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05-024 (9) 264 AUDUBON RD BP-2022-0115 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:05-024 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-2022-0115 Project# JS-2022-000202 Est.Cost: $13815.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: DANIEL WEST 106007 Lot Size(sq. ft.): 25482.60 Owner: KORZA RONALD W& KATHLEEN J Zoning: RR(100)/WSP(100)/ Applicant: DANIEL WEST AT:: 264 AUDUBON RD Applicant Address: Phone: Insurance: 11 PLYMOUTH AVE (413) 695-7311 WC FLORENCEMA01062 ISSUED ON:7/30/2021 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. ' Certificate of Occupancy Sionatur �� • r • 3- 1 el j ' I FeeType: Date Paid: Amount: Building 7/30/2021 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner '31c 14 The Commonwealth of Massachus tts / W Board of Building Regulations and S :ndar i sF 30 NICIALITY Massachusetts State Building Code, 80 C R `� U.E Building Permit Application To Construct, Repair R• •• .1 : Or Demolish ' ise, Mar 2011 One- or Two-Family Dwellin: Noi t i°(Don 41/ T is Section For Official Use Only e, ° ryas Buildin Permit Number: (60'01)—'/11 Date Applied: �0 evil.) " go55 //2--- 8-Z-ZOZi Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address; 1.2 Assess Map&Parcel Numbers Z4t , 1d4 V . 1.1 a Is this an accepted street?yes no Map Number ParcelTlumber 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:\ kA V--t... � a(r Lit—CAS 11 OM (Q 3 Name(Print) City,State,Zit' 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) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 54 Specify: R Brief Description of Proposed Work': R J1vtjX 4,4S1 S ctsp ‘i 1(bo;�' qn I "`✓\ IA17"?St c.,pvtr5e ‘ kii)kill L.L.,k1.-CA SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ `3 a(s e , - 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: 04 Check No.001 Check Amount: O Cash Amount: 6. Total Project Cost: $ 1--2j S , 0 Paid in Full 0 Outstanding Balance Due: • SECTION 5: CONSTRUCTION SERVICES 5.1 ConstructionSupervisor License(CSL) - I/n 4 a de�- �j to1-3 License Number Expiration D Name of CSL Holder (� A List CSL Type(see below) `"�V • No.and Street� • Type Description �� �Cb 2 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP' Masonry Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances (tAt-j �Q(5 13 \ dklk). e - S)Cl t•C6*-, I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor( C) 69) HIC Registration Number E irat Date HIC C �.Jan1y�Nam�e r HIC Registrtorti- ame ,,e N- ' tAttkZ ��� t` Email aMress 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 t 4 �- �-(yt (4 to act on my behalf,in all matters relative to work authorized by this building permit application. 1t,1 etsce24 111,14 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 contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date 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,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 Y ; DEPARTMENT OF BUILDING INSPECTIONS > • 'C212 Main Street •• Municipal Building r -^ Northampton, MA 01060 t?`yy ,a''\\ 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: nC (\ Location of Facility: k4ktV c4 Coe( T--.2)"k f-'471--_.5W.--.40 ltarN v\A• 1A., v ll. 01P40 The debris will be transported by: Name of Hauler: (61. u- ' '().0vC-, Gw City- pp Si nature of Applicant: J - Date: ?4. Z g rF The C'rrnrrrttrntrti•eretltlt of :%1tt .suc hu ettc , a ,1 t� Deportment Industrialref. 