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15B-037 236 CHESTERFIELD RD BP-2021-1238 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 15B-037 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:ACCESSORY BUILDIN(; BUILDING PERMIT Permit# BP-2021-1238 Project# JS-2021-000784 Est.Cost: $127800.00 Fee:$634.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ZACHARY KUSHNER 111252 Lot Size(so. ft.): 90604.80 Owner: FISHEL SHANNA&ANTHONY Zoning: RR(72)/URA(28)/ Applicant: ZACHARY KUSHNER AT: 236 CHESTERFIELD RD Applicant Address: Phone: Insurance: 120 EDGEWOOD AVE (860) 930-6606 WC LONGMEADOWMA01106 ISSUED ON:4/27/2021 0:00:00 TO PERFORM THE FOLLOWING WORK: 647SF DETACHED ACCESSORY STRUCTURE 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. . • ? • yg . 3- FeeType: Date Paid: Amount: Building 4/27/2021 0:00:00 $634.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner i zhukitte I��lI7'!S lf�• first " peg ; ApR � s FIRST PEAK LLC 2021 MA CSL#. CS-111252 P.O. Box 60861 Longmeadow,MA 01116 Np F©-4-,)0�3�-• .0 �" RT HAM�'• T Irv•^A7CTI°N3 Hi Kim, Please find attached the building permit application for 236 Chesterfield Rd in Leeds, MA. I have also attached the blueprints and the special permit record separately. If you have any questions please feel free to reach out to me directly at(860)-930-6606 or zach@firstpeakconstruction.com. Project Scope of Work: • Excavate and place concrete foundation (4'frost walls and footings), insulate. Crawl space floor to be crushed stone. • Excavate trench for sanitary and water line from existing house. Sanitary to tie-in to existing line in basement. • Set modular structure on foundation - by others. • Separately meter 100 Amp electrical service to be installed. Power will be obtained from existing electrical pole in driveway. Lines to be run overhead to detached accessory dwelling unit. • Licensed Plumber to install sewer and water line in trenches dug by site excavator. Lines to be placed on sand bed and covered in sand after inspection.Total run length approx. 50'—60'. • Install mini-split heat pump system. Min 15,000 BTUs. Blower door test once system is installed. • Seal and insulate attic hatch, blown in cellulose in attic, and spray foam rim joists. • Build ADA ramp from front entrance of the ADU to terminate on driveway asphalt. Build rear step at ADU. • Install wood stove-by others. first peak FIRST PEAK LLC MA CSL#: CS-111252 P.O. Box 60861 Longmeadow,MA 01116 236 Chesterfield Rd Leeds, MA Building Permit Submission Table of Contents • Completed Building Permit Application • Attached Set of Plans for Detached ADU • Attached Site Plan • Completed Workers Compensation Affadavit • Proof of Workers Comp and General Liability Insurance • Copy of Unrestricted CSL • Special Permit Record • Construction Debris Affidavit • Permit fee to be paid by check The Commonwealth of Massachusetts ,....„............., Board of Building Regulations and Standards FOR \h" Massachusetts State Building Code, 780 CMR MUNICIPALITY USE Building Permit Application To Construct, Repair,Renovate Or Demolish a Revised Mar 2011 _ One- or Two-Farnilv Dwelling This Section For Official'Use Orily Building Permit Number: "_.1 'LI- Date Applied: c W ' ' ,.. ._. _)6) L\il -_ 2-.,6r. ' 1/ '4'W III 17'_L3( [Wilding Official(Print Name) SECTION I: SITE INFORMATION — 1.1 Property Address: , t 1.2 Assessors Map& Parcel Numbers .401.1v_r4V di a icg oil 0*...I..._ - 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zpqing Information: a Ars) 1.4 PropertyDimensions: -— rttAtkeW. (101_4 in,K --- 109, Zoning District Proposed Use — Lot Atea(sq ft).. Frontage 0 1.5 Building Setbacks(ft) -..-e 4-a 441.46i,‘Iej P10.1- Pktn . Front Yard Side Yards Rear Yard Required Provided Required Provided Required ' Provided . . , 1.6 Water Supply:(M.G.L c,40.§54) I./ Flood Zone Information: 1.8 Sewage Disposal System: Zone: Outside Flood Zone? Public 6( Private 0 Cheek if yes0 Municipal On site disposal system 0 `-- - SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of ftectl: FrS1,10k altf oty 4 11,S 4014/1477— Name(Print) City,State,ZIP ZS() Ce,114,S4-e4ea a 413...7t744,4z sk4 MA iZIR,R1 44,41i.otAs No, and Street Telephone trnail Address SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply) • New Construction 0 Existing Building 0 Ovinci .Uccupicd 0 Repairs(s) 0 Alteration(s) LI Addition 0 Demolition 0 Accessory Bldg. er Number of Units they 0 Specify: Brief Desc.tiiption Proposed Work2:,._ gold w we.. q I iAs _ riv61---_kit I( 4e) itAr cooty.O_Nrckkaist4_11_7 --/- , i , . 1y40 _ _.............4_6: ..!..p*..._f.„..." ,....„._ 4 ..r. -,.4 exi.5.1. -it, 9c4!.. ir kL ._ (.4bis' _(44N. 4 4tt 4 tool,P • It. Ale wiwy_ AlthiP cc°I i 4 * Nti4-C,- SEC1ION 4: ESTIMATED CONSTRUCTION COSTS , — ..... Estimated Costs: Item Official Use Only L( abor and Materials) I. Building S ii 0.I' dO 0' 1. Building Permit Fee: S ,•____ Indicate how fee is determined: 0 Standard City/Town Application Fee 2. Electrical $ 00 ta (9 0 Total Project Cost'them 61 x multiplier , It 3. Plumbing , $ 61;,,,,,,,, 2. Other Fees: S_____ 4. Mechanical (IIVACI S C g 0 a I ist _....,_....__ 5.Mechanical (Fire i Suppression) $ Total All Fs: ,A -6 1/3 q 1 Check No,A Check mout , 6.Total Project Cost: $ 11 ii g 0 0 0 Paid in Full a Outstanding Balance ___ SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C5 Lz ‘.10. Z- I ZACA e. gitsitiler License Number Expiration Date Name of CSL Holder List CSL Type(see below) V a P___EllijAiloi; .4 0,0,9 Ave. No.and Street TYPe Description CA) MOW(0 4.1) AA- ono Unrestricted(Buildings up to 35,000 cu.ft.) Restricted l8r2 Family Dwelling Cityabten,State,ZIP IVI Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances giate•ISO 4.44 24cit‘ekk$41,06e&etyktoalati.46.406I Insulation Telephone Email address 0 Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street 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 Issuan•-of the building permit. Signed Affidavit Attached? Yes No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CON'TRACTORAPPI„:1ES-FOR HUILDIN6 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. Shanna Fishel 04.22.2021 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:* I. 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 find under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.govioca Information on the Construction Supervisor License can be found at www.mass.govidps 2. When substantial work is elanned,provide the information below: Total floor area(sq. ft.). 101.0 (including garage,finished basementlatties,decks or porch) Gross living area(sq. ft.) C.4.40 Habitable room count Number of fireplaces 0 Number of bedrooms Number of bathrooms I Number of half/baths Type of heating system frAkt wq14-- Number of decks/porches 0 Type of cooling systemAkil pi st- Enclosed ()Pen 3. "Total Project Square Footage!:may he substituted for"Total Project Cost" \ Property Line Foie \ \ Side setback line (15') k i i Pressure Treats • i •-el chair ramp ter •inating on i steps aid landing i existing driveway c minispiit m ii sso� layout/len.` h TBD by grade v i ,� `Pressure trea+=• -match steps `* Drive •ay , <� /i/ / ,-- /� / /. / 1 _. - Ce / < // N 7 i PT Stairs �N �,\ ,�/ ,/ \` @�E z '�✓� '�� `� '` - ��\� lectric Meter . a 2 al 8 m i Onsite Wood Stove \ \`�� // II ` h�;/,// ,�►.►�\\ . N (small). Include O \� N stone pad \` �x\ �/ �N� House Position: -,. ;,• `mac ♦t om\ o 'House 20 30'from garage ��� = � O �, a i 4m , m y i *Approx15 degrees off Water/sewer--enter N‘ `N ,/ W ;, i angle from garage. basement \` \ \`.\ // m Zone: URA Electric-Overhead or \\ share trench \ / DATE: ` Approval as: 2nd detached unit Sewer connection ` // 8/28/20 Well pressure system SCALE: Sewer: City Water: Private well SHEET: 1 Electric: OViell A-1 -il . . IP Conwrionwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Cons t rUCtibri Supervisor CS-111252 . Expires:06/10/2024 ZACHARY KUSHNER ....,. P.O.BOX 2236 AMHERST MA 01004 .1.....; ., . . . ,:..... .4.-----"' Commissioner • The Commonwealth of•Massachusetts ' Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 wwr'L: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):FIRST PEAK LLC Address:120 Edgewood Ave City/State/Zip:Longmeadow, MA 01106 Phone#:860-930-6606 Are you an employer?Check the appropriate box: Type of project(required): t.p✓ I am a employer with? employees(full and/or pan-time '. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees work ing for me in 8. [3 Remodeling any capacity.[No workers'comp.insurance required.] 1.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]' 9. El Demolition 0 El Building addition 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will I ensure that all contractors either have workers'compensation insurance or are sole i LEI Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5. i ant a general contractor and i have hired thr sub-contractors listed on the attached sheet. ❑ 3.0Roof repairs These sub-contractors have employees and have workers'comp.insurance.% 6.0 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. I'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. 1 am an employer that is providing workers'compensation insurance fur my employees. Below is the policy and job site information. Penns lvania Manufacturers Assoc Ins Co Insurance Company Nantes , y Policy#or Self-ins. Lic.#: CMA000156600 Expiration Date:09.18.21 Job Site Address:236 Chesterfield Rd __......._..._.. _ City/State/Zip:Leeds, MA 01053 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 tine of up to$250.00 a day against the violator.A copy of this statement may he forwarded to the Office of Investigations of the DR for insurance coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: „, ". ... . Date: 0 tit ZL 2 dZ t Phone#:860-930-6606 Official use only. 1)o not write in this area,to be completed by city or town official. City or Town: Permit/License# issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person:- __ Phone#:_ ___.___.._ Client* 1844421 FIRSTPEA1 ACORD„ CERTIFICATE OF LIABILITY INSURANCE DATE(MNIDOiTYYY) 4/19/2021 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 endorse-ci. ' If SUBROGATION IS WAIVED,subject to the terms and conditions at the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: USI Insurance Services LLC PHONE (AiC,No,EXI):855-874-01-23 — 1'FAX No)! 877-775-0110 333 Glen Street,Suite 302 E-MAIL AppREss helene.wendolovske@usi.corn _ Glens Falls, NY 12801 INSURER(SIAFFORDING COVERAGE NAIC a 855 874-0123 _ INSURER A:Evanston Insurance Company 35378 ... INSURED INSURER a i Pennsylvania Manufacturers Assoc.Ins. 12262 . First Peak LLC INSURER c i Progressive Casualty Insurance Co. 24260 120 Edgewood Ave INSURER D Longmeadow, MA 01106 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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 ADM SUBR- POLICY EFF POLICY EXP LTA TYPE OF INSURANCE ____Aatt WVD POLICY NUMBER (MMIDDNYVY1 (MikliDETYYM LIMITS A X COMMERCIAL GENERAL LIABILITY 3AA425192 09/17/2020 09/17/2021 EACH OCCURRENCE 11,000,000 CLAIMS-MADE X OCCUR RAM iC WIEJ'c'2;,%,,„, s I no smo X Ell/PO Ded:500 IMED EXP tAny one persom $5,000 PERSONAL A ADV INJURY $1,000,000 GE,'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $2,000,000 -----PRO, POLICY X.JECT 1 LOG PRODUCTS-COMP/OP AGO $2,000,000 OTHER- CO C AUTOMOBILE LIABILITY 030553010 12/24/2020 12/24/2021 maswiNciaSINGLE Limn' 1,000,000 ANY AUTO BODILY INJURY iPer oersoni $ — OWNED f y SCHEDULED BODILY INJURY(Per atiodenti $ AUTOS ONLY " AUTOS — HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY iPcr acobehh a , I . $ A UMBRELLA LiAtil X OCCUR EZXS30486 04/19/2021 09/17/2021 EACH OCCURRENCE $1pogpo0 X EXCESS LIAB CLAIMS-MADE AGGREGATE V1,0013,0013 DEC RETENTION$ $ . B WORKERS COMPENSATION WCMA000156600 09/18/2020 09/18/2021 X PER OTH- AND EMPLOYERS'LIABILITY STAIIITE ER Y i N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? y N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 It yes,describe iinder I DESCRIPTION OF OPERATIONS below —1- .--, E L DISEASE POLICY LIMIT $500,000 - - DESCRIPTION OF OPERATIONS i LOCATIONS i VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached II more space is requiredl 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 I ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S31815591/M31815344 TY RZP City of Northampton Massachusetts ' . r, DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street s Municipal Building a' Northampton, MA 01060frf 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: FA a 1 -C. �i I ( - i C Y j The debris will be transported by: A4,41, Name of Hauler: SS en,:,,,ye, Signature of Applicant: w-'" Date: 434f, 22 .2 r tt CITY OF NORTHAMPTON PERMIT DECISION Submitted 11/9/20 Owner Shanna &Anthony Fishel Northampton MA 01060 Name/Address Hearing 12/10/20 Applicant Name/ Backyard ADUs Whately MA 01093 Address(if 33 Laurel Mountain Rd different) Extension Applicant Contact Chris.Lee@backyardadus.com 413-586-7922 Hearing 12/10/2020 Site Address 236 Chesterfield Rd Leeds MA 01053 Closed Decision 12/10/2020 Site Assessor Map 15B-37 8k12622 P152 ID Zoning District URA Filed with 12/21/2020 Permit Type Zoning Board Special Permit Clerk Appeal 1/10/2021 Project Description Create detached accessory dwelling. Deadline An appeal of this decision by the Zoning Board may be made by any person within 20 days after the date of the filing of this decision with the City Clerk,as shown.Appeals by any aggrieved party must be pursuant to MGL Chapter 40A, Section 17 as amended and may be made to the Hampshire Superior Court with a certified copy of the appeal sent to the City Clerk of the City of Northampton. Plan Sheets/Supporting Documents by Map ID: 236 Chesterfield Plans,Application Narrative. BOARD MEMBER PRESENT!' FAVOR J OPPOSED I ABSTAIN/NO COUNT VOTE TALLY Favor-ppposed ____..� David Bloomberg,Chair ✓ ✓ Sara Northrup,Vice Chair ✓ ✓ ❑ U Elizabeth Silver © 0 Maureen Scanlon 0 U — Bob Bob Riddle ✓ ✓ _ LI ❑ 3-0 To Approve 1 PLr' APP VAi,cRITitnA W FINl s s 10.10 Tht. Zoning Board Administrate; '0 ,n urn d that [rt. r eque3t Tc r u e t esulting project that includes a 660 sf detached accessory structure met the criteria in the zoning with conditions as follows: (1)The apartment will be a complete, separate housekeeping unit containing both kitchen and bath. (2) Only one accessory apartment will be created on the single-family house lot. (3)The special permit for the accessory apartment automatically lapses if the owner no longer occupies one of the dwelling units. (4)Three off-street parking spaces will be available for use by the owner-occupant(s) and tenants. pg. 1 CITY OFNORTHAyNPTON PERMIT DECISION 17 --Prior to Issuance of a Building Permit pa-17-7 the plans Minutes Available ad WWW.NqrthaFnptu0KlaJGgy 1, Carolyn Misch, as agent to the Zoning Board certify that this is an accurate and true decision made by the Planning Board and certify that a copy of this and all plans have been filed with the Board and the City Clerk and that a copy of this decision has been mailed to the Owner,Applicant, ^ ' / pg. 2