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31B-213 (2)
BP-2023-0203 71 GOTHIC ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31B-213-001 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-2023-0203 PERMISSION IS HEREBY GRANTED TO: Project# REPAIR PORCHES 2023 Contractor: License: Kevin R. Schnell DBA Live Well Home Est. Cost: 40000 Improvement LLC 109600 Const.Class: Exp.Date: 10/19/2023 Use Group: Owner: RIVIN HAHN KENNETH &ANDREW S Lot Size (sq.ft.) Kevin R. Schnell DBA Live Well Home Improvement Zoning: URC Applicant: LLC Applicant Address Phone: Insurance: 33 LAUREL MOUNTAIN RD 413-409-2929 WCC-500-5024695 WHATELY, MA 01039 ISSUED ON: 03/15/2023 TO PERFORM THE FOLLOWING WORK: REPAIR FRONT AND SIDE PORCHES 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: • r •l 3-''I • Fees Paid: $260.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Buildinc Commissioner F� The Commonwealth of Massachusetts ;1 J ,, )•-rl,,p IL) Board of Building Regulations and Standards: ' 3 FOR Massachusetts State Building Code, 780 CMR::'4;;-. 0(92 MUNICIPALITY USE Building Permit Application To Construct,Repair, Renovate Or Demolish a , Revised Mar 2011 One-or Two-Family Dwelling - This Section For Official Use Only Building Permit Number: M. .- R03 Date Applied: flttiliiRCAMa ts. } ..fr' ►'' 3JS 3 Building Official(Print Name) Signature 1 • Da e SECTION 1:SITE INFORMATION 1.1 Propertx Address: 1.2 Aor Map Parcel Numbers 1 r U6tI1 iC- 5tfi ssess 3146 -).( col 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❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Rec rd: k-min0111 I- 6111v1 Nor ilia fnf fbh AA4 0l066 Name(Print) City,State,ZIP 2 '"i,Joc2(awn RdZ (3 /-5.2C_ krnhahn6,0 Sou,"/, real No.and Street Telephone Email Addre s SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) II Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': RQ ci (I l I'I(ovi i C( „& 5;Ge P p(1Y C h'PS ck 4iSlbc. •O L 4 -i la(Z )CuiJ 4-R BUILD SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 400 00 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All F6. ,�ZA 6 / Check No.01 Check Amount: Cash Amount: 6.Total Project Cost: $ `tot 00 0 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) f L_I 0 r,`o0 C 0 )` k'e visi h l n e I l License Number Expiration ate Name of CSL Holder / n ( 3 3 4 u st i /Mau G h A List CSL Type(see below) v No.and Street �/// Type Description {,W J y� �' O I (�O Unrestricted(Buildings up to 35,000 Cu.ft.) T y �/ t R Restricted 1&2 Family Dwelling City/Town,State,4IP M Masonry RC Roofing Covering n �`,C p j;J e�� 1 WS Window and Siding �j SF Solid Fuel Burning Appliances G I r i 1 OY—1 C1)4 h C*141 e 1(nPV0VtVAfilt COO\ I Insulation Telephone Email address D Demolition 5.2 Registeredii Home Improvement Contractor(HIC) r n i j Li 6 7/7/):3 �'I J c. VV�(i -Ic o e .. 1�Y1 �f C V�Y�} HIC Registrationl Number Expiration Date HIC Company Name or HIC Registrant a -13Lcto I Mouotciii c. OP-Ace IidP4/4PI/howl i010I0VeM erit:l.o No.COI\01 rely l4, 01 o3C1 1113`tio9 )-\G),9 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 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 contained in this application is true and accurate to the best of my knowledge and understanding. I/3-0 ,23 Print Owner's or Au orized ent's Name Electronic Signature) Dat ( g e 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 ?oa�H�M�roti: S�S•�«; sic Massachusetts 4?.' '<<G ' 4 DEPARTMENT OF BUILDING INSPECTIONS a ; '.. M %t, 212 Main Street • Municipal Building ` C ''�'•-`_ 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: V R I I'e C Cif n The debris will be transported by: Name of Hauler: S , R•Q c C l h Signature of Applicant:711/4,176--- Date: #) . The Commonwealth of Massachusetts hi.t ,, 1 t Department of Industrial Accidents �, 6 1 Congress Street,Suite 100 '"'"'y Boston, MA 02114-2017 1'h '..,,, ,,.,44, www.mass.gov/dia Workers'Compensation Insurance AHidavk:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMIITINC AlITHORITti'. Anolicant Information (� ( Please Print Legibly Name(Business Organizationttndmduall: I- j V f ik`e// l /o m P pry V ovettlekil Address: 33 LA tj W f'f Ai0 u 0 tU li'l ►o1,bc€ct City/State/Zip: (A)I/1611 I �/1/M if 0/0 31 Phone#: J/3 — L1 —411).y Are yew an eaaployer?Cheek the appe to box: Typeof project(required): P j e9 1. I am a employer with I employees(full anchor part-time)_• 7. New construction 201 am a sole proprietor or partnership end have no employees working forme in S. 0 Remodeling any cpacity.[No workers'comp.insurance required" 301 am a homeowner doing all wart myself_[No workers'comp.irsuraooe required"' 9. Demolition 4.0 I am a homeowner and will be hiring contractors so eondm t all wall on my property. I will 10 0 Building addition amine that all contractors either have workers'compensation insurance or am sole 1 La Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 50 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and love workers'ccenp.insurance.: 13D Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c_ 14.0 Other 152.f 1(4).and we have no employees.[No workers'camp.insurance required.] *Any applicant that checks boa al rust also fill out the section below showing their workers'compensation policy iafortrstian- t Homeowners who submit this affidavit indicating they art doing all work and then hire outside contractors smut submit a new affidavit indicating suck *Contractors that check this box must attached an additional sheet showing the name oldie man end state whether or not those entities have employees. If the sub-contractors have employees.they neat provide their workers'comp.policy number_ lam an employer that is providing workers'compensation insurance for arty employees. Below is the policy and job site Information. --}- Insurance Company Name:4 ji v/�/)I M e l iti/ .L 1 4 11(4f h Ce L 0 . Policy#or Self-irks.Lic.#: (6 500 apt 9 '5 cD)--Expiration Date: t'i nId 3 Job Site Address: '7 f G o j h I L 51(-p to CitytStateiZip: 01066 Attach a copy of the workers'compensation policy declaration page(showing the policy number and es tlon 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 ander the and penalties of perjury that the information provided above is true and correct Signature: ( Date: 2/20 2 3 Phone#: '( 1-I— 1-io ").q 1 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.Electrkal Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: KEVISCH-01 VCARRIER ,4coR0 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 1/6/2023 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 NAMeCT Lori Zapka Whalen Insurance Agency PHONE FAX 71 King Street ( ,No,�)` �( ,No)' Northampton,MA 01060 :lori@whaleninsuranCe.Com INSURER(S)AFFORDING COVERAGE NAIC M INSURER A:Main Street America Assurance 29939 INSURED INSURER B:AJ.M.Mutual Insurance Co. LiveWell Home Improvement,LLC INSURERC: 33 Laurel Mountain Road INSURER D: West Whately,MA 01039 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 SUBR POUCY NUMBER POLICY EFF POLICY EXP LIMITS LTRINSR WVD (MWDDIYYYYI (MMIDD/YYYY) A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ 1'000'000 CLAIMS-MADE OCCUR MPJ8868A 3/28/2022 3/28/2023 DPREMISES{AMAGETOEa R oaxlrrence) $ENTED 100,000 _ MED EXP(Any one person) $ _ _ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEM_AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 121a LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER $ AUTOMOBILECOMBINED SINGLE LIMIT LIABILITY (Ea accident) ANY AUTO BODILY INJURY(Per person) $OWNED ONLY AACUUTTTOOSSyyLNE�Dp BODILY INJURY(Per accident) $ - - AUTOS ONLY _EMU r«O,PEcR, Y DAMAGE $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ - DED RETENTION$ $ B WORKERS COMPENSATION PER STATUTE ER TH- AND EMPLOYERS'uA ILITYTNER/ WCC-500-5024695-2022 4/5/2022 4/612023 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A ( andatory in ) E.L.DISEASE-EA EMPLOYES 1�'�� E yes describe under 500,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Certificate issued as evidence of coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P ACCORDANCE WITH THE POLICY PROVISIONS. Main Street Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards Coast{ ton SlIpeivlsor CS-109600 tres: 1011912023 KEVIN SCHtLL 33 LAUREL MOU?TAIN ROAD WEST WHATELY MA 01039 i i y� dM ommissioner Oittia /) !ilr////l/('////'/'/I/{// (27. //,//%%%l% /� ' f1 Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC Registration: 181146 LIVEWELL HOME IMPROVEMENT LLC. Expiration: 07/08/2023 33 LAUREL MOUNTAIN ROAD WHATELY,MA 01039 Update Address and Return Card. ,CA t Cs 2054)5;t 7 HOME IMPROVEMENT CON TRACTOR Registration valid for individual use only TYPE:LLC before the xp' ation date.,If ound return to: RtglittAop Expiration Office of n imer A ' s d Business Regulation 181146 07 0812023 1000 i on r uite 710 t 1biG=WELL HOME IMPROVEMENT LLC. Bost 2 8 / i° , kEVIN SCHNE{'I,.. • 3:3 LAUREL MOtiHTAIN ROM? % .z -/#.4 NIHATFtY MA 01030 Undersecretary at valid without signature