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11A-044 (2)
BP-2023-0730 58 FRONT ST COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 11A-044-001 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-2023-0730 PERMISSION S HEREBY GRANTED TO: Project# REMOVE WINDOW 2023 Contractor: License: HAYDENVILLE W DWORKING & Est. Cost: 19540 DESIGN INC 116208 Const.Class: Exp.Date: 04/13/2025 Use Group: Owner: OTO B NTON SCOTT STUART &AKIYO Lot Size (sq.ft.) Zoning: URA Applicant: HAYDE LLE WOODWORKING &DESIGN INC Applicant Address Phone: Insurance: 35 CONZ ST (413)665-7402 WMZ-800-8007423-2022 NORTHAMPTON, MA 01060 ISSUED ON: 06/05/2023 TO PERFORM THE FOLLOWING WORK: REMOVE WINDOW IN KITCHEN 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: • >9 Fees Paid: $130.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commiss.oner c TheCommonwealth ofass cus s /M h r✓ J �� FOR „th Board of Building Regulations Stiv ds ` IPALITY Massachusetts State Building Code, e ry G? 0 SE Building Permit Application To Construct,Repair,Reno it) coolish a Rev sed Mar 2011 One-or Two-Family Dwelling � so0 This Section For Official Use Only A°'0Z/°tis Building Permit Number: 0 013- 734 Date Applied: 4_5_zoz, Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 58 Front St., Leeds 1.1a Is this an accepted street?yea-- 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 DX On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Scott Benton Leeds, MA 01053 Name(Print) City,State,ZIP 58 Front St. 413-552-6664 benton.oto@gmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) C3c Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify: Brief Description of Proposed Work': R¢,Meve,._L,Jtnr)nuJ.in peah 40 en' 04.01 (b f rXJ Q"'a(� k lat hor- (4.—20-p_ d slcKr,3 to Mge\- VArk\4,108 cede- qu. me -S.. - SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 19,540. 1. Building Permit Fee:$ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ 0 0 Total Project Cost3(Itetn.6)x multiplier x 3.Plumbing $ 0 2. Other Fees: $ 4.Mechanical (HVAC) $ 0 List: 5.Mechanical(Fire $ Suppression) 0 Total All Fees: Check No.11 heck Amount Cash Amount: 6.Total Project Cost: S 19,540. ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) I 116208 4/13/2025 Zinnia Wu Stetson License Number Expiration Date Name of CSL Holder List CSL Type(see below)U 35 Conz St. No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) Northampton, MA 01060 R Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Window WS Windodo a S w and Siding SF Solid Fuel Burning Appliances 413-665-7402 zinnia@HaydenvilleWD.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 110732 11/02/2024 Haydenville Woodworking&Design, Inc./Zinnia Stetson HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 35 Conz St., zinnia@HaydenvilleWD.com No.and Street 413-665-7402 Email address Northampton, MA 01060 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 ❑ 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 Haydenville Woodworking &Design, Inc./Zinnia Stetson to act on my behalf,in all ers relative to work authorized by this building permit application. Print Owner's Name(Electronic ignature) 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. Pri woe orred Authorized Agent's Name(Electronic Signature) Date g gn 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 Exit►x ° Department of Industrial Accidents 1� rb 1 Congress Street,Suite 100 roes• Boston. MA 02114-2017 www.mass.go►r/dia 11 a►kers'Compensation Insurance. ffidas it:Bulkiers/ContractorsrFkctriciana/l'lumbers. 10 HI FILED V.l i 11 I HE: 1'ER:%ll'ITING Al IDORI fi. Applicant Information Phase Print Letlhly Name I lttaslncss(lnanizatt.rn Individual►: Address: City/State/Zip: Phone#: Art you an employer?Check the apprupriate hose Ty pe of project(required): 1 1 am a ciarloycr with employees tlull and or plat-tatnel.• 7. ❑\e''. construction 20 I an,a sole prviprictcx or partnership and have no employ ce,Narking hor Inc in u.53 Rettlodeling any capacity.[No Ncxkers'cline.lnsuranie required] 9. ❑ Demolition I aIll a 11ortwVssrer doing all Nock ins self.[No nmisers'comp.insurance regturesl.] ID❑ Building addition 4.❑I am a hcaias'u rer and N ill be hiring.x.ntraetors to conduct all N ca k on my property. I is ill anon that all contractors either inic Norkcrs'coin's:nsatis t uuurance as an;sok 11.❑ Electrical repairs or additions proprietors ss ith no eniployeeu- 12.❑Plumbing repairs or additions 50 I ant a general contractor and I ha%e hind the sub-contractors listed on the attached sheet. Ihese sue-contractors h4'..:employees and ha%c Noilers'scarp.insurance.' 131:11 Roof repairs 6.0 We e aeorporaiion and its tinkers has a exercised tleu right of exemption per MOL t_ 14.❑Other at 152.t!1(4).and Nc lase nu eniployees.[No N orkcrs•calm.,n ancc required) *Any applicant that checks box n I must also till out the section beton%honing their N orkcrs eoirip:nsation liol eel intocination. Mimes+tiers+s ho submit this atYlds%tt indicating they ate doing all u oik and then hue outside.ontrastors must submit a iwu afttda%it irxhis:ming suck :conti:ktors that cheek this box must attached an additional sheet stuns in:the nano of the sub-eolitta.tixs and state sshwt er or not those.entities hase cmrby.es. It the suh-comicactoes have curio)oes.they must prosid.their solkrr,'eoair.p+lhcy nuunh ei. /am an employer that is providing workers'compensation insurance for my employees. Below is the police'and job►ite information. lnsutatice Company Name: 14 1\k. — Of Self=ins.Lic.#: 1,4/VI — 'OO g1)03 L123--2-02.2A Expiration Date: 17-- I— 2Q. lob Site Address: ) S'l i -S 4163tibfkrr City State'Zip: Vec,4S /vim 0 t0 S� Attach a copy of the workers"compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152.§25A is a criminal violation punishable by a tine up to S15(KI.00 and.'or one-year imprisonment.as vv ell as civ it penalties in the torn 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 flea%aided to the Office of Ins estigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: # — Date: Phone is ` SA-5-3 -5? OJrcial use only. Do not write in this area,to be completed by city or town oJJicial. Cite or-Town: Permit/License 4 Issuing Authority (circle one): I. Board of health 2. Building Department 3.City/limn Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other (*outset Person: Phone#: City of Northampton �Q[HAMP,o\, ,� ... .,SI s ' Massachusetts Q}S k c'c� VA ti 'd' l , t� �} DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building SJ ' C. Northampton, MA 01060 sb4-3;%j(� 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: The debris will be transported by: Name of Hauler: ,74/►q/1 -61--7PGfa/rj Signature of Applicant: - —_ Date: W '' 'ts Haydcnsillc WoodworkingRc Design.Inc. , l a n �a 'i00 5C _ .• w• • „ fi n M•711 ;. .+/wi{san •w• .e �.�:e i•N Skill • .•, 35 Conz Street No thampton,MA 01060,t:,' 413.665.7402(eke) • 413.270.5890(cer) C .ATt AMC oBY PATE V'rg , , 888 Acuc4t1ed Business _ }• uccrxonr_.., r `„ DATE ram.—. r • VRf 1'14r� ter+ ,i..,,,k ( 1 •-• ":y - 1 *C4:6-. ! /I t/ }, 8 ` s=, . j c 1 r ^ "INj l O , • F al4 0 `b w i.f • ` , tr • A , O u 7 a. .. A oas4 0 ? N - - �. ... Zs.Zs. 1� T i V'eCl ` O c, ,.tg 4, — —i 1 f., \ e. ,...* c, •• 4 + ^ Q. .. �, liN.Oe: 1 nOr. Q3-- y gyp& tr.' q 3 :r:k 0 40 fl- r THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE: Corporation Registration Expiration 110732 ' 11/02/2024 HAYDENVILLE WOODWORKING & DESIGN, INC. ZINNIA STETSON _ .� 'tti ,' 35 CONZ STREET : ;'' �� i �� NORTHAMPTON, MA 01060 i;.; Undersecretary Registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, MA 02118 o 1/114 N t v d without signature Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards `,io[r Constp+ccin SVvisor CS-116208 6ficpires:0411 3120 2 5 ZINNIA WU SJETSON v 1 HADFIELD AD SOUTH DEERFIELD MA 01373 :.%, rill) i a l'7t'.1A Commissioner 'iu a f. 1frn,7'n Construction Supervisor Unrestricted-Buildings of any use group which contain less than 36,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code Is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl 4 AC RO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 2/9/2023 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 CONTACT NAME: AXIA INSURANCE SERVICES INC PHONE 413-788-9000 FAX (A/C,No,Ert): I (A/C,No): 84 MYRON ST SUITE A E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# WEST SPRNGFIELD MA 01089 _-- - — --- —"" INSURER A: SELECTIVE INS CO OF AMERICA 12572 INSURED INSURER B HAYDENVILLE WOODWORKING INSURER C: 35 CONZ ST INSURER D: INSURER E: NORTHAMPTON MA 01060-3803 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 POLICY EFF POLICY EXP LIMITS LTR 1NSD WVD POLICY NUMBER IMM/DD/YYYY) (MM/DD/YYYY), x COMMERCIAL GENERAL LIABILITY X S 2377902 12/1/2022 12/1/2023 EACH OCCURRENCE DAMAGE TO RENTED $ 1,000,000 CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $ 500,000 MED EXP(Any one person) $ 15,000 A PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X JECOT X LOC PRODUCTS-COMP/OP AGG E 2,000,000 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ ONLY AUTOS ONLY (Per accident) A X UMBRELLA LIAB X OCCUR S 2377902 12/1/2022 12/1/2023 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED X I RETENTION$ZXRO $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I NI I STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) 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. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: ACORO ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED AXIA INSURANCE SERVICES INC HAYDENVILLE WOODWORKING POLICY NUMBER 35 CONZ ST S 2377902 CARRIER NAICCODE NORTHAMPTON MA 01060-3803 SELECTIVE INS CO OF AMERICA 12572 EFFECTIVE DATE: 12/1/2022 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE:CERTIFICATE OF LIABILITY INSURANCE JOB # JOB LOCATION ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD