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24C-059 (7)
BP-2021-2060 85 WOODLAWN AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24C-059-001 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-2021-2060 PERMISSION IS HEREBY GRANTED TO: Project# ROOF Contractor: License: Est. Cost: 11000 SARAFIN BUILDERS 053434179889 Const.Class: Exp.Date:04/28/202309/16/2022 Use Group: Owner: PAPORELLO LORI L TRUSTEE Lot Size (sq.ft.) Zoning: URA Applicant: SARAFIN BUILDERS Applicant Address Phone: Insurance: 85 RUSSELLVILLE RD 4135639256 WCC5005019027 SOUTHAMPTON, MA 01073 ISSUED ON:10/22/2021 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: ( i • . 'I • Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Buildine Commissioner i t I z _ '` The Commonwealth of Massachusetts yFOR r =� Board of Building Regulations and Standards MUNICIPALITY : "/ L� Massachusetts State Building Code, 780 CMR USE -L co uilding Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 ` One-or Two-Family Dwelling This Section For Official Use Only Building:Pe' it Number: e�� i " 2-OCa Date Applied: c_ _k:-—--1-:-11 LEV I i.i ,&.-A /� Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 11 l4roperty Agdress: 1.2 Assessors Map&Parcel Numbers a f}�no Q. h && )'-t 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'offilecord: L0r21 ra po2.•e.11 o (/\o4.4na,.,� , �•A. O‘OLE 0 Name(Print) City,State,ZIP Sc Woo Q\c..—., No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2 (check all that apply) New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other R Specify: et - god g Brief Description of Proposed Work': S- ‘ e q...cP Q-{-s',-.)\-e t_.... . .. cv�P�• 1-I- SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ i 1 000_— 1. Building Permit Fee: $ Indicate how fee is determined: t ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost3 (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All @as 't Check No 901 Check Amount: 6.Total Project Cost: $ /�, OO O O. " 0 Paid in Full 0 Outstanding Balance Due: City of Northampton � Massachusetts 401 - - < wi OLlt CO DEPARTMENT OF BUILDING INSPECTIONS 'v r' 212 Main Street • Municipal Building vd•.,_ Northampton, MA 01060 '�s'j: ; 3;ox4. PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS, DOORS, ROOFS, RENOVATIONS, ROOF MOUNTED SOLAR, ETC. 1. 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. Construction Debris Affidavit filled out and signed by applicant. 4. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance. 6. Energy Conservation Compliance Certificate (new /replacement windows). 7. Home owner's License Exemption Form (if applicable). 8. Note any Special Permit requirements (if applicable). 9. Energy Code —all new construction (Gut/Rehab) requires a HERS Rater Affidavit 10. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. The Commonwealth of Massachusetts • -' ° 1=— Department of Industrial Accidents F 1.- 1. E 1 Congress Street,Suite 100 Boston, MA 02114-2017 „, 4: www mass.govirlia — 11 urkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. To HIE..FILED WITH THE PERMIIIIN :.Ati 1'HOlttf'Y. Applicant Information Please Print Leeibly Name(liusinc VOrgsmzationrindividuaI): '5,4,,✓L W. ..N .).1/4\gO..+...--ic Address:_%c c2JS -e `1 J. `k. __._. tx.tO City/State/Zip. (Ac p It,"` OA LA O u-1-3 Phone #: y l 3-SCo 3-9 351. Are yea an employee!Chords the appropriate hot: Type of project(required): 1121.1 am a employer with 3 ,__employees(full and/or part-time I..* 7. Q New construction 201 am a sole proprietor or partnership and have no employers working for me in 8. a Remodeling any capacity_[No workers'comp.insurance required_] 9. ❑Demolition 3[J lam a homeowner doing all work myself.[No workers'cone.insurance required.]' I0 0 Building addition 4.0 I am a homeowner and will be hiring contractors so conduct all work on my property. I w ill ensure that all contractors either have w ttat*'rnrnpinsatro el n uurano:ea an:sole I i 0 Electrical repairs or additions proprietors with nu employees_ 12.0 Plumbing repairs or additions 510 lam a general contractor and I have hired the sub-contractors listed on the attached sheet TLeae sub-Contractors have employees and have workers'comp. ursuranee. 13 Roof repairs 14.DOther 6.0 Vie are a eorporaturn and its officers have exercised their neht of c.entptant ref Mt . ---__—__ I52,¢1(4),and we 11.1 ..no employees.[Nor wotteri.'comp.insurance riguir_ .1 *Any appliema that checks box.1 roust also tiii out the section bolo* show Ina then aort.-rs'compensation policy rnlornaation- t HomeOvvaers who submit aux allidaa it indicating they are doing all n oil and then hire outside contra:loesmutt submit a new affialav it indicating such. :Contractors that check this hos,must attached an addrtrunal sheet showing the name of the.0 h-ecmtraetorsand state whether or not those enirtie-.have .-mpluycea Vibe sub-euntractcvxlayvc.-nrluvices.lhe, Oust pros ide their Mortar! contr.gala:}•number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name. 4 �/t/\ Policy#or Self-ins.Lic.#: L CC-516-'2)t q o Z-4--dori 1 - �w Expiration Date: 7- 1-a i- Job Site Address: o S W o e.,tY\.A.w,.% A.--t City/Statel2ip. A'4c , vyk.A. O\Ul.e.-°) Attach a copy of the workers'compensation polky declaration page(showing the policy n with er and expiration date). Failure to secure coverage as required under MGL c. 152,*25A is a criminal violation punishable by a fine up to S 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 S250.00 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 certify der ix s an enerlti of erjurt•that the Information provided above is true and correct. Signature: 1 Dare. /e- -a I Phone#: LI) 3 -SCv -qa 5-0 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#: SECTION 5: CONSTRUCTION SERVICES II 5.1 Construction Supervisor License(CSL) CS-13S5t{514 4-f"a78"a 3 vv\uk.„,t.1r_ S•,qNr2•q�• License Number Expiration Date Name of CSL Holder List CSL Type(see below) U gS Q•.1SSe k1 .., . \1-e L2 No.and Street Type Description JO..r 4� 1 _ b 1 U-� 3 U Unrestricted(Buildings up to 35,000 Cu.ft.) `Y' R Restricted 1&2 Family Dwelling City/Town,State, M Masonry RC Roofing Covering WS Window and Siding a SFf Solid Fuel Burning Appliancesyi3'563-' to So.fa 1, ?,�4 If Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Say?u►F.� �.�.1g--C 1I-R� a ir I t a� HIC Registration Number Expiration Date HIC Company Name or HIC Registrant NameSVIAll t4F No.and S Email address City/To , te, IP 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 X. No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT v I,as Owner of the subject property,hereby authorize `tAvc_ L StA.vt,.4.r-1/‘ to act my beh lf,i 11 matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my nam= below,I here y attest under the pains and penalties of perjury that all of the information A' ' is �ica' is and urate to the best of my knowledge and understanding. /D- -4_a ) s or Aut orized 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 r , ,\ ,,,, , ,,c. r ,* Massachusetts ,„ /,- , ,� DEPARTMENT OF BUILDING INSPECTIONS tm'. ' z ev xr .3 212 Main Street • Municipal Building `'fit m Ca .- ,,- Northampton, MA 01060 r3{i44,0 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: t 11 '' Location of Facility: 1 ba �4-Lc,,.,A,, ,c,, The debris will be transported by: Name of Hauler: �W�L‘A- ‘•/\ '-u.. \c-er-"C Signature of Applicant: Date: '6 7' 2 0 City of Northampton ~ Massachusetts 5 '�� DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building vs ✓ Northampton, MA 010604 )\� HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDA 4 T I, (insert full egal name), born_ (insert month, day, year), '.•reby depose and state the following: 1. I am seeking a buz •ing permit pursuant to the homeowners'exe •tion to the permit requirements of the Massachusetts Stat' :uilding Code, codified at 780 CMR 110 '5.1.3.1, in connection with a project or work on a parcel of la ' to which I hold legal title. 2. I am not engaged in, and e project or work for wh'' I am seeking the aforementioned homeowners' exemption, does not involve .•field erection of ma, factured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building :He's de, ition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns a parcel of lane on which he/she resides or intends to reside, on which there is, or is intended to be, a or e-o two-family dwelling, attached or detached structures accessory to such use and/or far' struc res. A person who constructs more than one home in a two-year period shall not be .nsidered a ome owner. 4. I do not hold a valid Massac setts construction upervision license and, except to the extent that I qualify for and will abide by e Massachusetts State 'uilding Code's requirements for the supervision of the project or work on my 'arcel, I am not engaged in .• struction supervision in connection with any project or work involvi g construction, reconstructio alteration, repair, removal or demolition involving any activity r:gulated by any provision of the Ma 'chusetts State Building Code. 5. If I engage any other •erson or persons for hire in connection wit • aforementioned project or work on my parcel, I acknow edge that I am required to and will act as the sup•• isor for said project or work. Signed under the pains and penalties of perjury on this day of , 20_. (Signature) ACC)Rd CERTIFICATE OF LIABILITY INSURANCE DATE(MMI°DIYYYY) 8/16/2021 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: The Dowd Agencies, LLC PHONE Diane LaFleche FAX 14 Bobala Road INC,No.Ext):413-437-1062 INC,No):413-437-1462 Holyoke MA 01040 ADDRESS: dlefleche@dowd.com _ PRODUCER MARKSAR-01 CUSTOMER ID II: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:Phoenix Insurance Company 25623 • Mark Sarafin dba Sarafin Builders 85 Russellville Road INSURER B:Associated Employers Insurance Company Southampton MA 01073 INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 566051778 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 SUER POLICY EFF POLICY EXP LJMnS LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A GENERAL LIABILITY 68088298412 6/17/2021 6/17/2022 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PRMMGE TO RENTED PREMISES(Ea occurrence) $300,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 PRO- POLICY JET LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION S $ g WORKERS COMPENSATION WCC5005019027 7/1/2021 7/1/2022 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? NIA (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 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,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. Western Mass Environmental LLC 93 Wayside Ave West Springfield MA 01089 A�-U}THORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD