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43-165
BP-2023-1424 48 GREENLEAF DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 43-165-001 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-2023-1424 PERMISSION IS HEREBY GRANTED TO: Project# SIDING 2023 Contractor: License: BERNIE DRAPEAU HOME Est. Cost: 32000 IMPROVEMENTS 087891 Const.Class: Exp.Date: 10/03/2025 Use Group: Owner: OSTBERG ROBERT K&CAROL PETO-OSTBERG Lot Size (sq.ft.) Zoning: WSP Applicant: BERME DRAPEAU HOME IMPROVEMENTS Applicant Address Phone: Insurance: 116 LATHROP ST (413)348-0596 WCT3188R SOUTH HADLEY, MA 01075 ISSUED ON: 10/13/2023 TO PERFORM THE FOLLOWING WORK: VINYL SIDING 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: (' ' � ' o � � u0 Fees Paid: $60.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner Oct i$y //i The Commonwealth of Ma .cl s / �4r � 6 Board of Building Regulations an. ' c.:',. .s a FOR V➢�N3 Massachusetts State Building Code, 7: ! Air ti� 0�� M CUISPALITY Building Permit Application To Construct,Repair, Renova - I 00):. olis, a evised Mar 2011 One-or Two-Family Dwelling Co 0r0 This__Srtion For Official Use Only Building Permit Number: &^ A i -/ti,r Date Applied: 414.-.) , 5 /D-IZ-zoz3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Kroperg Ad`drrees`p 1.2 Assessors Map& Parcel Numbers 1.1a�Iss 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❑ SECTION 2: PROPERTY OWNERSHIP' 2gOwner'of RecQrd: do 4- C44vlo1 Osf6s-e ye C fsdinf /laser1.pplc--, caa6() Name(Print) City,State,ZIP if 61(5 1 /,Ai Yi3 575 33e,q No.and Street Telephone Email Address SECTION 3: DESCRIPT3PN OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 1r Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': [4,4to vY /Sili1 I//N /, 5/D/K MO fc,u .. 1 nSlo II t?5w VINY/ Si Nob; i4/kksliti t fAii+% i sor 1/ freA tro-c iA SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All FpfisA Check No. ' Check Amount. ) Cash Amount: 6.Total Project Cost: $ 3 dZ,coo 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS`d$ TQq 3 c S bez am 121514"( License Number Expi ati Date Name of CSL Holder / /& D N I "o.and Street List CSL Type(see below) A / Type Description S' R\I� O C U Unrestricted(Buildings up to 35,000 Cu.ft.) l U �/ � J V R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 4/3 3c/b D 5% 60rurot,(3377()c VM/J►/(�014•‘ I Insulation Telephone Email addr s D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1 SS y a a as ILL 1 Ak oti �tirlQ�✓� �N'' HIC Registration Number xpir ion Date HIC Company or HIC Registrant Name l�G� / s� 690er,k.,33r7a ,rot f•COW\ No.an Stre7i42,t Email ess 5• rhA p►0?� y/334EA:16 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 Issu of the building permit. Signed Affidavit Attached? Yes 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 to act on my behalf,in all matters relative to work authorized by this building permit application. apt, a erlilD1 OS/4W _ /o/e/; 3 Print Owner's Name(Electronic Signature) I 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. 4 C' ! DSII fi 2 /0/e/a3 Print Owner's or Authorized Agent's Name(Elecifonic 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" City of Northampton °K H a MP 01< S,S �� S1C Massachusetts ''-- 'C' y '<• { a . ii DEPARTMENT OF BUILDING INSPECTIONS y '� '�: -�} f 212 Main Street • Municipal Building JR Q. Y Northampton, MA 01060 SSbjy TON1N 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: Yte) Mu v G-.o' 7� i1q/(?v The debris will be transported by: Name of Hauler: 11 -u.) :e'1 illo o tU,is( Signature of Applicant: L....S._ Date: PA 23 � � DATE(MM/DD/YYYY) ACC CERTIFICATE OF LIABILITY INSURANCE 07/17/23 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: Jenny Murdza Metras Insurance Agency itkic.HO No.Ext): 413-536-1491 FAX No): 413-532-8522 2030 Memorial Drive E-MAIL Chicopee, ADDRESS: jmurdzalametrasinsurance.com MA 01020 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: NGM Insurance INSURED INSURER B: BERNIE DRAPEAU INSURER C: HOME IMPROVEMENTS INC INSURER D: 116 LATHROP STREET SOUTH HADLEY,MA 01075-3306 INSURER E: 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. IN TR S POLICY EFF POLICY EXP TYPE OF INSURANCE N W SD VD POLICY NUMBER L LIMITS (MMIDD/YYYY) (MMIDDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE CLAIMS-MADE 1-1 OCCURPREMISESO(Ea oicccuE re $ 500,000 MED EXP(Any one person) $ 10,000 A MPT3188R 03/09/23 03/09/24 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- . LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 500,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A AUTOS ONLY AUTOS AWNED X SCHEDULED M1T3188R 03/09/23 03/09/24 BODILY INJURY(Per accident) $ xHIRED x NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY _ AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? N/A WCT3188R 03/09/23 03/09/24 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I 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 �I• ••" r ACCORDANCE WITH THE POLICY PROVISIONS. //� �� Imo:•�'- AUTHORIZED REPRESENTATIVE ds' A Jenny Murdza / I � '1/ ©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 t* fr - Department of Industrial Accidents _ t :j�_a, 1 Congress Street,Suite 100 �':jli`Iltlr a Boston. MA 02114-201.f _,.�=�# wlvw.macs.gov/din 11 urkers'('ompensation Insurance Affidavit:Builder!u'ConlractorsiElectricions/Pluiuhers. Tt)HE 111 1:1)N1Il•ti'fHE PLRMI1TINGAUTHOR11 . Applicant Information E- Please Print Leeihls Name( u /� b3u.tr►ey.Or an alion,individual): IV z�2.4(1 j)t Address: 1 I w 1!1-HI"or 5f - . . City/State/Zip: S•tfADI y tom) A of 0 7S Phone#: i`/3 3 4 e C)Si(0 Are yam an rntpktyrr?(imbibe a*peoptriate heat: Type of project(required): 1. 1 atrn a cntpktves utth , 9. arupluyccs(full andur part-owlet-* 7. 0 NewL construction �i�... •••• t ant a soli proprietor or partnership and have no employee%%rskung tor me in 8. O Remodeling ally`A phony_INu um-liars' :mu mmy ura1 nsiussnal[ -- 30 Iran a IelneYhnw r dieing all work myself.Pilo wur►.ets-comp.insurance nsimi cd.I' 9. ❑ Demolition l00 Building addition 4.0 I am a Irnarewwn-r and will he luring ettriradors to conduct all work on my itrcptesty. I will enure that all contras-tors either lune workers-eunptenurrtm{.insurance or arc sole I l J Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I ant a general contractor and I have kind the sub-contracture listed on the attached sheet_ 130 Roof au� Tlrex sob-contractor.lust:employee%and have wurlcrs'comp.unurance. / �S �I 14. &tier PI!/ 6.D We an a corporation and its officers have essze'ised then right of cunspeWn per AKiL c. 151.,ti 11 d),and we have rw employees.[No wormer.'wrap.insurance reyuired.1 6 10 i i 'Any.applicant that chocks buy.. ni at1 mi also fdl out the mason helms shtrwinr their tuners'compensation polity ucfuran;attun_ J 'Iloarwwwr er.vibe+sulnmt this arltda%it indicating they me doing all work and then hoc outside eLanraeturs amnia sttbrtut a teem aft-Lida.,it indicating such. '(untracton that cheek this.but must attached an additional sheet showing then name of the sun>-:otttracturs caul,talc wlt:thcr or nut those entities hiss employees_ tt the sub-contraekVS lase enrt¢tluyccs.Cite, !mitt pros ill:their workers'cutup.pokey nuurtber- I am an employer that is providing nvurAe r..'compensation insurance for my employees. Below is the policy and job site information. Insurance;I.'enup'.anti. Name: A -1004 1 Q .6A04- )6 4 f ,— Policy#or SIC-ins. L . = Qj U: WC- 3 ' Expiration Date: 3/�j 0y Job Site Address: ‘Ir�(.7 l l/k,4 f 0o Afi1( )/�►�1 c ty,state/Zp: 61 beep Attack a copy oldie workers'compensation policy declaration page Ish.wing the policy umber and etpiratian date). Failure to secure coverage as required under MGL c. 152,*2 5A is a cruturial violation punishable by a fine up to S1.500.00 and.'ur one-year imprisonment,as well as civil penalties in the form ot'a STOP WORK ORDER and a fine 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 co+crags verification. I do hereby cgrlify under the pa' s and penalties of perjury that the ire jurmatirtn provided above is tree and correct Sioniltlire: `-�'1-�. Date.: Ib/ l�/� l Philip,: `//J 3v0 OS' 6 I ((( Official use only. Do not write in this area. to he completed by city or town official ( it or To+sn: PermitJl.icense a Issuing tuthoriti (circle one): I. Board of llealth 2.Building Department 3.('its town Clerk 4.Electrical Inspector 5, Plumbing Inspector 6. Other ('untuct Person: Phone#: