17A-183 (2) ACORD,. CER_TIFIC� T E OF LIABILITY INSURANCE 05!25/2001)
PRODUCER 41:.'. 467 9133 THIS CERTIFICATE IS ISSUED AS IIATTER OF INFORMATION
ONLY AND CONFERS NO BIGHTS ''TON THE CERTIFICATE
BROOKS NEYLON INSURANCE AGENCY HOLDER. THIS CERTIFICAIE DOES ' 'T AMEND, EXTEND OR
ALTER THE COVERAGE AI�OROED E i THE POLICIES BELOW.
80 WEST STATE STREET
GRANBY, MA 01033 INSURERS AFFORDING COVERAGE
INSURED INSURER A: ASSURANCE COMPANY OF AMERICA _
HARRY L. BARSTOW
MI �� INSURER 8
135 MIDDLE STREET 196 fiddle S1,Halft Y.MA INSURER C:
HADLEY, MA 01035 01095 (41$)584.5948 INSURER D.
-INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURE[.-)NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
I4AY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE j POLICY EXPIRATION LIMITS
GENERAL LIABILITY r EACH OCCURRENCE +$ _ 5'500,000
X COMMERCIAL GENERAL LIABILITY CFM25065658 03/20/01 03/20/02 FIRE DAMAGE(Any one fire) I $
CLAIMS MADE I OCCUR I MED EXP(Any one person) $ 10,000
j PERSONAL 8 AC INJURY {$ 5500,000
_
�GENERALAGGREGATE $ _ 1,000,000
GENT AGGREGATE LIMIT APPLIES PER: j PRODUCTS-COMPIOP AGG $ 1,000,000
_ POLICY PRO- --- LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO I (Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS ( + (Per person) $
� I _
HIRED AUTOS --__. _. - ---- -- ---- ------- -.__---- -
- BODILY IN.IURY $
NON-OWNED AUTOS (Per acadtt)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
- ANY AUTO - -
OTHER THAN EA ACC E
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
IOCCUR I I CLAIMS MADE I AGGREGATE $
DEDUCTIBLE _ $
RETENTION $ ! $
WORKERS COMPENSATION AND
TORY LIMITS ER
EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $
E.L.DISEASE-EA EMPLOYEE $
E.L.DISEASE-POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN
CITY OF NORTHAMPTON NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL
CITY HALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
MAIN STREET REPRESENTATIVES.
NORTHAMPTON, MA 01060 AUTHORIZED REPRESENTATIVE
/C a-1 + L)
ACORD 25-S(7/97) O ACORD CORPORATION 1988
Harry L. Barstow Estimate
DBA Handy Man Hank
136 Middle ST. DATE ESTIMATE#
Hadley, MA 01035 9/23/2002 28 �I
AK Properties
Sharon & Ken Hahn Phone& Email
25 Woodlawn ave.
Northampton, MA. 01060 413- 346 - HandyManHankl36 @aol.com
OCT - 1 2002
DEPT OF BUILDING INSPECTIONS
NORTHA 1PTON,M,A 01060
DESCRIPTION QTY RATE T TOTAL
185 N. Maple ST. Florence, MA.
Remove and install new Ceertinteed vinyl 43 j 310.00 13,330.00
windows. Low E
Remove and install new kitchen cabinets on second 64 30.00 1,920.00
floor. customer design and purchase from Home
Depot. j
Install 2 garage doors. 500.00 500.00
i
I
I
I
.Et
I
i
I
i I I
i
Terms, $6000.00 down and balance due on completion of work. TOTAL
$15,150.00
Ili
authoize this work. W ��
4�tiAHPJO
�0 a
9 8 Grx� 1af &Nart4aiIIpt1011
6 flasaachtrartta'
m DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORICER'S COMPENSATION INSURANCE AFFIDAVIT
(Iiceuseelpermittee)
with a principal place of business/residence at:
eio3> .
1�► lam S � ��y Jy+.�, (phone#)_sky-S3y�
(street/ci staieJzip)
do hereby certify, under the pains and penalties of perjury, (hat:
(-�_I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(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 Compauy/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach addition1 shoe ifneocuary to include mfonnizoa pcxtaining to all oodt rs)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:plisse be aware that whilo homeowocrs who employ pa-sons to do ma��coffimutioe or repair work on a dwelling of
not atom than three units is which the homoowmr wide or oa the grounds appurtenant therdo=no(&mcm ly ooandcrcd to be
employen under the works's c=*cnu4oa Act(GL152,=1(5)),applim6on by a homoowna for a Gcrnk a permit may evil the
legit datua of an employer under the Workceg Compemation Act
I understand that a oopy of this statement may be forwarded to the Dcpartmcrd of Indrutrial Aocidcnt.>'Of oc of In5t rinoa for the
covat(go VCnficatioo and that failure to azure coventgo under secboa 25A of MOL 152 can lead to tba k*osidOa of criminal P-ats
ooe isting of a&m of up to S1,500.00 and/or imprisotnxrd of up to ont year and civil pcn,16,in the form of a Stop Work Order and a
fine of S 100.00 a day against tae.
For d —Cady
permit Number
Map# Lot#
Signature ofLicensw-Rermitfee ,
SEC70�18 ;CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: �V/ Not Applicable ❑
Name of License Holder: Ky v"+ �Q+G♦it I C—K-
License Number
cs 0-5--?>��y
Address Expiration Date
Signature Telephone ? —a7 !Q
Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone .S-3 '/6
S CTIpN 10 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....... GK No...... ❑ ow ir--fti
� ® _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
CTION�a. 1166 W1, U00"O EDW _ Una licable
t>>I1
a p.q�3„, Yfi... � ,, x�?...��.a�1.. .:a i ..•a xs r: .., sl. ,'s ,u s�`�.�^i.,�"_.'`�"�a
New House ❑ Addition ❑ ReplacementA ndows Alteration(s) ❑ [Roofing ❑
Or Doors F,
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding( ] Other [ )
Brief Description of Proposed Work:_ lac 4M e1AI� 1✓Adowks K It JUe^f Cc 1 fAfe L
Alteration of existing bedroom Yes ✓� No Adding new bedroom Yes f No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll ❑- Sheet❑
H a d o id1tio�to eXisti . . si i scorn""let fal'10 1-owl-ft
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?_ ADO
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Mascheck Energy Compliance form attached?
h. Type of construction
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
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTIONa OWNER A[1TH0121ZATION TO BE COMPLETED WHEN
O IVh� RS AGE(VT OR CONTRACTOR AP"0LIES'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.
Signature of Owner Date
I,_ irw-/ Z, as Owner/Authorized Agent
hereby decl re 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.
14AR-RX 1, OVA anrd• �nav H
Print Name
Signature of Owner/Agen Date
. V
Section 4.
ALL INFORMATION MIDST 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 NO
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:
i C2— ity of Northampton
Building Department
212 Main Street
Room 100
N thampton, MA 01060
413 587 1240 Fax 413 587 1272
iO�NS O CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE 1,NFORMATION
This se #io #a "k�eompi"e"e lay off ce u
1.1 Property Address: s
I f6 y 2N c Zone r air bps#r c .�
Eim St:t)istrfctCB Dtstrict r _
SECTION'2- PROPERTY':OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
kA't d BPS Woojlaw,, Ave—
Name(Pr)nt) Current Mailing Address- AAA,
Telephone
l -/� oY aHc,/ N.
// r
Signature
2.2 Authorized Agent: `
L tea,�•cle vj 134 f h 1(d �.� s 7�• k�!1��/�/�.
Name(Print) Current Mailing Address:
W , �, -- ,3-IF y S3116
Signature Telephone
SECTiON 4- ESTIMATED'CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a) Building''Permit Fee
2. Electrical (b) Estimated Total'Cost of
Construction from. 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =0 + 2 + 3 + 4 + 5) Check Number
This Section:.For Official Use.O.nl`
Building:Perm it„Number: .. Date Issued: .
Signature:
Buildii gC00 ssJ._..p inspector of Bulld►n . . Date
185 NORTH MAPLE ST ; a BP-2003.0345
CIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A- 183 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0345
Project# JS-2003-0576
Est.Cost: $15750.00
Fee: $75.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HANDY MAN HANK 119936
Lot Size(sc.ft.): 7187.40 Owner: HAHN KEN&SHARON SALINE
Zoning.URB Applicant: HANDY MAN HANK
AT: 185 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
136 MIDDLE ST (413) 584-5346
HADLEYMA01035 ISSUED ON:10 11102 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS/GARAGE
DOORS & KITCHEN CABINETS
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 eFk /—/ q—p a
441,Tow-
THIS PERMIT MAY BE REVOKED BY THE CI Y OF NOR T` AMPTON UPON VIOLATION OV
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy_—. Si=nature
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 10/1/02 0:00:00 2782 $75.00
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo