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24D-048 (13) BP-2024-0069 32 STODDARD ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24D-048-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2024-0069 PERMISSION IS HEREBY GRANTED TO: Project# windows 2024 Contractor: License: Est.Cost: 2077 CHRISTOPHER JACOBS G5.—o6oc./ Const.Class: Exp.Date: Use Group: Owner: FULLER SARAH JANE Lot Size (sq.ft.) Zoning: URB Applicant: BARRON &JACOBS Applicant Address Phone: Insurance: 420 NORTH MAIN ST 413-586-8998 WMZ80080063652022A LEEDS, MA 01053 ISSUED ON: 0U23/2024 TO PERFORM THE FOLLOWING WORK: 2 REPLACEMENT WINDOWS 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: r►_ " I Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner f ' tm41/ The Commonwealth of Massachusetts \\r'' FOR •Y, Board of Building Regulations and Standards � c�� ry a Massachusetts State Building Code, 780 CMR 'per, MITNICIPALIT Y ,. 0 US;E 1 / t Building Permit Application To Construct, Repair, Renovate Or j sh a Jtevised ar 2011 One- or Two-Family Dwelling v'9;�� This Section For Official Use Only sU s Building Permit Number: n.-el-41 Date Applied: \� 1 a3 Building Official(Print Name) Signature to SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 1.1a Is 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' 2.1 Ownert of Record: , y�� t�- CC�Y .\, " V Y` _ Oar"' 4� ".9 _MP _SA L' Name(Print) City, State,ZIP 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. 0 Number of Units Other p Specify: W'ty .aS Brief Description of Proposed Work: 'j'ti,,.o .{ j y j,— r� v— FacioZ— il 5. 3 0 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only 1. Building $ 1-,0-41. I. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x_ 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Feewq Check No.\" eck Arnow- .ash Amount: 6. Total Project Cost: $ Z..`Q 1-1*- 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) �* (� - 060,A tt I to► S A 1; w t License Number Expiration Date Name of CSL Holder List CSL Type(see below) V No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) Restricted 1&2 Family Dwelling City`Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances t'er VC1c tVim+1,i c t t< • 1 . I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) IN ( 'n ��r k 'Sac:4 5 ` �`'` HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email a ess 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 y cc>_ fi `Seik to act on my behalf,in all matters relative to work authorized by this building permit application. .{ ex X-lam '1 t __ Print Owner's Name(Ele onic Signature)-1 Date SECTION 7b:OWNER1 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 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.govidps 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 No work can begin prior to the signing of the contract,and the owner receiving a copy of the contract. By signing below,you agree to items A, B and C. A. Alternative Dispute Settlement(Arbitration Clause): The Seller and the Buyer hereby mutually agree, in advance.that in the event of a dispute concerning this Agreement,the parties shall submit such dispute 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. B. By signing this agreement,you,as the owner of record,are hereby authorizing Ban-on&Jacobs Associates Inc.to act as your authorized agent in all matters pertaining to the building permit application. 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,their agents or representatives. DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES. � - -� 11 Cfi• i..� You,the Buyer,may cancel this transaction Buyer Date at any time prior to midnight of the third business day after the date of this transaction. See the attached notice of cancellation form Buyer Date for an explanation of this right. ,�/ ?/20-2, Seller retains an equal right to cancel. (,,�/1/ 1v Vc't/ Barron&Jacobs Representative Date Contact Information Office Manager: Sandy Scavotto Office:413-586-8998,x 102 l] Chris Jacobs, President CT HIS#0554397 Cell phone:413-250-6677 Office phone ext: 100 Home phone:413-665-9113 0 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 9 of 9 The Commonwealth of Massachusetts Department of Industrial Accidents .l Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.govldia 'Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PER JTTING AUTHORITY. Applicant Information Please Print Legibly Name (BusinessOrganization/individual): Ay`,(t)ve* tnr^ �,tf 1GVj v t .C) Address: LA— axy ce City/State/Zip: L--e-As iv\ ' 0\o`--3') Phone 5'c Vi1 Are you an employer?Check the appropriate box: Type of project(required): LipI am a employer with CA employees(thtl and'or part-time).• 7. ©New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in g. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.0 i am a homeowner doing a/I work myself[No workers'comp.insurance required.]1 4. Q Demolition 10 Building addition 4.0 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.E Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions sin I am a general contractor and I have hired the sub-contractors listed on the attached sheet 1 3.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 4 6.0 We are a corporation and its officers have exercised their right of exemption per h4GL c. 1 Y' et \Y 152,§1t4),and we have no employees.[No workers'comp.insurance required] *Any applicant that checks box#I 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 art 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: i NAV' s&, Policy#or Self ins.Lic.#: GV1V\1'i K)(133(0c'2-(3 'z-Pi Expiration Date: 51 t j 2.02�, Job Site Address: -- -\C`ielAAA c `' -h, City/StatefZip: :AArs soli) ! d\OLD 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 certifr under the 'ns and penalties,of perjury that the information provided above is true and correct. Signature: Date: I, 1 -r Phone -72 Official use only. Do not write in this area,to be completed by city or town off ciaL 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 It: IK AC CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 4kk....—.—' 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 PH µo,Eat): A (413)586-0111 FAX No): (413)586-5481 (Ar8 North King Street EMAIL aedgett@webberandgrinnell corn ADDRESS: INSURERS)AFFORDING COVERAGE NAtC N Northampton MA 01060 INSURER A: Main StreetAmerica/MSA 29939 INSURED INSURER B: NGM/MSA 1 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 ADDL-SUBR 1 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INS° WVD_ POLICY NUMBER iMOLIC YEFE I POLICY EXP LIMITS Xi COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE 5 1,000.000 t DAMAGE Tu REN I EL) I CLAIMS-MADE X OCCUR PRE M SES(Ea ocourrencel S 500,000 IMED EXP(Any one person) 5 10,000 A i MPT80490 03/09/2023 03/09/2024 1,000,000 PERSONAL 8 ADV INJURY S CEt L% GREGA ELIMITAPPLIESPER GENERAL AGGREGATE 5 3.000.000 PODGY PRO' 3,000.000 JECT LOC PRODUCTS.COMPIOPAGO S OTHER EPLI s 10.000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ea accident ANY AUTO BODII..Y INJURY(Per person) S 1,000.000 B ONNEO SCHEDULED M11-8049D 03/09/2023 03/09/2024 BOD!LY NJURY(Per acadenU S AUTOS ONLY X AUTOS v ZIT v NON-OWNED PROPERTY DAMAGE s AUTOS ONLY X AUTOS ONLY tPer acodenn I ' Medical payments S 5.000 UMBRELLA LIAR — OCCUR EACH OCCURRENCE S B EXCESS LIAR CLAIMS-MADE CUT8049D 03/09/2023 03/09/2024 AGGREGATE S DEL) X RETENTION 5 10,000 5 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N STATUTE ER C ANY PROPRIETORIPARTNER/EXECUTIVE E L EACH ACCIDENT 500.000 OFFICER/MEMBER EXCLUDED/ N NIA WMZ80080063652022A 03/01/2023 03/01/2024 (Mandatory in NH) E L DISEASE-EA EMPLOYEE 5 500.000 if yes,descnbe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 500,000 Ii _ i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space Is required) 1 I 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. t AUTHORIZED REPRESENTATIVE 4 I 0 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 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: \\I (k.\\1-2) 9-12- Name Waste-Facility `' aSi'inc,i„r, - v V.TC), !v Y 1 ' pk- Address of Waste Facility 111.5 Debris: As a condition of issuing a permit for the demolition, renovation, rehabilitation or other alteration of a build!*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. 111 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, 'a the holder of the permit shall notify the building official,in writing,as to the location where the debris will be disposed. 780 CMR—6"Edition (;2' Signature of Permit Applicant fvf Date