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15B-025 BP-2023-0981 112 CHESTERFIELD RD COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 15B-025-001 CITY OF NORTHA PTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0981 PERMISSIO IS HEREBY GRANTED TO: Project# PORCH REPAIRS 2023 Contractor: License: Est. Cost: 33061 CHRISTOPHER JAC BS 60475 Const.Class: Exp.Date: 11/10/202 Use Group: Owner: A GR AM PETER L &ELIZABETH Lot Size (sq.ft.) Zoning: URA Applicant: BARR &JACOBS Applicant Address Phone: Insurance: 420 NORTH MAIN ST 413-586-8998 WMZ80080063652022A LEEDS, MA 01053 ISSUED ON: 07/26/2023 TO PERFORM THE FOLLOWING WORK: REPAIRS TO SILL,PORCH 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: • 1 . «CJJJ��� I Fees Paid: $221.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commissi ner RECEIVED ,et-ftet„Go7 I 2 5 2023 The ommonwealth of Massachusetts Bo d o Building Regulations and Standards FOR MUNICIPALITY =, f sac setts State Building Code, 780 CMR USE o PT OF BUILDING INSPECTIONS NORT.t i t.t. i t, S„A 9,li•:tion To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 One- or Two-Family Dwelling This Section For Official Use Only Building Permit Number: A 3 '��/ Date Applied: 400 /0.55 7-Z/-202.3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 1\2, Lv\ v.LS-ovl 1.la Is this an accepted street?yes Y no Map Number Parcel Number 1.3 3yn"g Information: 1.4 Property Dimensions: Zoning District Propose se Lot Area(sq ft) Frontage(ft) • 1.5 Building Setbacks(ft) no tAeNAyseyJc`. ‘5� Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2. Ownerl of_Record: Name(Print) City,State,ZIP \\'L Canati �C,Ci1 L c-Ak (0ft- 'fob-S$t(i." 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) II Alteration(s) ❑ Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: "`I' � etci S� 0:nA; �n I 1 D kzus—. TD to, c'cci.ss si1\yac \\ rce.L r 1erna "ar,N; �vonn }'1�•� 1po�rt , O' \atid- we. c'i.c -�.� SAkIND,r\- it c -�,,p.�-4-. NeW �rrc.H kWticext vJ SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item (Labor and Materials) Official Use Only 1.Building $ 15)),O6 ` 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Aplicationj Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ _ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No.2541 Check Amount: / Cash Amount: 6.Total Project Cost: $ "2), 06 k ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS' OWE AlS \111011'`1 C_Ae\C‘5\-0.0•42..r 5O.C�119.5 License Number Expiration Date Name of CSL Holder List CSL Type(see below) (Au, - No.and Street Type Description . a M� b�,05� U Unrestricted(Buildings up to 35,000 Cu.ft.) Le_eR Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances Ls• Y off vc)r•a1NAJev-4-As wW^ I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) r I00 b ,yy1_' ` baY " �� S P1 �� �•O trr HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name ' 142. N .{V A-Vr .►'�ft_ c,Lb No.and Street Email address Loedft N� ��53 co-5k-vrlif 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 Q No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTORp _ APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize ✓OYY ty, i"-S0.cebo. to act on my behalf,in all matters relative to work authorized by this building permit application. Sp e ti oC,1�a 49L �J1 10 Print Owner's Name(Electroni�'9 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' Print Owner's or Authorized Agent's Name(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" SIGNATURES By signing below,you agree to items A. B and C. DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACE'. A. Alternative Dispute Settlement(Arbitration Clause): The Seller and the Buy r hereby mutually agree, in advance,that in the event of a dispute concerning this Agreement,the parties shall submit such .ispute to a professional,state-approved