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17A-202 BP-2022-1050 19 POWELL ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17A-202-001 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-2022-1050 PERMISSION IS HEREBY GRANTED TO: Project# stairs Contractor: License: Est. Cost: 500 STEWART WARREN 096126 Const.Class: Exp.Date:05/14/2024 Use Group: Owner: MARPA EAGER Lot Size(sq.ft.) Zoning: URB Applicant: STEWART WARREN Applicant Address Phone: Insurance: 20 LYN DR (413)237-9435 6S6OUB5B981926 GRANBY, MA 01035 ISSUED ON:08/26/2022 TO PERFORM THE FOLLOWING WORK: REPAIR STAIRS 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: Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 2ECEIVED 1 The Commonwealth of Massachus Board of Building Regulations and Standards FOR I Massachusetts State Building Coce, 780 C1 1J 2 5 202! MUNIUS ALITY E Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One- or Two-Family Dwelling no? N`oFrTinN5 This Section For Official Use Only''' "`^„'''''' Building,Permit Number:(SP . ," J 6 Date Applied: - AIVLS '1 g ' .(.03.,, Building Official(Print Name) Signature - / / Dad SECTION 1:SITE INFORMATION 1.1 Propecty Address: �� 1.2 Asses r Map&Parcel Number 1.1a 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 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Ownerl of Record: Name(Print) City,State,ZIP ,351 2E4544 r 5 &'E 016-794-7o71 ./11aj�A-E > .e'm,., No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK' (check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 18/1 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other Er-Specify: fNSGA-eL HNtN' Brief Description of Proposed Work': �— -ANu40f- fi rza•C- E rz 6'c3 j ' marts — T•Vsr.t-'1_ 44.4-vv RA-XL ['AI ova 5a i3 p- sca Z ZS' SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee: $ Indicate how fee is c.etermined: • 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 Fe Øt:J Check No. eck Am un 6. Total Project Cost: S 0 Paid in F 0 Ou tan...1 '.yce Due: pry City of Northampton 4. `° Massachusetts V. . t *` DEPARTMENT OF BUILDING INSPECTIONS �. 212 Main Street • Municipal Building ., '. Northampton, MA 01060 r41;1 1ti'` PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS, DOORS, ROOFS, RENOVATIONS, ROOF 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. Construction Debris Affidavit filled out and signed by applicant. 4. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance. 6. Energy Conservation Compliance Certificate (new /replacement windows). 7. Home owner's License Exemption Form (if applicable). 8. Note any Special Permit requirements (if applicable). 9. Energy Code —all new construction (Gut/Rehab) requires a HERS Rater Affidavit 10. 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) q CS -0bl:� /`5� AL( c�re-WAr' T 4Latwa i55/ License Number Expiration Date Name of CSL Holder Ljti D2. List CSL Type(see below) U No.and Street Type Description /'7 �A / o 33 U Unrestricted(Buildings up to 35,000 cu.ft.) ( � / C/ R Restricted 1&2 Family Dwelling City/Town,Sta e,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances /413 x37- 1qi-135 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) S �wAry kA¢>a ' D7/A VAT 2 4'i_SA,5 '��� 7/ay n HIC Registration Number Expirat on Date HIC Company Name or HIC Registrant Name 96 l y.. DR. beck-♦- — SII) 425 vo*caf tfdet' No and Street Email address Cvrr.A-.iF / 114, 01033 1413-237_ 1H35 beatSj-V 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 . 0 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 Si-w..4i 1,t/,Q,?t'27A/ to act �onn my behalf,in all matters relative to work authorized by this building permit application. Aiaik Pta,617.- 81,649Z. 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. :i t./AR 14/A-aR"u✓ /may A.2 Print Owner's or Authorized Agent's Name(Electronic Signature) ate 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.aov/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" .;, ,-(N,,_\ • The Commonwealth of Massachusetts •=1—... Department of Industrial Accidents ......... ..... .4 I Congress Street,Suite 100 =4....... Boston,MA 02114-2017 www.ntass.govidia 81.others' Compensation Insurance Affidavit:Builders/ContractorsiElectriciansiPlumbers. It)HE FILED S81111 THE PEILVIII7I4G AUTHOIDTV. Applicant Information Please Print Lenints. Name i Business Organuntioniludividuall: Address: City/StatelZip: Phone#: , Are yea an entplari er,-Cheek the Appropriate hoot * Tye of project(required): la 1 am a empior!. r wah ,, ptu)ees ifull andiar part-tinte0 • 7. 0 New construction 2C3 1 am a:wk propmeitur en pannorrarp•inti ha at hal entlIkIfyOza working for me in g_ Et Remodeling any L-apaerty.[No Woriera'comp.insaranu required] 9- ID Demolition 30 i am a homeowner doing all work myself No 4,4141,as'comp,insurance required.r 100 Building addition 4.C3 lam a litimizaWiter and will he hiring eatits ha corttlact all work on thy property. I will canine that all etioaraelors either have workers'carripennatiutt antrearwe or are wile a Electrical repairs or additions puipiierots With no employetn. 12.0 Plumbing rerrairs or additions 50 I ant a genera]contractor and I have hired the varamittractora hated On the attached sheet i 30 These sub-contractors tarot employees and/Awe workers'corrip.inannusee„: ROOirepatts Other 1 0 6.E]We are a eurpievation and its offoarra have exercised then rigla oleo:ern/Mon per NIG 4..L c. 152.§I ut l,and We have tit).1124th:wet-a.No workers',..oinia.iaance min-nisei'I▪Any applicant that checks hew#1 MUM also fill our the teen ,,lo,raz the iC ,,t kira....7., ..-+,rnpinon[whey interinatien +Heineowners who Aaron Lila% 'ktair IgithealIV the*are doull all Work art'Ll then hire ouraide ciaalractOtri tralar labtiat a de*affidavit andicatme sock Contractura that cheek this hut mum.iatanthed an Additional sheet show trig the name of the radr-couriracturs and date whether or out those eablica bane employees, II the sub-coraractins!nine each'!"Mi.ihey MUM provide their worker:a comp.puliey number. I am an employer that is providing worAers"compensation insurance for in employees. Below is the pillity and/oh i.ri.. information,. Insurance Company Name:: Pial ICI iJe. i) wd L ni5 (3 Ka iva C..0 _ Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address-. City,StatelZip: 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 punishabie by a fine up to SI,500.00 atlikOr one-year imprisonment,as well as civil penalties in the fonn of a STOP WORK ORDER and a fine of up to 1250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DR for insurance 0.54.crane verification. 1 du hereby eerh),under the pains and penalties of perjury that the information provided above is true and correct. SwilattlIV: Date: Phone it: Official use only. Do not write in firiA area,to be completed by city or town official City or Town: Permit/License#Issuing Authority(circle ono: I. Board of Health 2.Building Department 3.Cityfrown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton Massachusetts * DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building 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: The debris will be transported by: Name of Hauler: Signature of Applicant: Date: City of Northampton 1\1 Massachusetts I * ;'' DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building 1.. • Northampton, MA 01060 °--•• 1"� ` 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) City of Northampton ' �..-''^ ''" Massachusetts /w�'" S.,- 'A- ( 1 (,,. �` + WS ,t ir►L i ..f z DEPARTMENT OF BUILDING INSPECTIONS 6 212 Main Street • Municipal Building 717.1e7 + Northampton, MA 01060 f ,�, ma's -�Y 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: A 4th e ,e f /1 5 41c k c R ). 0 8 3 The debris will be transported by: Name of Hauler: 5-f-Q, wa‹'G W G it 4 �- R-1 4iel pp Signature of Applicant: Date: 1 g 1 ' • \• • * . ACC) ® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE sMMDD2 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 provI ions 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:Dowd Agencies, LLC PHONE John McGrath 14 Bobala Road tA/c,No.Ext):413-538-7444 FAX ,J:413-536-6020 Holyoke MA 01040 ADDRESS: imcgrath@dowd.com INSURER(S)AFFORDING COVERAGE NAIC K License*BR-1201657 INSURERA:Hartford Underwriters Insurance 30104 INSURED STEWWAR-01 INSURER B Stewart Warren - 20 Lyn Dr INSURERC: Granby MA 01033 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:384743112 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. LTR TYPE OF INSURANCE INSD SUBR AND POLICY NUMBER (MM DDY/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENTED $ CLAIMS-MADE OCCUR PREMISES Ea occurrence) $ MED EXP(Any one person $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JET 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 UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ A WORKERS COMPENSATION 6S60UB5B981926 5/11/2022 5/11/2023 PER ER4- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100,000 OFFICER/MEMBEREXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $100,000 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. Florence Building Department 212 Main St#100 Northampton MA 01060 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD