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35-248 (8) File #BP-2021-1821 APPLICANT/CONTACT PERSON:WRIGHT BUILDERS INC 48 Bates St NORTHAMPTON, MA 01060(413)586-8287(116) PROPERTY LOCATION 15 LADYSLIPPER LANE MAP:LOT 35-248-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED R e ` I DATE ZONING FORM FILLED OUT Building Permit Filled out �j Fee Paid $1,393.67 l Type of Construction: BUILD ADU ONTO EXISITING HOUSE ` New Construction Non Structural Renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement orLicense 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION )PRESENTED: Approved ( Additional permits required(see below) 6 , 11 '`�_ PLANNING BOARD PERMI QUIRED UNDER:§ lY > I/ , 11 Intermediate Project: Site Plan AND/OR SpecialPermit With Site Plan MajorProject: Site Plan AND/OR SpecialPermit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Wa ter Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay 1 '1 ;„7 I? j A,/;? i • VI/ 1 Sigr:ture of Building Official / Date Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards ofMGL 40A.Contact Office of Planning&Development for more information. RECEIVED AUG 3 1 2021 The Co oniireggiTgaviams IONS Board of Bui T 'titdaeds FOR :Cf: 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 This Section For Official Use Only Building Permit Number:6'9' I •k&I Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 15 L,aJysl pnu Lund 35 OY8-oo 1 1.1 a Is this an accepted street?yes )C no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: i wsr? wsP s4, 677 lay 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 ao' etr /5 ' 15' min. oho 4 20' min. 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public,� Private 0 Check if yeses Municipal 0 On site disposal system A SECTION 2: PROPERTY OWNERSHIP1 2.1 Ownerr of Record: Floyd cheern.] NotftiL wfvvl, MA- 0toGo Name(Print) City,State,ZIP /5 Lady,51;0er- Lance CGht?un 6 sm%fL,• e�l?v - No.and Street Telephone ail Address SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction,S) Existing Building2 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 115 Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: (3u11c11i,n av AbV or.4D exls1;n home. S-Lott p I4 yO.A - 14 (Alr� g+tgnxovr�, l t irvo✓✓1 • (41 s'r....-i dv, v-f n SCA"&vet pvrc.ln rl�� e�4, ' t!Det.k. Fjoe4rIs, and2 la;( cup ) SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item (Labor and Materials) Official Use Only 1.Building1. Building Permit Fee:$ Indicate how fee is determined: $ f 7�o,�� 0 Standard City/Town Application Fee 2.Electrical $ 4/675.. 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ /a OP 2. Other Fees: $ 4.Mechanical (HVAC) $ 9 o z 5' List: 5.Mechanical (Fire /� Suppression) $ Total All Fees: $ Check No�eck Amount: 'i Cash Amount: 6.Total Project Cost: $ see included ❑Paid in Full 0 Outstanding Balance Due: City of Northampton o-H_mero Massachusetts kt• * !<<G ' t 11 4 `( DEPARTMENT OF BUILDING INSPECTIONS �t � ►` 212 Main Street • Municipal Building Northampton, MA 01060 sfNlY. ���� PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW 1 &2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES, FENCES, GROUND MOUNTED SOLAR, ETC. I. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work. (Digital and hard copy) 3. Site plan with location of proposed structure(s)and set backs. 4. Construction Debris Affidavit filled out and signed by applicant. 5. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate (new/replacement windows). 8. Home Owner's License Exemption Form filled out and signed by Homeowner(if applicable). 9. Note any Conservation and/or special permit requirements (if applicable). 10. Driveway Permit (if applicable). 11. Proof of Water and Sewer entry fees paid (if applicable). 12. Trench Permit -public land by DPW/private land by Building Dept. 13. Stretch Energy Code -all new construction will require a HERS Rater Affidavit to be submitted with permit application before issuance of permit. 14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. • SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C$ -II5 96 Q1 S�3►� 4 K y 4.•4 J C►e4 r J u I( License Number Expiration Date Name of CSL Holder yrg o2 5 -ate 5+2e4 List CSL Type(see below) U No.and Street Type Description aBIGI►2r�W✓1 /17/Q /Qp U Unrestricted(Buildings up to 35,000 Cu.ft.) i R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding 802-233-9062 SF Solid Fuel Burning Appliances y/3- SKIP Bl RCraeide4//6 - co, I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) /eg/5 6 �v�aZ512Z Ive. 114 F3,-��r Ype/S =vtc. 4414u l4. HIC Registration Number Expiration Date HIC Cdhr any Name or HIC Registrant ame 48 tes S4r«! Ncvririti/7ler: bzl -/3ti�4.5 cork No.and Street �/ Fail address von- 4oDk 1 i'M 01o(.o Nr3- 5d(9-8a 87 Lily/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 24 No ❑ 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 j ur 104 /5 I..ti G to act on my behalf,in all matters relative to work authorized by this building permit application. Floyd Cheung X /27/2 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER1 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. Floyd Cheunq X 8/27/21 Print Owner's or Authorized Agent's Name(Eletonic 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.) °a l(( Habitable room count ID Number of fireplaces 3 Number of bedrooms 0.1 Number of bathrooms a Number of half/baths j Type of heating system p; ( Number of decks/porches 1 Type of cooling system Enclosed Open )( 3. "Total Project Square Footage"may be substituted for"Total Project Cost" CITY OF NORTHAMPTON SETBACK PLAN MAP: 35 LOT: a 9 8- oo 1 LOT SIZE: 5 qr 127.7 5v 4 t REAR LOT DIMENSION: //V. 66 REAR YARD ° I SIDE YARD /5 See Attached SIDE YARD / 5 Site Plan FRONT SETBACK a 0 FRONTAGE /a S 11.1 The Commonwealth of Massachusetts fig( Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 14t1111ft ntass.gor/dia tukcrs'('ompensation Insurance Affidavit:11ui1dersfContractors/Etectricians/Plumhers. 1'O BE FILED WITH THlE,PERNII`171N'C AUTHORITY, Antllicant Information /� Please Print Legibly Name(BusinessUrganiration/lndit'dunl): iv in Bv.I des 5 .zn C /I/1a-Ph( !.t/c't q h-I Address: yc3 6a-fe.5 `J City/State/Zip:A/a/,f'hkrsp Fo4i P O/Ob 0 Phone#: 41/3- 58('-8 a 8 7 Are-you un employer?Cheek the apprmrtate box: Type of project(required): 1.0I ant a employer with 2(7_en;pinywes(full aildrot pars-beret• 7. 0 New construction 20 I ant a sole proprietor or partnership and have rt.)enyttoyetis working for tax it 8. 0 Remodeling linty eapaeity.[No.workers'comp.itmsuranee requited." AO I ant a hoetro caner doing,all work rmyself.[No workers'comp.itt uaraiu.e _1 require 9. El Demolition 100 Building addition d.❑I ant a lionxo ner-and will be hiring omuntctors to conduct all work on my property. I will ensure that all eontraclors either have wmakcrs`comp.rensati nt inSurnwt e7 arse sole 1 I 421 Electrical repairs or additions proprietors with no employees. 12.E Plumbing repairs or additions 50 I ant a jtcno-al whirl air and I have kited the aub-c nttrae'Inrs listed nit the awaefui.d sheet. 13.❑Roof repairs These sub-cuuttactura have employees and have workers'comp.utauramce..: _ fi.❑We are a orporatiun and its officers have exercised their right of exenspticat per h1CiL e. 14.❑Other 152,x t(al-and we have no employees.[No workers'comp.insurance reunited.I *Any applicant that checks box t#1 must also fill out the seetion below showing their woke 'compensation policy information. t tCuaneow hers who subunit this affidavit uubeating they are doing all work and then hire outside th ctors anon submit a new affidavit indicting such. tCctntrrctors that cheek this box must attached an additional sheet showing lire name of the sub-tetrameters and state whether or not those entities hive uniployces_ If the sub-contractors have employees.they must provide their worker;':wamp.policy lumber. I dill an empioyer that is prodding workers'compensation litgliroftCe for my employees. Below is the policy and fob site information. Insurance Company Name: A. _ . iv' fY! fva I Tn S f.0 . AIR IC 0 3 3 313 Policy#or Self-ins.Lie.#: MCC- aZoo-o2ooe 53`i —Zo Zu A Expiration Date: ,j///Z 2 Job Site Address: J 5 Lady 5I)piper tune CitytStateJZip:NVorfrItcr►7O/oN, PIA O/O60 Attach a copy of the workers'compensation polky declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a tine up to S1,500.00 araVor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a day against the violator_ A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance eoverai�e verification. I do hereby certif., r I r w paints and penalties of perjury that the information propided above is true and correct Sienature: Date: 8/70/Z Phone#: yl 3- $ - $a 87 Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitiLicense Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CityfTown Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton O M U ? ,.:; ,y, S1 X.:.sj,C -,r._ ;i4 Massachusetts 41/ .,� * c Ji x.'. wt . i ;� •l.:( , DEPARTMENT OF BUILDING INSPECTIONS ''. 212 Main Street • Municipal Building yti� ` 4Cb' M�6 Northampton, MA 01060 fNh, ‘1 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: /v/A The debris will be transported by: Name of Hauler: l)orr lA ,c.k le "Tr ,,k4„j LL C. Signature of Applicant: Date: 8/01 — WRIGBUI-01 KAYLA A1/4 CCPMEr CERTIFICATE OF LIABILITY INSURANCE PAT 3/1/2021 YY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPQN 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 have ADDITIONAL.INSURED provisions or 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 Kayla Marie Drinkwine Phillips Insurance Agency,Inc. PHONE FAX 97 Center Street (A/C,No,EXt):(413)594-5984 1(wc,m8*(413)592-8499 Chicopee,MA 01013 ADDRESS:kayla@phiilipsinsurance.com _ INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:EMC Insurance Companies 21415 INSURED INSURERB:A.I. M.Mutual Ins. Co. 33758 Wright Builders,Inc. INSURERC: 48 Bates Street INSURERD: Northampton,MA 01060 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVp POLICY NUMBER JMM/DD/YYYYI (MM/DD/YYTy) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 6D18616 3/1/2021 3/1/2022 PREMISES EaEoccurence) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL$ADVINJURY $ 1,000,000 GEN'L AGGREGATE UMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X I POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: EMPLOYEE BENEFI $ 1,000,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO 6Z18616 3/1/2021 3/1/2022 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSRE ONLY _ AUTOS E BODILY INJURY(Per accident) $ _�AUTOS ONLY —AUTOS ONLY (Per PROPERTY DAMAGE $ $ A X UMBRELLA LIAR X I OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS UAB CLAIMS MADE 6J18616 3/1/2021 3/1/2022 AGGREGATE $ 5,000,000 DED X j RETENTION$ 10,000 $ B WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY MCC-200-2000534-2020A 3/1/2021 3/1/2022 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ FFICER/M MBER EXCLUDED? N N I A SOO,OOO (Mandatory n NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below , E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schodulo,may bo attached If more spaco is required) Florence Bank is listed as Additional Insured where required by written contract. • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Florence Bank Main Bank ACCORDANCE WITH THE POLICY PROVISIONS. 8treet Florence, MA 01062 AUTHORIZED REPRESENTATIVE PP I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD �� �� � $ w em : ,. a t She et „4.4,,, Project Name: Cheung 15 Ladyslipper Lane Florence, MA 01060 1. Deductions 2.Sales Cost 5.Cost of Permit $18,000 Design Total Customer Sale $258,882 Total rounded up to 1000* $161,000 $1,800 Final Cleaning Deductions* $44,471 Divided by 1000* $161 $300 Office Supplies Town Multiplier $10 $120 First Aid 3. Sales Cost After Deductions Product* $1,610 $8,000 Painting Total* $214,411 Town Additions $0 $3,000 Rubbish Building* $179,031 $1,100 Temp Toilet Electrical $10,155 TOTAL PERMIT COST $1,610 $2,101 Permits Plumbing $16,000 $2,500 Engineering Fee Mechanical $9,025 Key $3,000 Septic Design Fire Protection $200 * =Autofill $1,500 Spetic Permit- Inspect $1,500 Landscaping 4. Estimated Cost For Permit $1,550 Third Party HERS 0.75 of Sales Cost Total Cost for Permit* $160,808 Building* $134,273 Electrical* $7,616 Plumbing* $12,000 Mechanical* $6,769 Fire Protection* $150