arbitration� service(cost, if any,to be paid by the submitter)prior to either party proceeding to legal action in the courts. t mng gr t.you,as th authorize-a agent in all matters pertaining to the >uilding permit application. e v of are hereby authorizin `� Barron&Jacobs Associates Inc.to act ion. C. This is a binding Agreement. You may not cancel it except as stated. This Agreement covers and supersedes all conversations,statements and agreements,expressed or implied,between the parties heir agents or representatives. r „�— G - ` - % `3 You,the Buyer,may cancel this transaction Bu.cr Date at any time prior to midnight of the third —7 p n business day after the date of this transaction. �`� `/ (b'y __ `J I/nC.a(`3U9-3 See the attached notice of cancellation form u.c. fate for an explanation of this right. Seller retains an equal right to cancel. cc: h. 3/, ;,x;?-5 Bair &Jacobs Re resen H. t) Contact Information Office Manager: Sandy Scavotto Office:413-586-8998,x102 ❑ Chris Jacobs,President CT HIS#0554397 Cell phone:413-250-6677 Office phone ext: 100 Home phone:413-665-9113 ® lesha Gomillion,Senior Designer Cell phone:413-923-7003 Office phone ext: 104 MA Construction Supervisor License 060475 MA Home Improvement Contractor 100809 CT Home Improvement Contractor 518617 Purchase Agreement Page 10 of 10 , 1 '1. 1 - mt 1 / �1 /// i 1 J '1 .f i; I .- fI • �y'Z' f dEll/ f 1 /' 1♦ t ' l e i ' ' k.ft is 4 ..� fi . 1• !I • t ' lk k, d' t h t i y� • ,.. k ' �V� f .......:.y-,-- - ,, , , ,- i. - ik, ., H... — .. ..,s,„-:: 1 0 ,f',.1 'yj f, "." j { oohs 1• I `a A. .a ` 2 DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit # was issued with the condition that all debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L c. 111, s. 150A. The debris will be disposed of in: ( \\ 9-12 � Name of Waste�acility Address of Waste Facility 111.5 Debris: As a condition of issuing a permit for the demolition, renovation, rehabilitation or other alteration of a building or structure. M.G.L. c. 40 s. 54 requires that the debris resulting therefrom shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L.c. 1 l I s. 150 A.Signature of the permit applicant, date and number of the building permit to be issued shall be indicated on a form provided by the Building Department and attached to the office copy of the building permit retained by the Building Department. If the debris will not be disposed of as indicated, the holder of the permit shall notify the building official, in writing,as to the location where the debris will be disposed. 780 CMR—6th Edition Signature of Permit Applicant ) c--12--') Date A`CORCP CERTIFICATE OF LIABILITY INSURANCE DATEIMM/DD/YYYY) 03/03/2022 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 Adina Edgett.CISR NAME: Webber&Grinnell Ho N,Ertl: (413)586-0111 FAic,No): (413)586-6481 8 North King Street E MAIL aedgett@webberandgrinnell corn ADDRESS: INSURERS)AFFORDING COVERAGE NAIC M Northampton MA 01060 INSURER A: Main Street America/MSA 29939 INSURED INSURER B: NGM/MSA Barron&Jacobs Assoc Inc INSURER C: A.I.M Mutual/A I M 33758 420 N Main Street INSURER D: INSURER E: Leeds MA 01053 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 03/24 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 ADDLSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD _(MWDD/YYYY) (MWDDIYYYY) X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE 5DAMAGE T 1,000,000 ED CLAIMS-MADE X OCCUR PREMISESO(EaENi occu occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A MPT8049D 03/09/2023 03/09/2024 PERSONAL a ADV INJURY $ 1.000.000 GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 3,000,000 POLICY PRO 3,000,000 JECT LOC PRODUCTS-COMP/OPAGG S OTHER EPLI $ 10,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) S 1,000,000 B OWNED X SCHEDULED M 1 T8049D 03/09/2023 03/09/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE S B EXCESS LIAB CLAIMS-MADE CUT8049D 03/09/2023 03/09/2024 AGGREGATE S DED X RETENTION $ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN 500.000 C ANYCER/MEETOR/PARTNER/EXECUTIVE N N/A WMZ80080063652022A 03/01/2023 03/01/2024 EL EACH ACCIDENT S OFFICER/MEMBER EXCLUDED (Mandatory In NH) E L DISEASE-EA EMPLOYEE $ 500,000 If yes descnbe under 500,000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S I l DESCRIPTION OF OPERATIONS/LOCATIONS I 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 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD . The Commonwealth of Massachusetts 9 , ili Department of Industrial Accidents If 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): ?)A '.-1 - Ar-,ct 'Sfr t c 5 .�SS:�(,,cli.. -Cr....- Address: l k2-L) N;\(kv. any.\ ( t • City/State/Zip: leek-S r' 1 - 0\o Y) Phone#: ►'(1 -S$ZQ- V.-VI X Are you an employer?Check the appropriate box: Type of project(required): I.n I am a employer with 10 employees(full and/or part-time).* 7. EI New construction 2.01 m I am a sole proprietor or partnership and have no employees working for e in any capacity.[No workers'comp.insurance required.] g• Remodeling 9. ❑Demolition 3.E3 I am a homeowner doing all work myself[No workers'comp.insurance required.]' 10 Q Building addition 4.❑I 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 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 50 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13..0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.: ,p 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c 14.tPther r�,,,i) 152,§1(4),and we have no employees.[No workers'comp.insurance required.] T' *Any applicant that checks box NI 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 contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: fl \ My ".\ Policy#or Self-ins.Lic.#: Wi'V ?2 VD f(01)(p'�j /-01;2-Pc Expiration Date: 'j I t I iO2Lj Job Site Address: I I Z .S• T OA._ I City/State/Zip: Lo../2 )(.3� iv - 0 VO S 3 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 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains penalties/ of perjury that the information provided above is true and correct Signature: i!/�/ Date: "1" (2c 1 Z Phone#: 1-5 - S %- (121°1`� Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other ' Contact Person: Phone#: Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards Cons rvisor CS-060475 spires: 11/10/2024 CHRISTOPH§R F 420 NORTH MAIN LEEDS MA 04, et• A.OT.LKd�1�J Commissioner ,/, / F✓n THE COMMONWEALTH OF MAX ACHUSETTS Oirnx of Consumer Affair.and E u ine&. Regulation 1000 Wwh ngt n Street- Suite 710 Boston. M base€t i 02118 Horne Improvement Contractor Reek tration 4 Tyne- Corporation BARRON Si JAC+OB$A.MOCIATE3 INC- Mt00008 106f222o24 420 NORTH MAIN Li I HtET FErc MA 01053 � + Update Adorers sold Maths ttitt THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Regrtration valid fp indivitaYal y only before the HOME(IMPROVE T,CONTRACTOR e><pirItYon mete. rf+Dodd return to: TYPE:,Mwrabon Office of Consumer Affair and Busar.ess Re/platoon Rlgianstio t ,. expiration tfi[In Washington Sner t -SAMe 710 100500 4E2Z2teA orisio i,MA Gel In BARRON&JACOBS AL:ttlOiATES.INC. 13ttRY57 TH moon Jn s-rBS ne 2�^,0 AtlprATH MAYN�TREE7 0(2 LEEDS.MA 01053 Udder„ ubs iry Not valid wit signature Barron & Ja .obs DESIGN . BUILD . RE IODEL Dear Code Official, Enclosed please find an application and supporting documen ation for a requested building permit. i 1,arP PnrinePr� a ePlf_arlrlrPceari stamped_ envelope forte�nn enie 1!P Please ,,,a;i t too office. Th n1_you. Sincerely, \14-/- 0\\\ C-1t`na-' Q� �t-,, ;, v r- ` c ', Chris Jacobs A Tradition of Building Satisfaction, ''nce 1986 420 North Main Street, Leeds, Massachusetts 01053 413.'86.8998 barronandjacobs.com