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23A-225 (2) BP-2024-0406 105 NONOTUCK ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23A-225-001 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-2024-0406 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2024 Contractor: License: Est. Cost: 8000 JOSEPH DENETTE 113824 Const.Class: Exp.Date: 12/30/2024 Use Group: Owner: CLAY SARAH Lot Size (sq.ft.) Zoning: URB Applicant: JOSEPH DENETTE Applicant Address phone: Insurance: 102 ALDRICH ST (413)563-5759 GRANBY, MA 01033 ISSUED ON: 04/08/2024 TO PERFORM THE FOLLOWING WORK: METAL ROOF ON FRONT 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: Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner 'At'�i f// K 4' TS--t--- -~-1. The Commonwealth of Massachusetts I ~ A! Board of Building Regulations and Stan ds P" -. S F¢R ALIfy Massachusetts State Building Code, 780 MR0FA ? I SE r of Revis Mai011 Building Permit Application To Construct,Repair,Renovale�Ot ,ti� T�^ ,� One-or Two-Family Dwelling _•'-''' '.r,, o roipNs I This S ction For Official Use Only '~,,,, _J Building ermit Number: gP-a `4- LICJ eDate Applied: u„� /l�ss // 14-6-Zozy Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 49 S" il/onp li;rA— 5 ' 1.1 a 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 CI Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes SECTION 2: PROPE1R��TY OWNERSHIP' /0 2.1 Owner'of Recor,d: 1ad17611°) 414* Name(Print) City,State,ZIP !(). //0n044. 6 i" -91 g l 8'7" ( g C ,1 tUd Lag No.and Street Telephone Email ddress SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building l Owner-Occupied lg Repairs(s) Ig Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': /fe ✓ i2Zc / � el, on iaGtj. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ dog?. oil 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ NJ 0 Standard City/Town Application Fee / 0 Total Project Cost3 (Item 6)x multiplier x 3.Plumbing $ /y/1- 2. Other Fees: $ 4.Mechanical (HVAC) $ yt//e. List: 5.Mechanical (Fire Suppression) $ iv/it Total All Fes: VD c o Check No. yR0 Check Amount: 6.Total Project Cost: $ 4 ,GV 0 Paid in Full ❑Outstanding Balance Due: 1101110" City of Northampton yid rt,�t�q: Massachusetts . se�lc *At PG DEPARTMENT OF BUILDING INSPECTIONS a 212 Main Street • Municipal Building ~ Northampton, MA 01060 • 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. SECTION 5: CONSTRUCTION SERVICES V'5.1 Construction Supervisor License(CSL) / S-//370V' ` 0 x 51 7/Cs' 6 ,.. .i/ License Number Expiration Date Name of CSL Holder ` a ,J-ldr i / List CSL Type(see below) No. and Street Type Description 6/ /TA. O/O;- U Unrestricted(Buildings up to 35,000 Cu.ft.) Restricted 1&2 Family Dwelling City/Town,St e,ZIP , ,/ R M Masonry RC Roofing Covering WS Window and Siding �S�,�6 f �/ / � � I�� I Solid Fuel Burning Appliances !? Q.11 Insulation Telephone mail address D Demolition 5.2Registered� Home Improvement Contractor(HIC) f 9jl77 7 ,7n_, " VF pan HIC Registration Number xpiratiionDaDate HIC0 Company Name or C Registrant N-- 4?� G (kt�ev oo`L .�laC/"c ` t-�C No.and Street Email address (3re h.ILI 410. 61023 -W3-543,6751 City/Towd,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 A No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPPLIES 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. sacra '//67, Pcg Print Owner's Name(Elec onic 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. ` 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" The Commonwealth of Afassachusetts Department of Industrial Accidents 1'7 I Congress Street,Suite 100 Boston, MA 02114-2017 WWW-ntass.goWdia 11 inkers ('ow pens:Ilion Insurance Affidii‘it: BuildersXontractorsiElectriciansiPlumbers. HF I 1LL1J fill'11"FIL NERMIfilING At1110111-11 Applicant Information Plea Print Leeibil, Name Busitiess/OtwinizationfInciividutil t: -a7Sote/241 e hire_ Address: /0.07-% gieriM City/Stak. Zip:6etneit4 Phone #: Art yin'au einplo sr?Check the appropriate eras Ty pe of project(required): to atn ensphaysT*ids ,tmrioyees 1411 amain partlfinaer' New construction I am a sole proprietor or partnership arid have nu erriployees worionst for nic in K. 0 Remodeling any...-apacity [No shurirea'comp.insurance my awed.] 9. Demolition 30 Iani a homeowner daring all work myself[No wort-sm.'comp„ rixtutred.) 