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38B-088 (2) 45 LYMAN RD COMMONWEALTH OF MASSACHUSETTS BP-2021-1923 Map:Block:Lot:38B-088- 001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-202I-1923 PERMISSIONIS HEREBY GRANTED TO: Project# 2021 RENOVATION Contractor: License: Est. Cost: 147269 FOXTROT CONSTRUCTION INC 073102 Const.Class: Exp.Date:06/18/2022 Use Group: Owner: GISH,JANE &KRISTOPHER BANKS Lot Size (sq.ft.) Zoning: URB Applicant: FOXTROT CONSTRUCTION INC Applicant Address Phone: Insurance: 1350 MAIN ST SUIT 207 (413)333-7470 08WECADOKF6 SPRINGFIELD, MA 01103 ISSUED ON:09/23/2021 TO PERFORM THE FOLLOWING WORK: INTERIOR RENOVATIONS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector l nilerground: 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: Fees Paid: $957.00 212 Main Street,Phone(413)587-I240,Fax:(413)587-1272 Office of the Building Commissioner `F 4 ,ram The Commonwealth of Massachu etts F Board of Building Regulations and ` anda � ;, CIOP.(t/, ALI I Y Massachusetts State Building Cod: 780 MR Sep Permit Application To Construct,Rep.ir,Rs vate Or Derel§ta ' ised ar 2011 One-or Two-Family Dwe ', 4,,1 cUei Th3-I � !�i�3 lion For Official Use Applied:• �/moo N��sA Building Permit Number:11W pp i �✓a ‘Cr , .`)) "s a3 Building (Print Print Name) Signature DaSECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 45 Lyman Rd Northampton, MA 01060 Parcel ID 38B-088-001 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Residential Residential 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 6 Private❑ Zone: _ Outside Flood Zone? Municipal aOn site disposal system 0 Check ifyesg SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Kotker Zane H Trustee(Jane Gish/Kris Banks) Northampton, MA 01060 Name(Print) City,State,ZIP 45 Lyman Rd 646-327-0303 Jane©anngish.com 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) KI Alteration(s) 1'6 Addition Demolition 0 Accessory Bldg.0 Number of Units 1 Other 0 Specify: Brief Description of Proposed Work': Interior renovations as shown on plans. Addition of exit vestibule (Mud Room)at rear of home. SOW includes new windows, sheetrock, new wall layout, cabinets,finishes, new bathroom, plumbing, new HVAC and Electrical upgrades SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 72,095.06 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ 27,500.00 ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 13,500.00 2. Other Fees: $ 4.Mechanical (HVAC) $ 34,174.00 List: 5.Mechanical (Fire $ Total All Fees: $ -IJ /, OQ Suppression) 6.Total Project Cost: $147,269.06 Check No.9.3c3Check Amount: Paid in Full 0 Outstanding Balance Due: • SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS073102 06-18-2022 Jeffrey M O'Connor License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 20 Bircham St No.and Street Type Description Springfield, MA 01104 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted I&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-333-7470 joconnor@foxtrotconstruction.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 198402 04-23-2022 Foxtrot Construction Inc. HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 1350 Main St Suit 207 joconnor@foxtrotconstruction.com 5p ngf elc�, MA 01103 413-333-7470 Email address 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 P4 No .O SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject prope ,hereby -.a o ze Jeffrey M O'Connor of Foxtrot Construction Inc. to act on my behalf,in all ma e s - ative , ,•rk authorized by this building permit application. Jane Gish 09-22-2021 Print Owner's Name(Electra is Signatur- Date SEC i ' 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest +. the •ains and penalties of perjury that all of the information contained in this application • s e and . ate to the bes • knowledge and understanding. 09-22-2021 Jeffrey M O'Connor �f`_ Print Owner's or Authorized Agen i N e(Electronic ; . ure) 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" • The Commonwealth of Massachusetts riorio Department of industrial Accidents j ; 1 Congress Street,Suite 100 s:}; Boston. MA 0211.1 2017 ►t'w)t:m asS.gor/dia 11orkers' (•ontpensation Insurance_t1ftda%it:Bui tiers/Contractors/ElectricianslPlumbers. fl)HE l'ILEI)R 1111 1111.l'ERMI•ITING AtrrHURI'1•t. Applicant Information Please Print Leeibls. Foxtrot Construction Inc. Name I.11ustneS&.Organtzatwn lndtstdual): . Address' 1350 Main St Suite 207 City/State/Zip: Springfield, MA 01103 Phone 0: 413-333-7470 Art you an entphryer?Chark the appropriate hiss: Type 1.M t ant a ett4.iovaa with__. 7 poplosie s(full and'or part•tnneI.• 7. Q New construction `'a 1 am a sole proprietor or partnership and have no employee's working fare me in 8. Remodeling am capacity.iNu w onkers'comp.unuranat n:quinxl.) 9. ❑ Demolition ;.D 1 am a litmieown et doing,all work myself Inks werkias'comp insurance required..'" 10 a Building addition -LEI I am a Ir Y'Ntnt and will be hiring tiontractors to conduct aft wank on m±,rta.pasty. I will cmun that all contractors either have workers"evenpcursalio t insurance to an:sole I la Electrical repairs or additions proprietors with no.crnpk.yem.. 12.0 Plumbing repairs or additions i ant a genc,al contractor and I base hind the sus-sontiach r,listed on the attached sheet. 'Mow.sub -contractors have►atplrsees and Iliase s orker, ctanr.uu urance..^ 13 Roof repairs tip q e are a corporation and its officer.have exercised their"'phi of exernptio n per MtiL e. id.Q OtYtt'r IS?.*1141.and we have no an loytea.[No worker.'comp.trumane..teyuned j •Any applicant that cheeks box el must also fill out the section below show in their thin-Lars'compensation policy information. °Ili t irinen who submit this atfuto it indicating they arc doing all work and then hue outside contractors must submit a new affrlav it indicating,such. i o noactor,that cheek this hos must attached an additional sheet show Inc the nand of the sub-contractors amid stale whether or not those entities base empk, :.. I1'l-r;,td. :it':rt-Ii.r:cettlri,.n.ers.they nisi pros idetheir workers'. ir.t..pokes'number.. 1 am on employer that is providing rrorLers'compensation insurance for an enrplorees. Below is the policy and%ob site in fin-miring'. Hartford Accident and Indemnity Company Insurance:Company Name: — 08WECADOKF6 Date: 3/19/2022 Policy#or Self-ins.Lic.#: Expiration 45 Lyman Rd Northampton, MA 01060 Job Site Address: C"ityiState.Zip: Attach a cope of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as require!under MGL c. 152.*25A is a criminal violation punishable by a fine up to$1,500.1X1 &ntti+or 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 tire violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do her eb,v c •rU r t a realties of perjure.that the information provided above is true and correct. 09-22-2021 Sioaturr- Date: Phone#: 413- 470 t)f fie iccl use only. Do not write in this area,to be completed by cur or town ofciat ('ih or l oss rt: Prrntil'Licrnsr Issuing Autharit (circle one): I. Board of health 2. Building Drparttncnt 3.('its '1 oosn Clerk 4. Electrical Inspector 5. I'Iutnlrinr. Inspector 6.Other 1'untact Person: Phone#: City of Northampton aMAMY, n 5.. S/C - > Massachusetts �? - t.. DEPARTMENT OF BUILDING INSPECTIONS y, v �'x 212 Main Street • Municipal Building Northampton, MA 01060 ssNjy N 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: The debris will be transported by: Western Mass Demolition Corporation 1029 North Road, Suite 12 Name of Hauler: Westfield, MA 01085 09-22-2021 Signature of Applicant: Date: FOXTCON-01 RKOUVO .AcCioRCIP CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYIYY) 4/15/2021 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 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 ACT NAME: HUB International New England PHONE Fax 1070 Suffield St (ac,No,EA:(800)243$134 (AIC,No):(413)731-9539 Agawam,MA 01001o"bass: INSURERS)AFFORDING COVERAGE NAIC S_ INSURER A:Ohio Security insurance Company 24082 INSURED INSURER B:Liberty Mutual 23043 Foxtrot Construction Inc. INSURER C:Hartford Accident and Indemnity Company ,22357 1350 Main,Ste 207 INSURERD: Springfield,MA 01103 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD INVD IMM/DDIYYYYI (MMIDDIYYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR BKS59647907 3/18/2021 3/18/2022 DAMAGE TO RENTED 300,000 X PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEMAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ' LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ ANY AUTO BK559647907 3/18/2021 3/18/2022 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSRE� ONLY AUTOS BODILYBODILY INJURY(Per accident) $ X AUTOS ONLY X eats (Pteracodent)AMAGE B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE US059647907 3/18/2021 3/18/2022 AGGREGATE $ 1,000,000 DED X RETENTION$ 0 $ C AND EMPLOYERS'LIABILITY ATION X STATUTE OTH- ER YIN ' D8WECADOKF6 3/19/2021 3/19/2022 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA E.L.EACH ACCIDENT $ FFICE z,,,, ER EXCLUDED? andatory In H) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 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) CERTIFICATE HOLDER _ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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