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24D-024 205 PROSPECT ST BP-2020-0946 GIS#: COMMONWEALTH OF MASSACHUSETTS MV.Block:24D-024 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: KITCHEN RENO BUILDING PERMIT Permit# BP-2020-0946 Project# 'JS-2020-001574 Est.Cost: $20500.00 Fee: $133.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Group: CHRISTOPHER O'CONNELL108508 Lot Size(sa.ft.): 19863.36 Owner: LESKO WILLIAM D Zoning: URB(100Z Applicant: CHRISTOPHER O'CONNELL AT. 205 PROSPECT ST Applicant Address: Phone: Insurance: 63 WORTHINGTON RD (413) 539-1521 WC HUNTINGTONMA01050 ISSUED ON:2/21/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-KITCHEN RENO POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Servicer 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 Si<(nature: Fee'Cype: Date Paid: Amount: Building 2/21/2020 0:00:00 $133.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northamptolt Status of Permit: Building Department Cur6iCut/Driveway Permit 212 Main Street Sew4r/Septic Availability � ' Room 100 FEB 2 2Q. Water/Welj Availability Northampton, MA 01060 Two Sets clf Structural Plans phone 413-587-1240 Fax 413-587-1272 --- Plotl$ite Plans Other Specify _ p ify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address. `� This section to be completed by office Map a� `i J Lot Unit 205 Prospect St, Northampton Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: J I I I Lesko 205 Prospect St,Northampton, MA 01060 Name(Print) Current Mailing Address: Telephone 413-584-5195 Signature 2.2 Authorized Age t: Christopher O nnell 63 Worthington Rd, Huntington, MA 01050 Name(Print) Current Mailing Address: 413-539-1521 Signature (� (/ Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building t 5,000 (a) Building Permit Fee 2. Electrical 5,000 (b) Estimated Total Cost of Construction from 6 3. Plumbing 500 Building Permit Fee 4. Mechanical (HVAC) �-3 5. Fire Protection 6. Total = 0 +2 + 3 +4+ 5) 20,500 Check Number This Section For Official Use Only BuildingPermit Number: � aCl—i?��1 Date Issued: Signature: d Building Commissioner/Inspector of Buildings Date ocs413 @ gmail.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [E3] Other[p] Brief Description of Proposed Remodel Kitchen Work: 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 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 Jill Lesko as Owner of the subject property Christopher O'Connell hereby authorize to act on my behal i0,all mlAtters relative to work authorized by this building permit application. Signature of O er Date Christopher O'Connell l , 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. l( CV\�t��� ���tjv��•2v1 Print Name a aI �o�o Signature of ner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Christopher O'Connell License Number 63 Worthington Rd, Huntington, MA 01050 CS-108508 Address Expiration Date 06/24/2020 Signature Telephone 413-539-1521 9. Registered Home Improvement Contractor: Not Applicable ❑ Company Name O'Connell Construction LLC Registration Number 184844 Address Expiration Date 89 Dana Hill, Belchertown, MA 01007 413-539-1521 Telephone 5/22/2020 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. xx Signed Affidavit Attached Yes....... ❑ No...... ❑ City of Northampton "`�..: � sus•""�:•�S!c r• '` Massachusetts ,A � :G !, DEPARTMENT OF BUILDING INSPECTIONS Di K y% . . . 212 Main Street •Municipal Building `�6i•., p� Northampton, MA 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: 205 Prospect St (Please print house number and street name) Is to be disposed of at: Valley Recycling, Northampton, MA (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) rj'� U C� 02 40lc 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.mass.gov/dia «'orkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le6bly Name (Business/Organization/Individual):O'Connell Construction LLC Address:89 Dana Hill City/State/Zip:Belchertown, MA 01050 Phone#:413-539-1521 Are you an employer?Check the appropriate box: Type of project(required): 1.E✓ I am a employer with 2 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑✓ Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.F�I am a homeowner doing all work myself. [No workers'comp.insurance required.]t ]0 E] Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.r7 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[:]Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL a 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:Travelers Property Cas Co Of Am Policy#or Self-ins.Lic.#:7PJUBOG19637219 Expiration Date:07/28/2020 Job Site Address:205 Prospect St, Northampton, MA City/State/Zip:01060 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 hereby certify u er the pains and penalties of perjury that the information provided above is true and correct (Z/". Signature: U Date: Phone#:413-539-1521 Official 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#: ,acoR CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDD/YYVY) 11104/2019 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 pollcy(les)must 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: Michael BanaS BANAS & FICKERT INSURANCE AGENCY PHONE (413)527-2700 FAX No : ONE ADDRESS: so banaslnsurance.com 63 MAIN ST INSURER(S)AFFORDING COVERAGE NAICO_ EASTHAMPTON MA 01027 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER a: OCONNELL CONSTRUCTION LLC INSURER C: INSURER 0; 89 DANA HILL ROAD INSURER E: BELCHERTOWN MA 01007 INSURER F: COVERAGES CERTIFICATE NUMBER: 468901 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 NUMBER PMlDD1YYYY MM/DetrMl LIMITS COMMERCIAL GENERAL LIABILITY EACHOCCURRLNCE $DAMAGE NTED- _ CLAINIS-MADE OCCUR PREES E E MI r S MED EXP(Any one person) $ NIA PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ POLICY PRO- n LOC PRODUCTS-COMP/OPAGG S JECT _ OTHER $ ettidenl AUTOMOBILE LIABILITY COMBINED) L R $ ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NONAWNED PROPFRTYDAMAGE S __ HIRED AUTOS AUTOS Per acc dent_ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ Ul0 RETENTIONS OTH WORKERS COMPENSATION X PER ER AND EMPLOYERS'LIABILITY ANYPROPRIETOFUPARTNERIEXECLITIVE YIN ELFACHACCIDFJdT $ 1,000,000 A OFFICE RIMEMBER EXCLUDED? NIA NIA NIA 7PJUB0619637219 07/28/2019 07128/2020 (Mandatory In NH) EL DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe urdor DESCRIPTION OF OPERATIONS be'ow I IF L.DISEASE•POLICY LIMIT S 1,000,000 NIA DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is requi(ed) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in slates other Than Massachuselts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govAwd/workers-compensationAinvesligations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF NORTHAMPTON ACCORDANCE WITH THE POLICY PROVISIONS. 212 MAIN STREET#100 AUTHORIZED REPRESENTATIVE l ( (t_ur NORTHAMPTON MA 01060 Daniel M.Crow y,CPCU,Vice President—Residual Market"-WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD {± DATE(MMIDDlYYYY) �.. CERTIFICATE OF LIABILITY INSURANCE 11104119 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 NAME: Sanas and Fickert PAJC No ExD: 4'13-527-2700 FA No: 413-527-0849 Insurance Agency E-MAIL 63 Main Street ADDRESS: mb@banasinsurance.com Easthampton, MA 01027 INSURER(S)AFFORDING COVERAGE NAIC N _ INSURER A: Union Mutual Fire Insurance Co. INSURED INSURER R: O'Connell Construction,LLC INSURER C: 89 Dana Hill Road INSURER D; Belchertown, MA 01007 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY 1 HAT 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 CONTRACTOR OTHER DOCUMENT Willi 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. _LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER _ MM/DDY EFF MMIDD Y LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 x TO ED 50,000 CLAIMS-MADE OCCUR PREMISES Fa occurrence $ _ MED EXP(Any oneperson) S 5,000 A BOP0005285-07 09101/19 09/01/20 PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY PRO- JECT I I LOC PRODUCTS-COMPiOPAGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED)SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHFDULEO BODILY INJURY(Per accident) S AUTOS ONLY AUTOS _ HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ _ EXCESS LIAR CLAIMS-MADE AGGRFGATE $ DED RETENTIONS $ WORKERS COMPENSATION - _ PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER _ ANY PROPRIETORIPARTNERIEXECUTIVENIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) F.L,DISEASE-EA EMPLOYEE $ It yes,describe under DESCRIPTION OF OPERATIONS below F.L.DISEASE-POLICY 1 IMIT S DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Addltional Remarks Schedule,may be attached It more space Is required) CONSTRUCTION CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main Street#100 it I Northampton,MA 01060 AUTHORIZED REPqSJIN tKIVVE 15 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD