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36-297 (10) BP-2023-0853 41 SOVEREIGN WAY COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 36-297-001 CITY OF NORTHAMPTON Permit: Acc Structure PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0853 PERMISSION IS HEREBY GRANTED TO: Project# SHED Contractor: License: Est. Cost: 10710 HOMETOWN STRUCTURES 98186 Const.Class: Exp.Date: 08/03/2023 Use Group: Owner: TRUSTEE JACOBSON JUDITH C Lot Size (sq.ft.) Zoning: WSP Applicant: HOMETOWN STRUCTURES Applicant Address Phone: Insurance: 627 SOUTHAMPTON RD 4135627171 WCC-500-5026065 WESTFIELD, MA 01085 ISSUED ON: 06/29/2023 TO PERFORM THE FOLLOWING WORK: 12X20 SHED 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: k4ftioi I cf,t r A t r 1/ Fees Paid: $48.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner Z. -OR File #BP-2023-0853 APPLICANT/CONTACT PERSON:HOMETOWN STRUCTURES 627 SOUTHAMPTON RD WESTFIELD, MA 01085 4135627171 PROPERTY LOCATION 41 SOVEREIGN WAY MAP:LOT 36-297-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $48.00 Type of Construction: 12X20 SHED 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: u Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Spe•'al Permit With Site Plan Major Project: Site Plan AND/OR Spec al Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Va •nce* 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 •otability Board of Health Permit from Conservation Commission Permit f i m CB Architecture Committee Permit from Elm Street Commission Permit D'W Storm Water Management Demolition Delay (arm& j27 / 6/afa,2 Signhture of Building Official / Date Note: Issuance of a Zoning permit does not relieve a applicant's burde to comply with all zoning requirements and obtain all required permits from Board of Health,C nservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. The Commonwealth of Mass hus ,U c, Board of Building Regulations and n A ip ,. c�j F R Massachusetts State Building Code, 780 otic UN USE IPALITY Building Permit Application To Construct,Repair,Renovate T iN:.•y . R sed Mar 2011 One- or Two-Family Dwelling O'Qso/ONs ThiQ Q--`' n For Official Use Only Building Permit Number: 9)/` p? 3-• `2 - Date Applied: Official .i It tr: 6/d(PrintDatA Building Name) Signature SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 1/ISarer,,j W0, F/dr cnCe.., MA 0104 36 2R7- 00 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 013Information: 1 61 1.4 Property Dimensions: -C'+ Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provid d Required Provided 211 ' 1- Uzi' lzy 5004 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Informati n: 1.8 Sewage Disposal System: Public Private El Municipal_ Outside Flood Zone? Municipal H On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: CTtid41, C 7acabson Triis1 ee Flor.e,ac e 4 oio&2 Name(Print) City,State,ZIP` 'i/ Sovere3n r '-1I3-5GZ-oy70 Judccjacobson0gmai'l.cam 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) 0 Addition 0 Demolition 0 Accessory Bldg. ' Number of Units Other, 0 Specify: Brief Description of Proposed Work': (nnS+rac4;Oil OP dea d aCcessory rad r( (9ha) Size 1Zx20 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 'O/ 7/0, 00 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee .- _ — 0 Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ _ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ # 4Cash Check No71 heck Amount: Amount: 6.Total Project Cost: $ /0/ -710.. 00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVIC S 5.1 Construction Supervisor License(CSL) CS- o g )8to/ g/3 )2.1 A, fAreL4) . K v r t z. License Num..r Expiration Date Name of CSL Holder I I 8 PIeck fQni List CSL Type see below) V s+ree4 No.and Street Type Description (niQ f r U nrestricted(Buildings up to 35,000 Cu.ft.) G('An�y R ' -stricted 1&2 Family Dwelling City/Town,Slate,ZIP M asonry RC 'oofing Covering WS indow and Siding SF Slid Fuel Burning Appliances I I sulation Telephone Email address D Demolition 5.21''Registered Home Improvement Contractor(HIC) )sq 7 7 Z S 24120 Z / /'i'Ofl l'f otvn -Tr a-tireS Lk HIC Registration Number xpiration Date MC CompanyName or HIC Registrant Name (027 O" ka"tP)"" Koad Qndrew@AQ, t4oLvoS4nvcslvres'•can No.and S,reIt� I o 0 gs u/g-s.2_71' Email address WCi+ c A, J� 7 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 id/ No . 