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38B-102 (4)
BP-2022-1469 148 SOUTH ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-102-001 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-2022-1469 PERMISSION IS HEREBY GRANTED TO: Project# WINDOWS Contractor: License: Est. Cost: 22486 STEVEN HIOU 103080 Const.Class: Exp.Date: 01/27/2023 Use Group: Owner: BETTY ALLEN CHAPTER DAR Lot Size (sq.ft.) Zoning: URB Applicant: SHORE LOCK HOMES LLC Applicant Address Phone: Insurance: 2 PUMPKIN PINE RD (617)699-2006 6HUBOG21140A21 NATICK, MA 01760 ISSUED ON: 11/15/2022 TO PERFORM THE FOLLOWING WORK: INSTALL 31 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: ` ). . 3'1'� .. • .>2 I � Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner / / ....'..11 . N �Y\ti The Commonwealth of Massachusetts FOR • Of/ Board of Building Regulations and Standards lV ii. 10 20 M�(ssacl;usetts State Building Code,780 CMR MUNICIPALITY '7-,()F��,, a uilding rmi `Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 '• n/,v �� One-or Two-Family Dwelling "� s, ,.114�r e7•1--:.. This Section For Official Use Only Building Permit Number: 69' 3•l• /4(i 9 Date Applied: 4s-5 /7/'/G ll-/zJ-2-0Zz Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Pro pidr � 1.3jsgssors Map&Parcel Number s ura_"v 1.1 a fs tis an accepted street?yes 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.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 dyed] SECTION 2: PROPERTY OWNERSHIP' wnerl of Recor/5e_ ssely1.7 r 1`66.fa Name(Print) City,State,ZIP //e. 5o' ' S j.--- 9"3 - 302o- 75 74 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied Repairs(s) 0 Alteration(s) 0 Addition` � 0 J Demolition 0 Accessory Bldg. 0 Number ofof Units Other Specify: 3/ it 7 /Vial+a1,eG�' Brief Description of ProposedWo ,l� 61.11/ / S v A'4 S374 ,,, r.-,.freir 7 � �� ' SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ jg ��G 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 $ Total All Fees: Suppression) / Check No.sigraCheck Amount: 6.Total Project Cost: $ Z 21 04D 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor 'ce se(CSL) /O30 f) 17, So Z. Q (.� License Number iration D Name of C Holder , "C_. V le/71 /� A List CSL Type(see below) No.and Street �/ �/[6 Type Description U Unrestricted(Buildings up to 35,000 Cu.ft.) ,/7 R Restricted 1&2 Family Dwelling City/Town,S ,Z M Masonry RC Roofing Covering .44.4't_, WS Window and Siding 9/��i 2iy� Q �'+ r4/47;., SF Solid Fuel Burning Appliances /f7�rJ�`1'�✓/� CJ4 a- lif� IInsulationTelephone Email addressj, D Demolition 5.2 isteredd Ho a Improyeme ontractor / " " / 8 /* G-O Ct` �� C Registration Number / Expir ion Date �f" L11.5 Co y/-a or C Rehp ih_gi `t Name`AL1. Vitl�LGrK/ No)rfeet i r , A4051.- 4/7G0 6/7 ,-26 6 Email s City/Town,State,LI1r 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 0 No SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTO APPLIES FOR BUILDINu'G PERMIT I,as Owner of the subject property,hereby authoriz�0.F6-1 Gt h S I L' to a2h'xce my behalf,in all matt elative to wor authorized by this building permit application. . l� `l i 202z Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest er the pains and penalties of perjury that all of the information contained in this a lineation is true and ate to the best of my knowledge and understanding. - -e{ socJ a //' / 2 0 - Print Owner's or Authorized Agent's a(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 half7baths 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 11/6 The Commonwealth of Massachusetts Department of Industrial Accidents _ex. 1 Congress Street.Suite 100 ilil Boston. MA 02114-2017 - www mass.gov/dirt 1l Ill ker,' ('otnpcnsation Insurance AfTidavit:Builder. ( untrrctors/Ekctricians Plumbers. 10 Bk.FILED N I I Il II HE PERMIT!ICI;Ai'l'HOKI I . Applicant Information �f x�/// Pleasee Print Lei:ibis Nat1le(Hl tr. ,.ilr>ana7rtt.rnlnkft��clu311 1�- �jd j/ �/�Ll�� _f- �i�__ _ .._._.__ ...c2 r/r 4 ,,'j? ,,,- /2£�� City/State/Zip: 4%' _ j Phone#: Cy/ 2- e 22 c� ., Are yew w employe!?l heck the appropriate T,iw of project(required): la I am a employer with _ employees troll and or part•Umel' 7. CI New construction 2.0 lain a sole propoom or pannershap and has a no eniploy on w iikin Fur rise in S. 0 Remodeling any capacity.[No workers'comp.utwuran« requrn i I 9. 0 Demolition 30 I am a homeowner doing all work myself.[No workers'comp insurance mourned.) i 0 Q Building addition 4.0 I am a hunaeuw nes and w ill be hiring amtrac1urs to conduct all w irk on my property. I will ensure that all contractors either hase workers'conspensatunt unumnee fix air sole i I.fJ Electrical repairs or additions newt,with no cmployers- 5 am a general contractor and I has c hired the sub-contractors listed on the au/saved died174. i 3.3 Roof repairs v Tliesr sub-c.mtsar ours base rmpluvecs and Katie*matte comp.uuuran 12.0 Plumbing repairs or additions e.% / „/�� _/`� 60 w,a a corporation and its officers have eiaaed their right of exemption per MU c. 14 Ihet �< G(/k t!/Q S are rp we- 152.,1441..and use hase no employees.[No workers'camp.Mailroom required.! (/ •Any applicant that checks box c 1 must also till out the section below showing dreir workers'compensation pullet information. 'Homeowners tiers who submit this aromas it indnating they are doing all work and then hire outside cuastraeiotl lust submit a new affrdas it indicating such. :Contractors that cheek this box must attached an addiuirnal sheet showing the name of the sutr-cuuraet rxand state whether in not those entities hase employees It the sub-cumtrsetots Fa.,c a:tpluyee+.the'. must pit,.ide thee workx&s'comp.polies.umhar /am an employer that is providing wurAers'compensation insurance for my employees. Below is the policy and jab site information. Insurance Company Name: ,' CC.,.© / - � v/oe1 l..e_ 7 _____ Policy#or Self-ins.Lic.#: ad er 4(12�! V�/71_.__ Expiration Date: �/ !U 2 Job Site Address: L' �/ — 4°1i7�i( city.StateiZipo "`&.401•0,4 .t 4' . Attach a copy of the workers'compensation policy declaration page(showing the policy flambee said expiratio6 date). Failure to secure coverage as required under MGL c. I52,§25A is a criminal violation punishable by a tine up to S 1.500.(x) and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine 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. /do hereby certify un r I pains and perta o ' thee the lnformatian provided above is rue a correct. Signature:_ �J :g l/ 1):i1� /( 2-- ?a ZZ- Phone r /,: ' e 7 2/3 Official ial use only. Do not write in this area.to be completed by city or town official ( its or lawn: Permit/License* Issuing.tuthorits (circle one): I. Board of Health 2.Building Department 3.CO Jossn Clerk 4. Electrical Inspector 5. Plumbing Inspector G.Other Contact Person: Phone*: City of Northampton 4'". Massachusetts ,<, - .irs'e . N *.Y s � 1 '.tt.' DEPARTMENT OF BUILDING INSPECTIONS ti li .d.�r '�:,rr 212 Main Street • Municipal Building IgiJ� `ate tea+ Northampton, MA 01060 :NA,r. 0.. 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: / ,�Z sU‘ ,e' 7Pidd) g i2 ‘ 6/ OLocation of Facility. , !� The debris will be transported by: Name of Hauler: 1,Z S ‘.4‘1.:1- 4 _., Signature of Applicant: /W'gebiSI?) Date: !` 22.____ THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card 197821 SHORE LOCK HOMES LLC Re 2 PUMPKIN PINE ROAD pration:Expiration: 0 01/28/1/28/ 2024 NATICK, MA 01760 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Supplement Card Office of Consumer Affairs and Business Regulation Regigjtion Expiration 1000 Washington Street -Suite 710 197821 01/28/2024 Boston, MA 02118 SHORE LOCK HOMES LLC STEVEN HIOU 2 PUMPKIN PINE ROAD a• NATICK,MA 01760 Undersecretary Not valid without signature Construction Supervisor Commonwealth of Massachusetts 110 Division of Professional Licensure Unrestricted -Buildings of any use group which contain less than 35,000 cubic feet (991 cubic meters) of enclosed Board of Building Regulations and Standards space. C o nstruCtiOnSttpe ry i sor • CS-103080 Expires:01/27/2023 STEVEN C HIOU • 2 NEPTUNE ROA0f140 EAST BOSTON,MA 02128 'I. l�af�ti.itt� Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. �/� For information about this license Commissioner •• K. D4+1tJ4r0. Call(617)727-3200 or visit www.mass.govldpl AC R a CERTIFICATE OF LIABILITY INSURANCE DATE(MM!DDIYYYY) 3/30/2022 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 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 NAME CI Certificate Department oAX A-Costa Insurance Agency Inc (((@A-A/C!�IL No,Ext): 508-875-3488 (Aa c,No): 508-875-9388 1 Franklin Cmns ADDRESS: colcya-castains.com INSURER(S)AFFORDING COVERAGE NAIL# Framingham MA 01702 INSURER A: Evanston Ins Co 35378 INSURED INSURER B SHORE LOCK HOMES LLC INSURER C: 2 PUMPKIN PINE RD INSURER D: INSURER E: NATICK 01760 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. 1F TYPE OF INSURANCE AUUL'SOBR POLICY EH- POLA.Y EXP LTR 7 W LIMITS INSD VD POLICY NUMBER (MMIDDIYYYY) IMM/DDIVYYY)_ X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000.000 UA4.7AUt ro REN I tU CLAIMS,MADE X OCCUR PREMISES(Ea occurrence) $ 50,000 MED EXP(Anyone person) $ 1.000 A 2086944 3/30/2022 3/30/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000.000 X POLICY JET LOC PRODUCTS-COMP/OP AGG $ 1,000.000 OTHER: _ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ — ALL OWNED —SCHEDULED BODILY INJURY(Per accident) $ _ AUTOS AUTOS NON OWNED -FROPERTY-Dhx1A-GE HIRED AUTOS J AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S _ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED l I RETENTION$ S WORKERS COMPENSATION PER 0tH- AND EMPLOYERS LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N l A EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? J (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS 1 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Al /� ® DATE((A1N2022 l� l,.r CERTIFICATE OF LIABILITY INSURANCE oa/a4/zo2z 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 REPRESENTATLVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,sublect 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 Sara Reis AX -J&B INSURANCE AGENCY INC DBA ROCCO ROSE INSURANCE AGENCY f(C No,4�1i (508)584-71OD (NC No}: EMAIL ADDRESS: Sara QPrOCCOToSe.COm 360 Oak Street INSURER(s)AFFORDING COVERAGE NA1Ctt BROCKTON MA 02301 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURERS: SANCHEZ MICHAEL INSURERC: / DBA SANCHF7 ROOFING CONTRACTING INSURER b: 52 ELLIS ST APT 3 INSURER e: BROCKTON MA 02301 INSURERF: COVERAGES CERTIFICATE NUMBER: 756387 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. I EXP LTR TYPE OF INSURANCE Ii wvp POLICYNUMEER (MEIIDD1 YYY) (F MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S I CLAIMS-MADE I OCCUR ' PREMS�Eaoc 1rr nre S MEDEXP(Any one person) $ N/A PERSONAL&ALA/INJURY S GEN'L AGGREGATE OMIT APPLIES P ER: GENERAL AGGREGATE 5 iPOUCY—1 JECTT Lou PRODUCTS-COMP/OPAGG S OTHER: 5 HAUTOMOBILELIABILfTY COAtBINEDSINGLEUNIT $ (Ea accident) ' BODILYINJURY(Perpecson) S ALL OWNED SCHEDULED N/A BODILY INJURY(Per accidanl) S PROPERTY DAMAGE AUTOS AUTOS HIRED AUTOS AUTOS NON-OWNED (Par accident) $ $ UMBRELLA!JAB 4 OCCUR EACH OCCURRENCE S EXCESSLIAB CLAIMS-MADE N/A AGGREGATE S DED _RETENTIONS S WORKERS COMPENSATION _ X WRITE 0RH- AND EMPLOYERS'LIABILITY A OFFICRER!AMEMBEREICLUDEEo?EC � NIA NIA NIA 6HUBOG21140A21 08/04/2022 08/04/2023 EL EACH ACCIOfM S 100,000 (tCandataryInNH) EL DISEASE-EA EMPLOYEES 100.000_ !fyes,dcscnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 • N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(A CORO 101,Addition al Rem arks Schedule,may ba attached if mom r5pa ce is required) Workers'Compensation benefits will be paid to Massachusetts employees only-Pursuant to Endorsement WC 20 03 06 B.no authorization is given to pay claims for benefits to employees in states other than Massachuselts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on Ihu date that this certificate was issued(unless the expiration date on the above policy precedes the Issue date of this certificate of Insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/1wdfworkers-compensationlinvestigatlons/. Sole proprietor has not elected coverage. I CERTIFICATE HOLDER CANCELLATION , , SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN • ACCORDANCE WITH THE POLICY PROVISIONS. ALMiORIZED REPRESENTATIVE D.__ CS I Daniel M.Cro ,I ey,CPCU,Vice President—Residual Market—WCRIBMA O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD dame and logo are registered marks of ACORD