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10B-010 BP-2022-1226 48 AUDUBON RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 10B-010-001 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-2022-1226 PERMISSIONIS HEREBY GRANTEE TO: Project# KITCHEN/BATH RENO Contractor: License: Est. Cost: 84159 CHRISTOPHER JACOBS 60475 Const.Class: Exp.Date: 11/10/2022 Use Group: Owner: TRUSTEE ROGERS WILLIAM F Lot Size(sq.ft.) Zoning, URB Applicant: BARRON &JACOBS Applicant Address Phone: Insurance: 420 NORTH MAIN ST 413-586-8998 wmz8006365 LEEDS, MA 01053 ISSUED ON:09/27/2022 TO PERFORM THE FOLLOWING WORK: KITCHEN AND BATH RENO 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 VIO TION OF ANY OF ITS RULES AND REGULATIONS. Signature: A s • 1 ; .52 TiazR Fees Paid: $552.50 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner e\ C:k'NN `SF,o �l/ ;� The Commonwealth of Massac s c�j O Board of Building Regulations and St R `: , j` Massachusetts State Building Code, 780 0, 700 UNI ` LITY 04,c, USE Building Permit Application To Construct, Repair,Renovate � 'sh• R ised Mar 2011 One-or Two-Family Dwelling o,00,°4,s This S tion For Official Use Only Building Permit Number: A)+' 0 it/ Date Applied: '' 5atitAli i Building Official(Print Name) Signature V SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers `i 1 4) Q-4' b ras-DI o- no 1 1.la Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: i�5 Si✓`nt -'lM;� Zoning District Propose Use Lot Area(sq ft) Frontage(ft) I 1.5 Building Setbacks(ft) c,i - d e Ap ►`�; Front Yard Side Yardss)` 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 Private 0 Zone: Outside Flood Zone? Municipal On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 (ter'of Record: W iw. A- S�1(3 Ro l� . 1VApr 0‘oS_ Name "tit) City,State,ZIP g No.and d Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction ❑ Existing Building Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ,]id Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work'-: ' .4 Vw kLA aNi atlnaL VeNCA Otti4 �\od - ,..mow. A�5�� 4 Was a c,kU �p,,,,s (S ,reivovek. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only 1.Building $ (c..l 1(D°1 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ (p, 0 Total Project Cost' (Item 6)x multiplier _ x 3.Plumbing $ 10 C1L10 2. Other Fees: $ 4.Mechanical (HVAC) $ t i i-AST) List: 5.Mechanical (Fire $ Suppression) Total All Fees• � 4 �"'O Check No?i Check Amount O'Cash Amount: 6.Total Project Cost: $ gt-Votc \ CI Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ( W\5 40'..c:Z•t25 License Number Expiration Date Name of CSL Holaer 1-kLa A` „n \� List CSL Type(see below) U No.and Street tV Type Description �.��ls (�� a�05'J U Unrestricted(Buildings up to 35,000 Cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding �q SF Solid Fuel Burning Appliances 6)(gt 014&lox(ricA 251_,:y -N I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) IQ3�n ep('�Y`(A�\ "•11 � & - + HIC Registration Number Expiration Da e HIC Company Name or HIC Registrant Name `-t 7A N. IVNAtvN 'r �"cleavY C7-,c v j( a S L '\ No.and Street Email address I Mk— 613 11155 b-Een 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 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 AWYO." to act on my behalf,in all matters relative to work authorized by this building permit application. s� MP-4( — 6 Print Owner ame(Electronic Si to ue) 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. Print Owner's or Au orized 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,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" SIGNATURES By signing below,you agree to items A, B and C. DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES. A. Alternative Dispute Settlement(Arbitration Clause): The Seller and the Buyer hereby mutually agree,in a vance,that in the event of a dispute concerning this Agreement, the parties shall submit such dispute to a professional.state- pproved arbitration service(cost, if any,to be paid by the submitter)prior to either party proceeding to legal action in the courts. B. Bysigruntrffin agreemeiirybu, asth t rier of record.are hereby authorizing Barron&Jacobs Associates'Inc. to act as your authorized agent in all matter; pertaining to the budding permit application. C. This is a binding Agreement. You may not cancel it except as stated. This Agreement covers and superse s all conversations,statements and agreements,expressed or implied,between the parties,their agents or represents ives. (./11-AAR, CI ...v ? 3 o -2_2_ You,the Buyer, may cancel this transaction Buyer r) Date at any time prior to midnight of the third business day after the date of this transaction. 6 E ,� �-30 - Z Z Buyer See the attached notice of cancellation form Buyer � Dat for an explanation of this right. Seller retains an equal right to cancel. �'/��/� �?� Barron&Jacobs Representative DAL. - ********************************************************************************************* Contact Information Office Manager: Sandy Scavotto Office:413-586-8998, x102 El Chris Jacobs. President CT HIS#0554397 Cell phone:413-250-6677 Office phone ext: 100 Home phone:413-665-9113 ❑ Iesha Gomillion,Senior Designer Cell phone:413-923-7003 Office phone ext: 104 MA Construction Supervisor License 060475 MA Home Improvement Contractor 100809 CT Home Improvement Contractor 518617 Purchase Agreement Page 24 of 24 DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit was issued with the condition that all debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L c. 111, s. 150A. The debris will be disposed of in: Name of Wasteacility , !.)-0.k-1v,,) Ak Address of Waste Facility 111.5 Debris: As a condition of issuing a permit for the demolition, renovation, rehabilitation or other alteration of a building or structure, M.G.L. c.40 s.54 requires that the debris resulting therefrom shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L.c. 111 s. 150 A.Signature of the permit applicant, date and number of the building permit to be issued shall be indicated on a form provided by the Building Department and attached to the office copy of the building permit retained by the Building Department. If the debris will not be disposed of as indicated, the holder of the permit shall notify the building official,in writing,as to the location where the debris will be disposed. 780 CMR—6th Edition Signature of Permit Applicant Date The Commonwealth of Massachusetts ! __lit Department of Industrial Accidents ' -= - 1 Congress Street,Suite 100 1. __tx-ozY= Boston, MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information nn Please Print Legibly Name (Business/Organization/Individual): �)AY'ypv Ow-NA "/'1 i_C,i)j l'Cr--S_v_%.c5.Se4j ly-,c_- Address: LAW N�(kV.. i\1 U,�,n (t City/State/Zip: .,Q-c S I`n(),- 0\o�'5 Phone #: L-'j 1 1.:>-'S r,- v--,`1 x Are you an employer?Check the appropriate box: Type of project(required): I_u I am a employer with \0 employees(full and/or part-time).' 7. New construction 2 I am a sole proprietor or partnership and have no employees working for me in 8. tig Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 30I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 10 Q Building addition 4.O I am a homeowner and will be hiring contractors to conduct all work on my property I will ensure that all contractors either have workers'compensation insurance or are sole 11.®Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp insurance.: 6.a We area corporation and its officers have exercised their right of exemption per MGL c 14. Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] •ny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. *Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Pc ' isA Ivy u e Policy#or Self-ins.Lic.#: Vv IV\-i )Co (o'2 U'1-1--f" Expiration Date: ') I t I 2--0 Z3 Job Site Address: t—k ' Ppek.V 00,-. f-!--- City/State/Zip: Qtd(,S W\AI- o\oST3 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 punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$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. I do hereby certiffyunder the and penalties of perjury that the information provided above is true and correct Signature: v t/ Date: cil 'i2/17_Z Phone#: 1--)J S ., n1 a1`‘ 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): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACL CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) k.,..----- 03/03/2022 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 Adina Edgett,CISR NAME: Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Ext): (A/C,Nor___________ 8 North King Street E-MAIL aedgett@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Main Street America/MSA 29939 INSURED INSURER B: NGM/MSA i Barron&Jacobs Assoc. Inc. INSURER C: A.I.M.Mutual/A.I.M. I 33758 420 N Main Street INSURER D: INSURER E: I Beds MA 01053 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 03/23 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD MD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO CLAIMS-MADE X OCCUR PREMISES(EaENTED occu occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A MPT8049D 03/09/2022 03/09/2023 PERSONAL BADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 PRO- POLICYJECT LOC PRODUCTS $ 3,000,000 OTHER: EPLI $ 10,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 1,000,000 g OWNED X SCHEDULED M 1 T8049D 03/09/2022 03/09/2023 BODILY INJURY(Per accident) $ _ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY (Per accident) $ Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ B EXCESS LIAB CLAIMS-MADE CUT8049D 03/09/2022 03/09/2023 AGGREGATE $ DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- -SAND EMPLOYERS'LIABILITY Y/N STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA WMZ80080063652022A 03/01/2022 03/01/2023 • E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIM T $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street- Sidle 710 Boston.Massachusetts 02118 Home Improvement Contractor Regstration Type Corporation 100809 BARRON&JACOBS AMOCIATE3 INC Re> orationation O6 6/22,2 '4 420 NORTH MAIN STREET Expiration LEEK MA 01063 update Address end Return Card THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Aftge%a Business Regulation Registration wit for individual use only before the HOME IMPRO1ECONTRACTOR expiation dale. If found return to: TYPE: Office of Consumer Maws and Business Regulation 21fgea :w. E,i____ 1000 Wasnirlglitm Street-stale 710 10011011 , „ M1220024 Boston,NA Wits BARRON&JACOB:AMOCIlISTES.INC. CA-.120 dO OPMER N2TR , .t_^O^IORTH MAoN.;TREET u,R r �,„w. i (i•J MA 01053 Urefarxtittary Not valid ' signature Commonwealth of Massachusetts lir Division of Professional Licensure Board of Building R ulations and Standards Consk. ittypelvisor CS-060475 , "* spires: 11/10/2022 CHRISTOPHOt R 1 70 OLD SOU1ni SI 1 IN " NORTHAMPTC,I IM f. } 1()NS"1.1('- Commissioner �'90. K �n iLA Barron & Jacobs DESIGN . BUILD . REMODEL Dear Code Official, Enclosed please find an application and supporting documentation for a requested buildi g permit. I have enclosed a self-addressed, stamped envelope for your convenience. Please mail the building permit to our office. Thank you. Sincerely, Chris Jacobs A Tradition of Building Satisfaction,Since 1986 420 North Main Street, Leeds, Massachusetts 01053 413.586.8998 barronandjacobs. m 1 266E 1 l i I e 1 -o-i 1 - - - -BCB541a- - - -1 NOTES: v o DEMO EXISTING CABINETS DEMO/REUSE KITCHEN SINK // REMOVE DOOR & 4-_- FRAME OVER OPENING. CO — _ - 4) 4468 ! So _ — — T ,1 RELOCATE OPENING DEMO PANTRY CLOSET 1 1A [—] (1J CO �n 0 DEMOLITION PLAN Y ' J_i SCALE - 1/2" = 1' SCALE: AS STATED DRAWING TYPE: PROJECT: CLIENT INFO: DRAWING PHASE: SHEET: PROJECT CLIENT INFO DATE: 09.21.22 DRAWN BY: J. IRWIN 70 OLD SOUTH STREET,NORTHAMPTON,MA 01060 ALL DRAWINGS,PLANS,& DESIGNS ARE PROPERTY OF BARRON&JACOBS,INC. ir _2bb8_ I . ILi 'fiSCOB]jir m W1236R 1N301S W1236R CO) 1 CV 1 1 • 6" v BCB121 B12R1 1 - —R -rz .-1- - -� —_ . --.Z' NOTES: a m 1 CABINETS ON THIS DRAWING =CV - m --I / ARE FOR REFERENCE ONLY. I I m Q 0 1,--J FOR ACCURATE LAYOUT USE 1 K �k 1 DRAWINGS PROVIDED BY BUDGET CV 3 I 1 L 246E m i I NI- c5 \ 01:3 I N _c S al m 11 -5 1 /2 I ) . I / [ I -K - - -J I 31� 11 �J / ! , 0 a CO m I N A 6,1 Ni- - CO o m 1 B30 I t� 1 ,Aiiiillf,Ii. rl, W S r vi FLOOR PLAN _=11131DH= 2b68 =2330DH— ` i } SCALE - 1/2" = 1' SCALE: AS STATED DRAWING TYPE: PROJECT: CLIENT INFO: DRAWING PHASE: SHEET: PROJECT CLIENT INFO 2 DATE: 09.21.22 DRAWN BY: J. IRWIN 70 OLD SOUTH STREET,NORTHAMP ON,MA 01060 ALL DRAWINGS,PLANS,& DESIGNS ARE PROPERTY OF BARRON&JACOBS,INC.