0 i SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIESL FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize J4cvvie in S4r1._k rej L,LC. to act on my behalf,in all matt elative to work authorized by this building permit application. 40 --0/..g_i71---" G -2 g- 23 Print ner's Name(Electro ' �gnature) 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. G .t., 6 -2 - 23 Print Owner's or Authorized Agen ame(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.) 2(p (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces J Number of bedrooms Number of bathrooms / Number of half/baths Type of heating system r Number of decks/porches Type of cooling system I Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" Commonwealth of Massachusetts® Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-098186 Expires:08/0312023 ANDREW D KURTZ 118 PLEASANT STREET. 7:i • GRANBY MA 01033 r Commissioner jittetrit K. t14nc1Ca, THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC HOMETOWN STRUCTURES, LLC Re xpiration: 059772 627 SOUTHAMPTON RD Expiration: 05/26/2024 WESTFIELD, MA 01085 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:LLC Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 159772 05/26/2024 Boston,MA 02118 HOMETOWN STRUCTURES,LLC HA 627 627 SOUTHAMPTON RD S� �t'.c :zl40,4" WESTFIELD, MA 01085 Undersecretary Not valid without ature The Commonwealth of Massachusetts Il _*_•WM= Department of Industrial Accidents _= 1_ 1 Congress Street,Suite 10 t,_..{= Boston,MA 02114-2017 ',�= www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Cont actors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING A THORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):Hometown Structures Address:627 Southampton Road City/State/Zip:Westfield, MA 01085 Phone #:413-562-7171 Are you an employer?Check the appropriate box: Type of project(required): LID 1 am a employer with 22 employees(full and/or part-time).* 7. ❑New construction 2.01 am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10 ❑ Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.1=I Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 14.❑✓ Other accessory building 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside co tractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-con ctors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy umber. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:The Dowd Agencies, LLC Policy#or Self-ins.Lic.#:WCC-500-5026065-2022A Expiration Date: 11/27/2023 Job Site Address:41 Sovereign Way City/State/Zip:Florence, MA 01062 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 vi lation 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 ORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Offi a of Investigations 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: "L....i/c Date: Co de- d(.' 3 Phone#:413-562-7171 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.El rical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone : Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 I'el. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800) 876-2765 NCCI NO 40959 POLICY NO. I WCC-500-5026065-2022A PRIOR NO. WCC-500-5026065-2021A ITEM 1. The Insured: Hometown Structures Inc DBA: Mailing address: 627 Southampton Road • FEIN:**-***6332 Westfield, MA 01085 Legal Entity Type: Corporation Other workplaces not shown above: 2. The policy period is from 11/27/2022 to 11/27/2023 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06.B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration I Remuneration Premium INTRA 000337067 INTER SEE1 CLASS CODE SCHED4E Minimum Premium $500 Total Estimated Annual Premium $27,385 GOV GOV Deposit Premium $7,076 'STATE 'CLASS MA 2802 State Assessments/Surcharges $21,986.00 x 4.1800% $919 This policy, including all endorsements,is hereby countersigned by -- --- � 10/19/2022 Authorized ignature Date Service Office: The Dowd Agencies LLC 54 Third Avenue 14 Bobala Road Burlington MA 01803 Holyoke, MA 01040 WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation Insurance, used with its permission. z`I Coverage Is Provided In: Policy Number: liberty Ohio Security Insurance Company BKS (22) 5818 9460 Mutual. Policy Period: INSURANCE From 12/01/2021 To 12/01/2022 1Commercial General Liability In Standard Time at Inssurree d Mailing Location Declarations Basis:Occurrence Named Insured Agent HOMETOWN STRUCTURES LLC (866) 636-0244 BERKSHIRE INSURANCE GROUP INC - WESFFIELD MA SUMMARY OF LIMITS AND CHARGES Commercial DESCRIPTION LIMIT General Each Occurrence Limit 1,000,000 Liability Damage To Premises Rented To You Limit (Any One Premises) 100,000 Limits of Insurance Medical Expense Limit (Any One Person) 15,000 Personal and Advertising Injury Limit 1,000,000 General Aggregate Limit (Other than Products -Completed Operations) 2,000,000 Products-Completed Operations Aggregate Limit 2,000,000 Explanation of DESCRIPTION PREMIUM Charges General Liability Schedule Totals 16,090.00 Certified Acts of Terrorism Coverage 161.00 Total Advance Charges: $16,251.00 Note: This is not a bill To report a claim, call your Agent or 1-844-325-2467 DS70220108 10/03i21 58189460 POI SVCS 450 PCXOPPNO INSUNLO COPY 000634 PAGE 73 OF 248 a) 41 r'' I 114' 12x20shed 211' 124' 0 J f� s Owner: JACOBSON JUDITH C TRUSTEE Address: 1 Sovereign Way,Florence,MA 01062 Parcel ID: 3 -297-001 �J Use Code: 1 1 Acres: 1 495 according to GIS public record ( ctually closer to 7.1 acres) Zoning: SP Water/Sewer: unicipal +„ri Road . , .. . . Keystone �a • _ . TER BE Choose a Keystone Series Style Shed for: • Time-Proven Simple Designs.Virtually the same • Solid 2x6 Headers Over Doors. tried and true styles we've used since 2000. No sagging doorways. • Smaller Overhangs. • Built to the MA Code.Worry-free ownership. Less bold, more subdued appearance. • Full Dimension. Don't settle for 11'6" wide when • Build for the Snow Loads in Massachusetts. you pay for 12' wide! 11 No sagging ridge lines. • Fully Customizable. So it can be uniquely yours. y I- L .2. ea Ridge vent ,i -y y a) 30-year — ..... 2" x 4" rafters, • architectural . • 16" on center ci shingles over `` with collar ties, cu 1/2" CDX �`' - 4' center. 0 plywood roof • a sheeting a) 4 geP?--4 4 Double 2" x 4" top wall plate, Exclusive detailing, ¢ t 2" x 4" wall studs painted eaves, and wood corners 16" on center 4 I, - 'ice 11114 Double 2" x 6" Pressure-treated floor header over doors • system, 4" x 4" rails, i ' joists 12" on center with 3/4" plywood. 1/2" T1-11 fastened with galvanized nails, exterior acrylic latex paint—or 1/2" CDX with vinyl 15 Hometown Structures Sales Order 627 Southampton Road Westfield, MA 01085 Order: 0-12598 n �j (413) 562-7171 Date: 6/21/2023 �1 www.hometownstructures.com Lead Time: 3-4 weeks Sold by: Darvin Martin —Structure Layout (not to scale) Deliver To: Custom Built Assembled Jude Jacobson 41 Sovereign Way Wood Shed Florence, MA 01062 Keystone Cape Phone: (413) 563-0470 Email:judecjacobson@gmail.com 12x20 r .- 1 Colors Types Description Qty Rate Amount Tax Siding Red Floors,Walls, Roof 7,785.00 Roof Dual Gray Base Keystone Cape 12 x 20 (included) T Drip edge Brown Floor 2x4 Joists, spaced every 12" (included) T Trim Red Siding Wood LP SmartSide T1-11 Siding (included) T Corners Red Roof Architectural Shingles (included) T Doors Red Doors&Windows 1,450.00 Windows Brown Doors Wooden 72x72 Double Door T-F 1 550.00 550.00 T Doors Wooden 72x72 Double Door T-D 1 400.00 400.00 T Windows Transom Window 10 x 23 1 4 50.00 200.00 T Notes: Windows Standard Window 24 x 36 4 75.00 300.00 T Windows to have transoms Accessories 1,785.00 overtop. Keep up against top Ramp 6' wide x 4'deep Ramp 2 160.00 320.00 T plate of wall. Cupola Morton 24" PVC 1 1,005.00 1,005.00 T -metal roof, copper penny large hinges -cutout -screening Cupola Weathervane 1 340.00 340.00 T Graceful Blue Heron#1971P Misc Synchrony 12 month financing 1 120.00 120.00 Adjustments -350.00 Discount Instant Rebate! (valid for 30 days) 1 -350.00 -350.00 T Services 1,125.00 Site Prep Stone pad 12 x 20 plus 12" Margin 1 1,085.00 1,085.00 Delivery Overwidth Permits 1 40.00 40.00 Receipts Subtotal $11,795.00 6/21/2023 Check $4,000.00 MA Tax 6.25% $659.38 Total $12,454.38 Receipts $4,000.00 Balance $8,454.38 Additional Images for 0-12598 Rendering Weathervane 1111111 no as 'al 111 ow II 0 1111 1110 GRACEFUL BLUE HERON' - 1971 P We '7 a 34 21•L X 18"11 X 2.'N' Cupola, Morton Window style