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17C-193 (2)
16 WILDER PL BP-2021-1027 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C- 193 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Bath reno BUILDING PERMIT Permit# BP-2021-1027 Project# JS-2021-001753 Est.Cost: $32418.00 Fee: $214.50 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: WILLIAM LABOMBARD 060247 Lot Size(sq.ft.): 5575.68 Owner: SADOWSKI JEAN M Zoning: URB(99)/GB(1)/ Applicant: WILLIAM LABOMBARD AT: 16 WILDER PL Applicant Address: Phone: Insurance: 12A PARKER AVE (413) 687-7946 0 W(' NORTHFIELDMA01360 ISSUED ON:3/19/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:2ND FLOOR 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 NORTHAMPT U N VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Lett40,_, . ''1 • Certificate of Occupancy Si nature( FeeType: Date Paid: Amount: Building 3/19/2021 0:00:00 $214.50 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner RECEI VE MAR 1 8 2021 Th‘Commonwealth of Massachusetts FOR F3UILDING INSPECTiorOardbf Building Regulations and Standards THAmnioN.PsAoloso MUNICIPALITY Massachusetts State Building Code, 780 CMR USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 6 R.- pp'? D to Applied: EUIIJ �I�053 l7-- 3 18 Z Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Ass s ors Map&Parcel Numbers l to 16 Wilder Place. 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 Flood Zone Information: 1.8 Sewage Disposal System: Public al Private 0 Zone: Outside Flood Zone? — Municipal® On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Jean Sadowski Florence, MA, 01062 Name(Print) City,State,ZIP 16 Wilder Place 413-586-4084 sadowskijean©yahoo.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building fzi Owner-Occupied ® Repairs(s) 0 Alteration(s) lB Addition 0 Demolition Cl Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: Full gut renovation of 2nd floor full bathroom. Existing window being replaced with tempered bottom sash window. One exterior wall to be insulated to code. No structural changes taking place. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 24,462 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ 4,284 0 Standard City/Town Application Fee 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 3,672 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees: $ 6V Suppression) [.� Check No.1 TCheck Amoun : s Cash Amount: 6.Total Project Cost: $ 32,418 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 060247 06/06/2022 William LaBombard License Number Expiration Date Name of CSL Holder 11 12 B Parker Ave. List CSL Type(see below) No.and Street Type Description Northfield, MA 01360 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 SF Solid Fuel Burning Appliances 413-687-7946 bill@ aipbuilders.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 114593 21 William LaBombard 10/5 HIC Registration Number Expirationion Date HIC Company Name or HIC Registrant Name 12 B Parker Ave. bill@ aipbuilders.com No.and Street Email address Northfield, MA 01360 413-687-7946 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 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 Aging In Place Builders to act on my behalf,in all matters relative to work authorized by this building permit application. Jean Sadowski 3-15-21 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. William LaBombard 3-15-21 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 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" City of Northampton /(NRMp Massachusetts �?' I DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 141;•• N CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 554, 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: Valley Recycling - Northampton MA The debris will be transported by: Allen's Roll Off Containers Name of Hauler: Signature of Applicant: Date: Y / 72( The Commonwealth of Massachusetts l Department of Industrial Accidents • - 1 Congress Street,Suite 100 p—• 1 =.11 f�. Boston,MA 02114-2017 wwrtmass.gov/die !)uukers'Compensation Insurance Aff das it:BuildersfCm tractors/EketriciansIPlurnbers. I't)RE FILED W'ITFI fHk Pl=ItMI'I i'ISiG Atl fHORi I'1'. Applicant Information Please Print Legibly Nano( Individual): Aging In Place Builders, Inc. Address: 203 Birnam Rd. City/State/Zip: Northfield MA 01360 Phone D: 413-225-3047 Merle as employee Cheek the appropriate boa: Type of project(required): LEI I am a employee with 2 _empiloyee%[full and ur part-tarn t.• 7. ❑New construction 2E3 I am a sole proprietor partnership and have emplovctis working fur me m 8. l Remodeling any capacity.[No workers'comp.insurance required" p--p 3�I am a homniwner doing all work myself_[No workers'comp.im urn lte rcytrrred.]• 9. R__I Demolition 4.01 am a Iwnadrwner and will be hiringt+nrrtrscturs to conduct all work on my property. 1 w ill 10 0 Budding addition ensure that all eoraractors either have woken'ctrnpelewiN]a in_+urancr in are sole 11.❑Electrical repairs or additions proprietors with no empluyecs. 12.13 Plumbing repairs or addilitht» SO I am a general cuntn actor and I have hued the sub-comtraeton listed on the attached sheet. 130 Roofrepairs The sub-contractors have employees and have workers'comp.insurance_;Thew 6.©Vic arc a corporation and its careers have exercised their ngla of exemption per MIiL c. 14.Ej Oar 152,11141.and we have no employees.[No workoas'camp.insurance required.) "Any applicant that checks Inn#I taunt also fill out the section below showing their workers compensation policy information. *Homowtrcta wbo submit this affidavit indicating they are doing all wink and then hire uuai&ceaOractors mint submit a new affidavit indicating such. :Contractors that cheek this box mint attached an additional sheet showing the rare of die sub-coraractors and slate whether or not those errors have employees. If the rub-euntracnnn have employees.they unit provide their workers'imam.pone)nuance_ I am an employer that is providing workers'compensation insurance for my employers. Below h Ike policy and job site information. Insurance Company Name: Associated Employers Insurance Policy#or Self i ns.Lic.#: WCC50050211662020A Expiration pate: 10/28/2021 Job Site Address: 16 Wilder Place Cttyl5mte/lip:Florence, MA, 01062 Attach a copy of the workers'compensall..polity declaretisa pare Oman the policy aaatber and expiration date). Failure to secure coverage as required holder MGL c. 152,§25A is a criminal violation punishable by a fine up to SI,500.00 and?or one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a fine of up to S250.00 a day against the violator_A copy of this statement any be forwarded to the Office of Investigations of the DIA for insurance coverage%erlticatio n. I do hereby certify under►h Hs and pen its o 'ur'that the information provided aboveis true and correct. Signature: 44 Date: ! /ram.2/ Phone#: 413-687-7946 Official use only. Do not write in this area.to be completed by city or town ofjkial City nr Town: Permit/License Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CityTIoan Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other t.ontact Person: Phone#: AC0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) `.� 10/27/2020 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 policy(ies)must 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 Adina Edgett NAME: g Webber & Grinnell mot.ExO: (413)586 0111 FAX No): (413)586-6481 8 North King Street ADMDRESS: aedgett@webberandgrinnell.com INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A:Evanston/BRECK INSURED INSURER B:Citation 40274 Aging in Place Builders, Inc. INsuRERc:Associated Employers Insurance , 11104 Attn: Jeff LaBombard INSURERD: 203 Birnam Road INSURER E Northfield MA 01360-9526 INSURERF: COVERAGES CERTIFICATE NUMBER:Exp 10/21 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 INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR _INSD WVD POLICY NUMBER (MM/OD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X OCCUR DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ 3E80810 10/28/2020 10/28/2021 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- X JECT LOC PRODUCTS $ 2,000,000 POLICY OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED AUTOS X AUTOS aCDA51 10/28/2020 10/28/2021 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE _ HIRED AUTOS X AUTOS (Per accident) Uninsured motorist BI split limit $ 100,000 UMBRELLA LIAB _OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WCC50050211662020A X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Jeffrey J. LaBombard E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? Y N/A C (Mandatory in NH) is excluded from coverage. 10/28/2020 10/28/2021 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �J W Grinnell, CPCU, CIC ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) Commonwealth of Massachusetts +~ It: Division of Professional Licensure Board of Building Regulations and Standards Cons�i i t rvisor 'f CS-060247 pires: 06/06/2022 WILLIAM W LABOMBARD f, 12B PARKER AVE 1 NORTHFIELD MA 0136� �.'' fi 0 4)/\\ 1 'i Commissioner 4 0• 4'. biErr►j .,. ..., Mica of Con urr►sr ors# ►inrrrrs Regulation HOME ;MPROVV'MENT CONTRACTOR TYPE: !raickaal 1404 1 t021 AN i tAM W LABOMMP 't WILLIAM W_ LA D 12 A PARKER AVE1;,, ,,,r,,. +' ;: ' ', : Tl4FLC. 013 Undersecretary Original Floorplan: sz- Free Standing Cast Iron Tub • New Floorplan: (D1 ii 48"x36" Corner Walk-In