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25C-266 (2) 56 LINCOLN AVE BP-2020-1161 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25C-266 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Porch Enclosure BUILDING PERMIT Permit# BP-2020-1161 Proiect# JS-2020-001957 Est.Cost:$56113.00 Fee: $365.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Group: ROBERT GUENARD 094926 Lot Size(sg. ft.): 8363.52 Owner: STAUB MICHAEL Zoning: URB(100)/ Applicant: ROBERT GUENARD AT. 56 LINCOLN AVE Applicant Address: Phone: Insurance: 51 HILL ST (508) 728-1440 WC NortonMA02766 ISSUED ON:5/26/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-BUILD 12X13 3 SEASON PORCH 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 Sig(nature: FeeType: Date Paid: Amount: Building 5/26/2020 0:00:00 $365.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Y" MAY 2 Dep t use only t City of Northam ton �`' � Status of Permit: 3 Building Departmc;� �:, Curb Cut/Driveway Permit /1212 Mail Street S�werlSeptic Availability f Room 1fl � �� aterMell Availability Northampton, f1�i'A,04D60 01?0 Two,S of Structural Plans h, phone 413-587-1240 Fa X41�;'`�S8.-J 272 Plot/Site Pians 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 e / +1 Map Lot—_.._.........-.. d� Unit L , � L � �iJ Zone Overlay District Elm St.DistrictCB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: /� (� — 75-1 �'3C f­ie.4 c's�X Telephone Signature 2.2 Authorized Agent: �y C-JCE'+T /)A)" � '� r�ru7'S �tG S� SCa�cC 7� t,�e.5T rw�cs LJ Name(Print) Current Mailing Address: 6G 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 Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total= (1 +2+ 3+4 +5) 1 /J , G v Check Number This Section For Official Use OrAy Building Permit Number: a����6 I Date Issued: Signature: Building Comm issioneSo r/Inspector of Buildings Date s-Av N @ G A EA T D4 rpip A o g r' #1 ftj rs EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING Alt Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning Phis column to be filled in by Building Department Lot Size Frontage bC� Setbacks Front. ._ G Side L:' .1 R:s j a L.E R:f Rear *7y .._ Building Height _ c Bldg. Square Footage % Open Space Footage (Lot area minus bldg&paved 1, parking) #f of Parking Spaces Fill: (volumc&L.ocation) A. Has a Special Permit/Variance/Finding ever 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 Registry of Deeds? NO DON'T KNOW 0 YES 0 IF YES: enter Book ` Page' and/or Document#' B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Date Issued: 1 C. Do any signs exist on the property? YESQ NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 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 1 acre? YES 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 D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding[o] Other(dj Brief Description Qf Proposed Work: v r%d` l s� ?� f-i , /L�a v e i4 la S r c+�"�,Qaal� jos« rs, Q Ili 1 s }),x C1 Afl+v- Alteration of existing bedroom Yes X No Adding new bedroom Yes < No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll -Sheet &a. If New house and or addition to existing housing, complete the following: a. Use of building :One Family X Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? X�e-- d. Proposed Square footage of new construction. 3-& Dimensions /A x /. e. Number of stories? i f. Method of heating? �e_ 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, _ _, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, tistom-ec t C`z,ter + '_ 1>}" •�-r1tc�U �v r'S ,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. Print Na V- i7- & ,C:�) Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supffervisor: Not Applicable ❑ Name of License Holder; t.jj- O 5 � y 9 Licennse Number y Address ,�v /f Expiration Date Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ 6 it :'t J� ;+ i( r C , 'C "Ccs / j......._ /4, 7 l 4 9—, Company Name Registration Number a �-G C,a�'c ���'� L' v' / lh� '�a.0 t"tlf 7) 7 _ 2-G 2 Address Expiration Date 3t Jtar <T—. (),4Y Lr7%`*?CVf,;'1 i'�'i.et,rt Telephone 5L$'-ZtZ2�1 y6 G 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 A', , `S / •_ Massachusetts k 4 DEPARTMENT OF BUILDING INSPECTIONS St 212 Main Street • Municipal Building O� Northampton, MA 01060rj1 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("RIC"). 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: 5&t 5 W u 4-L Sv"140-1 JA ,x 13, Est. Cost: 5-6 3, Address of Work: rL L 4 ae- Date of Permit Application: 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: t - 0-2©Z0 61( -7 Li+Y -Ztyoocavc kl,t,-,11s 16 F5 (4 ;k Date Contractor Name H I C Registration No. OR: . Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton Massachusetts `G DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building X01 �a Northampton, MA 01060 J"; 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: (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: /6) C PIs (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. a s^� 500 Myles Standish Blvd. PAZ ' Taunton, MA 02780 Phone 508-822-196 ENCLO, 6 STANEK" t 08 F Fax 5 -821-9339 VV 7 NA NO,k18850P;m flap.1118700 D5'C.!?!~41'R41'k�41tJVLd1ENIS,LLC 0Y MAI DAY IMPflfrvE}AFNI'ti,LLC Owner ,Authorization for Permit (Application I Mi c-11i4,,e� as owner of the Subject Property located at L' 1-4.11 Z /I,, /IV"( All 1 1 M4 Hereby authorize GREAT DAY Improvements LLC., Taunton, MA to act on my behalf in all matters relative to work authorized,by this Building Permit Application fs Signature of Owr r Date CORPORATE OFFICES:720 Highland Road E Macedonia,OH 44056 1 800-230-6301 GREAT DAY ( greatdaAmprovements.com I patioenciosures.com I stanekwindows.com nn nn 1•riiovia.�•.r. . Contract 66 South Broad St. ,Westfield, MA 01085 PK Hartford@greatdayimprovements.com NORTHEAST REGION ENCT.4 G H Main: I Fax: *1W562 NV G:kA-WY PAP"VIEe95,LIZ Date: 3/5/2020 I,we hereby accept your proposal to furnish all labor and material necessary to perform the following work on the premises of the Owner Michael Staub located at 56 Lincoln Ave in the City of Northampton State of MA Zip 01060 Phone (609)751-3013 Customer email address mestaub@gmall.com Phone Sales representative Chip Doubleday License# N/A (if applicable) This contract shall be considered non-cancelable after legal cancellation period has expired. THE WORK TO CONSIST OF: Manufacture and professionally,install custom-made AIIView Elite Sunroom with insulated glass: - Dimensions to be approximate) 12.0' x 13.0' x 12,0'with an approximate 7.0'wall height. -Color:White-commercial grade aluminum, 3-1/8"wall depth. -Safety tempered edge-to-ed a glass. - Insulated, high performance Comfort-Gard®PLUS Low-E/Argm on glass(5/8"thickness), - Euro-Style color matched handles with dual-point locking systtewith setback night latch, dual tandem, rolling wheels with stainless steel ball-bearings,full interlocks and mylar-fin pol propylene weather stripping. - Includes beveled 7/8"extruded screen frame with black aluminum screen mesh. -A Wall to include: rolling windows with glass kneewalls - B Wall to include: rolling door and rolling window with glass kneewall -C Wall to include: rolling windows with glass kneewalls Manufacture and professionally install a 6" panelized gable roof system: - Dimensions to be approximately 15.0' wide with an approximate 13.0' projection. - Includes overhangs with new seamless gutters and downspouts. Engineered roof with center-ridge beam, structural I-beams and super-foam roof panels with aluminum skin. - Includes aluminum skin super-foam panel wings. - PE will install water fall shades(liht tan) - PE will install engineered flooring?Norwegian maple) - PE will remove old deck, dispose of debris and build a new 12x13 deck -Steps will have 3 risers,vinyl railings and timber tech steps(dark grey) Work to start approximately 2 to 4 weeks from the date of this contract and to be completed approximately 4 to 6 weeks after commencement if not delayed by building permit,delivery of materials,weather,strikes,fires,or other conditions beyond Seller's control. The completion date is not of the essence. Single-glazed AIIView and all non-thermally broken sunrooms with insulated glass ARE NOT designed to be heated or air conditioned. � V rc�s�o,�a.,rals± WHERE REQUIRED, HOMEOWNER TO GET PERMIT. Source of Sale Clipper Contract Price $56,113.00 THE DOWN PAYMENT SHALL BE A NONREFUNDABLE DEPOSIT Down Payment $16,833.90 ONCE THE THREE-DAY CANCELLATION PERIOD HAS EXPIRED. Upon Order of Manufactured Material $16,833,90 THIS CONTRACT CONSTITUTES THE ENTIRE UNDERSTANDING at Start of Installation $16,833.90 OF THE PARTIES. at Substantial Completion $5,611.30 CORPORATE OFFICES:720 Highland Road E I Macedonia,OH 440561800.230.8301 GREAT DAY I GREATEWIMPROWNIENTS.COM I PATIOENE'.IOSURES.COM I STANEKWINDOWS.COM 1 of 9 "' "' n....rrn.o i r oo�c.� eon;a �aci as�asono �Nar isn Cornmonwealth•of Massachusetts h Division of Professional Licensure Boston Design Center Board of Building Regulations and Standards Cons i&WA S"isor. �. 7FE CS-094925 _i'Gu�� A `;° T p Ea fpires. 09/0312020 NCLOSURES` WINDOWS 5i ✓�� ; z BY GREAT DAY IMPROVEMENTS,LLC ROBERT A GUEN';- 61 BILL STR9� ,r 0 f•; NORTON MA 02�66N,,. i. BOSTON OFFICE; ; 1trt�I.SS 1(0210 250 Cape Hwy.,Unit 6 Main;5OB-622-1966 .. i East Taunton,MA 02718 Toll-free:800-230-8301 I �1 11 M';GlH�BG71661;tAIh9���68 Comt Boston®greatdayimprovements.com tMl4g.�iBBSilissioner tr ,�P -� _._��.._._. .yi Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home lmproveme .,,Qbptractor Registration M, - � �' Type: Supplement Card vie , Registration: 168562 GREAT DAY IMPROVEMENTS,LLC. Expiration: 03/07/2021 250 CAPE HWY UNIT 8 EAST TAUNTON,MA 02718 Update Address and Return Card. 1 t5 2,0�M.05117 ,%!� GY7?/yl0/LLUG'IJ•CLIL 1. ✓!/U`CLddCl+/LLLJ,1,6 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYP wPDlement Card before the expiration date, if found return to: Regista qh Exylratlon Office of Consumer Affairs and Business Regulation ,68662-T 03/07/2021 One Ashburton Place-Suite 1301 }�'- 2–•4–rj' Boston,MA 02108 GREAT DAY IMPR7:UE =;A—S•,I'LC. t_ Q5 G g ME- BOB GUENARD 160 GREENTREE 51-jR.r,�SUITE 101 Not valid without sig ature DOVER,DE 19904 Undersecretary GREADAY-01 JSCHLICHTING CERTIFICATE OF LIABILITY INSURANCE r DATE(MMIDP20)yyyY)118120 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE.bc)Ss NOT Arr-iRmAnvm-y OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY TRE POLICIES BELOW. THIS CERTIFICATE OF INSURANcr-- DOES. NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holdet"Is all ADDITIONAL INSURED,life policy(Ips)must have ADDITIONAL INSURED provisions 01.he endorsed. it SUBROGATION ION IS WAIVED, subject I to the terms and conditions of the policy,pertain pollcles may require an endorsement. A statement on this qQ i[ficatie does.not confer rights to the cortiffeato holder In JkLiol"Ruclionclorsamenf(s), Co c"Jennifer SchliGhting pRODUCF.RIMP Schauer Group,Inc. p I PAX 200 Market Ave,N Fxt): AIS No Suite 160 4E�%Ag'bsslJeiiOlfet,.sclilichtind@srhauoi-gi-ouo.com 06ntah,OH 44702 INSURER(S)AFFORDING COVERAGE NA1041 li,isuRpA.-Selective Insurance Company.of America -- INSURED iNsuRERn:1-lbe y_KutuA[InsuranceCo. 23643 Great Day Improvements,LLC INSURE C: - - ----- --- 700 1-Highland Rd INSURER D: Macedonia,OH 44066 INSURER r: INSURER COVERAGES' CERTIFICATE f4UMBER, REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES Or INSURANCE LISTEO BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY'REQUIREMENT, TERM OR CONDITION OF ANY GUN-rRAar OR OTHER DbCI.fMENf WITH RESPECT TO'WHICH THIS CERTIFICATE MAY BE I'SSLIED 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 Ala SUBR Pouz�y,fff�o— POLICYEXI, I-Trz POLICY NUMBER IMM/Optyyyy]1MMMQM'yyL LIMITS .A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,0004000 CLAIMS-MADE EKOCCUR S2426046 11112020 11112021 DAM hSjMEmmTE=' r_q) s 500,000 MED EXP An one parson) S 16,000 PERSONA L&AD V INJURY S 1,000,000 GEN'L AGGREG TF LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 P, r—V-1 EX A I LOC PRODUCTS-COMP/OP AGG_ S .2,000,000 OTHER: S COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILELIABILITY P accidentl S ANY 6uro S2428040 I/1(2020 11112021 BODILY INJURY(Parperson) s — OWNED SCHEDULED AUI'OS ONLY F AS ro, pp BODILY INJURY(Per acclde6l) S 80 PER AMAGE r ecz Q -1 ANTUS ONLY aht S UMBRELLALIAB i OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION 3 $ El WORKERS COMPENSATION X I 8PTA11TUrE I I TH, AND EMPLOYERS'LIABILITY IR---- YIN WC7-Z61-292550-010 1/112020 1/112ov F.L*EACH ACCIDENT- 8 1,�000,000 ANY PR2rRIETOR/PARJNER?EXFCUTIVE [--] h NIA 1)FIOE MEMIf,SXC UOEl (hQatoryln. 121,DISEASE-EA EMPLOYE S 1,00D,000 It s,describe under E.LD)SE E-POLICYLIMit S 1,000,1)00 DE SCRIPTION 0 OPERATIONS below DEscRIpTIoN or OPERATIONS I LOCA'IfONS IVEHICLES JACORD 101,Additional Rarnarksloh-dule,may Iteclitid ifraoro'space is required) Workers Comp C6vered States;CT FL GA IL IN KY MD MA MI MN NJ OVO11AWI and Ohio Employers Liability CERTIFICATE HOLDER CANCELLATION ........... SHOULD ANY OF THE ABOVE.DESCRIBED POLICIES BE CANCELLED BEFORE THE.SHOULD. DATE Tjirmi4rzor, NOTICE WILL 13E DELIVERED IN For Informational Purposes Only ACCORDANCE WITH THER'POLICY PROVISIONS. 610 Gr6ht Day.Improvemitnts,'L.1-C 100 E'Ilighl;incl Rd MdcddcihIA,OH 44056 AUTHORIZED 119PRESENTATIVI! A06RD 25(201 b103) O 198£3-2015 ACORIDtORPORATION. All rights reserved. The ACORD name and logo are registered marks of AQORD The Commonwealth of Massachusetts x Department oflndustrialAccidents yR d 1 Congress Street,Suite 100 Boston, MA 02114-2017 5� www mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/lndividual):Great Day Improvements Address:250 Cape Highway unit 8 City/State/Zip:E Taunton Ma 02718 Phone#:(508)822- 1966 Are you an employer?Check the appropriate box: Type of project(required): LE I am a employer with 12 employees(full and/or part-time),* 7. New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.[]l am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10[,✓ Building addition 4.[]1 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.r-1 Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. l 3.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.F1 We arc a corporation and its officers have exercised their right of exemption per MGL C. 14.R✓ Othersunroom 152,§1(4),and we have no employees.[No workers'comp.insurance required.] IL *.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. fain an employer that is providing workers'Cofnl)e)isatlon insurance for my employees. Below is the policy and job site information. Insurance Company Name:Liberty Mutual Insurance Co. Policy#or Self-ins.Lic.#:WC7 Z51-292550 Expiration Date:1/1/2021 Job Site Address: X5'6 1-1N r-e/a A;e__ City/State/Zip: PAC-/4 t*,J0r'6,1,+ M 4 e-106 C 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 un er the pa an enalties of perjury that the information provided above is true and correct. Si afore: Date: Phone M 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 M N40RTGAGE LOAN INSPECTION f_ F E 2 STY WJF PARCEL! _ 6s `i SHED LOCUS REFERENCE: BOOK 10193 PAGE 62 PLAN BOOK 188 PAGE 76 _ t _ TO; FLORENCE SAVINGS BANK OWNER: GABRIEL THOMPSON CADE AND: VATIC Iz SARAH RUTH McDOWELL - I hereby report that the premises shown un this plan are LOCATION: 56 LINCOLN AVENUE not located within a Flood Hazard Arca as shown on the Feder-al Emergency Management Agency's Flood NORTHAMPTON MASSACHUSETTS Insurance Rate Map, r`r�nrmnnityNo.25o167-0002A HOLMBERG & HOWE, INC. PROFESSIONAL LAND SURVEYORS&CIVIL ENGINEERS E fictive Dale 87 UNION STREET,EASTHAMPTON MA 0 1027-0445 I also report,to the best ofnl)'knowledge,infirrtnation 37 DAMON POND ROAD,Cl1FS'TFRI=IFtLD MA 01012-0176 <` and belief,that this inspectiat plan shop's the 73 PRINCETON STREB.T,NORTli('ill-LMS(:(IRD,MA 01863 d 1 improvement or improvements as located on the premises described,that the improvements are cntirely u'itltin lot SCALE: lilies,and that there are no encronehntents upon the promises described by the improvement or improvements 1 = 30' Oran),adjoining premises,except as noted.I further report that there are no casements of record affecting the DATE: tract shown hereon,except as noted, k� OCTOBER 28, 2014 n f JOB NUMBER: 14-111 'tt115 Ill AN IS I'OR IDENTIFICATION PURPOSES ONLY AND DOES NOT CONSTITUTE A PROPERTY SURVEY. 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LIJ 0 j Q 12?i ,,, I *A ne U., CC 0 _j GREAT DAY IMPROVEMENTS,HARTFORD STAUB RESIDENCE R- 6 9 DRAWING# DESCRIPTION 0 I COVER MINIMUM DESIGN LOADS: PER 2016 IRC Wl 9TH EDITION 2 ELEVATION"B"WALL WA AMEN­DMEWfS__ 3 ELEVATION"A"&"C"WALL SUNROOM CATEGORY 11(PER 2015 IRC R301l1ll 4 DECK PLAN &AAMA I NPEA/NSA 2100)) 5 ROOF PLAN u 6 STANDARD DECK DETAILS L C° C> SNOW LOADS:GROUND SNOW LOAD 40 PSF SNOW..............LOADS:_ 7 STANDARD DECK DETAILS UL?IMATE DESIGN WIND 117 MPH,3 SEC.GUSTS 2 8 SYSTEM DETAILS 9 SYSTEM DETAILS w LIVE LOADS: o;........... z ROOF:30 PSF 2.FLOOR:40 PSF z ................. 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