Loading...
30B-067 272RIVERSIDE DR COMMONWEALTH OF MASSACHUSETTS BP-2021-1940 Map:Block:Lot:30B-067- 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-2021-1940 PERMISSION IS HEREBY GRANTED TO: Project# ROOF Contractor: License: Est. Cost: 10240 DANIEL WEST 106007 Const.Class: Exp.Date:07/08/2023 Use Group: Owner: MILLER JOYCE ANN Lot Size (sq.ft.) Zoning: URB Applicant: DANIEL WEST Applicant Address Phone: Insurance: 11 PLYMOUTH AVE (413)695-731 1 FLORENCE, MA 01062 ISSUED ON:09/24/2021 TO PERFORM THE FOLLOWING WORK: 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: g • r . .52 Teat, I Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Buildine Commissioner The Commonwealth of Massachusett. ,/V c Board of Building Regulations and Sta 'ards !' 14,/g Massachusetts State Building Code, 78' CM CIPA ITY US Building Permit Application To Construct, Repair, 'eno 4 -/ sed or 2011 One- or Two Family Dwelling tiOq feQ/p0ING 2n T t Section For Official Use Only 0,},zspFO�o Building Permit Number: OAcil/' li v Date Applied: A0r06o NS nC:.V►IJ 55 ffe 9-Z11-26Z Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address:,, nn 1.2 Assessors Map& Parcel Numbers 2�Z R 1uxrc St ( Q't 1.la 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 11) 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: Zone: Outside Flood Zone'? Public 0 Private 0 Municipal 0 On site disposal system 0 _ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: — 01.1L IPAt kW-- If 1x 16. lar,i Yv\,A .0 Q(Lk_6 Name(Print) City,State,ZIP 7-47- RkLier-stCit c (• &t13)_Sa—( 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 l Specify:WM, ! _ Brief Description of Proposed Work': `' k_., 0 i : !'le 1T 0,6c4' fie( l w5� 11 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building $ 0 0, .- I. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2. Electrical $ 0 Total Project Cost3 (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ D— Suppression) Total All Fees: $, 414 Check No. IA j Check Amount: Cash Amount: 6.Total Project Cost: S 10 i'NO t 13 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Lor9- 23 t IJi, k License Number Exp atio Date Name of CSL older Ply a^ List CSL Type(see below) \� No.and Stre t '^"'� Type Description ctb(b/i(e// tp�A �C Z U Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town,State,rLIPVYV7 R Restricted l&2 Family Dwelling Masonry Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances Insulation Telephone Email address D Demolition 5.2 Registered Home Improvementt Contractor� �ct (HIC) Il-f$?2.+ 2 Lma k�LsV' Si C _ HIC RegistrationNumber E pirat on Date HIC C mpany Name or HIC Registr ame ' ' O(4►„ i 4i ot. d to l'alEQs�k t � N nd St eet O 642 /q13 15:43 `' Email ad ress 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 1�,, (1-2-e4 q(4,_ �vJ L, 1ov to act on my behalf, in all matters relative to work authorized by this building permit plication. Print Ow er fr-i 's Name(Electronic Signature) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name b l w, hereby attest under the pains and penalties of perjury that all of the information contained • is ap do is true and accurate to the best of my knowledge and understanding. / 1/7z Prin 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 SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton �� Str. Massachusetts DEPARTMENT OF BUILDING INSPECTIONS ri 212 Main Street • Municipal Building Northampton, MA 01060 �sf, )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: ;14(4;93' (":;A9• col Z The debris will be transported by: Name of Hauler: ‘ftgbcagkvu,k Signature of Applicant: Date: ` 1:-6/1Vt( The Commonwealth of Massachusetts ,,• WA 4,7T—,„-,„ Department of Industrial Accidents 1 Congress Street, Suite 100 Ili .k. Boston. MA 02114-2017 .•1:,.... q www.mass.goWdia llurkers'Compensation Insurance Affidavit:BuildersiContractoniElectricia iiv Pin in b ers. TO HE 111.4.0'WITH'I IIE PERM mum:Ati-ttlOREElf. Aiiiilicant Information Please Print Legibts Name itiu:,Ini:-:,tif:!J n:./41 ion Indtv And r. D.L., 'u1c Addressike—ef- I k 94te\A44. C),k9C- City/State/Zip: Inppli/tr-c, (-010 yvt,A • eD(C)( C) Phone 4ti3)45_s- i Are a ou ittl 1.1110 vr?Clorth the appropriate hex: Tpe of project(required): I,4. Lava a employer with ." _employees(fun anifor pat t-LI Ma'1' ', 7. 0 New construction I an a sole peaprietor or pannership and have no 4.miployees w orkt ay to me in K. 3 Remodeling ‘.-siswity.[No workers'cutup.insurance manned. 9. LI,.:J1 atn a ifittUNAMAltel Joins all*ark myself.[No 0,,oriters'comp.nut-trance requir Demolitioned.)' 10 El Building addition .i.DI ant a homeounei and'A 111 be hiring eontnictors to Carldlla all work on im.property. I.., I. ensure that AI 1:4n111-3,01/4MN Cit bet hake workers"compensation Insuranee or are sole I la Electrical repairs or addition., prommors with no krillplOYCCS. 1 2.3 piumbang repairs or additions ••1-1 1:.rx:a itenenti contractor and I has e hared the sob-contractors listed on the avndsneci. I 3.0 Roof repairs ' liwst sub-coniractors have employees and have workers'0;41.117.insurance.; 34,CiPther rvi... 0--ec-4---. ,are a ranon and 16 officers have exercised then right of exertspnati per Wk.,. IS 2,§1141.,and we 11.11/4,e no anployees.[No'W‘ftkt'lli'eomp.insurance reqUIMI 'Ally applicant that cheeks boli'''i MEW AL,4..1 till LCE the werrint tvlow;•,,nowing then wOrkiX§:1:ornpcn,Ali,, 'Homeowners who Admit dm affidavrt mdicannit they are lung all work and they hue outside a:inora,1v,niwr',Amid a new affix/4a it nki icahng silo-A, tfonnactors that check this box must attached an additional sheet snow inF the name of the SU 1mantoor,and ate '-.t /tether ar not those en tll ic,Ita,,e If the Nub-o.ontr.mom ha'4 4:Ctliplk,1>CL'h..Lile‘i most po k..id,..mer ,,,,ikerh*onmp.pU16.,::,,IMACIIVI I am an employer that is providing woriers'compensation insurance far my emplovee.s. Below is the polity and job N he information. insurance Compimy Name: .A..-u,ylik. 36 ,,k.,kk, _ Policy#or Self-ins. Lie. #:A.1-3C t-t6i-t:53623 'Z 'Z Expiration Dale: 6 1 .-zoz z... Job Site Address: Z 4Z tc4,24- 4c-ist 'Dr% City,State'Zip:_ (444 N. 75c6c,t) .... Attach a copy of the workers'compensation policy declaration page(showing the policy number an expiration data Failure to secure coverage as l'-,v,. Ire,1 undLT Mi it e. 152. §25A is a,:rimina] %,whom)pimiNhable by ii lute up to S-1.5,00.00 arator one-year imprisonment. ...:-. '..\..:11 •t',.. ,r3 11 penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a day against the violator. A t'1211,. 