0 .-I rcirlcittts ,�1, '`'s, I Congress Street, Suite 100 t ' •' ` Boston, .11.4 02114-?'01 !1'F1 141 nr Its.1.gtr titltlt stieukers'Compensation IttturanceAf1ida+it: I3tJi1iJtrs:(.untractorvl:lec•triciatesPlunther"s. 10 1I1•: tll.I I)1A1111 I11I•. I't.10111 I I\G.At 11101i111. .Npplitalit Information ) f /� ,� '_ Please Print I.er;ibts Natil a t3unris. >t_t.i.r.. .°a1J:n„Itr.::s idu:t:F -lam `.'6ry S l.f t/..t .,?r Addrea,: A V 4 t_'_ Utt1 Slate Zip. . vt C� - Otocct (Phone #: 3) 4`i:S-1-3L1 An',tttt an.•ratpttntr.'a 1tetAt the apprerttrialt:trot.: I>,Iti'ill project (required I I. 1 aui a Krogrl€,fez t'Ith ctt{ u}t h r lull and J�hurt-urr t' 1 ..\--k:kk con trticuoir I an,a aide prupraciur t.rp rtndm hap and bare all Cratpi,+..5..A.11.++,,.+rktu 3i>r ow.In S. 0 It tn;t ichita: au",eapaty l'1t•u ur(:kr,'comp.utmanintk n 41Ureat E t1. I) rnttllt tut jI ata a hustacattaCI Li;xierZ,all Mari,..Itity-It'.r.Ns w.>14:1.1x.urn4+ xrs,41M11.a rtngastrJ; 10` J 13titkltrn;auciltiicn A.riI ant a hxtrtaAp...rr4'^r and.k di tx hunts cx• rntrar.tkrs , w•to r idt all:ootrk on of ,rr'.ilY I o.ti T t"nviurr that all outftr-.t,Yurm cithci hut, herr4.h,.1, corm,..•..rsuaf artsuranue tB a:. n•I. 1 1.0 1:1Cetrtcnl rcpeln"'a or additions ,rn.prit r,....Oa no ctnplo:c rt. I 2.rj Plutnhin z repairs or additions 1.tit a teiteiO cucitiac i ,.•.11 I...sa tur.,dth.• Fr-.-t ;t>r,.l ,lt 'Jt:=i_. ;,L.,. ,.. tb e aub-orratractura L. :.4.1 .a.. ,Ind 11 ...a.rrar.tnautanct I_'a ` Roof Itrti1EFs 14.7- .Abet .) R.SbOce 60 4ti"e art-a a<st{*urr,stautt art• : .. _•,tt,i Ixu rrsht ot c tctr:{+iaa*tt tkt•r'<9l al. i '2.. It4t_and r.e lute._: . • ::•..:, aikanp.invUra.rzr realurrt:d.l "haa apptia,ani that ctetia•&,txa ::rut. ;firma t ill._x,•rtttaf hlo„ h...a.in'p thtrt u.ilk.,: •a>netxuaalaun prlre utk nwi.:'ti ' :d,rmcknktwr' - bu .ub.nri Lk, t1 lat_I in..1: atany diet atrda n}g ad••,mi and tta.:r;bu. ut,iJ.Curtrak:b*r,nuel;=uhut.t a i18lk 4111.114it rrsdt...e:, .. `1.trilracim.ra that elect,thra hku .a.,t attak1 :d art:s:Islat what..hect..hou.me rltt name.uflbe.atih-aunttta..k,r,Ind tat..wtt.:ther or rim th....: rtt.rtn_' e... ;n1•10,r4, L I_:-.e t•„a,..,, .L.z-,t:earl.1 ers.they rrtal^-4 I'tr•.I.!,._..r; ,,,.,II, -�,trtip !*.Fire?rzrainl,;•r. I air an condoler(Int is prulielin workers*compensation iusuretnc'efin-my etrrplu)•era: Below is the polio!'and jab.site info rnra/rr,n. n IA\ III ..Itl..l e..•onipar.} Name ) ✓_r O`• Oki f....145�4&.4( 6 Palm•~s or sell ris. I_te. . .; VP(--, c2_._ t 3q5 Zt /r Lxptralton I1t e. 1 Z iob Stte Address:l_te Li ,Gb.7 .1r_ _ �..._._ C'it.,' Sia e'Zip:L.4ad5, (V • 0 (P 5-3 Attach a cops of the ssurkers'compensation policy declaration pale(shouting the polio. number sod expiration date). Failure to Ne,:ure col.eratre as reciL leJ under \it l.. i:. I , 32.5 1 r, a crnririta] tioLitr..ui punishable by t line up to)1.5iii1 I, ) Jailor one-,.ear imprisonment,a:, .+till its,..i+r1 penalties in ill,. I.•tin 0: at ST1_-iP ‘,VORK (.0kDIA and a line ot'up to j'ita.t)t)a clan a tautst the+;to)atur_ A cops ..01 'hi, •,tatentent ini be fore..traecl it+the t'l ii•_d•F1 Inte.it3;atmtns of the I)IA for nn,ufanee .,:o%.crdeL teltitti„TJ 'U. I do hereht-cc r}'.anti_r her aitrs unripe penalties aJ perjury that the information ormatio,n provided e{Iruve� +true am/ceorre ct. St nattuzL. 1).2 .4 -r i 1 Phone: 6,1,})G9 — —31 / Official use only. Du tun n'rife in this area.to be c`ermpletell hi•city or town nJ%h ial ('it♦ or'fossil: Permit-license 0 Issuing Authority (circle omit: I. Board of health 2. I31Jillin;; I/enactmennt 3.(.ii' .I.is ii Clerk 4. Electrical Inspector S. Plumt,iuj Inspector h.Other Contact Person: Phone#: ACORet — CERTIFICATE OF LIABILITY INSURANCE DATE05/1 /2021 Y) 05l13t202t THIS CERTIFICATE 13 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 POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER IMP t°e +IvNi If the certificate holder Is an ADDITIONAL INSURED, the olio les must be endorsed, If SUBROGATION IS WAIVED,subject to , th®tfcat and conditions of the policy,certain pollclee may require en endorsement. A statement on this certificate does not confer rights to the certificate holder In Ilea of such endorsement(s). PRODUCER ...-----.�._ ________ CONTACT KSK INSURANCE AGENCY INC NAME Travis Sias PAX P1w L,di (413)527-7859 ,Arc,No3; iamb wAIL trevisaiea•iksk-)nsurence corn 203 NORTHAMPTON ST ADDRESS; wsuftEwsi AFFORDING COVERAGE NAIL a EASTHAMPTON MA 01027 'iesuRER A, AIM MUTUAL INS CO 33758 INSURED INSURER et 1 DANIEL WEST INSURER D L WEST ROOFING CONTRACTOR INSURER O: 11 PLYMOUTH AVE INSURER E FLORENCE MA 01062 _IvavRERF:.___ �— COVERAGES CERTIFICATE NUMBER: 655152 REVISION NUMBER: THIS IS To CERTIFY THAT THE POLICIES OF INSURAMCE LISTED e=i OW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD I 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 _ IL R' TYPE OF INSURANCE - POLICY NUMBER __�..1M000YEF3 rMIPO LY CP LOOTS AD[SL"�UBR PM1DB/YY1'Y.1..,yCiN,1+Q.41!rY.�X.L...... COMMERCIAL GENERAL LIABILITY i i EACH OCCURRENCE S DA1dAG. 'O R.NTED— I CLAIMS-MADE ( I OCCUR - PREMISES(Ea occurrence, f i ( MED EXP(Any on.person) ,S , NIA PERSONAL A ADV INJURY $ GEM/AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S I POLICY 1 7 Tel i LOG OTHER. PRODUCTS•COMP/OP AGO S I • _.. - I COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY _...-ry' _... i/Es acddorris S ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per acodeni) S AUTOS AUTOS NON-OWNED [ N/A{ `PROPERTY DAMAGE S _,,,..�HIRED AUTOS AUTOS - per accideros ., _ m UMBRELLA LIAR OCCUR EACH OCCURRENCE S 1 EXCESS LUie CLAIMS-MADE I N/A AGGREGATE S 0€0 RETENTIONS $ WORKERS COMPENSATION I X g 0TH STATUTE _ AND EMPLOYSRVIJABILITY AMYPROPRIETOWPARTNEPJEXECUTtvE YIN EL EACH ACCIDENT S 100,000 A ;OFFlCERlMEMeEREXCLUDED7 1NlAJ N/A :NIA AWC40070363902021A 05/01/2021 05l01t2022 . (Mandatory In NH) I E.L.DISEASE•EA EMPLOYEE s 100,000 If yea describe under ) .-- DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT S 500,000 N/A 1 DESCRIPTION OF OPERATIONS I LOCATIONS r VEHICLES IACORD 101,Addllional Remarks Schedule,may be attached IT more apace Is required) Workers'Compensation benefits NU be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 6 no authorization is given to pay claims for benefits to employees In states other than Massachusetts It 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 dale 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 wwrv.mass.goviiwdhvorkers-campensatloniinvestigations/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION 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 POLICY PROVISIONS. 329 Southampton Road AUTHORIZED REPRESENTATIVE •Westhampton MA 01027 _,L.•.(� Lt 7X- i Daniel M.CroW,Jey,CPCU,Vice President-Residual Market-WCRIBMA i ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AC©RU"40(ztriwu.yi