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30B-090 (2) BP-2021-2282 70 FEDERAL ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 30B-090-001 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-2021-2282 PERMISSIONIS HEREBY GRANTED TO: Project# BP-2019-0285 Contractor: License: Est. Cost: 60000 - GLENN BUILDING INC .039970 Const.Class: Exp.Date:06/28/2022 Use Group: Owner: LAVOIE PATRICIA A Lot Size (sq.ft.) Zoning: URB/WP Applicant: GLENN BUILDING INC Applicant Address Phone: Insurance: 18 Ashley Circle WVC-100-6022438 EASTHAMPTON, MA 01027 ISSUED ON:12/10/2021 TO PERFORM THE FOLLOWING WORK: KITCHEN/BATH RENO 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: ,,s1411‘, ., Fees Paid: $390.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner VVV r '_ The Commonwealth of Massac use r ` j �'. �w FOR ,�. I Board of Building Regulations andStanards �MUI�ICIPALITY 1'y ; Massachusetts State Building Code, 780 CNOfC 1 1 22 r Building Permit Application To Construct, Repoli*, Re ovate Or Demo is i a f Revi#edMar 2011 One-or Two-Family Dwelling'',r O� Thi ection For Official Use ly_____ r nr,L S°F^ri Building Permit Number: - J A'? "3' Date Applied: )Cu,rJ (z_5 iz . a-v &e Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers o 1.1a Is this an accepted street?yes v' no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions:7 , 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: Zone: Outside Flood Zone? Public Q/. Private❑ Municipal On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: /9i>l�l/0s� *•0 r 0/06a Name(Print) City,State,ZIP 70 er Z :5. . 3 6 "* 9 fi/ i7-7d & .nj --;e-o/ No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2 (check all that apply) New Construction 0 Existing Building IA/Owner-Occupied C Repairs(s) tYJ Alteration(s) N d Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': ReslIa,ade.2j 7' ,, e9 i .�rs4" A---` 1' J 7/ ' SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ . 7cOc, — 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 6 0 Standard City/Town Application Fee r 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ i6/ere i 2. Other Fees: $ 4. Mechanical (HVAC) $ .45c29 — List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ a/r �r Check No. li 21y Check Amount: ,7"I 6. Total Project Cost: $ �'(r 0 Paid in Full 0 Outstanding Balance Due: 0 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 6. jt � // License Number Expirapi on Date Name of CSL Holder f � � �� List CSL Type(see below) No.and Street / Type Description � 1v '/ Unrestricted(Buildings up to 35,000 cu.ft.) � I7 iV ./,,j0 C24,7 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances ,eW+S' et..e",4 I Insulation Telephone Email address D Demolition 5.2 Registered�� Home Improvement Contractor(HIC) S, `i J A' irr HIC Registration Number Exp . on Date HIC Company Name or HIC Regi5trant Name No.9d Street Email address ,its.4,41/l' oJ2/ /A City/Town, State,ZIP Telephone SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 25C(6)) Workers Compensation Insurance affidavit must be •.mpleted and submitted with this application. Failure to provide this affidavit will result in the denial of the Iss '- of the building permit. Signed Affidavit Attached? Yes .......... 'A 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 / '7 . "F 7_.Z:e to act on my behalf,in all matters relative to work authorized by this building permit application. • ?6..t— Q '( (104-'2- /4 �/ Print Owner's Name(Electronic Signature) D e 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 knowl e and understanding. Ale/42/0',4J/ /.;2A(9%7 Print Owner's or Authorized Agent's Name(Electrons 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 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 w w.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is laruted,provide the information below: Total floor area(sq.ft.) 670 (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" / / • 9-' • Commonwealth of Massachusetts \ Division of Professional Licensure /.__ - - - 3oard of Building-Regulations and Standards Constlttrvisor CS-039970 E�tpires:06/28/2022 "� NORMAN F GLENN,JR - 18 ASHLEY CIR EASTHAMPTO l MA 01027 44 / \tifire, ° .,,,,, &' 8? • , . _v. li Commissioner of,`!. R. `t ,ata_. --, The Commonwealth of Massachusetts Department of industrial Accidents ! Congress Street,Suite 100 Boston, MA 02114-2017 www:mass goy/dia 1%otters'('ong.rnsation Insurance Affidas it:Builders,'('ontractors/Electriciansirlmnbrrs. 11)BE FILED 111111'liii:PERMf1'fIM(:Al IIIURI 11. Applicant Information � Phase Print I.ct jbh Name tUusiness()maul/at ion InJn idual l "�'� 43 ')l—.eti' Addrt. s: City State Zip: -' 0/49) phone it#:__ %4 9O .err in an cmplu4cr:'( heek the appropriate trait: Ty pc of project(required): I t attl a:ltiptosoT MitlI einployees(lull and of part-tune►-' ] 0 •ev construction ' I Jill i1,olc proprietor ur p i incrJap and base no etupk.ee,...inking lint ire in 8. Remodeling any rapaclt\ [No workers'comp. utsutaner rtyunsah_I ;71 i hue a lariroco Silt doing all nod.ritywit.174 t.workos`comp.utae r%t. tt nqumtl.I r 9. ❑ thtnuhtiun I Building addition -1.711I am a lionKtinIt 9 and Mill eel'hiring cYMetrwdurs to conduct all Mark on in prupeity_ I will - ormatc that all etMlltaclurs s'etliir have%ticke'r) compensation nlsuranei or an sole 11a Electrical repairs or additions prteirntttte+wail ear etnplo.ecs.. 12.a Plumbing repairs or additions I 4111 a ge-Ieral conttaelter and I has a hued du:sub-contractors I1+tctl on dor attad of she:(. • 13..Ej Roof repairs {hesesub"tt.ntr:rtloisI{75elirrplt st>'andila..MotLery comp.illU111SIC. 14.❑Other 6.�we arc a Lt.gstYatt.ar and Its officer.lay:cactcl,ed twee nett of ea:uga on per Will_c. It_5_wli-II"and M:has.sin171gslinees.lNostO1I.cr, 01101Ir.1II,Ur11eleticqurit•J.I 'An!.applicant that died.,hvos=I must also till out the section tie lt+M,)onset)their Mot l.eTS Compensation pole} iitiuintateo,t. Ilomeon wrs Mew,sut.nut this alttJasit irtthtatint tic4 arc dn.ni all'toik and their hurl outside contractors Iliust submit a nen atlitlat it il,lllc ttltiu slier. C omtractun.that check this ht.%must attached an additional sheet shooing the nave of the sot+-cc8etr-a:ttrrs anti date M halter or nut those entities.has: aelploliees It the sub-C 1itrattin fuse c111)rioscc,.tlisA must punktc ilien 55urt.cn'comp.pi.IIs intenl+et, i am an employer that is providin,t'.rorAiers'compensation insurance for my employee.. Below is the policy and job site information. .�,// /�f �/y� Insurance Company Naitte:,4-,Z.:/i/„ ///LJ.G/j4U_---- /J� �j(� . Policy#or Self-ins.Lie.#: f�/�"�Q© Expiration Date: ©9/o�,12 Job Site Address: city State.Zip: _ Attach a cope of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure co%Braze as required under MGL c. 152..*25A is a criminal ♦tulatiun punishable by a line up to SI.50I.00 and or one-year intprisoninent.as well as civil penalties in the torn of a STOP WORK ORDER and a line of up to S250.00 a day against the a ttilator. A copy of this statement may he forwarded to the Otiice of Investigations of the 1)1A for insurance co%crage%eriticatitin. I do hereby certify under the par anti of perjury that the information provided above i5 true and correct Date: */(yer9/ Official use only. Do not.write in this area,to be completed by city or town oJpcial ( its or"Town: Permitilacense tt Issuing:authority(circle one): I. Board of Ilealth 2. Building Department 3.(.ity.[rown(jerk 4.Electrical inspector 5. Plumbing Inspector 6.Other ( ontact Person: Phone#: J � Atlantic Casualty_ INSURANCE COMPANY- COMMON POLICY DECLARATIONS L185000456-5 Policy Number L185000456-6 Renewal of Number Item 1. Named Insured and Mailing Address: GLENN BUILDING INC. PO BOX 1105 EASTHAMPTON MA 01027 Item 2. Policy Period From: 09/17/2021 To: 09/17/2022 Term 365 Day(s) 1 2 :0 1 A.M.Standard Time at the address of the Named Insured as stated herein Item 3. Item 3. Business Description: Contractor In return for the payment of the premium, and subject to all the terms of this policy,we agree with you to provide the insurance as stated in this policy. This policy consists of the following coverage parts for which a premium is indicated. W here no premium is shown,there is no coverage. This premium may be subject to adjustment. Coverage Part(s) Form No and Edition Date Premium Commercial General Liability Coverage Part $ 2,809.00 tc �G` \e‘ a6111 e e�Co�1tt sats �h�cr N\rt0 ee �‘..1 cox%�r nd� ' $ ny�°t siPe cl°\ co\Ve��y �ved°1 gea�ch,pan.1`Sv\V S�revb\fl Subtotal $ 2,809.00 s\.e G°m��O e�er�c� vsekcs�� Tax $ 112.36 �r`v ce Gc a d,m P Mas-t,C�� Policy Fee $ 50.00 \�s�rSUtar a Pa�aa`! 'f5, $ shhap�E� �50.`. c $ • Total $ 2,971.36 Audit Period Annual unless otherwise stated: Item 4. Forms andendorsementsapplicable to all Coverage Parts: See Schedule of Forms and Endorsements Agent No.: 200185 General Agent: R-T SPECIALTY, LLC Address: 1000 FRANKLIN VILLAGE DRIVE, SUITE 206 FRANKLIN MA 02038 Producer Code No.: Producer Name: Finck&Perras Insurance Agency Inc. Producer Address: Countersigned 09/17/2021 By DATE COUNTERSIGNATURE THIS COMMON POLICY DECLARATIONS AND THE SUPPLEMENTAL DECLARATIONS,TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S)AND ENDORSEMENTS COMPLETE THE ABOVE NUMBER POLICY. IN WITNESS WHEREOF,this Company has caused the Policy to be signed by its President and as Secretary and countersigned by a duly authorized representative. President Secretary . ACD 09-20 INSURED COPY--Page 3 �l .f City of Northampton cak4. H M �s ' ' s/ Massachusetts A. *�- r'{�c A. �:--� � DEPARTMENT OF BUILDING INSPECTIONS ?y 212 Main Street • Municipal Building CD Northampton, MA 01060 sbh. v�`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: � � � �/J�� `/C'�% 4'/� 7Un /f The debris will be transported by: Name of Hauler: r . 61;/ , .,/ gi'/��! -�'��/i- Signature of Applicant: Date: % i'// 21'2 5'6 -- 2'6 7' - 6'2 -- 1 -1'3 1'3- 3'1 3'11 1'9 -. 4'5 11030 2028 0) f.:ii.) ) ( N I 21030 in in I I 1 O BATH i 1 21—'I � wD24 B15DB15 ,j 6' x 7'8 301 SB30 LS36 0 - Nr n Ij 1 30 0 B1 N. co _15_B15i - CO / O 0 1 Zo KITCHEN B2727 N �CO 12'8 x 12'11 - - co io co N CO CD —0— ( 4) N — a b 1 I , L d / 2450 2668 3'9 -- 5'6 4'1 - ,1'6-- 6'4 , - 13'4 -II 21'2 GLENN BUILDING INC. EXISTING KITCHEN AND BATH Pat Lavoie Residence 70 Federal St. Florence MA 12/10/21 (260 Sq. Ft. Total area) 21'2 _ y 8' 7' 6'2 1'3fi� 3'1 3'11 -1'9 - 4'S i�►uoow ►�� I -le P 1 I l Heat XP 1 0 2028 — 1 P&-r. Coy Tiled Shower Area CO MShower Pivot New W+D M Valve/head Glass • N I 2 21030 Glass Door BATH LWD24 6' x7'8 \\ N l L B15! SB30 LS36- - U 1 B27 <> / 30 h- cp 1/48 27 I I B 18 0o 90 30T---Micro unit 130 ti 0 u ___l_ co io 15B 5 T co- KITCHEN co _ N co - 12'8 x 12'11 to N co CV3684 N b i i _ i_ 2450 2668 • 3'9 -- 5'6 4'1 'I ,1'6-- 6'4 - 13'4 — -i ,- 21'2 - GLENN BUILDING INC. UPGRADED KITCHEN AND BATH Pat Lavoie Residence 70 Federal St. Florence MA 12/10/21 (260 Sq. Ft. Total area)