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31C-063 (4) 31 HIGGINS WAY BP-2020-0799 GIS#: COMMONWEALTH OF MASSACHUSETTS MV.Block: 3 1 C-063 CITY OF NORTHAMPTON Lot: - PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categrv: BASEMENT RENOVATION BUILDING PERMIT Permit# BP-2020-0799 Proiect# JS-2020-001385 Est.Cost: $42298.00 Fee: $274.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MICHAEL POTASKY 096660 Lot Size(sq. ft.): Owner: CHIPKIN STUART zonine: Applicant: MICHAEL POTASKY AT. 31 HIGGINS WAY Applicant Address: Phone: Insurance: 592 SALISBURY ST (508)847-1891 WC WORCESTERMA01609 ISSUED ON.1/14/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-RENO WALK OUT REC ROOM WITH FULL BATH 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 1/14/2020 0:00:00 $274.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northam on �'� � us of Permit: Building Department/ 6rt�CE Driveway Permit 41x 212 Main Street 14N Sel / optic Apailability Room 100 n` 3 Water ell A ilability Northampton, MA 01Two is of tructural Plans -�^- phone 413-587-1240 Fax 4Plot/ ite P ns nN'A'�SpFc ter Sp cify APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OI '�EMOL H A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 1 �A16�CT nS pay Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: (� , \ c?-Y v\ 1�-� \\ C�1 p k 1 I 1 G l n V (A �(/�r'1 Name Print) h r Current Ma' `[ Address: Lj _ 1 1 r� 1+ 17 7-A `' Telephone "� t Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: dI'T-a-) <7,6 D Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical ©O (b)Estimated Total Cost of Construction from 6 3. Plumbing ?� 000 Building Permit Fee 'f 4. Mechanical(HVAC) / 5. Fire Protection 44 6. Total= (1 +2 + 3 +.4 + 5) Check Number This Section For Official Use Only -7 Date Building Permit Number: V Issued: Signature: y Building Commissioner/Inspector of Buildings Date @ c-- 4 , EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) C� SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House F-1Addition ❑ Replacement Windows Alterations] RoofingEl Or Doors � Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [E] Siding[p] Other[Co Brief Description of Proposed ` l Work: W _ CX\K 0V\, ��c_ mor. &5Q0Xnf �`;}y, VLA( Alteration of existing bedroom Yes--(No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building Qne Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms a 1=r I fi 3 gL� �ooMS c. Is there a garage attached? --\ooE�- �� 3 x a 5 � 1 d. Proposed Square footage of rem construction. Dimensions e. Number of stories? Q ,Q n f. Method of heating? �' eplaces 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 I, S-r(A/-9 i C K I ?'k't^ as Owner of the subject property hereby authorize t ► 7 to act on my behalf,in all matters relative to work authorized by this building permit dpplication. Signature of Owner Date I, *U AA T A• CH 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. S-r?- 1,ZT %� , CHr ?Kr Print Name /n1 o SignatLffe of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Superrvii{sfor::f T Not Applicable Name of License Holder: ���V�V/�L� s :9e0%/6 v License Nurnber AV/ Address Expirati Date 9- "/ Signature lephone 9.Realstered Home Improvement Contractor: Not Applicable ❑ -"ei�2'6818 Company Name Registration um er -� lely;5�A AMzz 2F1007-1 Address Expiration Date TelephoneU�v SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insurance affida 't must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the build' g permit. Signed Affidavit Attached Yes....... No...... ❑ City of Northampton Massachusetts � 4 ,t DEPARTMENT OF BUILDING INSPECTIONS \' 212 Main Street •Municipal Building Northampton, MA 01060 rsyh•_ ;^o 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: eq (Please print house n mber and street name) Is to be disposed of at: C NJ (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signa0e of Permit'Applican r Ownei 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. AlCl DATE(MMlDDlYYYYj ` CERTIFICATE OF LIABILITY INSURANCE 01/14/2020 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 endDrsement s. PRODUCER CONTACT NAME! Jordan OtfnoSkl J.S.Ott Agency Inc ZC. ONE (860)635-3545 Fac No: 2 Willowbrook EMAIL DRE . Jordan 'sotta enc .com INSURERS AFFORDING COVERAGE NAIC4 Cromwell CT 06416 INSURERA: MAIN ST AMER ASSUR CO 29939 INSURED INSURER 13: NGM INS CO 14788 BETTER BUILT BASEMENTS LLC INSURER C: P.O. BOX 41 INSURER D: INSURER E: MIDDLETOWN CT 06457-0041 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 SUER POLICY NUMBER MO DDY EFF POLICYMEXP DDLIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Fx-]OCCUR PREMISES Ea oGGurrence S 500,000 MED EXP(Any one person) $ 10,000 A MPP1176L 12/16/2019 12/16/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER! GENERAL AGGREGATE $ 2,000,000 POUCY[X]j�7 F—] LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ B AUTOS ONLY AUTOS OWNED X SCHEDULED B1P1176L 09/19/2019 09/19/2020 BODILY INJURY(Per accident) $ HRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per acrid. $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $. WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Yf N STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICERIMEMBEREXCLUDED9 N❑ NIA WCK81581 01/19/2020 01/13/2021 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 I1yes,tl-scribe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS f VEHICLES (ACORD 101,Additional Remarts Schedule,may be attached if more space is required) RENOVATIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTHAMPTON ACCORDANCE WITH THE POLICY PROVISIONS. 212 MAIN STREET#100 AUTHORIZED REPRESENTATIVE JOHN OTT NORTHAMPTON MA 01060 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD UNFINISHED 13 0 36-0 vls"-- -- TILE � I I ` f Ip = 1 II UNFINISHED I I �HE7�TII iO I O SHE ETROCK BACK OF WALL AND ROXUL UP I i � I � II II I II II UNFINISHED II II II II UNFINISHED II II CUSTOMER SIGNATURE THESE DRAWNGS ARE THE PROPRIETARY NARK PRODUCT AND PROPERTY OF BETTER BUILT BASEMENTS,LLC.DEVELOPED FOR THE EXCLUSIVE USE OF SAID COMPANY. USE OF THESE DRANANGS AND CONCEPTS CONTAINED THEREIN NATHOUT THE Y RITTEN CONSENT OF SAID COMPANY IS PROHIBITED AND MAY SUBJECT YOU TO A CLAIM FOR DAMAGES. DESIGNER:ROBERT PINCUS 992-00.1apa BETTER BUILT BASEMENTS BUREK-CHIPKIN RESIDENCE SCALE: 1/8"=1'0° 229 CHRISTIAN LANE 31 HIGGINS WAY DATE: 12-17-2019 SHEET. BERLIN, CT 06037 NORTH HAMPTON, MA DRAWN BY: K.TRANMER A-2 1/2"INCH DRYWALL VERTICAL FIREBLOCKINGEVERY 10FEET CROSS SECTIONAL OF WALL 1/2 INCH DRYWALL FIREBLOCKING R-21 KRAFT FACED INSULATION 91" 81" 97" CEILING BEAM HEIGHT STAIR HEADROOM HEIGHT HEIGHT 3 5/8 STEEL TRACK THESE DRAWINGS ARE THE PROPRIETARY WORK PRODUCT AND PROPERTY OF BETTER BUILT BASEMENTS,LLC.,DEVELOPED FOR THE EXCLUSIVE USE OF SAID COMPANY USE OF THESE DRAWINGS AND CONCEPTS CONTAINED THEREIN WITHOUT THE WRITTEN PERMISSION OF SAID CUSTOMER SIGNATURE COMPANY IS PROHIBITED AND MAY SUBJECT YOU TO A CLAIM FOR DAMAGES. BUREK-CHIPKIN RESIDENCE FLOOR PLAN gsz BETTER BUILT BASEMENTS' 31 HIGGINS WAY SCALE: 1 / 2" = 1' 0" 229 CHRISTIAN LANE BERLIN, CT 06037 NORTH HAMPTON, MA DATE 12-17-2019 SHEET DRAWN BY: K.TRANMER A-1 r 90-:.tP Better Built Basements Better Built Basements, LLC 229 Christian Lane Berlin, CT 06037 T: (860)829-8587 F: (860) 829-8801 www.beffer-built-basements.com Date: I, James Tranmer, authorize the bearer of this letter, \ �CKl G-�k\ e T, to sign the building permit application as my agent to perform work at: 1� Address: i �Q Cl\C1 nU)Ca i t Iyl )'V A4 aMoy-y A Com)m(DQ Job Description: pec- C��ff--� UO��� ��� �h Start Date: nj License #: HIC 0674237 Exp. 11/30/2020 Agent Signature: Licensed Contractor Signature: K") ,rr"onwealth of Massachusetts ivision of Professional Licens.r�� �f Board of Building Regulations and Standarus Construction Supervisor CS-096660 Expires:05/08/2020 MICHAEL J POTASKY - 592 SALISBURY ST WORCESTER MA 01609 t Commissioner Office f Consumer Affairs/&Business�F�egulation HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration Expiration 176818 09/29/2021 MICHAEL POTASKY MICHAEL POTASKY ? 592 SALISBURY STREET WORCESTER,MA 01609 Undersecretary i I /Z/5 ��� The Cotnnzomvealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street _ Boston,MA 02111 tvtviv.tnass a ov/dza Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers lease Print Legibv Applicant Information Name(Business/Organization/Individual): (lndividual): /1 �� Address: �'_6 ` City/State/Zip: � Gl v6`l5 Phone#: Arc you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with /D 4. E] 1 am a general contractor and I 6 E]New construction have hired the sub-contractors employees(full and/or part-time)." listed on the attached sheet 7. E]Remodeling 2.El I a sole proprietor er- These sub-contractors have 3. Demolition ship p and have no emplooyeesgees employees and have workers' working for me in any capacity. 9. ❑Building addition comp.insurance? [No workers'comp.insurance 5. [] We are a corporation and its 10.[]Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12. Roof rep 'rs aired. c. 152,§1(4),and we have no 13 Other tiIS/�/� rQ Ste, 7 insurance required.]] employees.[No workers' comp.insurance required.] 'any applicant that checks box n1 must also fill out the section below showin.-their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicatin_such. =Contractors that check this box must attached an additional sheet showing the name orthe 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 fur rrry employees. Below is the policy and job site — irrfornration. s v�/ 6- � 2 011 -E-�G Insurance Company Name: V 13 Zv Z D Policy'- 5 6 Expiration Date:.'or Self-ins.Lic.;': 1 / ��j(7�/US ( /`� Q ,rC`i'ty/State/Zip: �" r Job Site Address: Attach a copy of the workers'compensation policy deck ration 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 o;a fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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. Ido hereby certifi?rurder•the pains an pen Ities ury at the information provided a o/ve' true and correct. Signature. / Phone: Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License n issuing Authority(circle one): g Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 1.Board of health 3.Buildin 6.Other Phone# Contact Person- •