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17C-124 (15) 60 SHEFFIELD LN OP4019.1098 QW, COMMONWEALTH OF MASSACHUSETTS Mgji.�Slock: 17C. 124 CITY OF NORTHAMPTON Lot, .001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Pa mit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) CatqgQrv� &QQF BUILDING PERMIT Pstd�3 x P. 1 .1 P i Fag S 1P.4 Op. PERMISSION Is MAURERY GRANTED T@a coal, Jpcg„ G'antractarf Zkonsaf Usc Grouu: COMPLETE RESTORATION SOLUTIONS 103014 Lot Size(sa ft.): 250033.44 Ofvner: EUN STEPHEN Zoning,URa(100) Apaltcant: CQMPLETE RESTORATI NO SOLUTIONS AT: 68 SHEFFIELD LN AvyaMn_I Address: one: Insurance: 10 HAYES CIRC (413) 592-2772 WC CHICOPEEMA01020 ISSUED ON:LIM019 0:00:00 TO PERFORM THEFOLLOWING WORK.REPLACE ROOFING DUE TO WIND STORM AND TREE POST THIS CARD $O IT IS VISIBLE PROM THE STREET Inspector of Plumbing InspeetorotWiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House Foundation fPrlvewey Final: Final: Final: Rough Frame; Gas: Firspiaee(Chlinnyl Rough: R: losalatioul Final: Snake: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS• Eertifleate gf OccuDanly g�i�e: FeeTvuei Date Paid: Annuntl auildmg S'W/2919O;20:00 $1141@9 212 Main Street,Phone(413)5874240,Fax:(413)587.1272 Louis Hasbrouck-wilding Commissioner ,-v 48 2HEEE!ECD 54 C0 L1-1-t - w ,( idgIr }�EPF}I(L5 IJtw 111096 INFO U- Department use only City of Northampton Status of Permit', BuilQ ding Department Curb Cut/Driveway Permit 212 Mein Street SewebSeptic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sats of Structural Plans phone 413587-1240 Fax 413-687-1272 Pl its Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DE/MMOLISH AONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION I✓& /7 L—/(7 f/ 1.1 Prorerty Address: Thissection to be completed by office Map C - Lot 1 >X-/ Unit 68 Sheffield Lane, Florence, MA 01062 zone Overlay District Elm St District CO District SECr10N 2-PROPERTY OWNERSHIP/AUTHORIZED ALENT 21 2ord: Stephen Bur 68 Sheffield Lane,Florence,MA 01062 Name(Pngp Current Mailing Address: 626-720-7717 Telephone Signe n • I Complete Re am-on Solutions rlu i3� /7(t�I/j y(d'e lnsC UId.7U Name(Print) Current Madng Address: '//3-J 2,7 17Zp SlgnaMre Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed bpermit applicant 1. Building 19,08804 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction Rom 6 3. Plumbing Building Permit Fee -�'•{/ s�jO 1 n ti po'' 4. Mechanical(HVAC) 5.Fire Protecting 6. Total=(1 +2+3+4+5) 19,088.04 Check Number J.�7 This SecOon For Official On Building Perms Number. Dale f ssued' 1 Signature: Jr' 'Z 3-20)9 Building Comonsedonerllnspector of Buildings Dab EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) A Section 4. ZONING AB Inlormabon Must Be Completed.Permf[can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be Died in by Building Department Lot Size Frontage Setbacks Front Side L: R: - L: R: . Rest ....._.. Building Height Bldg.Square Footage % Open Space Footage _ % (Lot ams meas bldg&peved puking) #of Parki Spates; Fill: volume&Location ---- --- A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW Q YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES 0..... -.,.. 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 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 O IF YES, describe sire,type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe sire, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it pan of a common plan that will disturb over 1 acre? YES © NO O IF YES,then a Northampton Sloan Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows AHeration(s) ❑ Rooting 0 Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [q Siding[0] Other[[j Brief Description of Proposed Replace mefng due w wind corm eM tree on home. Work: NEW 2.1t) RAI'it25 Alteration of existing bedroom____Yes X No Adding new bedroom Yes x No Attached Narrative Renovating unfinished basement _Yes x No Plans Attached Roll -Sheet sa. If New house and or addition to ex[stina housing, complete the following: a. Use of building One Family X Two Family Other b. Number of rooms in each family unit: 9 Number of Bathrooms 3 c. Is there a garage attached? NO d. Proposed Square footage of new construction. Dimensions e. Number of stones? f. Method of heating? Fireplaces or Woodsloves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? It. Type of construction I. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain_Yes_No j. D.:plh 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 wall City water Supply_ SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT • I, � 36r•Y as Owner of Me subject progeny Complete Restoration Solutions, Inc. hereby a on to act o If,i all ma lative to work authorized by this building permit application. S' mudiisn\\oo•f(��,n�^e44r r� Dale I, Tn� t�Ura� ,as Owner/Authorized Agent hereby tieclare 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. stww Print Nam Sio2 ature of nedAgenl Nis SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: NM Applicable ❑ N.mo or Lieen..Nolaer: Joseph Gillette License Number 6 Shady Lane, West Simsbury, CT 06092 CS-103014 Address ExpireBon Date 413-592-2772 04/30/2019 Signature Telephone ir 9. m nt Contrator. Not Applicable ❑ a Company Name Registration Number 86FFtti�nG9 GI UP C1ilCrl�rer K� 0/ozd 164927 Address ° Expiration Date Telephone /3' �� I TV 12/01/2019 SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.162,1 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 penn8. Signed Affidavit Attached Yes......9< No...... ❑ City of Northampton 5 .=: .. Massachusetts i pEPAR2SAN2' OF BUILDING SNHP&'ClION3 212 Min Street • Huniapal avilaing .t OCs Herthea ' M oloSo n �, 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 fora 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"reconsbuctim, alteration,renovation, repair,modernization, conversion, improvement,removal, demolition, or construction of an addition to any pre-exisling owner o cupied building containing at least one but not mora than four dwelling units....orto shuctures which are adjacent to such residence or building"be done by registered contractors. Note:ijthe homeowner ha/fs,contracted with a corporation or LLC,that entity nag be registered Type of Work: ?DrOtrl{na, tI aiin,rs Est.Cost: 0l5 dSkdq Address of Work: IaX A1Pl+i-I ld lance Fkahu MP dj[J(aa 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.C.L.Chapter IIIA.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: 1 hereby apply for a building permit as the agent of the owner: H--d-19 ('omple.+r a� jretjirn i�dWu hf'J!x• Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I he apply r Mmit as the owner of the above property: 2 / to Own ame and S' City of Northampton Hassachusetts i �' � s x ' D212 i. 8 OF BUILDING l B illZ(' 2 212 qin Btree[ • Municipal Beiltlinq �. C NoxthemptonNl 01060 Massachusetts Residential Building Code Section 110.R5.1.2 Homeowner: Person(s) who own a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Section 110.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5,provided that if a homeowner engages a person(s) for hire to do such work,then such homeowner shall act as supervisor. Such homeowner shall submit to the Building Official,on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation)and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)you hire to perform work for you under this permit. City of Northampton - Massachusetts or DaPMTMENT OF BGILDING INSPECTIONS l 212 Naia Street 6N icipal Suildinq F NorNupton, M 01060 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: ky oAlil( /QnLV Arwo , "4P 4W.;I- (Please prim house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: &SW;rti1-Pd bili d X Wtc&r$ 3,V Ai6ar�y p� n�c�ela�NfF d lad (company /Name �and Ad ss) 0 Signatur init Applicaotobr Owner Date r 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. I' The Commonwealth ofMassaehuseas Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 0 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeib►v Name (Business/Organiration/Individua0: Com�lete Restoration Solutions, Inc. Address: 30 Haynes Circle City/State/Zip: Chicopee,MA 01020 Phone #: 413-592-2772 Are you an employer?Check the appropriate boa: Type of project(required): 1.2 1 am a employer with 15 4. ❑ 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.E] 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp,insurance comp.insurance.: required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' wrap. right of exemption per MGL 12 ® Roof repairs insurance required.] t c. 152, §t(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside convector 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. Ifthe sub-contractors hate employees,they must provide their workercomp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site informaion. Insurance Company Name: Zurich Insurance Services Policy#or Self-ins. Lic.#: UBOG26388 Expiration Date: 9-1-19 Job Site Address: 68 Sheffield Lane City/State/Zip: Florence, MA 01062 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance covers a verification. I do hereby certify an r e pains and ies of perjury that the information provided above is true and correct. Si Lure: Date: Phone#: 413-5 -2 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuii•g Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE �oa0�o B n THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERT!aICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If Me certificate holder is an ADDITIONAL INSURED,Ne policy(ba)most have ADDITIONAL INSURED PmV i$iOrS or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of Ne policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endomemer(3). PROWLER MAME: ON C.W Goma kl ImMeras1U3)586-5011 xo: (/13)586]9]3 BB King Street,Suis B moRE6e. gooemancri Nebin.unce m IXSUIER191AFFORON000VTRPGe XAIC. Nor9mmptpn MA 01060-3257 MURERA: Admlrellnaumnm Company NSUREp ansum0.a: ZurchinsumnCBSandcas ZUR001 Consists Restoration Solutions lm. annex C: He. M92 30 Haynes Circle MN RD: NSU ERE: CM1impss MA 01020 StlIUrE0.F: COVERAGES CERnFICATENUMBER: IW19 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED MOVE FOR THE POLICY PERIOD INDICATED. NOTNATHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT MATH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBIECTTO ALL THE TERMS. EXCLUSIORSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ma ILTR TYPECFIXsimmos PoL .UMeaR ICV EFF I RY LIMIr3 X COMMERCIRLOENEW LMMUW CCURREXCE $ 1.000000 CWMSNLO. r>4.UR EB y 300,000 X CPL PI mn—) a am A Prafembmal LNNlby FEIECC2398001 OW2MG18 MSADv IwLRY a 1.000.000 MORE EUMRMPUFBFER: ALAOOREOTE a 2.000.000 ExFIXCY ®79 IDC CTS-WIIPKPAW a2'000'CCO OTHER'. Poll Lab a 1.000.000 AIROMCHLEDAaRPY WE MIT i XYAUIO INURY IPm perwnl a aCF£DAED INARY1Pere .) a AUTO80XLYAVnMHREO NOMPMIEDAUTO60NLV AUTOB ONLY a lX UMMiE14LIAB OCCUR EACH CCCLRRENBE a BON'MI' A El.L1Aa C1IM6AM0E FEIEXS2398101 082&2018 08282019 ,WBR. 5.000.000 DED RETENTON a s WgNEReCWPIHePTpX X6TNlE ERM AmmPDraBDr MaaUTY YIM 1,000.000 MY FRWRIETONPPATNSAE%EcUrVE EL FACNACCIOENT 3 B OFFNERAIESBEA EXCLUDED] O i UBOG283A96 OBN12019 OMD1/2019 menNMryM Mn EL 38EMR-EA EMPLOYEE s rEr t'OOO'000 armneum.r 1.000.000 EBCRIPWNOF OPEMTON9 Lticw E.L pBFA6E-POUCV UMrt 3 C BMlment C..' RHN96595405 OW =018 OMWO19 Ded51000 35DOOD DEef IONOFCPEM ONSILOLATWSIWHICLE9 IACORD 101.A0Mtlanel Wnuale%MOMe.Ie•ypeM1eM xn,eneyulerpugwl CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Cloy Of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 212 mein SUe d Suite 100 NoMampton MA 01080 TxcaMEDrEPRESexnnv1 zz ®1988-2015 ACORD CORPORATION. All rightereserved. ACORD25(201&03) The ACORD name and logo am reg'sbred mars of ACORD ® mxaAC setts Uepanment of Public Safety Board of Building Regulations and Standards License: CB-103016 Construction Supervisor JOSEPH MG IMETE S SHADY LE WEST SIMSBIIRY CT MaM /1<114—(.i 7I,Ka,._ Expiration: ' 'Commissloner N/AM1Y Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Corpora0on COMPLETE RESTORATION SOLUTIONS,INC. Registration: 184927 30 HAYNES CIRCLE E�Iratlon: 12/01/2019 CHICOPEE,MA 01020 Upsets Address and Return Card. 9CFr � NANOLI.]L " p yrrvigcmm�t�/�e ^ett.Jnrfre.se dso HOME al E IMPRO Mala 8 CONTRACTOR RpOR NOMEIMPRPEEMENT CONTRACTOR beforeM tor Ifouse only TYPE:Caoaanal Ochre Meonsurti0nsato. 6buMiness to: a E�49 OMce M Consumer 5170 aM easiness Rpulation 16I�] 1]Wlt2p19 tO Park Raza-Suits 5l]6 COMPLETE RESTORATION SOLUTIONS.INC. BsamrMA 02116 JOSEPH GILLETTE 00 HAYNES CIRCLE CHICOPEE.MA 01020 Undereecrelary Ntva11 " out signature 312912P19 Northampton, VA:Assessor Database: Northampton, MA : Assessor Database Property Search: Parcel To: Owner Name: Street Number: Street Name: UWq 68 SHEFFIELD LN Se—arch '.,I Reset Property Detail: Parcel ID: Cord: Street Name: Street Number: Zimag: :State Clado: ACTe: Not; 17C-124-001 1 SHEFFIELD LN 68 Single Family Residence 0.57 Owner Milarmatiom Property[mages: Owner Name: BURG STEPHEN P pictu a: Owner 2 Name: I� M1�I�Ii' t 1 Owner 3 Name: Street 1: 68 SHEFFIELD LN City: FLORENCE State: MA b Lip: 01062 Dwelling Information: Style: RAISED RANCH Year Built 1974 Entenor walls: ALUM/VINYL Story Neighs 2.0 Attic: NONE easement: NONE Sketch: Bsmt Gar Be...: 2 Demurol/Alea Total Living Area: 3296 A2F1 Total Living Area Minus Feu: '.3296 14 18 1500 sqR 8:1 F/B Finished Basement Area: ':.0 298 Sell 22! t Wood 1FrB 1b 1b 16 16 CWaod Deck Ret,Room: 0 O 224sgR Heating System: GAS/HOT WATER 8 6 18 D:FBAY 8 Soft Central Air. Yes 50 Fireplaces: 2 Rooms: 9 2Fr Bedrooms: 4 30 .1508 30 Full Baths: 3 Half B.N.: 0 50 Valuation: �1 Appraised Land: $110,300.00 Appraised Bldg: $292,SOO.00 Appraised Total: $402,800.00 nodhampton.ias-citwlNpemel.detail.php?id=17C-124.00101 112 3/29/2019 Northampton,MA;Assessor Database: The information dellvered through this on-line database is provided In the spltl[of Open access to government Information and is intender as an enhanced service and convenience for croons of Northampton,MA. The pr itlers of this database:Tyler CLT,BI9 Room Studios,and Northampton,MA assume no liablliy for any error or omission in the Information provided here. Comments regarding this servlce should be directed to:Jsara9ntinorthamptanassessor.us Fn.March 29,2019:09:29 AM :0.09,: 10mb i umm northampton.iascltcomfpamebdetail.php?Id=17G124.00101 212