Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
38C-061 (2)
402 SOUTH ST BP-2020-0118 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:38C-061 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2020-0118 Proiect# JS-2020-000195 Est.Cost: $11000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RICARDO VIRUET 078480 Lot Size(sg.ft.): 5009.40 Owner: ARCAND WILLIAM Zoning: URB(100)/ Applicant: RICARDO VIRUET AT. 402 SOUTH ST Applicant Address: Phone: Insurance: 2201 WILBRAHAM RD (413) 372-3590 SPRINGFIELDMA01129 ISSUED ON.713012019 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF 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 7/30/2019 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner -E�EI V Department use only City of NorthamptQ" ' os of P rmit: Building Department Cut/ riveway Permit 212 Main 5treet� Se r/Se ticAvailability JUL Room 100 ! 3 201Wa rNV I Availability Northampton, A 0 060 Tw p Sets f Structural Plans phone 413-587-1240 Fax 443-6 Q, _ ,IN SPEC i (�SSite fans NORTHAMPTON.MA070 ther Sp Clfy APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 6 P -)�0 " //y This section to be completed by office 1.1 Property Address: �� C7� Map 3 v/ Lot 0-(WUnitZone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: We- Al gumwr LLC. '31'11 A fcDrtjce Sf ; &lGrfay,C bi &4 Name(Print) Current MailingAddress: X / hogl3 _ 3 2U - TeleP 3CvDS Signatufsr 2.2 Authorized Agent: �j i cafc�o V rue z e)i ' �i��M Name(Print) Current Mailing Address: T 11Y_ 372 36 716) Si nature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building �,( / Ccs r (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: 7- 3� Z�icj Building Commissioner/Inspector of Buildings Date 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 J LLJ Side L: R: L: R:C__.._j Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved J parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DON'T KNOW ® YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW © YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW © YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q 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 © NO IF YES, describe size, type and location: E. Will the construction activity disturb(Gearing, grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q 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 Alteration(s) Roofing Or Doors ID Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[0] Other[E7 Brief Dev4iptiion of Proposed Work: ` V.e- /61 'lna as a t e /ate ne ,) o e Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yeso Plans Attached Roll -Sheet 6a. 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 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. 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 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, .3/'// At ca n ei as Owner of the subject property hereby authorize C�� i Vi r ad to act on my behalf, in all matters r ative to work aut rized by this building permit applica ion. 2 Signature of weer Date .1-WI, I(lark as Owner/Authorized Agent hereby declare 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. �2 I &,,r I Ya Print Name _q 19aq S re of Owner/Agent t Dat SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable /❑ Name of License Holder: � � �C�YIZ�o I//f^(it(�/� CJ - 0 / O LiOO License Number 2- .2o 1 ru m'q S 0 e �4 j/0/202-1 Ad ssr Expiration Date V&- 3 17 2 v Signature Telephone 9.Registered Home Improvement Contractor:: Not Applicable ❑ it reW1,14 / 9 7 6 16 Company Name Registration Number Address Expiration Date Telephone 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....... H`- No...... ❑ City of Northampton r Massachusetts mow? -._ �<< ((s G +_ DEPARTMENT OF BUIZDZNG INSPECTIONS \ ' 212 Main Street • Municipal Building Northampton, MA 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 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 with a corporation or LLC,that entity must be registered Type of Work: /'( O'Qe Est. Cost: Ali 000 • 011? Address of Work: Sra2 �a iAA (W Date of Permit Application: 7Z2 Y/l q 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 RESPONSIBIIdTES 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: q/2R/20/q 4"W/016r/Zo Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building ermit as the owner of the above property: 1/2-71"M ate Owne ame and Signature City of Northampton :�.,�:. _ • j Massachusetts i {- DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building X. C�1 Northampton, MA 01060 rfy •„ `�0 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: �S Sect 1!1 St (Please print 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: ctrorl'S •boll Off Serv,cC1 (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 I Congress Street, Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lezibly Name (Business/Organization/Individual): ` l J Address: 2- 2(21 &2L lLlrt h M "/ U City/State/Zip: Qi A44 Phone#: I l3. 3r72, - 35f 6 Are you an employer?Check thea propriate box: Type Of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.O I am a sole proprietor or partnership and have no employees working for me in 8. r-1 Remodeling any capacity.[No workers'comp.insurance required.] 3.F]I am a homeowner doingall work myself r 9. ❑Demolition y [No workers'comp.insurance required.] 4.❑[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 I L❑Electrical repairs or additions 5.�proprietors with no employees. 12.[E e]Po(mbing repairs or additions am a general contractor and[have hired the sub contractors listed on the attached sheet. 13. f re airs These sub-contractors have employees and have workers'comp.insurance.= p 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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 hereb ertify under the pains nd penalties of perjury that the information provided above is true and correct Signature: Date: Phone#: Oficial 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#: ' 1 DATE(MMIDD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE `.� 1 07/26/2019 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(ies) 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 NAME: Heather Fleury CHI Insurance Agency,Inc. iPaHic"N �I: (413)536-2685 Fa No): (413)532-0889 416 Main Street E-MAIL eu Chia enc ADDRESS: hflry ae .Com g Y INSURERS AFFORDING COVERAGE NAIC# Holyoke MA 01040 INSURER A: TRAVELERS PROP CAS CO OF AMER 25674 INSURED INSURER B: PENN-AMERICA 328_59 Sadi Gonzalez dba Pinguino's Construction INSURER C 221 Hancock St INSURER D: INSURER E: Springfield MA 01109 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 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. INSR TYPE OF INSURANCE ADDL'SUBR POLICY EFF POLICY EXP LTRPOLICY NUMBER LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED $ 50,000 PREMIE E occurrence) _ MED EXP(Any one n $ 5,000 B J PAV0178010 08/04/2018 08/04/2019 PERSONAL a ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY F—]jE 0 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X I PER STATUTE ERH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE YIN N E.L.EACH ACCIDENT $ 100,000 A OFFICERIMEMBER EXCLUDED? N/A TBD 07/23/2019 07/23/2020 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate issued as evidence of insurance. Once the WC policy#is provided,an updated certificate will be issued.Notice of Assignment also included in lieu of the policy#. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Rick Birut ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NOTICE OF ASSIGNMENT EMPLOYER: COMBO I.D. STATUS OF EMPLOYER SADI GONZALEZ DBA PINGINOS CONSTRUCTION 001109771 Individual 221 HANCOCK ST SPRINGFIELD, MA 01109 COVERAGE GROUP 1172971 Coverage under this assignment The Waiver of Our Right to applies to Massachusetts Recover from Others Endorsement operations only. For coverage is available on Pool policies. outside of Massachusetts, contact Contact your agent for details. the appropriate Pool or Plan for that state. INSURANCE COMPANY: AGENT CHI INSURANCE AGENCY DBA CHAFFEE HELLIWELL TRAVELERS PROPERTY CAS CO OF AM OR INSURANCE AGENCY TRAVELERS - RMD PRODUCER: HEATHER FLEURY P 0 BOX 5600 17 COLLEGE ST HARTFORD, CT 06102-5600 SOUTH HADLEY, MA 01075 (800) 443-4404 AGENCY FEIN: 352169721 CLASSIFICATION OF OPERATION CLASS ESTIMATED RATE ESTIMATED CODE TOTAL ANNUAL PREMIUM REMUNERATION -------------------------------------------- ----- -------------- ---------- ---------- ROOFING NOC & YARD EMP, DRIVERS 5545 $10,000 35.68 $3,568 ROOFING-BUILT UP - YARD EMP & DRIVERS 5547 $40,000 11.44 $4,576 CARPENTRY - RES DWELLINGS NOT EXCEEDING 3 5645 $25,000 7.10 $1,775 STORIES IN HEIGHT PAINTING OR PAPERHANGING NOC & SHOP OPERS, DR 5474 $15,000 4.25 $638 CARPENTRY-RES DWELLINGS EXCEEDING 3 STORIES OR 5403 $0 7.64 $0 COMM STRUCTRS EMPLOYERS LIABILITY 100/100/500 9845 STANDARD PREMIUM $10,557 EXPENSE CONSTANT 0900 $338 TERRORISM CHARGE 9740 $27 TOTAL POLICY MINIMUM PREMIUM $500 TOTAL ESTIMATED PREMIUM $10,922 DIA ASSESS. 3.510 $371 TOTAL EST. PREMIUM PLUS ASSESSMENT $11,293 INSTALLMENT BASIS: Annual DEPOSIT PREMIUM: $11,293 THIS IS NOT A BILL COMMENTS Coverage effective 12:01 AM on 07/23/19. EMPLOYER NOTE: Coverage under this assignment is contingent upon compliance with the carrier's requests to complete the scheduled audit and payment of any additional audit premium. Noncompliance will result in cancellation of current coverage. CARRIER NOTE: The WCRIBMA reviewed the classifications and description provided with the application and determined that a change to the classes provided on the application was The Workers'Compensation Rating and Inspection Bureau of Massachusetts 101 Arch Street - Boston, MA 02110 (617)439-9030 - FAX(617)439-6055 -www.wcribma.org NOTICE OF ASSIGNMENT warranted. The classes listed on the Notice of Assignment are correct based on the information submitted. DATE OF NOTICE: 07/26/19 PREPARED BY: Maryellen Nee EXT 532 * * VOLUNTARY DIRECT ASSIGNMENT LETTER ID: 5260714 The Workers'Compensation Rating and Inspection Bureau of Massachusetts 101 Arch Street • Boston, MA 02110 (617)439-9030 - FAX (617)439-6055 • www.wcribma.org