organization should check box#I.
I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy information.
Insurance Company Name: /t�/pat�I s kel�I
Insurer's Address:LplA f�l✓Cirt
City/State/Zip:1IJD�S (�Ip ?���/ �nIA 2 /9l�
Policy#or Self-ins.Lie.# - f V U 8 — [ f�tq/03 Expiration Date: 2,11312-0
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cerfiffyy�//ceder the pains andpenalties ofperjuy that the information provided above is true and correct
Signalize, ® / IDaw �7
Phone# A1/3 -dlA - 03/1
Official use only. Do not write in this area,to be completed by city or town offilcia/.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Cityffown Clerk 4.Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
wwwmms.gov/dia
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste 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 byMI/ GL c111 , S 150A.
Address of the work: ( I dl� Uct l�eQ K'xi �/
�
The debris will be transported by: �-na -40IJ oA
The debris will be received by:
Building permit number: p nnf^
Name of Permit Applicant �wlet'Q�� L l &t 1s
Lf
Date Oignture of Permit Applicant