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24A-162 (6)
BP-2022-0754 333 PROSPECT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24A-162-001 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-2022-0754 PERMISSIONIS HEREBY GRANTE TO: Project# DECK Contractor: License: Est.Cost: 12790 THOMAS BACIS 070061 Const.Class: Exp.Date:03/06/2023 Use Group: Owner: ANACLETO SOBRAL,FILIPE &HEIDI ELIZABETH Lot Size (sq.ft.) Zoning: URA Applicant: NEW ENGLAND REMODELING GC INC Applicant Address Phone: Insurance: 75 VALLEY RD (413)478-5272 5006015012021 SOUTHAMPTON, MA 01073 ISSUED ON:06/30/2022 TO PERFORM THE FOLLOWING WORK: 12X20 FREE STANDING DECK 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 '► i • • Fees Paid: $48.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner • Z- 0le File #BP-2022-0754 APPLICANT/CONTACT PERSON:NEW ENGLAND REMODELING GC INC 75 VALLEY RD SOUTHAMPTON, MA 01073(413)478-5272 PROPERTY LOCATION 333 PROSPECT ST MAP:LOT 24A-162-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $48.00 Type of Construction: 12X20 FREE STANDING DECK New Construction Non Structural Renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans/Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: pproved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Penn it With Site Plan Major Project: Site Plan AND/OR Special Perm it With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit_ Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Penn its Required: Curb Cut from DPW Water Availability Sewer Availability Septic ApprovalBoard of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay 4 ,Ttbly Sly'ature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. fC. —moo ,1: , The Commonwealth of Massachusetts SUN 2 3 F• ' / ``*0Ir Board of Building Regulations and Stan rds 23 �i Massachusetts State Building Code, 780 MIpFPT OF FJN IC PEALI N 80 Building Permit Application To Construct, Repair,Renovate ffio ' iNsp ' ' e 'Mar 1011 One-or Two-Family Dwelling 'Mq o1o501oNs n This Section For Official Use Only Building Permit Number: �P"'' 4)'› —7 (1 Date Aj ied: Tiuu1/41.) 6/Sate' Building Official(Print Name) Signature UU , Da SECTION 1: SITE INFORMATION 1.1 Pro erty A ress: 1.2 Assess rs Map& Parcel Numbers 333 roc c�' ,Tee c::)—(1 1 U Z — 1.1a Is this an accepted street?yes X 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 i 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Private❑ Zone: Outside Flood Zone?Check if yes❑ Municipal On site disposal system SECTION 2: PROPERTY OWNERSHIP' 2.1 q�ner f.Reco Hein , _ 'tnOa1' No( 44 arr)9 J oto(PO Name cPnng City,State,ZIP 333 Frocp Lek 51-rex,i- No.and Street I 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 X Specify:1 tpt,gla 'tvd d C,cX Brief Description of Proposed Work': S`t`[d 4 1)-y )a C9 rove/ if lit/ d'CIc 6'lc_ 57ep u r° i=1orr. The p 7iI . .a.y ro For- ac I —' Se4h - — SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ iliMaitfrpeR 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x I ' 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire �Suppression) $ Total All Fee i a Check No� heck Amount: Cash Amount: 6.Total Project Cost: $ t{�r�go, 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor Li ense(CSL) � , Cs- o7ooc�l � . b. 2oa3 T1 at'n a, C� C i 5 License Number Expiration Date NameCSL Holder ' I t 0 n v 1 ' 5 U K U List CSL Type(see below) No.and Street �� Type Description 5 oV 01� ' ��6/Y1 `/j �� UUnrestricted(Buildings up to 35,000 cu.I.)I R Restricted 1&2 Family Dwelling City/Town,State,ZIP I M Masonry RC Roofing Covering WS Window and Siding p \ ( , SF Solid Fuel Burning Appliances 498 0 .5 Z9. ilf f c rp of 2.I Ingeact(terpti- I Insulation • leph ne Email addtess D Demolition 'I 5.2 Registered Home Improvgent Contractor(HIC) l Li CI u g .aa. a Qa 'I �'horn QS M aC`S HIC! Registration Dumber Expiration Date HIC Company a or HIC istr t Name /c '1c t oael fier'emodA� I , chpr)-e(. el-i' No.and t et I Emil dress SvJHICI()I& , Mrs "73 013)(4/ s727a City/Town,State, IP 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 Issu ce of the building permit. Signed Affidavit Attached? Yes 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 to act on my behalf,in all matters relative to work authorized by this building permit application. 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. /1-d 41 ace Lr ''s (9 —23 -. Z` 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,fmished 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 "? ______-_-__-__ v cid e , \)--1-)-0 6,14A) ' Q rr P 61-7 g+--�' , C SIDE YARD SIDE YARD • \r(d be- FRONT SETBACK I FRONTAGE City of Northampton 1 s e '� Massachusetts 4? C'E� 1 1, ,h �f �4 t VS. �_ . ! DEPARTMENT OF BUILDING INSPECTIONS v r 4 ` C 212 Main Street • Municipal Building ,, �5�' :" . Northampton, MA 01060 srk{Y 71�� 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: r) Location of Facility: V 01 L.i, e c Li c 1 j 1 Ni c(i')Grn i-ai ) _✓ The debris will be transported by: ‘ [ Name of Hauler: NE no )a n t Q 1�YI ad � I !1 gam,, gam, 6 _ 2,, _z_ ZSignature of Applicant: Date: ., ‘ The Commonwealth of Massachusetts Department of Industrial Accidents # Congress Street,Suite 100 -.., ,..... Boston, MA 02114-2017 ... www.rnass.gowilia loiters'compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. 1.40 HE FILED%VIII'"I IIE PERNIITIENG AUTillOktry. Aoolicant Information Please Print Leeibli Name(Business,'Organmation/IndtviciunlyN PIA) ,0,5 an() e...aca eitia). City/Stale/Zip: Cook i,,rt,i,01„,y, JAA 010-6 Phone#: i 111 ) (4-pz - )7 Art re.an emplo C e yer? approprLit box: Type of project(required): is i I am a emploer y %At emp4oyeint(full andor part-time).* 7. 0 New construction 2.0 I dial a N:ole pinprick)/ot partner-slop and have no employees norksiv for me sn 8. 0 Remodeling 1 any capacity,Pin'nutters'comp.insurance requared I 9. 0 Demolition %LI I ifill a horroconstei&Mg all watt myself.Rio tkorken:et.try,insurance rettumail 10 Ei Building addition -1.0 1 ant a hotraWW11117 and will be hams curaracturs to conduct all work on my property. I will ensure that all contractors either have workers°cormicnsanon insurance u my oar i 1 ID Electrical repairs additions Finsprietors with no employeens. 12.0 Plumbing repairs o additions SO I arn a etmetal contractor and I hat e hind the sub-contractors lined tan the attadied sheet 1 1 These sub-contractors bate employees and base winters'comp.insuraner.1‘ 13 Roof repairs 14. Other Cy"Oigla t tVe 6.0 i.s .are a corporation and its officers have exercised tlitu ngtsi of exemplum per MU c. I.1,2. (14}..and we ha Ve au employees.[Nu workers comp.insin-ance riNurred.j •Att),applicant that clacs:kc h .i must also till out the%action helots show ing their wurioys'compensation pot 1.4.y information. t liumeow ram w hi,submil this a trIALLA it milicatios they are doing all sink and than hire outside contractors moss subriut a new affidav it indiesonse',wit kontractom that eta k lilt.Iv).must attached an.wictitioreil sheet chow ine the mane of the sub-contractors mid dale N.hohcr on not(hose unities has, employees If the sub-ciiinractots hate employees,.they most plot ide their workers"comp.pcdicy rsumbei lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and Joh site information. Insurance Company Name: A-1_1 M u Li al Ins Comp Policy#or Self-ins.Lie.#: W CC- 500- 5 00 b 015- a 0 2,I A Expiration Date: 9 (I. R oa?, Job Site Address: 33 Vroso_er 5 -.._ City/Statelip:Ndito,_,1 1 Ai i A 0)01A Attach a copy of the workers'comensotion policy declaration page(showing the policy number and e , .don date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a tine up to 51,500.00 and/or one-year imprisonment,as well as civil penalties in the fonn 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. /do hereby certify under pains and penalties ot perjury that the information provided above iN true and correct. SnaWir: ' )1 te -r-,' Date: - 2,3 2' - p,„,,,,,, )--- -, . Official use only. Do not write in this area.to be completed by city ow town official City or Town.: „ „ Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.Ckyfrown Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other I ontact Person: Phone#: • THE COMMONWEALTH OF Bus SAC Regina ion Office of Consumer Affairs&Bus Reg HOME IMPROVE11ifEN_p TYPE: TOR �eipjra upitition Register & 2024 NEW ENGLAND RE a F _= L CONTRACTORS, INC. LV 75 M.BACIS r,_ 75 VALLEY ROAD :`�yk SOUTHAMPTON,MA 01• ;,x » Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Cons�rt$1111Srvisor ij CS-070061ipires: 03/06/2023 THOMAS M EjACIS � : 75 VALLEY ROAD 3. SOUTHAMPTi* MA. Commissioner djc i . YEnnita AC R CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDO/YYYY) 06/23/2022 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 Scott King,CIC NAME: King&Cushman Inc. PHONE (413)584-5610 (413)564-9322 ()USA No.E>rH: t+VC3 N�. P.O.Box 447 "19" sking®kingcushman.com ADDRESS: 176 King Street INSURER(S)AFFORDING COVERAGE NAIC S Northampton MA 01061 INSURER A: Northfield Insurance CO INSURED INSURER B: AIM Mutual Ins CO New England Remodeling INSURER C: General Contractors,Inc. INSURER D: 75 Valley Road INSURER E: Southampton MA 01073 INSURER F: FICATE COVERAGES SCERTIFY THAT THE POLICIES OF IINISURANC NUMBER: CL2262304844 BELOW AVE BEENABOVE ISSUED TO THE INSURED NAMED REVISION THEPO THIS I TOICY PE RIOD 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 AUDL�SUBR . POLICY EFF POLICY EXP INSO wvp POLICY NUMBER W(MMIDDIYYYYJ (MM/DDIYYYY) LIMITS �,,�r COMMERCIAL GENERAL LIABILITY +"► EACH OCCURRENCE 4$ 1,000,000 DAMAGE RENTEU CLAIMS-MADE XI OCCUR PREMISES a occurrence) $ 100,000 MED EXP(Any one person) $ 10,000 A WS445136 10/23/2021 10/23/2022 ,,PERSONAL&ADV INJURY I $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000,000 PRO- POLICY -JECT I.00 PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER. $ AUTOMOBILE LIABILITY COMBINED MfItEE LIMIT $ - (a t) 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 accidera) $ UMBRELLA LIAR OCCUR ,EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE ' $ DED RETENTION$ $ WORKERS COMPENSATION — PER TUTE 0TH I AND EMPLOYERS'LIABILITY Y/N 100,000 B OFFICER/MEMBER EXCLUDED? ANY PROPRIETOR/PARTNER/EXECUTIVE NfA WCC5006015012021A 09/04/2021 09/04/2022 EL EACH ACCIDENT $ (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 I LOCATIONS/VEHICLES (ACORD 101,Addkional 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. 210 Main St AUTHORIZED REPRESENTATIVE Northampton MA 01060 ,!_,' { I .,,�, .,(.,a...% ,f.11.—.. /4 -I J . ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD