23D-081 (15) BP-2023-0517
73 WARNER ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23D-081-001 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-2023-0517 PERMISSION IS HEREBY GRANTED TO:
Project# COVER STOOP 2023 Contractor: License:
Est. Cost: 8000 GLENN GRILLEY 79910
Const.Class: Exp.Date: 07/07/2023
Use Group: Owner: KERSTEN ELAINE RENATE
Lot Size (sq.ft.)
Zoning: URB Applicant: GLENN GRILLEY
Applicant Address Phone: Insurance:
40 KATHY TERR (413)374-4942
FEEDING HILLS,MA 01030
ISSUED ON: 04/27/2023
TO PERFORM THE FOLLOWING WORK:
5X12 COVERED FRONT STOOP
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�' V
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
-0Iz
File #BP-2023-0517
APPLICANT/CONTACT PERSON:GLENN GRILLEY
40 KATHY TERR FEEDING HILLS,MA 01030(413)374-4942
PROPERTY LOCATION 73 WARNER ST
MAP:LOT 23D-081-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $65.00
Type of Construction: 5X12 COVERED FRONT STOOP
New Construction
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
Driveway Grade%
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
XApproved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Va ance*
Received&Recorded at Registry of Deeds Proof Enclos d
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
.; 'i, -> . : 9 ? 93
Sign.ture of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Depar ent
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict stand rds of MGL 40A.Contact Office of
Planning&Development for more information.
1
-. ... .
1----
...._
The Commonwealth of Massachusetts
Board of Building Regulations and Standatils APR 2 ,,„23 WNIC1PALITY
FOR
IF, Massachusetts State Building Code, 780 C$R
s' 41/
Building Permit Application To Construct,Repair,RenovafpOrd,i,th 1SE
a evzseff Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Oiily
Building Permit Number: 60-A 3 - 677 Date Applied:
elliillitk, 1 k IV / I r Li/a Dat
Signature I
Building Official(Print Name)
SECTION 1:SITE INFORMATION
1.1 75rty AdcAiress:r iseA____ S7L._. 1.2 Assessors Map&Parcel Numbers
1.la Is this an accepted street?yes i no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(11)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
Z5 I
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone?
_____ Check if yesig
Public FE( Private 0 Municipal Ed On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Eia in e Ktrs-teel FAreat, MA ototo 2
Name(Print) City,State,ZIP
73 tiAlrittr 5-t, ot-073.9 _
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)% Addition 0
Demolition El Accessory Bldg. CI Number of Units Other 0 Specify:
Brief Description of Proposed Work':
CY /i covered -Front- sloop
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $
0 Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire
$ Total All Fee 1 (A 16
Suppression)
Check No. l'iV I Check Amount: V
6.Total Project Cost: $ ie op - 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 0�99 r0 _
6�4 �ar,�� p�?ation 23
�,/ LicenseNumber Expiration Date
Name of CSL Holder /
(10 GCaM y Tee List CSL Type(see below)_ u
No.and Street Type Description
Feed I' f�I��s� 1414 01030 U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,Mite,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
13-371 y9ta 03e,4v ram I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
P1 C �j l3(l81W 2-/5 zy
r t'l�e HIC Registration Number Expiration Date
HIC Company a or HIC Registrant Name
Ko h Ter - (i-‘'/( 050 A01•ca'y,
No.and treet 'Email address
F t 11110 MA o1030 (0 37g-'lige
City/Town,State,GIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AW IDAVIT(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
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES I!OR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize 611r1,I 6,,
to act on my behalf,in all matters relative to work authorized by this building permit pplication.
(// �6r.SVen 1/-75-23
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER1 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.
Gin T-23
Print Owner's or Authorized Agent's Nam (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 intimination 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"maybe substituted for"Total Project Cost"
'` The Commonwealth of Massachusetts
Department of Industrial.-lccidents
1 Congress Street,Suite 100
Boston, .11-102114-201 7
^-- N'ww.masS.gov/dla
•
11 in kers' ('ontprnsation Insurance.Affidas it: BuildrrsiContractonirl kctriciansplumbers.
I t)BE F11.1.1)1%WI H 1111: PER1111-I IM;.%1 1110111 11.
.tttplicant Information Please Print Leiibly
Name(Buslors&Organization,Inllnardlaall: t1ln
Address: y0 t 11 y T r•
City.fState/Zip: F.etd(/' r(t'ls l MA 01030 Phone#: `r'13`37 L" vita
Art you an amphfy/se Cheek the appropriate boa: Type of project(required):
1.0 I am a enfpluya with employees(full and-ar psi-" • 7. 0 New construction
20 I am a sole proprietor or ptntnenhip and tame no employees working for arc m $. 31 Remodeling
any rapacity_(No workers'comp.insuraset reywrc:l.l
lam a hwneowncr doing all earl nitwit(No workers comp.nrsurane re l"e yurred. 9. Demolition
10 0 Building addition
4.0 I am a ltuarcoixnet and will be hiring contractors to conduct all work am my property. I*AI
ensure that all contractors ether lace waken"compensation msuranca ar an:wile 11.1 Electrical repairs or additions
proprietors with no crnfolotrem. 12.E Plumbing repairs or additions
t I am a general contractor an!I lade hind the sob eontracwn listed on the attached sleet. 13 0 Raof rerepairsat
thew st>b-conttxtun l insurance:':
employees and lase workers'cainsurance:': P
14.0Other
6.0 V.e are a corporation and its officers luxe exmciscd dice right of exemption per Mt&a
1 S...114).and we hate no employees.(do workers'comp.msuranee required.'
•And applicant that checks bus 4:1 cruet also fill out the section below show sag their 1nur►ers'uompcnsttiou policy utla«atttatto n
llumeawrkn w Is'submit this attalssit indicating they arc doing all work and then hire outbids:contractors snout submit a new atfudas at nnduatmg such.
;Contractors that cheek this vas smut attached an additional,heel showing the name of the sul.curetractors and state whether as not doom:entities hate
a-mplowcs. if the sub-et traitors lute employees.tit:r rvdost pno%rde then workers'comp.pule>numeeha-r.
I am an employer that is providing workers'compensation insurance for art'employees. Below is the policy and job site
information.
Insurance Company `nine:
Policy#or Self-ire.Lie.#: Expiration Date:
Job Site Address: City:State Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under tit(iL c. 152. *25A is a criminal violation punishable by a tine up to Sl.500.00
and or one-year impnsonntent.as well as civil penalties in the form of a STOP WORK ORDER and a line of up to S250.00 a
day against the violator-A copy of this statement may be forwarded to the Office of Investigations dot the DIA for insurance
coverage verification.
I do hereby cernfj'under I ,ad penalties of pecfury that the information provided above is true and correct_
Signature: Data 7 /5 � 2 3
Phone#: (0 3 .. 3)1t" 1(9y2
Official use onh: Do not write in this area.to be completed by city or town official
City or Town: Permit license is
Issuing Authority lcircle one):
1. Berard of Ilcalth 2. Building Department 3.('ity rI'uwn Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
('untied Person: Phone#:
City of Northampton
•�" ` Massachusetts 5 f �- ' c'�c
171
44.1
DEPARTMENT OF BUILDING INSPECTIONS "t‘
.r'' ° 212 Main Street • Municipal Building Je. ',
C
! ~
+ f:4✓ Northampton, MA 01060 �SN,Y•'4•3‘�
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: w R&ye/ i, IiIe.c1- S$rfit/ eW, 44
The debris will be transported by:
Name of Hauler: 614,0 C7rJ //t7
Signature of Applicant: Date:
/� Zj
isi Commonwealth of Massachysetts
Division of Professional Licensure
Board of Building Regulations and Standards
Cons rutt}hAtS$$rvisor
CS-079910
.,(pires:07/07/2023
GLENN E GRILLEY , }
40 KATHY TER
FEEDING HILLS MA
i '• �O
,/'f)/5S..,l:%0-1‘�
Commissioner di•
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs 8 Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE:`1n'8ividual
Registration Expiration
134876 + 02/15/2024
GLENN GRILLEY
•
GLENN E.GRILLEY �' "�
40 KATHY TER Louvt..-, CL-(
FEEDING HILLS,MA 01030 Undersecretary
@ MAPFRE INSURANCE
MAPFRE Insurance Company
11 Gore Road, Webster, MA 01570
BUSINESSOWNERS
GENERAL CHANGE ENDORSEMENT
POLICY NO: 8008030008702
RENEWAL OF 8008030008702
ACCOUNT NUMBER:
NAMED INSURED AND MAILING ADDRESS AGEN -t vry•• -•- - '^
GLENN GRILLEY DBA GRILLEY HOME IMPROVEMENT
RUSH INSURANCE GROUP, INC
40 KATHY TER 637 GRATTAN STREET
FEEDING HILLS,MA 01030 CHICOPEE,MA 01020
POLICY PERIOD: FROM 09/24/2022 TO 09/24/2023 AT 12.01 AM STANDARD TIME AT YOUR MAILING ADDRESS SHOWN
ABOVE.
EFFECTIVE 09/24/2022 THIS POLICY AMENDED AS SHOWN
BUSINESSOWNERS
For an additional/return premium, the items below are changed as indicated:
UPDATING PAYROLL PER RECENT PHYSICAL AUDIT TO 52,600 FROM 33,850
DESCRIBED PREMISES
Prem. Bldg.
No. No. Premises Address:
1 1 40 KATHY TERRACE, Feeding Hills, MA 01030
SECTION I-PROPERTY
Deductibles (Apply Per Location, Per Occurrence)
Optional Coverage (Other Than
Equipment Breakdown
Protection Coverage) Windstorm Or Hail
Prem. No. Property Deductible Deductible Percentage Deductible
(Location 1, $ 500 $ 500 N/A
Building 1)
SECTION II- LIABILITY AND MEDICAL EXPENSES
Each paid claim for the following coverages reduces the amount of insurance we provide during the applicable annual period.
Please refer to Section II-Liability in the Businessowners Coverage Form and any attached endorsements.
01-11-23 Page 1 of 3
® MAPFRE ( INSURANCE'
BUSINESSOWNERS
GENERAL CHANGE ENDORSEMENT
POLICY NO: 8008030008702 EFFECTIVE DATE: 09/24/2022
INSURED: GLENN GRILTYY DBA GRILLEY HOME AGENT: RUSH INSURANCE GROUP, INC
IMPROVEMENT
Location: (Location 1, Building 1)
Coverage Limit Of Insurance
Liability And Medical Expenses $ 500,000 Per Occurrence
Medical Expenses $ 5,000 Per Person
Damage To Premises Rented To You $ 100,000 Any One Premises
Other Than Products/Completed Operations $ 1,000,000
Aggregate
Products/Completed Operations Aggregate $ 1,000,000
Optional Coverages (Applicable only if an "X" is shown in the boxes below)
Broadened Coverage For Damage To $ Per Occurrence
Premises Rented To You (BP 04 55)
Self-storage Facilities-Customer Goods $ Per Occurrence
Legal Liability
(Optional Increased Limits)
Motels-Liability For Guests' Property $ Per Occurrence
(Optional Limits)
Motels-Liability For Guests' Property In $ Per Guest
Safe Deposit Boxes $ Per Occurrence
Deductible
Optional Property Damage Liability Deductible: $ 500
Per Claim (Refer to BP 07 03); or x Per Occurrence(Refer to BP 07 04)
Coverage Annual Premium Transaction Premium
01-11-23 Page 2 of 3
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