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31B-155 (3) BP-2023-0538 11 TRUMBULL RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31B-155-001 CITY OF NORTHA$PTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0538 PERMISSIO IS HEREBY GRANTED TO: Project# ADD BATH 2023 Contractor: License: Est. Cost: 15000 MICHAEL PRIGN O 104390 Const.Class: Exp.Date: 01/08/202 Use Group: Owner: STUB S SUSAN L& BARRY GOLDSTEIN Lot Size (sq.ft.) Zoning: URC Applicant: HILLSI E BUILDERS & REMODELERS Applicant Address Phone: Insurance: 121 WEST STATE ST 413-218-5247 H1WC241467 GRANBY, MA 01033 ISSUED ON: 05/01/2023 TO PERFORM THE FOLLOWING WORK: ADD BATHROOM 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 NO1 THAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: ). )2 . TAIT Fees Paid: $195.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner r^,\1_ ri The Commonwealth of Massachusetts w Board of Building Regulations and'StandardeP/7 FOR MUNICIPALITY Massachusetts State Building Code, 780 CMR 8 2t7� USE Building Permit Application To Construct, Repair, Renovate r Demolish a ` Revised Mar 2011 One-or Two-Family Dwelling '`'h, A 7 mws r This Section For Official Use Only °r eo°'''s Building Permit Number: 6P..ti3 6-31, Date Applied: 1l y4,) -,-i // 5-/-202, Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address:j' Iva�/ I- 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❑ qq SECTION 2: PROPERTY/ OWNERSHIP' 2.1.> 'eer s vI6s + (I4cr f o01�5 ;, /VC/r-l- l9'111/'i- MA- Name(Print) City,State,ZIP I? Tr' l/ s 4-- (-1 13 (1Z7 -1-°51// 55 T UBPS @ OrV,cen4-f• cx'`j 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) li/ Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:_ Brief Description of Proposed Work': /Mcgt(;n9 .'k W ba#hr�fy, t4:+ -ti t✓alh ;n I s;, e OtAr �v- ,1e f- . r ra/.1,nc one f1,ev l.Na l/, Ven4.0 (4i off -1-c)r` -� t k'f,G('.r�r- SECTION 4: ESTIMATED.CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ ---/I _ 00 1. Building Permit Fee: $ j q rj Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ }i 000 • CO 0 Total Project Costa(Item 6)x multiplier x 6. �j 3. Plumbing $ blv(j(,.()(J 2. Other Fees: $ q7• �0 rto ? ft:4% 1+S{-krt-dF wdp ti 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire y� �1 Suppression) $ Total All Fees: $ i g%- 00 on �0 Check No.111 0 Check Amount: 15 Cash Amount: 6.Total Project Cost: $ 15, ❑Paid in Full 0 Outstanding Balance Due: 4 4-ac.e) bete peck+ = 5' Ot 000 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 10q?#-° �L. License Number pir ion Date Name of CSL Holder AA ' /I/n/ C/ae / /, • List CSL Type(see below) 1/ No.and Street /A l I v Pr' C tctA Type Description L 1 /1/01 O^ 5+'' / Unrestricted(Buildings up to 35,000 Cu.ft.) l -`l 1 Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry ( i0s.tib/ 14q 0/ 03 ? RC Roofing Covering lr L WS Window and Siding £ / I l SF Solid Fuel Burning Appliances 41? r, )4 D 7 17 I f if, eiV, char Q (.6A-015'f•/ ' I Insulation Telephone Email address D Demolition 5.2 gi tered Ho a Improvement Contractor(HIC) r 1 / 5 Jc;iiccf_ y ;/derc 4-f�e el�. Y IC"Ng 1/ �/ I� � S IA G �IC Registration Number xp ration Date HIC ompany Name or HI gstrant N e 1\4 Wes f 5teS� 14*it6V,/Jers e Comeasf.Aei- No. d StreetEmail address r t. by A4Pr( ld�) (11) ug5W7 City Town, Stitte,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 lfir 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 "l IG h 4 G, Pr i/ 9 no.n o�N.//S�dk t?i f Ier to act on my behalf,in all matters relative to work authorized by this building permit application. SJsv,r) Stcibbs 07t),(ya3 Print Owner's Name(Electronic Signature) ate 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. rni1ae ()I �'ri `/ A r -17 - Z3 Print Owner's or Authorized Agent1Name(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" ®� Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Re ulations and Standards Cons ionf$ visor CS-104390 9icpires:01/08/2024 MICHAEL J Pfi IGNANO. + m 12 MORGAN.ST GRANBY MA':91033 "l.t,t' Commissioner d. /. K. SlEm;i=a". Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Corporation Reaistr tion Expiration 174941 04/01/202iK HILLSIDE BUILDERS AND REMODELERS fNC. MICHAEL PRIGNANO j2 169 EAST STi LUDLOW,MA 01056 Undersecretary I /'1 HILLBUI-01 DALDRICH "AC-O'RO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/18/2022 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: Haberman Insurance PHONE FAX 95 Ashley Ave (/uc,No Ext:(413)T81-7000 (ac,No):(413)733-9545 West Springfield,MA 01089 ass:Info@habermaninsurance.com INSURER(S)AFFORDING COVERAGE NAIL I INSURER A:Preferred Mutual Ins.Co. 15024 INSURED INSURER B:Selective Insurance Comp any of America 12572 Hillside Builders&Remodelers LLC INSURER C:Selective Insurance Group , 121 West State St,Ste#5 INSURER o:AmGluard Ins CO 43290 Granby,MA 01033 - - INSURERE: 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. BIER ADDL SUER POLICY EFFPOLICY EXP LTR TYPE OF INSURANCE MD INVD POLICY NUMBER (M D1YyyY) ( IDDIYYYY) UNITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR BOP0100727499 10/4/2022 10/4/2023 DAMAGE TO RENTED 50,000 X X PREMISES s occurrence) X Business Owners MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEM.AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 JECT I LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY ccident)S ANGLE LIMIT $ ANY AUTO TBD 10/4/2022 10/4/2023 BODILY INJURY(Per person) $ 1,000,000 OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY(Per accident) $ X HIRED X NON-OWNED p�OPERTY pAMAGE AUTOS ONLY AUTOS ONLY (Faraccidenti $ $ C X UMBRELLALIAB X OCCUR 2,000,000 EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE S 2517878 10/4/2022 10/4/2023 AGGREGATE $ 2,000,000 DED X RETENTIONS 10,000 $ D WORKERS AND EMPLOYERS'COMPENSATION ABILITY Y/N X STATUTE OTH- ER _ HIWC345268 6/24/2022 6/24/22023 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT , QF gtRoMEMBEREXCLUDED? Y N/A ndatory in NH) E.L.DISEASE-EA EMPLOYEE S ,000 If yes describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Partners Michael Prignano&Michael Vumbaco are excluded from workers compensation coverage. CIL and its Subsidiaries are named as Additional Insured in regards to General Liability on a Primary and non-contributory basis applies,revised certificate. 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. AUTHO�RIZED�REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD City of Northampton Massachusetts �� _ /<. 1 !"jI L` 41DEPARTMENT OF BUILDING INSPECTIONS oti 1".y 212 Main Street • Municipal Building vb � Northampton, MA 01060 s3'Nh `'N 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: Vc (ley RtJtyC linG d-� L� T&75.14,,,,,v,f---,4i�J i 4 i Q O/060 J The debris will be transported by: Name of Hauler: i4- f 1 de b ';/c)ciS 11 Signature of Applicant: Date: 3 The Commonwealth of Massachusetts • I' � Department of Industrial Accidents 1 congress Street,Suite 100 Boston.MA 02114-2017 ww► .mass.gov/dia utkers' ( untpenvatinn Insurance Aftidas it:Buildersf('oniractolsiF ectriciansPlumbers. II)K!. 1114.1)1111M LI H is PE R%I I I I I G.,t1 111OI1l 11. _annlicant Information a Please Print Leeibl% Name l Business Organization Ind ,dutt i C /1C cJb c/ �" � 0 J / i Address: I l-s( Wecl" C IC City/StatefZip:V fr^[J6y Mat 0 IC)?3 Phone 0: t1( 1"Ll7 n,yes am ltiplayee Clydt the apprupnalr►ern: , Type of project(required): I.f2rane a cntprlaNria wdlt :net*Ytir*cY,ilia':and or part-tune 1• 7. 0 New construction 0 1 ant a war piopriekir or parinclshrp and hate no cartel,cr.working lot Inc rn K. unexlehng are}eapu its..[NU wilier,camp.m uramc reywretl.I 9. Demolition 30 I am a omer..net dating all...oil intic&(�lV nor►i.Ts comp IllsUE 71Ci required" h 1 p a Building addition ICI I am a IumwYsw net and w ill he hmntg.wlurmiun W ctnduo all atoll,on tut pn.pLTty. I w ill .mute that all contractor.other hat worker.*cunrpent:rin+n m uran.c ix an MAC I 11.01_Icctncal repairs or additions prtif7nrtur.with no employe.. 12.0 Plumbing repairs or additions :01 am a general contractor and 1 hot c hind the whcuntracttn h.t vl tin the attached sheet. These wh-c.mtra.k,n hate anphuyccs and kite'worker.'comp.uuurancc. I Q Roof r�patr� 1,.0 we an a tsnpura i&.0 and officer.hat c exercised then right ut exemption per\a1L c. 14.0 Odic* 1 S_^,II4I.and w r hate m.eniplosecs.I No to,tx►cn'.aanp.msunanc.rewired.[ ":1nt•applicant that.lief.,.,box=1 mini abr.,till out tth rcdluut Mall%shots tug Ikeda wtntr t".onlpentatlt,n Infurrnat111n. * I k.mooxtnets w tK.sut*7ntt this adedatrt ntth.airmy tlnt arc liana•all wail.and then hue outside ct iirs tics mint submit a new atlidat it indicating such. t ontractt,r.that dice,this hot anus,attached an additional sheel shot.me the name of the sal*-.t nira ors and state whether or nut those atria?hate ctnplo.o.:s. It tl0.'sal+ct t tor%hate clnplo...oc,.thct ututi Fronde then ...miters" teunnlsci. I um an employer that is providing workers'compensation insurance for nay employees Below is the policy and job site information. �n, [ ice', In.ut:utet ('onipany Name. Vl�l (Sal i re 144- alticty 6im'c) I PililtA ter Sell-ins.Lic. L4.110 G)-1 Yp 8 Expiration Date: 6/ )-ct Job Site Address: l ( 1 rvMbui fr (Il} Stale lip. r p►Y t Attach a copy of the workers"compensation policy declaration page(showing the polies number and expiration date,. Failure to secure coverage as required under M(iL c_ 152,§25A is a criminal violation punishable by a tine up to SI.S00.00 and or one-year imprisonment,as well as civil penalties in the titnn of a STOP WORK ORDER and a tine of up to S250.00 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 c •antler t e ins and penalties of perju)•that the information provided bore is true and correct. Signature: ( / / � / ('y '��f� Daft::: �-L? z3 Phone : - ` 3 !�I tJ �'7 7 I� Official use only. Do nut write in this area,to be completed by,city or town officiaL ('its ur Town: Permitil icense rl Issuing:authority (circle one): I. Board of Health 2.Building Ikpartment 3.(its Jima Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other ( intact Person: Phone#: Beaulieu HOME IMPROVEMENT, INC. SCE. 1Y6; [Quoted text hidden] ass S 60 (1 J.