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31A-227 (3) BP-2023-0151 34 HARRISON AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31A-227-001 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-2023-0151 PERMISSION IS HEREBY GRANTED TO: Project# 2023 WINDOWS Contractor: License: Est. Cost: CHRISTOPHER JACOBS 60475 Const.Class: Exp.Date: 11/10/2024 Use Group: Owner: FORTGANG, SUSAN &NEHRING, DAVID M. Lot Size (sq.ft.) Zoning: URB Applicant: BARRON & JACOBS Applicant Address Phone: Insurance: 420 NORTH MAIN ST 413-586-8998 WMZ80080063652022A LEEDS, MA 01053 ISSUED ON: 02/09/2023 TO PERFORM THE FOLLOWING WORK: REPLACE 35 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: ."9 Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Buildinc Commissioner m The Commonwealth of Massachusetts wco Board of Building Regulations and Standards FOR' Massachusetts State Building Code, 780 CMR MUNICIPALITY co o USE o Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011 w One- or Two-Family Dwelling This Section For Official Use Only Building Permit Number:RP702- --0 5( Date Applied: 1/ vim J�o-5s /// Z-erZ6Z3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 'A /I sc /c1L, IA - Z -(7:31 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: -Q,.S.U)a-A S1/4r'1,--.4-trct- Pc.`). \O, s'? (o'> Zoning District Propos6d'Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) y C...1,.,A\,.l I v S fi Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided I 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 ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: S J Stiv. kQci\ IgYklcv--r"\p. - Mff t.1robo Name(Print) City,State,ZIP q 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 Work': 12-4- 16,c_e_. ADS h1�v\ck-A,w 5 wINA Jk-\-o.St-- New w ►i,\\ \a, M ai v\r. d eiv\&c,x nQ;r,),— +).v ,aiS , W c,V =Fo, ,1 c o - . 2P( (. 1.0, b1-t- i 6) .,tt-.0(--. . 2-1-L( sc--,N.Q - -- av•A .r� , SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ LA0 ti2'1 1. Building Permit Fee: $ (in;' Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ _ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees: $ Suppression) +u Check No.Z37-ZIP Check Amount:yD Cash Amount: 6. Total Project Cost: $ L'aI ZL`\ 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License (CSL) CS- 0( -1'D` l /ID ) y CAN \5 {Os,Q�.- Z�CA� License Number Expiration Date Name of CSL Holder1 List CSL Type(see below) LA2O N\CN‘r, St No.and Street Type Description 1 1 M� O 1�j� U Unrestricted(Buildings up to 35,000 Cu.ft.) 9-0 AS R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances Lik3'ST10- f ')K \rAo e_a,\N wrci,A,j,& .abs c I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1,izsk I Z71 B. w''�'r'SN-00$ /p\��',c^ \V(-' HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name t 1O N, \v‘`-It, ' - @J VV0,--av-4.``,,e`4D4/3S.,-, . No.and Street Email address 4,n*O V'SI) 13-S Sl°1c e 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 pro • e this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes IP 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 2VV0— k 7 %bS to act on my behalf,in all matters relative to work authorizedby this building permit application. Srw L1�� tvrae-Mv.�i- el• 1\/' b Print Owner's Name(Eleciconic 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 apQ' is true and accurate to the best of my knowledge and understanding. 1/1, �� ( (z3 Print Owner's or Authgent'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 four.d 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" SIGNATURES By signing below,you agree to items A,B and C. DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES. A. Alternative Dispute Settlement(Arbitration Clause):The Seller and the Buyer hereby mutually agree,in ad nce,that in the event of a dispute concerning this Agreement,the parties shall submit such dispute to a professional,state-a proved arbitration service(cost, if any,to be paid by the submitter)prior to either party proceeding to legal action in th courts. y signinglitfrigreement,you,as the owner of record.are hereby authorizing Barron&Jat;ini§'AsSodifes c.to act r as your authorized agent in all matters pertaining to the building permit application C. This is a binding Agreement. You may not cancel it except as stated. This Agreement covers and supersede. all conversations,statements and agreements,expressed or implied,between the parties,their agents or representati es. You,the Buyer,may cancel this transaction Buyer Date at any time prior to midnight of the third 74 business day after the date of this transaction. See the attached notice of cancellation form Buyer Date for an explanation of this right. Seller retains an equal right to cancel. 49/1s-k_5 Barr &Jacobs Repres tive Date Contact Information Office Manager: Sandy Scavotto Office:413-586-8998,x102 111 Chris Jacobs, President CT HIS#0554397 Cell phone:413-250-6677 Office phone ext: 100 Home phone:413-665-9113 O Iesha Gomillion,Senior Designer Cell phone:413-923-7003 Office phone ext: 104 MA Construction Supervisor License 060475 MA Home Improvement Contractor 100809 CT Home Improvement Contractor 518617 Purchase Agreement Page 11 of 11 THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs.and Business Regulation 1000 Washingtgt:feet- Suite 710 Boston,Massachusetts 02118 Home Improvement Contractor Registration Tyne Cbrporanon Registration 100809 i3ARRON&JACO8S A.MOCIATES INC Expiation 06/222024 420 NORTH MAIN STREET LEER^.., MA 01053 Update Address and Return Card THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs A Business Regulation Registration wad for individual use only before the HOME III CO Mai 1 NTRACTOR expiration dole. 0 Sound return to: TYPE:G.y.�CO axon office of Consumer Marrs and Business Regulation Rldist ad 1000 Nestling Ion Street -Stine 710 100100d Boston,MA 021 lb BARRON&JACOBS ASSOCBATE5.INC, CMR1ST EA 1 6_^0 NORTH MAIN.;T'REET LEEDS.MA 01053 Underxcretary Not valid signature Commonwealth of Massachusetts Division of Occupational Licensure 1111 Board of Building Regulations and Standards ConstkOdkg Vit,tvisor CS-060475 t _ wires: 11/1p 024 CHRISTOPHR R 420 NORTH holm j j° LEEDS MA O''1953k, ?YOt.Lvdsl,0 e, �. S&ice The Commonwealth of Massachusetts Department of Industrial Accidents m~ ' 1 Congress Street,Suite 100 IlifBoston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lggibly Name (Business/Organization/Individual): ?OY(The. Gk.-.et 'Srk(x,1')5 5;V_,,,p, �' Address: -kw Nv�k GUI ct . City/State/Zip: 1�J2-e-- S INA 1\--- U\o 5 Phone#: ►--j 1 ID-S TL. - Xc--1. 1 g Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with ,D employees(full and/or part-time).' 7, New construction 2.0 I am a sole proprietor or partnership and have no employees working forme in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 30 I am a homeowner doing all work myself.[No workers'comp.insurance required.]r 4. Q Demolition 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 50 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.' 6.❑We are a co tion and its officers have exercised their ri t of exe 14• Ti!!OtherN W �{fie t,/�iL,-›' tpora gh rnption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: a 1 N\ M v e` Policy#or Self-ins.Lic.#: V•iW\1>V)(o73(o`<j 1-0ti1-_A' Expiration Date: -I t I 2--02-' Job Site Address: 9)3\ c'\GW— A4e- City/State/Zip: D('k : o !WC V3to Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 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 do hereby certify under the p ' and penalties of perjury that the information provided above is true and correct. Signature: / Date: I (n I 7.--3 Phone#: -11-77 - S %- sd(°1 61 5‘ Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# , Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector . 6.Other Contact Person: Phone#: 1 Ago CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYYI kia..../ 03/03/2022 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 Adina Edgett,CISR Webber&Grinnell PHO,N o EMI (413)586-0111 {A/CNo): (413)586-6481 8 North King Street E-MAIL aedgett©webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC I Northampton MA 01060 INSURER A: Main Street Amerlca/MSA 29939 INSURED INSURER B: NGM/MSA Barron&Jacobs Assoc.Inc. INSURER C: A.I.M Mutual/A.I.M. 33758 420 N Main Street INSURER D: INSURER E: I eeds MA 01053 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 03/23 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYIPERIOD 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 SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD wVD POLICY NUMBER (MWDD/YYYY) (MM/DD/YYYY) WITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 MAGE CLAIMS-MADE X OCCUR PREM SESO(Ea occuErrenceL $ 500,000 MED EXP(Any one person) S 10,000 A MPT8049D 03/09/2022 03/09/2023 PERSONAL SAOVINJURY $ 1,000.000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 3,000,000 POLICY PRO 3,000.000 JECT LOC PRODUCTS-COMP/OP ACIG S OTHER EPLI S 10,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 $ (Ea accident) ANY AUTO BODILY INJURY(Per person) S 1,000,000 B OWNED X SCHEDULED M1T8049D 03/09/2022 03/09/2023 BODILY INJURY(Per acadent) S AUTOS ONLY AUTOS X HIRED �/ NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY (Per accident) Medical payments S 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE S — B EXCESS LIAR ^ CLAIMS-MADE CUT8049D 03/09/2022 03/09/2023 AGGREGATE $ DED X RETENTIONS 10,000 $ �IIS COMPENSATION PER OTH- [IMp Y 1 NA STATUTE ER LOYERS'LIABILITY I 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE I- E.L.EACH ACCIDENT S C OFFICER/MEMBER EXCLUDED') 1 N 1 N/A 80080063652022A 03/01/2022 03101/202‘ (Mandatory in NH) E L.DISEASE-EA EMPLOYEE S 500,000 If yes descnbe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS 1 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 11 il-.. .,J- 11 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit # was issued with the condition that all debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L c. 111, s. 150A. The debris will be disposed of in: c;k,\ 12c�c,1� Name of Waste acility Address of Waste Facility 111.5 Debris: As a condition of issuing a permit for the demolition, renovation, rehabilitation or other alteration of a building or structure, M.G.L. c. 40 s. 54 requires that the debris resulting therefrom shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L.c. 111 s. 150 A.Signature of the permit applicant, date and number of the building permit to be issued shall be indicated on a form provided by the Building Department and attached to the office copy of the building permit retained by the Building Department. If the debris will not be disposed of as indicated, the holder of the permit shall notify the building official, in writing,as to the location where the debris will be disposed. 780 CMR—6th Edition Signature of Permit Applicant Date