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17B-020 (6) 447 BRIDGE RD BP-2019-1365 GIS N: COMMONWEALTH OF MASSACHUSETTS Mao:BIOCk: 17B-020 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:Siding BUILDING PERMIT Pemlit N BP-2019-1365 Proiecta JS-2019-002200 Est.Cost:$12500.00 Fee:$60.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BERNIE DRAPEAU 087891 Lot Size(so.ft.): 9234.72 Owner: ROGERS ANNE Zoning: URB(100)/ Applicant: BERNIE DRAPEAU AT: 447 BRIDGE RD Applicant Address: Phone: Insurance: 116 LATHROP ST (413) 348-0596 WC SOUTH HADLEYMA01075 ISSUED ON.5130,2019 0:00:00 TO PERFORM THE FOLLOWING WORK.REMOVE EXISTING VINYL AND REPLACE NEW VINYL SIDING 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 Deaarlment Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY HE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy signature: FeeTyoe: Date Paid: Amount: Building 5/3020190:00:00 $60.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner lou P S/DIIV6-- Department use only Cay of Northampton Status of Permit: ` - Building Department Curb Cut/Dnveway Permit 212 Main Street Sewer/Septic Availability •!� Room 100 Water/Well Availability s Northampton, MA 01060 Two Sets of Structural Plans phone 413587-1240 Fax 413587-1272 Plot(Sde Plans Other Specify APPLICATION TO CONSTRUCT OR DEMOLISH A ONE//OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Proo l Address AI AY 2 9 2019 This section to be completed by office 411"76L�d41 Me Lot eqa✓ Unit /_ DEPT NO THA"PIOKN APOCOao Na Overlay District Elm SL District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: AOn r KOf9/LJ Name(Print) CurrantCurreM Mai Telephone Signature 2/.2�Authorized Adam: // L 17Cr<'ytrF D/lY7lO>: /�-c.l I I Ia L4�17,0 r S 7 Nayypp��(Print) n Current Mailing Address: Q q/3 WO 0274P Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 1), S� VU (a)Building Permit Fee 2. Electrical L/I f y f J 'Vol'Ns (b) Estimated Total Cost of / Construction from 8 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) V� 5.Fire Protection 6. Total=(1 +2.3+4+5) 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) Section 4. ZONING All Information Alasl Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Depannc t Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage % Open Space Footage % tu,area minus bldg&pavM vkin #of Parking Spaces Fill: volume&location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Gr— DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0— DONT KNOW O YES O 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 V 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 Q— IF YES, describe size, 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 t acre? YES O NO (a— IF IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows AfisreHon(a) ❑ Roofing ❑ or Doors Accessory Bldg. ❑ Demolition ❑ New Signs Iol Docks [[7 Siding Dei" Other[O) Brief Descripyppn of Proposed Work: y(Evwn9nr:) eef eLOIC} r-L') I/y ?yl Alteration of existing bedroom YesNNo Adding new bedroom Yes No Attached Narrative Renovating unfinished basement _Yes --No Plans Attached Roll -Sheet sa.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. Dimensions a. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? In. Type of construction 1. Is construction within 100 ft.of wetlands? Yes _No. Is construction within 100 yr. floodplain_Yes_No I. Depth of basement or cellar floor below finished grace 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 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , 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. Signature of Owner , Dab I, 1 `t✓Lh t f ').C'`h/L Jfh ,as Owner/Authorized Agent hereby declare that the stifit.ments and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Sig under under the p ns and penalties of perjury. ,J cfiell rf ✓t Pit Nam Neme �/a Y! Spntlure of Owner/Apt em D / r SECTION a-CONSTRUCTION SERVICES 8.1 Licensed Construction Suoxriwr:1A , n �n Not Applicable p❑ Nome of License Holder'. /511.�(t' U1�-YAW rte/' (� 06 7 07 License Number iit� Lr4ftiapo s1 S N�+�l�y ✓t� Ft o �a7S io/o3faD(9 '113 3y8 aS9(o Eon Det/ Signature Talsolone 9.Reolstered home Imorovement Contractor: Not Applicable ❑ Comoan Registration Number 11(o L�,eoa � y/aa/a� Address ��y p 6 raeon ate .5,m�✓n A-f aV Telephone[l 09-� SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L e.15Y,§25C(8)) Workers Compensalion Insurance affidavit must be completed and submitted with this applimbon.Failure to provide this afidavd will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... ❑ No...... ❑ CERTIFICATE OF LIABILITY INSURANCE M 01i 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(Sl,AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the cerDgcate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to Ne terms and conditions of the policy,certain policies may require an endorsement A statement on this ce dficate does not confer rights to Ne certificate holder in lieu of such endorsemmlys). MDAILER 6mTe Jenny Martin YWRS Insurance AgencyPxoxE . 411.029-1191 /134324522 2030 Msmorfel Odve CMegw,IIA 0f02o A0°x�s' llalkutmfaj APFwIMxo lwaeuoE woes Maevil NGM Insurance IxsuRED meq_ DRAPEAU and GALINDO HOME M6MIIBl C: IMPROVEMENT SERVICES,INC. xwR>ao: 116 LATHROP STREET SOUTH HADLEY,MA010763306 Ma1R161F: 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. NOTWITHSTANDINGANY REQUIREMENT,TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO YMICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTOALLTHE TERMS, EXCLUSIONSAHD CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PND CLAIMS. LINB&D 0PoI1W'MIIMMI I101e X NIRiC1ALOM6MLILiBx FACx CIX.IIAAFMEE S 1,999,990 CIAIY6YKE ®OCGM PR { 999,999 YED FSV { 10,900 A VPT310SR 03109119 03AM20 PERSDNAL{ADJmAMv a 1,000,000 CFM KaGREWTE1JYn IFRE$PMc (MINERALAGCFEGATE f 2,000,000 X PpJCY❑ ❑LOC PeCOUCTS-COMPIOPAGG { 2,000,000 OTER: E AUMYDMIA IMSl1Y a 500,000 NIYAWD sOgLY INJURY IPIfFtltle S A °ORMNE°oNLr X AIAA ® M7731pR OL09119 03109120 BODaYINJURY(Pa e f AUTOS X HIRED rlDwoAAEn s AUPOSOMU, AUTOSOIAr Peramaam s BrMJALMOgLTM EACH OCCURREIICE f EM1p LW cwY9MAre AGGREGATE s Ca RETMr1oas f wORRMMCpIMBMlgll A AND BRLOrIBQIJA�l1Y ANY ETOprPAa1I YIR EL EJvnAmOENr f 1,000,000 A oFncEwYEMBER ERGB[EOI ❑n RIA MICT31pR 02109119 03N9120 rye,WwF YMIq EL�-E .IOM f 1,000.000 Il pa OesTGu1 OESCNIPIIW OFOPDUIgX$4Yr EL D6FA4E-Fp14V UYlT i 1,000.000 DESCNPnpIpOFEMIIMIe ILePAl10Me IYFM°IEa MCORD m-aak ea` leaMsep,NYplq MMCbGIIInn WaY rYe 4TRADEMS71i qq7 62�abr 5 s / /7 ✓QA- CERTIFICATE HOLDER CANCELLATION SHOIJID ANY OF WE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PRONSIONS. AUTHKRREDREPRESENTATNE Jenny Murcas ©1988-2015ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts DepartmentICongress Street,IndustrialSmile 1Accidents I Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.sovIdis Wvwrkerrs'Compensation Insurance Affidavit:Builders/Contractors/Electricians/1'lumben. '1'0 BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information /� 'L Please Print Le ib NameBasunescl(hganiratioMLndiividuar: 67,"lS RN✓4e4+++ /ryA45 Lie Address: //Ip LA7 h wqp iL 11// ,�a� City/State/Zip: dlL Phone#: 0 3� 7EM l �0 An you on employer'Cheek the spian adme boa: Type of project(required): I.dam a employerwith 3 employes(full and/or pan-Nre)• 7. GI N consinudlon 2.�lamaoole proprieumorpaaneMip and have no enploY sworking forme. 8. mnodelimg any capacity.[No workers'amp.immance required.] 3MIamahomeownerdoingallworkmyself lNoworkers'comp.imuranoe"rad.lt 9. ❑Dem0a 4.�1 an a homeowner and coal be hiring cwuecmm w cuMuct dl work on my progeny. 1 will 10�Buildingngaddition erasure and all conmo, r either have workers cnnpneatiaa...m an,sole 11.0 Electrical repairs or additions propnebm witr tro e�loyees. 12.[]Plumbing repairs or additions 5.0 1.a general aonoxtur and 1 have hired rhe suh-cormewoors ersforedo.tcee aaa had ahem 13.�Roof repairs These sub<onlmemrs have employees and have work 'comp.incur 6.[]We are a corporation and its omoers have exercised their nglu or exemption per MGL c 14.❑Olher 152,§I(4),and we lr�e an employees,poo workers'coop.insmmcc required.] *Any applicant Nat checks box#I amt also fill out ma section below showing their workers'connpeneation polity information. t I lomaowners who mbmit Nis affidavit indicating trey ere doing all work and men hhe..side cormachns must mhmit a new amdavlt indicating such. :Contracnnx mat chink Nis box must umehed an additi.ml ohoet showing Ne omw of the sub-.tram...and sate whenher ,,not Nae cminics have employees Ifthesub.contra nhaveemploye ,fleynaarpowide Heir wwkers'cmnp.puhcy nate] /am an employer tkal is providing workers'rompensadon insurance for my employees. Below is rh700,po!/icy andjob she information. y1 M/`7 /p© pc y Insurance Company Name: / r oI/m ��� /'1/`73166 r- 7 /,, / Policy#or Self-ins.Lie.#: IQn A44t h F D /. eS,4//'/[ rP'$ Expiration Date: J/"7 / Z� Job Site Address: �7 /7.2([75 S 12/) City/Smte/Zip:��T n /k bF-- Anaeh a copy of the workers'comps tion policy declaration page(showing the policy mr.;6kand mpira ion 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 fire 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 veriBcatioa !do hereby ceerafy�under the pains and penables ofperjm y than the information provided above is true and correcL S' nmla ar e' 1 J✓^" 91— Dale' Ph ire# tO 34S OSI) to Oficial use only. Do not write in this area,to be enertpleledby city or town official. City or Town: Permit/License# Issuing Authority(circk one): t. Board of Health 2.Building Department 3.Citytrown Clerk d.Electrical Inspector S.Plumbing Impector 6.Other Contact Person: Phone#: City of Northampton Massachusetts eG 1 „ nspxaaaex or soraolBa xasracxxoas 212 Main Street .Municipal Building C� �� .. Morthampton, 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: yN7 6x105 ? ✓1b (Please print house nunYber and street name) Is to be disposed of at: JA s� N�►ulf .,� �. f�r�SO� �� (Please print name arg location of facility) Or will be disposed of in a [dumpster onsite rented or leasee from: l �Sf} oc't/'p7rr G • WmagoA ` T- n (Company Namme 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. City of Northampton / f Massachusetts Ais c, I! i n AFCENENY Or =WING =5VJrC7Z0F5 n 212 Win Str t a M icipal Building i scrtbaaptoa, W 01060 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 most 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-exis6'ng 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 Ike homeowner has contracted with a corporation or LLC,fkat entity marr be registered Type of Work: Est.Cost: Address of Work: 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 owneroccupied _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 RESPONSIBHLITES 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: 5/d8//q 8542il;l URraDSFv. /5S375s Date Contractor N HIC Registration No. OR: Notwithstanding the above notice, 1 hereby apply for a building permit as the owner of the above property: 3- Date Owner Name and Signature City of Northampton Massachusetts ffi z MT T OF 80 WMG rH"XMIMS 212 Na St t • Municipal H ild q Q Northam n, t 01060 Massachusetts Residential Building Code Section 110.115.1.2 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 I I O 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. C ori,ma ce�Mdo SO 7 r a a Nam 1W4Li Sema" Inc w� Reg "-155555 C$L* 87891 �•� 116 Lathrop St 1 South Hadley, MA 01075 f/}} 4135338684 -lo IL5roa No. _ JOBNAUP �IA�YStf(,'�'�.Ib/I (� /♦ aOa IOGTdv __ ._ ___ TEPMS AI� rft.r�r.V>f•lS " �NOO/B` fLt 'I,Ea 6 ��vt�SR..c O UFI,N � hq F Fxtifi ,Jr o �7o I L 3/ /v, c� ca ro✓) )ryrc f. A—e, oil-rvrJOw ddo n S A ks - F l iS /. W h fF vlf ' f a f /p. Vic ,Oezi3 rfzo r h Asc � n ARE exp SIGNED BY ANNE ROGERS ' — 3 � i Z'd 1+898££S£L4 neede,p ery,eg dS£:Z06l 8Z Aet,4 n glfiu Ndenaumx M,.ABusirau,Reanlaeen Registration valid for individual use only NOME IMPROVEMENT CONTRACTOR before the expiration data. If found return to: TYPE:, ratlP o,rsUon of,,.of Consumer Affairs and Business Regulation pd/WAigi1 1000 Washington Street -Suite 710 1 Boston,MA 02118 BERNIE DRAPEAU HOME IMPROVEMENTS,INC. P, BERNARD R.DRAPEAU f� M.(y,�Ia(!w.✓r.* Not Valid wRhout Blgnature So1J6 HADLEY, A UUnnd—efsecM SO HADLEY,MA 01075 ary II S Commonwealth of Massachusetts Vfi Division of Professional Licensure Board of Building Regulations and Standards Constwction Supervisor CS087891Expires: 10/0312019 BERNARD R DRAPEAU 116 LATHROP ST SOUTH HADLEY MA 01076 Commissioner ✓""