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29-574 (4) BP-2023-0093 188 OVERLOOK DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-574-001 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-2023-0093 PERMISSION IS HEREBY GRANTED TO: Project# 2ND FL RENO 2023 Contractor: License: Est. Cost: 41000 DANIEL THOUIN 061831 Const.Class: Exp.Date: 07/09/2023 Use Group: Owner: MECCA KRISTEN L &CHRISTINE L BRYSON Lot Size (sq.ft.) Zoning: WSP Applicant: DANIEL THOUIN Applicant Address Phone: Insurance: 137 TOB HILL RD (413)320-5296 SOLE PROPRIETOR WESTHAMPTON, MA 01027 ISSUED ON: 01/26/2023 TO PERFORM THE FOLLOWING WORK: ADD BEROOM AND BATH TO 2ND FLOOR 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: Fees Paid: $267.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner .---ettetce--- ka r) / ii. ,,,,,, � ' �" /" ;-.›-„.. ' u IL, The Commonwealth of Massachusetts qN 6 FOR j u Board of Building Regulations and Staniar (20 420 r0' Massachusetts State Building Code, 780 CMJL,,, ,MUNICIPALITY •,,./',,, / 'USE Building Permit Application To Construct,Repair,Renovate Or Deih..a / Revised Mar 2011 One-or Two-Family Dwelling'0-` °,;i�. This Section For Official Use Only Building Permit Number:bil9-? 3 q . Date Applied: l 4a3 Building Official(Print Name) ---:('11616C11\LSignature / SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers i8b Ovulook Dr. Flo,rtetu- 1.la Is this 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 El 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: krtskr% Math: + Gnris-h.nc. &Ito., F(vrGv ,c 1 MA 01042- . -- Name(Print City,State,ZIP 18e OVed Look 1(. A03)4z?-O051 Aso![kW ykm @ I. Cow► No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied/11, Repairs(s) 0 Alteration(s) Addition ❑ Demolition 0 Accessory Bldg.0 Number of Units Other 0 Spedfy: �/ Brief Description of Proposed Work': Adaf ft, l24.cp(rQ are-t,t- &141 v 2 + L0Z SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only (Labor and Materials) 1.Building $ -2 S�) 1. Building Permit Fee: $ Indicate how fee is determined: $ ❑Standard City/Town Application Fee 2.Electrical L 00 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ / 0) 6710 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No.A2)/ (Check Amount:tP CI? 6.Total Project Cost: $ GI/1 607), 0 Paid in Full ElOutstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C �+ — O/ J f p 3 I v 2_o ,co c 3 14 pc. ('>,(�` ill 0 t2 t License Number D Expiration Date Name of CSL Holder i r 1 J T O 10 ) r (� ( (\ I c�a List CSL Type(see below) V '1 No.and Street Type Description 1 li E U Unrestricted(Buildings up to 35,000 Cu.it) iJ�/�lJ e S I �-I-0C) � ,l M Ql O R Restricted 1&2 Family Dwelling City own,State,ZIP M Masonry n +_ II RC Roofing Covering Q/_ � Q 1�j41 IDv"�'CYI e�" WS Window and Siding w q3 —3a v (lX SF Solid Fuel Burning Appliances r C� C 461 e(D Y� I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) - g g i U b- 10 . 0 `,O, •f/-\�&y1 '�Il ho-t, \ HIC Registrations Number Expiration Date HIj o anyNarn or Incfg(tsant Na 1 � b c � 61 wd bJ�c� tre 61. . Cam, No.andStreet I Email address 1i3 ---h p--6 ii t MA '/13 --36 -5aq(e City/Town,State,ZIF I 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 V 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 pit r1/ei 1 Kp0l.' to act on my behalf, in all matters relative to work authorized by this building permit application. t 262-3 Prim er'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. XPrint Owner'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(HTC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HTC 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" The Commonwealth of Massachusetts Department of Industrial A ccidents /11. 1:w fi 1 Congress Street.Suite 100 'mnorBoston. MA 02114-2017 °++ ww►►:mass.govidia no:kers'Compensation Insurance Affidavit: Buildersl('ontractors/Electricians/Plumbers. '14)BE FILET)'.'lilt"tNE PER%III I I%(:At"1'llORt"l i. lnnlicant Information 1� Please Print Leeibl\ Name(BusincssiOrt aniratton Indis aduai l: .. exo i �1 \ '! U (\ Address: I 3 t> To I eoc,d, City,'State.'Zip: W e S-4-ti 6(4,,v) ±0 11 /14A•Phone#: 11 /3 -2 C' - `5 a re you an employer'!Cheek the appropriate bus: Type of project(require ): 1.0 I am a employer with enipkayee^r(full and or part•tiine).• 7. [3 New construction 2 fermi a sole proprietor or partnership and have no employees working for me in g. 0 Remodeling any capacity.(No workers'ct*np.insurance required.( I am a Iwnt.ownet doing all work myself.(No workers'comp.inverse reyuircd.t" 9. Deinolltictn 10 fl Building addition 4.0 1 am a turn om er and wall be htrmg contractors to conduct all work on my property_ I will errsurc that all contractor.either has workers'compensation insurance or are sole i 1a Electrical repairs or additions proprietors with nu employees" 12.0 Plumbing repairs or additions S0 I am a general contractor'and I have hind the wbctnrtracton listed on the attached sheet. lba w cub-ccnntrxlon have employees and have workers'comp.insurance. 13 Roof repairs 6.0 We an:a corporation and its oftieen hase.xa.iaed their right of exemption per 5k.t.c" 14.0Other 132.i 114,.and we have no employees.(to workers'comp.insurance required.) •Any applicant that cheeks but nI must also till out the section below showing their workers'conpa.matiun policy information. r llorncow nen who submit this affrdas it indicating they are doing all w oak and then bin outside contractors must au1 mat a new affidavit indacatiog ouch. Contractors that check this Ivv must attached an additional shod show in the mars,or ilic sob-coeara.Kors and state whaler or cut those entities'has. employees. lithe sub-contractors have employees.they must prosidc their workers'comp policy number I am an employer that is providing workers'compensation insurance for my employees. Below is the polio 7.and% site information. / f.A Insurance Company Name: /4 UeR rt ra /7 S 5 C J ed.-e > ._ C/ Policy#or Self-ins.Lie. : (3 ) ? 7 i SO d O Expiration Date: I — %S — a b a3 lob Site Address: I 1 O 6(/r 1 oo k 0r(v r rig e Citv State Zip: ofU 6. Attach a copy of the storkers'compensation policy declaration pag shossing the policy number and expiration date). Failure to secure coverage as required under MGL e. 152,*25A is a criminal violation punishable by a tine up to$ ,500.00 and-or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to /50.00 a dad against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for i trance coverage verification. I do hereby cert'y under th pain. and penalties of perjury that the information provided above is//true and correct Signature: dYj JG Date: Q/ -c7qbal.3 Phone: q./' , 3 iD 5 cl 6 Official use only. Do not write in this area.to be completed by city or town official ('its or Tots n: Permitll.icense# Issuing Authority (circle one): I.Board of Health 2.Building Department 3.('ityfi'ossit Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: ACORO® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 01/06/2023 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 Christina zzBarrett NAME: Aquadro&Associates PHONE (413)586-7373 FAX (413)584-0859 (A/C,No,Ext): (A/C,No): 355 Bridge St.,P.O.Box 357 E-MAIL christina@aquadroinsurance.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01061 INSURER A: Fidelity&Guaranty Insurance Co 35386 INSURED INSURER B: Daniel Thouin INSURER C: 137 Tob Hill Rd INSURER D: INSURER E: Westhampton MA 01027-9615 INSURER F: COVERAGES CERTIFICATE NUMBER: CL231610846 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 ADDLSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A BIP7R715020 12/15/2022 12/15/2023 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 PRO- 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OPAGG $ OTHER Hired/borrowed $ 1,000,000 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 OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 Kristen L.Mecca ACCORDANCE WITH THE POLICY PROVISIONS. 188 Overlook Drive AUTHORIZED REPRESENTATIVE Florence MA 01062 r f 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD City of Northampton oar M'r S:5'" Massachusetts ci 51 ( DEPARTMENT OF BUILDING INSPECTIONS 5. m �� 212 Main Street • Municipal Building v� Northampton, MA 01060 ssf t" 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: vi1 1 LeilZ -i'tjL1 i o ) The debris will be transported by: Name of Hauler: Signature of Applicant: g /A., �'--\• Date: / /2-1,7002„3 -„ Ir / ,. . • ' . ! , I . . 1 . _ 1 1 ........,.............fj •• „ ,.. _. ... .. . '..` 4...... , .. ...,4 , . - .... I im.,. ... ..: I ,„..m....- I) , 11'1 '''"-i . .., ' '• 1. 4'Ilk• -... 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