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22D-099 (3) 74 RYAN RD BP-2020-1175 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:22D-099' CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cate !y: Deck BUILDING PERMIT Permit# BP-2020-1175 Proiect# JS-2020-001980 Est.Cost: $2000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Group: THEODORE TOWNE 000722 Lot Size(sa.ft.): 8407.08 Owner: DENNO MICHAEL J Zoning:URA(100)/WSP(100) Applicant: THEODORE TOWNE AT. 74 RYAN RD Applicant Address: Phone: Insurance: PO BOX 1503 Workers Compensation EASTHAMPTONMA01027 ISSUED ON:5/29/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-FREE STANDING DECK 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 sib nature: FeeType: Date Paid: Amount: Building 5/29/2020 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only -`s City of Northampt n � Status of Permit: Building Depart ent Curb Cut/Driveway Permit r' 212 Main Str et #4Y ev er/Septic Availability f '(. Room 1 < 9 / Availability l Northampton,M �O� 0 �n�o �ter"l Sets of Structural Plans phone 413-587-1240 Fa 72 Plot/Site Plans Othor Specify GF N APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENO �R D MOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Z Z D Lot et Unit 641=- -7#1-Ryan 41=--7#t-Ryan Rd, Florence , MA 01062 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Mike Dennb VRyan Rd, Floence, MA 01062 Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: 413 297-2916 413 297-2916 Name(Print) �- Current Mailing Address: 413 297-2916 Signat a Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $ 2,000 00 (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 Z7 1Y 6. Total = (1 +2+3+4+5) $ 2,000.00 Check Number / / This Section For Official Use Only ate Building Permit Number: �// ` 1` 7S Is /fsued: Signature: Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 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 Frontager- Setbacks Front l� t--t Side L: R: L:0 R:= 0 Rear F I I� Building Height 1� Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces 7-71 Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book ; Page' and/or Document#' B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: --� D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O 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 O NO 0 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 13 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Wicks [Q Siding[0] �L [O] Brief Description of Proposed Replace a 5'X 10"landing and step Work: `J 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 X Two Family Other exterior stairs 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 I, as Owner of the subject property Theodore Towne Jr hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date as Owner/Authorized Agent ho&by declare that the statiftents and inforr#dtion on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. i rI GAG r0 �3 t$ / saw [i V 2 Print Name 2.0Z Signature of ner/Agent Date SECTION 8-CONSTRUCTION SERVICES 7 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Theodore Towne Jr License Number P.O.Box 1503 Easthampton MA 01027 CS000722 Address Expiration Date ::2zL::-Z1 ::D�� 8/20/21 Signa a fTel one 413 297-2916 9. Registered Home Improvement Contractor: Not Applicable ❑ 1:_1C, 02,L, / d�..: ti l j I- Company Name Registration Number �. (�. 3G� /5�> 1��'L7 j�/Ar✓; i J/ I 132751 Address u L-7 Expiration Date / I � /� Telephone 04/01/21 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 (' DEPARTMENT OF BUILDING INSPECTIONS ? je \ 212 Main Street • Municipal Building Northampton, MA 01060 rf V7�10 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, modemization, 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: Est. Cost: Address of Work: 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: S 6 s 4 2r.'l a IN Leo pc rz lo-oke- JP, 132' -75 Date Contractor Name HIC 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 r` Massachusetts DEPARrMNT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 sf �• ;�0 Massachusetts Residential Building Code Section 110.R5.1.2 Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Section 110.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner shall act as supervisor. Such homeowner shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. City of Northampton Massachusetts ���5. A.- ,c,�e � G \ DEPARTMENT OF BUILDING INSPECTIONS ?'• 212 Main Street •Nunicipal Building 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: tr 2 YA" R-n FLM-CAS 4S A4 P (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: (Company Name and Address) --?/" -:a� Signatilre of Permit Applica iTt or OiNfier 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. ,per v '\ The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 ur 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/individual): Theodore Towne Jr Address: P.O. Box 1503 City/State/Zip: Easthampton, MA 01027 Phone#: 413 297-2916 Are you an employer?Check the appropriate box: Type of project(required): l.O lam a employer with employees(full and/or part-time).* 7. ❑New construction 2.a I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.[]l am a homeowner doing all work myself.[No workers'comp.insurance required.]t 1 ❑Demolition 10 Q Building addition 4.O 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 11.Q Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.QRoof repairs These sub-contractors have employees and have workers'comp.insurance.* 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other exterior stairs 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:Main St America/MSA Policy#or Self-ins.Lic.#:#29939 Expiration Date:6/29/2020 f17 0 Job Site Address:VH3'Ryan Rd City/State/Zip:Florence MA 01062 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 under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: .S" - Za 2 Phone#:413 2 -2916 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#: --11-1 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 06/28/2019 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 ^ EPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. .APORTANT: 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 Brenda Klaus NAME: Webber 8 Grinnell AJC,N Ext): (413)586-0111 FAX No: (413)586-6481 8 North King Street E-MAIL bklaus@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 0 Northampton MA 01060 INSURER A: Main Street America/MSA 29939 INSURED INSURER 8: Theodore Towne,Jr. INSURER C: PO BOX 1503 INSURER 0: INSURER E: Easthampton MA 01027 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 06/20 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 ADDLSUBIR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MWDD/YYYY MM/DD[YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1'000'000 CLAIMS-MADE ©OCCUR PREMISES Ea occurrence $ 500,000 MED EXP(Any one person) $ 10.000 A MP151046 06/29/2019 06/29/2020 PERSONAL BADV INJURY $ 1.000,000 GEN'LAGGREGATELIMIT APPLIES PER- GENERAL AGGREGATE $ 2,000,000 POLICY PRO PRODUCTS-COMP/OP AGG $ JECT �LOC 2,000,000 OTHER: EPLI $ 10,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ OED RETENTION S S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT S (Mandatory in NH) If yes.describe under E.L DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below I I E.L-DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be 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 Evidence of Insurance 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 Unrestricted -Buildings of any use group which contain less than 35,000 cubic feet 991 cubic meters of enclosed Commonwealth of Massachusetts ( ) Division of Professional Licensure space. Board of Building Regulations and Standards Construction'Supervisor ``'-000722 Expires:08/20/2021 THEODORE D TOWNE JR PO BOX 1503 EASTHAMPTON AAA 01027 ` Failure to possess a current edition of the Massachusetts i/,.. `'` State Building Code is cause for revocation of this license. r ,.ttl'� For information about this license / Call(617)727-3200 or visit www.mass.gov/dpi Commissioner agistraticc yplid for individu;9 use only !rare gpirauan date if fn, returnto: Office of Consumer Affairs&Business Regulation ..Cfce of ..onsumer Affairs 9r ' .mess Regulation HOME IMPROVEMENT CONTRACTOR :0 Wa- hington Street u. 710 TYPE:Individual L:)sL-on,• A 02118 Registration Expiration 132751 04/0112021 THEODORE TOWNE JR. Not valid wit ut signatu THEODORE TOWNE 21 LOUDVILLE RD. -1���` t EASTHAMPTON,MA 01027 Undersecretary `I f Descriptor/Area A:UAl2Fr/B 624 sgft i B:1.5FrlB 10 10 19 240 sot 9 0FP 9 9 1 Fr 9 9 1 R/0 C.EFP 90 � 180 12 240 sgft D:1 Fr1B 10 10 26 33 180 sgft E:OFP 90 sgft F:1 Fr EFP 1 5FF/8 UAl2FrlB 90 sgft 24(W4 24 24 240 L4 24 6�4 24 10 10 26 Out-Buildings: Code: Description: Units: Year Built: Sizel: Size2: Area: Grade: Condition: RS1 1 2000 1 240 240 C AVERAGE(Res) The information delivered through this on-line database is provided in the spirit of open access to government information and is intended as an enhanced service and convenience for citizens of Northampton,MA. The providers of this database:Tyler CLT,Big Room Studios,and Northampton,MA assume no liability for any error or omission in the information provided here. Comments regarding this service should be directed to:jsarafin@northamptonassessor.us Thu.May 28,2020:08:07 AM : 0.08s: 10mb rnxn�._ IV,c K�/�►-�,,� � L Nov c to p!/G "�Z 1