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18C-057 (5) BP-2023-0070 142 PROSPECT AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 18C-057-001 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-2023-0070 PERMISSION IS HEREBY GRANTED TO: Project# STAIRS 2023 Contractor: License: Est. Cost: 5700 PIONEER LANDSCAPES INC CS-082616 Const.Class: Exp.Date: 09/06/2024 Use Group: Owner: CZELUSNIAK JAY R Lot Size (sq.ft.) Zoning: URB Applicant: PIONEER LANDSCAPES INC Applicant Address Phone: Insurance: 223 Cardinal Way (413)539-3685 0 UB1T874617 FLORENCE, MA 01062 ISSUED ON: 01/23/2023 TO PERFORM THE FOLLOWING WORK: RECOVER EXISTING STAIRS 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: outtLi lI Fees Paid: $130.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner '/ J� �N4 The Commonwealth of Massachus t9c. 9 Board of Building Regulations and Stand' <'O - FOR Massachusetts State Building Code, 780 CIVi�'�, MUNICIPALITY USE Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling 's;, This Section For Official Use Only Building Permit Number: go._.3• 70 Date Applied: .: i sp ,bo . .. • 1/ , aa Building Official(Print Name) I Signature i Da SECTION 1:SITE INFORMATION 1.1Property-Address:�Js 'AUQ 1.2 Asieigrs Map&Parcel Num�e 1 1.1 a Is this an accepted st of et?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 ElPrivate 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: ��1 TA^t Czgk)SIN�k K /UcrT rwIto 111 F 0 40 Namv(Print) City,State,ZIP lit - RA-0 ,:.4- -, 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. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: ecv.er ,Qy St o.r5 • SECTION 4:ESTIMATED CONSTRUCTION COSTS 1 I Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ /�� 4.Mechanical (HVAC) $ List: (Old,aD x, , 5.Mechanical (Fire Suppression) $ Total •All Fee : $ JCS•c'u Check No. l � iiheck Amount: Cash Amount: 6.Total Project Cost: $ S 7()C)7 0 Paid in Full 0 Outstanding Balance Due: City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS frb 212 Main Street • Municipal Building ~f, Northampton, MA 01060 { 'i? PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW 1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES, FENCES, GROUND MOUNTED SOLAR, ETC. I. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work. (Digital and hard copy) 3. Site plan with location of proposed structure(s) and set backs. 4. Construction Debris Affidavit filled out and signed by applicant. 5. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate (new/ replacement windows). 8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable). 9. Note any Conservation and/or special permit requirements (if applicable). 10. Driveway Permit (if applicable). 11. Proof of Water and Sewer entry fees paid (if applicable). 12. Trench Permit - public land by DPW/ private land by Building Dept. 13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit application before issuance of permit. 14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. I SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) e S„dg NI, — t -1& C. d't II I License Number Expirati n Date Name of CSL Holder ,}�-3 C,n,�d List CSL Type(see below) ,c ��AA W��No.and Street Type Description V` N/1 A 0 0 U Unrestricted(Buildings up to 35,000 cu.fl.) KK`-ev1G� 1' ( �—` R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding �11�6� SF Solid Fuel Burning Appliances '1 3— �/a,n�p.vr.eCr1 .OMI Insulation Telephone !Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Jri Sy I /r t /iq HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name br)a-CJ o.o'.ie2 C No.and Street Email address 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 0 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 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 ent- '•: • y name below,I hereby attest under the pains and penalties of perjury that all of the information lio ` • .plication is true and accurate to the best of my knowledge and understanding. t AO 1/1 1 Pri V • •er'- uthorized Agent's Name(Electronic Signature) AT ae 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/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 SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE r City of Northampton Massachusetts /41 Via- �j3 DEPARTMENT OF BUILDING INSPECTIONS ? ! r✓,'. ,. ., 212 Main Street • Municipal Building r, Northampton, MA 01060 �s"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: V,4 -1(e7 ec c-1-e- The debris will be transported by: Name of Hauler: Signature of Applicant: • Date: — The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114,01 7 wwnmuss Compensation Insurance Affidavit:BulidersiContrartorsiElectriciansl'Plumbers. l'O BE FILED W1111'111E AC1110B11'1. Applicant Information Please Print Let Name 41:tusiness,-OrganizationIndivicivali:, • Address: CityiStatelZip.: Phone _. . Axe!mu an employer!Check the apprupdate hoc I Type of project(required), sin a employ's with ,mnpiorsys trial=dor part-titnt 7 El New construction 21:3 I am a sale proprietor in parinerahip and bave no employem` tor me in 8„ 'emodeling airy t-apacay„INO workers tonna.tnattrance resporcs1.] 9. Demolition ant a hornooss net doin8 all*ink myself.[No*inters'ion ' arsurance retina-ed.] I CI Building addition 4.CD lam a homeowner and 1.111.1 hiring t.s.antractors canaltict all work on tiny property, I will ensure that all contractor%either haw workers'ciporkasatrin insuranix or are sole II 0 Elt..-ctrical repairs or addititms proprietors*ith no employees. 2.0 Plumbing repairs or additions $C3 I ant a Lament.'contractor and I base hired the sula-cuntrattiats Listed on die attached;beet. 13 Roof repairs These Aib-ollitiaciors ltast!employee*ana hart*inters'comp.insumuce.;.' 14,r:10/her 6.0 we arc a Lsorpinatuan and its officers have Viatised their nght exesriMiust MC&l% I$2,§I 3.and'AV h...11,cnui.ntaplu>as.[No workers"cony.'marmite requisett.1 °Any applatto that checks box is most attarUl OW the%in:lion/tam showing their workera'eornperwation pla trtl'inmation, t Hoineowners who%anent this affidavit'ilia:maw they are doing all work and then hire outside centimeters MUM submit a new alfidmit trathcabnguh IContractora dal chmt thzs.box mmit attached an mishourtal sheet showing the name of the sub-contractors and Ante Whether tst not there ottstievii.v“: einpluyees. If the sub-contractors haw etplo.yets...they nni41 prOVD.le their Atttkas' tup. raxibel l am an employer that Is prorldihg workers'compensation insurance fOr'IV employees. Below is the policy and job site injOrmation. Insurance Company Name: Policy or Self-ins.Lie,#: Expiration Date: Job Site Address: CityStateiZip: Attach a copy of the Is orkers'compensation policy declaration page Ishowing the policy number and expiration date). Failure to secure coverage as required under MOL.e. 152. §25A is a criminal violation punishable by a fine up to SI,5001)0 anti 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 cif this statement may be forwarded to the Office of Investigations of the DIA for insurance coveraue Neritication. I der herd), Trlity A er pains ad penalties of perjury that the information provided above is true and correct. Datc. Signature: Phone : IA Official use only. Da not write in this area,to be completed by thy or town official City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2.Building Department 3.f'itytToun Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other ('(ontact Person: Phone 4: AC CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 3/28/2022 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 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 The Dowd Agencies, LLC PHONE Rebecca J.Kubosiak,CIC, CISR FAX 14 Bobala Road _(A/c.No.Exti:413-437-1019 (A/c,NA):413-437-1419 Holyoke MA 01040 ADDRESS: rkubosiak@dowd.com PRODUCER PIONLAN-01 _CUSTOMER ID#:_ INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:Travelers Casualty Insurance Company of America 19046 Pioneer Landscapes, Inc. INSURER B:Charter Oak Fire Insurance Company 25615 15 Industrial Parkway Easthampton MA 01027 INSURER C:Travelers Property Casualty Company of America 25674 INSURER D:Travelers Indemnity Company of Connecticut 25682 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1687075500 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. LTR TYPE OF INSURANCE N W SR SVD POLICY NUMBER POLICY EFF POLICY EXP/Y(MM/DDYY1n (MM/DD/YYYY) LIMITS B GENERAL LIABILITY 6807K306848 3/15/2022 3/15/2023 EACH OCCURRENCE $1,000,000 TX COMMERCIAL GENERAL LIABILITY PR PREEMIMI ESESS(Ea RENTED occurrence) $300,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 PERSONAL 8,ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PEof LOC $ A AUTOMOBILE LIABILITY BA8L940392 3/15/2022 3/15/2023 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $20,000 ALL OWNED AUTOS - -- - BODILY INJURY(Per accident) $40,000 X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS $ C X UMBRELLA LIAB X OCCUR CUP7K353420 3/15/2022 3/15/2023 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DEDUCTIBLE $ X ` RETENTION $5.000 $ D WORKERS COMPENSATION UB1T874617 3/15/2022 3/15/2023 X WC LIMITSU- OTH- AND EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETOR/PARTNER/EXECUTIVE n E.L.EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000.000 B Herbicide/Pesticide 6807K306848 3/15/2022 3/15/2023 1,000,000 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,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. Proof of Insurance Only AUTHORIZED REPRESENTATIVE Y4tk, ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD