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22D-006 (11) BP-2021-2137 81 RYAN RD COMMONWEALTH OF MASSACHUSETTS Map:B lock:Lot: 22D-006-001 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-2021-2137 PERMISSIONIS HEREBY GRANTED TO: Project# STRUCTURAL REPAIR Contractor: License: Est. Cost: 15938 EDWARD GAGNON 115534 Const.Class: Exp.Date:04/27/2024 Use Group: Owner: ASHMAN SUSAN C Lot Size (sq.ft.) Zoning: WSP Applicant: EZ CONSTRUCTION LLC Applicant Address Phone: Insurance: 40 BELLWOOD RD (413)949-2868 SPRINGFIELD, MA 01119 ISSUED ON:02/03/2022 TO PERFORM THE FOLLO WING WORK: STRUCTURAL REPAIRS 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: Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I Fees Paid: $75.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner &VEEo DPP 1$4)I -c ler CA-L�r-n- 1- ID-22— C►4LLe iI-Z- 2j CALI-el') I-3-ZZ. is Cxlt,,A, 1'2-14-Z1 CAcLdO 1-"1-z2 _RECEIVED_ _,._ The Commonwealth of Massacl usett W Board of Building Regulations and Stan rdsNOV - 1 2021 FOR IIPALITY Massachusetts State Building Code, 780 MR t{TSE Building Permit Application To Construct,Repair,Renorte Ai ,, _,,._i , ayised\Mar 2011 One-or Two-Family Dwelling ;,,,,,,, -, cL, ,____„_ This Section For Official Use Only Buildin Permit Number: fa 1 p D rb 7 Date Appli d: Building ° /' 0v" -/Pc/ Official(Print Name) �� Si a S. Date ! SECTION 1:SITE INFORMATION 1.1 �rop�rty��ss: R� 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(It) 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' Na2,] O er�lof1Reco-d:<1^C A C (t J M� Old B me(Print) r 1i Y u� City,State,ZIP a RL\a.r, ea . u\3 2:81 $asc 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) Y'V Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify: Brief Description of Proposed Work': 0Q ( 0 Qt Q+L 4tt,,e4u u I ovacc SECTION 4:ESTIMATED EONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ ``- 1. Building Permit Fee: $ Indicate how fee is determined: ;` " 0 Standard City/Town Application Fee 2.Electrical $ C 0 Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees• $ n Check No. Ill I Check Amount: J'Cash Amount: 6.Total Project Cost: $\3 9M 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ��s3�1 r�� _ ,a� ' (yAcn License Number Expiration Date Name of CSL Holder �� --�� ` ` n c Rd List CSL Type(see below) No.and Street �J11 Type Description 4Town, CI�IkPtOlt_ciUUnrestricted(Buildings up to 35,000 cu.ft.) Z� l(� R Restricted I&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding ry(,y I�a SF Solid Fuel Burning Appliances t113'1U1 1 g 4�Q -(71�'Q fr(�C-i-ki\ U t I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor HI ) \Cik5- 0 S LoPlaa HIC Registration Number Expiration Date q8mpa5 Na it HI Re ' a e ' ,,,,t'"f and St a el uL��o 1 1 R ' 1 t`Sci+ 'q 3_ 619 Email address r /To ,State,L 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........... El SECTION 7a:OWNE HORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR�. f uBUILDIjNG� PERMIT I,as Owner of the subject property,hereby authorize t 2, CC'il i) to act on my behalf,in all matters relative to work authorized by this building permit application. k. --€ a ( QlI L Print Owner's Name(Electronic 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 cont ined in this application is true and accurate to the best of my knowledge and understanding. ip Pri er's or Authorized Agent's Name(Electronic Signature) �la 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 S . t..,, it, DEPARTMENT OF BUILDING INSPECTIONS� 212 Main Street • Municipal Building J-;_ ' * Northampton, MA 01060 1 !'jy. .4,,,i� \ 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: ,93- FaS-t pi n `'g IV , The debris will be transported by: Name of Hauler: (,,7i C 1 UOV--11 Signature of Applican : — — Date: ( 00 EZ Construction LLC 40 Bellwood Rd Springfield, MA 01119 US 413.351.9662 EZ CONSTOUCT1ON.LLC ezconstructionusa@gmail.com Estimate ADDRESS ESTIMATE# 0236 Susan Ashman DATE 09/20/2021 81 Ryan Road Northampton, MA 01062 JOB NUMBER 0149 DATE DESCRIPTION QTY RATE AMOUNT Labor 1 10,560.00 10,560.00 Materials 1 4,078.00 4,078.00 Electrician 1 1,000.00 1,000.00 Subcontractor Disposal 1 200.00 200.00 Permit Fees 1 100.00 100.00 Terms and Conditions: TOTAL $15 938.00 1/2 down payment is due at time of contract agreement.Prices subject to change based on materials and/or customer requests. Accepted By S aH �Na� Accepted Date Susan AShman(Oct 6,202110:46 EDT) Adding new 2x8 floor joists on 16" center from wall to main beam showing on drawing from inspector. Utilizing new floor joists to support wall system. vs c. _ Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards C onstf=uCtkiml§Upgrvisor CS-115534 cpires:04/27/2024 EDWARD II GAGNON 40 BELLWOOD RD SPRINGFIELD MA 01119 ) Commissioner die0. K. YEymilta., Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual ice,!! Registration: 198673 EDWARD GAGNON IZ! Expiration: 06/02/2022 40 BELLWOOD ROAD SPRINGFIELD,MA 01119 ti%, P f� err\ ti;+ —'' Update Address and Return Card. SCA t 0 20M-05/17 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 198673 06/02/2022 1000 Washington Street -Suite 710 EDWARD GAGNON Boston,MA 02118 EDWARD H.GAGNON � )1/1'k4 40 BELLWOOD ROAD (Qum SPRINGFIELD,MA 01119 Undersecretary Not valid with" ut signature The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):EZ Construction LLC Address:40 Bellwood Road City/State/Zip:Springfield MA 01119 Phone#:413-949-2868 Are you an employer? Check the appropriate box: Type of project(required): 1.El I am a employer with L 4. I am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ®Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp.insurance comp.insurance.: required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp. insurance required.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy 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:Associated Employers Insurance Policy#or Self-ins. Lic.#:5024793 Expiration Date:4/7/2022 S Job Site Address: 1 ( )jCU"\ City/State/Zip:tpi41(11)1(0 C I V� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce ' under the pains and penalties of pedury that the information provided above istruet r and correct. Si afore• Date: Phone#: 413-949-2868 Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.0Other Contact Person: Phone#: ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/26/2021 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 CON rALT Adina Edgett, CISR NAME: g Webber & Grinnell PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Ext): (AIC,No): 8 North King Street E-MAIL aedgett@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC• Northampton MA 01060 INSURER A:Atlantic Casualty/R—T/BIS INSURED INSURER B:NGM/MSA EZ Construction, LLC INSURER c:Associated Employers Insurance 11104 40 Bellwood Road INSURER D: INSURER E: Springfield MA 01119 INSURER F: COVERAGES CERTIFICATE NUMBER:Exp 04/22 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 INSR W D1 VD POLICY NUMBER IMMIDYYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X OCCUR DAMAGE TO RENTED 100,000 PREMISES (Ea occurrence) $ M1850004211 10/5/2021 10/5/2022 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY (Per person) $ B ALL OWNED SCHEDULED t41P9798Y 11/19/2020 11/19/2021 BODILY INJURY(Per accident) $ AUTOS X AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N N/A C (Mandatory In NH) WCC50050247932021A 4/7/2021 4/7/2022 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under _ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 L 000 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /J W Grinnell, CPCU, CIC f.�� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2014011