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38A-025
BP-2022-0582 34 RUST AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38A-025-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0582 PERMISSION IS HEREBY GRANTED TO: Project# ROOF Contractor: License: Est.Cost: 6500 BRIAN MITCHELL 115753 Const.Class: Exp.Date: 12/20/2024 Use Group: Owner: PITTORE CLI VIA Lot Size (sq.ft.) Zoning: URB Applicant: BRIAN MITCHELL Applicant Address Phone: Insurance: 316 BROOKSIDE CIRCLE (413)949-2300 WCC50050247022022 FLORENCE, MA 01062 ISSUED ON:05/24/2022 TO PERFORM THE FOLLOWING WORK: PARTIAL ROOF REPAIR 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: I I ' ,2 1 ra Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Buildinc Commissioner . , • The Commonwealth of Massachusetts . .1). ' ' Board of Building Regulations and Standards FOR Massachusetts State Building Code, 780 OvaMUISICIPALITY USE Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling. • - This Section For Official Use Only o c g� N Builrimg Permit Number. a(� ��•6' Date'App}ied =v c i f,f}• N rac Building Official(Print Name) �- Signature Date f --2 SEC•1'ION 1: SITE INFORMATION `_ 1:1 Property A dress: 1.2 Assessors Map &Parcel Numbers• • • St . 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: —/ Zone: _ Outside Flood Zone? Public iS Private❑ Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2. Ownerr,of Record:, /,.� • . L;hir = Cliv,C.a �s e. i/%✓Pia"t)/Tel , ✓" `A- -. a-106 Z . Name(Print) City,State,I.IP 3� /Z13f !4'e - I#3- 3-864-17Z/ C/iV 4 e.�0Jm4, c� r No. and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK' (check all that apply) New Construction 0 Existing Building V Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory.Bldg.0 Number of,Units . Other 0 .Specify: Brief Description of Proposed Work': "3-e di,kc-r.h eer r✓.t rt e .-,, S Iry c�'0�• J1 t/, r fir' ,,,L Yc,r�)� f vv-,- f t,-,kA• C� '7 rr� i�// 6; p p(4, h t�. c • 2l G�`,�y) ,r a 5 CA. l..rved i -J c l y,�t.r� SECTION 4: ESTIMATED CONS.'RUCTION COSTS . Item . Estimated Costs: _ _ OfficiaLUse-Only_____.._ . —_ _. -- (Labor and Maitenals)T - `1 Building $ 65 U(j u 1. Building Permit Fee: $ Indicate how fee is determined_ ❑ Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier "K 3.Plumbing $ 2. Other Fees: $ . 4. Mechanical (HVAC) $ List . 5. Mechanical (Fire $ II Suppression) Total All Fees: Check No' )' Check Amount 1' Cash Amount 6. Total Project Cost: $ / r o G, ( ❑Paid in Full ❑ Outstanding Balance Due: MA Historic Commission Review Process: Is their review completed? _ Yes No SEC'PION 5: CONSTRUCTION SERVICES 5.1 Construction•Snpervisor License(CSL) s //c 753 f2/?o . rr Z- Z LI �3f/4�� �� �-l��„j �J • License Nnmhed Fxp� on Name of CSL Holder o List CSL Type(see below) • 3/4 i3rce9 k5 c, t ; No.and Street - Type Description • Ih' U Unrestricted(Buildlints up to 35,000 eu. d r-e'? /' 1/14A- U i t Z R Restricted 1&2 Family Dwellin..g City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding / SF Solid Fuel Burning Appliances y/3` '1 4/9- 23OO • C Li , 109 rn ,/,Lei I Insulation Telephone Fa-nail address • D Demolition 5.2 Registered Home Improvement Contractor.(BIC) /17 13 L/ (,23 ICJ rl em �, 7i `' l HIC Registration Number anon Date HIC Company Name or HIC Registrant Name • 3/6 f3ru fzs,c& G', h-Z Ci NC/7 42, jcina-;l, et`" No. and Street ,^, r� L' 7 py�/�• 7 addrs y-�G ACC / 44, as L 7/J� /7%"G.Jco F.mai] s City/Town, State, ZIP Telephone • SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIIJAVIT (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 j r/k ri m 'r `i e to act on my behalf,in all matters relative to work authorized by this building permit application. t . s C I>r✓ict. -- f7951' . ,j - 24/ 2e22 Print Owner's Name(Electronic Signature) Date • SECTION 7b:_OWNER1.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(Electronic Signature) Date NOTES: I. 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(HICj Progl-am),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 • \a'ww.m ass.cov/oca Information on the Construction Supervisor License can be found at wv w.mass.cov/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 halffbaths Type of heating system • Number of deeps/porches Type of cooling system Enclosed • Open 3 "Total Project Square Footage"may be substituted for"Total Project Cost" link The Commonwealth of Massachusetts ') ' Department of Industrial Accidents � � 1 Congress Street,Suite 100 �C�- Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): k•*9dri.vi 18vi I di/1) ' 6 h frt., -flit 0], TAP c • Address: 3/C giD'U/fj4& GLSrc.4_ City/State/Zip: /G1c,-ems,ci,/ yvl i-. 0/06 2 Phone#: '1, 3- 9 V q .2300 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.['Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 164. I 65riit/l I /l Policy#or Self-ins.Lic.#:LJ CC coo S 0 21 70 Z 2 D ZZ 4 Expiration Date: 3JZSI 13 Job Site Address: 3`f P vs-A- A-J'Q.), V't? City/State/Zip: lJ ovIA k.-r , MA , Attach a copy of the workers'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 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u er the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: c/Z t1/ZO 2 2 Phone#: 4/3y`l'9' Z 3w (( 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 212 Main Street, Northampton, MA 01060 Solid Waste 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. Address of the work: 3'/ ,' vs-1 Ave The debris will be transported by: Lo lac i-/ plc,•3daro? / v /rI Cr, The debris will be received by: (A/1 , /c t cyc/.-if,Z3y t r{-40�,� ,�z /1) Building permit number: Name of Permit Applicant d.-1 an e r/ Date Signature of Permit Applicant Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-115753 Expires: 12/20/2024 BRIAN I.MITCHELL 316 BESIDE CIRCLE FLORENCE MA o1062 Commissioner. v, f: f �� iJ Unrestricted-Buildings of any use group which contain less than 35,01X1 cubic feet t991 cubic meters) of enclosed space. failure to possess a current edition of the Massachusetts Staff Building Code is Muse for revocation of this license. For information about this license Call f617)727-3200 or visit wtiww.maas.govidpl Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual BRIAN MITCHELL Registration: 187134 Expiration: 04/04/2023 D/B/A KINGDOM BUILDING & CONTRACTING 81 CAMBRIDGE STREET SPRINGFIELD, MA 01109 3//Co h /_QAQ��u-f9'1 t-ei9 C Al Update Address and Return Card. Office of Consumer Affairs& Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE: Individual before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 187134 04/04/2023 1000 Washington Street -Suite 710 AN MITCHELL Boston, MA 02118 /A KINGDOM BUILDING & CONTRACTING AN MITCHELL .76-`174:4-/ :3AMBRIDGE STREET RINGFIELD, MA 01109 Undersecretary Not valid without signature DATE(MM/DDNYYY) AC GRo® CERTIFICATE OF LIABILITY INSURANCE 04/28/2022 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 Mary Clark CISR NAME: Webber&Grinnell (PnHioNN,Est): (413)586-0111 FAX No): (413)586-6481 8 North King Street EMAIL mclark@RossWG.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC N Northampton MA 01060 INSURER A: Associated Employers Insurance 11104 INSURED INSURER B: Kingdom Building and Contracting,Inc. INSURER C: 316 Brookside Circle INSURER D: INSURER E: Florence MA 01062 INSURER F: COVERAGES CERTIFICATE NUMBER: 2022 Master 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 ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE N W SD VD POLICY NUMBER LIMITS (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEM.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 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'LIABIUTY STATUTE ER Y/N 100 000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ , A OFFICER/MEMBER EXCLUDED? N N/A WCC50050247022022A 03/25/2022 03/25/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 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) proof of insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Kingdom Building and Contracting,Inc ACCORDANCE WITH THE POLICY PROVISIONS. 81 Cambridge St AUTHORIZED REPRESENTATIVE Springfield MA 01109 I �I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD v Ae(3 eor CERTIFICATE OF LIABILITY INSURANCE DAAYE(:•_',-.)D YYVY)'� 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 INRURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL NSURED,the policy(ias)must have ADDITIONAL INSURED provisions or hendorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on thin certificate does not confer rights to the certificate holder in lieu of such endorsement(s). � � Pii00lICEtt �_- „A,,E. 13R'1>a•a Van N..our t Frick A Perils Insurancekjency lei:.Canvas E»/t�—' (613)527.5520 1(A1C.' r•AxHo: )(413 527-5970 ti 0 Caras Lane int.naEess! bvonmOtDiK�ta:RLkalitleenes.cuni �. _ INSURER'S)AfFORn:Ye COVERAGE h ,_ raw Lasltiamptun f.A 01027 iSSUREH A: R'I n Street America Ass,Co � iQ;!) A ''SLIMED isSulaa e: HINGDO'.1 BUILDING&CONTRACTING INSURER C: —~� _ -- U6an i.:'.t lief INSURER D: 310 Utw-,s,Is C'rCI INSURER E: INSURERS: COVERAGES CERTIFICATE NUMBER: C1216OOS01:1 REVISION NUMBER: ��� nr_���F THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 701 HE INSURED NAMED ABOVE _ —FOR THE POLICY PFHiCD - --. INO:c/acn. NOTt`•.TUSTAUU't.0 Ae]v REOUiRE".ENT,TEUY.t OR CONDITION OF ANY CO511RAC I OR OTHER 00CU:.:0;T WITH RESPECT 10 INI0i041 Uft; CERTIFUNTTE 'itY BE ISSUED Olt L'AY PERTAI:4,1HE I.(SURAT.CFAFFOROEO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS A`:O CONDITIONS OF SUCH POLICIES.L!•`.'iTS SHOWN.'.'AY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICY P LI R TYPE OF INSURANCE gtl$IRp730RR'"" OP Ala Policy NUMBER Y'ODIYYYY DM DDIYYYY UNITS K CO.. FIICIAt.GENERA!.LIAeiLI1Y EACIt O::t:U:r7r>;CE 1,000.000 1 _ ..?01[lfi:t 00,011i . Ct/.v' . OE �C C(R F119F$IEIr+.:r•: l S, .,t:O CRP j r,r.,.•,i::-•,;) �1f1,OU0' A - .-_ __ —_ -- MPP3465C C6!05i2021 06!0512022 FCRsos.1l.K,w, 'i.AY _ ✓ 1 A50,fI(TO+ _ (a]r;Lfi(i:Pt LCAIEU';RR"P'_SNER C£r.£UJ,LAGG!tEGATE $ 2,000,0110' PRO- 000 t_.. P:DICY rj jEcT u LOC FAOMICTS-CM.Y.0'n::3 2'0 h' ._ .. . y� OTI-:Ett S AUTO"De1LE LIAutuTY _ C0'.'t .:Eir)FZLF 1.lY:rf $ A•:1'Am0 O ii.Y1':.Sit?IP:fE•.•'il S O-.(NMIseriinn Ira F1:37 LY r:S.rft (r:'':.t'..'s) •� AUTOSO.::.Y AVTOS — M.•i[p t.C":.(144E0 rttwpL r`:0':ta— i _ AUTOS(`•:.V _-,_ Al,rGsONLY (Po:;:'-:'•.') �,y . .. .... .ter._ • U'.'DRELtAt1A9 ___GI:CUR £•ACa Or:CU!NNE:CE $ �. EXCESS LIAO , CLA't S•Y,I)E AGGREGATE WORi<F.RSCOVPESSATIO'N PER AM)Er;PLOYEIIS'LIABILITY � raTutr~l_ Din. vrR P'NYPno:'ii:ET03•PAITI.rn rxeCUTIA! (-'-1 c L.EACIIACC.O£t.Y E O!'rIL£R YE':Fr Il EXCLIIDEO? J t41A — -- -_ -...----.-_.---..- CVandatoryrnRRl EL DUGS!",EA 'PiOYCE I't-.,:-!".11.-Cr: 117SCR in ir,:OrAPF.RITIP,7.S1:'-:r - .�Y^ IEL.DISEASE.FCLICYL"',T t UESCR,PT►OH OF OPERATIONS/LOCATIONS/VEHICLES(ACORO 151,Mil bn'rl)tc.'riffs Stl,cdr?•'.ir'y b3:Inn l.cd itrtere sp'co is rcIpi ran ( 1 L...._ .20.316.C1,-,..S-71....LIMJIMER/f ' '.....-. .........--............... - - • . -,,.........-...... ....-......--.... '........ ....... ".......'.-......“.'.......' - CERTIFICATE HOLDER_�r _ .��.�.� CANCELLATION SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCE1.101 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL HE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. - ..... 'AUTHOR+ZED REPSSSCNTAI.VE ...,a. a...�. .�a...._e.•.�.......+.•-....