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29-056 (4) 46 GILRAIN TER BP-2021-0110 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-056 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 &BATH RENO BUILDING PERMIT. Permit# BP-2021-0110 Proiect# JS-2021-000177 Est.Cost: $5425.00 Fee: $100.00 PERMISSION IS HEREB Y GRANTED TO: Const.Class: Contractor: License: Use Group: THOMAS QUINN 108861 Lot Size(sq.ft.): 34717.32 Owner. THOMAS F QUINN zoning: Applicant. THOMAS QUINN AT. 46 GILRAIN TER Applicant Address: Phone: Insurance: PO BOX 247 (413) 320-20300 WC LEEDSMA01053 ISSUED ON.7/28/2020 0:00.00 TO PERFORM THE FOLLOWING WORK.-KITCHEN, AND BATH 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 7/28/2020 0:00:00 $100.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner I �°O o The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR V Massachusetts State Building Code, 780 CMR MUNICIPALITY USE ing Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 N One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: / Date Applied: a Building Official(Print Name) Signature Dat SECTION 1:SITE INFORMATION 1.1 PropertyAd j qress: •/ 1.2 Assessors Map&Parcel Numbers �� �O'•! I?/t�fir/ '�«eoce_ f/piR..Ce A-2 14 —O c 1 1.1 a Is this an accepted street?yes V 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 Flood Zone Information: 1.8 Sewage Disposal System: Public® Private❑ Zone: _ Outside Flood Zone? Municipal It On site disposal system ❑ Check if yesEl SECTION 2: PROPERTY OWNERSHIP' 2. Owner'of Record: 7a l-4 S 'r r1:� Name(Print) City,State,ZIP No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': 12r l+Qcc C , o, r. � /-/- /loe ` er- 2 /1 Z32 C4 Ile SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) 1. Building $ -0 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ �?f ❑ Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3. Plumbing $ 3 loci . `� 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ q, 401, 6. Total Project Cost: „� Check No. Check Amount: Cash Amount: $ L S-� ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction S77111A-v r License(CSL) 2d �"'r 1 License Number Expiration Date Name of CSL Holder —7 � K�� /,-W �D, /30� q List CSL Type(see below) y No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding r f SF Solid Fuel Burning Appliances C41i 3/ 3?o -?d3 0 ?p—� 6G c( a� f r-(0 t,coati 1 Insulation Telephone Email address D Demolition 5.2 Registered Home ImpiLovement Contractor(HIC) HIC Company Narpe or HIC Re&trant Name HIC Registration Number Expiration Date No.a d Street Email address _-r�7s /ham o/oS" yi3 ?o-Do�c5 Ci /Town,9tate,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 ..........VP No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize Thu ryt� 0 v t n h to act on my behalf;in all matters relative to work authorized by this building permit application.vt r 7pl '?1MIZ aZ Print Owner's N (Electronic Signature) Date SECTION 7b:OWNERI 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./ we 4 r "r- a f w-✓ "' f°�� �l�?F (/ ?0 2 0 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.maaL.g-ov/oca Information on the Construction Supervisor License can be found at www.masssoy/dips 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 halFbaths 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 Commonivealth t>f.Massachusetts Dellartment of Industrial.-1 ecidents 1 Congress Street.Saito 100 Boston, 31.402114-201- Km m moss.got ldia I$os kers'Compensation Insurance Affidavit: Builders[('ontractorx'E k-cirician%?Plumbers. 10 81.FILED N I I It l llE 11:K1111TING At 1110R]11. Applicant Information Please Print L ibh Name Il;usury%sOrgantration'Individual l: Address: I '? CityfStatdZip: ��-r�� `hla Dlg?,r-7 Pion 0:r /3 3�)v - -2o Are yii air mpiwee(Berk for apprupriate baa: Tape of project(rryuired): L(B I am a cmpkwcr with cr W6yxcs(fill)and or part-ureic).* 7. a New construction ±c]1 ansa suk:pnipm-kv or paanmAip and haw nu cnpkvym%working fur nsc mF art) ►capacity.1%u%tilos'cunW.mittramv roquiral.l S. 0 Remotlelin 9. ❑Drnwlt[tcxt 301 am a hunKxmAnkv dwng all work rr►rsclf.1\u wort rs'cm op.imutawc wtItured.l' 401 am a hurmvwner and will be hirmg curWaton to cox dmi alk wcrk on nth pnperty. 1 will 1U Building addition eruure that all cwdrttun crihrr have woricn'comp%:n%atron uksurancY car:mc mAc 11.0 Electrical repairs or additions pnaprw-ton w sth m?rmployvcs. 12.[E]Plumbing repairs or additions y�t ant a gc-rrcral contractor and I hu�c hind the wb ccmtractors bAM on the attached shcsy.. Tbesc sub-cuntracton ha�.c Lmooycc-,and(nye wortrn'coup.irwurarnc.- 13.E]Roof repairs 6.Q We an,a cogxwalrcm and It]offican ha%c exctused dwiF nght of cunptruo per Mil.l- 14.0Othet — -- 132 1141.mW we hare no cmWloycvs.I%o wm"'con►.insurancemquiw&) 'An)applicant that check:box a 1 rnw-A also rill out the iamtwn bckaw showing diene WOrltu� to uspcnsaluon policy i 1famuds tit. ►Horueownrn who submit this affinkvit inahcaturg they arc dc.ing all work and hies Wee ouLmik-%a4-va sours awe Millie&a now affanit mdicytmy aar:h- C ontracton that cbccl this.Ks%nuM attached an mikhuonal ahcvt show rasa tic name of dw yuFrcontta,:u. and tonne trltmler a tion those cnuurs tsaec crs7g>r U)v%—s. if the sola-cosNraitlxs ime arrplovcvs.thcs mu,d pnaaidc their wvttkcn'c-&mrp.Fw ho.minty:. I ant an employer that is providing workers'compensation insurance for net'employees. Below is the policy and job site information. Insurance Company Nerve: zvra.e-t Cornonevircrk ---------- Policy --..---Policy#or Self-ins.Life.#: GZZLj ^-7// 7.T _qS"—y— Expiration Date: /� Job Site Address: e7lell �'� 411-11c Citya'S1ate Zip://-0--c-cr ^.* Attaci a copy of the workers'compensation policy declaration page(showing the policy num ober and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a file up to$1.500.00 an or one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a fine of up to 6250.00 a Clay 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 herebycerdjy and ins and pen_ ojpery"ary that the information provided above is true and c orrecL i Signature: Darr o Phone ///3 310 r 2 3U Official use only. Do not write in this area,to be completed by city or town offi-ciaL City or Town: Permit/License!! [%suing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing inspector 6.Other Contact Peron: Phone#: City of Northampton Massachusetts .,A N. DEPARTMENT OF BUILDING INSPECTIONS y: ; 212 Main Street • Municipal Building Northampton, MA 01060 rsy `10 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 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, S 150A. The debris will be disposed of in: Location of Facility: The debris will be transported by: Name of Hauler: Mm Date: Signature of Applicant: ( / o�a CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE A�® CERTIFICATE OF LIABILITY INSURANCE DATEIMM/DD/YYYY) 04/10/2020 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 polioy(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 Elizabeth Carballo,CISR NAME: Finck&Perras Insurance Agency Inc. PHONE., . (413)527-5520 FAX No: (413)527-5970 6 Campus Lane EMAIL bcarballo@finckandperras.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC s Easthampton MA 01027 INSURERA: State Auto Insurance Companies INSURED INSURER B: Thomas Quinn INSURER C: P 0 BOX 247 INSURER D: INSURER E Leeds MA 01053 INSURER F COVERAGES CERTIFICATE NUMBER: CL2041004835 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. I SR ADDLISUBR POLICY TYPE OF INSURANCE POLICY NUMBER MWOD EFF POLICY NDD EXP LTR LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,000 TAMAGE70 RENTED50,000 CLAIMS-MADE ©OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ 5,000 A BOP2689181 08/21/2019 08/21/2020 PERSONAL&ADV INJURY $ 500,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 POLICY F-1 ECT F1 LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED P $ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER ER AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E .DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Proof of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Tim Seney Contracting Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 371 Prospect St. AUTHORIZED REPRESENTATIVE Northampton MA 01060 Vx 6"�a ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD '01 v ,t4�. ...•:1.�.�G rsr. , 'r. .Crt 12:" -1 v-i_. " i+;;."bti.{t: +�� �i�iY+: ,..',C••.� �ilt^ r,.p,'1ii�r.rlhy .',h•_. ft^�N•.:.j•-. .;1.'.+,,.'�y't a~C t?"!,: i}i.(.�.:.: !:TF.�: .. 74:%,-'1, a �r.. 1t,.' 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")C its.,_...� s .;r: . •C -,h_ .. �' ,.. - - `. t _ � •'•v r�'dt o .. ..'. ice. ire_ t-t.,:.... �re,r .,.. - ;�.i+la.'L7:'ir#(�ti+"i. y...,.... ...--. .,-. .vrM+ar -.....w,.�..�i�.,,_- ..�w.w+.w.a...,. ..«......�arr••rwr ..a,.+w..u...-,.... 4 �,.-,F�. _a ....www _e.r. , •_<...w/il..a .+vs...yw•..,.,..,_.,w.w�.r.ra_... , r t .r t ,ia t!kld. .C_('Y' car. --Y r�I 3,:•i Il:##af�rr{H'IC, .0 ...'•••'�.i:.0 � � r' (; � 6 'yjC }A3 1.0(t}4r { •'1 f i} �� iii..rt�`.e jt ai::;r # -g;1e a .� nt P !9� t41 :l!' d ati ttn0 ♦ .Y "ihr ,h;_`?tf l.'it:'!. 5...:c ?; t`c{"' t.; ot" t., ' .- '�! 1.�.`.'P1�L e; "" f« t ..•!c�x'i19;;,I-lt3x :.''rti�v�;. ,l�.ek: .�S t, '° r � c#= -G GE; l;? DATE(MM/DDIYYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE Imo/ 06/30/2020 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 poliey(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 Cyndie Henderson CISR,CPIA NAME: Webber&Grinnell cNo 4 -0111 (413)586-6481a/ NExt: ANa: 8 North King Street E-MAIL chenderson@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA: Northern Security 25992 INSURED INSURER B: Allmerica Financial Benefit/Han 41840 Julie Martyn and John Geryk INSURER C: Massachusetts Bay Ins/Hanover 22306 89 Oak Street INSURER D: INSURER E: Florence MA 01062 INSURER F: COVERAGES CERTIFICATE NUMBER: Master Exp 11/2020 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 POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MMIDD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 500 000 CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ 15,000 A BP21056505 03/05/2020 03/05/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 3,000,000 POLICY ❑PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 3'l)00'000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1.000 000 Ea accident ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED AWNH9175600 11/15/2019 11/15/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS XHIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY Per accident Underinsured motorist BI $ 100,000 UMBRELLA LAB ter' OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN 500,000 C ANYPROPRIR/PARTNER/EXECUTIVE NIA WDNHO9187000 03/12/2020 03/12/2021 E.L.EACH ACCIDENT $ OFFICER/MEMBMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I 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 Town of Amherst ACCORDANCE WITH THE POLICY PROVISIONS. Boltwood Walk AUTHORIZED REPRESENTATIVE Amherst MA 01002 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD k �/' :!?�I . . (�%}-% ,:w,i�: .j' •;j�` N'islJ:1(liy:Ct': _!.G.'.se'li.. ,+!1`.•-;?'�", ... .r„ - . - - � ,Ty '�•s* .;i% rani-" - �kti;i`7.L+r`/}" ;:e.? 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