Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
24C-048 (5)
21 WOODLAWN AVE COMMONWEALTH OF MASSACHUSETTS BP-202I-1918 Map:BkckBlock:Lot:24C-048- 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-2021-1918 PERMISSION IS HEREBY GRANTED TO: Project# CHIMNEY REPAIRS Contractor: License: Est. Cost: 3913 FIRESAFE CHIMNEY SERVICES INC 105507 Const.Class: Exp.Date:01/19/2022 Use Group: Owner: ROTH-KATZ MATTHEW &ESTHER Lot Size (sq.ft.) Zoning: URA Applicant: FIRESAFE CHIMNEY SERVICES INC Applicant Address Phone: Insurance: 277 PALMER RD (413)436-7946 7pjub06033546 WARE, MA 01082 ISSUED ON:09/23/2021 TO PERFORM THE FOLLOWING WORK: RELINE CHIMNEY 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 "2 3-1 . . I. Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner I of The Commonwealth of Massachusetts '�-' FOR i" 7 :' Board of Building Regulations and Standards G' Massachusetts State Building Code, 780 CMR MUNICIPALITY �, �_. USE 0 I._ . N Bui13 a Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011 _s, One- or Two-Family Dwelling '` ccrr_-�� ''� ��2 ThisSectjpn For Official Use Only Building Permit N ;ben;bent/ .2 1 4 1`7n I o Date Ap lied: Z Z �t=v�,.) 55 C 2 20 1 BuildingOfficial(Print Name) Signature Date gn SECTION 1:SITE INFORMATION 1.1 proper Ad ess: 1.2 Assessors Map&Parcel Numbers 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: plek ro = lr,-vka.`1' f r)(A %unl p-- , (11 IC of DU Name(Print) City,State,ZIP 31 VDCUAWLt.;r1 CI.Ve_} Citt5)6i -Loot 5 nrIa-iii.vL•ro-th1 ,40.rtza8ev kl. No.and Street Telephone Email Address (..0n*N 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: 1115 Brief Description of Proposed Work': iAAP-rt-th15 It 0 c\ 2 "L 4 " LCOCet LI/ScrVit- tn_o_A..)' SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 13 00 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee ❑Total Project Costa (Item 6)x multiplier x 3. Plumbing $ PC 2. Other Fees: $ 4.Mechanical (HVAC) $ e List: 5. Mechanical (Fire $ r Suppression) Total All Fee Check No.)No.rivl I Check Amount: u Cash Amount: 6. Total Project Cost: $ 31 I fR J "A 0 Paid in Full 0 Outstanding Balance Due: t SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) I.o C�56-1 leb l l Lt License Number Exp atio Date Name of CSL Holder p L4 ) 190 y�t4D List CSL Type(see below) g No.and Street k Type Description i1 U Unrestricted(Buildings up to 35,000 Cu.ft.) . re 1 Q I`-'�� R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry )U LreS0 kd1(ant per r✓1cos, RC Roofing Covering i `Ct� Window and Siding Solid Fuel Burning Appliances (413)L43(6 7761�f�4 I Insulation Telephone Email address D Demolition 5.2 Registered Ho(meI�mprovement Contractor(HIC) � S`'-�dp `\' 1 _r t)L w-5 HIC Registration Number E piratio Date HIC CoApanyOlamg or C� Registr N e r u CO 1 p� J lc, C C,,,wtea "'� No and Street ` � UY�0.Email�P On bk.p oz C� 3� - 7qz- c� addressss mow, City/Towntate,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: OWNE AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. ri\CCHA(V2, (zukieN- vket-t- ct I Print Owner's Name(Electronic Signature) to 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. 02\-a-liLLVt- 1 k Print Owner's or Authorized Agent's Name(Electro 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 �w�S 'e` �t w & 'tit 1 �,,. al DEPARTMENT OF BUILDING INSPECTIONS y. .4- ,. , " = .?. 212 Main Street • Municipal Building vd Pa` \ Northampton, MA 01060 5'J DN�J 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: 0771 Pcdry r\ 12.d Li fY)P OtO ( c The debris will be transported by: Name of Hauler: rt1 C C.h Linn KU ‘r kA-Ce,S Signature of Applicant: r l Date: 7 ai The Commonwealth of Massachusetts (i Department of Industrial Accidents F i...... ' s I Congress Street,Suite 100 • ='•' Boston,MA 02114-2017 :,.• www mass.gov/dia 1%oiters'Counpeasation Iasuraace Affidavit:Buildersg:lotractors/Electricians/Plul hers. TO RE FILED WITH THE PERMITTING AI_rTHORITC. Applicant Information �y� ,Pllease PPrri� tnt Le ably Name(Business/Organ�tionlindividual): E e-5 c 1 L flc_ Y to-(L-tS Address: o?11 cc \f Asur 9-cl City/State/Zip:AS 1\E) C)b Phone#: (q(3)gsck--rig 0 Are yaw an employer?Cheek She apprrptiate tine Type of project(required): I Aam a employer with employees(tldl arNorpmri-brae)_• 1. ?. 0 New construction I am a rule proprietor or mw pestiip and have m egrhryees walking for me in S. 0 Remodeling► any capacity.[No workers'carp.innrarae requited] 30 I am a hoeutnrer doing all wok myself.[No workers'comp.iarrranee impaired_]r 9. El Demolition rn 4.0I am a homeowner tad will be harem uoelraetors to eorduct all work my properly. I will 10 Q Building addition terwre this all cams either have waken'coop ion iawmroe or arc gale 11.J Electrical repairs or additions proprietors with no employees. 12.0 Plumbing,repairs or additions 50 I am a general coots cwr and I have kited the sob-contractors listed no the attached sheet. 13(�Roof repairs These nab maactors have employees and have waters'carp.� e r 'Lrher J �� t ^ 6❑We are a comer cium and its oftwers have exercised their right of exemption per MGL t 14. ,/wi 1�(toy IS2,11(4),and we have so employees.[No waters cramp_iaswraace required.] 1 S r 'Any apphnnt that checks boo tl matt also lt�I out the section below shawiag their workers'comprrwanor policy infonmtron *Homeowners who submit this affidavit indicating they ate doing all wok and drew hire astride contactors morn submit a new affidavit i dicating such. =Cortracsoa that check this hot must attached an additionl sheet showing the name(lithe sub-conuactors and state whether or rot those entities have employees. If the sub.cotaractars have employees.they nom provide their markets`on policy nmealan. I oar an employer time is providing markers'ca arperr.ioa insurance far my eaip ogees. Below is the paltry snip*die l rforaratioa. Insurance Company Name: T(1Q ' 1(S Policy#or Self-ire Lic.#71 Pri We)e_7 e)V 3 5 qCO Expiration Date: 5 I t R. 1070QR Job Site Address: S i L IOC 1 Q ik) avV City/State/Zip: t MA f Attack a copy of the workers'compensation policy declaration page(showing the policy number and expirati ■date)coul b Failure to secure coverage as required under MGL c. 152,*25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 da hereby eerN Ike ins and penalties of perjury that the information provideed�above Is true and correct Sig*tnature: i2�---- Date: L 1 1 kc)& I Phone#: CLI 13.) �-1,2U,- -Kt `i Lei 66 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Division of Professional Licensors Board of Building Regulations and Standards • ConstrucUot`t S eMsor Specialty CSSL-105507 E*pires:01/19/2022 JAMES J WALLING kit • 40 HIGH STREET P.O.BOX 40 SOUTH BARRE'MA 010T4 • Commissioner plc..-; --- - -- J • • ro/n~:neveadeo-/A 41- Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: 182449 FIRESAFE CHIMNEY SERVICES INC Expiration: 06/25/2023 277 PALMER RD UNIT 2D WARE, MA 01082 Update Address and Return Card. SCA 1 ea 200M�M--05/17 !`'G ,g Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 182449 06/25/2023 1000 Washington Street -Suite 710 FIRESAFE CHIMNEY SERVICES INC Boston,MA 02118 JAMES WALLING JR 277 PALMER RD "`OT C iZi""k WARE,MA 01082 N alid wi t signature Undersecretary ® DATE(MM/DD/YYYY) AcoRD CERTIFICATE OF LIABILITY INSURANCE 08/03/2021 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 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 NAME: Jessica Pierce BRABO INSURANCE (oJc°.No.Ext): (508)830-3800 FAX No): E-MAIL ADDRESS: ipierce@braboinsurance.com 65 Cordage Park Circle INSURER(S)AFFORDING COVERAGE NAIC# Plymouth MA 02360 INSURERA: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B: FIRESAFE CHIMNEY SERVICES INC INSURERC: INSURER D: 277 PALMER ROAD INSURER E: WARE MA 01082 INSURER F: COVERAGES CERTIFICATE NUMBER: 681364 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. INSRPOLICY ADDL SUBR POLICY NUMBER (M TYPE OF INSURANCE LTR INSD WVD D/DD/YYYY) (MM/ IIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENTED $ CLAIMS-MADE OCCUR PREMISES Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PERTUTE ERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A 7PJUB0003354621 05/12/2021 05/12/2022 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space 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 other 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 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/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main St AUTHORIZED REPRESENTATIVE Northampton MA 01060 > C � i Daniel M.Crowley,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 FIRECHI-01 JPIERCE ACORO DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8/3/2021 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 CONTACT NAME: Brabo Insurance Agency 65 Cordage Park Circle (n°,Nri,Est) (508)830-3800 jvC,No):(508)746-1540 Plymouth,MA 02360 AODRIEss:info@braboinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Northfield Insurance Company INSURED INSURER B: Firesafe Chimney Services Inc. INSURER C: 277 Palmer Rd INSURER D Ware,MA 01082 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 JNSD WVD (MMIDD1YYYYI (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR WS420788 7/15/2021 7/15/2022 DPREMISESO(Ea occurDrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILECOMBINED SINGLE LIMIT LIABILITY Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I 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 Cityof Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P ACCORDANCE WITH THE POLICY PROVISIONS. Puchalski Municipal Building 212 Main St Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD