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24B-072 80 BARRETT BLDGS A - D 80 BARRETT ST-BUILD A-D BP-2022-0068 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24B-072 CITY OF NORTHAMPTON Lot:-000 PERSONS CONTRACI ING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Stair BUILDING PERMIT Permit# BP-2022-0068 Project# JS-2022-000124 Est.Cost:$12000.00 Fee:$100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: CHESTER D MITCHELL 67026 Lot Size(sq.ft.): Owner: FABOS ANITA&BETTINA Zoning: Applicant: CHESTER D MITCHELL AT: 80 BARRETT ST - BUILD A - D Applicant Address: Phone: Insurance: 2 PATTEN HILL RD (413)625-2167 SOLE PROPRIETOR COLRAINMA01340 ISSUED ON:7/21/20210:00:00 TO PERFORM THE FOLLOWING WORK:BUILD NEW FRONT EGRESS LANDINGS 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 NORTHAMPTO UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. I . Certificate of Occupancy si#naturt! FeeType: Date Paid: Amount: Building 7/21/2021 0:00:00 $100.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 14 The Commonwealth of Massachusetts Board o Building Regulations and Standards. FOR Massachusetts State Building Code, 780 CMR MUNICIPALITY USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling . Thi Section For Official Use Only Building Permit Number: 6'i U1 Z Z' Date Applied: Building Official(Print Name) Signature I ' /D�te SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Man& Parcel Numbers Bo Barren 5tr�� ay6 -air)-._ ,14* ii i-c:, 1,la Is this an accepted street?Yes X no. Map Number Parce umber f3 l'6 G -1.-4 1.3 Zoning Information: 1.4 Property Dimensions: 0 1-6 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 Private❑ Zone: Outside Flood Zone? Municipal j�f On site disposal system 0 Check ifyes / F SECTION 2: PROPERTY OWNERSHIP' 21 Owner'of eco d: iivn.�6a it �tirac FFC b 0 5 kitheicr 114 14 0 Lob 2 Name(Print) City,State,ZIP 11--j(.l4e33tkrt Sr €i13)2306223 de,6 5(LaS` 5 P. .o 0 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Owner-Occupied 0 Repairs(s)# Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify: lanoAuy 5ttp5 re f r e/I4e e Brief Description of Proposed Work': 0 Z. a r ON. „�e A,� i,U/ S'�'PS/3 i' sQ if, oi-er e xi is hv► ovtcre, .e _ -r 5 Foo r latetu'15 a 5-1 4 cs '1740.1 --) SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only (Lor and Materials) 1.Building $ ' lZ et 0 4D 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ 0 Total Pled COSt3(Iteiii 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: tX) Check No.1 Check Amount/ I CD Cash Amount; 6.Total Project Cost: $ I-Z 0� 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Snuperviso �cense(CSL) $_a`7D� 3 Ck `u N ) J ( ` 2 2oe � 'Yt,(1 License Number iratioo Date Name of CSL Holder V Pcc`tvt tl fie List CSL Type(see below) No.and Street 'C Type Description ( vl1 r-ct.l 4. O tT y U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling ('itv/Town,State,ZIP M Masonry RC Roofing Covering - w OW WS _ Window and Siding _ Jii SF Solid Fuel Burning Appliances \ __ 35 74 5 7 Cluj 9 Zj fq 0'Cew I Insulation elephone Email adder s / D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1 g LI I bet i Z )zozIi1 D. f e.l l vIC pany Name or HIC Re ' Name C Registrati Num'brer Exp' oon Date No.an Street Email addresl C��r c* ,MN- 0t3y6 (t-i(---.) 535 7`157 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 I,as Owner of the stitSjec property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. I Print Owner's Name(Electronic 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 con fined in this pplication is true and accurate to the best of my knowledge and understanding. th l /1 /Ce4n' c(c_ P��" 7 Mco,..r— `7I Print Owner's or uthorized ( g Agent's ante Electronic Signature) l ate NOTES: I. 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, rovide the information below: Total floor area(sq.ft.) tiOSF )(_ ISOFF (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" City of Northampton Massachusetts ?rr ._ '<< .t' A' oFu: "-at it` DEPARTMENT OF BUILDING INSPECTIONS S a j„ 212 Main Street • Municipal Building O`, cD� Northampton, MA 01060 f ; TO° 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: Co 1 FAA tIV PI 0 LOCI-4C Dl 5p o.a- I C The debris will be transported by: Name of Hauler: r ste_ ( k A--ra( Signature of Applicant: Date: 3J4. ��(2Oz 1 The Commonwealth of Massachusetts f> Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114 2017 www.mass.gor/dia 11 urkers'('omprnsal' Insurance Affidavit:Buildersit'onlractor Electricians+rlumbers. fq lit. t I1.t:D Willi T11E PERMITTING Al 111t)R111. Applicant Information C __ n, ` , I Please Print Leeibls Name l lfustness Ori.anll aeon Indnielatal): vl�� c p• f.1 L4'^i-` I Address: PoAte I � City/State/Zip: Cct1at.Z 1M, Mg Phone#:6-f(-5)53 -71157 Are ono an employ re?I heck the appropriate hot: Type of project(required): ICI I am a eiteilo cr with employees tlill motor part-tiara l.• 7. Q New construction 2171 I am a snk proprietor or partnership and hate no employees working fur me in $. al Remodeling any capacity.IN or uu o workers'cusp. meaner reyuintl.l 9. Demolition I arse a homeowner Jung aft wort myself[No workers'comp,insurance reatumd.l" 4.(,I airs a lrinreoviner and will be hung contractors to conduct all work on my proprrtg. 1 will 1tJ❑Building addition �-+comic that all contractors either hate nortca'eatntpcoutiarn uauranee or are sack i 1.0 Electrical repairs or additions pngrrxta,rs with no employees. 12.0 Plumbing repairs or additions :SO I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-coatrxs kite employee%and hate workers'coop inra uncr 13 Roof repairs ► 6.0 we are a corporation and its officers have exercised their rightof exemption per MUSL c. 14.0Othe1 IS2 yt 1it1.and to.:hate no unpiuyces.jNo workers'comp.insurance required.) •,any applicant that checks but al must also fill out the section twluw%buttins then workers'conrpewatron potiet mto•ranatto. *lturnconners who submit this ati chart labelling they are doing all wut and then hire outside contractor,.nut.uhnnl a ncu athdat it m:licatrne.wit. :Contractor that sheet ibis box must attached an additional ahect showing doe mune oldie sub-ctso tt actor,and.fate w lacthcr or not atw+c.mutts,,hay: einpltryinm. If the sub-co iractort hate employees.they rust monk then workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. — Insurance Company Nlame: 4'4 - g,( Policy#or Self-ins.Lie.#: PteC)/12 y � Expiration Date: I J Z Job Site Address: )O U/ai T 5T lt7tt'-r l'i'`^€ City/Statc'2ip: I Attach a copy of the norkcrs'cons nsatiod policy declarationpage show the lies number sad expiration date). oP. Pc Po ! (showingpolicy Id 1 Failure to secure coscrage as required under MGL e. 152.§25A is a criminal violation punishable by a fox up to$1,500.00 andlor one-year imprisonment,as well as civil penalties in the tier»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 fonvarted 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 in jnrmation provided above is true and correct Signature: Date. Phone#: Official use only. Do nut write in this urea,to he completed by city or town official City or Town: Pernik/license h Issuing Authority(circle one): 1. Board of health 2.Building Department 3.Cits rTussn Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: AC4R®® CERTIFICATE OF LIABILITY INSURANCE DATE 4/2M/DIN 2) 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 CON IACT Michelle Bettencourt NAME: A.H. Rist Insurance Agency, Inc. PHONE (413)863-4373 a,No1: (413)863-9658 EAIL 159 Avenue A AD ADDDRR ESS: P.O. Box 391 INSURER(S)AFFORDING COVERAGE NAIC# Turners Falls MA 01376 INSURER A:NGM Insurance Company INSURED INSURER B: Chester D. Mitchell INSURERC: 2 Patten Hill Road INSURER D: INSURER E: Colrain MA 01340 INSURER F: COVERAGES CERTIFICATE NUMBER:2020 Certificate 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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIkIRS LTR •n WVD POLICY NUMBER IMM!DD/YYYYI IMMIDD/YYYYI x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,000 A CLAIMS-MADE n OCCUR PREMM DAMAGEoccurrence)SO RENTED ISES (Ea occurrence) $ 100,000 NPT0042Y 9/4/2020 9/4/2021 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 300,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 1 POLICY n 7rC7 n LOC PRODUCTS-COMP/OPAGG $ 500,000 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO 000ILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB —~ CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION I STATUTE E PER I ORTH- AND EMPLOYERS'LIABILITY Y/N piANY PROPRIETOR/PARTNER/EXECUTIVE )N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Classification: Carpentry - residential 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 212 Main St ACCORDANCE WITH THE POLICY PROVISIONS. Northampton, MA 01060 AUTHORIZED REPRESENTATIVE Tracey Kuklewicz/MB �...� .7(4/. • ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD INS025(2o1401) - I ---7- H i H I 1 t , t } , , ., ,., t ,: i ; , i / . j ) , - L.---) e\f-te, I , ., , (,) 11 ,,l- i • —7 'Vi—` \)\ki i .II6k.klif a L____________1 ill ; il! . , :.;N ' 1 . I V)N) ' r �� J — Rc5, V\e,f,>, &) 2.64( 13.),...:-6)-u- \'I \''' \,,iZ- ii9ferP‘4\c‘s ,4._ \\. t . Pi-oi)495%eA r 4.4.0,3 ..) ..„...tia 1 e*,- 2N I __ , jFt- -------"At( C'f . , 1 ----- --1- ! ct. 1 _c_. 0 --- --, , c) , ,..--ce i \Si.). -- - , 4\ cK 4 417.;* 4000 .) _ _ _ . _ 44042.0\1/4 T ___ , _ ___ _ ._, � ticel9 � �; rat ! k.3.\_ i 9i:ex1/4-, (74c . f Yivc3-;? (iv ...0 <7......_ .....„ _........z t -1:)--.\ v ro I -1) cikr AMJ� 1 9r,,Y 5 Ae. � c_ Z Akel ( From: C 1) A A To: Jonathan Flagg Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 The Massachusetts Building Code, section 107.1 allows for an exclusion from requirements for construction control in certain situations. In accordance with code section 104.10, I request that you grant a modification to waive the requirement for c•nstrucjon control of the project at $ s because gQ work is of a minor na ure, will not affect structural elements, health, accessibility, life or fire safety, and will be done in accordance with the prescriptive requirements of the code. Thank you for your consideration. R spe/ fuyly,