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30B-043 (4) 291 RIVERSIDE DR BP-2021-1003 GIs#: COMMONWEALTH F MASSACHUSETTS Map:Block: 30B-043 CITY OF NO THAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGI TIRED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:demolition BUILDING PERMIT Permit# BP-2021-1003 Project# JS-2021-001717 Est.Cost:$5000.00 Fee: $75.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: NU-WAY HOMES INC 013693 Lot Size(sq.ft.): 17990.28 Owner: NU-WAY HOMES INC Zoning: URB(100)/ Applicant: NU-WAY HOMES INC AT: 291 RIVERSIDE DR Applicant Address: Phone: Insurance: 10 WHITE AVE (413) 563-0085 Liability EAST LONGMEADOWMA01028 ISSUED ON:3/19/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:TO REMOVE EXISITNG GARAGE 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 OFNORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. I ; I )I . Certificate of Occupancy Signature I FeeType: Date Paid: Amount: Building 3/19/20210:00:00 $75.00 212 Main Street,Phone(413)587-1240, Fax:(413) 87-1272 Louis Hasbrouck—Building Commissioner 4 \irRtr File#BP-2021-1003 APPLICANT/CONTACT PERSON NU-WAY HOMES INC ADDRESS/PHONE 10 WHITE AVE EAST LONGMEADOW (413)563-0085 PROPERTY LOCATION 291 RIVERSIDE DR MAP 30B PARCEL 043 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 14 16 Fee Paid Typeof Construction:_TO REMOVE EXISITNG GARAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 013693 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: X Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay ' � i )�� � � 3/I Si.nature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. ' F.'I ,_„it-/ 9n2 i'''II i nPr.." -WE- _- The Commonwealth of Massachusetts If! Board of Building Regulations and StandardFOR ICIPALITY Massachusetts State Building Code, 780 CMR _ USE Building Permit Application To Construct, Repair,Renovat&Oi;"Demolish:a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: s( j-?/-/D 5 Date Applied: i ' 14 icT3''; .34 a1 BuildingOfficial(Print Name) Signature 1 Dalte SECTION 1: SITE INFORMATION 1.1 o erty Address: 1.2 Assessors Map&Parcel Numbers Yi tei IA/Srere 01771 3 6 F d Y''> --on i 1.1 a Is this an accepted street?yes `'"-- no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Ur( Ofiry.In_ Je Zoningistrict 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 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: t/ii -c/a / 7e ..1�c. L, L�'�y ., eRr.� / 6i4/ 0/0 Name(Print) / ry/i`City, State; IP h 4,i4:r7 a v/ - ( J 5-6 3 eo�'r �U��,%.�e> el 961,44,2,60,7 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑ Demolition 7( Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: 72, g << ✓C .L,r'r 5f j a~7 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 3 Ger U 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ 0 Total Project Cost3 (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire 474 Suppression) $ Total All Fees Check No. 10 MU Check Amount. Cash Amount: 6. Total Project Cost: $ 3-7 060 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 3 Co)$ f, J/Yj,,t,,he ( License Number Ex cation Date Name of CSL Holder List CSL Type(see below) /V. /9Ve Description No.and Street Zen/4 /LM ,/14rNeildltX /0,4 OJo / Unrestricted(Buildings up to 35,000 cu.ft.) Restricted 1&2 Family Dwelling City/Town,Stgte,ZIP M Masonry RC Roofing Covering ��/�3 WS Window and Siding J '$ iv e SF Solid Fuel Burning Appliances 56 3 i0 U J1e,ae s Go P G(1/Xa'/, I Insulation Telephone v Email address ro-py D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street / - I m 1 address City/Towrf,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 .....!� No ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,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. 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 be my knowledge ders ding. a4017,A, /,Xiaeht„,77,_r;IfeeSe/„?.(.. 4 Print Owner's or Authorized Agent's Name(Electronic Signa ate 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 www.mass.gov/dps 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" ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 03/01/2021 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 Anne Brunk NAME: Crimmins/Graveline Insurance Agency,Inc. (A/CNNo Ext): (413)283-8378 FAX No): (413)283-2556 1382 Main St. ADMDARIESS: abrunk@cgins.com P 0 Box 905 INSURER(S)AFFORDING COVERAGE NAIC# Palmer MA 01069 INSURER A: James River Insurance Co. INSURED INSURER B Nu-Way Homes Inc INSURER C: 10 White Avenue INSURER D: INSURER E: East Longmeadow MA 01028 INSURER F: COVERAGES CERTIFICATE NUMBER: 2020 GL 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 RETED CLAIMS-MADE X OCCUR PREMISESDAMAGE TO(Ea occurrence) $ 100'000 MED EXP(Any one person) $ 5,000 A 000840842 08/06/2020 08/06/2021 PERSONAL a ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS_ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:57 Warner Street Northampton MA 61 Warner Street Northampton MA 6 Warner Street Northampton MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main Street AUTHORIZED REPRESENTATIVE � //!/J Northampton MA 01060 �Seie as ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD City of Northampton _ Massachusetts }' s,'••f 4 DEPARTMENT OF BUILDING INSPECTION 71 212 Main Street • Municipal Building) wsti. Q� Northampton, MA 01060 f 0 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: V/ Itl y,r_i? The debris will be transported by: /1/1-4 ire /9 Name of Hauler: Signature of Applicant: Date: 3/ The Commonwealth of Massachusetts A * 1, Department of Industrial Accidents et= 1 Congress Street, Suite 100 _ �•�__MI Boston,MA 02114-2017 • �.�'` 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): ill6"ti goy,r s .4.7 ci Address: /6 4->h,7e /1 tile ,,q At C.)/d a City/State/Zip: 7 -, 4,,,,, ,�p NAV Phone#: ( ' f - `— iI$ Are you an employer?Check the apprropriate box: Type of project(required): 1.0 I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.1=1 I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9— .])emolition 10 ❑ Building addition 4.❑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.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.14 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 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. tConactors 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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 certi under the pains n penalties perjury that the information provided above is true and correct �� ,ram Signature: I/ - l'`t i Date: 3/ ,/ ,:2 l Phone#: (W))56 !J 4 ,i�— 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�oh nCrr, DAZE(MM/DO/YYVY) �...r CERTIFICATE OF LIABILITY INSURANCE 03r01r2021 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 ICONTACT Anne Brunk NAME: Crimmins/Graveline Insurance Agency,Inc. (aCNNo.ems): (413)283-8378 FAX ( No)_ (413)283-2556 1382 Main St. abrunk@cgins.com ADDRESS: P 0 Box 905 INSURER(S)AFFORDING COVERAGE NAIC 0 Palmer MA 01069 INsuRERA: James River Insurance Co. INSURED INSURER B: Nu-Way Homes Inc INSURER C: 10 White Avenue INSURER D: INSURER E: East Longmeadow MA 01028 INSURER F: COVERAGES CERTIFICATE NUMBER: 2020 GL 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 I TYPE OF INSURANCE IN D Sw11BypR POLICY NUMBER PMICYDDr EFF POLICY EXP LIMITS LTR (MMIDDMfYY) (MM/DDrrYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1.000'000 DAMAGE RENTED CLAIMS-MADE XI OCCUR PREMISESO(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A 000840842 08/06/2020 08/06/2021 PERSONAL&ADV INJURY $ 1'°°°'°°° GEM_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY JT I I LOCEC 00 2, 0,0 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS_ HIRED NON-OWNED PROPERTY DAMAGE _ AUTOS ONLY AUTOS ONLY (Per accident) S UMBRELLA UAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE S DED RETENTIONS $ WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY YIN STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISPOSE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RE:57 Warner Street Northampton MA 61 Warner Street Northampton MA 6 Warner Street Northampton MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main Street AUTHORIZED REPRESENTATIVE /� Northampton MA 01060 ��(Stk/,f/r/ gfA ®1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD