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31B-182 BP-2022-1101 108 STATE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31 B-182-001 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-2022-1101 PERMISSIONIS HEREBY GRANTED TO: Project# WINDOW Contractor: License: COLONIAL CARPENTRY Est. Cost: 49500 INNOVATIONS INC 98619 Const.Class: Exp.Date: 10/22/2023 Use Group: Owner: DEMARTINO, EMILY D. SEGAL, CAMDEN G. Lot Size (sq.ft.) Zoning: URC Applicant: COLONIAL CARPENTRY INNOVATIONS INC Applicant Address Phone: Insurance:. 566 AMHERST RD 413-322-9031 COWC 083398 SOUTH HADLEY, MA 01075 ISSUED ON:09/12/2022 TO PERFORM THE FOLLOWING WORK: 22 WINDOWS 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: Mt Wri >9 3317( Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner c n .tom * f ' 1 ^F' -- The Commonwealth of Massachusetts �— ... Board of Building Regulations and Standar FOR! Massachusetts State Building Code, 780 CM SEP CIPaLI:Y 2 2022 US> Building Permit Application To Construct,Repair, Renovatie emolish a Revi ed Mhr 2011 One-or Two-Family Dwelling :,',..a` ��i fl i� i�� r u�� C This Section For Official Use Only _-104 o f oso Building Permit Number: bP-). '110 I Date Applied: 40i#...) `► 5‘, / // 9-9-zozz Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 roperty Address:. 1.2 Assessors�' Map&Parcel Numbers ` S t� �( to I 1.1a Is this an accepted street?yes k 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 0 Private❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Caw&A Seta I lk)nr �'t.i , i A d/D 66 Name(Print) City,State,ZIP 10i S to 9 co3-92-7-/07) cam de,r►..some_ cap , CpM No.and Street Telephone E i1 Addres SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 111( Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: 1 h c-Itti I eckol1 a-f ?2 1/1 S e.r-l- w►4 d c LA/3 0-Rcm€- r 2& SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ y R 0:00 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 Check No..00heck Amount: -6 Cash Amount: 6.Total Project Cost: $ It 9 l CO 0) CI Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Q 9 6 I C iQ 2 2_RCS Igj er-i A).. S kiarz License Number Expiration ate Name of CSL Holder n w J,Qrs List CSL Type(see below) No.and Street 1 Type Description Co U144 1'FOk.11 Q 11AA O I O 7S U Unrestricted(Buildings up to 35,000 Cu. ft.) City/Town,State,ZIP Y + R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding I SF Solid Fuel Burning Appliances 411-372-7031 S-i-c c C010✓i Al;eirfaved;oil to" I Insulation Telephone Email address D Demolition 5.2�Registere1d Home Improvement Contractor(HIC) 112-3 C.610 1 I a I l671 eA Ill✓t e✓al!i n its let r HIC� �Registration Number E p►r ion Date HIC Company Name od HI1C Re ant Name /� c6 C A►til i e r547 S'tuT-�. C0/041 al►pan c✓01 .1 .e cksh No.and Stree Email address S50 ad'R-y, MA-- in 1075-- 413-322-'10 31 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 'D!( 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 (0'0✓11 t.i (Grp eel-by1d el 0 V ck-koitS l•let.r to act on my behalf,in all matters relative to work authorized by this builds ng permit application.eG.M cieA SesQ, /2-5 izo Z? Print Owner's Name( lectronic Signature) Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION B - : g my name below,I hereby attest under the pains and penalties of perjury that all of the information onta ► i t 's applic ion ' true and accurate to the best of my knowledge and understanding. gIaq/ -0zz Print Owner's or Authori nt'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,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 \, r yi,C Fill t `, aMassachusetts �i DEPARTMENT OF BUILDING INSPECTIONS {= k �1 ¢ 4, 5 212 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 dispoed 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: )3 Vn Ul veil LL [5 -1 ' 14 CA Q 66 kZ . The debris will be transported by: Name of Hauler: USA 1-1-AUG/1 .a.- R-ec r I: y Ay ( if i Signature of Applicant: 10" Date: g g 02 _ - The Commonwealth of Massachusetts t' .7..-.... __', Department of Industrial Accidents =N/ll' - 1 Congress Street,Suite 100 =`=!:i= Boston, MA 02114-2017 . x!�, www meass.gov/d a S%ulifers'Compensation Insurance Affidavit:Builders/Contractors/EketrlrianslPlumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aunlicant Inf+►nuathin /� 1 Please Priat Lejibh Name(Rosiness+Organizationilndividual): CO?oii ci ( l C�reetil ( 1✓4✓�Q�/2t+ 'tS jet Address: SI 6 AAA I er 41 City/State/Zip:SoL4-k Itact I fyi/14 6 01.1 Phone#: 11 t3 3 2 2 — 90 5) Me yea an empire rr.Chord the ap rmwiate boa: Type of project(required). inlii ant a employes with d employees Mu andia part-time).• 7. D New construction 20 I am a sole proprietor or pssuteesbip and have no employees working for me in 8. 0 Remodeling any capacity.INn'rakers'snap.intuutar req ] 3� watt am a homeowner doing all k myself.[No"rakers'comp.in atrance retlu,nd.)' 9. Demolition 4.01 ant a homeowner and will he hiring contractors to conduct all week on my pvuptrty_ I will 10 D Building addition ensure that all en,ntr••n:tura either hate workers'compensation insurance or are sole I I.o Electrical repairs or additions pnaptieterrs with no crttplotcas- 12.0 Plumbing repairs or additions 501 am a general contractor and I hat e hired the aut*-cuatractora listed un the attached sheer 13 ]�Roof repairs —These sub orm-ictors byters'empluvet. and hare wutte comp.in ananea.t t}� 6.❑'.1'c arc a ester tstion and as uiticen have exercised their right of exemption petkaGL c. I4.�Other l/1l t e.t.a ��Iae, e.�I't 1.3. J 11 a i.and v.c ha...:nu employees.[No workers*comp.tnsuranalrequited.] 'Any applicant that checks Ivr n I must also fill out the r..cti,rn beluw showing their workers'compensation pulley information. 'Homeowners who submit this a[lt:hat 7t utdreattng the). arc Join all work and then hilt outside contractors mint subnut a new affidavit milieu g such. tC untractors that check this ho's muss attached an a National sheet show mg the name of the sub-contra to s and stare%hether or not those entitle have employees. if the sub-contractors hate employees.theyost m provide their w cx orkers' rntp.pier number_ I urn un employer that is providing workers'compensation Insurance,for my employees. Below is the policy andlob site titlurntation. Insurance Company Name: 61 vat d I t15LJ/aA r t1? Policy#or Self-ins.Lic.#: CO W C 0 f?j3 ( r Expiration Date: lb/I3 Job Site Address: ID f J 57 City/Statea'Zip: a s 0 1416 0 Attach a copy of the workers'compensation policy declaration page(showing the policy number on date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to S ,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 .00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for' urance coverage verilicati t n. I do l�!'lreby c under the i s a tenu - of perjury that the injormuliun provided hove i true and correct. Signature / ' f Dale. 9 g,__ Phone#: W 3 -3-22- Sa3 ,! Official use only. Du nut write in this urea.to he completed by city or town officiaL ('ity or Town:_ PermitiLicense 4 1 Issuing Authority (circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector G.Other _ t Contact Person: Phone#: ,4cc�rzn CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �..�' 08/30/22 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 NAME Bruce Plquette Metras Insurance Agency (A/c No,Ext): 413-536-1491 FAX,_No): 413-532-8522 2030 Memorial Drive E-MAIL Chicopee,MA 01020 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: NGM Insurance INSURED INSURER B: Guard Insurance Colonial Carpentry INSURER C: Innovations,Inc. INSURER D 566 Amherst Road South Hadley,MA 01075 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 ADDL3UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER (MM/DD/YYYY) (MM/DO/YYYY) LIMITS X COMMERCIAL GENERAL UABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A MPT7325P 08/30/22 08/30/23 PERSONAL$ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 X POLICY PET LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER' $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED- AUTOS ONLY AU X SCHEDTOSULED M1T7325P 08/30/22 08/30/23 BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A - EXCESS LIAB CLAIMS-MADE CUT7325P 08/30/22 08/30/23 AGGREGATE $ 1,000,000 DED X RETENTION$ 10000 $ WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABILITY STATUTE ER B OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVEANY YYN N/A COWC905285 10/13/21 10/13/22 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE,' $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Robert Szklarz is excluded under the workers'compensation coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DEWERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. Northampton,MA 01060 AUTHORIZED REPRESENTATIVE Bruce Piquette ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD