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30A-052 (3) 61 LIBERTY ST BP-2017-0292 (315#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30A-052 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2017-0292 Project if JS-2017-000492 Fs 60.00 fee:$260.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: WILLIAM J HARNUM 102199 Lot Size(sq. ft.): 15594.48 Owner: WATSON DAMIAN A Zoning UR8{t00Lr Applicant WILLIAM J HARNUM AT: 61 LIBERTY ST Applicant Address: Phone: Insurance: 53 METZYER PLACE (413) 519-3593 WC S P R I N G F I E L D M A01104 ISSUED ON:916/2016 0:00:00 TO PERFORM THE FOLLOWING WORK KITCHEN REMODEL, ADD BATHROOM ON 1ST FLOOR, INSTALL WINDOWS 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 ft Foundation: Driveway Final: Final: Final: Rough Frame: Cas: 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 Signature: FeeType: Date Paid: Amount: Building 9/6/2016 0:00:00 $260.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only r-:t City of Northampton Status of Permit: RE �Lr�� Building Department Curb Cut/Driveway Permit SEP _ 6 . 212 Main Street Sewer/Septic Availability Room 100 WaterANell Availability Northampton, MA 01060 Two Sets of Structural Plans Derr OF BUR. 413-587-1240 Fax 413-587-1272 PIOVSSite Plans NIU➢Rn:1\ M1I:.S..r. Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION t -SITE INFORMATION 1.1 Property Address: This section to be completed by office 41 I iherJy SI Map Lot Unit l f f Zone Overlay Matelot r/breracc Mq Elm St.Dishicl CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 SI 16A) I WA , SAM{ Current Mailing Address:ry Sin ,9S7 ,9S / , 9/9 • 9473 2.2 Authorized Agent Uligilf /-lur.✓ut-i S3 f7,' #24-r ®l Name(Print) Current Mailing Addresst/ '/13 S /9 3093 Signatuit Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 33, oad . 00 (a)Building Permit Fee 2. Electrical r (b)Estimated Total Cost of ✓/ �� •00 Construction from(6) 3. Plumbing 2 yoc OO Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection X/ 6. Total=(1 +2+3+4+5) y/)/ (Joe •4d Check Number /a/9 `Yd+ This Section For Official Use Only Date Building Permit Number: ee Issued: Signature: / Building ommissioner/Inspector of Buildings Date Section 4. ZONING All Information Meat Be Completed.Permit Can Be Denied Due To Incomplete 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 put area minus bldg&paved Palling) M of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW 0 YS O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O Y13 O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO IF 125, describe size, type and location: D. Are there any proposed charges to or additions of signs intended for the property? YES O NO fk. IF YES, describe size, type and location: E. VMS the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) X Roofing n Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[0] Other[01 Brief Description of Proposed Work: ifflrlr... QGMzde/, Add 4.✓6,-,w b.,/ risl c/oari t,14// G/%.�1<c/S Alteration of existing bedroom Yes X No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes X No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing,complete the following: 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? 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. Masscheck 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 SECTION 7a -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT ,O1R(�CONTRACTOR APPLIES FOR BUILDING PERMIT AiI, 1`I I i93 A u`/A'r5j� ,as Owner of the subject property toaherty . o h V/ tail rs rel N (.Jof�] a 'o�-half, in all matters relative to work authorized by this building permit application. Sig. .t ( o// Ovlmr . Date i , I, Wr//IAn-I �-i6rr ,l , 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 underIthe pains and penalties of perjury. ill;Nll;f r-1 T Al.criv0 rl Print Name Signature of Orae Ag t Date f/31p 47 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Superviisor. .y- Not Applicable Name of Monne Holder: tt1t'1t/l /- t f" S /i,rr.•JuM Yr ...._ c` 5 - /02/9/ License Number • J G 4 / 49//7 izove Address / Expiation Date � 4� ye5 • c/9. 3cn Signature Tel p one 9.Reuktemd Home Improvement Contractor Not Applicable 1. S./-1 r!�x✓S/i Xo,/ /670170 Company Name ��"" ,,y/,�� Registration Number 5-3 me J3$, 7/ . /f� t4 evtt . 2e7/. Address !i / Expiration sate Telephone Sari/ SECTION 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,1)('. No 11. - Homy Owner Exemption The current exemption for"homeowners"was extended to include Owner-pecupied DwelIInts of one(I) or two(2)amities 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 188.35.1. 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 lime 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 perarm 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 _ City of Northampton 212 Main Street,Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, 554, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: t / L/1(«/if ,,i5I � �!/7e(_ .c /fr41 The debris will be transported by: G .5 The debris will be received by: 14 5 /* Building permit number: Name of Permit Applicant S13i4 GTL__ Date Signature of Permit Applicant City of Northampton Massachusetts may yo' ' l C $ z I { : 4,E DEPARTNRNT OF BUILDING INSPECTIONS 5 212 Main Street . Mu»iripal Building F C~ NorthaIDpten, LA 01060 'rtyjt t INSPECTOR Louis Hasbrouck Chuck Miller BuPding Commissioner Assistant Commissioner flER EXFMPTION ACKNOWLEDGEMENT The State of Massachusetts Slows the homeowner the right under 780CMR 1083.4 to act as his/her construction supervisor.The state defines"Homeowner as, `Person(s) who owns a parcel on which he/she resides or intends 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? The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages,which include • It :. • r. r •. - • r- • " 1 . t •n do);- . rginspection (before work is c •sled)...insulation inspection (if required) and a final building..inspection., The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failur€to obtain a .i •... t - i i i - work can.be_ itispectet If the homeowner hires other trades to perform work (electrical, plumbing &gas)the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issu:d, and that they get their required inspections. Failure of the individual trades to secure the per i and inspections as required can DELAY the project until such time as the proper permits and in-p= . s are made _—moi" Ii. • �, understand the above. { T'"* •.wner residen s signature requesting exemption) I wi3. .- -, schedule all required building inspections necessary for the building permit issued to me. Date (/l///4.. Address of work location 7 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston,1114 02114-2017 www.mass.gov/dia Workers Compensation InsuranceAffidavit: Builders/Contractors/Electricians/Plumbers Applicant InformationJ // // Please Print Legibly Name Business/Organizationhlndivklua0: /-ff[Qn/Pri i2w'S/rfA(L/k-a+ Address: 0 Nle /7 G er 0010/, ,r/ro MA Ol4'C/ City/State/Zip: ✓ Phone#: y/3 , s-/g - 3593 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction r�I employees(full and/or part-time).* have hired the sub-contractors 2.[V 1 am a sole proprietor or partner- listed on the attached sheet. 7. p Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and ha✓eworker5 [No workers comp. insurance comp. insurance.= 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions mysalf. [No workers cony. right of exemption per MGL 1 12.5 Roof repairsinsurancei c. 152, 4 ,and we have noance required.] § ( ) employees. [No workers I 3.5 Other comp. insurance required.] 'Ary wpli rattIM decks box*1 must asp fi II eat thesalian below Slotting theirwurkes ompesiim policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must anached an additional sheet slowing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors harenployes,they mug provirlether wakes wry.policy nunta I an an employer that is providing workers compensation inslrancefa my employes Below isthe pd icy and job site information. .y. // Insurance Company Name: /74 /�/N�` / f Policy#or Self-ins. Lie.#: Aw� Yo® 703 Y3-92204/expiration Date: ?/)s7;7 Job Site Address: /j/ L//4.- s/. City/State/Zip: I-0re..r(f/ 7/9 Attach a apy of theworkers' compensation policy declaration page(showing thepd icy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties ofa 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 fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury Mat the information provided abo e is true and correct. Signature: tilt/l! Date: O / 3///L Phone 4: y/3 - r�GJ • 313 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Maasacusetts Galas Laws chapter 152 requires all employers to provide workers' cnrpeis3i al for ther employees Pursuant to this statute,an employee isdeli ned as"...every person in the service of a other under any contrast of hire, express a implied,oral or written.° An employer isdefirert es'err irsdvidtta,patnered°assasiOion,coporaiona atter legal witty,et ay two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounda building appurtenant thereto shall not boos=of such employment bedeanel to be al a P10110 " MGL chapter 152,§25C(6)also aaestha"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage requited? Additionally,MGL chapter 152, §25C(7)Odes"Neither the commonwealth rho any of itspolitical subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been printed to the contrasting authority.' ............ _. sees. Applicants Reatefill out the wortare carpal icn afida/it cra:Maly, by disking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members a pates,ere rd required to terry works° compensation irtswadse If ah LLC or ILP dais hare employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of !ruktrid Accidents. Should you hare ay questions regrading the lav or if you ae required toobtain awakes' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appm riate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current poli)infomoiitlon(if nex sy)aid oder"Job SteAdttesa' theappiign stpddwrite'at!outlaw in (City Or town)."A copy of theafidevit that has been offiddly aarped or naked by thedty or town mar be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would Ike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. ., . . The Department s address,tdephone aid fax nunta: The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations t Congress Street,Suite 100 Roston,MA 02114-201- Tel 2114-201Tel. = 6I---2--4900 ext-406 or I-8 MASS.AFE Fax= 61 Revised 7-2013 www.mass.gov dia ^1 WJHCO-1 OP ID:IR a`a-Ra CERTIFICATE OF LIABILITY INSURANCE 68/3q/""o 8Y' 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,ANO THE CERTIFICATE HOLDER. IMPORTANT: N the certNceate homer is an ADDITIONAL INSURED,the pormyfies)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(-). FROWNS UGRIAN NAME: !Naga Riley PHILLIPS INSURANCE AGENCY INC 97 CENTER STREET TEL. 13 4894-5984 res,Ahy 413-592-8499 CHICOPEE,MA 01013 ADDRESS:eyssaaphWipsinsurance.com PHILLIPS INSURANCE AGENCY INC _ MM.:TR(SI MERMEN(AVERAGE NAD• INSURER A:EMC Insurance Companies _ - '21415 INSURED Hamum Construction INSURERS:A.1.M.Mutual Ina.Co. 33758 William Hamum -' —" - - -- 53 Metzger Place INSURER--. Springfield.MA 01104 M'$o ER0: -.. _. _....... wswuRE. 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 I INDICATED. NORNRHSTANDING ANY REQUIREMENT,TERM OR CONOFTION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY SE ISSUED OR WAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS DE SUCH POLICES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS, _ ERCIAL GENERAL LIABILITY 5/33894916 11/11/2015 11/11/2 10 6l t _A SYR mVL IM'p YYY1,1 LIMITS ' I rwto WSIOMKE MDT SINN VOUCY NUMBER Iiseco P GENERAL UABiuIY 'EACs OCCURRENCE S 1,000,000 A X win DPaeusEa . , _ �+.^snit_ s 100,000 1 CLAIMSM=DE X^]Ecco$ MED EXP(Pay ape seem s SA00 PERSONAL d ADV INJURY , 1,000,000 GENERAL AGGREGATE IS 2,000,000 I GENL AGGREGATE IMO APPLIES PER'. 1 'PROD OMPS}PAGG IS 2,000,000 POLICY I i I jry LOC : _ $ AUTOMO E tIA try L,COMBINED LIMIT scsomatt S — ANY AUTO 'BODILY INJURY(St, onor,) E —"All OYMEO I .SCHEDULED _BODILY INJURY(va,.mee„o S. HIRED AUTOS OS ' AUTOS GGWOWNED PROPERTY 1 ; AUTOS (PER ACCIDENT) ._ LE MuAHa URELLOCCUR INCH OCCURRENCE 1 _. EXCES� ewMSWnE .AGGREGATE 1 a RETENTION¢ T)DN E WORSER$COMPEN ATICNWCSTATV- OTH- •NDEMPLOYERS'WanV y IN _D EFE FR B ANY PROPRETORppRTNEWESECUTM1E NI4 AWC400T0343322016A 03/25/2016 03/25/2017 ELL EACHCHACCIDENT 'E 100,0001 CFFIGEIVME R EXCLUDED(' I1 1M.RMa1MYin NH) EL.DISEASE.EAEMPIDYEEI s 100. o stirIP'L OF O E ATII:S e.ow e..msEASE-wLeV tlMI;s 500,000 IESCPLT S/N OF OPERADONS IL:CAMM;VEwnE3(Attach ACOR0I111,Mations!%marls(SomwM,if mom.P.c.M(POPS) CERTIFICATE HOLDER CANCELLATION NORTHBU SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Northampton Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS, 212 Main St 4100 AMPRROL u REPRESENT ATSPE NorthampGM,MA 01880 E's , -4.044 Cl� ,_�,©1 SSS$-4 2010 ACORD CORPORATION. All rights rammed. ACORD 25(2010105) The ACORD name and logo are registered Burka of ACORD toMassachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-102199 Construction Supervisor WILLIAM J NARNUM,JR 53 METZGER PLACE SPRINGFIELD MA 01104 f%51 ts_ — Expiration: Commissioner 0/17/1016 %'lir ficn,m4;m.n. - Orrice of Consumer Affairs&Business Regulation 4` OME IMPROVEMENT CONTRACTOR Nit;{ 9istration: 181860 Type: ¢'Ik" Expiration: 11/872016 OSA W.J M,CONSTRUCTION WILLIAM HARNUM JR. 53 METZGER PL. ,_ice. SPRINGFIELD,MA 01104 Undersecretary INV()[::71 ilormotsi City of Northampton Building Department Plan Review rU 212 Main Street Northampton, MA 01060 �N( (y! -11!)) it ); /�// Ofgr'I(1 111400/1 ,,y05,/ ti s (—tric yi i- I Iy r,��