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24A-132 (4) 23 PROSPECT AVE BP-2021-1222 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24A- 132 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: REPLACE FIXTURES BUILDING PERMIT Permit# BP-2021-1222 Project# JS-2021-001837 Est.Cost: $13750.00 Fee: $91.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JOSEPH DENETTE 113824 Lot Size(sq. ft.): 10193.04 Owner: KASSIS PETER B&ELIZABETH A FRIEDMAN Zoning: URA(100)/ Applicant: JOSEPH DENETTE AT: 23 PROSPECT AVE Applicant Address: Phone: Insurance: 102 ALDRICH ST (413) 563-5759 SOLE PROPRIETOR GRANBYMA01033 ISSUED ON:4/26/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE BATHROOM FIXTURES ON 2 FLOORS 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. 14644:1L 3-1 Certificate of Occupancy Signature:' I FeeTvpe: Date Paid: Amount: Building 4/26/2021 0:00:00 $91.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner i ' j v + F APR232021 1 The Commonwealth of Massachusetts '.(0 Board of Building Regulations and Stand s FOR 1 Massachusetts State Building Code, 780 CNIR ;,,on;s MUNICIPALITY USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 1607 2(-. Date Applied:r I' I_ VolBuilding Official(Print Name) Signature Da SECTION 1:SITE INFORMATION 1.1 Property Addreess.� 1.2 Assessors Map&Parcel N`tg` rs 023 Pr&sp -r ,'Ye aS -/3,2-00< 1.1a Is this an accepted street?yes A no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Sig/:ti 6 ResiIceu Gs,,.3 ,4, s Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public Private 0 Check if yes Municipal i$' On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: ,/ /4lytr k g.ssir,' E/Z.i�! �t1ls� w /'�/L / nil. ave,0 Name(Print) City,State.ZIP ,1,,a /-Y* -l..4Y-zwy [[ (t eo-v t .co►� No.and Street Telephone Email Address l� SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 121 Addition 0 Demolition 0 Accessory Bldg.0 Number of Unitsl Other 0 Specify: Brief Description of Pr sed Work': J�ve./h�+.-Co(� c4- o7Acif -Am/ 6 a /ri7pr9_ /0-4•-) rzki; • ND CNRs,JG,R. �r© Pt-aoRpy4 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ %j 7 S--Q I. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) Total All Fees:$ 1 Check No. Check Amount: 6.Total Project Cost: $ /3/7S^L ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction` Supervisor License,,ns (CSL) ,., ✓ i,/2 / v /X �€/1e51 `t/ License Number ( Expirationpiir Date Name of CSL Holder n ^;��e ��/, List CSL Type(see below) No. rand Street `7 �` Type Description 6,r.,,w ail" /Nj 6/P33 U Unrestricted(Buildings up to 35,000 cu.ft.) lty J R Restricted I&2 Family Dwelling City/Town, tate,ZIP M Masonr y RC Roofing Covering WS Window and Siding �,�� / / SF Solid Fuel Burning Appliances *3-.5c63-S7S� /��,e t.�c�/7 /rirt7 cern I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) fi6/17 o7 CraCe,r 4l ne HIC Registration Number piration Date HIC Company '/ Name H Registrant Name rc �ro11P# ? � �}laP.zi No.and St et mail address gez7 Ail City/Towd,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 L.) .sr/eh JZ M to act on my behalf,in all matters relative t work uthorized by this building permit application. L v2 ah �� a Print O is Name(Electronic Signat re ate 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. 0/ / Print Own 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" Client#: 22843 DENJO2 YYYY) MM/DDI ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE 4/21/2021( MDD! 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 Samantha DeSantis NAME: Baerman-Jubinville Ins.Agency PHONE 413 538-8293 FAx 413 538-5970 (NC,No,Ext): (A/C,No): 39 Lamb Street E4i SS: samanthad@jubinville.com P.O. Box 789 INSURER(S)AFFORDING COVERAGE NAIC# South Hadley, MA 01075 - y INSURER A:Preened Mutual Insurance company INSURED INSURER B: Joseph E. Denette INSURER C: 102 Aldrich Street INSURER D: Granby, MA 01033 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 ADDL SUBR POLICY EFT POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/VYYY) (MM/DD/YYYY) A GENERAL LIABILITY BOP0100728322 02/01/2021 02/01/2022 EACH OCCURRENCE S1,000,000 X COMMERCIAL GENERAL LIABILITY PRAEMISES EaEoNTTEir ante) $50,000 CLAIMS-MADE X OCCUR MED EXP(My one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- LOC $ PRO- JECT AUTOMOBILECOMBINED SINGLE LIMIT LIABILITY (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE _- E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ] N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below _ EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) These are the limits at policy inception CERTIFICATE HOLDER CANCELLATION Town of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE (� THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Inspector ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main St#100 Northampton, MA 01060 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S32509/M32508 SBD ` The Commonwealth of Massachusetts 1 lainr- Tir I ig e Department of industrial Accidents 1= 1 Congress Street,Suite 100 `-"'' Boston. MA 02114-2017 ''-,,,,y wwH.trtaSS.gO)'/die %Sorkers'('ontpensatiun Insurance Affidavit:Builders/(`ontractarsurEIertriciarns Plumbers. It)BE TILED WITH T11k;PEItMrliIMG Alrillt)KII I . .kuulicant Information Please Print Leeiblt Name lBusmennOrganizntioninditidual l: Z 9M E E. J,7 e'T!'C Address:/0. R rim Sr-. City/StateiZip: ‘),0-/t17, /N, e(O 3 Phone#: 43 -5'63- S'ZI Art arMa MI amithoNte('he,rd the appropriate but: Type of project(required): I.Q 1 ant a employer ugh.____..._._._._eripk it'es that and to part-time I.' 7. 0 New construction I ant a sole proprietor et p it airship and hate rut emplttyees wtarkiat tt'r m.in $. ` Remodeling any capacity.rto workers"clamp.insurance reymnd.I 30 I a a homavwner doing all work myself.[No au>kara"comp..insurance required.)" 9. El Dominion m Ili 0 Building addition 4.0 I:am a hutauuwrni curd mall b.Initna euntraehrrs to t.undut.t all sock en my property.. I Will ensure that all contractor.either trite worker.'compensation insurance is air sole 11.0 Electrical repairs or additions p tpnetua with no employer 12.0 Plumbing repairs or additions 3CI I ant a general contractor and I hate hard the sub-euntra dues listed on the attached street I3 Roof repairs These aub.ctmtracturs hate eanplust�es and hate it oilier;et np.insurance.' 60 Yie a a corporation and its officers hate exercised[hear nght of exemption per Wail.e- 1 s•:.§It4l,and we lute no to ,iuy0ca.INK,wutkt:n'eurnp.inataann.teyutnd.l 'Any applicant that cheeks box nn1 mast also tilt out the seetivn beluu shy..ine their setter'comps tatiun pules aal.irinattun. +tltrraomineta tuho submit this alYadatit udteating diet are doing all stork and then hire outside eontrseturs mint submit a na.n affattat it indicating sunk. :Contractor,that check this but must atta.hovl an adthtiunal sheet shuwina tls:name arf the inns:rrraetars anal state whe-elier on not those esrtrties lure employees. if die sub-contractors hate employees.they nau,1 prof ide their Ntrkcr..'eaPmp.polies number. I am an employer that is providing w orAers'compensation insurance for my employers. Below is the polity and job site information. Insurance Company Nam: Policy#or Self ils.Lic.#: Expiration Dale: Job Site Address: file State Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure t:ov erage as required under MGL c. 152.§25A is a criminal t iolatton punishable by a tine up to S 0.500.00 and'or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to 5250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA tier insurance coverage verification. 1 do hereby certify under the painsand penalties� of perjury that the information provided d above is 7true and correct. Su^_�aaature: /e. 2e •-- Dale `, 0''/ t7'1 Pt;two.:T: g/J^..re„ , .5 7 Official use only. Do not write in this area,to be complrled by city or talon official ( it or'Iowa: Prrrnitl.icense 4 Issuing Authority (circle one): I. Board of Health 2.Building Department 3.('it);Tow n Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton Oa<H-e-'1 S .t. S 41 Massachusetts 4., ' t ce Ci g t (t.;t t DEPARTMENT OF BUILDING INSPECTIONS . r: �;w ♦ •. 212 Main Street • Municipal Building J`. Q. Northampton, MA 01060 J'St-h, 3,.: N�1 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: ;841NisL '7:--4,Gk.,%r , o` LPi/osai dc► `6X' �raA4, m,. 4/103 &4 *5/6 7- 97c zi 061 Signature of Applicant: . i/2.•. Date: Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Individual _ .Expiration - 07/15/2021 JOSEPH DENS• i \} • sid JOSEPH DEN , _ `� 102ALDRICHSTR- ,;_s: / .�.�flG.�.cGLwk' �--_-- GRANBY,MA 01033 Undersecretary Commonwealth of Massachusetts '� . • . • Division of Professional Licensure Board of Building Regulations and Standards tonsitrt ti6AIS rvisor, r. CS-113824 i, i JOSEPH E DENETTE plres:.12/30/2022 102 ALDRICHrSTREET,' •=- H +GRANBY MA 01033 \--"-''':. ----.1 ifilit—E- ',4""I:10 Comrhissioner , ,,,-1.----_"