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34-007 (6) `M 1 3 71w�3�j t a ,a SOAP OF°SUILOINWGULATiONS Ucm=w. 40NSTRuc-nON SUPERVISOR Numbbn;ZS 047758 Birptdate{ 12!97!1848 iris: 12117/2001 Tr.no: 9908 Restricted To: 1 G 4 CHARLES V FORTIN _/ l 30 TIPPING ROCK RD G�....�► , WESTHAMPTON MA 01027 Administrator .f 1 `4ftkSF`M,i*tiiuw;tCfs�;ti+,htai�t�4.[ttk,, Y tw•.-?n?ckiw;,;,k,t;,�. ,x •c; BPMFORD INS. AGENCY Fa-x:4135625848 Dec 15 '00 16:22 P.01r01 AC-OW. GERTIFIGA_TE OF 1. AMUTY INSU-RAl - DAT.(MMMDDrrrl FRDOYONE _ - - 12�1sn000 BAMFORD INSURANCE AGENCY,INC. 413-b88.789D ONLY AND QONFE S No 0RH S-UPONRTHE CERTIFICATE P.O. ELM 46 - HOLDER.fR fE CE f p BY TME�PpID(CE,BS BELOW. . BOX 480 WE&TF1EtET MA oiW INSURERS AFFORDING COVERAGE MSUIED INSURtR A CENTRAL INSURANCE COMPANIES CHARLES FORTIN Yr4URER B 80 SCENIC RD. INSURER c WESTFIEtD,Mlk 01085 INSURER D INSURER E-, COVERAGES THE POLICIESOF INSURANCE tISTEO IKLOW"AVE BE£NYSSUEpT07HE INBURED+IAMEDABOVEFOR THE POUCYPEfwDMIDICATED NOTWITHSTANOINQ ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THWCERTIEICATE MAY BE ISSUED OR MAY PERTAIIF.TNFtNBUR*NCE ARFO*Mo-SrTHe POLICIES DESCRIBED NE1REMIS SUB3ECTTO ALL THE TERMS,EXCLUSIONS ANDICONDMIONS OF SUCH POLICIES.AGGREQATELAOTS SHOWN MAY KWE-.BEEN RIEDUCED BY PAID CLAIMS. T"s OF WNMNcB POLICY KUFA E Y M LYETB SEMINAL LIABILITY 500,000. A X COMMERCIAL GENERAL IJABILITY SOP7889819 5/27100 5127101 FINE DAMApEIAIIYAn*nn.l f _ 100 000, CLAIMS MADE Q OCCUR 1060 EIA�My_aoaprpA� f 5 000, P6RBONUL{ADV INJURY { ._500.000. OENERAL AGGREGATE_. f 1.0w.000. GEN'L AGGREOATE LIMIT APPLIES PER; PRODUCTS.OOMPIOP AGG f 500,000. X POLICY 79 LOC AUTOMDNILEWBMdTY COMBINED SINGLE LIMB t ANY AUTO (6►wcepnll- ALL OWNED AUTOS -SODwr INAJIIY { SCHEDULEQAUTOB (Put Owgan). HIRED AUTOS i #ODKY NJURY t NON4WMED AUTOS (Par�miawttl (P.r OAMAOE t SMRADELAEILITY _ - AUTO ONLY.EA ACCIDEMq { ANY AUTO EA ACC { OTHER THAN AuTODNLr: A { EIEESELIA161TY EACNOCCURRENCE f OCCUR- 71 CtA1MRM*OC AGGREGATE { f RETENTION f - f MIORKS"DDMFENBATION AMR Y ER EM LOVNAE'MAI LITY EACNAOCIDEN_T { E.L.DISEASE•EA EMPLOYEE f E.L.DISEASE•POLICY LIMIT f OTHER DE{RGIIFTDM OF FROyrpUR _ , CERTIFICATE HOLDER ADDITIONAL INNRND•EMIYRR L■TTR: CANCELLATION SHOULD ANY OF THE AEOYN OUCOJOD FMAMI GANCELLM SWORE THE EXPIRATION *ATE THREOF.THE NNW"INSURER WILL EMDMVOR TO MAIL 10 DAYS WRMM NORTHAMPTON BUILOtNG-DEPT. NOTION TO THE CRTIPMATB HOLDER NAMED TD THE LEFT,*U7 FAILURE TO DO 00 SMALL 212 MAIN-ST- NMFDSN ND OELMIATOM OR LNNLf1Y OF ANY KIND UPON YIN MEURR.ITS AENNTS ON NORTHAMPTON, MA 01080 RIP N TATM 4L Aur«oNlsNO _ holT►NS-F.Somfold ACORD 254(7107) PORATION 111U �� Uv iv •.'« ..`��� ,.,.w✓'"'tea _.+ �= Von OD g'CK�PT 8 Gxt� of 'Wart 4aillp toll $ e �a3sarf(tssrtta' e _ DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORT ER'S COMPENSATION INSURANCE AFFIDAVIT (Iicensee/pelmittee} with a principal place of business/residence at: ei 2, �C) S (�/VJ e ��� ' S I ,. M#'Q (phone#) ,-5-6 2 x-173 (streeilcity/statrlap) do hereby certify, under the pains and penalties of per}ury, that: (,,KI am an employer providing the following worker's compensation coverage for my employees worcing on this job: 7-C (Insurance Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additiorW sheet if necessary to include info CKI pextaiuing to ell 000tM tort) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE-please be aware that wfrilo homeowners who employ pazom to do maiatenanec,o=suuctioa or repair work on a dwelling of not more than throe units is which the homeowner resides or oa the grouaris appurteawA thereto arc not gene rally coaiidered to be employers under the works oompe ns4on Act(GL152,ss 1(5)),application by a homeowner for a license or permit may evidenoo the legal su - of an employer under the Wosicoea Compeoution AcL I undastaad that a copy of this statemeat may be forwwded to the Dcpermxos of Industrial Accidea&Ofoc of kvm1oca for the coverage verification and that failure to secure ooventgo under socUoa 25A of MGL 152 can lead to tha imposition of aiminal penalties coosbeng of a fine of up to$1,500.00 andlor of up to one year and civil penalties in the form of a Stop Work order and a firm of S 100.00 a day against me. For dTxtm n uao only Permit Number �� I,ot# gn tab=of Licensee/Permiuee Mte s F7777777 5ECT11$ 03NSTRUCTI©N SER1ICE5 �.., , 3.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : C14AJ A—F-5 6r000 1 AJ 6 L4%75—IR License Number Address ,} Expiration Date Signature Telephone Not Applicable ❑ Company Name Registration Number b 0 0 11 Address Expl(ation Date Telephone 2 47-7 c.1S2,11 C(6 W M E }) " 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...... ❑ fiAY 1t-�- l -A The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own 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 homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature l �' CR1PT1 1 table) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: 5 _Y1/>rr—J%1PJ-- (lAylA � Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement _Yes No Plans Attached Roll ❑ - Sheet❑ a. Use of building : One Family�_ Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached?�-5 d. Proposed Square footage of new construction. I Dimensions e. Number of stories? Z- f. Method of heating? k'419kahk (P— Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? L Type of construction 6ARIVN. i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade —I f'-� k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank 4 City Sewer Private well City water Supply 5 0 "0 W""h ." R A'lJ't'H >gIXA" �bN =.Tp Bi COMP 7 ED WHEN QWNE RACIPgR ARlP1. 5 FQR B IJIt;DING PERMIT 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. 6iiiiwner Date I, GAA/�'t-6;s Gf as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. CJ-44 R, tct"" air,/V Print Na Signature of Owner/Agent Date Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES N0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property?YES_ No IF YES, describe size, type and location: Tc�� � `�' [ ` �Qity of Northampton j�ding Department 12 Main Street D EC 1 3 2a Room 100 Northampton, MA 01060 �PT4F8' hone 413-587 1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING E CTIQN 1 SITE INFORMIIiON 1.1 Pro"rtv Address: , : y. ECTfONFP PERTY OWNERSHIP/AUTIOIZ1 'AGi*NT .. . .: 2.1 Owner of Record: IkE H JTT71J t;6 Da Rco-� U-,VfjK Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Name(Pr' t) Curre nt Mailing Address: 1_r/2_ 'L Signature Telephone 3 '�. IMATE Item Estimated Cost(Dollars)to be of only co feted by ermit applicant 1. Building (a),Building Permit Fee 2. Electrical {b)Ist111ated Total; File#BP-2001-0577 APPLICANT/CONTACT PERSON CHARLES FORTIN ADDRESS/PHONE 60 SCENIC RD (413)562-4732 PROPERTY LOCATION 158 TURKEY HILL RD MAP 34 PARCEL 007 ZONE RR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: REMODEL BASEMENT New Construction Non Structural interior renovations Addition to Existing Accessoa Structure Building Plans Included: Owner/Statement or License 047758 3 sets Plans/Plot Plan VLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: pproved as presented/based on information presented. Denied as presented: Special Permit and/or Site Plan Required under: § PLANNING BOARD ZONING BOARD Received&Recorded at Registry of Deeds Proof Enclosed Finding Required under: § w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Variance Required under: § w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Co * ion Permit from CB Architecture/Conmum-nii ee o Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. 158 TURKEY HILL RD BP-2001-0577 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 34-007 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2001-0577 Project# JS-2001-1032 Est.Cost: $31500.00 Fee: $157.50 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CHARLES FORTIN 047758 Lot Size(sq.ft.): 109335.60 Owner: WEINBERGER DOREEN&CLAIRE HUTTLINGER Zoning:RR Applicant: CHARLES FORTIN AT. 158 TURKEY HILL RD Applicant Address: Phone: Insurance: 60 SCENIC RD (413) 562-4732 WESTFIELDMA01085 ISSUED ON.12119100 0:00:00 TO PERFORM THE FOLLOWING WORK.REMODEL BASEMENT POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: 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 Sijjnature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 12/19/00 0:00:00 1367 $157.50 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo wi