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07-053 (4) BP-2022-0575 400NORTH FARMS RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 07-053-001 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-2022-0575 PERMISSIONIS HEREBY GRANTED TO: Project# CHIMNEY REBUILD Contractor: License: Est. Cost: 10000 RICHARD COOPER 100736 Const.Class: Exp.Date:07/12/2022 Use Group: Owner: STRYSKO EDWARD C&KATHLEEN M TRUSTEES Lot Size (sq.ft.) Zoning: WP/WSP Applicant: RICHARD COOPER Applicant Address Phone: Insurance: 189 BEECH ST (413)687-7326 7PJUB-4N47860-3-21 HOLYOKE, MA 01040 ISSUED ON:05/23/2022 TO PERFORM THE FOLLOWING WORK: CHIMNEY REBUILD 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: Q Fees Paid: S65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner R CAVE The Commonwealth of Massachus s I Board of Building Regulations and Sta dards MAY 2 0 ZQ� F Massachusetts State Building Code, 78 CMR ICI➢ALITY NORTHAMPTON.MA o oso NS USE Building Permit Application To Construct,Repair,Re ovate } 'sea Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: P a ) t'-76-' Date Applied: eu it..) !Yvum 55 j Z 5-26.2622. Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property A ess: 1.2 Assessors Map&Parcel Numbers SOC) Llorlt. r*.s Qaad FCfcNCi IVIA 0-2 G63 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(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 CI Municipal Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: c' ED SA-6/ Gc U +tod er MA V to co,- Name(Print) City,State,ZIP 900 1\1ort�i►f rtn.c (2o0.-c . 4t3 SMY-(go zS G 4rs1Sku @Colvccusf,1_1E1 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. 0 Number of Units Other 0 Specify: Briefepescription of Proposed ork2:Gael a, M fit. e V,A4) rc►jk f f(L . Mart- 2 .K.. 40 1.Kul irto4..kocteciow %N 14-44.►a CY 1/.0.0 + . SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 10 000.do 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ �{� Check No.PAR Check AmountJ'( Cash Amount: 6. Total Project Cost: S 10 0300 ❑Paid in Full 0 Outstanding Balance Due: r City of Northampton r - �� Massachusetts mit.*c #.• kv :ii . �t DEPARTMENT OF BUILDING INSPECTIONS 7m ,' 212 Main Street • Municipal Building �O\ -:a' Gp,,-T Northampton, MA 01060 •i 1:N' 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. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction\Supervisor License(CSL) cs_ l CO36 d'11f21 toZZ iz,6.4.c Cooi3E License Number Expiration Date Name of CSL HolderV ` L _1 4�7eCth ST List CSL Type(see below) No.and Street Type Description rM AfT O`U U U Unrestricted(Buildings up to 35,000 cu.ft.) V„ R Restricted 1&2 Family Dwelling City/Town, Slate,ZIP M Masonry RC Roofing Covering WS Window and Siding 't SF Solid Fuel Burning Appliances 4 47`[32‘ A o ctima Qitk air row I Insulation Telephone address J D Demolition 5.2 Registered Home Improvement Contractor(HIC) ` ,/9 19 2.4 1� o'1(bt(2ozz 2 l(V%PrA COO10E 1` HIC Registration Number Expiration Date HIC Compan Name or HIC Regis ant Name td6 1 O�k AsoNY b.4 ,�e,cti a n w,►,1 C11�. . No.andStreet Emil address J tytl . ern4 o(O4o ur3 ?-732(. 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 ❑ No 0 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 to act on my behalf,in all matters relative to work authorized by this building permit application. Fiore c f�I(o lc* — c 1 u)72• Print Owner's Name(Electric 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. E-h.,no.00 Ejtreyst� c!4,,.4.1- sit %— Print Owner's or Authorized Agent's Name(Electronic Sign ) 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 SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton i Massachusetts --- 't, / 1 * i. I b' x DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building `C"'" 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: VA—.c. OuJ1..,t4f5 ?co -try • The debris will be transported by: Name of Hauler: Ern; O 2b SA-rf-k Sk o Signature of Applicant: 8_„„f3s. Date: ie. t" 1 . . The Commonwealth of Massachusetts Department of Industrial Accidents 7,11; I Congress Street,Suite 100 1 '7 Boston, MA 02114-.01, •,-.:7'1,,i.", WWW.mass.gorldin — 11 01 kers'Compensation Insurance Affidavit:BuiklersContractorstElectriciansiPlumbers. TO BE 1:11.ED WITI t t IIE PERMITTING AUTHORITY. Applicant Information Please Print Legilils Name(nusines.i'Orgamnitt.,n Ind I'll&ha i: %tIrVidre Groee 1?-- Address: 1C6ct, Zee cl, st-T.A.A.A. . ._. . C itylS t ate Zip:' (4) ,k/f.Aer-a— DM. 0(°44° Phone#:tit 3 (cFc7-732-(0 A.,uu an eniptoyer,Check Lbw apprvpriail:hot: Type of project(required): 1.E3 I am a employer with _employees ifall and or part-tinie).• 7. c]N .construction ....'..219.0-z a sole proprietor or partnership and have nu enipklees wort-ins fur gm in 8. ernodeling an)capacity,[Nu*urikers'cutup.insurazio: requarortI 9. 1:3 Demolition CII am a lierineowner titans all wort MySCIL iNe**mien:'comp,ursuranx v.:Aimed,j' I 0 CI Building addition 4.0 I ant a horneoWiller and will be haws enamours to 0.induci all*oil on ni propert . I,..II. ensure that all exintr.seturs either hare*voters'currtps-risation insurance or WV:1431C I 143 Electrical repairs or taddiUM.S proprietors*ith nu ernp103e . I 2.0 Plumbing repairs or additions 5C3 1 arn a meneral cimtructur and I have hired the 04h-contractors listed vu the attached bile,: 1 13E3 Roof repairs These sub-contracturs lose miployees and have*ottem.comp.IIINLIMACC.."'. 14.00d1C2 fi-El Wi:tilt a oarporatiun and its officers have exercised their right of exemption pet IkelCiL L.. 152,§1114t„and cc have no employers.r.,..k,workers cutup.insurance required.! *Any applicant 1'66 cht.0..s iNt14.z I ITILL-.r also fill inn the seetion Selo*silo*ins their uurkers'eoilipensati,,n pulic- udocination. +Homeowners skitu suinnit this atrida sit rndicatins tiles are doing all murk and then hire outside contractor- must submit a never&Pinta,it indicating ma:I-. ;Contractors[hat ehect.thr,ls......ain't attn.dnqi"art Adattarnal sliett hill.AlriF Cbs:manic of the it..-,..q:nirda.:1,orr and 3Lar:mitahlr:or not ilium:cnlatitra have crtiplo>ctr, II th..,L1,-cord!.,..t.,:,1^...,,,.:onpl,,,,..c.....tn_!, iltu, pr,,LI.. :.1,I: ,,,,T1e7-. ...1:11, I am an employer that is providing Priori en'compensation insurance for my empli.PreCA. Be 101V i.... the policy and job site information. Insurance Company Name: — Policy#or Self-Ms.Lie.#: Expiration Date: Job Site Address: City'State.:Zip: Attach a copy of the winters'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152.§25A is a criminal violation punishable by a tine 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 do agalust the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance ,:0',erage verification. I do hereby cc ' i.anther tlre pain.. am/pelt attics of perjury that the information provided above is true and correct. Si ru gnare:'" ,I 0 c 7..... ,:late: 17 wl. Phone m : 111S Ces°t'7-13?_(„As Official use only. Do not write in this area. to he completed by city or too-n official. City or Town: • Permit...License# laming Authority (circle one): . I.Board of Health 2. Building Department 3.City/Town Clerk 4.Ekctrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: a City of Northampton rt.t Massachusetts --• fr DEPARTMENT OF BUILDING INSPECTIONS St '; 40 °e 212 Main Street • Municipal Building " Northampton, MA 01060 P;q,0 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) USIC PROTECTING INFRASTRUCTURE Ticket Status Notification To: SAME/ED STRYSKO Email: MASONRYBYRICH@GMAIL.COM Below lists utilities that were statused by USIC. Please note there may be other Utilities which include private facilities that may be present in the work area and are NOT the responsibility of USIC to locate or mark. You are receiving this notification because your contact information is listed on the above ticket from the One Call System. If you have any questions regarding this notification, please contact USIC at 1-800-762-0592. Ticket Address 20221802657 400 N FARMS RD,NORTHAMPTON,MA Utility Locate Date / Status Detail Comcast Cab 05/4/22 09:25 AM Not Marked Excavation Site Clear NatGrid East Ele 05/4/22 09:25 AM Not Marked Excavation Site Clear Stay Up-to-Date with Real-Time Access to USIC's assigned Tickets through our DigCheck Pro App. You will have the flexibility to see Open and Closed Tickets, Post Locate Photos, and Street Views! There is no cost to access our DigCheck Pro App. Sign up by emailing DigCheck(c usicllc.com and provide your First Name: Last Name: Company Name: Email Address: State or States: Phone Number: I You can download DigCheck Questions or Comments: Pro from Apple App Store or DigCheck Google Play Store Now! DigCheck al�usicllc.com Powered by USIC It's Free! Kevin There wasn't a lot of room on the form for a good description. What we are looking to do at 40o North Farms Road Florence is to make the existing chimney wider to accept two flues. Inside the homeowner's house there are three elements (Wood stove, gas water heater and oil furnace) going into one flue. The two new flues would be for the water heater and the other for the furnace, leaving the wood stove in its own original flue. To do this we would form and pour a new if thick concrete footing and build the new foundation walls with 8" cmu filled solid. We would use joint reinforcement ever 16" on center and pin into the foundation walls at two locations. One location mid-way up the wall and the other near the top of the wall. We would install 4" thick masonry between the house and the chimney all the way to the roof line where it would turn into the brick veneer. We would remove the existing charm stone veneer on the original fireplace. From grade the entire chimney would be new brick using type N mortar. The chimney flashing will be copper. At the top the chimney the cap will be a 4" thick concrete cap that overhangs the body of the chimney with the flues sticking above the cap approximately 6". Thank you for your help. Thanks Rich I 4 --.',,,,. •44 ( .4' .. ••••••••00.1.... . i i 1 L. 4 ra . CHICOPEE MASON . ..._ . .. y a cdu6eeSUPPLIES, i ? t 1 r ( Cr) _ N,—_,.,......___.-- 1-- r 1. i \, i_ 1 1 i --I- -i- r , , ,----- , 1 1 , 4E- _ I -,.... . .. fl - Y 4 .,,I , , --- - -, , , . 1 ; ; . , ; , -1— 1 Z.:.--:—"i•ei ..? \ - , --.. 04 ' — ,. ! E , ..... a , ,_.. ..., • ,... ; ......, N ,...---• ,, F. .....„. it .,..., "r. E, T.7. .e...... 451 McKinstry Ave. • Chicopee, MA 01020 --7---- .I IL Like us on acebook 1 Tel: 413-534-4516 • Fax: 413-534-0652 -=-4— --,4:—.) www.cmsblock.com Li\ ACT. lV DATE(MM/DD/YYYY) ��. CERTIFICATE OF LIABILITY INSURANCE 05/18/22 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: Cecilia Olsen Dale A Frank Insurance Agency,Inc. (AH/c No.Est): 413-665-8324 (ac,No): 413-665-1280 PO Box 455 E-MAIL @ ADDRESS: info@DaleFrankInsurance.com Sunderland,MA 01375 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Main Street America INSURED INSURER B: Travelers Richard W.Cooper Jr.dba Masonry by Rich INSURER C: 189 Beech St INSURER D: Holyoke,MA 01040 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. NSR ADDLSUBR POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDFYYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED 500,000 CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 A MPP0019H 05/01/22 05/01/23 PERSONAL F.ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 6,000,000 POLICY PE� LOC PRODUCTS-COMP/OP AGG $ 6,000,000 $ OTHER. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ - OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDED? N/A 7PJUB-4N47860-3-21 07/17/21 07/17/22 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 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 Cecilia Olsen ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD