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36-116 (7)
BP-2024-0089 4 OVERLOOK DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 36-116-001 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-2024-0089 PERMISSION IS HEREBY GRANTED TO: Project# BASEMENT BATHROOM 2024 Contractor: License: Est. Cost: 21413 RHI CONSTRUCTION Const.Class: Exp.Date: Use Group: Owner: TEDESCO, BILLIE&JOSEPH TRUSTEES Lot Size (sq.ft.) Zoning: WSP Applicant: RHI CONSTRUCTION Applicant Address Phone: Insurance: 128 RYAN RD 413-885-9038 7PJUB1K0603849923 FLORENCE, MA 01062 ISSUED ON: 01/31/2024 TO PERFORM THE FOLLOWING WORK: ADD BATHROOM TO BASEMENT 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: 1,1\ftiCrIk.d Fees Paid: $139.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner Y, The Commonwealth of Massachu tts 11/44/ t 11 r Board of Building Regulations and S anda 2 9 �Q2� FO V. Massachusetts State Building Code, .80 n ti U E ITY null 0 Building Permit Application To Construct,Repair,Renovate-dt_ e�,,.,,.��,,,,�i;ttir o ised ar 2011 One-or Two-Family Dwelling -----:'".r4gOj�foNs This Section For Official Use Only Building Permit Number: 6,+ a..4-- p ' Date Applliied: I. . ' y . 31- I 1 (21 Building Official(Print Name) Signature 1 SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers LA a.l trleQM Q(\>Jt, 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 Owner'of Record: U u �Q�� 1-eZe�' •� 4 2 u, PAAlk Name(Print) City,State,ZIP _ �. CSQU lLcM b 6 qvi- gai-aT1 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) ❑ Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': n SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ t^) s-A\3- )k, 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 3()01) 0 Standard City/Town Application Fee 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ WOO ,CIO 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees:$ �}� Check No21 Check Amount�'� ' 6.Total Project Cost: $ Zk4r ,5 b R Paid in Full 0 Outstanding Balance Due: City of Northampton Massachusetts , DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 St, N PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS, DOORS,ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR,ETC. 1. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work(Digital and hard copy). 3. Construction Debris Affidavit filled out and signed by applicant. 4. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance. 6. Energy Conservation Compliance Certificate(new /replacement windows). 7. Home owner's License Exemption Form (if applicable). 8. Note any Special Permit requirements(if applicable). 9. Energy Code—all new construction (Gut/Rehab) requires a HERS Rater Affidavit 10. Please provide the appropriate fee in the'form of a check made payable to: The City of Northampton. n�y.r 12,n44- SECTION 5: CONSTRUCTION SERVICES 4)1, vcr-,,cs 5.1 Construction Supervisor License(CSL) -�,. C5-0SSZb 1-16"-Z� Or Zur-.,w N I.--- r A-k. License Number Expiration Date Name of CSL Holder 02 L.. `0 s List CSL Type(see below) No.and Street c/ T Description Wkliitil4t/ NA-- U- 'z_- C Unrestricted(Buildings up to 35,000 cu. lt.) 1� Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding �� (r""WA _ SF Solid Fuel Burning Appliances `1`` Jf Ab •e•`nWrr,R. V I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) S-CS- HIC Registration Number Expiration Date HIC Com any Name or C Registrant Name Wg-- 0- � C-Cam.•A�e.vc. No.and Str L y6)� Email address V\PCitty/Towwn 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.mi Signed Affidavit Attached? Yes 0 No L 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 Q,rv.,r› ,AI,C _' to act on my behalf,in all matters relative to work authorized by this building permit application. --3-&C (—Z.4—Z`A Print Owner's Name(Electronic Signature) 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. ‘Nylk,cu-e.- k—?A v 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" . 1 LZ\ The Commonwealth of Massachusetts - ,,mmeiq Department of industrial Accidents .1=1,7 i........... r‘ 1 Congress Street,Suite 100 Sat -— k ei Boston, ilA 02114-201 ...t!'• www.ntass.goridia ', or kers' timipensation Insurance Affida%it:BuildersiContractorsitiectricians/Plumhers. 10 tit.FILED WITH THE PERM!111.7st;AUTHORFI-V. Annlicant Information Please Prim Legibly Name filuaubessaOrganizatkonandsvidua4: Vdk"\---11 CiANS .A Address: \?,S" 0-viN, c1.1- City/State/Zip: `cts?- k4r- OWL fl, Phone g: -"•\ --rs..-s--- C.) 1-. Ire ur*a empisr,cr?I heck the appropriate box: Type of project(requirei!): I 0 I Am 9 tutpig6'es Akith___.........el:M.61)4;es(full wittor paittnne Le 7. Neu sonstr u holt Ci - , 2 0 I am a auk proprietor or pouiendup and have no miployreA working for me Us 1 8, el-Remodeling UV y capacity,[No%Atriums'comp,insurance sequared i 3 9, 0 Demolition ;.[:j i am a hunk-ov.net doing All wog*mpolf.Itio willitas:comp,.irburatti.v riNunial ' 10 0 Building addition 4.0 1 ant u lunnoirwricr and will bc lursti rMiuta It CAM/LICI all 4%oil on no properks, I'Ad.! otmar that AI Contr.,u-lurs tit hart WM-kir;tl)cnrermiliati ileitar.imx or an:%oli: I 1 1:3 Electrical repairs or additions pi mains is ith no atiployees,AM a cral CUI3IrJeltlt and I h o ate hand the sub-contractor,.listed cm the matt he ed set.zyfip 12,0 Plumbing repairs or additions mi p. 13.0 Roof repairs Thics4:subsanurackirs bate enaployees and have workers'com ansuranee.: 6.0 14.0 Other Iscr-0 6 Alaafte\We are a oorporanon and its officers hate exercised thew nee of exemption per MG&t I 2.§If4t,and we hate no employees.[No workers'comp..inaurariee required.' k- *Any apptiii that checks box*I mum also fill out the section below shots mg that workas eompensation politl,anformanon *tiomeow DOT%),hi)submit that affniatat andteating they are akoing all work and then hoe outside contractors must suiimat a new affidavit indiezging such ontractor%dun cht.'-ek thii box must attached an additional sheet show in g the came of the tubstontractors and state U.&AIN Ot riot Chotik'ladies hiss i.tni,10:ic‘-, It the si..1-,--ei3ntiactor,.ha..c.uripi. ,x,,Limy must pnIVIcir their *orb:1'h'comic,.puite,monists /um an employer that is providing ovorAers'compensation insurance for my employees. Below is the pa/lc, tins/lab site information. Insurance Company Name: — Policy#or Seat ins Lic. :: Expiration Date: Job Site Address: kA- 04--r\LOkil.. ..%) iVi‹.--- C ay/State/Zip: -PtiAre",24—AAAA--601 Z_ Attach a copy of the workers'compensation pnlky declaration page(shloving the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal %iolation punishable by a tine up to$1.500.00 andior one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a tine 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 coverage verification. /do hereby corrifr sunder the pain andanal 'es t tut the information provided above i.%true am!correct. Signature- Date: Official use only. Do not write in this area,to he completed hi city or town offieiaL I City or Town: Permit/License# Issuing Authority icircle one): 1. Board of Health 2.Building Department 3.City/I-oven Clerk 4.Elettrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton ��r Massachusetts ,�,• �._ DEPARTMENT OF BUILDING INSPECTIONS .4411H, 212 Main Street • Municipal Building �?' —�� Northampton, MA 01060 Soy 1� CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 554, 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: V ``` Q..e„.z.6, The debris will be transported by: Name of Hauler: Signature of Applican Date: ZcI�Z $ City of Northampton Massachusetts w .> 7 get it DEPARTMENT OF BUILDING INSPECTIONS - I� f 212 Main Street • Municipal Building ..," , � ¢h.�,,.�:; Northampton, MA 01060 y'. ,i HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert full legal name), born_(insert month, day, year), hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners' exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this day of ,20_. (Signature) 1/29/24, 10:22AM IMG_2590.jpg Wlibingrair" TIM. 14 0)4(+f .4i-n ) .A. '; .*t` -•-" . .(be ti01/Ili fffritc1tr P o" ttOott ' .� -�fri rfLsxr•nrlty- r : k" lrir�y .__ i�lWer .. ,,,,_„„--A k_`r0+•trtsig _•"< Or s ; Sayre-.Tp rn f,+f. '1>nt _ _ __ _ .rhilk i-CI.t Shaer2rcufr Cictr R. Or Rainer Sixe- , r- - ..._..... ... a 4 t sne • t2 )a^ 19.v" 3t R # $p*n r4 R:lfVr Species- _ } kialr - Sing ctilirta J04t sin!. , ,. . Sllv"&kt telling Jo:af Fpuler . . /2"16w. i5^*24�' ffrsultadot! - R Walt f f irir t-tor Finish - Aflit 'Vetttits.ti n . Tro.triorPsi$ - •--.) Wa lls: Siding S beg firing- :r Ixuluticrn - -k,`1 '` .1. '(. ^ Wall Frirr:utg- zs _ „ !l earl Grs. x jn:c:rior•Flxihir- Pr a k.4. f .j. Nev- a I loan 1- iisPi ,d tF oaI.- 1.1." Su1)-.Flogr ~ a:$-Roar - # i Size - _ Spacing- !2"16" 19,2" 74" kborjarsi I. Sp:n - a - ~ . Clear r "to the oplicitfte wppon . ride- J 1/2 https://mail.google.com/mail/u/1/#inbox/FMfcgzGwJvlBrsKcNtlVwrKzDhXfSFI W?projector=1 C ® DATE(MM/DD/YYYY) A CC CERTIFICATE OF LIABILITY INSURANCE 01/29/2024 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 Susan Fleury rY THE HILB GROUP OF NEW ENGLAND LLC PHONE (413)250-8652 FAX (A/C.No.Ext1: (A/C,No): E-MAIL ADDRESS: sfleury@hilbgroup.com com p• 120 Turnpike Rd INSURER(S)AFFORDING COVERAGE NAIC# Southborough MA 01772 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B RHI.CONSTRUCTION INC INSURER C: INSURER D: 128 RYAN RD INSURER E: FLORENCE MA 01062 INSURER F: COVERAGES CERTIFICATE NUMBER: 972417 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP INSD,WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _ POLICY PRO-JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ �/ $ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY Y/N A OF IC R MEMBEREXCLUDED?ECUTtVE N/A N/A N/A 7PJUB0W34849924 01/18/2024 01/18/2025 E.L.EACH ACCIDENT $ 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires, or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage- Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main St —-- AUTHORIZED REPRESENTATIVE Northampton MA 01060 Daniel M.Croy(/' y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD