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23D-001 (11) BP-2022-0490 51 NONOTUCK ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23D-001-001 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-2022-0490 PERMISSIONISHEREBYGRANTED TO: Project# DECKS Contractor: License: Est.Cost: 12000 ANTHONY FALCETTI 114469 Const.Class: Exp.Date: 11/24/2023 BOUCHARD MARY J &JACQUELINE M Use Group: Owner: BOUCHARD Lot Size (sq.ft.) Zoning: URB Applicant: AG FALCETTI CARPENTRY INC Applicant Address Phone: Insurance: 262 PAPER MILL RD (413)537-8313 WC9097956 WESTFIELD, MA 01085 ISSUED ON:05/05/2022 TO PERFORM THE FOLLOWING WORK: RE-BUILD EXISTING DECKS 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: 5.2 3- i • III Fees Paid: $78.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner • a RECEIVED The Commonwealth of Massac sett. wt Board of Building Regulations and tan..rds t K( - 5 2022 OR Massachusetts State Building Code, 80 R I IPALITY SE Building Permit Application To Construct,Repair, eno : *;rA .sd>�IIE° I )Vise Mar 2011 One-or Two-Family Dwellin_ �Eallog-r.t �r.rON-.�nAo� This Section For Official Use Only _ Building Permit Number: fP ?�-• y90 Date Applied: f _ Building Official(Print Name) Signature to SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Pro'erty Dimensions: 1 b 3a.L/1 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 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' q 2.1 Owner'of Record W l�'Pi vt L e� , "4 G7 r 0 G Na (Prim City, State,ZIP —.;-14:1—C)1442---qZ21---C------ -- -1,=(A3—LA tr 6 1W 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) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other Specify: Brief Description of Proposed Wprk2:_ i) -e 15vt : tri , ivie) t, )( 4 ;1/1 D fe 05 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 'd� ' I. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire Suppression) $ Total All Fees: $ `h.,),00 �q�) Check No.i3d1! Check Amount: Cash Amount: 6. Total Project Cost: S a/L'" V l"Paid in Full 0 Outstanding Balance Due: n f; City of Northampton • Massachusetts 'fV DEPARTMENT OF BUILDING INSPECTIONS t1: ,' . + 212 Main Street Municipal Building i1 Northampton, MA 01060 �` ? ir,v'`'� PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW 1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES, FENCES, GROUND MOUNTED SOLAR, ETC. I. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work. (Digital and hard copy) 3. Site plan with location of proposed structure(s) and set backs. 4. Construction Debris Affidavit filled out and signed by applicant. 5. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate (new / replacement windows). 8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable). 9. Note any Conservation and/or special permit requirements (if applicable). 10. Driveway Permit (if applicable). 11. Proof of Water and Sewer entry fees paid (if applicable). 12. Trench Permit - public land by DPW / private land by Building Dept. 13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit application before issuance of permit. 14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: /� LOT SIZE: ' �/- /1 L r-c-5 REAR LOT DIMENSION: REAR YARD P oc) Care*e SIDE YARD ( SIDE YARD 0/x Tv F FRONT SETBACK FRONTAGE SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor icens ( SL) C ' LlO I4 a'Ga /aO�) p6 C / License Number Expiration Date Nami of CSL Holder a 6a RA. �r m i G( kb List CSL Type(see below) No.and Street Type Description ' .`'{ 2 (I4/ �/�'r/t,t Q r 0 5-5 U Unrestricted(Buildings upto 35,000 cu. ft.) WRestricted 1&2 Family Dwelling City/Town,Sta.e,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413 537�3 r3 "L6. l k UNr�s / I Insulation Telephone mail addr s / ,�t4 D Demolition 5.2 /Re isteree�Home Improvement Contractor kIIC) a O 5 1).3 0q/2 1 iay 11.G, cvt'Of/ Cc t' 'Ir- -1" il 6, + HIC Registration Number Expiration Date HICco_pan Na a or HIC Regi trant�TamL a / uveAiy �'of Wit K n •6-,A14- Gct.V ert�rr No. and tr r I 1 Q 0 G'I�,�` G�'� _mail addr s City/Town, State,ZIP Telephone g a/ ( "Co VII 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 ' )(JYL,(J !" to act on my behalf,in all matters relative to work authorized by this bug permit application. z1aCgvd 1 ( a 'c_ic1,^re 574j a a.. 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 contained in this application is true and accurate to the best of my knowledge and understanding. acaue_l►t 13ouc.Inar7 5/Lt- L .aZ Print 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" City of Northampton H p Massachusetts '' ..--- s * c I it- -441 DEPARTMENT OF BUILDING INSPECTIONS h .r r 212 Main Street • Municipal Building, - Northampton, MA 01060 r�' ),'% 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: 4lee4. f i i �'�0( The debris will be transported by: Name of Hauler: ` toty t): tr4f1)11 od ,,,,,Signature of Applicant: 14,,a,. `' "� Date: I The Commonwealth of Massachusetts =CO.-111111111•••• ......=Tr.111 011=•••• Department of Industrial Accidents E.1-Far= 1 Congress Street,Suite 100 17-iili.r=7 Boston, MA 02114-2017 1 i ,11••••••. n.moss.gov/dia t‘taker%'Compensation Insurance Affidavit:BuildersiContractorsfElectriciansfPlumbers. TO I3E FILED‘S 1111 111E PERMITTING ALTHOFUTV. Applicant Information Please Print Legibly --, Name iliosines...,Organwationflndividual 1; r 6,-, , ( . vi Address: 1,6 )..._ .pot ,,,rvi, 1 t ( gD - . city:statezip..