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24D-058 (3) ' BP-2023-0194 181 PROSPECT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24D-058-001 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-2023-0194 PERMISSION IS HEREBY GRANTED TO: Project# REPAIRS 2023 Contractor: License: Est. Cost: 3000 WITMAN PROPERTIES INC 103446 Const.Class: Exp.Date: 08/15/2023 RODRIGUEZ NAOMI GLENN-LEVIN R.JASON Use Group: Owner: ANTHONY RODRIGUEZ Lot Size (sq.ft.) Zoning: URB Applicant: WITMAN PROPERTIES INC Applicant Address Phone: Insurance: 121 MAIN ST 4135362714 W1WC335663 HOLYOKE, MA 01040 ISSUED ON: 02/17/2023 TO PERFORM THE FOLLOWING WORK: REPAIRS TO ENTRY 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: (j-;5)1 • .4. ' I , Fees Paid: $65.00 212 Maui Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner 2,,,e) , 1 t y _ The Commonwealth of Massachusetts Wt Board of Building Regulations and Standards FOR Massachusetts State Building Code, 780 CMR MUNICIPALITY USE Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 201I One- or Two-Family Dwelling /J This Sectio For Official Use Only Building Permit Number: /"'2 . `q Date Applied: /4 i,--i 411 147 2- 17-2Oz3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Projizerty Address: 1.2 Assessors Map& Parcel Numbers 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided . Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2 1 Owner'of Record: n- nn '�043PAA CT lc - -►-even RDayft x,Gl G-ev Ck, 1\N 1.1-‘,1 (0 Name(Print) City,State,ZIP i L Ma Ai 7A (SS5g)3ct5-t¢(A Z ngom\ P, \. orr) P No.and Street Telephone j it Addcgss SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) l Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': ct if-ri-cro-N tr-cpcur5 c„ exisA- C o I,t,,,ni S t 1rtrA,n›..re i l$ , SECTION 4: ESTIMATED CONSTRUCTION COSTS 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 Cost' (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees �� p Check No. 1 7 CYeck Amount: t-t" Cash Amount: 6. Total Project Cost: $ 31 U-WD 0 Paid in Full 0 Outstanding Balance Due: j SECTION 5: CONSTRUCTION SERVICES • 5.1 Construction Supervisor License(CSL) C9_to344 p License Number Expiration ate Name of CSL Holdfr List CSL Type(see below) Vz\ vA h CA No.and Street Type Description 004 a�1Unrestricted(Buildings up to 35,000 cu. ft.) Restricted I&2 Family Dwelling City/Ttate,ZIP M Masonry RC Roofing Covering WS Window and Siding l� 1�� c SF Solid Fuel Burning Appliances ‘3V 21 l 1 �Ov\.ew-ilv K,cd eS I Insulation Telephone Email address D Demolition 5.2 Registered H ImprovementtI Contractor(HIC) , - �pi ‘5 -2. 1 Vv t'{-M e rp `-t'"l. S HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name Mom 1 T v� "� (A)ti-AACIO1�rv� (�-t�S - No.and Street Email address if\�,,r r or1 LA AS 3 L1 G OVA City/Town,State,Z_P Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE A}HDAVIT(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 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 entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contai ' this appli • is true and accurate to the best of my knowledge and understanding. 69/C-3 Print Owner's or Authorized Agent's Name(Electronic Signature) Da 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 fo(tnd 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 City of Northampton LT�Ii �... t '411; f r�, �s »..»...s� r Massachusetts a��S��' �cr ki DEPARTMENT ECTIONS y ��° , 1 212 Main Sitori0eaFren:::InmLuDitlfipoIaiNoiS6:P uildingJ1 i)Nor 31iy,7, 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: 4-7 / / )/(_<. I ) ? Y go ty0L-€._ /1//9- 0l ivX / The debris will be transported by: Name of Hauler: 4)/40 Ck vi v.v 1-1rLS Signature of Applicant: /6(..,&10,-r.. --)L----"D Date: 7-/ b . 2 /..1411 WITMPRO-01 KPAVLENKO ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `r' 11/14/2022 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 NAME: Kovalev Insurance Agency,Inc. 188 Needham St Suite 220 (NCC,,"N,Ext):(617)562-0060 I IN,No):(617)562-0990 Newton,MA 02464 E-MAIL LADDRESS:insurance@kovalevinsurance.com 1 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Scottsdale Insurance INSURED ,INSURER B:Safety Insurance Company -- ____ 39454 Witman Properties Inc INSURER C:Nautilus Ins Co 17370 121 Main St [INSURER D:Guard Insurance Group _ - 42390 Holyoke,MA 01040 1INSURER E:Hlscox 10200 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 INSD WVD (MM/DD/YYYYI (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CPS7505231 6/27/2022 6/27/2023 DAMAGE r0 RENTED 100,000 PREMISES(Ea occurrence), $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2r000,000 X POLICY LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 .(Ea accident) 1 $ ANY AUTO 5925342 6/27/2022 6/27/2023 _BODILY INJURY(Per pers4) $ OWNED r X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY_(Per accident) $ IIRREE A p i PROPERTY DAMAGE X AUT S ONLY X AUTOS ONLY _(Per accident) $ C UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS-MADE' AN1263143 6/27/2022 6/27/2023 AGGREGATE _ $ 2,000,000 DED X RETENTION$ 10,000 ' $ D WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATTUTE EERH _ WIWC335663 6/27/2022 6/27/2023 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ., E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A I - - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ E Prof.Liability MEOHS000329000 6/27/2022 6/27/2023 lEach Occurrence 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Property Management,landscape,snow removal,and other operations typical to insureds business. $2M Excess Liability Over General Liability Only and does not provide coverage over any other policies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 121 Main St Ho yoke THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REZPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents • lb 1 Congress Street,Suite 100 4I= Boston, MA 02114-2017 www.mass.gov/dia 11 or kers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. "10 RE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print 'Adak Name(13usirtcssi(hganz.ation'lndndclual): Vv 1,k`kit\-0 pro 5 Address: V2\ '\&:e? V\ qv-- City/State/Zip: ' alb Y \Phone #: � — 27 114 Are yen lover?Check ttae appropriate but: Type of project(required): I. I am a employer with n employees(lull aodior part-time).* 7. Q New constructi 201 am a sole proprietor or pmtnership and have no employees working fur me in 8. Remodeling any capacity_[No waters'comp.insurance required" L! 30 l am a homeowner doing all work myself.[No waters'comp_imutram required_]' 9. Demolition❑ wo 10 El Building addition 4.01 am a homeowner and will be hiring owuraciurs so conduct all work on my property. 1 will ensure that all contractors either ha%e wrorken'conspritsatiurt insurance or sue sole I t a Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 50 1 am a genial contractor and 1 have hired the sub-contractors listed tan the attached sheet. 130 Roof repairs These sub-contracture have employers and have workers'comp.insurance.: 6.0 We area melioration and its officers have exercised their right of exemption per MGL e. 14.�t�illletf a t '� �C!<<�`^�`5 132,¢101),and we have no employees.[No workers'comp.insurance required.] 5. •.Any applicant that checks boa a 1 must also fill out the seetiun below showing their workers'compensation policy information. Roane w n•rs w hu sutnnit this atfida%it ouheatrng they are doing all work and then hire outside contractor.mini submit a new affidavit indicating such. 'Contractors that cheek this box must attached an additional sheet showing the name of the sutrcuatrracturs and state whether or not those aTtitie.have employees If thse sub-cuniractors base employ ins.they must pro%ulc their workers'cwmp.policy number. __ ... lam aN employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: (O '� vVSt�rUv\L� — Policy#or Self-ins.Lic.#: VJ U\Ca3G 10` Expiration Date: C2 1 'i I 23 Job Site Address: ` &?ro City/StateiZip: Attach a copy of the workers'cam sensation policy declaradoo page(showing the policy number and eipira n date). Ott)to C 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 certi n e he pains and penalties ofperjury'that the information provided above is t ue and correct. Signature: Y Date: Z, 1 Le 2--3 Phone#: j j(o ' Z (Vidal 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 S.Plumbing I or 6.Other Contact Person: Phone#: