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32C-303 (3) BP-2023-1729 11 VALLEY ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32C-303-001 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-2023-1729 PERMISSION IS HEREBY GRANTED TO: Project# 2023 RENO Contractor: License: Est. Cost: 28000 RICHARD HANKS CS-108730 Const.Class: Exp.Date: 03/30/2025 EQUITY TRUST COMPANY CUSTODIAN FBO Use Group: Owner: ARMANDO ROMAN IRA Lot Size (sq.ft.) Zoning: URC Applicant: HANKS CONSTRUCTION COMPANY Applicant Address Phone: Insurance: 267 FOUNTAIN ST (413)433-7425 SPRINGFIELD, MA 01108 ISSUED ON: 12/21/2023 TO PERFORM THE FOLLOWING WORK: NEW ROOF, REPAIR FRONT PORCH,NEW FLOORING, CABINET REPLACEMENT & PAINTING 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: lo 1 . a, 1 0 Fees Paid: $182.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner The Commonwealth of Massachusetts a Board of Building Regulations and Standards FOR Massachusetts State Building Code, 780 CMR MUNICIPALITY USE _, Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling �; This Section For Official Use Only Building Permit Nunnber:Be-Z0-2-3 -/72 9 Date A lied: 04A,, '11111 I lob i 3 Building Official(Print Name) Signature I e SECTION 1: SITE INFORMATION 1.1 Properfty Vat�ydylress: 1.2 Assessors Map&Parcel Numbers S I 32c_ --- 303 -OO 1.1a Is this an accefted street?yes I—no Map Number Parcel Number 1,�Zoning Information: 1.4 Property Dimensions: ,t µ acrc. 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 Cl Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 9ivnerl of Record ,� Name(Print) City,State,ZIP 7o.s /aii I) Jr dv 1474 �/3 �S-z?S mod!-s-/ ���1 t ��l�ti�o�tiat/S1° �M and Street / J Telephone Email Address /144 SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction ❑ Existing Building Or" Owner-Occupied 0 Repairs(s) IVAlteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': AJ i RA,�� OA r r- �tr r y f oU r c`j 6a6PAt" rePb-CL . /�st,itfl �-1�. rri'� ,4 i SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 2 , a 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ j y on o 0 Standard City/Town Application Fee ! Sv °? / ❑Total Project Cost (Item 6)x multiplier x 0 . 3.Plumbing $ (aJ oe'0 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ z� I g2 Suppression) Total All Fees: Check No...V-i Check Amount: Cash Amount: 6.Total Project Cost: $ 2 g pe, 0 f�Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Ccygstructipu Supervise ense( A Ig( O (f S l G h a__��`LLL �7 S License umber cs? ' n D e Name of CSL Holder /2 i� J List CSL Type(see below) g(vim s No.and Street T Description //� A--\ i ` Unrestricted(Buildings up to 35,000 Cu.ft.) �/ /f (, Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding gl rrIS—,K4tr— SF Solid Fuel Burning Appliances �f��y ro y t^� I Insulation Telephone Email address D Demolition 5.2 Home rove ent Contractor(HIC) A d!fA , 7 '_u_1/ 4 `S HIC Registration Number Ex ' n to HIC Com.any ame or HIC Registra z3e o. • ',.•w•t Qfddress n r `/ 44 _4"f- ja- 29�,� 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 a building permit. Signed Affidavit Attached? Yes No ..0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN 6.f OWNER'S AGENT OR CONTRACT R APPLIES FOR BUILD PERMIT I,as Owner of the subject property,hereby authorize !cA 4,, /w to act on my behalf,in all matters relative to work authorized by this b 'lding p it application. //r/14 4404 t0/4 M A l 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,ttue and accurate to the best of my knowledge and understanding. Ailj Act,olo gD/1/1 Ac,4 A 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 Information on the Construction Supervisor License can be found at 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 • Sys :: s4-. r Massachusetts ��� 'e, . c . tt A- ` DEPARTM NT OF BUILDING INSPECTIONS y ;: r;g5. r 212 Main Street • Municipal Building Northampton, MA 01060 J 1'4 V.:1,''. 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: 4flr �.-e� ���� ��/�t�'�1 Location of Facility: Sprr�fi dJ/ Mn The debris will be transported by: Name of Hauler: f Signature of Applicant: /jiL /4-.. Date: l�- �/ z3 ` The Commonwealth of Massachusetts Department of Industrial Accidents s'1�►_ Office of Investigations =::t= 1 Congress Street, Suite 100 �1.a Boston,MA 02114-2017 no www.mass.gov/dia g v/dca Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): I e/ a Ml A,f� kt,---f Address: (26 2 Li—Ovil2"Zik-, 5 j City/State/Zip: <5Pri Al -6/l - Phone#: V/d Yd' 79; — Are you an employer?Check the appropriate box: Type of project(required): 1.(1 1 am ployer with 4. ❑ I am a general contractor and I ployees (full and/or part-time).* have hired the sub contractors 6. El New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling shipand have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. , right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' I3.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I.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: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ' u er t pajns and ti of perjury that the information provided above is tr e and correct. Signature: f /ill Date: q `% 2__? Phone#: 4"6 V-33 // C 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. Electrical Inspector 5.Plumbing Inspector 6. Other • Contact Person: Phone#: ACCPRE, DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/13/2023 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: Orlando Alban Alban Insurance Agency A/CNNo,Ext): (413)733-5630 FAX No): R5 Wilbraham Road (A/C oalhangalhaninsurance.com ADDRESS: Ci INSURER(S)AFFORDING COVERAGE NAIC# Springfield MA 01109 INSURER A: INSURED INSURER B: Hanks Construction Company INSURER C: 53 CLEVELAND ST INSURER D: INSURER E: SPRINGFIELD MA 011042401 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. INTRR AuuLsTYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY YYEl- POLICY YY LIMITS (MM/DD/YYYY) (MM/DD/YYYY) x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any ono person) $ 5.000 A RAK-91670-1 02/14/2023 02/14/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 K POLICY JECT LOC PRODUCTS-COMP/OP AGG $ Included OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED -SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPER fY DAMAGE S AUTOS ONLY AUTOS ONLY - (Per accident) • $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTION$ $ WORKERS COMPENSATION - PLR OI H- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 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 QrLp.t4o At-- ., ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • Commonwealth of Massachusetts j Division of Occupational Licensure . Board of Building Re ulations and Standards Constr of IS ervisor CS-108730 z' 'i F3�ires: 03/30/2025 RICHARD Hq�VKS�' „MI ' 267 FOUNTAIN ST ' I ;mil ,' , SPRINGFIELDIJMA._1 tt tt y _Iv% ? r b r �'T 0 ,r 4UI.LVdit,3 3 Commissioner a as, K. ` tru ., ' _.. COMMONWEAL O&Bus nes HUSE ion THE Office of Consumer AffatN�..,CONTRACTOR HOME IMP TMPEIIrraMdual * 07ra12t on Rya sbtlo 09I 5 183192i, _ RICHARD HANKS , f 4 RICHARD HANKS 267 FOUNTAIN ST 1108 Undersecretary SPRINGFIELD.MA 0