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31B-314 (15)
15 PARK AVE BP-2020-1208 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:31 B-314 CITY OF NORTHAMPTON Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Penn it# BP-2020-1208 a Proiect# JS-2020-002030 Est.Cost: $2549.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Group: RENAISSANCE BUILDERS 013302 Lot Size(sg.ft.): Owner: ELIZABETH WADHAM Zoning:URC(100)/ Applicant: RENAISSANCE BUILDERS AT. 15 PARK AVE Applicant Address: Phone: Insurance: P O Box 272 (413) 863-8316 Workers Compensation TURNERS FALLSMA01376 ISSUED ON.6/5/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-PARTIAL ROOF REPAIR 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 6/5/2020 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Status of Permit: t , . Building Department \�_ Curb Cut/Driveway Permit A 212 Main Street SON Sewer/Septic Availability Room 100 '?090 Water/Well Avaslability Northampton, MA 01(7 TWo Sets of Structural Plans phone 413-587-1240 Fax 41 F� Plot/Site Plans q nips�o 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 3 / Unit 15A Park Ave, Northampton, MA 01060 Zone Overlay District Elm St.District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: e 550'v c.�- Name(Print), Current Mailing Address: a Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $2,549.00 (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 6. Total = 0 + 2 + 3 + 4 + 5) $2,549.00 Check Number SW7 n This Section For Official Use Only Building Permit Number: I' a� �a0� Date Issued: Signature: -J-Z0zo Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Sec. CAvc r J JV o c f}AM CE 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 C Frontage Setbacks Front Side L:= R:0 L: R:.-._� Rear Building Height L Bldg. Square Footage0/0 ' Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces -----� Fill: volume&Location ------ � A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ® DON'T KNOW ® YES IF YES, date issued:! IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW 0 YES 0 IF YES: enter Book 7--1 Pagel and/or Document !# B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW ® YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO 0 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 [O] Decks [Q Siding [O] Other[L7] Brief Description ofropose Work:— :?&11-U YOp� 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 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 _E_O\ S 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, 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 Name Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: .^ 1 Not Applicablle� ❑ Name of License Holder: S �" ` v 1,1�{Q,In 1J1�od Q4 e,s — V 1 � License Number V-\ �-�T El\ , Int I°t 0 �� LA /n 1 ( U z l Address Expiratioh Date r3- 81a3 - 'bl Signatur Telephone 9. Registered Home Improvement Contractor: Not Applicable q❑ Company Name Registration Number ?Q g o�c Z`l2 . 71�6yu r > l�S MH- 613-7(e 1 /22126 Addres Q Expiration Date Telephone CJ(93'83r 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....... A No...... ❑ 1_1/� RENAISSANCE BUILDERS PO BOX 272, TURNERS FALLS, MA 01376, 413.863.8316 INFO@RENBUILD.NET, WWW.RENBUILD.NET May 28, 2020 Elisabeth Wadham 15 A Park Ave. Northampton, MA 01060 Work List for Partial Roof Replacement on Unit A at Above Address. Scope to include the following: Strip and replace roofing on right side of dormer only above back entry door. Leave existing snow belting in place. 1000 GENERAL CONDITIONS 1530 Temporary Protection A. Provide protection to vegetation at affected work areas. 1950 Owner Responsibilities A. Remove and reset plants. B. Cost of electricity and water during construction. C. All other phases not specifically outlined in this Proposal. 2000 SITE WORK 2220 Demolition, Exterior A. Remove and legally dispose of existing roof shingles in specified area. 7000 THERMAL & MOISTURE PROTECTION 7300 Roofing A. Install WR Grace Ice & Water Shield roofing underlayment over entire specified area. B. Install one (1) new aluminum plumbing boot. C. Install continuous ridge vent. D. Install 35-year, architectural shingles, LANDMARK Woodscape Series, by CertainTeed. END OF WORK LIST Wadham Proposal Page 3 ACCEPTANCE OF PROPOSAL: Agreement between: Elisabeth Wadham, 15 A Park Ave, Northampton, MA 01060 And Renaissance Builders, PO Box 272, Turners Falls, MA 01376 The prices, specifications, and conditions are satisfactory and are hereby accepted_ You are authorized to do the following work as specified in the Proposal dated May 20, 2020: Partial Roof Replacement $ 2,549.00 Please make the following changes or clarifications: Payment will be made as outlined below: Deposit on signed acceptance of Proposal: $ 500.00 Balance due on substantial completion. I authorize you to apply for a building permit, if required, on my behalf. '0W ce-I t52v 2o20 Customer Signature Date C i i 2 a�e�b-i y ecd 1 I_a V-pi Please print legal name for Contract Documents Customer Signature Date Please print legal name for Contract Documents All individuals listed as Owners of Record for a property are required to sign Contract Agreements. Please note any corrections to your name or address. Also, please give us your phone number(s) and the best times to reach you so we can keep you posted regarding our schedule. You may also provide an email address if that is a good way to contact you. Note: Please return only this signed acceptance sheet along with deposit. Retain the Proposal for your records. Renaissance Builders, PO Box 272, Turners Falls, MA 01376 License#013302, Registration#106490 5/20/2020 The Commonwealth of Massachusetts j Department of Industrial Accidents Office of Investigations E_ 600 Washington Street r Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): RENAISSANCE BUILDERS Address: PO BOX 272 City/State/Zip: TURNERS FALLS MA 01376 Phone #: 413-863-8316 Are you an employer?Check the appropriate box: Type of project(required): 1.[X I am a employer with 22 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8, ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13. Other comp. insurance required.] *Any applicant that checks box#I 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: AIM MUTUAL INSURANCE CO Policy#or Self-ins. Lic.#: MCC20020004972020A Expiration Date: 01/01/2021 Job Site Address: Is P� 1palrk Avf— City/State/Zip: Ov lb Miq bIU(o0 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herehY certify d r to pains and penalties of perjurh tlrr tlt nforncntion provided above i.c true and correct. Si nature: Date: Int Z0Zd Phone#: 413-863-8316 _. 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#: A ® DATE(MM/2020 Y) 16-� CERTIFICATE OF LIABILITY INSURANCE o5/2a/2o2o 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: Webber&Grinnell PHONE (413)586-0111 FAY (413)586-6481 WC, IC No Ext): C No): 8 North King Street E-MAIL afeeley@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC p Northampton MA 01060 INSURERA: Arbella Protection 41360 INSURED INSURER B: MA Employers/A.I.M. 12886 Gill Building Corporation INSURERC: GuideOne National/BRECK 14167 DBA:Renaissance Builders INSURER D: PO BOX 272 INSURER E: Turners Falls MA 01376 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 1/2020 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 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 INSURANCEADULSUBM POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YY MMIDD/YYYY COMMERCIAL GENERAL LIABILITY1,000,000 EACH OCCURRENCE $ DAMAGE TO REN71� CLAIMS-MADE ®OCCUR PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 15,000 A 8500066134 08/01/2019 08/01/2020 -PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ® PRO ❑ 2,000,000 JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED 1020057016 08/01/2019 08/01/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY M 1 $ AUTOS ONLY Per accident UMBRELLA LIABX OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAR CLAIMS-MADE 4620085703 08/01/2019 08/01/2020 AGGREGATE $ 5,000,000 DED I>d RETENTION$ 10,000 $ WORKERS COMPENSATION YIN PER OTH- AND EMPLOYERS'LIABILITY STATUTEI ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? a NIA MCC20020004972020A 01/01/2020 01/01/2021 (Mandatory In NH) E .DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 PTOF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Each Occurrence $500,000 nactors Pollution Liability JDCE.SCRIION ENV562000484 08/01/2019 08/01/2020 Aggregate $500,000 Deductible $2,500 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) For interior renovations at the address below. CERTIFICATE HOLDER CANCELLATION Elizabeth Wadham SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 15A Park Ave THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Northampton,MA 01060 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 AFFIDAVIT FOR DISPOSAL OF DEMOLITION DEBRIS Supplement to Permit Application As a result of theprovisions of MGL c. 40, s54, I acknowledge that as a condition of the issuance of a 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. I certify that debris resulting from this demolition will be disposed of as listed below. Job Site Location: Is Iq pp• r1t!- 14V YL�"ayn htl�'(1+6 Name of Permit Applicant: Renaissance Builders Disposal Facility: F & G Recycling Address of Facility: 15 Mullen Rd., Enfield, Ct 06082 IF--SAID-FACILITY ISOTHER- ti TiAT I HAVE LISTED,I CERTIFY THAT I WILL NOTIFY THE BUILDING OFFICIAL OF THE CORRECT LOCATION OF THE SOLID WASTE DISPOSAL FACILITY WITHIN TWO MONTHS OF THE DATE OF THIS APPLICATION. Signature of Applicant ate RENAISSANCE BUILDERS PO BOX 272, TURNERS FALLS, MA 01376, 413.863.8316 INFO@RENBUILD.NET, WWW.RENBUILD.NET May 28, 2020 Louis Hasbrouck Building Commissioner's Office 212 Main St. Northampton, MA 01060 Louis, Enclosed is a permit application for a partial roof replacement, leak repair, for Elizabeth Wadham. The work is at 15A Park Ave, Northampton, owned by Elizabeth Wadham who has provided us with the parcel ID 31B314002. We could not locate a property card for her property in the Northampton database. There are sections of the permit application I was unable to complete. Hopefully the property ID number will provide you with the information you need. Stephen is the project manager for this job. His cell phone number is 772-9430 if you have questions or concerns. Also included is: ❑ A scope of the work ❑ An Owner Authorization signature page ❑ A Worker's Compensation Insurance Affidavit ❑ A current COI ❑ Demolition Affidavit ❑ A copy of Stephen Greenwald's Construction Supervisor License ❑ A copy of Renaissance Builders HIC ❑ A check for $40.00 T ank you, Natasha Olanyk Administrative Assistant natasha(a)_renbuild.net