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39A-063 (5) 69 LYMAN RD BP-2021-1248 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:39A-063 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2021-1248 Project# JS-2021-002076 Est.Cost: $6000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: THAYER STREET ASSOC INC 045159 Lot Size(sq.ft.): 7013.16 Owner: LEVITT SAMUEL W Zoning: URB(100)/ Applicant: THAYER STREET ASSOC INC AT: 69 LYMAN RD Applicant Address: Phone: Insurance: 8A COATES AVE (416)665-4018 Workers Compensation SOUTH DEERFIELDMA01373ISSUED ON:4/28/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE ROOF ON MAIN SECTION OF HOUSE AND PORCH ROOF 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 Siknatur: el • ' • IT FeeType: Date Paid: Amount: Building 4/28/2021 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner The Commonwealth of Massachusetts ofiAz Board of Building Regulations and Standards,, 9 2 ▪ `' R Massachusetts State Building Code, 780 CM .-''° Rai 1~O• iCIPALITY s c�� /USE. Building Permit Application To Construct, Repair,Renovate Of, e 2o.)ish a /, Raiised Mar 2011 One-or Two-Family Dwelling : :: f Th' Section For Official Use Only N.'0 o"s Building Permit Number: el--A I-/�yI Date Applied: g„,,,,(E,, 1•Z3-Zb21 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assemors Map&Parcel Numbers 7 Lf isletsSf rc 1'' '-3-1A 1.1 a Is this an accepted street?yes ,/ no Map Number ParcelYum 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 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: SaMuc. t Levi f1- ,VOrfhh kiipiofl, /H 4 /060 Name(Print) City,State,ZIP 6 V Lyftz4 0 Sitcc-f 4/3—S3a-f84,i setm@ 49 iyAlah. cows No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: R C I Q G G roof= 6 ri frill i h S c e f 0 n' o f hd0Se ah d ?or to roof- SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. 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: $r, Check No3,]��lleck Amount: Cash Amount: 6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due: I - / �tt!'li f,la. {ii.j ( it t , I r i 4 it 1 r(1._ _... � (1rlr .,2i{pc fl'iid4tze, i;lr , , r , . . �T•• ( tAc'' } y1r1Cvi"1 21l1 '1':ir: ti fr • , • ,� ,'1 s� i i cr., i. 1 7 . r-Y i C i,i rrr ,,'.•di i iirmk,;• r .+11"i-Uilr.i _- . T'ftf.iiVG::j i [ ?) 4 1 i. .j 1 - : a.'�r, 1 Itl4 f raft; I 'F v 'C. , r I , p; 1 i iCi•.11; f • i ofi a •' 1_fcSr., .i 1.,_ ° _0 /_ Lr — i.iiclt,tt,,•ir1 01 j:I111.1PriC", ;ri ; . i,i$t (?c 1\i1L — _ _ P1.;(,ttti3! 7' �'1L+';, ,' :i-s� �iKti'}d _I.1`.11"'Ye.';.? .-. , „I, , \( '(: ♦rt•f,1 `l,1,1Cui4.,4f7 ,r ^ ^,/-,v ., +"''`.. rs r 1---. •!. { 7 i'- _.i r.' r •, v-1;J ,- i` ---..,.{.._ , 1r.1riflili'.r a , 4 ! vr;(.r. n.),1.1 fy. 1--, r7/r1111F,4"; r 1`1. (;V;, {_.. , .?4..1,! ";:i ( ',1) : 1 a , O., 1 lr.1{fir i rkJ 0.'t.11 '•`i(:)';(1 1 yir..rit ' V ', — - }l't pi` i+.i ;-'C( 34A) ' : ote( !tio.'t it),,, G+ i. :1,.1f'.•E)?L0 M.)ISK, tr•}atr;rx;, kPs-finZ-:fi.) ! r'1r' '' • (ttrr, t-' r, 1 i r:it u'''.1 •1.11r.Ltit.Ai _ti ;..4 lit }, .:0 i;.f.h.U: . • . • �, w•at r �ti 1 _ _ __. py 1,.r -1 J 'r1ji i.' %r,r'7 -}��1 t r 11t'frt-i`I CI 1 P it rri ,� ;j1% I—, i i r` td`3ii.L..;liithi;. it,,r 1 4 1 6': ' i.y L1+ 1 �;O1tt 0frlt)t.ill8itt+i : ..( H J-rein r)ft1Nr i7,'t'r,e,iii' 1 a-..... ('ri. . ' .1r;•r,- tS"if,t_ ,�_ b ..._,', _j .(. _ __.. ._'_.__ _l1__ rrr _ ,r_ • d ;i(0,,•• i17,1,1yi lei.! ,-f t' 1 ! .s \t:1. It ,:2.1. ..il'i;,rpis. ' :'t GIL(. 't•,• i Dt?tii.J�K.iie': ` .> .0 .+ if_,. /;. (t;.r a(I' rq;,pr ; 1.1 i„,..•ri'(.Lti ttfait,,•7 ,•3 •.f204., 'iLi ',kph r Law.(,,i '04f1f31;•1r,1. rI ' ..►O.'' : ?f r,i. fliP4iifrri t-i!O 1i,, t.' rQ'A>WIN C: cir.i ykUltioli, 1 i • i _ __. . _. _ • r' ; ;,-...,flit ,;. . .11 •v 1 :1_-J.: 1 tI 'raKrJN!!: < r!:i.i ` I i!`•t)il!i i i t, r'r'f l:Ir.1r+;.i;iii •,ii)!r!!r'Vi: ,11 C I)r;ril;->ii.l1'at'fichfi.1 '�CIJ•:'La G 4'ii..� at4Gi, '1 i ,,,''..'''E.` '►!1,4- -i.,t . i fa`F,. '1( j lP; ?raft;[3}ilr 1)M ( 1ti' ,_,iJi '.3 '' (a C!!t r F ; '1 bri;t`` r rii t gr-r:; iifq:":tL.,1. , f,:lii;..4tle t 'rNf1.Lr11 ;1ru1 i' i d '(- .`,?J.':.ifiti 1C:d1{1: t11 it; 1�anr•IJ•:!i,if i ♦=\, ,` .``v_Lt (- . v ,` SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) so4S15q 4— 3 — a V cr/t o rI ka f r i vt 0,4 0 H License Number Expiration Date Name of CSL Holder List CSL Type(see below) V No.and Street Type Description r Ct J AA ,J U Unrestricted(Buildings up to 35,000 Cu.ft.) D CC(r 41 , /v'/t , 0/ 3 7 3 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 41/3-oiS- yo/f v Crag Mays/s 6scfau0c4rirs I Insulation Telephone Email address • Cob.. D Demolition 5.2 Registered Home Improvement Contractor(HIC) / 8'/0 -/6-�� l kay.rt S 4rrc 4 As s oc i d(is HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name S. hod 4 4 v c v et 1,14,lrsfrrrf crsso c;oar$,t ef'+ No.and Street Email address S. I�cCt 4/ll/1 D/.873 din-(6S-vol f 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 12k No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLI/ES FOR BUILDING PERMIT I,as Owner of the subject pro ,hereby authorize Vet N a H 64a t ri K' Io to act on my behalf,in all rs elative k auth ed by this building permit application. Samuel L.Gvi4 1- y-A7 Print Owner's Name(E ectfonic ignature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby ttest under pains and alties of perjury that all of the information contained in this application i d ace a best o knowledge and understanding. V MOO/ I car f• �Oh _ / • y-a 7- 2/ Print Owner's or Authorized Agent's Name(Electronic Si ure) 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" 1 • • • �•. :r•I'` ' •'it ri1' • • ri•.(4 I IE' (11.. t I• I.' •Gy'a I:. •.� it • (.•'i'" 4.4I:1 . t� �'Ir If. , 'i i ' :l{l;i: i„i.'�..(1(..2 J:,I+•, } •5. -f1'jr !` ;liJ ,rl; i 3,4N.i!Ac,l.,'.,.'•. .;f 'tU•', f 1-1j.! .. ",:') . '.r.' i+ n. .:''' ' "i.+:Id �) r'f:!.k r'. •.1 ;)r - ; '> n+ ,.r.. , • .1 ' .1.4:iN l y44_ • • ,.' _ •• 'V r , w• t h;• f` • • t - 4 , .. ;,:Ir r/Df! `,!f}s•.. °IU 7.' ;'%.'.: ; •ai ft� •)..{'1:!)rc I i? , ..'i•; it(Jt'F )L7 .IfiL 'i� I.., . 1- : 3 )' n . iL• • !{4'i.. ' • r.i tr '.' _• `.':I ,'i.Hf :a= 'i' I �f.iir t;jt;it 1 .�! ' • - ix' a.:i.' V . a , ' . •I n, :J •f,l ,fr. ;• P,i' .�( 51._IS:- a1i:' I: rid i �' _ _ 4 ,.i tdJ• t• L 'I (y;(. ;i .t. ., • '• {+ ., .+, ;. r fr +S :4}1.5 i•�l f / yt;i'Y , )i`.• i)1::.f.i5/t. )j5 ' j.f.: Fi rtil( '4),li • 'F':r:f, f. +t` Her.1 J,p. • f;".,;4PN ',q j,F'f;t `�:J. ii)'s 1.,() Al: t t1tSt tit 7 /,p.,1',,, tl+ r e f. r ':r i..,i^l' ! • �,r.. •1 , .... .011f G.1), ,a: ..' t1, • :f' d: { '�( i?#r'! fdilt. .".'' f E ,7.1. _ �^i'1t.i', / c 'Ii,t":�q)!r�.t. �:"j`^', iin '} 'i : -. . ._ • • r .•'.rlil6:.Ff! >:JlfFt S'_'Fjl..11r:(31t.pfr Ol'.,n:!'; ( all ) t. .. 4. T • t . t �•Il i :. �. - - _ _". - f :i, Ell.'. : t • a J' 4.+i11 ))f 4.,-;:•.Y. 4..i1,. fret t f,.,•�(•t 4 • r -'r'f' - I / • City of Northampton aYHAMpT\ /?O 0,�:\ SAS ... � SAC y �' Massachusetts a,,t k- 'ee �. w x d" I. d' s' DEPARTMENT OF BUILDING INSPECTIONS ;.. t�.r• -%-.y i, 212 Main Street • Municipal Building 0 a j°s1r.i Northampton, MA 01060 �SN,y j�10c 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: 6 $& yliq;$1 S f (cel a /y,, GcP AA. o !oY O The debris will be transported by: Name of Hauler: At./focal ojc'spo s a I S`/3- Y'oa -S q3 O Signature of Applicant: ate: 9- a 7- a The Commonwealth of Massachusetts ,. _*— Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 ,,,�,,� wwwmass.gov/dia 1)esters'('umpeusation Insurance Affidavit:Builders/('ontractor Ekctricians.FPlumbers. It)BE FILED N'fi H l HE PE ttsiirra t:AFiII )KI'I Y. Applicant Information Please Print Legibly Name tBusmcssiOrgani atiotr''tndmidual1: 7�k ty e r s f i r c / ASS o C i d f ei Address: 8 (O a c S A- City/State/Zip: S. T)re t(-lc(01, . D/r 7) Phone#: 9/3 —4 6 S - 96/ 1 Are y.n an employee Check the appropriate bet: Type of project(required): 1.1 I am a employes with 0 employee%(full and or part-hunt t' 7. New construction 2 fl t am a solo pnorietar or partnership and have no employees working brook 8. CI Remodeling any capacity-[No workers'comp.insurance requital" y 3.❑lam a I omouwms doing all word myself[Nu workers'comp.inseirm nr e prrel.]+ 9. El Demolition a.❑tam a homeowner and is ill be luring csw n.racto to conduct all stork on my property_I!trill 1 0Q Building addition ensure that all contractors either!cure wurkcm'compensation m,ttranoc or arc sole 11 a Electrical repairs Or additions proprietors with no esrgaluyem. 12.0 Plumbing repairs or additions SCji lam a general ccmuactur aril I have hued the sub-cowrtracturs lissted on the attached sheet- 132 Roof repans These sub-contractors have onployees and have makers'comp.oruraorc.• 6.0 c are a corporation and its officers hate car-wised their of exemption per hit&c. 14. Other❑ W 132.cy 1(i),and we ham nu employees.[No workers"comp_insurance requiiodj 'Any applicant that clocks bon 6l mint also fill out the section below showing dick sorters'compensation policy infdrmatipn- o thrnemenen who Admit this at'adavit ini ieatitog they are doing all work and then hire outside contractors mint submit a new affitia%it indicating suck. ICuntraccturs that check kris bus must attrthed au additional shut sbou frig the mane oido sub-contractors and state wMher or nut those entities hate employees. If the sub-cogrraci s here - ors.duct runt prosaic their worker;amp-polity nmrber- t sit an employer that is providing woraters'compensation insurance for m).employees. Below is the policy and Job site information. Insurance Company Name:A 1 /1t Policy#or Self ins.Lic.#: WM .S 0 O 100 714 19 - 01019A- Expiration Mite: S-3 1 - a l lob Site Address: by Ly.14K heel- City State'Zip:/ OtT4 a.s�•/ iarMl.0/040 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MIGL c. 152,§25A is a criminal violation punishable by a fine up to 51.500.00 and or one-year imprisons Ott.as well as civil in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator copy of th" statement forwarded to the Office of Investigations of the DIA for insurance coverage veriftca I do hereby a the and es of 'that the infer provided above is trim and comet. Si nitture: Date: 4'-. 1- Phone#: �/l 3- Ce 6.S' 'y 0 Y Official use only. Do not write in this area,to be completed by city or town official ('itv or Town: Permit/License Iz Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City flown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Client#: 16074 THAST ACORD, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 2/04/2021 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 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 ACT Anne Daley T.P.Daley Insurance Agcy,Inc PHONE Ext):413 788-0971 FAX 413 739-2645 1381 Westfield St. EMAIL (mac'No) ADDRESS: annedaley@O7tpdaleyinsurance.com P.O. Box 1150 INSURER(S)AFFORDING COVERAGE NAIL# West Springfield,MA 01090 INSURER A:Acadia Insurance Companies INSURED INSURER B:AIM Mutual Insurance Co Thayer Street Associates,Inc. 8 Coates Avenue INSURER c South Deerfield,MA 01373 INSURER D 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. INLTR TYPE OF INSURANCE INSR WVDRI POLICY NUMBER POLICY EFF POLICY EXP LIMITS I (MMIDD/YYY1) (MMIDDIYYYY) A GENERAL LIABILITY CPA015057026 06/15/2020 06/15/2021 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $300,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: i PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- LOC $ JECT A AUTOMOBILE LIABILITY MAA015496125 06/15/2020 06/15/2021 (E accideD SINGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS - X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) A X UMBRELLA LIAB X OCCUR CUA020193025 06/15/2020 06/15/2021 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION$ B WORKERS COMPENSATION WMZ80074992019A 05/27/2020 05/27/2021 X WC STATU- OTH- AND EMPLOYERS'LIABILITY __...._TORY LIMIT$__ ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? I N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $1,000,000 � I I 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) General Certificate Property coverage includes stored material at a limit of $70,000 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 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S156170/M154567 AEK