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17A-060 (4) BP-2022-0310 205 NORTH MAPLE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17A-060-001 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-2022-0310 PERMISSIONIS HEREBY GRANTED TO: Project# 2022 BATH RENO Contractor: License: HAYDENVILLE WOODWORKING & Est. Cost: 17985 DESIGN INC 115879 Const.Class: Exp.Date:06/22/2025 Use Group: Owner: L CIVJAN SCOTT A& SHERYL Lot Size (sq.ft.) Zoning: URB Applicant: HAYDENVILLE WOODWORKING &DESIGN INC Applicant Address Phone: Insurance: 35 CONZ ST (413)665-7402 WMZ-800-8007423-2021A NORTHAMPTON, MA 01060 ISSUED ON:03/29/2022 TO PERFORM THE FOLLOWING WORK: BATHROOM 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 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: 'v yg )ll cg Fees Paid: $117.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner Department use only oa „ City of Northampton Status of Permit: ÷..� Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability {ICw* Northampton, MA 01060 Two Sets of Structural Plans ' -, >•' ph!one 413-587-1240 Fax 413-587-1272 Plot/Site Plans .. .: -N Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 SITE INFORMATION 1.1 Property Address: This section to be completed by office Map 17 A Lot 06,0 Unit 00 205 North Maple St Zone U,lee Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Sheryl Civjan 205 North Maple Street Name..Pri t) / Current Mailing Address: 413-559-9113 (� 1% Telephone un3 2.2 Authorized Agent: Haydenville Woodworking&Design,Inc. 35 Conz Street,Northampton,MA 01060 Name(Print / Current Mailing Address: 413-665-7402 nature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 8,860 (a) Building Permit Fee 2. Electrical 100 (b)Estimated Total Cost of �! ° Construction from (6) i 3. Plumbing 9,025 Building Permit Fee t� 4. Mechanical(HVAC) / / / 7 5. Fire Protection 0 6. Total=(1 +2+3+4+5) 17,985 Check Number 24O I This Section For Official Use Only Building Permit Number:4 fb2Z i-0310 sssuu ed: signature: ,;' '3 Z9- ZOZ Z Building Commissioner/Inspector of Buildings Date Zinnia HaydenvilleWD.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW Q YES Q IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing ❑ Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [El] Decks [Q Siding[D] Other[0] Brief Description of Proposed bathroom renovation Work: Alteration of existing bedroom Yes X No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes x No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms _ c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Sheryl Civjan , as Owner of the subject property Haydenville Woodworking& Design, Inc. hereby authorize to act on m half, in all matters relative to work authorized by this building permit application. 4 of Owner Date I, J- J)L*V V(.IL )0(M044V I' t)�/ l//V�ii JAL rSf.4l v , as Owner/Authorized Agent hereby declare that the statements and information on the fore oing application are true a d accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Na Signature of er/A en Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Christopher Burkhardt License Number 35 Conz Street, Northampton, MA 01060 115879 Address _ _/ -/ Expiration Date 1/3 (PISS 416 L— 06/22/2025 S' a r Tele ne _ 9.Registered Home Improvement Contractor: Not Applicable 0 Company Name Registration Number Haydenville Woodworking & Design, Inc. — 110732 Address Expiration Date 35 Conz Street, Northampton, MA 0106Q_ Telephone �3 -0 11/02/2022 SECTION 10-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 • City of Northampton oqiH^MFt ti„ SAS _.S'Ci Massachusetts 4? VA N U i L { ; DEPARTMENT OF BUILDING INSPECTIONS 9 ;; 212 Main Street •Municipal Building `)j, ,C?` r bra Northampton, MA 01060 fr y A,OC‘ Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: 205 North Maple St (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: Amherst Trucking (Company Name and Address) `c 4 Signature f Perm pplicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts Department of Industrial Accidents t*=,s 07.,.. Office of Investigations + __?C__* 600 Washington Street ' -1.0_ Boston,MA 02111 . www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Haydenville Woodworking & Design, Inc. Address: 35 Conz Street, Northampton, MA 01060 City/State/Zip: Phone#: 413-665-7402 Are ou an employer?Check the appropriate box: Type of project(required): I Jail I am a employer with c- — 4. 0 I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors �y 2.El am a sole proprietor or partner- listed on the attached sheet.$ 2• Jt. Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers'comp. insurance 5. 0 We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions , 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' comp. insurance required.] 13.0 Other *Any 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A.I.M. Mutual Insurance Policy#or Self-ins.Lic.#: WMZ-800-8007423-2021A Expiration Date: 12/1/2022 Job Site Address:205 North Maple St City/State/ZiPorthampton, MA 01060 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 certify under the pai and penalties of perjury that the information provided above is true and correct. Signature: , Date: Phone#: 4 -66 -74 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): 1.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton ev. Massachusetts �� , A. DEPARTMENT OF BUILDING INSPECTIONS x am 212 Main Street • Municipal Building Jk �.� r'C,y_.-4� Northampton, MA 01060 sNh " AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered bathroom renovation 17,985 Type of Work: Est.Cost: Address of Work: 205 North Maple STreet Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): Job under$1,000.00 Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: v '4 , Haydenville Woodworking & Design, Inc. 1 V 132 Date Contractor Name H1C Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature �....N HAYDENWO01 KTOMLIN A�ORS CERTIFICATE OF LIABILITY INSURANCE DAT/25/2D/YYYY) 1/25/2021 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). C9NTACT PRODUCER NAME: AXiA Insurance Services PHONE(A/C,No,Ext):(413)788-9000 �FAX No):(413)886-0190 933 East Columbus Ave Springfield,MA 01105 iss:ktomlin@axiagroup.net INSURERS)AFFORDING COVERAGE NAIC INSURER A:Selective Insurance Company of America INSURED INSURER B:Preferred Mutual Insurance Company 15024 Haydenville Woodworking& INSURER C:A.I.M.Mutual Insurance Co. PO Box 132 INSURER D: South Deerfield,MA 01373 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 EFF POLICY EXP TYPE OF INSURANCE INSD DL SWVD POLICY NUMBER (MM/DDUBR Y/YYYY) (MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR S 2377902 12/1/2020 1211/2021 DAMAGE TO RENTED Ea 500,000 PREMISES( occurrence) $ MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY jeIf LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABIUTY (Ea aBINED SINGLE LIMIT $ ANY AUTO PCA0100300348 12/1/2020 12/1/2021 BODILY INJURY(Per person) $ 1,000,000 — OWNED " SCHEDULED BODILY INJURY(Per accident) $ — AUTOS ONLYAUUTNOpSN X AUTOS ONLY X AUTOS yy ONLYEp (( err acadent)AMAGE $ a A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE S 2377902 12/1/2020 12/1/2021 AGGREGATE $ DED RETENTION$ $ C AND EMPLOYERS'COMPENSATION PER OTH- STATUTE ER Y/N WMZ-800-8007423-2020A 12/31/2020 12/31/2021 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OpFFICER/MEMggEER EXCLUDED? N/A 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 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 Proof of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 2'-4 1/4" / existing cabinet 4 / existing radiator , 1I 1 � -,4- 6 ,,.___, ,, , . , .,,\. \ ..c.„ v O , i_____ _t, ,s, - i ; _o a O -01 . \<I p r. 1 i ---\ \ -cn \ -- IIIIIII:1441: -N half wall-wet wall 2'-6" \ 8" 1 , 4" / / 6" 1'-l0" / / REVISIONS III Haydenville Woodworking& Design,Inc. /DD/x�r x�n>ucs T-1 DDesign+Build—Gencral Contractors—Residential Construction—Since I9$4 1 11/lOf 11 Z4 0 FLOOR PLAN + ELEVATION z CIVJAN-205 NORTH MAPLE ST FLORENCE 4 __/__/__ ... exposed CARPENTRY: existing cabinet tub/shower -Add cabinets above toilet+vanity trim -Add tile around tub walls -Replace window trim with PVC-match existing style r- -Add half wall at wet wall -Replace vanityI-Trim+finishes to match existing house i = . -Add bath accessories polished chrome-TP holder,2 towel bars,1 - f y towel ring. j -Not pictured:repair ceiling in living room FLOOR/TILE: -Replace flooring with LVT or tile,TBD 1 3 -Subway tile around tub/shower walls 1 r`, d ,.o STONE: `') -Add top to half wall+niche base to match vanity top ° GLASS: er L.— -Add glass shower enclosure and hole for showerhead support PLUMBING: -Replace clawfoot tub with Rubix tub 6032,left hand drain,white. -Replace lay faucet with Moen Weymouth-polished chrome -Replace tub/shower trim with Newport Brass Aylesbury-use 1 exposed shower pipe.polished chrome i -Check leaks in floor at toilet,shower and first floor ceiling. r- \u -Remove and reinstall toilet+radiator to facilitate floor replacement. -replace drain at tub —+ ; II. i _ _ ELECTRICAL: `, 8„ -Replace two vanity lights with new ones / -Replace receptacles if needed existing radiator • I'� REVISIONS 1I, Haydenville Woodworking& Design, Inc. MM/DD/YY REMARKS CV ii, Design+Build-General Contractors-Residential Construction-Since 1984 1 i1/10/21 Z3 0 i BATH ELEVATIONS 2 / / CIVJAN-205 NORTH MAPLE ST FLORENCE a __/__/__ ... 5 __/__I__ ...