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43-156 (2)
BP-2022-1433 30 HAWTHORNE TERR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 43-156-001 CITY OF NORTHAMPTON Permit: Acc Structure PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-1433 PERMISSION IS HEREBY GRANTED TO: Project# ACCESSORY STRUCTURE Contractor: License: Est. Cost: 63000 WRIGHT BUILDERS Const.Class: Exp.Date: Use Group: Owner: CLAY FIERST, DANIEL L. &NAOMI G. Lot Size (sq.ft.) Zoning: WSP Applicant: WRIGHT BUILDERS Applicant Address Phone: Insurance: 48 Bates St 413586-8287 MCC20020005342021A NORTHAMPTON, MA 01060 ISSUED ON: 11/02/2022 TO PERFORM THE FOLLOWING WORK: ADD NEW DETACHED 400 SQ FT ACCESSORY STRUCTURE 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: (1644051/4.) , Fees Paid: $80.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner Z -of< File #BP-2022-1433 APPLICANT/CONTACT PERSON:WRIGHT BUILDERS 48 Bates St NORTHAMPTON, MA 01060 413586-8287 PROPERTY LOCATION 30 HAWTHORNE TERR MAP:LOT 43-156-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $80.00 Type of Construction: ADD NEW DETACHED 400 SQ FT ACCESSORY STRUCTURE New Construction Non Structural Renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: lc Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay ,; I eIT:b1/41 II/2/ 1C/ Signa' re of Building Official Date Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Depart ent of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office o Planning&Development for more information. PIAMS Jn L. 17 NOV; ' 1 i:Z.U_____L_Er-Viz.:1) The ommonwealth of Massachusetts 2 2022 B and o Building Regulations and Standards FOR M ssac usetts State Building Code,780 CMR MUNICIPALITY • USE °` ppli ation To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 THa.,,t,T r�q o�oso Ns One-or Two-Family Dwelling �� This Section For Official Use Only Building Permit Number: .g 0_ �"' /y3 Date Applied: *� ` •V 0 tig, 1 Va/aa Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 30 Hawthorne Terrace 43 156-001 1.1 a Is this an accepted street?yes x no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: WSP Residential 45, 302- sf 100 Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) (Accessory Setbacks) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 20 ' 178+- 10 ' 15 '+ 10 ' 15+ 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public El Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system Check if yes® SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Northampton, MA 010 62 Daniel Fierst/ Naomi Clay p Name(Print) City,State,ZIP 30 Hawthorne Terr. 303-915-2791 danfierst@gmail.com 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) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. ® Number of Units Other 0 Specify: Brief Description of ProposedWork2: new accessory structure, approx 400 sf, shed, fully enclosed, solar permit by others SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 68, 000 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 4, 000 0 Standard City/Town Application Fee - 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ na 2. Other Fees: $ 4.Mechanical (HVAC) $ na List: 5.Mechanical (Fire $ na Total All Fees: $ Suppression) Check No.(jlj tCheck Amount: 0 Cash Amount: 6.Total Project Cost: $ 63, 000 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C S—10 7 9 0 8 3/16/2 0 2 4 Matthew O'Grady License Number Expiration Date Name of CSL Holder U List CSL Type(see below) 744 Main St No.and Street Type Description Wilbraham, MA 01095 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry 413—3 2 0—8 510 RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances mogrady@wright—builders.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 101536 6/2 5/2 0 2 4 Wright Builders, Inc. HIC Registration Number Expiration Date HIG om any Name or HIC Registrant Name 4 Bates St. info@wright—builders.com No.and Street Email address Northampton, MA 01060 413-586-8287 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 .❑ 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 Wright Builders, Inc. to act on my be ,' afters alive to work authorized by this building permit application. 11 /t I to22 er's Name ctrotuc Signature)... ` .,2,3_5.k., 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 couta. ed in ' application is true and accurate to the best of my knowledge and understanding. Ryan Crandall, Wright Builders 11/1/2022 vner's or Authorized 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.) <4 0 0 S f (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) na Habitable room count na Number of fireplaces na Number of bedrooms na Number of bathrooms na Number ofhalf/baths na Type of heating system na Number of decks/porches na Type of cooling system n a Enclosed <4 0 0 sf Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" CITY OF NORTHAMPTON SETBACK PLAN MAP: 43 LOT: 156 LOT SIZE: 1 . 0 4 a c REAR LOT DIMENSION: 18 6 . 71+- ' REAR YARD 15 ' + SIDE YARD 15 '+ accessory , 25 ' existi g home so. •A. ,..1... ...0 . _ ,s,_. e a e S/kb Tk' ,-a/ , v. , `fir. ''3ByRO pF`W7/O ,.v. sir / 1 '' .tor 's-`I. • \ /ds.+Bh, he 7/ . /- ) • q,\\, �4*$1 9'DpQS9 k ,`\ a A • i �Ok�QAR F SIDE YARD 7 5 ' +— TF° gF Fpr,� i`' r,Qti I I f na 4 "v � `ems. y.F,,'�L •�ira$� --'sehs '4 . Qk /l I h. y ' QP P'PIc 4'F FRONT SETBACK 178 '+ FRONTAGE 10 0 ' City of Northampton 'f' t Massachusetts Fw)?��~ =- ; DEPARTMENT OF BUILDING INSPECTIONS y 212 Main Street • Municipal Building Jk% et. Northampton, MA 01060 j' ••i0 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: Valley Recycling, 234 Easthampton Rd. Northampton MA 01060 The debris will be transported by: Name of Hauler: J&J Transport and/or Wright Builders Inc. Signature of Applicant: -�Oli Date: 11/1/202 The Commonwealth of Massachusetts + *g Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.gorldia Winters'Compensation Insurance Affidavit:BuildersiContractu&ElectririansTlundlers. TO BE FILED Will TILE PERMITTING AITIIORI l . -'4i hcaltt Ilifnrittatiew Pleat Print Lei'il►ly Name tliusitresvOrganitzatiowledieiduall: Wright Builders, Inc . Address: 48 Bates St. Northampton, MA 01060 413-586-8287 x101 C.ota'`State Zip: Phone#: art'Ann:n1 ciitlada6\rr t'lurk the aliprmprrale box: hype of project(required):. I.Q l am a einplo_a er rt ith 23 ernplc ei:s Clad)and or part-Bone)• 7. XO Nevv construction 2.0 I ant a'oh:perptram or putnemliip and Moe cur employ cv uorkirt_• lair me un $. Renlu,lc ltng any t:apaenty-Lou wurkers'comp.ucwuran.r: etquire-d.[ rJ 9. ❑Demolition 301 ant a lurmuuwnet adorn!all aurk 311:4 f.f'Au!w. .xs"cortga.noontime requiter:) 10 4.0 I ant a lumnavr'ne ma and v.nCl be picot.can :a:t .w to conduct all mock on run property. I a ill �Building addition en.�ure that all cc.nttreiurl either ha%e sett ent'cvampt-ruaeitrcat insurance or an:hole I I.Q Ele it ICU L reports or additions prupri:teas ugh no employee:, 12.0 Plumbing repairs or additions sin I am a cc:teral contractor anti I hate hired the sub-contractors listed un the attached sheet 13�Roof repairs these sub-contractor,.line employ er ees and ho workers'wimp.insurance.: 6.El We are a c-utputAiwa and it,.officers line cxnnvoed their right of exemption per MIA e_ 14_rx Other accessory 152.$1(1).and we laiee no.inpink'Ci71.[Nu wari insurance crt'camp-insance requincnL) s t r u c t ore 'Any applicant that checks but Fl must also fill out the suction below stowing their t utters'eompersaiotpthec information.. +Iknneuwners\A ho submit this atIlitan it itdnatireg they are doing all work and then hire outside contactors merit submit it new aftaglat it rurtiie.aim!such_ %C ontrctors that check this but must attached an adAtional sheet slowing the none of the sub-contacturs and star:whether or not tdurse entities Ease employees It the sub-ecmtraetu s lute cn5,kisaxs.they must protide illicit workers'comp-whey number- _ i ant an employer that is providing winters'compensation insurance for my employer& Below is the policy and job site in formation. Insurance Company Name: Phillips Insurance Agency, Inc. _ Policy or Self-ins_Lie_#: MCC-200-2000534-2021A Expiration Dare: 3/1/2023 lob Site Address: 30 Hawthorne Terrace city/state/zip:Northampton, MA 01060 Attach a copy of the workers'compensation policy declaration page(showing the policy Dumber and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable b)a tine up to S1.500.00 anddor one-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a tine 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 DIA for insurance coverage verification. I rho hereby c +under pains and penalties ofperjury that the information provided abort is true and correct. Stanature: late: 11/1/2 0 2 2 Puttee#: 413-586-8287 x 101 Ofcial use oak Do not write in this area,ID be completed by city or town official (its or Town: Permit/License 41 mioLeiher Issuing Authorit (circle one): 1.Board of Ilealth 2.Building Department 3.('itv.i roan Clerk 4.Electrical Inspector 5. Plumbing 6.Other Contact Person: Phone#: Commonwealth of Massachusetts ' Division of Occupational Licensure Board of Building Re ulations and Standards I ' Cons IonfS rvisor s CS-107908 pires:03116/2024 MATTHEW OpRADY A 744 MAIN STREET WILBRAHAM1AA 01095 =+ 1, a v $)Commissioner K. D[vnc6.ca.. l �....40 WRIGBUI-01 KAYLA '4�ORO CERTIFICATE OF LIABILITY INSURANCE DA2/28/2022 ' 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 Kayla Marie Drinkwine NAME: Phillips Insurance Agency,Inc. PHOE 97 Center Street (A/CNNo,Ext): (413)594-5984 FAX No):(413)592-8499 Chicopee,MA 01013 A DRIESS:kayla@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:EMC Insurance Companies 21415 INSURED INSURER B:Massachusetts Employers Insurance Company Wright Builders,Inc. INSURER C: 48 Bates Street INSURER D: Northampton,MA 01060 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYYI (MM/DD/YYYYI, A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 6D18616 3/1/2022 3/1/2023 DAMAGETORENTED 500,000 PREMISESlEaoccurrence! $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1'000'000 GENIIAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X JE LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: EMPLOYEE BENEFI $ 1,000,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Me accident) $ X ANY AUTO 6Z18616 3/1/2022 3/1/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOS ONLY AUTOS yy Ep BODILY INJURY(Per accident) $ AUR OS ONLY _ AUTOS ONNLY (Perr accciidentyAMAGE $ _- $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE 6J18616 3/1/2022 3/1/2023 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE ERH X MCC-200-2000534-2021A 3/1/2022 3/1/2023 500,000 ANY OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE N N/A _E.L.EACH ACCIDENT $ (Mandatory in NH) ' E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I 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 Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD