24A-070 (5) 64 RIDGEWOOD TER BP-2022-0075
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24A-070 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-2022-0075
Project# JS-2022-000138
Est.Cost:$12995.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DANIEL WEST 106007
Lot Size(sq.ft.): 15071.76 Owner: MCCORMICK MEGHAN
Zoning: URA(100)/ Applicant: DANIEL WEST
AT: 64 RIDGEWOOD TER
Applicant Address: Phone: Insurance:
11 PLYMOUTH AVE (413) 695-7311 WC
FLORENCEMA01062 ISSUED ON:7/21/20210:00:00
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.
(. . r i . Ti .
Certificate of Occupancy signatn
FeeType: Date Paid: Amount:
Building 7/21/2021 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
•
/M
1 , The Commonwealth of Massachuse s
Board of Building Regulations and St�'ttdar 4/0 OFOR
Massachusetts State Building Code, 180 H 49 �D�l MU IUSIP: LITY
Building Permit Application To Construct, Repair,Ren }19 ish a R ised ar 2011
One- or Two-Family Dwelling �'' �' ro r insp
This Section For Official Use Only N ti)q°�6700vs
J5 tvi�
Buildin Permit•Number: OP'�}• 7S Date Applied:
Koss ///2 Zl ZOZI
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Prop rty ddress: 1.2 Assessors Map&Parcel 1 u r�,
C.eKrC t cr. a- 1d p�
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)
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:
0Ae ,VN.cAv\ VIALta it 1Mi L r IADv- 1 i ry A . bCe°
Name(Prin0 City,State,ZIP
No.and Street elephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other Specify: ()..) c=C4-1
Brief Description of Propose'dA Work': Re �Ve,(I: .eX� /c P(a,.-1- c� �C- (��r - '-K c�k SkQ,nc -C...
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ v2.1 c1 s. . 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2. Electrical $ ❑Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No. 13 646-Check Amount: t4.0 Cash Amount:
6. Total Project Cost: $ \ L1 C \5, -- 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
lc` ,)C.j License Number Expiratt D
Name of CSL Holder
k P q.J r 1 fn• -, List CSL Type(see below)
No.and Streit J/� Type Description
'F ocaAa t n K n tL.�^L'�^ U Unrestricted(Buildings up to 35,000 Cu.ft.)
V VJ R Restricted 1842 Family Dwelling
City/Town,State,ZAP • Masonry
RC Roofing Covering
S Window and Siding
�' CAS— 3 I ot t �'7 0�, SF Solid Fuel Burning Appliances
l W � ,--C..((Jn��w 6(l• 0VLI I Insulation
Telephone Email a ss D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Exp' ion Date
HIC •i.any NameA%HIC,, g Name Q
No. d S et Email attdress
-���etnce. , IrnA•6 0 — 3R
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 subject property,hereby authorize•L.( :02,T.Stj to�6$G LC�4tL +it 0-
to act on my behalf,in all matters relative to work authorized by this building permit application.
N a cr n f..c� C. �
Print is 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
contained in this application is true and accurate to the best of my knowledge and understanding.
l itc.( ,)--c
Print Owner's or Authorized Agents 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"
City of Northampton
// Massachusetts ?� .� '!
., 1 - DEPARTMENT OF BUILDING INSPECTIONS S to�;5a 212 Main Street • Municipal Building �Jp Cly
Northampton, MA 01060 ssrW �'`�
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: \MN QN.ec cctIAS Z3:-A 64 (d(N 'Ec_i\-
kn, MA. oloce 6
The debris will be transported by:
Name of Hauler: .1.., W Rtb,c4As Nor-
Signature of Applicant: Date: QA-aZ
The Commonwealth of Massachusetts
"`r" Department of Industrial.-1 ccidentx
._4 iiii ti 1 Congres3 Street.Suite 100
—9i; MABoston. M 02114-2017
'", :t ►t IPW.mass got/din
—. f urkers'Compensation tnsuranet Affidavit:BuiIders1('ontrurtor IEkctrki*n /Plumhrrs.
ro a 11u n N 1111 1 ILL MOD l'I'LNG_<<I 1-U0111 i.
Applicant Information �! / Please Print trends
Main: I Huhn ess'Urguimition lndir idur11:__ . L.-U Q+ xY\S WAc e.aL V—
Addr -.__\1PI ,,,A.,v fj.u.�
City.State Zip: Pprr c,e imp,_ O LOCe? Phone #: Ell-3) (sLCZS—`4-3t
Ur 3vo an tYpptMltY.'t lint!:the apdrultrwtr loon.:
Type of project(required)
PSL.=a lamploy!Menke 2.,. cn iiirrt,I,Inil&ad&r Fat-noon.* 7. CI Neaa cons t11Vu n
2_01 am a ails pa lun.7a nr}autinattup and hate no tmpl7a.%taken era roc m }l CI Remodeling
any capacity [vie umker."cutup.u wi.rnery requite!.]
al am u boanatwtry dons All Munk mynclt(Nu to 9• D�Ittulitlum
! ( camp.mmwra'•t mitettal_]'
4 Q I as a homeowner nod stto toe 5c ,ter ringra 1n amine?ale nark on rm;inert, I*Ill !CI Btttl+l►ng addition
homeowner
Mindy dui all coon/saint cilhar lute wwuaa':,adorn ktauuurct or an ink 11.o Electrical repairs or additions
laer]tterl►ats with no empiteyeti.
1?p Plumbing rtpai s ere tuldition,
T:j I ant a'AL-meal L.untraLeur anal t least katTii the mth.tx,hrt.n.so a baba on lbw auuthwl sheet I rxi1 repairs
nose rub-r'urdacrub hart t luyra aced lame wutk>Sn'Lump ninlattater'
a 0 Vic are n a u and
d eta utfnim haw:.tsviactl[Ire teeth an e of ragan as per tinge_c
1 4.❑Other (\Q b��
IS.:I ti.IL and wt lure no onsplomrew [No works.'carte insurance frowntit
`Oust unpl ..ma that tilcels lairs III must also till Wtt the nor hint bckot,alumw'wg then is urkm',LimmIw;autin larlb,:y Lntminrtr=Ri
.I l[1Fa dcocoLYr A kin nutttutl this offotkm ie mrhenethy they we doing nit south owl then hire outside contes..lor r must L rtteiut a no,.at:uln4 tt mtktcstiup.u:h.
:i cmlrnturr that asteit then ke,x mail attaclfnl an:thbtu,rrai Aral thnw"mg Ilse murk ill the nen,cusaracker,and date r+u 1her at Tit thrf rntttrr,lu',.
cugdt.ac It rh. soh,:t,ttuattur%h:,rr:tannl iy!a,they rmu.t prin,vie!lair r4rxker.'vmh.itvlic►nuunccr
t ant on employer that is providing workers'curpe'ntation insurance for my employere+.t. Below it the policy and Job site
information.
insurance Company Name: fit' V\ \NO 4-465. Cob .
Policy r#or Self-ins. Lir.u: C,45w1-e3(e3tY2r-1 A Expiration Darr. 5 tt 113rz-Z—
LC(
Job Stir AddresskikRtfJl$�2lP2'CAtf• t ity'Stntc-.Lip- Ottic 'c, 6(d 0
Attach a copy of the workers compensation polio decl►trntlun page(thawing the policy number and 1eipie'>,thin date).
Failure to secure coverage as retpuned under MGL a:. 152,,§25A is a criminal violation puntxhsble by a tine up to S1:M0-►ail
mdVor one-year impri omnenl.as well as civil penalties in the!`[win or STOP WORN.ORDER and n line of up to S150.00 a
day again-tit the v►ulntar_A ropy of this statement may be forwarded to the Office ut Inveatigattun!.of the DIA ten in*tuani e
co+rrauc s erification.
1 du hereby Ijr urrd t e ins and penalties of perjure'that the information provided 61 true ilnd correct.
Stgnatwe-, Data: z
Phtmc-: E`" ) t-2-1C- -4 3 1
I Official use and}•. Do not write to this area.to he completed by city or town official.
City ar Town: Permh/L icenwc*
lwiuing Autharih (circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical lawpector S. Plumping Inspector
4,Other
Contact Person: Phone sr:
coRd ox„ n ...\
CERTIFICATE OF LIABILITY INSURANCE13f2 ,
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
BELOW.
DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
REPRESENTATIVE THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the t:ertffleate holder Is an ADDITIONAL INSURED,the poicc les must be endorsed. M SUBROGATION IS WAIVED,■ubJect to
the terms and corm lieu of such endoreeman s).PRODUCER _
AMwavis -_-��� - -.
KSK INSURANCE AGENCY INC N"�"E; Tr�.,. (sta)S szl•7esgIBS -
E MoREaIL ss._.travisslas i ksk-Insurance.00m
Ao 203 NORTHAMPTON ST I ENSURER,S;AFFORDING cov_arRA0l---_ _,__._.i NAIc r_
EASTHAMPTON _ MA 01027 1;mimeo.A; AIM MUTUAL INS CO 133758
MUMS) J
DANIEL WEST insuiame: _--- —— —
D L WEST ROOFING CONTRACTOR agVR010: .
11 PLYMOUTH AVE INSURER■: ._ ___.._.__ i
FLORENCE __ILA 01062 ,INaURaR r:
COVERAGES CERTIFICATE NUMBER: 655152 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 WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCC AFFORDED BY THE POLICIES DESCRIBED HEREIN f8 SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LINTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
_ - - poucrerF POLICY '"cY EXP
UNITE
LEI -.-.. TYPE OF INSURANCE lase4e__ �Ipt,ACY NVMaUR .M_ M700/'rY!TI kI
COR�IERCIAL GENERAL LIREIJTY t II .-._--`--
C )AG Ql�RI7�
pAa1�MADE OOCUR i PREMISES(6►9J1 •.S
I MEDEX_Y Omen!yrso I S
1 - N/A ..-
PERSONAL LAOVINJURY S .�.._.. ._ ._.
_---
GENL AGGREGATE LIMIT APPLES PER j GENERAL AGGREGATE_ .S
POLICY r 1 JEECT n LOC I LPRODUGrs-COAPIOPeats :•
iOTHER ? E
AUTOMOBI.EUAB11.nY (70i�f.1E0$INGLEUENI'Y�=ANY AUTO OOCLLYY EB$NMY1 (Perpsma) S
ALL OWNED SCHEDULED I N/A BODILY INJURY(Per sodderA) S .. __. _.
-"� NO AUTOS NOS-OWNED i • PROPERTY DAMAGE-- .5 .
HIRED AUTOS AUTOS Per scadhtl S
r I EACH OCCURRENCE 5
UIte1RELt.A LIAR OCCUR __.-____
EXCESS LAB CLAIMS-MADE° N/A AGGREGATE S .-- -.---
DE6 RETENTIONS v - - S
' COMPENSATION X_FACHALCI, ERH•
!WORKERS
PER
AND EMPLOYERS LlAalltTY Y I N
ANYPROFRIETOR/PARTIER/EXECU'TME S 100,000
A :oFncERJFI9ABFRF_liCLt/DED9 �wAI;N/A NIA AWC400703&3902U21A �051'0112021 OSl01/2022
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE$ 100,000
IDESCRwnow OF OPERATIONS halo. E.L.DISEASE-POUCYLssT S 500,000
—
N/A
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES IACORD 101,Additional Remarks Schedule,may be sllsched If more space Is required)
Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 8,no authorization is given to pay claims for benefits to
employees In states ether than Massachusetts if the Insured hires,or has hired those employees outside of Massachusetts.
This certificate of Insurance shows the policy In force on the date that this certificate was Issued(unless the expiration date on the above policy precedes the Issue date of Phis
certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at
www.mass.govAwd1vorkers-campensatiorVinvesllgat,ons/,
Sole proprietor has not elected coverage.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICES 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
Westhampton MA 01027 (' t>
c i Daniel M.Cr Way,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 Zb(Lwow.);