Loading...
31B-099 IIBARRETTPL BP-2018-1090 GIs#: COMMONWEALTH OF MASSACHUSETTS Map�Block:31 B-099 CITY OF NORTHAMPTON Lot -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeorv� ROOF BUILDING PERMIT Permit BP-2018-1090 Project# JS-2018-001964 Est Cost $39000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: TEAGNO CONSTRUCTION INC 82248 Lot Size(su.ft.): 13416.48 Owner: WILLIAMS BARBARA S&STAUNTON WILLIAMS 1R Zoning URC(100) Applicant: TEAGNO CONSTRUCTION INC AT. 11 BARRETT PL Applicant Address: Phone: Insurance: 228 TRIANGLE ST (413)549-0803 Workers Compensation AMHERSTMA01002 ISSUED ON:4/25/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF 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: O_ 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: FeeTvpe: Date Paid: Amount_ Building 4/25/2018 0:00:00 540.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 470r-09 ADO 0 Departmenfuse only Cit of Nor pt n of PRaraC °`-SOFt�lt�ltg,` "rtm t CUTE" way Permit N A'M 4 14 Main Street SeweD�epdo'AvidabHlty 'I Room 100 Wateri4Availability Northampton, MA 01060 TWo Sets of Structural Plana phone 413-587-1240 Fax 413-587-1272 PloVSne Plans Other APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING F,07-19-SECTION t-SITE INFORMATION p v—/9_ Z`�/' 0 1.1 Property Address: This section to be completed by office Map 3 Lot Unit Zone Oveday District Elm SL District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: STo.IA4na OJI htmsse. Name(Print) 1 Curren)Malling Address _ ,Lj l elepM1one Signature 2.2 Authorized Agent. 1-QJ iI GaIh4razc T / TrrG� {� a f� /�r14,M/tQO Name(Prop Current Mailing Adtlres Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed y permitapplicant 11 1" Building3 (a)Building Permit Fee o- 2. Electrical (b)Estimated Total Cost of Construction from e 3. Plumbing Building Permit Fee Z1 4, Mechanical (HVAC) 5, Fire Protection 6. Total=(1 +2+3+4+5) 3 Check Number This Section For Official Use Only Budding Permit Number: Date Issued. Signatu L Buildin ommissionerilnspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) p o Section 4. ZONING7 All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing proposed Required by Zoning Tris column to he filled in by Bnik1mg Department Lot Size Frontage Setbacks Front Side L:..._ R:.. L: R....... Rear _......... Building Height Bldg_Secure Pootage Open Space Foofagc °o (Lot urea minus bids&paced _. orlon a of Prokure Spaces _.... Fill: polumc&Locahnn) A. Has a Special Permit/Variance/Finding ever been issued for/an the site? NO O DONT KNOW (g YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW O YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW O YES O 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 O NO 'tel IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb(Gearing,grading,excavation,or filling)over f acre or is it part of a common plan that will disturb over 1 aci YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION S DESCRIPTION OF PROPOSED WORN Othock all applicable) New House ❑ Addition ❑ Replacement Windows JAfterai�R..�fmg �?r Or Doors O Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [E] Siding[[--3] Other[DI Brief Description of Proposed /J Work: e-rri� -'nocF- SL.irv:�et iu;l-kl1 SKo� Cktit 4fe tf&gif flra'upfl'f�- Alteration of existing bedroom_Yes No Adding new bedroom SA Ve3 �} o UfJo $fid uµ=F� a�RRf R Attached Narrative Renovating unfinished basement Yes No Plans Attached Rail -Sheet Se.if New houseand or addition to exiStina houMnia,Complete the following: a. Use of building One Family Two Family Other It. Number of rooms in each family unit Number of Bathrooms c. Is there a garage attached? J, Proposed Square footage of new construction. Dimensions e. Number of stories? L Method of healing? 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 1D0 yr. floodplain_Yes No I. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. SepticTark CitySewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the sob act property hereby authorize �CU;S h blIIAJd IC.0 I 41V0 �D/JJ :u C'i-rdz.J Z%uc. to act on my behalf,in all matters relative to work arr prized by his building Tenni(application. Signature of Owner bate ,, //n0UIS �A111A4P / ,as Owner( thoriz Ag hereby deaiare that the statements and information on the foregoing application are true and accurate,to the best of my nowletlge and belief. Signed under the painsand penalties of perjury. Lout GO-L/ l n o r o Pmh N me AZt"-, � a� y zoic' 51 alum of OwnerlAgen De SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder�� ll/S (7C{///J An i p8a-a r/ lLicense Numder i3J /� �rNacbu �2) / s* it. Cr�9 0/0�� /3d��/� Address q-� Expiration D�— /Q -tel\ nature Telephone 9.Rapiatered.Home Improvement Contractor Not Applicable ❑ � ti+�' F�IJS}ruc�len TuC Compan Name Re isVation Nu ber ,2 Tr t , A0 S,1- • a awl Addres{§ Eigbrat n D e ,qN'( Prf+, M<]- / p'� TelephoneL��CIO i 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 provitle this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... No...... ❑ The Commonwealth o(Massaehusetts Department oflndustrial Accidents ] Congress StreetSuite 7 Boston,MA 0271 14-1017 www.mass.gov/dia MY Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibly Business/Organization Name:_ Ai�`,e CI A.CI �1G 1 S�CTMN �"/�C Address: ( ( r^ 1 City/State/Zip: . L Phone p: Are you an employer?Check thea ropriate box: Business Type(required): D® I am a employer with employees(fall and, 5. ❑Retail 11 orpart-lime)t 6. E]ReslaurantBac'Gnting Establishment 2.0 1 am a sole Its or partnership and have no 7_ ❑Office and/or Sales(incl,real estate,auto,etc) employees working for me in any capacity. [No workers'comp.insurance required] K. E] Non-profit 3.ElWe are a corporation and its officers hove exercised 9. ❑ Entertainment their right of exemption per c 152,§I(4),and we have IO-❑ManuLamming no employees. [No workers'comp.insurance required]* I I ❑Health Care L❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workerscomp-insurance req.] 12.❑Other "Any applicant that cask,box#1 must also fill out the rection below shoming thelnvoden'cnmpmeatitm polies information `^IRhecoryomtenllinebat'eexemptad lhemselvc.but[M1e corpnmtion hasp0cr anplorrees,awoikers compensation policy is mgttlrcd end such an orpeniration would checkkbrx t.L I am an employer that is providing workers'cmnpensatinn insurance far my employees. Below is the police injarmatimi. Insurance Company Name: 4, : vr./ /,((,Ly({�p(� tU� �� Insurer's Address: City/statdzip: Policy 3 or Sa1f-ms.Lm.a Expiration Data / 2a/ Attach a copy of the workers'compensation policy declaration page(showing the policy number and .pira[ion date). Failure to secure coverage as required under Section 25A of MCL c. 152 can lead to the imposition ofcriminal penalties of fine up to 51,500.00 and/or one-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy ofthis statement may be forwarded to the Office of Investigations of DIA for insurance coverage venfication. I it,,hereby Cerro"under the painsand nfperjury that the information prarided above is true and correct. S-g i Date 'f��L2.61 Phone 4. �p- Yf3 'J [ /'� W 03 / Official use only. Do not write in this area,to be completed by city or town official Cit, or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: "do TEAGCON-01 CHRYSTAL +corm CERTIFICATE OF LIABILITY INSURANCE ° 0410M2 0 410 3 8 01 01 8 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 policyIes)must have ADDITIONAL INSURED provisions a be erd.rsed. If SUBROGATION IS WANED, suhlect to the terms..it conditions Of the policy,certain policies may require an endorsement. A wUNHm Nn on this certificate does not confer rights to the cents icate holder In lieu of such eneorsemem(s. PROTUCER NOME^CT Chrystal L Greenleaf Phillips Insurance Agency,Inc. IHGD"x 97 Center Street ,EFq,(413)594-5984 �iuc.No)(413)592$489 Chicopee,MA 01010 AMS cv chrySMI hillipsinsuranee.com INSURERfi AGGORgNG COVER4OE _ NY01 Nausar,A:MID Security Insurance Co _ 24082 INSURED INS REBS Ohl ,CaustualI 124074 Teagno Construction,Inc. INSURER D.A.1.M.Mutual Ins.Co. 93]58 Mr.Donald Teagno _ -- 228 Triangle Street INSURER D. - Amhmst,MA 01002 IxsugEg E INBUNESI COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREI N IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS I.NSRI vEapSVpAxCE AD Um Not WD PoNCv xuMaER PoLKYEFF POOCr FIP LIM119 A I X COMMERCIALGENERALOA6ILT' 1,000,000 EACH CCCURnENCF cLAIMSMAOE �occua 'IBKSS/TSOBZ] � 6LOtI2016 WI%I2019 DAEwGE iOREMIriEli(EavarvarDel � son DOB Fr MET EKE M — 10,000 PERSONALeAOV INE DRY 1,0¢0,000 `ENLAGGREGq LIMRAPPJESPER'. GENEfl LAGGREGATE 2'000,OD0 � y'PRo L¢ 2,000,000 Prij, EJECT ❑ ' PRopu Ts-COMPIOPAGG A AurouoML ONOMIL s uANLm cOMNNED sIrvGi _ LE Lwrt 1,000,000 ANY AUTO BAS$]]SD62] 041018018 04/01/2019 sowLr INJUR9"NOP., e.s AUq�O�S ONLV X NED p�N�ITHyyOEJJSyyUyyLryryEFFIOI�� BOwLY INJURY Per arlJe,M1 4 .TOBONLY '' x M. - VIR PFvrRO PERttpM1AGE r B ' XX NMBRELLA NAB X DCCVq EACH OCCURRENCE 1 11000'000 ExcEss Lae cwMsnuOE US057]506]7 Iduot8o18 aIala"19 AGGREGATE 4 1,000,000 CET X RETENnoxa 10,000' S D ANaEWRWYEIRa ANS IN X PC E X ER ANYPROPwETOwP�RTNER,TJIEwrne MZ600522304018A OM018o18 Dd'o'Q019 1,000,000 FlCERINQ ELUDEDT r�IN IA' ryy EL FACHACLIOENi S i e"e°I°'Y'"�E�11 EL.DX sE-EAEMPLOYE 11000,000 n m.1O 1,000,000 GEBLPoPTION OF OPEPATIME. IEC.DISEASE-PRICY LIMIT DESCRIPTION OF MFMTbNS I LOCATIONS VEHICLES IACORO IM.APPRE.Ran'arLe atlWUM.May W,MaNM It Wm s NpWMIN CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence oflnsurence THE EXPIRATION DATE THEREOF, NOTICE WILL BE DIONERED IN ACCORDANCE WITH THE POUCY PROVISIONS. ALTHORQED REPRESENTATIVE ACORD 25(2016103) IS 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD City of Northampton Massachusetts e}`'�i JfOfr \/ �6 t DEPARTMENT OF BUILDING INSPECTIONS 212 Nein Street • Municipal auiltling JC Noctpampton, MA 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes.Prior to performing work on such homes,a contractor must be registered as a Home improvement Contractor("HIC'). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair,modernization, convection, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity most be registered. Type of Work: — ( F Est.Cost:$ n Address of Work: // S rrrLLL�� T/ T- ?L/KIFC Date of Permit Application: I hereby certify that Registration is not required for the following reason(s): Work excluded by law(explain): —Job under 51,000.00 Owner obtaining own permit(explain):______ _Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGIS'I FRED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS'rO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILI I'ES FOR ALL WORK PERFORMED UNDER THE BUILDING PER511 F.SEE NEXT PACE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the okcner: 4410 1 C'ac voPn rf��ifia �. �E �/ Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton Massachusetts x DR OF BUILDING INSPECTIONS 212Xein 212 in Street *Municipal Building 5�.cca XA 01060 s✓'".�\d Debris Disposal Affidavit In accordance of the provisions of MOL c 40, S54, 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, 5 150A. The debris from construction work being performed at: 11 � sis T (Please print house number and s reef name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: a� Try — V /ky R�cycl(-4y (Company Name and Address) /lcK-f-hA-frc,J Signe of P rmit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed.