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02-025
BP-2022-0458 661 NORTH FARMS RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 02-025-001 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-2022-0458 PERMISSION IS HEREBY GRANTED TO: Project# KITCH/BATH RENO Contractor: License: Est. Cost: 47300 STEPHEN ROSS 079160 Const.Class: Exp.Date:04/28/2023 Use Group: Owner: V COULON STEPHEN C& SUSAN Lot Size (sq.ft.) Zoning: WSP Applicant: STEPHEN ROSS Applicant Address Phone: Insurance: 36 Service Center Rd (413)584-1224 WMZ-800-8006546-2020A NORTHAMPTON, MA 01060 ISSUED ON:04/29/2022 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 1 >2 . .1 Fees Paid: $312.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 4 The Commonwealth of Massachusetts „ '' Board of Building Regulations and Standards `;. 7 8 2022 780 CMR MUNIFOR Massachusetts State Building Code, CIPALITY '• USE _ Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011 i -.'ansp-rr) , One- or Two-Family Dwelling fi This Section For Official Use Only Buildin Permit Number: .bn—o1Z- L(� Date Applied: l�t v i� r lCo�t —7,2 Li ZM-202Z Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property A dr ss:: 1.2 Assessors Map&Parcel Numbers GG , /P/•.✓ 1 ... /J , ffiZ 4 �/ai-.is.-c-. -• 02 1.1a Is this an accepted street?yes ✓ no Map Number ParcelNumber 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 ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 wner'of Reco0., Name( rint) City,State,ZIP G 6I A4✓,A- 7' s,,.., i.e..._ ri-7-47o/ ,,Ceu 6 r•G.,pr , th C.4. .e J Li No. and Street Telephone Ema Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units A Other 0 Specify: Brief Description of Proposed Work': 0Z dGA-�. etc ki4.�f 1 "i; ., ell, 4c,fir44,41 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ y2 s9'd,..N 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ye/ ❑ Standard City/Town Application Fee g'Od' 0 Total Project Costa (Item 6)x multiplier x 3. Plumbing $ .3, gad. ' 2. Other Fees: $ 4. Mechanical (HVAC) $ (> - List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ 6.Total Project Cost: $ c f 7 a •J Check No.yU� Check Amount: 4✓f a Cash Amount: 1�Ui 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Constructiontr Supervisoror License(CSL) /!e H p/G b �" ',7" �' klai5 Licenset- Numberr / Expiration Date Name of CSL Holder 34 �erv;'c_e.C'•en.c� "fob List CSL Type(see below) V No.and Street Type Description Ai'OL „p fi,i, m� U 6/IL/_ U Unrestricted(Buildings up to 35,000 cu.ft.) �/c,w / �F R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding ,5 /a LAO�D4' ''/ ((�� y�dr1 55 40VG(�pp•COIYI SF SodFuelBurningAppliances ^'T V� I I Insulation Telephone Email address D Demolition 5.2 Registered_ L Home Improvementt Contractor(HIC) ,5 V f/ o•. _ 4.o c3 ' /7 ,eh cUt JD �c,t'$3 6ened e r HIC Registration Number Expirations Date v� HIC Cofnpany Name or IC Registr ame c�3en�tct: Ggate/ eelOdr�ss a�yatra)•Gorn.r No.and Street Ernaifaddress Mierhi-,nitim '114 o/OGd g/3•SSY-14.0y 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 of the building permit. Signed Affidavit Attached? Yes 0 No .❑ 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 4' µ `'PL P. s to act on my behalf,in all matters relative to work authorized by this building permit application. C'. � u,,.- rint Owner's Name(Electronic Signature) ate 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' this application's true and accurate to the best of my knowledge and understanding./ -`—�> V 21 2Z- mt Owner's or Authorized 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" __...."', CONSTRAS01 CKELLY ,4coRO CERTIFICATE OF LIABILITY INSURANCE DATD/YWY) 6/30/2021 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). PRODUCER CONTACT NAME: AXiA Insurance Services PHONE FAX 933 East Columbus Ave (NC,No,Eat):(413)788-9000 (A/C,No):(413)886-0190 Springfield,MA 01105 E-MAIL info©axiagroup.net INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Arbella Mutual Insurance Company 17000 INSURED INSURER B:A.I.M. Mutual Insurance Co. Construct Associates Inc. INSURER C: 36 Service Center Road INSURER D: Northampton,MA 01060 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD, IMM/DD/YYYYI (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 8500071119 7/1/2021 7/1/2022 DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JE0 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: EPLI $ 25,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ ANY AUTO 1020098280 02 7/1/2021 7/1/2022 BODILY INJURY(Per person) $ — OWNED AUTOS ONLY X AUTOS BODILY BODILY INJURY(Per accident) $ 1,000,000 X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY 1—_ AUTOS ONLY (Per accident) $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE 8500071119 7/1/2021 7/1/2022 AGGREGATE $ DED X RETENTION$ 10,000 $ 2,000,000 B WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY Y/N WMZ-800-8007507-2020A 7/1/2021 7/1/2022 STATUTE ERH - 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (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/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 Proof Of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /" ,t • ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD aJJ SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construti ftltlipe,rvisor CS-079160 spires:04128/2023 STEPHEN D ROSS 36 SERVICE CTR RD NORTHAMPTON MA 01060 Commissioner YaG K. "E.)'&n a t:7Z Fet-W1W-AePeadi 07/ a-J-J-ar Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual STEPHEN D. ROSS Registration: 150847 36 SERVICE CENTER RD. Expiration: 05/03/2022 NORTHAMPTON, MA 01060 Update Address and Return Card. SCA 1 Cs 20M-05/17 City of Northampton t Massachusetts ��s _ "' !� ,: '! e.c L.r1 a7 DEPARTMENT OF BUILDING INSPECTIONS %( t� !. t^ '17 212 Main Street • Municipal Building �J''y ra4 ,J Northampton, MA 01060 s ��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: Location of Facility: / /ice �--t C 2 e1 3 The debris will be transported by: Name of Hauler: eo ,i,iio_� /-,-„_ ,_ k 7 i ____„ Signature of Applicant: Date: 0,0