„..im,4ft.d.otilek 0 toPhone .-y , .4 i'LL53(-7—ic.3 /3 Are!too ilI1 CM Ilkqee Chat the appropriate hot: Type of project(required): 1.119,i sin a employer with k employees i full and,cn pini-tinse).* 7. 0 New construction 2 111 1 am a ao4e proprietor or partnership and have nu trick..ores working for Mr in g. 0 Remodeling say earsseit!,(No workers'comp.insurance required.) 0 Demolition .4.:j 1 am a homeowner dun r all work myself[No workers'comp,insuranoe mineral.]' 9. 10 CI Building addition 4.13 1 am a homeowner and will be hiring contractors k,conduct all wink on m) property. 1 will ensure that an contractors either have workers"corripmsauon insurano:or art sole , 11.0 Electrical repairs or additions prop Lora with no employees_ 12.0 Plumbing repairs or additions 501 3fti a reneral contractor and I have hued the sub-contractors listed on the attached sheer 131:Roof repairs These solverairractors have employee:,and have workers comp.insurance.; ',4.K,tfIlict_D ...‘01:11Q-4 ReBki I.V f.i.S6Ve are a corporation and its officers have exercised then right of exciramon pet tiolCiL c. 152,+1(4 and we have no tinplo.pres.[No workers'comp.insurance required.' 1 eC (C. Any applicant that checks No;3 mile 41.67 fill out the section below showing then workers'compensation polaii,information +Homeowners.who submit this affidavit intheatirir the)are doting all work and then hut outside contnictors mot Nubtrut a new,affidas it inctiL-.411ng,uch. :Ccoutrtictom that erica this btA must attached an additional shmt silo%in ti..v sunny 4,1 the%ut•-con.truetec,and:state. ..4 hobo-in not thus4:ohmic,h ..c ettip14,4ec, If the schh-cuar .:tor,ItIst mirk.,ecs.the!, ntu,t rro4 Idc!btu ',41,tiert.:,.:01:11, I an,an employer that is providing trailers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Nan :i1 CA, tA... . [friC— Poky#or Self ins Lit..#: 01 poi 7 ct 5 6, Expiration Date: A Job Site Address: AA I NOVI cy 14-& C/A.-- citystatez ip:14 140 14 6 ilfAril Clt , Attach a copy of the o pricers'compensation policy declaration page(showing the policy number and es ignition date). o, 0 Failure to secure cos crage as required under MGL c. 152,*25A is a criminal violation punishable by 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 dare against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance co%-.:rage verification. I do hereby c lir rider the pains and penalties 4 perjury that the information provided above is true and correct. Sqpiature: i L.teec4/)V/ 1)2.1,- kl /4 a f Phone#: 14 / ), -c-, I ) Official use only. Do not write in this area,to be completed by city or town official City or Town: Permitticense# Issoimig Authority (circle one): Official Board of Health 2. Building Department 3.City(Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ---, ANTHFAL-01 DALDRICH ACORO CERTIFICATE OF LIABILITY INSURANCE DATE 5/2/2 D/YYYY) `.....-� /2/2022 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 dons not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Haberman Insurance PHONE 413 781-7000 FAX 413 733-9545 96 Ashley Ave {A/C,No,Eat):( ) {A/c,No):( ) West Springfield,MA 01089 Mikes:info@habermaninsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company of America 12572 INSURED INSURER B:Selective Insurance Company of the Southeast 39926 Anthony Falcetti,AG Falcetti Carpentry Inc INSURER C: 262 Paper Mill Road INSURER D: Westfield,MA 01086 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. !NM ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD yyvD POLICY NUMBER (MM/DD/YYYY1 (MM/DD/YYYYL UNITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR S 2611860 1/1/2022 1/1/2023 DREAMMISEAGE TSO(Ea R rre $ ENTED 600,000 P occunce) MED EXP(Any one person) $ 16,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY ye, LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY (Ea aiiJdeen SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ^ OWNED TU OS ONLY AUUTTOgyUyLNEEDp BODILY INJURY(Per accident) $ — HIREDTO ONLY _ AUTOS ONLY (PeOPE 10AMAGE PP 1! $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B AANND EMPLOYERS UABIUTNY X STATUTE ER PER H Y/N WC 9097966 1/11/2022 1/11/2023 600,000 AANYIPROPRIETOR EXCLUDED?ECUTIVE N N/A E.L.EACH ACCIDENT $ (Mandatory m ) E.L.DISEASE-EA EMPLOYEE $ 600,000 If yes,describe under 600,000 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 City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. Northampton City Hall 210 Main Street Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1888.2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DN.6. 11,17e-1 1 �� `e1 SAT I --_sl1 7;4 0 ?If nil )1,y, to-9 ),j-ti t ad --� 1� ik City of Northampton Massachusetts �- DEPARTMENT OF BUILDING INSPECTIONS t , 212 Main Street • Municipal Building Northampton, MA 01060j11 •'* HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT • I, (insert full legal name), born _ (insert month, day, year), hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners' exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this day of , 20_. (Signature)