24C-012 271 PROSPECT ST BP-2021-1464
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24C-012 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-2021-1464
Project# JS-2021-002438
Est.Cost:$23770.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DANIEL WEST 106007
Lot Size(sq. ft.): 17467.56 Owner: HARVEY P MESSECK
Zoning: URB(99)/ Applicant: DANIEL WEST
AT: 271 PROSPECT ST
Applicant Address: Phone: Insurance:
11 PLYMOUTH AVE (413) 695-7311 WC
FLORENCEMA01062 ISSUED ON:6/8/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE 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. CPPM-
Certificate of Occupancy SOnatt ': r '
sv .
FeeType: Date Paid: Amount:
Building 6/8/2021 0:00:00 $40.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
a
The Commonwealth of Massachusetts e FOR
it Board of Building Regulations and Standar, �111)NI AL1TY
Massachusetts State Building Code, 80 C ' ✓(//V U
Building Permit Application To Construct, Repo' ,Rem?. Or Demolia , '• ise ar 2011
One-or Two-Family Dwelling.,. 'v '
�' This S,eiction For Official Use Only pTh 1raroN^�,L., o
Building P rmit Number: 5? �Ya`7 D to Applied: Soso Ns
_, .
cult lSS �� - 4-8-zz]
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Proper Address: 1.2 Assessors Map&Parcel Numbers
2`l1 �Ct3Sp iE 1 •
1.la Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
..2'/G' O/2—
Zoning District Proposed Use Lot Area(sq ft) Frontage(II)
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:
\--karv.<� V �5 cc.� V1pf �n? O(o�6
Name(Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied I] Repairs(s) El Alteration(s) CIAddition 0
Demolition CIAccessory Bldg.0 Number of Units 6her 0 Specify:`�1 &-)- c'f
Brief Description of Proposed Work': r ve_ `54-0 i �-ti(, O1
tfltiv,› -36--(-e ci r eye b c1 v .. -. ,t, \ , •.
YviV\ (- Se Cktf‘ k G-, 5P -
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $�3)----+(icc. 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $�
Check No.12 S Check Amount 40 Cash Amount:
6.Total Project Cost: $`L3,J- e9,- 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) ��- �DCe�" �r D: ZP
' 1 License Number
Name of CSL Q
�(� List CSL Type(see below) 1,
,'l - ' Type Description
IYa and
C/� � � ,nn�, U Unrestricted(Buildings up to 35,000 cu.ft.)
L 1C:N�C e Y , V , • 6t�'C Z R Restricted 1&2 Family Dwelling
Ciiyfrown,Stacy Z P
WS Window and Siding
SF Solid Fuel Burning Appliances
6,l ) ,c- ( 0(c 4sf[�'r is ‘( I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) ,- -i a.
L �s� 11s _c✓\ i r 6 / HIC Registration Number Ex irat on Date
HIC Company Name or HIC�Re,goi t Name --7
/,1 P i"GRo vcl'\ f��' CA(u�l-e;S0C( ( '�
No,and S t Email address-'
Flatioa VIA)9, O(Oce2 613_) j5--j31
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 0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT L
I,as Owner of the subject property,hereby authorize �, ( , LC U� , C cA{'
to act on my behalf,in all matters relative to work authorized by this building permit applIlion.
t 1 v ] v v�TSS 2C '&57
Print Owner's Nape(Electronic Signature) Date
SECTION 7b:OWNER5 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.
ee
Print Owner's or Authorized Agent's Name(Electronic Signature) ate
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"
SECTION 5: CONSTRUCTION SERVICES
City of Northampton
y�J.1'f-
tt,i +rr. �..
S`S . Si
Massachusetts 4. • C
_ 'e
lt:( '. r w
'� s DEPARTMENT OF BUILDING INSPECTIONS �'
$• *y, , 212 Main Street • Municipal Building J,y cIf
S Northampton, MA 01060 ssbjti; �'���
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: V4.16 A Ce
2 51 Radk•
kcrn( vv
n cue O
The debris will be transported by:
Name of Hauler: '.t... (1-3 13r -Ciftc
Signature of Applicant: Date: /4/1.e't-/
The Commonwealth of Massachusetts
y ~----( Department of lndusttial.-accidents
Fi 1 Congress Street.Suite 100
, r Boston. MA 02114-2017
"*., ✓.. "" Ww»:massgov/din
fl rrrktrs'Compensation Insurance Affidavit Butlderztt'onirlsctorsiElectrkinnsfPtumbers.
ru hi t tLLI►Wit ti I Ilk PtilbliTTING Al 1tic►w rt.
Applicant Informatiuo .- r — Please Print Lt ib s
Ninte41Juttutcss!etgang>sat ti.hullsivuail: ¶.L t,u w(S t R im ( i--
Adds- k.V P(i V =,., ,
City;Ststr'.r'Zip: '"l�C 4 C t( �/ . COC L E'ltctn : `'G\3)L�t - 13
Art pro an tat ithrtrr'44 1etk Ellin approltrwtr tart, t
Typeotproject irrynfrtrrly
1 fJ-tant a vmpktytts watt rntirhrywers dull aett•ua putt-tear I.' 7. CI Nevi, cefrrSTtttc ien
10 I ran a salt penman'.or p trans top amd haw no anolort ra*wham tar oat m 8. o Remodeling
any capacity [Ni*Wien'cutup.t.trwnncv ttcpliniti I
9. 0 Demolition
1!.0 I am a htntstttwticr dump All autk!resell:f No Nankai romps.uttartnit trsitstmLl'
A 0t arm a lama a y*TUX=tl a dj IX heat It).Aadtni utt w,ak Ja ttn vanilla'', t wall 1(M Budding mltfitiofi
curing that all cautia.i►nf dthtr lufrtr vtratjct.'ct*upt aaalnnt ittraunttact or am sale 1 1a Elixurm&al repairs or addition!,
pnrimtet►xv*ilk sat aztaplttytrLw i ID Plumbing repairs et additions
°,0i i tan jgcntral cantrarwrmai I have that the .tb-tnntrm:uor+.t!stci..ec tt+tc 21sut:l,ti1 thc.I I 3. RtLoI airs
w'Tha abbot tots h t i svt tpliJma Old lai4t wutktxar tamp I,,i1.t-,rL•t,.
14. Other V\,19-0 (kp _
h 0 We ace a t'viptinentu and Ira uffstant Imo(cILLTIMIEtt[hear II M of d.t.a:u Ftuat NI 1,41(iL L"
i5.1 It 4 L tuai Kc havy tiv tstolutoct•.IN i wudcn'tinny:. !ruin ant:[:ttryurrtvl.I
•Mint up!hc utt ttrur dwelt.-boa rI tuutt alto Ili out the met:taint l ckrw tut.,[tut;them it uriar►'crantpturtmauu mho tutoruuttum
Ik.nttcttt•tt►-ta IA kuvalltnut taut atlitltt'it ittaluatinu airy strwl•.-u u all-r;:L unit then hirrutui,dc Cattltn:'tI,L IcuL't Ath,nut a not at t.datit n•tftut:uu.tsk
t canna:tom that thccta tint hot tart(mta!:hai an AltIntonal ubct-%hoot to they tram tit Uar srrtr•ctx"trwt:t;ar••n,"tot..wmyhzz at a.-.I thtt ,.-nuttic-lea.
-•,lu me. If the sub-..oiateacttu'hat:=IOL 4'tate,I1I. mutt lvta•itk du: utukuto'anal,.pu.lit.,t:Lunbcr
i am an employer that is.providing workers'compensation rtion insurance for rn,P rattpltrtttrs. Below is the policy tend job ilk
information.
Insurance Company?slam; .A. L L.�• til4-34._1-,A 4.4-, /wzz .
Polity t1 or Sclffias, Lie.0: ADC,a0c -0-6(,,- (OZvz I Expiration Dater/t
lob Sae Addrew_ 2 ' Cyes S� . Cty'Stac�- • O(O4'0
Attach a copy of the workers'comtiensatinn polar)declaration page(showing the polity number and es irattion date).
Failure to secure coverage as requited under MCiL c. 13*.. ,2L5A is a criminal violation punishable by at line up to S1't1U.0tl
a+ter one-yt r imprisonment-n+well as civil pen hies m the hoary or a STOP WORT ORDER and a fine of up hi i DF,t$i a
day against the violator_A copy or this,statement may be i.arwarekd to the Office of investigations of the DIA for ittitunnce
Loterugc teeth atton,
1 do herby c a trod r he ins and penalties of perjury that the information prorlikd above is trite and correct
Sivatwr - 2- Doty `e1T11-10-Z-1
lta;,,,nc t(3J "i-3 r I
( t ira/use only: Thi not write In this area.to be completed by city or town official
Cat) or Town: Permit!Lieensr k
issuing Authority trimly one):
I.Board of!health L Building Department 3.('it .`1 uwn Clerk 4.Electrical Inspector 5. Plumping inspector
6,Other
Contact Penton: Phone#:
6/3/202r— ,.....1 Town of Hadley Building Dept,MA-online payments •
ACORe ,�„wrwa.r.Y,
CERTIFICAT OF'LIABILITY INSURANCE 05►1312021
THIS CERTIFICAT -""Y° __. ,_ _.___-.----.-,
IS*UEO q3 A M E OF' v FERS t#O RIGHTS UVON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT,AFFIRIYIATI 7 R NE�A Ak A1tC Oft ALTER it)E COVER GE 4FFORDED BY THE POLICIES
REPRE THIS CERORF'CATE>OF INSURANCE DOE'S tote.. • A t,J tTR�YCT BETMtIEEN THE ISSUING Ir SURt R(S), AUTHORIZED
..\
REPRESENTATIVE OR PRODUCER,AND THE CERTWFICATENOLOER
IMPORTANT: It the ceriflcate holder Is en ADDITIONAL INSURED,the poltcy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and condltltxis of the poilcy,certain policies may require an endorsement. A statement on this urtlncate don not confer rights to the
certificate holder in lieu of such endoreemangs). —
PRODUCER c Traria Sias PAS
KSK INSURANCE AGENCY INC NAMe; Atc --
I PHONE q 13)527.7859 ice,No;:
N E.ii i
rya• trevtsslas;c,ksk-Insurence.com ____
203 NORTHAMPTON ST INSURER,SI AFFORDINS COVERAGE _..,. , -- _,..,_!tr 33758
EASTHAMPTON MA 01027 A, AIM MUTUAL INS CO
INSURED _-
DANIEL WEST IwiMeac; ___,_ —'
D L WEST ROOFING CONTRACTOR i
11 PLYMOUTH AVE mun e a -
FLORENCE _ _MA 01062 .1., ►•
COVERAGES CERTIFICATE NUMBER: 855152 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHK:It THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL T!E TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
SUSS - MlCM roue POLICY� brie
LaTR' TYPE OP MURANC! IN'5UL wv. POLICY NUMaatt AteyeRrSDYCL1MMA?QDT►I
COMMERCIAL GENERAL LABILITY 'EACH 00CURRENCE I s
11 PRENI L. __$
.-.. CWLIS-MADE OCCUR
{ ma EIP IARP ono prim) S
— -_-.
NM PERSONAL II ADV INJURY f _
I i --- _____
DEAL AGGREGATE LIMIT APPLIES PER GENERA.AGGREGATE S
POLICY[..-1 J�ECT LOC ¢ PRODUCTS; -CO MP/OP AGG #
S
OT j COMSINED SINGLE LIMIT S
AUTOMON0.ELIABILRY } i.' occident Ea adenl
..__ . ._
ANYAUTO 1 I BODILY INJURY(Per person) $
I" ALL OWNED SCHEDIR.ED N/A BODILY INJURY(Per acvdant) 5
ALROS AUTOS 'PROPERTY DAMAGE S
•' IAUTOS AUTON-OWNED -INE.e el..
S
}ureseeLLA W W OCCUR EACH OCCURRENCE $
EXCESS LW _CL IMS-MADE N/A
AGGREGATE $
i DED RETENTIONS 1 X L j�. r$
A- S�piUTF
AND EMPLOYERS'LlABILRY E-L EACH i 100,000
!WORKERS COMPENSATION
Y!N
,ANYPROPM TOR/PARTNERIEXECUTNE -
A OFFICERIMEMSEREXCLUDEOT U NIA # AWC40070383902021A 05101t2021 05/01/2022
£L.DISEASE-EAEnPLrnrts 100,000
(Mandatory In NH) !
DEssCRIPTION O doicnba PERATIONS tHtene £.L.DISEASE-POLICY LIMIT[$ 500,000
i
.,,, N/A
DESCRIPTION OP OPERATIONS I LOCATIONS 1 VEHICLES IACORD 101,Additional Remarks Scheduts,may be attached H more apace I.required)
r Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to
employees In stales other than Massachusetts if the Insured hires,or has hired iho-e employees outside of Massachusetts.
This cenificale of insurance stoves the policy in force on the dale that this certificaie was issued(unless the expiration date on the above policy precedes the issue date of this
certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at
www.rnass.goviiwdAvorkers-compensatiorVinvesfigalions/
Sole proprietor has not elected coverage.
CERTIFICATE HOLDER CANCELLATION
_y 1
xs( SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Matt Murphy Construction ACCORDANCE WITH THE POUCY PROVISIONS.
329 Southampton Road
AUTHORIZED REPRESENTATIVE
J
Westhampton MA 01027 �_. ( L C".
Daniel M.Crgi ey,CPCU,Vice President-Residual Market-WCRIBMA
01988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
ACORu 10(CUIOiUai