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31B-030 (4)
File #BP-2022-1450 APPLICANT/CONTACT PERSON:NU-WAY HOMES INC 10 WHITE AVE EAST LONGMEADOW, MA 01028(413)563-0085 PROPERTY LOCATION 43 SUMMER ST MAP:LOT 31B-030-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $75.00 Type of Construction: DEMO GARAGE 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: 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 Pe it from Elm Street Commission Permit DPW Storm Water Management emolition Delay ► ri i J1/69p)_ Sign:ture of Building Official ' I 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,Depar i i 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. 1 RECEIVI � _ i _ The Commonwealth of Mass4chus tts FOR „ 1 e Board of Building Regulations and St dal*v - 7 2022 M ICIPALITY Massachusetts State Building Code, 78 CMR _ USE Building Permit Application To Construct, Repaiir Reined Mar 2011 ' PT OF BUD 1 INSPECTIONS One- or Two-Family Dw4lli NOR THArv1II_PTION MA 01060 This Section For Official Use Only Building Permit Number: 6, �3- "I(1ST' Date Applied: BuildingOfficial(Print Name) Signature Date gn SECTION 1: SITE INFORMATION 1 1 Pro erty Address: 1.2 Assessors Map&Parcel Numbers y.3 Sc,..,,n,,r, S7 /.3 —030 00, 1.la Is this an accepted street?yes no Map Number Parcel Number 1.3 7�on ng Information: �C O 1.4 Property Dimensions: Zoning District Proposed41se 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 Owner'of Record: /U0--1tJ1 h New e.S .,ac-, rr4, 7- L to .27, es,dcrr - m ►4 C/6 Name(Print) �' City, State,ZIP /0 601.7,`Te five (Y'3)S-, 3 Fs" YUvG>M /-1 r5 t{0Vfripwz�� 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) ❑ Alteration(s) 0 Addition 0 Demolition X Accessory Bldg. ❑ Number of Units Other 0 Specify: Brief Description of Proposed Work2: 7-6 /p Z c 7-11-r G-6 Atye ear7'1,e _A` P -77'r /-,Qv3 p-r 4/3 &o.y.-✓• S77 / //I "-10-T ae, T i Li7 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost3 (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ 4 Check No.li'151 Check Amount: 17 Cash Amount: 6. Total Project Cost: $ ,..”l 060 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) i \.,,,} /'Vl 19'v License Number Expiration Date Name of CSL Holder List CSL Type(see below) /0 G 'I-/7? /We- No.and Street Description c w� Looi4iP,c6/J �� D/� i? Unrestricted(Buildings up to 35,000 Cu.ft.) R Restricted 1&2 Family Dwelling City/Town, State,ZlP M Masonry RC Roofing Covering WS Window and Siding (y 3 _5-6 �s wuw� SF Solid Fuel Burning Appliances � y,,,F c;6U e I Insulation Telephone Email address edrr D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number xpiration Date HIC Company Name or HIC ant Name No. and Street Email address City/ , 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: OWNE AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. 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. AJCS—ttli Print Own or Authorized Agent's Na lectronic Si nat ) ure / 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/ba Type of heating syste Number of dec porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton oa '4 Massachusetts mow? t.- • # A DEPARTMENT OF BUILDING INSPECTIONS - ' 212 Main Street • Municipal Building vh la1 Northampton, MA 01060 �skh 3>>�`} Fee Calculator for New Residential Construction ONLY Location : Square Footage Amount Basement @ .20 1ST Floor @ .50 2nd Floor @ .50 1/2 Floors, Finish Attic, Garage @ .20 Deck / Porches @ .20 Total : /* �'� City of Northampton Massachusetts 4? w . 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: i/ _L C C '17/_ 4/441/1(e The debris will be transported by: Name of Hauler: Signature of Applicant: Date: A v The Commonwealth of Massachusetts Department of Industrial Accidents MEW 7,1110= _:O= I Congress Street,Suite 100 NM= Boston, MA 02114-2017 lhiaw.mass.govidia -- V uikers"Compensation Insurance Affida'it:BuildersiContractorsiElectricians(Plumbers. 10 BE FILED WITH'11.11E PF:Rllrrl ING AUTHORITY. Applicant Information Please Print Legibly Name 4Business'Ctrganiiz" m atttonilnddualt (l-6{44 el Address: d i/ e _ may► �y� p �f�/J' L /►�/¢ Ja� City/StatefZip: ,I ` .. C 47O"Y!_ Phone#: �V'3) 3 -e5oY3 Are ear an a mpinyer!Cheek Ihe rpprapr ,= Type of project(required): t.©I am a ctrtpl L1r with entployoes(full and-ur part-time'." ?. 3 New':instruct' n 2 I am a suk pruprxuma or partnership and haw nu employees working tur nse m s. Remodeling airy capacity.[Nu workers'comp.tnatrrantt required.' -t�_...!I ant.a hunuc�cnnru-t&sine all work myself.[No in alias"comp.,rearm..regarnrd.t e-mu t ton 0 Building additio 4.[,I am a It i o—snet and will be hiring et Lr.w urs Eu conduct all work on my property. I will a_i ensure that all contractors either have wxml era'eu eruahurt insurance or an:sole I 1.0 Electrical repai air additions proprietors with nu employees. 12.0 Plumbing repai •or additions S I am a general contractor and I I©rc hired the sub-cuntraetors hailed un the;attached sheet. The sub contractors lerw+e employees and l e wurkera•e+map.insurance.; I Roof repairs 14.❑Other b. run and sib officers have exen iaied their right of a wntp/ion per NSA c. 1 y2¢lt4t.and w•e 11a4e nu engrluyeca.[Nu workers'cxmnp.insurance requirod.1 `Any applicant that diocks box=t must also fill um the section below showing their workers'compensation pulley information. ▪Homeowners who submit this affidavit indicating they are doing all work and Heed hire outside cunirreiors roust submit anew affidavit midi ailing such. teuntraetora than check this has rnuat attached an additional shoe'showing the name of the aatlra:untructates and state whether am nut house anti ies lta�w e mployees. if the sub-eurnractays lame c'npluraxs.t e mum poi+ide their workers'uwnp.policy nutnbs.r. I am an employer that is providing workers'compensation insurance for my employees Below is the policy d fob site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: CityStatei2ip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expi Dion date). Failure to secure coverage as required under MGL c_ 152,*25A is a criminal violation punishable by a tine up to$1.500.00 andlor one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a tine of up o$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA t`o insurance coverage v n. I do her- y certify n r t1 e writ an t Ili that the in formation provided above is true and tact Signature: / Date: // D 3/='-D Phone#: / 97 �y 3) - a , Official use only‘ Do not write in this urea.to be completed by city or t town official City or Town: PermitiLicense#! Issuing.luthhorii) Iiirclr one): 1. Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector ta,Other ( (intact Person: Phone#: City of Northampton 212 Main Street, Northampton, MA 101060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: 4-/ The debris will be transported by: e l r n' ,4' ucl(i The debris will be received by: Building permit number: Name of Permit Applicant Nu — L(,,1/y es �,G, // O3 ) O . Date Signa ure of Permit Applicant ACO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 07/28/2022 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 Paula Belisle NAME: Crimmins-Graveline Insurance PHONE N ,Ext1: (413)283-8378 FAX No): (413)283-2556 (Arc1382 Main Street E-MAIL pbelisle c ins.com ADDRESS: @ g P.O.Box 905 INSURER(S)AFFORDING COVERAGE NAIL ft Palmer MA 01069 INSURERA: James River Insurance Company 12203 INSURED INSURER B Nu-Way Homes Inc INSURER C: 10 White Avenue INSURER D: INSURER E: East Longmeadow MA 01028 INSURER F: COVERAGES CERTIFICATE NUMBER: 2022 GL 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_WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,DAMAGE TO RENTE 000.000 CLAIMS-MADE X OCCUR PREMISES(Ea occur ence) $ 100,000 MED EXP(Any one person) $ 5,000 A 000840844 08/06/2022 08/06/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2'000'000 POLICY PRO 2,000,000 JECT 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 LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTFi- AND EMPLOYERS'LIABILITY Y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: 18 Corticelli St Florence,MA 01062 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELI ERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. Building Department AUTHORIZED REPRESENTATIVE 212 Main Street Northampton MA 01060 VierG�� dWeL ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD