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23A-081 (4) 51 CHESTNUT ST COMMONWEALTH OF MASSACHUSETTS BP-2021-1853 Map:Block:Lot:23A-081- 001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-1853 PERMISSIONIS HEREBY GRANTED TO: Project# ROOF Contractor: License: Est.Cost: 8855 106007 Const.Class: Exp.Date:07/08/2023 Use Group: Owner: MAZESKI WILLIAM F&DEBRA A Lot Size (sq.ft.) Zoning: URB Applicant: DL WEST ROOFING CONTRACTOR Applicant Address Phone: Insurance: 11 PLYMOUTH AVE FLORENCE, MA 01062 ISSUED ON:09/13/2021 TO PERFORM THE FOLLOWING WORK: NEW 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. Signature: I„I . , �'1 • Fees l'aid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner fM f 1:173 The Commonwealth of Massachusetts • I� Board of Building Regulations and Standards FOR a Massachusetts State Building Code, 780 CMR MUNICIPALITY $ ding Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only s Buil jumber: Q e" .1 I- I.a5 3 Date Applied: EVW 1155 lD-za zj Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: d rvA j� 1.2 Assessors Map&Parcel Numbers 1.1a 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 Stwnert of Record: • 4 JQ� Mc',Z-(Z \ C.1d6j�-ei MA, c>1o( L Name(Print) City,State,ZIP S Cant-S-0(LL'A 5 &it3.)aeZ-8°84e No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building 0 Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Mier 0 Specify krg}... € Brief Description of Proposed Work2: Qptk ctrj P � ( � m 1^ Ok .kiN Se cc c\S *l( nue, `3e) -� SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building $ $ $Ss, ..--' 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical 0 Total Project Costa(Item 6)x multiplier $ x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) Total All Fees: $ Check No. 1'319 Check Amount: `l Cash Amount: 6.Total Project Cost: $ S.5s. ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) (04 Ems+ g 2®23 l 4 - License Number Ex a i Date Name of CSL Holder List CSL Type(see below) R�1 l. v ' �x-. No.an S t Type Description Cll/b I( � Y r` . • D lb(R`� U Unrestricted(Buildings up to 35,000 Cu.ft.) Restricted I&2 Family Dwelling City/Town,State,ZtY 1 R M Masonry Roofing Covering S Window and Siding /� SF Solid Fuel Burning Appliances 6t-969c-4-3j 1) .A1(4)1545 6)Crl1J1' (cx/A I Insulation Telephone Email addi,est. D Demolition 5..2�Registered Home Improvement� ContractorJ (HIC) 1 g3Z� •�f���ZZ ''"'` w 5� I f't-t I t �N I-1 `i z iV HIIC Registration Number Elxpp irat on Date HIC Co any Name or HxN�C Regi., ame � w S C ��, k1 �� v+.`OvNn AFL• LoGt.Y1 No. d Stre t Email ad �1 A• 6[oc1`Z (913)(45 31 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 .❑ 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 D.L. L3 eS1- ` cpc.Q &elltr4c to r to act on my behalf,in all matters relative to work authorized by this building permit appli tion. - ..? PAcc-7._-e_.3 t 9(s fee-YZI 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" is app •• io is true a d accurate to the best of my knowledge and understanding. ?/5- Print er's or Authorized Agent's 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 i � S.' Jr_ Cif� � Massachusetts ��?� � DEPARTMENT OF BUILDING INSPECTIONS j; �� • w 212 Main Street • Municipal Building yvd OD --'•rr-= Northampton, MA 01060 rs�ry )X�3 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: U 1 `Z 4.1As 12-- ��'cS cfDr\ O • iikPC The debris will be transported by: Name of Hauler: \� C-, ( ,L {, K.(c)na.Vt Co • Signature of Applicant: Date: _!_4 .1Z\ The Commonwealth of.•tlitssachusetis Department of industrial Accidents .I 1 Congress Street, Suite 100 - • Boston, MA 02114-2017 www.mass.goWdia mkers't'ampcfm,awia Insurance Affidavit:Eniklers/ContractorsfElectriciansiPlu ni hers. 'rill":PERMITTING t1011.11T1i. Information Please Print LettihIs Name slits Orkintealtein Inthivictualr kj\cxmle,(1\c•-• Address: CityiStatelZip: ci--76:›1ZJA0,4 W CP(C,C.t?.. Phone : k—.5) (Cqc:74-50 Are you an ealakiyte(leek the appropriate butt I fat of project(required): am a employer with crriployees(fa arictor part-F.11mi iNeys construction jjI a sole proprietor or partnership and have no ernpkiyccs working tin rm.in 8 Remodeling capacipt [Nu workers'comp.insurance resaurnal.) Demolition 1.0 1 am a homeowner doing all work ithv:11.[No workers'eunç.insurance retwired.) 10 1:3 Building addition 4.0 I am a ItunkvsoAnel and vk ail b hirui xattra'tumw conduct all w ark on my property. I will ensun:that all contractors either haw workers'compensation msunince are sole 114:j Electrical repairs or additions proprietors with no employees 2.0 Plumbing repairs or additions aim a general contractor and I base hind the Nub-cuaractors it .don the atZiktica I 30 Roof repairs fbese sub-contractors leave employees 4Ind litasc workers'comp.insurance.; i 4.VdtOttun R,Ceier (ID We arc a twirporation and th officers lino c exercised then right or exemption per IsiGL 152.§ii4j.,rind we havenocinplolwws.[No SktifikeIN'comp.nista:ince required.] 'Any applicant that checks box.1 must also fill out the section Is. s ing their^workers'compensation rvinky-mat/on. 4'Homeowners'who submit this affidavit indi.eating they at e dome ii ork and then hue outside conlractors finest submit a new altidac it and itaiing such tCuraractors that check this bo inus!anat.-bed an additional skeet&Jaws ing the atone of the subs:mitt actors and state V.lictlier or not those entities tiros: is,:hub--coniractt... .Iia cauployah,Uic mumside tcar 'Aotkcrs' ant an employer that is prodding workers'compensation insurance jar my employee'. Below 18 tire policy and job site information. (-07, Insurance Company Name: AIM VIALY6- diLIAS, (C) • Policy#or Self-ins. Lie. 4: 44)-)C e35-T11,-zzy-zt A Expiration Date: 5 II -tc"a-Z__ Job Site Address: Ck' E .s* citystatezip: (PC e-D(b - Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL L. 152, §25A is a criminal violation punishable by a line up to S1,5(X/00 andior one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of up to S250.00 a day against the violator. A copy of ilu teinent may be forwarded to the Office of in c Algauoi IN of the DIA for insurance coeratw eritication. 1 do hereby cer y and re et Ms and )ert trifle%of perjury that the information provided abov 18 true and correct. Sinature • Date; 1.1 Phone#: Li(-3) (°- Official toe tatty. Do no:write in this area,to be completed by city or town officiai t'ity or TO*4,n: PermitiLicense Issuing Autloirit) (circle one): I. 13miril of Health 2. Budding 1)ellartineot 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6, Oilier Contact Person: Phone 4: A R©W OATS DIGNOGrITYY) ,_\ SCE CERTIFICATE OF LIABILITY INSURANCE ( o�MmOr 1 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 POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED i REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. tMPORTANT: If the certlRcate holder Is an ADDITIONAL INSURED,the polleyges)must be endorsed. N SUBROGATION IS WAIVED,subject to the!arms and conditions of the policy,certain poilcies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ilea of such endorsament(s). PRODUCER "'"�"""' „_-'• — —" KSK INSURANCE AGENCY INC CONTA T Travis Sias NAME; FAX PRONE (413)527-7e59 Afc.�; O N tali EMAIL traYISSIOS.r ksk-Insurance Cam 203 NORTHAMPTON ST INSURES Cf AFFORDING COVERAGE NAIL a EASTHAMPTON MA 01027 INsuRERA AIM MUTUAL INS CO 33766 INSURED INSURER B DANIEL WEST INSURER C: -- D L WEST ROOFING CONTRACTOR INSURER 0: --- 11 PLYMOUTH AVE I INSURER E LORENCE MA 062 FTHis is TO CERTIFY THAT THE POLICIES OF INSURANCE Li5TED1BELOW HAVE E BEERF: _"__ COVERAGES CERTIFICATE NUMBER: 655152 REVISION NUMBER: VE 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 1 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 POLICY EFF POUCY EXP UMRa LTR TYPE OF INSURANCE _, ,,_1NSU_.YCYLL-_- POLICY NUMBER INMIOOFFYYY1.1 .MIN. COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE I I OCCUR I !. PREMISES Ea occurrence,!I S I MED EXP(Arry one Paoli 1 I _ .. N/A PERSONAL A ADV INJURY y S__ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE . POLICY j EC ri LOC 1 PRODUCT S-COMP/OP AGG S S OTHER _ .�._--.. .- COMB NED SIN L I S AUTOMOBILE LIABILITY i,Ea pcOdenl BODILY INJURY(Pet perten) S i ANY AUTO I 1 ALL OWNED SCHEDULED 1 N/A BODILY INJURY(Per acodent) S AUTOS AUTOS PROPERTY PROP DAMAGE NON-OWNED PerERTYl S HIRED AUTOS , AUTOS _S - `UMBRELLA LIAe {OCCUR ^. . - EACH OCCURRENCE S -- EXCESS LIES CLAIMS-MADE N/A AGGREGATE .S ... " .. ,... DED RETENTIONS I S WORKERS COMPENSATION I I X STATUTE ERH- !AND EMPLOYERS'UASILRY - . " . 'ANYPROARIETDWPARTNFJUEXECUTIVE MINI 1 E,L.EACH ACCIDENT S 100,000 A OFF10ER'MEMBEREXCLUDED') N!A WA N/A AWC40070363902021A 05/01/2021 05/01/2022 '-- (Mandatory in NHI E.L.DISEASE-EA EMPLOYEES 100,000 _ Kgqaaaa,daeciibe undo . E.L.DISEASE-POLICY LIMIT S 500,000 i7£SGRtPTION�OPERATIONS below -.._. N/A DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached IT more apace Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization Is given to pay claims for benefits to employees in states uiFer than UassachuseUs it the insured hires,or teas Fired moss 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 this 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.gov/iwd/workers-compensation/investigations/. 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 AUTH ORIZED REPRESENTATIV E Westhampton MA 01027 — `.( CL 9 c Daniel M.Crow)ey,CPCU,Vice President-Residual Market-WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ACoRU 10(tut Diva,