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29-574 188 OVERLOOK DR BP-2020-0947 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-574 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Catea Ky: KITCHEN RENO BUILDING PERMIT, Permit# BP-2020-0947 Proiect# JS-2020-001612 Est.Cost: $43048.00 Fee: $280.00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor: License: Use Group: INTEGRITY DEVELOPMENT & CONSTRUCTION INC 90514 Lot Size(sq. ft.): 25395.48 Owner: BRYSON CHRISTINE zoning: Applicant: INTEGRITY DEVELOPMENT & CONSTRUCTION INC AT. 188 OVERLOOK DR Applicant Address: Phone: Insurance: 110 PULPIT HILL RD (413)549-7919 Workers Compensation AMHERSTMA01002 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: Service: Meter: Footings: Rough: Rough House# Foundation: Driveway Final: Final: Final: Rough Frame: Cas: 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(,naturc: FeeTyge: Date Paid: Amount: Building 2/21/ 020 0:00:00 $280.00 12 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner M1 R F .�. r. Department use only ON i - City of Northamptop �\ Stftis o#,Permit: Building Departmen B 2rb Cut/Driveway Permit 212 Male Str et Zweriteptic Availability t Room 100"�� Water/Well Availability Northampton MA, 0� � p m,,�p TwSets of Structural Plans .� phone 413-587-1240 Fax 413 ''ta2 io Pl t/Site Plans so NS , Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION k�oI �ns 1.1 Property Address: This section to be completed by office`Qs Av�loG� &t-. Map '241 Lot 5 �/7 7 Unit � I GA06 J,— Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: �A(,o1\ C�(AIDC\L k7 - F\o(t.�« .MA Olct Name rint — Current Mailing Address: �T 413- Telephone Signature 2.2 Authorized Agent: MheNk . hAA O Wrix Name(Print) Current Mailing Address: 1413 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 (b)Estimated Total Cost of S 5 Construction from 6 3. Plumbing �I t Building Permit Fee r 4. Mechanical (HVAC) 5. Fire Protection 6. Total= 0 +2+ 3+4 + 5) py Check Number CI /�,� l (��1 This Section For Official Use Only Building Permit Number: lP —C(1rt—'7 j ,Z Date Issued: Signature: g- o Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) �ac�h \,,'i f\(\V�Io rh N00.h @ 1 �e'kkIi\k'11 � . co M� 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 L 4a M� 1®-� Frontage l`L0. Skma— Setbacks Front Side LaEj R: KU' L: R: i Rear T§4.'.. Building Height o NR Bldg. Square Footage MU % Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location A. Has a Special Permit/Variance/Findin ver been issued for/on the site? NO 0 DON'T KNOW YES 0 IF YES, date issued:''... IF YES: Was the permit recorded at the Reg' ry of Deeds? NO 0 DON'T KNOW YES Q �—"! ..,..... IF YES: enter Book Page :, and/or Document#1 B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 Date Issued: C. Do any signs exist on the property? YES 0 NO (2( IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over t acre? YESQ 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 ❑ ReplacementWjrfdows Alteration(s) Roofing Or Doors E Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [0] Other[Q] Brief Description of Proposed Work:_ t,JtN zN, C t,i CtMA")�P— I! .,��n1�o �ernoye w0.\ / ceD � �1N� bq brtarA, 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 i4ditio% 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. 1. 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. L34 �r!r\0 �f `��i0n as Owner of the subject property hereby authorize Nr\ntl. 00\<- to act n behalf, �nall matters relative to work authorized by this building permit application. --Z// Signature of Owner / Date I, Qtgt\(" COOK 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. Rnt\�. CoQ Print Nam Signature o wner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable EIName of License Holder: Ar f�lw �L'0� l` — 6 65 \� License Number q I \a- I �z Addr ss Expiration Date 5 M 74\q Signature Telephone 9.Registered Home Improvement Contractor. Not Applicable ❑ Compan a Registration Number lIn qV\.\ \8k,\\ AMM'er�t- M� , o\oar \ I k� l lo,\ Address p Expiration Date 0A11 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....... No...... ❑ r City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building a `b t 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: WS e'�PJAUO';-- (Please print house number and street name) Is to be disposed of at: (Please p ' t nafheand location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) n I I �IAL Sign pplicant 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 0 1 Congress Street,Suite 100 Boston,MA 02114-2017 "r www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNHTTING AUTHORITY. AtMicant Information Please Print Let=_ibly Name (Business/Organization/Individual): Q\_Oo MkXV AA& (t9 S VW1%A Address: lkb ocb City/State/Zip: hkAVntry< MN ,b oo2�- Phone #: �II�"S `�`1 -74�°► Are you an employer?Check the appropriate boa: Type of project(required): 1.V91 am a employer with `"\ 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 $, odeling any capacity.[No workers'comp.insurance required] 3.EJ 1 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. RDemolition 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10 0 Building addition ensure that all contractors either have workers'compensation insurance.or are sole I LE]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.[:]We arc 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. Tf 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:_\\M MV-k\-\W\ Policy#or Self-ins.Lic.#: W kA 0()0'00 6Expiration Date: "Ah O 40 Job Site Address: $$ ©yeA Oaf C.r City/State/Zip:_%r#ALe. C W 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 certi under the ains a d penalties of perjury that the information provided above is true and correct Signature: Date: 0 Phone 9: '10 -5 4t1 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#: AC4-_>RO® DATE(MMIDD YYYY) CERTIFICATE OF LIABILITY INSURANCE 04/16/2019 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 Andrea Feeley NAME: PHOWebber&Grinnell AICNNo,EAI: (413)586 0111 FAA/C,No: (413)586-6481 8 North King Street ADDARIEss: afeeley@webberandgrinnell.com INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Arbelle Protection 41360 INSURED INSURER 8: A.I.M.Mutual/A.I.M. Integrity Development and Construction,Inc. INSURER C: Attn:Anna and Heidi INSURER D: 110 Pulpit Hill Road INSURER E: Amherst MA 01002 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 4/2020 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MWDD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AMA N 100,000 CLAIMS-MADE X OCCUR PREMISES Ea occurrence MED EXP(Any one person) $ 5,000 A 8500065625 04/10/2019 04/10/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY FXJ PRI 7 LOC 2,000,000 JECT PRODUCTS-COMP/OP AGG $ OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ A OWNED �/ SCHEDULED 1020051526 04/10/2019 04/10/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIABX OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR CLAIMS-MADE 4600065628 04/10/2019 04/10/2020 AGGREGATE $ 1'000'000 DED I X1 RETENTION $ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE ERH SOO,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE NIA WMZ80080062242019A 04/10/2019 04/10/2020 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 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 t Commonwealth of Massachusetts . Division of Professional. , Board of Buildin Licensure j g Regulations and Standards J Construction"Supervisor ' CS-090514 f, EXpires: 09/12/2020 ANNA R COOK _ 113 JANUARY41ILLS ROAD AMHERST MA 01002 ,_ a Commissioner L/'a^ 37Tie iv���rresau eal/r cy`��iaw:ac curly Office of Consumer Affairs&Business Reguiation HOME IMPROVEMENT CONTRACTOR TYPE:Corporation Registration_. soiration 11804T= 01/1912021 INTEGRITY DEVECDPMEN AND CONSTRUCTION,INC." ANNA COOK 110 PULPIT HILL RD" AMHERST,MA 01002 Undersecretan