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24A-124 (7) BP 023-0121 5 CALVIN TERR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24A-124-001 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-2023-0121 PERMISSION IS HEREBY GRANTED TO: Project# ADD BATH 2023 Contractor: License: Est. Cost: 31000 Alexander Lane 1 1741 1 Const.Class: Exp.Date: 05/04/2026 Use Group: Owner: MILLER POLLIN ROBERT N& SIGRI Lot Size (sq.ft.) Zoning: URA Applicant: ALEXANDER LANE Applicant Address Phone: Insurance: 57 Prospect Ave. 9174704122 6562ub-ow34856 NORTHAMPTON, MA 01060 ISSUED ON: 02/13/2023 TO PERFORM THE FOLLOWING WORK: ADD BATII 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 VIO ATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 1 7)13, Fees Paid: $202.00 212 Maui Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner The Commonwealth of Massachusetts -- Board of Building Regulations and Standards r O MUNICIPALITY Massachusetts State Building Code, 780 CMR F t b - .� ? USE Building Permit Application To Construct, Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling , .,- -- n This Section For Official Use Only Building Permit Number: j0' --A 3-/ -/ Date Applied: k 1 (14su-",5 ��� -Z 2-'13-ZOZ3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1 1 Property Address: 1.2 Assessors Map&Parcel Numbers 6,I w t"-TerVikz e.,r4a .ytai P4 o tObO e)--1 A 1)-9 1.1a Is this an accepted street?yes no Map Number Parcel Number .3 ning,informatiga „c 1.4 Property Dimensions: I l° \�(� b oning District Proposed Use Lot AreaL(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: Zone: _ Outside Flood Zone? Public Private❑ Check if yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' ( 1`Ow r'of Re ord• { ( ` r \L )th} ���� �i^t 1``�\����1'�� N OV r tf� 11 A t IO�Ol7 Name(Print) \ J City,State,ZIP JJJ $ C-oiV'v. Tecr..t.c `(13 -3`kq- tti . s tivAerp e nu;` .can No.and Street Telephone m d ess SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) Er Addition ❑ Demolition I2 Accessory Bldg. 0 Number of Units \Other 0 Specify: Brief Description of Proposed Work': v..sk4Lk o„, nk- a NA S..L 0.^ )4 -I nor. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ ,pl D o 0 1. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2. Electrical $ a' DOD 0 Total Project Costa (Item 6)x multiplier x 3. Plumbing $ y p00 2. Other Fees: $ 4. Mechanical (HVAC) $ 5 cyr List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No.14j0 I Check Amo : l 0 6. Total Project Cost: $ 31 t ?`==> ❑Paid in Full 0 Outstanding Balance Due: a PEAR, LLC ❑ 1688 Meridian Ave.,Suite 301,Miami Beach,FL 33139 T. 305 479 2300 ❑ 4701 Willard Ave.,Suite 221,Chevy Chase,MD20815 T. 301 718 2243 ❑ Gordon Hall,418 N.Pleasant St.,Amherst,MA 01002 T. 413 345 2650 www.pear-energy.com SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 6. r 117 Lill S A\e's I/�' �'&& License Number Expiratio Date Name of CSL Holder ..5-n DC9.TQii A _ List CSL Type(see below) v No.and Street rTv'`• Type Description N+ `^�4 Tt _ _ _ �v. C7 4N o`0(0D U Unrestricted(Buildings up to 35,000 cu.ft.) ,� ' / R Restricted 1&2 Family Dwelling City/Town,State,ZIW M Masonry RC Roofing Covering WS Window and Siding 1 SF Solid Fuel Burning Appliances 1t7•T1°'4)3-4)- AL(.Z` rt1 ar rjs.i1•Co) I Insulation Telephone Emai ad ess D Demolition 5.2 Registered Home Improvement Contractor(HIC) G 6 69 4k( it i b.-) 'N-Q' HIC Registration Number Expiration Date HIC Cotlpany Name or HIC Registrant Name 5-`1 l'roSN I�� Cr AL ,re_carl rzo.;l ,ca.n N`�.and S reet aT 6� 0 kofoo ct��,�r1 O`(f(a 4 Email ess N City/Town,Sta e,ZIP Telephonep 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 Issuannce of the building permit. Signed Affidavit Attached? Yes I3 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 4\.C?CI.�C(�' Lc...6,c to act on my behalf,in all matters relative to work authorized by this building permit application. .//'�4,16• /'/ > 6 / 20.23 Print is Name(Electronic Signature) Date I SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under thepains andpenalties of perjury that all of the information P J rY contai in a ication is true and accurate to the best of my knowledge and understanding. .>11 -3 tint 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(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" The Commonwealth of Massachusetts ►^10 ° 0 !l, Department of Industrial Accidents " au`' lam] 1 Congress Street, Suite 100 ' will Boston,MA 02114-2017 wwx.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): f 'k a'r`De(' L-c ',_.Q Address: 5 rl Qva►.yezt ry-e.• City/State/Zip: ..31-1 ,,,,..,, IA, (?J 0 6v 60 Phone#: l • K'-/o 4(a-(S. Are you an employer?Check the appropriate box: Type of project(required): I. I am a employer with ) employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. IC_I Remodeling any capacity.[No workers'comp.insurance required.] 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs o`additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 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. rr Insurance Company Name: I(0 t'*i Ql¢4-S ',\\ Policy#or Self-ins.Lic.#: Sh l) - w wt St-7-3-3 Expiration Date: (,1-,9 Job Site Address: Q 1U — City/State/Zip: 0X4na ►kol,.-.i C Attach a copy of the workers'compensation policy declaration page(showing the policy number and expittation Bate). 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 verificatio I do hereby c if de e pains and penalties of perjug that the information provided above is true and correct. Signatur Date: 1113 Phone#: '\ 1- i `r'-L" 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#: City of Northampton (/..--- Massachusetts : _. A ' 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: A 2 tl t. Ov ""'..)kff.,"I I-7A The debris will be transported by: Name of Hauler: Te-t-t fl Nfrq r�n'T 5crv:et.4 LAC . Signature of Applicant Date: t`9 Id-3 1/31/23, 1:21 PM Office of Consumer Affairs&Business Regulation-Mass Gov I~ ' ., Mass.gov Ti t ,o, 1 T 1 / t ' 0 i " ro r r Consumer„,, 4 , C'! %///Y////�/ b y// , r, r% 4 ,k/z.,„,,,,,,,, ,,,- t,„ ;,, el ,,,, Home Improvement Contractor Registration Lookup To search by registration number, enter the registration number in the textbox below and click the 'Search' button. Please note pressing the Enter key will clear fields. Search by Registration Number Search You must click the "Search Registrant" button to search by name or location. Please not pressing the Enter key will clear fields. https://services.oca.state.ma.us/hic/licenseelist.aspx I/2 1/31/23,1:21 PM Office of Consumer Affairs&Business Regulation-Mass.Gov Search by Registrant Company name Search Registrant Search by Registrant Last name lane Search by Registrant First name alexander City/Town State Zip code Click on the registration number to view complaint history. You can also view arbitration and Guaranty Fund history. The list is current as of Tuesday,January 31, 2023. Search Results RegistrantName RESPONSIBLE REGISTRATIONADDRESS 1EXPIR TIONSTAT S INDIVIDUAL NUMBER DAT :Alexander Lane :Lane, Alexander 196667 57 Prospect Ave 09/11/2023 Current Northampton, MA i 01060 Site Policies Contact Us © 2018 Commonwealth of Massachusetts. Mass.Gov® is a registered service mark of the Commonwealth of Massachusetts. https://services.oca.state.ma.us/hic/Iicenseelist.aspx 2/2 10 Commonwealth of Massachusetts 1 Division of Occupational Licensure Board of Building Re ulations and Standards I T' Cons ion$visor CS-117411 _'_ • icpires: 05/04/2026 ALEXANDER .ANE 57 PROSPECT AVE NORTHAMPTON MA 01060 f Commissioner • 0�, K. DEvnat&., ' —COUNTER TOP 7 SHELF TILE EDGE MILLER P O L L I N 110 ARCHITECTURE 12c0 SOUTH EAST STREET A I 3 MHERST,MA 01002 3 d 8 C Ell I 1 ?? 1 ,ITJ WI 1 El 111 ) L_. __ 1 •, ./ _ — + r , ,.„ I — 111 tr✓✓ 5 CALVIN TERRACE BATHROOM RENOVATION & 2 DEMOLITION PLAN 3 ' SECTION DEMOLITION FLOOR PLANPARCEL ID 2012d-001 J, DATE DESCRIPTION vial —VI,— —r.e• r a• —r.e• DATE ........'............."...7''',. .........."/........." 1.8.2023 STAMP ..:N A UMWINGITTIE I T C., I., i�- T 'T — LTHCI — I, --I a a — II-- SCHEME 4 INTERIOR ELEVATION s INTERIOR ELEVATION e INTERIOR ELEVATION ( 2 ) INTERIOR ELEVATION AO.O 1 1/2,1'-0• Ake- DWTE(MM/DD/YYYY) mow.. CERTIFICATE OF LIABILITY INSURANCE 01/11/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE 1 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 SUBROGATIONIS 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 NAME: FINCK&PERRAS INSURANCE AGCY INC PHONE (413)527-3000 Fax 08081515 6 CAMPUS LANE (A/C,No,Ext): (A/C,No): EASTHAMPTON MA 01027 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Hartford Underwriters Insurance Company 30104 INSURED INSURER B: ALEXANDER LANE INSURER C: 57 PROSPECT AVE NORTHAMPTON MA 01060-1625 INSURER D: INSURER E: 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. INSR TYPE OF INSURANCE ADDL SUER' POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD IMM/DD/YYYY1 IMM/DD/YYYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED $1,000,000 PREMISES(Ea occurrence) x General Liability MED EXP(Any one person) $10,000 A 08 SBM AV7BYU 01/10/2023 01/10/2024 PERSONAL BADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X PRO- LOC PRODUCTS-COMP/OP AGG $2,000,000 JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) • _ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- AGGREGATE MADE DED RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY Y/N E.L.EACH ACCIDENT PROPRIETOR/PARTNER/EXECUTIVE — N/A OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE (Mandatory in NH)If yes,describe under E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below A Employment Practices Liability 08 SBM AV7BYU 01/10/2023 01/10/2024 Each Claim Limit $25,000 Insurance Annual Aggregate Limit $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION For Informational Purposes SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 57 PROSPECT AVE BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED NORTHAMPTON MA 01060-1625 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE <217r�aGl�Riz�c2!2> ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 00530 -AM CHUBB` P.O. BOX 5600 HARTFORD CT 06102 Date: 01-18-23 Policy No: (6S62UB-0W34856-7-23) Effective Date: 01-11-23 LANE, ALEXANDER 57 PROSPECT AVE NORTHAMPTON MA 01060 ACE AMERICAN INSURANCE COMPANY has been assigned as the servicing carrier for your Assigned Risk Workers Compensation Insurance policy. We have contracted with Travelers to service your policy, and we welcome you as a customer. We have received your application and premium. Your policy will be issued shortly. Please note that your binder is proof of coverage until cancelled or the policy is issued. In the meantime, should you find it necessary to file a claim, request a certificate, or communicate with us, please note the following: For a certificate of insurance: For Claims Reporting: For Policy Services: Fax a written regLest to: 1-800-832-7839 (877) 336-6036 ACE AMERICAN INSURANCE COMPANY P.O. BOX 5600 HARTFORD CT 06102 The Claim Reporting system is a toll-free service that is available seven days a week, twenty-four hours a day. Usage of this system has been proven to provide significant benefits, with the immediate assignment of a Case Manager, automatic production of the First Report of Injury form, and earlier resolution of employee Claims. Safety and Loss Prevention are critical concerns to any business. We have long been a pioneer in the field of ac- cident prevention, having the experience, resources and capabilities to provide a complete range of safety ser- vices. Your policy will include more details regarding these services. Please keep this information available. Reference the above policy number on any correspondence and have it available when contactinn us or submitting correspondence. You are able to self service your policy online. Please visit www.travelers.com/reqister in order to register and view your policy, make a payment, request loss runs and certificate of insurance, and more! It is our pleasure to work with you. Sincerely, ACE AMERICAN INSURANCE COMPANY CC: FINCK & PERRAS INS AGCY 6 CAMPUS LANE EASTHAMPTON MA 01027 W20M2G10 Page 1 of 1 I 1 1 , I r a I 1. S a • N . ,_ (1 q fJ 3 O zr( lj� ,I/ 1 „ 1 t cY_ v \ I ,r t 4 I 1 , ';) 1 rt T I y :n f i 1 i .7,,Mz c •N. - Wes` �1 ��� ' 't 0.1 f :'�' } \\\ �+vildl�] I _ V „4;L ram" 4 —) -y SL : Aker L kAAA [ MILLER POLLIN 7 90 5• TH FAST Si MET 4 I 3 AMMER.T.MA 0€007 7 A 8 S.Mtllf .•iiM♦l: LOM G C 2 5 111.110 .i. M c.M C E L L 1E110111F 1 .. p (Ap I l t ! MinI �A�m`- . 7 _ _._. `Eefta►-1 A-A 4 T - - c ab .. RE OVATION 8. © E M O l I T I 0 N aARCEl�.24A-12P-&II REV. DATE DESCRIPTION itilCI) T I L I I f�. ( imp ., { 1.__I tl 1 �GAW C €C trJr igiage, "l I J 1 1c- � . j I r DATE f I I 2.2.2023 4 ..._._---. .�. ... -_-. ". I _ Ate+# ( iKXt11 Ief 5. } i, I LW a ! . " $4,19 E„1C _ T DRAM ,TRIF. � b "' P A N S & LI S ; CTIONS 11 u�i :5hf7Cly'$" SHEET i A0.00 Sf_M1