01 111.!, 'j.,I tement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerf , nyder e 'n.,,and.pen erItiey of perju ry that the Warm otion prided above is true and correct. Sietature: Dale: 1 t -4 )—t I Phone L'.:6-074:jtec— 7 3 lt Official use only. Do nal write in this area.to be completed by city or town official City or Town: Permitilicense 1( Issuing Auttioriq (circle one): I. Board of Health 2.Building Department 3.("ityrfown Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other . f'ontaci Person: Phone#: . . — City of Northampton Massachusetts '', m DEPARTMENT OF BUILDING INSPECTIONS fi 212 Main Street • Municipal Building Northampton, MA 01060 ph ?\' 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. A���� BATE IMMJDOr'rYYY) CERTIFICATE OF LIABILITY INSURANCE D 13nort 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 REPRESER(TATIyE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the allc les)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 doss not confer rights to the certificate holder In lieu of such endoreement(s). PRODUCER .. CONTACT NAME: TrayiS SIa5 X KSK INSURANCE AGENCY INC 'PHONE r413)527-7859SAX SA AOORE 'vA1L 99: trevlsSle8 1 ksk-insurence.com 203 NORTHAMPTON ST INS UREA,s1 AFFORDING COVERAGE NAM a EASTHAMPTON 33758 .,,.„ . MA 01027 I',aoRERA: AIM MUTUAL INS CO INSURED ,INSURER B _ , DANIEL WEST I , INSURER C. .... .._...... D L WEST ROOFING CONTRACTOR INSURER O: 11 PLYMOUTH AVE INSURER E FLORENCE MA 01062 INSURER P: _a -- COVERAGES �� CERTIFICATE NUMBER: 655152 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 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 ADOL SUER POLICY EPF POLICY EXP _.. LIMITS LTrt TYPE OF INSURANCE _ _.1tSR iwn POLICY NUMBER tMM1oWY'Yl"ft...1SMlttfrO!J.. I COMMERCIAL GENERAL LIABILITY EAC''OCCURRENCE 5 - DAIAAGt T O W.'NTED"'-- - CLAIMS-MADE I I OCCUR 1 I PREMISES(Ea(=prim}_ S. l MED EXP(Any one parson) I S __... _ _.... 1 N/A PERSONAL&AOV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: • GENERAL AGGREGATE -,S POLICY f 7 JECT I I LOC : PRODUCTS-COMPVOP AGO S.... _ .. -OTHER I S AUTOMOBILE LIABILITY i—COMBINED BiNGLE Leer s T- I BODILY INJURY(Per person) S ANY AUTO ! - - — ALL OWNED SCHEDULED i N/A NO BODILY INJURY(Per ecodani) 5 1 AUTOS AUTOS NON--OWNED PROPERTY DAMAGE '5 HIRED AUTOS , AUTOS I ;Per scooters!: • S UMBRELLA LIAB ,OCCUR EACH OCCURRENCE S 1 EXCESS LIAB CLAIMS-MADE N/A AGGREGATE ,S , D£0 RETENTIONS i ,_ PER OTH- _,.� IWORKERS COMPENSATION i X STATUTE , ER_ AND EMPLOYERS'LIABILITY - 'ANYFROPREETOR!PARTNEIUEXECUTIVE fYIN 1 E.L.EACH ACCIDENT $ 100,000 A OfFlCER/ME ER EXCLUDED') WA NIA AWC40070363902021A 05/01/2021 05/01/2022 - (Mandatory In NN) E.L.DISEASE-EA EMPLOYEE S 100,000 MMC. describe Inu1u _... .. . C.i PTION OF OPERATIONS below ._ _ E.L.DISEASE-POLICY LIMIT S 500,0a0 N/A DESCRIPTION OF OPERATIONS(LOCATIONS!VEHICLES IACORD 101,Addtllonal Remarks Schad ate,may be attached It more space Is required) Workers'Compensation benefits wilt 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 csrtit(nte of insurance shows the policy to force on the date that this certificate e::as Issued(unless the expiration dote an the above poiicy pre:odes 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.goviwdMrorkers-compensatfonlinvest(gations/. i • Sole proprietor has not elected coverage. I CERTIFICATE HOLDER CANCELLATION I 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 (.L C` Westhampton MA 01027 `_„f' �� 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 r ACORIU to tuaoJu.:j IL____