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16B-048 '10 NN TI4 MAIN ST BP-2011-0471 GIs #: COMMONWEALTH OF MASSACHUSETTS MW:Bloc 16B - 048 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2011 -0471 Project# JS- 2011 - 000765 Est. Cost: $592.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: LOW E'S 96999 Lot Size(sa. ft.): 10149.48 Owner: LACROIX DONNA E Zoning: URB(100) Applicant: LOWE'S AT: 221 NORTH MAIN ST Applicant Address: Phone: Insurance: 282 RUSSELL ST (413) 588 -0270 WC HADLEYMA01035 ISSUED ON :11/18/2010 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT DOOR 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Sienature: FeeType: Date Paid: Amount: Building 11/18/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner The Commonwealth of Massachusetts FOR Board of Building Regulations and Standards MLrMCIPALITY Massachusetts State Building Code, 780 CMR, 7 edition USE Building Permit Application To Construct. Repair, Renovate Or Demolish a Revised January One- or Two-Family Dwelling 1, 2008 This Section For Official Use Onl Building Permit Number: I Date Applied: Signature: Building Commissioner/ inspector of Buildings Date SECTION I: SITE INFORMATION 1.1 X Add ress: 1.2 Assessors Map & Parcel Numbers & �n ` h s i - 1. a Is thi an accepted street? no Map Number Number 1.3 Zoning Information: i.4 Property Dimensions: Zoning District Proposed Usc - - Lot Area (sq ft) — Frontago (R) - — 1.5 tuilding Setbacks (ft) Front Yard Sidc Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Wnter Supply; (IvI.G.L c. 40,§54) 1.7 Flood Zone Information: 1.8 Sewage ;Disposal System: Public O Private d Zone: Outside Flood Zone? Municipal ❑ On site disposal ;system ❑ Check if es❑ SECTION 2: PROPERTY OWNERSHIP' r 2. ,own�r' of i �- ,il l / Y / 2& �J' t J ff ; Narne (Print) `� A I ss for Service: Signahttt elephone SECTION 3: DESCRIPTION OF PROPOSED WORK (cheek all that apply) New Construction ❑ Existing Building D Owner - Occupied ❑ 1 Repairs(s) V Alteration(g) C1 Addition 0 Demolition ❑ Accessory Bid$, 4 Number of Units Othor la Specify: Brief Description of Proposed WOW: f SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Vse Only Labor and Materials? I. Building $ ­6 q h l . Building Permit Fee: $_ Indicate how fee is determined: 2. Electrical $ 0 Standard City/Town Application Fee ❑ Total Project Cost' (Item 6) x multiplier 3. Plumbing $ 2. Other Foes: $ _ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Su ression Total All Pecs: $ Cheek No, _ Check Amount: Cash Amount; 6. otail Project Cost: $ � p Paid in Full ❑ Outstanding Balance Due: LA d OSI 9W saMol PAGE 82/02 08/o3/2�l8 11 07 4l32673390 SECTION 5- CONMUCTION SERV(Ca Naft of CSL- Holder ddresl� - 2 U U Telephone M Ra Window and Siding -- 6.- WORKEPS COMPENSATION INSURANCE AFFIDAVIT (M.G.L c. 152, V 2SC(6)) Workerx ComPen'-Won Inturance affidavit MtL';t be 0011 VIOW AAd 'u4miltCd with thi$ appli=ion. Failure to provide thi affWav't will ftlWt in the denial of the 1,% of Iding P=1L IN Owner of the subjoct property hereby to act on my behalf, in all mmem M to WQrk,2Uth0ri7Ad by this building permit upplicadon. UTHORIZED AGENT DECLARATION on arc true and u%urasc, to the best of my lawwltdgc and that Laments information on tk foregoi NOTES- (not regi-vew;d in the Home Improvelmnt convactor (HIC) Program). will M have accom to the arbintion progtAm or guamty fund vadcr M.G.L. o. 142A, Other importwst information o4 the faC Prog= and Construction Supervisw Licensing (C$L) cu be found in 730 CMR Rcgukitions I 10.R6 and I 1O.P.S. rcspcctively- work is planned, provide the informati4o Wow Total floors aren (Sq, FQ (including gaiage, finished bmenteattattics. decks or porch) Gross living am (Sq. Ft.) HXINT,;ible room co=t Number of fireplaces Number of bedroorns, Number of bAthrovrns Number of half/baft 3. "Total Pmj&t St1wwc Footage' =y be substituted fbr'TotW Project CoW ` ` ` - � � PAGE 01/02 4 i. 2 U, I-VWW 0 4VJUVd111W5 .1.111zie.Wo t%:;)1:Vd An PAUt Z/ I)V4 r ax oerver •e COMMO-dweaft'h of lvas=hfaetu Department of Industrial Accidents Office o, f' , nvesfigado"S 600 Wathingjonqireol Boswr4 MA 02111 VWWJ1WU-g0V1di4 Workers' Compensation- lastwance Affidavit'. BuUders/ContractoirAtectrickus[PlumbM AgRagnt IftrM Pim _afion �t Print &Mk1j Ze- Qty/state/zip; Mj4i Phone #: Are yplfi mployer? rl Check h appro priate box; Typo orprojed (required); employees 1. F am 4 employer with 4. 1 am a general contmetov and r 6, Ntw codmuction V411 and/or pact -fim4t have hired the soh- contractors istcd on the attac heel keo t. 7. Re modr&& 2. C1 I am a sole proprietor or pafter- l ship . have no emplaytes Thesc sub-oummctors have S. ociziorldon working for me in any capaoity. Unployces and W6 Work-S, 9. Suilding addition [No workers' comp, immnce comp. insummtJ vaquiral Wc are a corporation and its 10.❑ Eiecwcal Mrairs of additions I = a homeowner doing all work officers have wmised their 11.[3 Plurab4 rqaITS Of Additions myself. [No workers oomp, right of exemption per MGL 12.[3 Roof rqx6rs insumucc rCqW1cd.j1 c. 112, $1(4), and we pave U9 aroplayces. [No worle= I I other come, insurance imquired.) J I "rltry nppticam tbar cheeks tsox �!! mwt also Silt am ttx seulotf bdkno s►towln$ thelrtivotn�` cOtripChtitian policy infomtndoa HOMOW-M who submit ft., ftuvit i"4C.Ulft they W d64 pal V/6f* MA #" hW 4OUJAU 40aftqfM fM'.7 SWW* it W W AffidaVtt W&ehjjfi su ch. 4 COD►Aftm that check tU b09 must aftchm tA addkival s1to shwk$ ft x= of the tub-wMmcvr. and mo wboba or am *0W offlilwS hm OmPl"= Ir the ub-oamcws bryt employees, th-q inva promz their workers" COW, policy =MbW, dat an employer that is providing worWV compensation imunwceformy omoyers. Bekw is the policy acrd job site Insurance Company Name t7 It Policy # or Sclr-ins, Lic, M Expimion Daw Job Site AddtCSS' 0A 72Vi4- 1---' - — Attach a copy orthe ;0(e;e c ompensation policy declaration page (showing the policy number and expiration date). %UuTr to se4mrc coverage as rcqui=d under Soction 25A of MGL c. 1526wlead to the imptultion o$ oimt W penalties of a :ruir. up ;* $ 1 ,. 500.00 and/or one-year impxisQnmw, is well as civil paWtics io the fom of a STOP WOOS ORDER and a foo of up to $250,00 z day ago:= the violator. Ar, advise4 that a c opy of this statoment may be forwarded to tho Office of Investigations of the DIA for insurance ommSc verification. I orp herrity i: — 11 MI afthenaltles o p erjury that th'a information provided above is true and Wrrom r ITP 419 pe D z :! M Otmiol use only. Do not write in Wx am#, to be completed by My or town offidd4 City or Iowa; 0 L Authority (circle om L Bw rd of Health 2. Widing Department 9. CitytTown Clerk 4, Otetrical Wpector S. Plumbing Itaspen G. (kher Contact Per%..n << Wo 081 9W Samol 1 :OL 0-90-00-,, 021. aCat ,� CERTIFICATE OF LIABILITY INSURANCE Pita>uCl�c THIS CEftTWICATE M ISSUED AS A MATTER OF INFORIMAT Richard R Green insurance Ag en cy, ONLY AND COMFLR$ NO RM fM UPON THE Cg�N17, HOL.DER. THIS cERTIFACATE DOES NOT AMEND, EXTEND 11 Allen Slr+eet ALTER THE COVERAGE AFFORDED BY THE POLICIES SELL H ampden, MA 01036 INSURERS A RDM FFONO COVERAGE NAfC tF 3NsLS� munm& Travelers Insura.rrGe KortekanV GOnoftix lOn U.0 U Mutual B"n KoFtek2�rnp iwauxr:c: Commence tn9uratxx 27 Butler Road rrsurm�o Monson, MA 01057 COVERAGES THE POUCI OP NWaANCE L wq-o HAVE SEEN wsuW TO T NiSURW HAM A OVE FOR THE P OLICY POW INDICAT WOTWFM ANY MAY PERTAIN. T HE AFFORDED BY TM POMMS MMM SIS MJECT TO ALL TM 7ER W LSKM AND COND M OF SUC POLICIES.A meGATELIMrrSeHOMM AY MV99MREDl10EDBYPAIDCIAW. MW MWIL POUCYMIAMEJt P°" Los" nnn O��n iACiiOC�CtJ�@10E f 1000.000 A ,/ COMAEMNALGeMMALUAA&M am■enoel i 100 cxnwsMnotl 91 MOM upew on "w ) s 5.000 d non d � 6808565P31A 02/05/ 2010 0210 /2011 PERa0WL&AOVw,MW $1.000,000 trir�d auto a+erw wowear+ae s 2,000,000 c,�rrL reLrrrrA�lfear� nwmium- col+mapA~# s 2.000,000 pvucr LOC Al 70Moft>•Lwntry . AnrAVM COMMMSMMZLDArr $ ALLMNMAUroa ✓ SCHWULGO A M s 100,000 C s BBMV1.107 0211512010 02/0512041 800 o,-y -A s 300,000 f NON -OMq WAUTM 1 �rRr,°R°s�raraen OAMA°E $ 100,000 GARAA4S:IJAM.r1'Y AVrOONLY- rbAACC10�Tr i AW AMO z.,ACC s OTHER TT1AM Auraon.Y Aoa s EXORMAJUMMAUTAMM 0040CCUARP" s o MOAN AGGROMME s MUM" s s s MN M COMPEM"MIANO B UPMM WC1 >:L EAt:NACCIL�!!dr s 100 - 315 - 374661 - 01 9 09/24109 09/24110 aFlracluom► a c. a- �.eMw�av�ae: :100,000 e�..eaeASe- atxicvu. i 50 0,000 DESM�rnarr OF4PERwnONSr I.00A'rrOMC ri>OCtuorq� ADOriD •r ro�ooRiEMflNtrrsiaull wfoaara<ws LQwys CO mpardes, im- and "MY and all Suhliidiades of named as addWord Insured as respect w General Wbility Ind Automobile Lla6ility" Non- Owned/Hired Auto Is Included on Travelers P06W 6806585P31A CERTIFICATE HOLDER CANC SElou►oAfnnF TRIMAWWDNBC/M WPOUCU M OARA:BIFDMBPG yUEFEATIM 101�rH's C 11 ies, Ir1C. (Attu: IS fnsurartc e) t— TNe11em Tw MM>1 No~ au ummvva To wuL - oms N P.O. Box 1111 NOTE TO TIE CW tw4ATe rALOW *MUD TO 7M � —. BW PANAM M Yo no sa ekft4 Norttl Wilkesboro, NC 28M NOTE fa Os MUM OR UMMM OF AMY MW UPM ME fM AGEMM a ACORD 25 (280110 0 ADD CGPJNX% .nCM IM 06/2 2 I u o6: 58 4132673390 PAGE C11/01 Board of Buildin Rcgulations a"d Standards W Office file Construction Supervisor License License: CS 96999 HOME ImpRovEmEw CONTRACTOR Restricted to- 00 Type Expiration- _VO12 LLC T TODD KORTEKAMP KAMP T0QW,"`--'. rMp 27 BUTLER ROAD 'An MONSON, MA 01057 TODD KORTEKA 27 BUTLER RD Expiration: 6/2&2012 MONSON, MA 01057 Undersecretary T rX: 27751 Restricted t** OU Lietan or registration valid for individul use only before the expiration date- V found return to: 00 - Unrestricted Office of Consumer Affairs and Business Rep"on IG -1 2 Family 111onves 10 Park Plaza - Suite 5170 Boston, MA 02116 Failure to po$se$g a current edition of the Massachusetts State Building Code is cause for revocation of this licenW ILV-el� Refer to: YjWW.Aj=LGoVADpS Not valid without sloaftre 4 - \ — Office of Consumer Affairs & Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation l k" Registration: 148688 Type: 10 Park Plaza - Suite 5170 Expiration: 1011&2011 Supplement Card Boston, MA 02116 LOWE'S HOMES CENTERS INC JAMIE SPOFFORD 136 TURNPIKE RD. SUITE 100 SOUTH BOROUGH, MA 01772 Undersecretary Not valid without signature -v a, m ?. so N r-- O m N 4 � ui N b CD �- ° 0 r a N N oc; @� 0 to t7 O c O tGt y � Q Cp � ui n G r c �, n .« o cs o N O j o 0 3 n 3 m C 6 0 -. m 7 �^ cD p o c D o a ' c tin o$ n Z a 3 N m Qa CD 0 M m S O N w o °D p. C f? Z o tJ� N m 0 p %� � m D m "� W ID • • (tl N — N [� ° c c cs m c cP r O N N 0 �Q p O = o0 a S - 0 P, o m m ao Z N 3 n ° M 3J •� � X � O Z a �'� - � G coo 3 ��°�, °° cn m O O o tDm ° (7 Q � �@ m c C ,_ .0 0 r'• N N '6 ¢ #� N v m 0 n N m t9 - N' fl 3 m co O o °`" m° N 0 'goo .• o 77 fn o 3 O 3. 01- m �. 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