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30B-011 (5) BP-2021-2004 41 LIBERTY ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 30B-011-001 CITY OF NORTHAMPTON Permit: Addition PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2021-2004 PERMISSIONIS HEREBY GRANTED TO: Project# ADD DECK Contractor: License: ELEMENTAL CARPENTRY & Est. Cost: 18000 CONSTRUCTION INC 103229 Const.Class: Exp.Date:06/27/2023 Use Group: Owner: KRANTZ STEFANIE L& MELYSA I FRIEDMAN Lot Size (sq.ft.) Zoning: URB Applicant: ELEMENTAL CARPENTRY &CONSTRUCTION INC Applicant Address Phone: Insurance: 118 HAWLEY ST 4133206427 UB-4J6 1 985 3-2 1-42 NORTHAMPTON, MA 01060 ISSUED ON:10/07/2021 TO PERFORM THE FOLLO WING WORK: ADD SECTION TO DECK 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 e, f >2 . 11/4r Fees Paid: $117.00 212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner Z—oK File #BP-2021-2004 APPLICANT/CONTACT PERSON:ELEMENTAL CARPENTRY & CONSTRUCTION INC 118 HAWLEY ST NORTHAMPTON, MA 010604133206427 PROPERTY LOCATION 41 LIBERTY ST MAP:LOT 30B-011-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $1 1 7.00 Type of Construction: ADD SECTION TO DECK New Construction Non Structural Renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: XC Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability SewerAvailability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay • i 10 7� � , 1 Signa re of Building Official If Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. /^ Vcd ` The Commonwealth of Massachuse / oer F R *4)r Board of Building Regulations and S dar 1 ' Massachusetts State Building Code,7 Cog `6 I PAL Y ' / pro • SE Building Permit Application To Construct,Repair,Ren h Revis d Ma 2011 One-or Two-Family Dwelling AMnrpN llNsp This Section For Official Use Only °/0so h$ Building Permit Number: grr)d•62/' Date Applied: .g .e 1 , ,o al Building Official(Print Name) Signature I to SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers _ 4/i L,her/Li Sf. 3o 6 • oti - 001 1.1a Is this an accepted street?yes >< no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property pimensions: Vet? ecsdoel•;a I /0, 4/CY 41- Zorn ng District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) 1 Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided /0 ' Id ' Is ' 4' a6- _ co ' t . 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Private❑ Zone: — Outside Flood Zone? Municipa'On site disposal system 0 l Check if yepct SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'�o^f Record: ,,/ ���''� Ael S4 rtir6ltnan .S71Y�init /T'ran�2 A/0rMu�pfln ` Affix( , MA D/06a- Name(Print) City,State,ZIP fir' 1....;bfi7 S4, '43- 330 -87b/ ()le(/e:St.&itdAA4 Lf ,rnai/. G,,,, 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)X Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: Add fmo le?Xd' i elt,'u i -is fouS+t d ia. f telgez deck, . SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building $ It, Uco 1. Building Permit Fee:S 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 FeptiR Check No.I4 heck Amount: l(7 6.Total Project Cost: S /r/---O UD 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) S 1 l 03r2 3 .J iioi1 (raver License Number Ex iopi Date Name of CSL Holder 110 I-1N4r1(y • List CSL Type(see below) No.and Street Type Description Mt'AO ein MA 010 b 0 U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,/Gown,State,Z R Restricted l&2 Family Dwelling Y M Masonry RC Roofing Covering - - WS Window and Siding SF Solid Fuel Burning Appliances '-113-310-1,9 -) tie mewl.) Chrpenli,y Q f voa I Insulation Telephone Email ddres D Demolition 5.2 Registered Home Improvement Contractor(HIC) /77 VO 'femathh( Cffe41 2 G��S}rNc411" HIC Registration Number Ex$iratiion Date HIC Company Name or HIC egistr t Name Il f Hawley S+. e koitittAl CsrvtnfvJ e „maw/.c.a, No.and Street 'Email gddress V Melltankpb./is , NIA 01060 1-1/3.3d 0 Lys? 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 .JASOut G,,Vg ' to act on mybe 4011 matters relative to work authorized by this building permit application. ark /WO Print Owners me(El ctronic 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 in this application is true and accurate to the best of my knowledge and understanding. AO* — /0/07 f Print Owner's or Authorized Agent's ame( ctroni i ature) 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 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.govioca 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" :Zs The Comniormealth of Afassachusetts k ....,__. .. . , Department of Industrial Ac cidents 1 congress Street,Smite 100 Boston,MA 02114-2017 _ . „ www.mass.gattidia 1Voriters'Compensation Insurance Affidav it:BuiklerslUontritetors/Eieetricians/Plumbers. U)at: FILIA)%%in+ rat:PERM]TEING AUTHORITY. Applicant Information Please Print Legibly Name 4 Husinesa,Organization'ladividnail: tieni etrtei (a rpenhy $ (oos)-f utii P.n ,7ric•_ Address: At jj4w1.eiF Si. . City/State/Zip: /Vorikamphn i enA 0/0(0 Phone#: ire!Oil an elopktyee?Check die apperbprimit how Type of project(required): minplOyET with 4.„, ,,,ettroloyee.dull 2111/VOT pari-tinte)•RI 7. C3 New construction .:4 I tan a op4..vli:.propmtor or partneraiup mad have no employers working tOr Che in g.75.ReniOclefirig any.... acity.[No vairkera'comp.imuranee manorial.' 9. 0 Demolition am s heinvowdsor doing all*mit mull..IN°*urinrs'comp.arourame to:tuned"' 4.0 I ain a huirirownet and will be hina oanttactora to imoduct ail work on my property I will I 0 0 Building addition at.ute that all eontrA.ICIT's either ha..‹%otters'onnponsanun insurantt or art Noir 11.0 Electrical repairs or additions portmoors w ith no employees.. 12.E3 Plumbing repairs or additions 1:3 i am a gott-ral runt/a:4x mad I have hued the sub-contra:tom!Wed un the attached.heel and 1313 Roof repairs thinie sub-rundraniun.haw alai:doyens has.r workers'vump.maurunee.'. 14.0 Other 6.E3 Wa are a empurtenin and Its officem have exercised their nabs of exemption per MCA.e. I$2.*1141.and we have no employee..[No aeiwkers comp.imuiranec required] *An}applicant that cheek*box el mod also fill tit the%echoes Won*honing their n urkers'curniamastiun pike,/int onnatum *lionieowners*ho submit this affidavit incletatin nicy sre Joins all work and then tine nutsade cumnictor.must mdsrnst 4 rtev,Alicia,.it nal Kam.%%tah. ICunt.rarlms that therk dus bus weal&tarbed lin aldltiumil sheet ahun Las the mune of the sAll,-,..:(Xlinsomr.,and Ave whether.,..1 not Mu*:,..-nld IC,1141 C' :I OW,A.b,:l.rAraCti..11 L1....l nrpt... .ees tia-2,must pm,.ide their winker.'...,,'.>trip poru..'y numhot I am an employer that is providing workers'compensation insurance for my etnployees. Below IS the policy and job site information. ,---; Insurance Conipany Name'. /reiVeleri Policy#or Self-Ms.Lic.a: (,)6 - 4/.31, 14,363 - ii - 4 1 01. Expiration Date: lob Site Address: q/ Liber-4-1_ 54.. CityState'Zip: Akorlitamitlart /114 6'/e6e Attach a copy of tbe workers'coiiipensation polic) declaration page(showing the policy number and expiration date I. Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to S1,500.(a) andd'or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine 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. , . . _ I do hereby cerr(fj.under the s and penalties of perjury tkai the information provided above is true and correct Sienature. D Ibott Phone 4; 4/13*1)0 • srl 7 Official use only. Do not write in this area,to he completed by city or town official (Ay or Tows: Permit/License tt ... Is,titin2 Authority(circle one): ' I.Board of Health 2.Building Departitient 3.( it v[fun clerk 4.Electrical Inspector 5. Plumbing Inspeeto:1 ti.Other i ('outset Person: Phone - -- -- City of Northampton Massachusetts _ 'r a t f DEPARTMENT OF BUILDING INSPECTIONS ,,, g 212 Main Street • Municipal Building mob 4 :y.� Northampton, MA 01060 T)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: UApcy Pailti .),y Eu6 /'G�"j �V N Al. d'r a '/^ '" 1 The debris will be transported by: Name of Hauler: Pen,eh / (Ar,Puiry / (dksd4kv;6r arc. Signature of Applicant: 7.--- Date: /4/0f_ Sectional Building Plan ' - Shingles Roof Assembly: Felt ('itch Rafter Ice Batrior Covering- or - `N. Sheathing Truss tantlerinytncnt- '`., tee barrier- • Ceiling Joist �\ Sheathing- - \/ Truax-Cut3 Sheet Required Lim Sinn,to tho opposite utppou A Rafter Size- 1 I ltafier Spacing- 12" 16" 19.2" 24" la, . . . Rafter Clear Span- - _ . • •- . Ratter 5pecics __._ Ridge- Siding . Ceiling Joist Size- . Sheathing —.____-, - Ceiling Joist Spacing- 12"16"19.2"24" t St Ceiling Joist Species- • Insulation -.- t E Insulation-R Interior Finish• • Wall Framing Attic Ventilation- • ittteriorfinisi -----• Walls: Siding- Sheathing- ' Insulation- Wall Framing- !leaders- 1 Interior Finish- Floor: Finished Floor- 4-f'f X le 1-rex Sub-Floor Sub-Floor- Floor Joist Size- a_!► Fktoriolat. Floor Joist Spacing-12" *19.2"24" lataa Floor Joist Clear Span- ///(, ., >xom grade Floor Joist Species- t¢ ,, r,� - 1. Clatr:4pan,to the opposite s;tpport .. 'Ream Type&Size- '3 - i uD r'c ,;• Distance From Grade- l't'4 30" Sill Plate ',,... {�•;.... a ' :riff, Foundation: . Foundation Auer ' 1,. ,2 � ."N Anchorage- j bolts _ _. ____ • --- • .=4.• x Sill Plate- Fotmdation Wail 't'`$' 1VallTypeRSize-, �� i'` i`f ;Y`:h:;s.s Reinforcement- Wein(o,centctit :`?�^y Concrete Floot•'t'hickness- n Vapor Barrier Concrete Floor ,,` r , '��`` Column Pad Size- A X • ' i''`? . .__Column Spacing- ;, w Footing Width- / ' c o fwhr<i. Vapor ; Jl trytip,, R PC?r Barrier• Footing Height-_ eff . Footing S ' Footing Depth Below Grade- Nb 7. / i /12"Th e e /Jew ( o? .1 ffitfy? 'ettj. - Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: 177980 ELEMENTAL CARPENTRY&CONSTRUCTIM INC, Expiration: 03103/2022 118 HAWLEY ST NORTHAMPTON,MA 01060 Update Address and Return Card, 41! 14e -'6,LPttlenetwea& ey: Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Crjior before the expiration date. tf found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 177880 01!0a2022 1000 Washington Street -Suite 710 ELEMENTAL CAPPENTPCY'&CONSTRUCTION INC! Boston,MA 02118 JASON GRAVER tie HAWLEY SI NORTHAMPTON,MA 010B0 Undersecretary Not valid without signature Commonwealth of Massachusetts Division of Professions! Licensure Board of Building Regulations and Standards ConstrUeittth Supe-VISOT CS-103229 Expires 061272023 JASON W GRAVER 118 HAWLEY ST NORTHAMPTON MA WINO a • • k:‘ ' COMMiSSiOner - AccoRr) DATE(MM/DD/YYYY) Le/ CERTIFICATE OF LIABILITY INSURANCE 10/06/2021 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 Denise Sawicki NAME: Amherst Insurance Agency Inc (PAHiONE Ext): (413)253-5555 FAX No): (413)256-8354 20 Gatehouse Rd. E-MAIL dsawicki@nathanagencies.com ADDRESS: P.O.Box 48 INSURER(S)AFFORDING COVERAGE NAIC# Amherst MA 01002 INSURER A: Travelers Casualty Ins.Co.of America 19046 INSURED INSURER B: Travelers Indemnity Co.of Connecticut 25682 Elemental Carpentry&Construction Inc INSURER C 118 Hawley St INSURER D: INSURER E: Northampton MA 01060 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2110603668 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 EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RETED CLAIMS-MADE X OCCUR PREM SES(a occurrrence) $ 300,000 MED EXP(Any one person) $ 5,000 A 6802C687310 09/01/2021 09/01/2022 PERSONAL RADV INJURY $ 1.000'000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000'000 POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $ 2.000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ - OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS 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 X STATUTE EORH AND EMPLOYERS'LIABILITY Y/N 100,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA UB4J619853 09/01/2021 09/01/2022 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED. 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 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 City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 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