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23D-003 BP-2022-0251 23 NONOTUCK ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23D-003-001 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-2022-0251 PERMISSION IS HEREBY GRANTED TO: Project# RENOVATION Contractor: License: Est. Cost: 28000 WILCOX BUILDERS INC CSL75440 Const.Class: Exp.Date:06/20/2023 Use Group: Owner: E MOOREHOUSE, ADRIANA C&ANDREW Lot Size (sq.ft.) Zoning: URB Applicant: WILCOX BUILDERS INC Applicant Address Phone: Insurance: 7 NOLAN CIRCLE 413-522-1894 6H128/54 HATFIELD, MA 01038 ISSUED ON:03/29/2022 TO PERFORM THE FOLLOWING WORK: INTERIOR RENOVATION 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 Driveoa 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 (� . 1' . I . Tal 6 I Fees Paid: S364.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 2- z tr,----7)„.._ The Commonwealth of MassachusettsW MAR 6 �IFOR Board of Building Regulations and Standards 1 Massachusetts State Building Code, 780 CMR ?Qa�N1UN"ICIPALITY -0._ C ' USE Building Permit Application To Construct,Repair, Renovate, 3—ii:Walsh a Revised Mar 2011 One-or Two-Family Dwelling '. This Section For Official Use Only `� '�' Building Permit Number: &P• 1).^ y S'I D e Applied: i eE-LA �55 / �� 3.2ct-ZozZ Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1 .LP oper Address: 1.2 Assessors Map&Parcel Numbers /7000 f c 4 S I<I.YKIC a3 0 r 00 -00/ 1.1 a Is this an accepted street?yes tno 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 ply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage_ Di �System: Public Private❑ Zone: _ Outside Flood Zone? Municipal Q On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: / A w 1,r�'0' sC t/i 7h;rris 4.5 /11 O/O'fr''ji Name(Print) City,State,ZIP T V fOti. 6 p4---ef �c7 7/, /}yhamtge(o04�Rf7`r f o.and Street Telephone EmailAddress SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) ,/ New Construction 0 Existing Building&caner-Occupied 0 Repairs(s) 0 Alteration(s) & Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units / Other 0 Specify: Brief Description of/Propose/d Work': /4sow v.( i/*t/1tn / 7, C/«/j5/ /64/9e .Ais4f/ 2 -(. 124I'e:Zj `t m, c2 l(41/' 1 4S r r /4 /' `i���►�(y�/ AS. (Ntr/�1, . A 4I/ 5044—) g 1_o.. n4L., LV(e fswf r irearIe/ 0•-4► //, .►Sir/f 1.4yX Ask ,i.er., .e..riot AV J i cioz . 37 Ate,/ /Ar /44.-z e'vi SECTIO1 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ /Qr ds v 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ l 0 Standard City/Town Application Fee OW' 0 Total Project Costa(Item 6)x multiplier x 3. Plumbing $ a'�td 2. Other Fees: $ 4. Mechanical (HVAC) $ l List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Ci Check No35 3p Check Amount. ✓" Cash Amount: 6.Total Project Cost: $ �a Odra ❑Paid in Full ( 0 Outstanding Balance Due: rcb Pa _ LL r,'4 f J5 i i/V P-e r.-r2� f SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor' License(CSL) �.s - , O �, � (�(/r �'py x License Number E iratio D e o CSL older (c. List CSL Type(see below)_gt6e° d treet Type Description ( /`/(4 Ore �G Unrestricted(Buildings up to 35,000 Cu.ft.) /f Restricted 1&2 Family Dwelling ity/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding / SF Solid Fuel Burning Appliances V/j (#9 y 'L/"(err 04 ® ew I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) /7��/, Cil r/r d 4- ‹cf' ' 1 P( H!C Registrationn�Nu�ber xpirah_04/on eHI Compaany Name o ;Registrant Name fl' (C ���1e A.- sift/-A./Email a'iidress ;I &-'47 N .and Str t ,66.0V404 Saa/flgy 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 o e building permit. Signed Affidavit Attached? Yes No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPPLLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize i�i��%1 r/ CA,%or�C to act on lf,in all matters relative to work authorized by this building permit application. 3/1 4z z Print Owner's Name(Electronic igna re D to 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. Print Owner's or Authorized Agent's Name(E ectronic Signature) /te g Bn ) 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 Ae DEPARTMENT OF BUILDING INSPECTIONS Jr 212 Main Street • Municipal Building Northampton, MA 01060 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: U , G/ / 't (7,4 The debris will be transported by: Name of Hauler: liter r <o,{ `//Kr/✓C''S 47 Signature of Applicant: Date: /0.77.".2 .,...=all. The Commonwealth of Massachusetts t` Department of Industrial.4ccidents s.=11 / Congress Street.Suite 100 1: Boston. .M.102114-201 ,`` wrwx:mttus.govldia . i,t" 11 orkers'('umpensatiun Insurance Affidavit:BuiIders/('ontractnrsiF lectriclanstPlumbers. 11)Ht.FIELD N all'1111.P}:RMII J ISG At THORITI. kpplicant In rut ni. Iion Please Print Leaihly Name ktiustncss C)rganrraiurn'individual 1' tjt/"/iD/ 'tr Address: 7 7'/ cr C/ (c C ity!StateiZip:(4 4//,49 0,70 f. Phone##:_ S 2/ 7 Art�as sir.'( bead.the appropriate hen: Type of project(required). I. am a empkw cr with g employees tfutt and or part-hank i' 7. ❑Ne onstruction 20 1 am a wok pmirrioe.z or pann.rshep and hate nu employee,working tin ate at K S. emctdtain any capacity. ;\u,.urker,'comp.tmaurance requital 9. ❑Demolition 10 I aim u honks.%rteT dolt,all work myself.[Now.,%.t.T,'romp tneuranc a -i to Building addition 4.0 I am a homeowner and will be hurray contractors to conduct all work on my;nrpm tkwl enaun that all contractors either hate worker'.ratare saran utsurance in are rule 11.0 Electrical repairs or additions proprietors,s tilt no employees 12.0 Plumbing repairs or additions 1rj 1 am a general contractor and I has a hued the tub-contractors listed.nt the attached she'd. 13 Roof repairs These suh-ccnttracture hate employees and hate worker,'comp insurance.' 14.0Other h N e arc a core looms and it,officer,hate exercised their nght ot exemption per Mt it_c 152,41141.and w e!Lase no employees.'No winker.'comp.insurance reyurred..I 'sans applicant that shucks hoe aI rniaa mks.,fin out the seetton below,hawing their workers eunpensatioaiiialicy.Bttttttttttttliw. 'Itomctow nen who submit this atl'tdatit uJicatmp they are dainty all work and then lure outside contractors matt submit tea atlidat it iodicatmt:such. IC'untracton that check this bit must attached an al.Ltionat short shov.ing the name ot the euts.scmtrackn,and state tY1f0eh or not those entities hta,e .rnplcryee, It the sub contra,tins hat.employes.trot must prat sib.their workers c.>utp pottte..number I am an employer that is providing workers'compensation insurance for my employees. Below i.s the policy and job site information. It,t_aence Company Nan e:_erfriC Aj4 islv�"e. (Ors -- Policy# Self�ms.Lie. : t`J( f�'s y Expirattun Data /p/�,�� -- Job Site Address. 2.3_._!!I d/461_.-4-e 4 Whist_% City State Zip goreit-e-/�/` Attach a copy of the workers'compensation policy declaration page(showing the policy number and espit!atiun date). Failure to sacure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a tine up to S1.500.00 antkor one-year imprisonment.as well as civil penalties in the former 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 tier insurance coverage verification. /do hereby certify under the pains and penalties o f perjury that the information provided uhoce is true and correct. Signature, Date. 3 /a/2 Z Phone::. /7/ � 7 r Official use only. Do nut write in this area.to he completed!hi city or riot n official City or Town: Permit/l.icensee is Issuing Authority (circle one(: I. Board of Health 2. 8uildiu„Department 3.( itv•Tossn Clerk 4. Electrical Inspector 5. PIunihint Inspector 6.Other Contact Person: Phone a: AC CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) kiii......-----. 03/14/2022 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 Kathy Parker NAME: Webber&Grinnell PHONE (413)586-0111 FAX (413)• 586-6481 (A/C,No,Ext): (A/C,No): 8 North King Street E-MAIL kparker@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Employers Mutual Casualty Company 21415 INSURED INSURER B: Wilcox Builders,Inc. INSURER C: Attn:Matthew Wilcox INSURER D: 7 Nolan Circle INSURER E: Hatfield MA 01038 INSURER F: COVERAGES CERTIFICATE NUMBER: CL21112216966 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 ADDLSUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PREM SESDAMAGO(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A 6D12857 11/01/2021 11/01/2022 PERSONAL BADVINJURY $ 1'000'000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 3,000,000 POLICY X JECT PRO- LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: $ —AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED './ SCHEDULED 6Z12857 11/01/2021 11/01/2022 BODILY INJURY(Per accident) $ AUTOS ONLY d'sri AUTOS XHIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY (Per accident) Medical payments $ 5,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS-MADE 6J12857 11/01/2021 11/01/2022 AGGREGATE $ 2,000,000 DED X RETENTION $ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N 500000 A ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A 6H 12854 12/15/2021 12/15/2022 E.L.EACH ACCIDENT $ , OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I 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 Andrew Morehouse ACCORDANCE WITH THE POLICY PROVISIONS. 23 Nonotuck St AUTHORIZED REPRESENTATIVE Florence MA 1)4 LD -,,JP I , ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD (' 1 �No *vrt Kevin Ross <kross@northamptonma.gov> Nonotuck window sticker 1 message Matt Wilcox <wilcoxbuilders@msn.com> Mon, Mar 28, 2022 at 4:21 PM To: "kross@northamptonma.gov" <kross@northamptonma.gov> Matt Wilcox Wilcox Builders Inc 7 Nolan Circle Hatfield MA 01038 413-522-1894 IMG_1419.heic :7'2 fs,, 1248K