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30B-028 (10) BP-2022-0868 269 RIVERSIDE DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 30B-028-001 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-2022-0868 PERMISSION IS HEREBY GRANTE TO: Project# repair Contractor: License: Est. Cost: 10000 KEVIN R SCHNELL 109600 Const.Class: Exp.Date: 10/19/2023 Use Group: Owner: J THOMSON JULIE R& MACGREGOR 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:07/25/2022 TO PERFORM THE FOLLOWING WORK: REPAIR ROT DAMAGE 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 VIOL TION OF ANY OF ITS RULES AND REGULATIONS. Signature: )2 . 3-'1 Fees Paid: $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner RECEIVED JUL 2 2 2022 DFze,OF BUILDING INSPECTIONS The Commonwealth of Massachusetts„Q'4iTHAMPTON,MA 01060 Board f Building Regulations and Standards FOR Massachusetts State Building Code,780 CMR MUNICIPALITY 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 Building Permit Number: G,O- g� I_ Date Applied: i .2 ' _ii_Va_5- a Building Official(Print Name) Signature SECTION 1:SITE INFORMATION 1. Pxpp�rty.1dtdress:, 1. e ors Map&Parcel Numb 7 b 11 v-er l'aCe r� ) U 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property?i en ions: Zoning District Proposed Use Lot Area4Me(1t)1 cvc 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' 2.1�v� �c : 'of 7(✓I(7 400 Narilictwrptoii,A II-4 0 (0'6-Z Name(Print City,State,ZIP Q-69 IK iv�°�-' age Dr 74b-�Get Y-i% pile,f.fhvmrsont jtvir1 COY ) 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) 141L. Alteration(s) 0 Addition ❑ Demolition ❑ Accessory Bldg.0 Number of Units Other ❑ Specify Brief Desgription of Proposed W ork2: R--P P Ct i/^ 1 PI) [�'v i- �of yf 4(l,' s a in 6,111 O v G�nq, o thev gtrjPca S SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: V Official Use Only (Labor �d S) 1.Building $(Vi 0./ 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: y �� 1 r} Check No.t O)- Check Amount� Cash Amount: 6.Total Project Cost: $ (�/ (f 0 Paid in Full 0 Outstanding Balance Due: City of Northampton s<41��• irlr, 7/ It Massachusetts DEPARTMENT OF BUILDING INSPECTIONS .•� 212 Main Street • Municipal Building yJti•. .''sue Northampton, MA 01060 r`"^••• ��C 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 a License(CSL) CS— t�/y ea) _(O /b 3 E'y In S c hi ('e I License Number Expiration ate Name of CSL Holder U Ye I �'A/Yl n • List CSL Type(see below) 11 No. d Street /` f�(� Type Description 1{, �1 /�/� _/� O O U Unrestricted(Buildings up to 35,000 cu.ft.) w ' 0 V 7� Restricted 1&2 Family Dwelling City/Town, tate,Z l M Masonry RC Roofing Covering WS Window and Siding C P five �� SF Solid Fuel Burning Appliances �((� -C 67-"(Li home jVNoie 01 evil CO M I Insulation Telephone Email address D Demolition 5.2 Refistered Home Improvement Contractor(HIC) r 1/4L /� -evh 5�h yl ell HICRegistratiCon Number Ex i on Date HICCompany 4Li 11�NQQ�rrIe or HI egisySar►t ame Same an © r C s L. No.and Street Y I `� C JEma]address C(ThG.Tt°own,�tvte M 4 ®10� ��`�/7 Via 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 UTHORIZATION 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< eV/ s�h Vl r`f 11 ?•Z1 Print Owner's or Authorized Agent's Name(Electronic Signature) D to 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 The Commonwealth of Massachusetts rizeqiii =' =er. Department of Industrial Accidents = �=0 1 Congress Street,Suite 100 • z Boston.MA 02114-2017 9-,4- www.tmass.gov/dia V%orkers'Compensation Insurance Aflidarit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING Al THORITY. Applicant Information /) Please Print Legibly I Name 4 Business Organization individual): -i D �[,�p ii k10me 01 prOv- n 'r1----.. Address: 33 L.tiVv-e( l" ``t QGt L City/State/Zip: 3 Phone#: CL13 — C 1 (7_ r Are yet me tatlitoyer?('heck the ap a boa: Type of project(required): I am a eirpIoyer with employees(full amain min-trine g7. New constructionI am a sole propnetur or paMershrp and have nu employees working for me in g. 0 Remodeling any capacity-(Nu workers'comp.insurance mowed.) 10 I am a homeowner doing all suit myself-(So workers'coop.insurance requiter!.)• 9. ❑Demolition an I am a hitmeouner and will be hiring a r:tra tors to conduct all work on my property. 1 will 10 O Building addition ensue that all cxrataeturs either have sunken'compensation%muranat or are sole 11. Electrical repairs or additions proprietors sith no employees_ 12.0 Plumbing repairs or additions S0 I am a general contractor and I have hired the sub contractor listed on the attnhed sheet. 13ci Roof repatirs rh sm esc b,cont actors r have employees and have workers,'comp.unurance. y 5 t�'ye/ � ��i r 5 6.0 re We a a evaporation and its officer. Wit_hay s exercised then right of exemption per t 4. Other -r' IS`.i I(a l,and se have no et plusees.[No workers'camp.insurance re uued.1 'Any applicant that checks bus Pi must also till out the section below showing their sorters'compensation putwy information_ 'Homeowners slw submit this affidavit indicating they arc doing all work and then dire outside contractor,must submit a new atYidav it mnlicatia ',Contractors that check din bus must attached an additional sheet sbowing the name of the sudreureraetors and state*hotter or not those entitieshine employees If the sub-contractors hive employ v s.they must provide their workers'crimp,policy number. I am an employer that is providing workers'compensation insurance for my employees !Mew is the pay and job site information. Insurance Company Nairn: ! '! a 0 5jteel /� io . 4 5 v q he�' Policya'orSelf-ins.Lie.#: I W, fJ1 5 -4- Expiration Date: 3) a-g/d) n Job Site Address: 9 n 0/P✓S fa e p� city state:zip:No elk) k) 4 4 o( fore � 06R Attach a copy of t workers'compeaaad.n polity declaration page(showing the policy number and eipira n date). Failure to secure coverage as required under MGL c. 152. 4$25A is a criminal s tolation punishable by a fine up to S1,500.00 andior 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 DR for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above Is true an correct.y Si •nut. Date: ' Phone C: Li r 3 — i 7- - 1 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): I.Board of Health 2.Building Department 3.Cityilown Clerk 4.Electrical Inspector S. Plumbing Inspector 6.Other ( ontact Person: Phone#: City of Northampton oarrnpro> r.....SAC Massachusetts �?•' 3._ ' !� d.' t P DEPARTMENT OF BUILDING INSPECTIONS 2; 212 Main Street a Municipal Building '�''' Northampton, MA 01060 Nti•• ..c 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: Ilany �Location of Facility: 0 5 The debris will be transported by: Name of Hauler: \il-el/ 1r vovf 0480 7 Signature of Applicant: ✓ Date: 7// / 2_ KEVISCH-01 LZAPKA AFRO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 7n/Zozz 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 _SAME: Whalen Insurance Agency PHONE FAX 71 King Street (A/c,No,E dl:(413)586-1000 (A/C,No):(413)585-0401 Northampton,MA 01060 Mass:info@WhalenInsurance.com INSURERS)AFFORDING COVERAGE NAIC S INSURER A:Main Street America Assurance 29939 INSURED INSURER B:A.I.M.Mutual Insurance Co. LiveWell Home Improvement,LLC INSURERC: 33 Laurel Mountain Road INSURERD: 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. TYPE OF INSURANCE POLICY NUMBER INSR ADDL SUER POLICY EFF POLICY EXP T LIMITS LTR INSD yrVD (MMIDD/YYYYI'(MM/DD/YYYYI' A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR MPJ8858A 3/28/2022 3/28/2023 DAMAGE TO RENTED 100,000 PREMISES fEe ocwrrence) $ MED EXP(Any one person) $ 10,000 PERSONAL 6 ADV INJURY $ 1,000,000 GE AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 1 2,000,000 GEM POUCY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ — (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED _AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NONWNED PROPERTYDAMAGE AUTOS ONLY AUTOSONLY (Per acedent $ $ UMBRELLA LIAR _ OCCUR ' EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ 0E0 RETENTION$ $ B WORKERS COMPENSATION PER I OTH- AHD EMPLOYERS' stall JTY �,/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEWCC-500-5024695-2022 4/5/2022 4/5/2023 100,000 OFFICER/MEMBER EXCLUDED? N I A EL EACH ACCIDENT $ (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under I 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) Certificate issued as evidence of coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY P ACCORDANCE WITH THE POLICY PROVISIONS. Main Street Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Division of Occupational Ltcensure Board of Budding Requtatrons and Standards Cor}st +oil S visor CS-109600 plres: 10f1912023 KEVIN sci-fi*LL 33 LAUREL MOIJNTAM ROAD WEST WHATELY MA 01039 111 J 1 /1 It.t 4 l` VCommissroner z r f �.. 1 + il'fl////(W//r/'//f// l/• / //)% // l7.)/-�J 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. ,GA 1 0 20t44:15f17 ' AMPRO ENtC# TOR HOME Registration valid for individual use only TYPE:LLC before the xp mFrfound to: Registratipn gxpt ratio n Office of n mer s d Business Regulation 181146 07/08/2023 1000 1 on r uite 710