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17C-282 (10) 18 LILLY ST BP-2021-0031 GIS#: COMMONWEALTH OF MASSACHUSETTS MM:Block: 17C-282 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) CateQorv: Deck BUILDING PERMIT. Permit# BP-2021-0031 Project# JS-2020-002177 Est.Cost: $12400.00 Fee: $81.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: KENT HICKS 66104 Lot Size(sq. ft.): 16857.72 Owner: HOOKER MICHAEL D Zoning:URB(100)/ Applicant. KENT HICKS AT. 18 LILLY ST Applicant Address: Phone: Insurance: P O BOX 57 (413) 296-0123 O WC WEST CHESTERFIELDMA01084 ISSUED ON:7/10/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.deck and new doorway 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 7/10/2020 0:00:00 $81.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner r Ll 7� 3 The Commonwealth of Massachusetts >wETD Board of Building Regulations and Standards FOR Massachusetts State Building Code,780 CMR MUNICIPALITY v USE o y QJ Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mw-2011 o© One or Two Family Dwelling This Section For Official Use Only a unit Number: Date A plied: �/ JO Building Official(Print Name) Signature Da SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 18 Ll t-LV -A-. 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 FIood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check ifyes❑ SECTION 2. PROPERTY OWNERSHIPI 2.1 Owner'of Record: P,K Lr 1f caKt f t�rte�N c t� /t'l e/o 4 Z Name(Print) City,State,ZIP t,VLl� S4 #(? '32-0 - W1O No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that appl)) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units I Other ❑ Specify: Brief Description of Proposed Work': ck d-U.) p oo 2 W k 5 f crV tYl�, W;4- ,in > P rah SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) 1.Building S 1. Building Permit Fee:S Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) S List: 5.Mechanical (Fire S Su ression) Tota]All Fees:$ Check No. Check Amount:K Cash Amount: 6.Total Project Cost: $ /2� y 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) e-S -off G/off 1/12-/7-7-- r l t License Number Expiration Date Name of CSL Bolder List CSL Type(see below) U No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) MA- O (Ot'l R Restricted 18,•.2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding #13 1yo/Z3 e-wr l 16 t-Sr-o• S mu OttwSF Solid Fuel Burning Appliancesliances Ce M I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) !2o K; -z-t 2 ZZ /c L,N r Fh al-5 Co ii S mo a R o-tJ C 6 • HIC Registration Number Expiration Date FITC Company Name or HIC Registrant Name ve-ra r@ 4 3%4 A4 yy-t nJ (L D - r-e Pi rift et"rL onl S Tn u c E7 cN• f dm No.and Street IN • GrE S S rtrrc;=i tr't_t),M -A D 10 Z�l ^612-3 Email address City/Town,State,ZIP Telephone SECTION 6: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.......... 0( No...........El SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNTER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize . k 5 to act on my behalf,in all matters relative to work authorized by this building permit application. M; k e -�g J&,A V--) _ �.0.), a Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at wwnv.mass.,ov/dns 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of Massachusetts = Department of Industrial Accidents a d I Congress Street, Suite 100 Boston,MA 02114-2017 o,M www mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Business/Organization Name: Kent Hicks Construction Co. Address:P.O. Box 57 City/State/Zip:W Chesterfield, MA 01084 Phone#:413-296-0123 Are you an employer?Check the appropriate box: Business Type(required): 1.21 I am a employer with 10 employees(full and/ 5. ❑Retail or part-time).* 6. ❑Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7_ ❑Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] g• E]Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152, §1(4),and we have 10.❑ Manufacturing no employees. [No workers' comp.insurance required]* I 1 ❑ Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers' comp.insurance req.] 12.❑✓ Other Construction *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#l. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name:Webber&Grinnell Insurer's Address:8 North King Street City/State/Zip: Northampton, MA 01060 Policy#or Self-ins.Lie.#5B9686920 Expiration Date: 12/8/2020 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 hereby certify,under the pains and penalties of perjury that the information provided above is true and correct. Signature: ,� ZDate: L�ZD Phone#:413-296-0123 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. Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia The City of Northampton Building Department 212 Main Street Northampton, Massachusetts 01060 Phone (413) 587-1240 Fax (413) 587-1272 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVAT ION PROJECTS) In accordance with the provisions of MGL c40, s54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, sl 50A. The debris will be disposed of in: Location of Facility The debris will be transported by: Name of Hauler C—AS vnV (SAS-� 5L(S µS Signature of Applicant: Date: A�" 04/299//22020020 W) CERTIFICATE OF LIABILITY INSURANCE DATE(M 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 FAX (413)586-6481 AIC No Ext): AIC No 8 North King Street E-MAIL afeeley@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC i Northampton MA 01060 INSURERA: Employers Mutual Casualty Company 21415 INSURED INSURER B: Kent Hicks Construction Co.,Inc. INSURER C: Attn: Kent Hicks INSURER D: PO BOX 57 INSURER E: West Chesterfield MA 01084-0119 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 12/2020 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 ADDLSUBR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICYNUMBER MMIDD/YYYY MMIDD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED- CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 500,000 MED EXP(Any one person) $ 10,000 A 5D9686920 12/08/2019 12/08/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑X JRD- FILOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED 529686920 12/08/2019 12/08/2020 BODILY INJURY(Per accident) $ AUTOS ONLYAUTOS X HIRED IX NON-OWNED PROPERTY DAMAGE $ AUTOS ONLYAUTOS ONLY Per acddent $ X UMBRELLA LIARX OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR 11 CLAIMS-MADE 5,19686920 12/08/2019 12/08/2020 AGGREGATE $ 1,000,000 DED I X RETENTION$ 10,000 $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY YIN X STATUTE ER 500,000 A ANY PROPRIETOR/EXCLUDE R/EXECUTIVE N/A 589686920 04/05/2020 12/08/2020 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,desc be under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If mare 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 Jauoiss!tuwo v �H ksio i1d33H0 � 1S3M ZZOZ2l/l0:say! ` [S X08 Od OIH S 1N3m �os!N cu \ VO1990-So a sp�ePueiS pue sT " +�SU0 3 a-insua:)!.7 lelnSa leuo, a6u!p1!ns apJeo8alo�suasn asse Of Jo uo! �o431"MuotUwoO �^) �.rn„aorzraw4 , /�A�sa�.�u�f�,. �-- Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR �..� TYlt.\Individual R � _ Ex iration —"— 2/27/2022 yr KENT HICKS KENT S.HICKS 634 MAIN ROAD WEST CHESTERFIELD,MA 01084 Undersecretary EXISTING STRUCTURE BEYOND CO!) c i U z s cj F l ' a 0 2X8 PT LEDGER Z E­ W z x 1�I O 2 ROWS 3/8" LAG F�1 BOLTS ® 16" O.C. STAGGERED PER CODE Ucoo 0 2X8 JOISTS 0 16" O.C. o 0 DOUBLE 2X8 PT RIM JOISTS, TYP. U N ue`�i ^• 4X4 PT POST 3 r E ALAN I SCALE: 3/4" = 1'-0" WOOD GUARDRAIL POSTS AT CORNERS WOOD GUARDRAIL POSTS AT AND MID-SPAN CORNERS AND MID-SPAN 36" HIGH DECK 36" HIGH DECK GUARDRAIL O GUARDRAIL WITH WITH STAINLESS STEEL CABLE STAINLESS STEEL SYSTEM. SPACE CABLES 3" CABLE SYSTEM. O.C. AS PER CODE SPACE CABLES 3" O.C. AS PER CODE DOUBLE 2X8 PT RIM w JOISTS, TYP 3 SIDES w NEW 2668 DOOR SIMPSON LCE4 PLATES TO FASTEN TREX COMPOSITE DECKING POST TO JOISTS 4X4 PT POST SIMPSON LUS26SS JOIST Q HANGERS INSTALLED ON BOTH ENDS OF EACH EXISTING 2X10 JOIST RAFTERS ® 16" O.C. -- 2 i 12 2 FASTEN POST TO —_ 2 ROWS 3/8" LAG EXISTING RAFTER AND O BOLTS 0 16" O.C. TOP PLATE WITH 1/2- STAGGERED /2"STAGGERED PER CODE BOLTS AND SIMPSON HL33 ANGLES FAS EXIT TopTING RAFTEWITRE WITH 1 HU EACH EXISTING RAFTEROP EXISTING RAFTER AND HURRICANE TIES INSTALLED NEW SIMPSON H1 2 BOLTS AND SIMPSON AND FASTENED TO EXISTING HL33 ANGLES EXISTING 2X10 EXISTING TOP PLATES RAFTERS 0 STRUCTURE w o 16" O.C. ✓ BEYOND EXISTING TOP PLATES EXISTING STUDS AND STUDS AND TOP PLATES LEVATION — SIDE VIEW LEVATION — FRONT VIEW 2 SCALE: 3/4" = V-0" 3SCALE: 3/4" = 1'-0" 1.0