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24C-177 (5)
BP-2022-0805 181 CRESCENT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24C-177-001 CITY OF NORTHAMPTON Permit: Ails Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0805 PERMISSIONIS HEREBY GRANTED TO: Project# 2022 PORCH REPAIR Contractor: License: Est. Cost: 10000 KEVIN R SCHNELL CS-109600 Const.Class: Exp.Date: 10/19/2023 Use Group: Owner: LOWENTHAL JAMES D& MARY BETH BROOKER Lot Size (sq.ft.) Zoning: URB Applicant: LIVEWELL HOME IMPROVEMENT LLC Applicant Address Phone: Insurance: 33 LAUREL MOUNTAIN RD (413)409-2929 WCC-500-5024695-2022 WEST WHATELY, MA 01039-9604 ISSUED ON:07/11/2022 TO PERFORM THE FOLLOWING WORK: REPAIR ROTTED PORCH 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: • if • >2 . 51-'1 • I � Fees Paid: $130.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner JL_ r, Z: T a C (F SJ, C_✓ The Commonwealth of Massachusetts v 7 'u'� Board of Building Regulations and Standards FOR 1r _- i� Massachusetts State Building Code,780 CMR MUNIUSEALITY o Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 I" One-or Two-Family Dwelling 1_ This Section For Official Use Only Building Permit Number:3P 2O2'-0 Sac Dat Applied:07/07/24 22— Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.i Pxpperty Ass: S,t__ 1.2 Aes�ors�l�lap&Parcel Num11 7 1.l a Is this an accepted steet?yes no Map Number Parce Number 1.3 Zoning Information: 1.4 P91ropfr�y Ddmensions: ll Zoning District Proposed Use Lot Are1(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'2h2.�_01 rner'0 Rec rd: r f �o q p 1 v 1 � 4 (.4060 Name(Pri City,State, IP 141 r e 5619K1 5 t q(3-a1Oi151 W,urybr1k) bro8 gCOWI rci6/0 p7- No.andStreet' Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) yi Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other !P<Specify: Brief Description of Proposed Work': ?CI C il rep q j 1r5 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I.Building $ ! D 000 1. Building Permit Fee:$it 6vY, Indicate how fee is determined: 2.Electrical $ ( ji;1 Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List:( c4 k -I,ss,rlc.GorfPnuv,h pe. 1'f- 5.Mechanical (Fire $ Suppression) Total All Fees:$ 130"-� p u ��(�� Check Not 0214 Check Amount: .5a ,Cash Amount: 6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due: City of Northampton (c,....., Massachusetts * '-, <ta DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building i,,, •<- ,C 14% s.,. L Northampton, MA 01060 y`» %1 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) (r "-(0 /S6 —_��12�/,,. �2:3 `n f ll I 7 �pCd r f S h h License Number Expiratt n Da e tame of CSL older ` / 3 4 u re f , 4-n a /f List CSL Type(see below) (I No.and Street / `/�l (� Type Description . d 1 /�/ n 10q .3 a U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town, tale,J� (�`( R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering c)F(� �p WS Window and Siding c i le & t iVe k-e II SF Solid Fuel Burning Appliances q t3-401-Ma'1 H d rn g i m p fotlerv►.evit.Corn I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) y l C,1/q i __ f �_3 1 rvc tiJ{ll Yam e I r t�vr w rer / HIC Registration Number Expiration Date H o pany Name or HIC a strant m 1-a U et f 4i I d11 ke e l l vecl'ell horse No.and Sneer i Email address LA) a lA e / 444 o(® 0-3 11(3_uaI-?.saq im overrfV1 Cows 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 ❑ 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. /4'a 4 ci�1r, Co53'j/P iici):2_ Print Owner's or Authorized Agent's Name(E ectronic 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 SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE Commonwealth of Massachusetts Diviswn of Occupational Licensure Board of Building Regullattons and Standards Ti"''"-FF�'R!'t S rvfsor CS-109600 tires. 10119/2023 KEVIN SCHINfLL 33 LAUREL MOUNTAIN WEST WHATELY MA 010111 'f i'YA Comrnissroner :10,016. .1//l' flirt////1/(V//e/ <7/7/i f/. . . iri .;/17%i/1>/74; Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC Registration: 181146 LIVEWELL HOME IMPROVEMENT LLC. Expiration: 07/08/2023 33 LAUREL MOUNTAIN ROAD WHATELY, MA 01039 Update Address and Return Card, :A 1 0 444-05117 3j E, I OR ¢ td g2, HOME MOVE eNt CO Q Registration valid for individual use only TYPE:LLC before the •xp' ation date. if ound return to: R¢piaLfdlipn ExPir,s1.1ion Office of .n/mer s d Business Regulation 161146 07/08/2 s23 1000 on r uite 710 Lk/EWELL HOMEIMPROVEMENT Li C. Bost. t 2 8 Kt VIN SCHNELL LAl'FILL MOUNTAIN ROAD o» • WHATFt Y MA 010 Undersecretary . of valid without signature City of Northampton '5., .. .Si Massachusetts c t -,„ i DEPARTMENT OF BUILDING INSPECTIONS S:, 212 Main Street • Municipal Building Northampton, MA 01060 4;11 .^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: f / Location of Facility: l� O1 lIy e C y The debris will be transported by: Name of Hauler: /,' i/e W e 11 Nome vo pi, vemprier--- Signature of Applica : ate: 7(67,2----a- /ns l rein C—e— h f,aA c_, " ,. The Commonwealth of:Nassachusei �,,�o� (�` • `ass° et Department of Industrial Accident v v `c'`'/ '� 1 Congress Street,Suite 100 "�=ls Boston,MA 02114-2017 z- 4. wtvty mass.govldia Vi ofkers'Compensation Insurance AIM**it:Builders/Contractors/EkctricianstPlumbers. 10 BE FILED WITH f 111E PERMITTING AUTHORITY. Applicant Information Pkase Print t.eeibis Name(Business rganira n uo7ndrvtdual): � e )V _(4-el( tne__._... ,eip ovelentonfi Address: 3 1-NA/r s I All+V j City/State/Zip: 3'hone#:_ka.3'10 ii - Lf q gel Arc yes as employer'Cheek tie ap r Mrs: Type of project(required): I 1 am a employer with C enpi oyecs(foil and or r part-tittle 7. New construction 2 I am a sole proprietor or purtnershop and have nu empoyees working for me to 8. 0 Remodeling any carmen),[No workers'comp.insurance nxpured.j 30 I ant a homeowner doing all work myself[No workers'con; tawraar'e fego tell.] 9. [j Demolition 4.0r mw I am a lwner and will be hiring cxtrstactorn to conduct all work on my property. I will 10 CI Building addition ensure that all cuu#raclun either have workers'compensation mauraneu or are sole 11.o Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 50 I am a general contractor and I has hired the sob-conuaetors tilted on the attached sheet these sub-contractors have employees and hone workers'comp.insurance., 13 3 D Roof repairs 6.0 We arc a cY atuot and its officers have exercised then right of exe 14.(` Other Pa IC' Repq� "rPo► exemption per fsk.L c. 152.i It i I,and we hose no exryolonn:es.[No workers'comp.insurance required.j •Any applicant that checks but a1 must also fill out the section below showing their worker,'compensation pulley information. 'Fkmxs+wtien who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new militias it indicating such. :Contractors that check thn box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have empl.nces If the sub-contractors have employees.they must provide their worker'army.policy number. I am an employer that is providing workers'compensation insurance for sty employees. Below is the policy and job site information. Insurance Company 'iliac:/vi I 5-1 re 'I (l1/1 er, cod- A 55 (f iloi v c _ Policy#or Self-ins.Lie.4: f A PT q �5 Expiration Date: '�3 " Job Site Address: I U I C C'ec C'e --71 city.(state:'zip: /0(f h g nipioY)1 Ji4 4 01060 Attach a copy of the workers'compensation policy declaration page(showing the policy number and tipirhtion date). Failure to secure coverage as required under MGL c. 152.*25A is a criminal violation punishable by a fine up to S1.500.00 an or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 under the pains and penalties of perjr ,the information provided abov is true d correct. St trmturc . Date.. ... ----- Phonee: &I13 - ,)_3 7_ 9- ri-6 Official use only. Do not Write in this area,to be completed by city or town official ('its or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.CityFTossn Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i�....N KEVISCH-01 LZAPKA ,t►coRO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YY1fY) `-� 7n/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 NONTACT Whalen Insurance Agency PHONE /C No,Ext (413)586-1000 FAX 71 King Street l ): WC,No):(413)585-0401 Northampton,MA 01060 Mass,SS_info@Whalenlnsurance.com INSURER(S)AFFORDING COVERAGE NAIC S INSURER A:Main Street America Assurance 29939 INSURED INSURER a:A.I.M.Mutual Insurance Co. LiveWell Home Improvement,LLC INSURER C: 33 Laurel Mountain Road INSURER D: West Whately,MA 01039 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 YY POLICY EFF POLICY EXP UMITS LTR INSD WVD (MM/OD/ YYI (MMIDD/YYYYI A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR MPJ8858A 3/28/2022 3/28/2023 DEMSEE STO EoNcwTne nce) $ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 jt POLICY PELT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ -ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSE� ONLY _AUTOS Wry D BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS ONLY PROPERTY ardent)DAMAGE $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS ND EMPLOYERSENIABILI / YIN STATUTE ERH WCC-500-5024695-2022 4/5/2022 4/5/2023 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ QF�FI Bator EM EXCLUDED? N/A E.L.DISEASE-EA EMPLOYEE$ (alandatory In�ij 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 N more space Is required) Certificate issued as evidence of coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Northampton ACCORDANCER (WITH THE POON DATE LICY PROVISIONS. NOTICE WILL BE DELIVERED IN Main Street Northampton,MA 01060 AUTHORIZED REPRESENTATIVE/ 7NT/ Y, ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD City of Northampton Massachusetts 4�?r << 4 ti DEPARTMENT OF BUILDING INSPECTIONS �'•. 212 Main Street • Municipal Building Northampton, MA 01060 , PO 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)