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29-435 (2)
35 ELLINGTON RD BP-2022-0054 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-435 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Stair BUILDING PERMIT Permit# BP-2022-0054 Project# JS-2022-000093 Est.Cost: $7000.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ALISHA PHILLIPS 106378 Lot Size(sq.ft.): 10018.80 Owner: CAREY KATHERINE Zoning: Applicant: ALISHA PHILLIPS AT: 35 ELLINGTON RD Applicant Address: Phone: Insurance: 40 PINE VALLEY RD (413) 586-5986 WC FLORENCEMA01062 ISSUED ON:7/19/20210:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE STEPS 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 signal ': �'�' . i FeeType: Date Paid: Amount: Building 7/19/20210:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner F <The Commonwealth of Massachusetts 4/.0 7s O Board of Building Regulations and Standards e' R c , kt,-* Massachusetts State Building Code 780 CMR >�+ •I.1TY �"J Building Permit Application To Construct.Repair,Renovate Or Demolish a Revise ,, Vi" One-or Two-Family Dwelling 9oc , is ection For Official Use Only 49 'I'd' VP'Building Permit Number: .._,--- ___.._._-.___..__ Date Applied: ty 1 .ig . ... ....„ Building Official(Print Name) Signature ,1 LlaTc SECTION 1:SITE INFORMATION 1.1 Property Address: I 1 2 Asse rs Map&Parcel Number r 3S Eth� /D,sr + •,� ��jf I.l a Is this an accepted strect?yes no Map Num r Parcel: amber 1.3 Zoning Information: ___ �. 1.4 Property Dimensions: Zoning District Proposed Use I.ot Area(sq ft) Frontage(II) 1,5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required I':prided 3 4 ft .ter f vs r'i I vo A 1.6 Water Supply: M.G.I.( . c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: — Outside Flnod 7 el Public Private CIMunicipal Ott site disposal system 0 t'lit'ck if ve SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: YS►tl trleM. C" _-- rim,/4cf 014 0/0C Name(Print) City.State,ZIP f ! r t� L!T 3S" Eli yt - 314-€ Y k�itj<4,c.. cleft .tr'. Mclf4 t S , < 1.1 No.and Street V' Telephone Email AddresV 3:DESCRIPTION OF PROPOSED WORK`(check all that apply) New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s),, Alteration(s) 0 Addition 0 Demolition ❑ Accessory Bldg.0 Number of Units I Other D Specify: Brief Description of Proposed Work : Qt>,H, „4, 0141_4!'4Mrhb, (dw.c.'fte {rti „Jr it rlt II/t v SJsr.i Sifi'l 4 r/ ''I. _arty PMt- et P f` 74•.Je. -41011111.11011.0 SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ElStandard City/Town Application Fee i---- 0 Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: S 4.Mechanical (FIVAC) S List: S.Mechanical (Fire S Total All F Su ession) s:$ ! Check Neck Amount: _C7 Cash Amount: 6.Total Project Cost S 7 00 00 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES ---------- 5.1 Construction Supervisor License(CSL) 4S- /04 2 (, e 24 2 ,'[tstik /4 f4t1(t License Number E. . ut ion Da Name of C;SL Holder I LID '1 t a�A1f9, I..it.t CSl_Type(see below) 4_ VIt --- Na and Street Y Type Desenption F 0 st + Unrestricted(Buildings up to 35,000 Cu.I)! _ _t it "'` R Restricted I&2 Family Dwelling CityTown,State.LIP h1 Masonry RC Roolin C©verint; WS Window and Sidir , `�r3- Ste-SS SF Solid Fuel Burning Appliances �G 4 XIt4'114l1t 4 Lot. C i insulation Telephone Entail address ur440 D Demolition 5.2 Registered Home Improvement Contractor(H 17111411 Fxpir 21� �Zt ALritsl.antootJseq t, t gout TmliAl#I/a7f LL - _ _. �t_� __..._.._.______...... HIC" ta;ttion �ueiber stir n pith Name or FIIC Regtstr nt Name f / _�:P._ �t s.. 141f� Q ...___ G]Xt�th19*tdRM+t_�t0wa ism C�'+�? No.and Street. (J Email addresc �// Rawest. r1Q 4 Opt, . `tL. -Sal t'a—Sit-6 City'Town,State.ZIP l ett:phone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M,G.L.c.1.52.§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 r a / b tl /Vs I,as Owner of the subject property,hereby authorize f'll Sits �ry4f !"it to act on my be f,in all matters relative to work authorized by this building permit applic 7/2/21 Print Owner's Name(Ele rc tie 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 bes y knowledge and understanding. t nPSt4., PI,:teat —.1,/_p.9 _z-1 Print Owner's or Authorized Agent's Name(I:leetroni• if, azure) Da 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 us the/louse 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•.tnass.govidps 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 T ---•-- Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton ->" S Massachusettstrn'< kt I BOPARTMEIVT OF BUILDING INSPECTIONS y Kr 212 Main Street • Municipal Building j' Northampton, MA 01060 9f3 ;v7‘` ' 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: I / /1? Location of Facility: v^ le 77/ r The debris will be transported by: Name of Hauler: At' t1 LgNdlcfIs.( -101 44-1M/4 t Signature of Applicant: Date: G 7 Z The Commonwealth of Massachusetts Department of Industrial Accidents ; 7--71,01,r RI 1 Congress Street,Suite 100 if ... , L. Boston, AL-I 0114-2017 www mass.gor/dia I'l otters'Compensation Insurance Affidas it:Builders/ContractorsfElectricians/Plumbers. It)HE FILED W I Ill I IIE PERMI EfING AVIHORI IA. .tnolicant Information Please Print Letihis A , 'Yt a Name(Busine're("/r .11 y! m 73i1Oniindi vickia1):_jt ivl Lail,k itilt / 14(414 .1.19/11-telerti- I Address: 110 1 D,4 fhb lily,- iipld C.ity/Stateli F. FloieeId ft/V 01062 Phone#: , 11/3- S-66 . . .k re hula VI Omer?Check the appropriate bus: Type of project(required): I, ain a employer with (di , employees i fall int.1'04 part-timei• 7. 0 New construction .11:1 lam a rude peopnera*or gurtnirrrhip and have no emplaryees working fur me in 8. C3 Remodeling any capacity..(No worker.'comp.ITINU1111VX required j 9. 0 Demolition 30 1 am a horrreorriurr doing all or inyrelt[No worker, comp,31:1Anuntx retptinair II 0 ci Building addition 4.0 I am a homeowner and*ill be hiring 4.4,ntrasium to conduct all work on my property. 1 will ensure.that all coritractorm either hare workers'compenvation insurance or am sole i 1.0 Electrical repairs or addition, proprietorr w ith no employees. 12.0 Plumbing repairs or additions NO lam a general contractor and 1 11.1.•0 hired the sub-euntraetori listed on the andio.t.sheet. i 3421 Roof repairs There*1h-contractors hare employees and hare worker**comp.insuranec. 14Xither IVY Fast- 511t.t. 60 we are a corpiannon and its officers have exercised then right 01 cm:cm:4km lier NA&e. 152..tilt41.and w e hat no emplurver.[No*rakers'comp.inn:ranee requirt11.1 *Any applicant that chocks kit.4 I mat also till out the WalEnt Mu lk Ai-W.1w their ir otter,'compensation policy Mformation. t fiennoiwneng who euirmit this atrielavit indicatinj.they are doing all work and then hue outside erintraetors mug ubnui a new aftidai it indienting such 1Contracrins that e bee I.the,box must attached an ariditionai shirt showing the name of the suir-euntracrors and state whether in not those owner hare employ ees It the•euli-euturactore have einirloy e'er.they most prt,'.id.:lin:tr a t•rk en,',..1,111P.ph k`)•number I ant an employer that is providing ii,orlier.s'compensation insurance for mi'entployees. Below A the polity and job site infarmation. Insurance Company Name: A. T. Al, jii" tii 4 / Policy g or Self-ins.Lie. 4: laiCC.- S-00 "" ,i-o2.00 w3-7.42./A Expiration Date: 407/Z6'22 Job Site Address: 35" eivItiai kield City/State:Zip: F40 4,1c.e Ad' 0/6'4. Attach a coo of the workers'colInpensation polky.declaration page(showing the policy number and emtiration date). Failure to.es-ure coverage as required under MGL e. 152.§25A is a criminal violanon punishable by a line up to$1,500.00 anikor one-year imprisonment.as well as civil penalties in the furrn of a STOP NN t.,113..K 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 verdication. I do hereby certify under the pains and penalties of perjury that the information provided abort is true and correct Signature: Date: te/ 2,/1/ 1,6,n,r-. li/3 - .5-- C- 5-78-C Official use only. Do ma 14 rife in this area,to be completed hi'city or town official City or Town: PermitiLicense# Issuing Authorits, (circle one): I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other °intact Person: Phone#: . . ACE 1 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 11/26/2019 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 Sarah Premo NAME: Martin J Clayton Insurance Agency, Inc. IA/C.PHONE FAX (413)536-0804 (AIC,NO): (413)534-1a74 1649 Northampton Street E-MAIL remo@m'cla ton.com ADDRESS:s p y P. O. Box 989 INSURER(S)AFFORDING COVERAGE NAIC M Holyoke MA 01041-0989 INSURER A:Safety Insurance Company 0014 INSURED INSURERS:Safety Indemnity HO Preferred 33618 Axiom Landscape 5 Home Improvement LLC INSURER C:AIM Mutual Ins. Co. 053 40 Pine Valley Rd INSURER D: INSURER E Florence MA 01062 INSURERF: COVERAGES CERTIFICATE NUMBER:19 MASTER 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 SUER POUCY EFF POLICY EXP LTR TYPE OF INSURANCE INSDJMCD POUCY NUMBER IMMIDDIYYYYI IMMIDDIYYYY)_ LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,001 A CLAIMS-MADE X OCCUR DAMAGETO RENTED PREMISES(Ea occurrence) S 100,001 8MA0028548 1/11/2019 1/11/2020 MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ 1,000,001 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,001 X POLICY JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,001 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,001 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED AUTOS X AUTOS 5907002 1/11/2019 1/11/2020 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) $ Medical payments S 5,001 UMBRELLA LIAB _OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ _ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'UABIUTY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDENT $ 500,00( OFFICER/MEMBER EXCLUDED? I it NIA C (Mandatory In NH) 14CC5005020083 4/17/2019 4/17/2020 E.L.DISEASE-EA EMPLOYEE $ 500,00( If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00( L I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) RE: 75 GOTHIC STREET, NORTHAMPTON, MA 01050 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF NORTHAMPTON THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN BUILDING DEPT. ACCORDANCE WITH THE POLICY PROVISIONS. 212 MAIN STREET, #100 NORTHAMPTON, MA 01060 AUTHORIZED REPRESENTATIVE Michael Regan/FMT P 1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) Cet/tr) CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD 40 } Sad I trio SIDE YARD 1`U S L SIDE YARD ee� FRONT SETBACK 3 4 f� FRONTAGE 105 -I