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41-062
BP-2022-1243 38 RIDGE VIEW RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 41-062-001 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-2022-1243 PERMISSION IS HEREBY GRANTED TO: Project# WATER REPAIRS Contractor: License: Est. Cost: 331200 SOVEREIGN BUILDERS INC 060176 Const.Class: Exp.Date:01/19/2023 Use Group: Owner: LISA QUEENIN JONATHAN & Lot Size (sq.ft.) Zoning: RR Applicant: SOVEREIGN BUILDERS INC Applicant Address Phone: Insurance: 710 SOUTHAMPTON RD 413-527-8001 CMQ8013720 WESTFIELD, MA 01085 ISSUED ON:10/06/2022 TO PERFORM THE FOLLOWING WORK: WATER DAMAGE REPAIRS 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: I• "2 Fees Paid: $2,153.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner ECEIi �i .---- - / . • T e Commonwealt-0'1' as.achu.etts Iding Regulations :nd S andards FOR w oa aT = MUNICIPALITY assacb r44t ,,;Au sde, 80 CMR APonToN,,A,AECTiONg USE Building Permit Application o (Repair, enovate Or Demolish a Revised Mar 20/1 One- or Two-Family Dwelling This Section For Official Use Only Building Permit Number: - 'ZZ,-j ..(-I. Date Applied: it 6t 6 l' i .2 T ' .._, , Attt Building Official(Print Name) Signature /D 41 e SECTION 1:SITE INFORMATION 1.1 Pp 124 ems y e� (Z 8 1.2 Assessors Map&Parcel NumbersZ 1.1 a Is this an accepted street?yes C.-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. ,§54) 1.7 Flood Zone Information: .8 Sewage Disposal System: Public 0 Private Zone: Outside FI one' Municipal 0 On site disposal systenL Check if yes SECTION 2: PROPERTY OWNERSHIP' 2r].�ca-ner'of Rec d: _ rrJ Name(Print)... City,State,ZIP No.and Street J Telephone Email Address SECTION 3:DESCRIPTI F PROPOSED WORK2(check all at apply) New Construction ElExisting Building Owner-Occupied 0 Repairs(s) Alteration(s).Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: _ B ief Description of Proposed Work' h4..1 i(Z i> /VAAp. .Q (�✓/I it ,vlho a 1 , �.C� v,,v►p „fit- -fib l.c..�n-e.k..e..� 4- C vi✓ f tux_ N-e. 12 d, ) i,J1 / >r /�✓, A_ i-, f?"4-.fir-,.fir /U<Q4i ,� c ti-c-&.w C n/ w / /v�‘.1 I' �.,".z p ��i"f if-ii SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ V 0 g -7 u 0 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ / ® 0 Standard City/Town Application Fee I 0 Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ St V J v 2. Other Fees: $ 4.Mechanical (HVAC) $ fir' (SV� List: 5.Mechanical (Fire C / Suppression) $ J; L ) Total All Fees: $ 4 `j Check No./3��I Check Amount: a1• Cash Amount: 6.Total Project Cost: s 3 31 2,0 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) f `'0( 017 b / /5//j„ 238d Cc,( /JI License Number Expi ation Date Name of CSL Holder / 3.� -�^ _ ,fJ 77 )7U /f . /� List CSL Type(see below) `/ No.and Street �JV fh fir+ /�'� Type Description 5 A h` - G/e ? U Unrestricted(Buildings up to 35,000 Cu.ft.) v P�)/ R Restricted I&2 Family Dwelling ity/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding q/;-12,7 4�v/ �C1it � J ` SF Solid Fuel Burning Appliances © gAP f //�/✓44 I Insulation Telephone Email address D Demolition 5.2 egistered Home Impro ement contractor(HIC / 1Z('U 5/2�'�.20z y 5v-e.reA AJ t of /d,4jt4 C, HIC Registration Number Expirat on Date H Co an ame IC Re strant Nam 5 �'`�� rS Aw. .4 raefiLliaP 50ateeefn.)bO,,Nc/CS., and S reef Email address 1,t i9 s it 1 N/J, - 0/o 2/7 V/3—rL7-dt 4dj j City/Town,St e,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 p/ovide this affidavit will result in the denial of the Issuance of uilding permit. Signed Affidavit Attached? Yes No .0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT e > r I,as Owner of the subject property,hereby authorize cp V e V e 1 , �7.�v 'A.evci ( D PP Ce nue3 to act on my behalf,in all matters relative to work authorized by this building permit application. 1 � � QJ ee h , 9/27 Z� rmt Owner's Name(Electronic Signature Da e SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my nam- below,I hereb test under the pains and penalties of perjury that all of the information contained in this/'cation is d accurate to the best of my knowledge and understandin z Print I ner's r Autho ent's Name(Electronic Silmature) Date NOTES: I. 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/dus 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 // y . '' A Massachusetts / �' ,jit I DEPARTMENT OF BUILDING INSPECTIONS l 5 �, _ 212 Main Street • Municipal Building JJJIII f 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: ,,/ / I'�� The debris will be transported by: /71-Name of Hauler: 0 L I ( fLQ-J - ; Signature of Applicant: Date: 7 2 7 2 Z The Commonwealth of Massachusetts tr.i " 0 Department of Industrial Accidents i =1/1' '; I Congress Street,Suite 100 �='i?f_ Boston,MA 02114-2017 =� �y 't•-• NE",�.- www.mass.gov/die 1ti1,rkers' ('DUI pcnsation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. It)BE FILED'WITH THE PERMITTING AUTHORITY. A i licant Information 'lease Print ,J_:,1 Name IBusiness Oreaneaattott Individual): v' �- r-e% c A r V/ P ,...4._-_s._ c, Addles: 7 1 L sl r1-1\ (2-0 iA City/State.Zip:1 e., Phone#: '/ 7 T2, 7- 1(00 I Are a un an employer?(leek the appropriate but: Type of project(required) I our a employer with 7S cnyrlosees I Lull and or part-Bete).• 7 L! emo N� on 2.1 I am a sok proprietor or partnership an have no employees working for me in deling any capacity [No workers'comp. mutante required I 9. 0 Demolition 1..0 I am a homeowner doing all work myself:(No*tariffs'comp_imuran:c mgwrad.]' 4.0 I am a homeowner and will he hiring emiractors to conduct all work on my property I will 10 0 Building addition enaun:that all contractor.either have workers'compensation n insurance or arc SOte 11.0 Electrical repairs or idtittionN proprietors with no employees 12.0 Plumbing repairs or additions 50 I am a general contractor and 1 have hued the sub-contractors listed on the anacbed sheet. 13 Q Roof repairs These sub-aomtractort have employees and have workers'comp.insurance.: 6.0 W e are a corporation and es officers has a excretsed their right of exemption per!.t iL c 14.❑other 1S2,tIt41.and we have no etgrloyees.[No workers'comp,insurance required. •Any applicant that checks hot xl must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this atrmdasa indicating they are doing all work and then hire outside contractors must submit a new affidavit mducatm!such. :Contractor.that check this tax must attached an aldataunal'loci showing the name of the sub-contractors and stale whether or net those entities hair employees_ If the sub-contractors have eni+loyers,they must provide their workers'camp.policy number I am an employer that is providing workers'compensation insurance fer my employees. Below is the polices and job►ite information. /J/(��J�' , /�Insurance Coinflany Name:fr--A/4/I _ r � " " r 41 `f ^''v-� Policy a or Self ins.Lic.#: Win 7 itt,.)$UU 7 7 2, ti Expiration Date: 20 lob Site Address: 3(( r`i 6 f e v/ems (2-4 ( City/State/Zip:/VO c4.1- 0/d 6 C Attach a copy of the workers'compensation policy declaration page(showing the policy number and a ration 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 andlor 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 cer -y er t pai .y a penal, s of perjury that the information provided above is true and correct SignalCy- -' C Date. (7---- 7 — 2----Z. Phone#: q 3 TZ 7 — ye) d Official use only. Do not write in this area,to be completed by city or town official ( itv or Town: Perniitr'License# Issuing.luthority (circle one): ' I. Board of health 2.Building Department 3.('itytTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other ( outset Person: Phone#: at ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YVYY) `,,.--- 09/19/2022 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 Sarah Premo NAME: Clayton Insurance Agency,Inc. (A/CONN,Eat): (413)536-0804 FA NO): (413)534-7874 1649 Northampton Street EMAIL spremo@claytoninsurance.net ADDRESS: P.O.Box 989 INSURER(S)AFFORDING COVERAGE1 NAIL A Holyoke MA 01041-0989 INSURER A: Green Mountain Insurance Company INSURED INSURER B: AIM Mutual Insurance Company Sovereign Builders,Inc. INSURER C: 710 Southampton Road INSURER D: INSURER E: Westfield MA 01085 INSURER F COVERAGES CERTIFICATE NUMBER: 22 MASTER REVISION NUMBER: 1 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 LTR TYPE OF INSURANCE INSD s POLICY EFF POLICY EXP VDR- POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED 50,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A 20042797 07/01/2022 07/01/2023 PERSONAL&ADVINJURY $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY X PRD 4,000,000 J ECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A ONED X W SCHEDULED 20042796 07/01/2022 07/01/2023 BODILY INJURY(Per accident) $ AUTOS ONLY __ AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY (Per accident) $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE 20042797 07/01/2022 07/01/2023 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABILITY Y/N B ANY PROPRIETOR/PARTNER/EXECUTIVE Y N/A WMZ8008007724 07/01/2022 07/01/2023 1,000,000 OFFICER/MEMBER EXCLUDED? E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , SCHEDULED EQUIP $373,400 A TOOLSLS&CONTRACTORS' ENTALLATION, 20042797 07/01/2022 07/02/2023 PROP AT EAC JOB SITE $100,000 EQUIPMENT RENTED/LEASE EQUIP $100,000 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 City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 125 Locust Street AUTHORIZED REPRESENTATIVE Northampton MA 01060 //ls44cr./ P I ,j�a+. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD