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24D-048 (9)
32 STODDARD ST BP-2021-1434 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24D-048 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2021-1434 Project# JS-2021-002385 Est.Cost: $2520.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BARRON & JACOBS 60475 Lot Size(sq.ft.): 13547.16 Owner: FULLER SARAH H JANE Zoning: URB(100)/ Applicant: BARRON & JACOBS AT: 32 STODDARD ST Applicant Address: Phone: Insurance: 70 OLD SOUTH ST (413) 586-8998 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:6/2/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 3 REPLACEMENT WINDOWS 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. �L� 1 Certificate of Occupancy Signatur � �U FeeType: Date Paid: Amount: Building 6/2/20210:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner The Commonwealth of Massachusetts "�--�` � �: ,./ Board of Building Regulations and Standards FO Massachusetts State Building Code, 780 CM JUW 7 _ CIP ITY 204 J US Building Permit Application To Construct, Repair,Renovat Demolish a Rev sed ar 2011 One-or Two-Family Dwelling; PFef O€Nil 01 p This Section For Official Use Only -- ;"N;M4 otosn N9 Build'kLi ermit Number: Gr ' 02 I •'[�(actDate Applied: - ) Z ///72 6 Z. Zzzi Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Par umbers '32 S kA rel- 1t • D- owl 1 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) 140 c [ 1C) ¢ 1 SIIIrND 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 y2 Private 0 Cheeckkif yes Municipa On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Name(Print) City,State,ZIP 7D 2 r 4 et,. 41 -5810-2-r1- 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) q Alteration(s) 917 Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: 1r'1Nire-4-.. d t..Q\et Live- '%v SW S- SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 2-1 fj Zv 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ 41 Suppression) Total All Fees: $ Check Not1'gii heck Amount: b f Cash Amount: 6.Total Project Cost: $ 2(5 W 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C3j— fl�0`cl !1 110 I yz_ G�(\S ircy V.,:lr 1 G-c_.obs License Number Expiration Date Name of CSL Holder 7 0kk StR S'e'• List CSL Type(see below) U No.and Street Type Description - 1 � �� 0�� U Unrestricted(Buildings up to 35,000 Cu.ft.) N R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 1A127"+i `ii1ai �►�N2b4r�r0✓�o►yrGtcjbSQy I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 50'1 0 Z y olVW01f.'r ' as-aloS S'6Z 4K S HIC Registration Number Expiration Date HI Company Name or HIC Re 'strant Name No.and Street Email addres' City/Town,State,Z 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 TO No 0 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 Y y ywN `� �Q..,,A,S f() s to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electfeerriiic 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. Prinees or Aut ri 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" SIGNATURES By signing below,you agree to items A, B and C. DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES. A. Alternative Dispute Settlement(Arbitration Clause): The Seller and the Buyer hereby mutually agree, in advance,that in the event of a dispute concerning this Agreement,the parties shall submit such dispute to a professional,state-approved arbitration service(cost,if any,to be paid by the submitter)prior to either party proceeding to legal action in the courts. . y signing this agreement,you,as the owner of record,are hereby authorizing Barron&Jacobs Associates Inc.to act as your authorized agent in all tuatters-pertairtitlgtOThe building permit application. C. This is a binding Agreement. You may not cancel it except as stated. This Agreement covers and supersedes all conversations,statements and agreements,expressed or implied,between the parties,their agents or representatives. ,)124(Z Gt. - � .g . Z I You,the Buyer,may cancel this transaction Buyer Date at any time prior to midnight of the third business day after the date of this transaction. See the attached notice of cancellation form Buyer Date for an explanation of this right. Seller retains an equal right to cancel. Barron&Jacobs Representative Da —Cr(aci— ********************************************************************************************* Contact Information Office Manager: Sandy Scavotto Office:413-586-8998,x100 0 Chris Jacobs,President CT HIS#0554397 Cell phone:413-250-6677 Home phone:413-665-9113 Office phone ext: 103 ❑ lesha Gomillion,Senior Designer Cell p:ione:413-923-7003 Office phone ext: 106 MA Construction Supervisor License 060475 MA Home Improvement Contractor 100809 CT Home Improvement Contractor 518617 Purchase Agreement Page 9 of 9 DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit # was issued with the condition that all debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L c. 111, s. 150A. The debris will be disposed of in: j Name Oft Waste-'acility Address of Waste Facility 111.5 Debris: As a condition of issuing a permit for the demolition, renovation, rehabilitation or other alteration of a building or structure, M.G.L.c.40 s. 54 requires that the debris resulting therefrom shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L.c. 111 s. 150 A.Signature of the permit applicant, date and number of the building permit to be issued shall be indicated on a form provided by the Building Department and attached to the office copy of the building permit retained by the Building Department. If the debris will not be disposed of as indicated, the holder of the permit shall notify the building official, in writing,as to the location where the debris will be disposed. 780 CMR—66 Edition Signature of Permit Applicant -I-_( /2 ( Date AC ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDM(YY) 02/23/2021 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 Adina Edgett NAME: Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Ext): (A/C,No): 8 North King Street E-MAIL aedgett@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Main StreetAmerica/MSA 29939 INSURED INSURER B: NGM/MSA Barron&Jacobs Assoc. Inc. INSURER C: A.I M Mutual/A.I M 33758 70 Old South Street INSURER D: INSURER E: Northampton MA 01060-3833 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 03/22 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 SUBW POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD,WVD_ POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED 500.000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10.000 A MPT8049D 03/09/2021 03/09/2022 PERSONAL 8 ADV INJURY $ 1.000,000 GENII AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000 PRO- JECT LOC PRODUCTS-COMP/OP AGG g 3.000.000 POLICY OTHER EPLI $ 10.000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 1,000,000 B OWNED v SCHEDULED M1T8049D 03/09/2021 03/09/2022 BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY _ AUTOS ONLY (Per accident) Medical payments S 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 8 EXCESS LIAB CLAIMS-MADE CUT8049D 03/09/2021 03/09/2022 AGGREGATE S DED X RETENTION$ 10,000 , $ //WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER r/N 500,000 C ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA WMZ80080063652020A 03/01/2021 03/01/2022 E L CH ACCIDENT OFFICER/MEMBER EXCLUDED $ (Mandatory in NH) E L ISEASE-EA EMPLOYEE $ 500,000 If yes describe under _ 500.000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S Borrowed or Inland Marine A MPT8049D 03/09/2021 03/09/2022 Rented Equipment 9100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it 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 I V ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts r Department of Industrial Accidents —�- - 1 Congress Street, Suite 100 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): bc\o-Cc'\ 0,'(1c\jc“._4.; S 5�.:e .c� %Z \rL• Address: G 0 \Gt S kVN ' t City/State/Zip: i)•I t1i'Vx c0✓\ ;LNPc 01060 Phone #: 13 ' k \O kre yuu an employer?Check the appropriate box: Type of project(required): I ®I am a employer with 10 employees(full and/or part-time).* 7. El New construction 1 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp. insurance required.) 3.09.a homeowner doing all work myself.[No workers'comp.insurance required.]' 9. Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole ILO.®Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions ❑ I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.1:Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 14.El Other r,Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§I(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#I must also till out the section below showing their workers'compensation policy information. r 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. l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Pt, v\ N'ilkua, _ Policy#or Self-ins. Lic. #: Vitt/ ' 'oQ C,`bt,5 ZO 2-0, PS Expiration Date: 1 12:02 _ Job Site Address: 'b2- S ir) ¶• City/State/Zip: t o J vrs .\ Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). (lpb° 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date. I / Zl Phone#: `'11)) "(-;sc(4 `'S'Y1`3' 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Barron & Jacobs DESIGN . BUILD . REMODEL Dear Code Official, Enclosed please find an application and supporting documentation for a requested building permit. I have enclosed a self-addressed, stamped envelope for your convenience. Please mail the building permit to our office. Thank you. Sincerely, Chris Jacobs A Tradition of Building Satisfaction, Since 1986 70 Old South Street,Northampton, Massachusetts 01060 413.586.8998 barronandjacobs.com