0 ET Building addition 4,0I am a hunacuwner and will be luring contractors to c.onduct all w ark on env Tritrporty. I will ensure that all contractors either base vvorkers'corrigensalsori maurance ot2LTV Si.110 I I 43 Electrical repairs or additions ptupnctors with no empluyem_ 12.0 Plumbing repairs or additions lain a general contractor and 1 hour hired the sub-contractors hated on the=admit sheet Th 10 Roof repairs ese sub-commetors have employees arid!save workers'cony.insurance i4.0 Other 6.0 We arc a 1.-wpm-alum and its officers have exercised their nen of exemption per h4CiL c. 152,•$ 4),and we Litt<no amployees.[No workers'comp.insurance requotiti 'Any apphcant that ehials b I must alsu lull out the section below show mg then winters'conycci,atimipott niforinatton Homeowners who submit this affidavit indicating ta)!arc doerig all work and then hoe outside contractor,must submit a nor atTidAs it indicating such. that check dies box must attached an additional sheet show mg the name of the sub-ccraractor,and%soh whether or not those clime,h-r,e II thr sLb-cutawr,h. ttployecx.thc!, oust pru.,ide their nt.ALIN number.. 1 am an employer that is providing workers'compensation insurance for my employees. Below is tire policy and/oh site information. insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: CityiStateiZip: Attach a copy of the workers'cotpenyation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under M.GL 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 tine of up to S250.00 a day against the s iolator.A copy of this statement may be forwarded to the Office of investtgatiom of the DIA for insurance coverage verilkatioil. I do hereby cerriti•under the pains and penalties ofperjwy that the information provided above ir true and correct. Si'mature: Date: Piton, 'V/b- C-6.3 — ()Picini use only. Do not write in this area.to be completed by city or town official. its or Town: PermitiLkente fl Issuing Authority (circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5. Plumbing lospvcRii- fi.Other ('outset Person: Phone#: City of Northampton _ _ ,„ ., .r. _ � Massachusetts M,. �,. DEPARTMENT OF BUILDING INSPECTIONS '. 212 Main Street • Municipal Building , T:• Northampton, MA 01060 fs#; �._»A.\\ 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: AV/7 Nye 7 ci 07,_sp,/� D The debris will be transported by: Name of Hauler: � � Signature of Applicant: 6L%..�s4��� Date: City of Northampton /.° ' ;� , sic Massachusettsmite �s' ° DEPARTMENT OF BUILDING INSPECTIONS S' j : 212 Main Street • Municipal Building #� y Northampton, MA 01060 0 HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT 1, (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. 1 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) Client#: 22843 DENJO2 ACORD., CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/08/2024 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 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 Baerman-Jubinville Ins. Agency PHONE Samantha DeSantis(A/C,No,Ext):413 538-8293 (A FAx X No): 413 538-5970 39 Lamb Street E-MAIL ubinvilIe.com P.O. Box 789 ADDRESS: samanthad@jubinville.com South Hadley, MA 01075 INSURER(S)AFFORDING COVERAGE NAIC X INSURER A:Preferred Mutual(neurones Company INSURED INSURER B: Joseph E. Denette INSURER C: Joseph E Denette Jr - INSURER D: 102 Aldrich Street INSURER E Granby, MA 01033 ,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. INSRT TYPE OF INSURANCE INSR Swvo POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DDIYYYY)jMM/DDIYYYY) A GENERAL LIABILITY BOP0100728322 02/01/2024 02/01/2025 pEAACCHp�OECCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea axu ence) $50,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $10,000 PERSONAL BADVINJURY $1,000,000 GENERAL AGGREGATE $2,000,000 _ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 _ POLICY JET LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) UMBRELLA LIAR _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) These are the limits at policy inception CERTIFICATE HOLDER CANCELLATION City of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Inspector ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main St#100 Northampton, MA 01060 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S38939/M38938 SBD