Loading...
16A-004 (3) 87 CHESTERFIELD RD BP-2020-0968 GIS#: COMMONWEALTH OF MASSACHUSETTS MO.Block: 16A-004 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-2020-0968 Proiect# JS-2020-001645 Est.Cost: $15000.00 Fee:$98.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MELISSA FOWLER 114370 Lot Size(sq. ft.): 47916.00 Owner. FOWLER MELISSA Zoning: URA(100)/ Applicant: MELISSA FOWLER AT. 87 CHESTERFIELD RD Applicant Address: Phone: Insurance: 87 CHESTERFIELD RD (413) 977-0455 WC LEEDSMA01053 ISSUED ON:3/10/2020 0:00:00 TO PERFORM THE FOLLOWING WORK:KITCH 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: 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 3/10/2020 0:00:00 $98.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck--Building Commissioner ---------------------- ke-1.Er_7- Cit of Northamptonepartment use only Y p Status of P('rmit: Building Departme t Cur`gCut/Driveway Permit ff 212 Main Street 2 6 20� Sew r/Septic Availability q ROOM 100 Wat r/Wel Availability D1 Northampton, MA 0 ;FEB=SUILDINc INSPE , ets of Structural Plans <,. phone 413-587-1240 Fax 41,3'- QN.MA o1 fot/Site Plans Other Specify 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_ ` — Lot OVy Unit 87 Chesterfield Road, Leeds MA Zone Overlay District Elm St.District CB District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Melissa Fowler 87 Chesterfield Road, Leeds MA Name ri Current Mailing Address: 413-977-0455 Signal re Telephone 2.2 Authorized A ent: fir,` 610 Name(Print) Current Mailing Address: Signature 41 �1-�r04 Telephone SECTION 3- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $10,000 (a) Building Permit Fee 2 Electrical (b) Estimated Total Cost of $2,500 Construction from 6 3. Plumbing $2,500 Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 0 6. Total =(1 +2+ 3+4 +5) $15,000 Check Number f �J This Section For Official Use Only-- Building Pe it Number: / ' ?0— q Date Issued: Signature: 3UV - Building Commissioner/Inspector of Buildings Date melissa @ goodstrongbean.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 Accessory Bldg. ❑ Demolition ❑ New Signs [ED] Decks [Q Siding [0] Other[O] Brief Description of Proposed Kitchen Remodel,new cabinets,countertops,flooring Work: Alteration of existing bedroom Yes NO No Adding new bedroom Yes NO No Attached Narrative Renovating unfinished basement Yes NO 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 as Owner of the subject property hereby authori e L�N�`m"`+� COJJUCh � Y�LES to act on h f, in rs elative to work authorized by this building permit application. a.a(o--�O Signature o Owner I Date 55A ' "wL�L as Owner/Authorized Agent hereby declare that the statements and information on the foregoing g g application are true and accurate, to the best of my�knowledge and belief. Signed under the pains and penalties of perjury. L�54a OcAit Print Name 9/ ,A 6 CL,, ab Signature of Owner/A96nt Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Melissa A Fowler 87 Chesterfield Road License Number 114370 Address Expiration Date Leeds MA 01/30/2023 Signature Telephone 413-977-0455 9. Re ister Home Im ro ement Contractor: Not Applicable ❑ Ne c'sA Al-fbwr-C-,2 Company Name I / Registration Number f)q Leers F NSA 0)0 S 3 197490 Address Expiration Date Telephone q,3'9� -0 S 12/17/2021 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... .. ❑ City of Northampton Massachusetts f - A ` t DEPARTMENT OF BUILDING 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: At>ACN ��.erftQr L Est. Cost: 4)5J U Ob Address of Work: 9J-1 V,ES O `22b5 MA 01061 Date of Permit Application: o2•a6• act 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 RESPONSIBILITES 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: Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice I hereby1 fora apply y building permit as the owner of the above property: Date Owner Name and Signature -� City of Northampton Massachusetts 1 i -' DEPARTMENT OF BUILDING INSPECTIONS �. 212 Main Street •Municipal Building sJti y� \ ^J� 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: Sic (Please print house number and street name) Is to be disposed of at: e,-RYI�U.E Ecs i a3q �4sTrt�►y► '�� �, N�il.jl�►�m� `y�� (Please print name and locati n of facility) Or will be disposed of in a dumpster onsite rented or leased from: A M H& s-rF --r" (Company Name and Address) a(a SignaturOPlicant 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. I The Commonwealth of Massachusetts = Department of Industrial Accidents o l Congress Street,Suite 100 Boston,MA 02114-2017 M . ' www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aimlicant Information Please Print Le ibl Name(Business/Organization/Inddividual): nn 'S�F1 W 1, I � I(QO Address: -4 City/State/Zip: EST i t,�VC �O• h City/State/Zip: Lf tVS YY1 0 Phone#: 413 ' q4 O N 5_S I Are You an employer?Check the appropriate box: Type of project(required): I ❑I am a employer with employees(full and/or part-time).' 7. C] ew construction 2❑1 am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] Remodeling of 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property.ro I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 I.❑Electrical repairs or additions proprietors with no employees. 5, am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 12.EJ Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.t 13.❑Roof repairs 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. /am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information. Insurance Company Name:_ LIQ&Vti AU'NA(, _S Policy#or Self-ins.Lic.#: WC o?31 56?20 633019 Expiration Date:0 10 V5 I Job Site Address: �' ('�rlf� �/ \tD l„QPrpS MA 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 hereby ce7* 7pa' s a enal es of rjury that the in formation provided above is true and correct. Si*nature: Date: a• a� a Phone#: 0 Official use only. Do not write in this area, to be completed by city or town officdnl. 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#: A�Roy CERTIFICATE OF LIABILITY INSURANCE DATEtMMIDDIYYYY) 12/04/2019 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 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 NAMEAC Cynthia Squires HUB INTERNATIONAL NEW ENGLAND LLC PHONE , (413)733-3131 No; E-MAILDnthia.s uires hubintemafionai.com 564 Center Street INSURER(S)AFFORDING COVERAGE NAICY Ludlow MA 01056 INSURER A: LIBERTY MUTUAL FIRE INS CO 23035 INSURED -- INSURERD• _ UNLIMITED CONSTRUCTION SERVICES INC INSURERC: INSURER D: 267 CADY ST INSURER F: LUDLOW MA 01056 INSURER F: COVERAGES CERTIFICATE NUMBER: 480003 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 HE 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 9UBR POLICYNUMBER MO DD EFF POLICY EXP LIMIT'S LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ U � DAMAGE TORO i2Ft17Eb Cl. u .AIM'-MADE OCCUR PREMISES(Ea occurrence $ MED EXP(Anyam n) $ N/A PERSONAL 3 ADV INJURY S GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY LJ PRO- JECT 1-1 LOC PRODUCTS-COMPIOP AGG S OTHER: $ MaCOMBINED acci AUTOMOBILE LIABILITY B WA) GLE LIMIT $ Ea ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) S AUTOS AUTOS S — NON-OWNED PPReOPERTYDAMAGE HIRED AUTOS AUTOS --- — UMBRELLA LIAR HOCCU. EACH OCCURRENCE $ EXCESS ILIAD CLAIMS MADE NIA AGGREGATE S DED I I RETENTIONS $ WORKERS COMPENSATION X g q T= OTETH- AND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNER/EXECUTI✓< YIN E.LEACH ACCIDENT $ 1,000,000 A OFFICERNEMBEREXCLUDEDI NIA NIA NIA WC231S620633019 11/28/2019 1112812020 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPT ION OF OPERATIONS below E.LDISEASE-POLICYLIMIT Is 1,000,000 NIA DESCRIPTION OF OPERATIONS I LOCA71ONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 states other than Massachusetts 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 he monitored dally by accessing the Proof of Coverage-Coverage Verification Search too!at wwvr.mass.govAwdtworkers-compensati°nfinvestigations/. CERTIFICATE HOLDER CANCELLATION %IOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Western Builders ACCORDANCE WITH THE POLICY PROVISIONS. 73 Pleasant Street AUTHORIZED REPRESENTATIVE Granby MA 01033 Danie M LC;q v cT 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 ----- UNLICON-01 AODIORNE . ft O CERTIFICATE OF LIABILITY INSURANCE DATD/YYY() � 9/112/21212019 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 License#1780862 NTACT Amy Odlorne HUB International New England PHONEFAXFAX 96 Shaker Rd. _(A/C,No,Eat):(413)224-7112 I(AM,wo): East Longmeadow,MA 01028 Ji)m&&ss:A .0diome@hubintemational.com INSURERI81 AFFORDING COVERAGE _NAIC# INSURERA:Atlandc Casualty Insurance Company 42846 INSURED INSURER B: Unlimited Construction Services Inc INSURERC: 267 Cady St INSURER D: Ludlow,MA 01056 --- INSURER E 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 I TYPE OF INSURANCE ADOL SUER POLICY NUMBER POLICY EFF POLICY EXPLTR rAnrm VAS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE OCCUR X X L261002402-1 511/2019 SW2020 PRA AGE TO RETED occurrence) III 100,000 MED EXP one S 3'000 — PERSONAL B ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑m F-1 LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINdEDD SINGLE LIMITMe $ ANY AUTO BODILY INJURY Pat S OWNED SCHEDULED AUTOS ONLY AAUUTNOSyWyNN pp BODILY INJURY Peracdderd S AUTOS ONLY AUTOWtV OPER]Y_ GE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAO CLAIMS-MADE AGGREGATE $ DED RETENTIONS WORKERS COMPENSATION PTT ORH ANDEMPLOYERS'LIABILITY —TsY I N ANY PROPRIETORIPARTNER/EXECUTIVE j EL.EACH ACCIDENT S FICCERIMEMBEREXCLUDED? a NIA andatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) Certificate holder is considered additional insured for completed and ongoing operations for commercial general liability when required in a contract. RE:Sage at Hudson—253 Washington St.Hudson,Ma.Western Builders,Inc.and(Owner)SHI-111 Sage Hudson Owner,LLC c/o Sage Senior Living,LLC are named Additional Insureds with respect to General Liability,Business Automobile Liability and Excess Umbrella(following form)Liability Coverages.General Liability Additional Insured Endorsement including ongoing and completed operations is attached.Business Automobile Blanket Additional Insured Endorsement is attached.General Liability and Business Automobile Liability Policies are on a Primary and Non-Contributory basis-endorsements attached. Waiver of Subrogation in favor of Additional Insureds applies to all policies-General Liability,Business Automobile and Excess Umbrella Liability(as SEE ATTACHED ACORD 101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Builders THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Western 73 Pleasant ACCORDANCE WITH THE POLICY PROVISIONS. St Granby,MA 01033 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Commonwealth of Massacnusens Division of Professional Licensur_ Board of Buildina Reaulations and Standard_. C©nstr4ictior.Suz)eri:s7 CS-114370 EXpires:01/30/2023 MELISSA A FOWLER,A 317 KENNEDY ROAD LEEDS MA 01053 Commissioner � '�— Office of Consumer Affays�Busmess Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 197490 12/17/2021 1000 Washington Street -Suite 710 MELISSA FOWLER Boston,MA 02118 MELISSA A.FOWLER 87 CHESTERFIELD ROAD LEEDS,MA 01053 Not valid without signature Undersecretary