36-044 (2) 19 WINCHESTER TER BP-2018-1336
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-044 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: BuMiM DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categorv� ROOF BUILDING PERMIT
Permit# BP-2018-1336
Project# JS-2018-002375
Est.Cost: $6752.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: CEDAR VALLEY EXTERIORS INC - FRANK MANNELLA
102898
Lot Size(so. R): 10018.80 Owner: BLAKESLEY CLAIRE
zoning: Applicant: CEDAR VALLEY EXTERIORS INC - FRANK MANNELLA
AT.- 19 WINCHESTER TER
Applicant Address: Phone: Insurance:
13501 BALSAM LANE SUITE 20 (800) 871-7115 WC
DaytonMA55327 ISSUED ON.611412018 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: 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 6/14/20180:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck-Building Commissioner
RECEIVED
JUN ' 4 2 Department use only
��y of Non ampton Status of Parma:
" ..y Buildin De artmenl Curb Cut/Dnveway Permit
.: A FBUIL DINO,INSP. ain treat Sewer/Septic Avaiiabiliry
�� - ;'!_ 1nAMv1oN..nAems 00 Water/Well Availability
-` Northampton, MA 01060 Two Sets of Structural Plans
� , • phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specs .-
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION „R P-1 2-13 3Q
1.1 Properly AddressThis section to be completed by office
1 IcYiunlvC\�vt) k•v I' lgeMap ii Lot 0 Yy__Unit
1VA V I
Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Ow er of Rec
mar a l N1ta MA 61040
e(�rinQ Curr nt Mail Address T
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building r /Cl`I (a)Building Permit Fee
7 I V li
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee I7�/
4. Mechanical(HVAC)
5.Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Building Permit Nu er: DateIssued'.
Signature'
Build,g Co is oner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Mus[Be CDmplefed. Permit Can Be Denied Due To Incomplete Information
Ewting Proposed Required by Zoning
This column to bn filled In by
Building Department
Lot Size
Frontage
Setbacks Front
Side L:_. R: - L:' R:
Rear
Building l leight
Bldg. Square Footage %
Open Space
ot
Foage %
(Lot Brea minus bldg&paved
parking)
M of Parking Spaces
Fill:
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO ® DONT KNOW O YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® DONT KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO ® 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 YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO Qp
IF YES, describe size, type and location:
E. Will 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 S.DESCRIPTION OF PROPOSED WORK/check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteradonls) Q Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs 101 Decks [M Sidingl01 Other[O]
Brief Dny iption of�PropOsed ( I
Work I`0 ✓I)Dt --1'P 0.J/ 04., rl/1`$ [ VYII flit QS��1(A.�JC \-/ Uyl—*
,
Alteration of existing bedroom Yes No Adding new bedroom Vseas 7 Np,
Attached Narrative Renovating unfinished basement —Yes_Yes No
Plans Attached Roll -Sheet
Ba. If New house and or addition to existing housing, cornDlete 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?
In, Type of construction
i. Is construction within 100 hof 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 OR CONTRACTOR APPLIES 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, ,as Owner/Authorized
Agent hereby deciare that the statements and information on the foregoing application are true and accurate, to the beat of my knowledge
and belief.
Signed under the pains and penalties of pegury.
Print Name
Signature of OwnerlAgent Data
SECTION 8-CONSTRUCTION SERVICES
8.t Licensed Construction u ervisor nq Nolt/Applicab a ❑1 P/v1�T(f�
Name of Licence Holder: QR1 `—�
Limn s Nu ber
P� I si�� M� 553D3
Andres I Expira on One
-aaa I
Signature Telephone
9.Registered H me In ro AntContractor- Not Applicable ❑
s IAl -2? 1
Company Name II Rei ratio Nul ber
I �iD( I �SG1WL �NP AiC 1�1> IYLi N IMA\, I
Address
Expiration Date
Telephone ' 1 � Il
Sl
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.Ill
25C(61(
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...... ❑
City of Northampton
Massachusetts ot" �L
��G iI&PAn1TLHT OF BFZLDSNG INSPECTIONS F,212 Hein Street • Hunicipal auildinq24CNorthampton, M 01060 r ,
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, conversion,
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 mast be registered. rT
Type of Work: Q r 01 11 `'� Est. Cost: (p r-75ay
Address of Work: I / f �W � �}'���j
Date of Permit Application: L
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
Job under$1,000.00
Owner obtaining own permit(explain): _
_Building not owner-occupied
Other(specify): - _
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALI,WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
1 hereby apply for a b ' ing pei[ s the agent Ithe owner:
U L4 f ft V W 7 l
Date Contracto 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
1 M1� DEPAETMENT OF BUILDING INSPECTIONS i =
212 Mein Sweet • Municipal Builtling T
'� xoxthamptoq 1.A 03060
Massachusetts Residential Building Code
Section 110.R5.1.2
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.
Section 110.R5.1.3.1
Any homeowner performing work for which a building permit is required shall be exempt from
the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a persons)
for hire to do such work, then such homeowner shall act as supervisor.
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 persons) you hire to perform work for you
under this permit.
City of Northampton
Massachusetts d'�s r
I
= x
{ DEPARTMENT OF BUILDING INSPECTIONS w
212 Ksin Street *Municipal Building 2
m
\. Northa ron, M 01060 �sLIN yjP��
Debris Disposal Affidavit
In accordance of the provisions of MGL 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, S 150A.
The debris from construction work being performed at:
1 q 1L1ivic- S{
(Please print house number and street 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:
(Company Name and Address) I
Signature of Per
e it 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.
The Commonwealth of Massachusetts
W
Department of IndustrialAccidents
1 Congress Suite 100
Boston,MAA02 02114-20177
www.massgov/dia
Workers'Compensation Insurance Affidavit:Buildere/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY,
Artificial Information L Print Le ibl
Name (Business/Organrzar�nMndilvianaq. S
Address: I :7�D � p
City/State/Zip! fJ 3 Phone � h - W�_
Aveyounnemployw?Check t eapprwir rte box: Type of project(required):
1 I am aemployer with 2 employees(full and/or pan-time)" 7. ❑New construction
2 l am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capuciry.
IN.waders wmp.iusumnre required]
3-FJ I am a homeowner doingall work myself No woreco'com .insurance ed 9. ❑Demolition
a / [ pin eregwr ]t
4 l ams homeoxmerand will be Actin tracers w tonductall work an m I"ll 10E] Building addition
g con yresole
ensure that an contractors either have workers wmponsation insurance or are sole 11.❑Electrical repairs or additions
proprietors with re employees.
12.[]Plumbing repairs or additions
5 or am a general contractor and I have hired the s meonuaeers listed on the attached sneer 13�f repaid
These suh-eomractorm have employees and have workers'wmp.insurance.
6.❑We are a Connotation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,$1(4),and we have no employees.[Noworkers comp_insurance pasomed.]
-Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
I Homeowners who submit this amdnen Indicating they are doing all work and than hire outside contractors must submit a new stlldavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and sma whether or not those entities have
employees. If the subcontractors have employees,they,must provide their workers comppolicy number.
I am ars employer that is providing workers'compensation insurance for my employees. Below is the polity and joh site
Information. ,r
Insurance Company Name: ttai1 lyl/'
Policy#or Self-ins.L/ii]]c.#: C/ � 6 13 A Expiration Da
Job Site Address: 1 l,�IrC�4�S ?VV� City/State/Zi 4 lo&,2
Attach a copy of the workers'compensation policy declaration page(showing the policy number and pItalian date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a 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$250.00 a
day against th violator.A copy ofthis statement may be forwarded to the Office of Investigations o the DIA for insurance
coverage v fi tion.
I do her y cer - under the pains and penaldes of periary that the information provided on i and correct
Si nature: ✓ Date:
Phone#: 91 /
Official use only. Do not write in this area,to be completed by city or fawn off+cial.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Cityffown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
CL
. .
/
�
s
CommonweallA of MaszacAuxltz
Dm]sion of Prufesslanal Licensure
Board of Buil ding Regulations and Standards
Construction Supervisor
CS-102898 ETpires: 0�/09/20t9
FPANK A MANNELLA 'a lIR
-
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ACC)R& CERTIFICATE OF LIABILITY INSURANCE
li.� I 0610612019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy)ies) must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the Policy,certain Policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsements).
PRODUCER 01300-GOT 2RUTA_T Blanch 1340-1 �q
Stephen W Gersh Ins Agency Inc a"�$I{fo EvO. ls0el4es-19x6 Ak.Rn, Iso6)4B5-ens
9 Monument Avenue65. - - - - -
Marlboro,MA 01782 - - - - -
SISUREm,51AMITU cCOVEROD _ AIC.
_ INSURER A- A. M.Mutual Insurance Company 33758
INSURED INSURER B'. _
Cedar Valley Exteriors Inc - --
INSURERC- -
13501 ealsam IN N - Ste 120 INSINSURER -
Dayton, M 55327-9469 -
IMSURER E:
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
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSUPHNCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
gyEXCLUSIONS AND CONDITIONS OF SUCH POLIpCIIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
ILTp TYPE OF INSURAXOE is 'LICYNUMBER IMMNmY MIdCp YY LIMITS
GENERAL LIABILITY FACHOOOURRFNCE
COMMERCIAL GENERAL LIABILITY DAMAGETORE $
-
_ PREMGEB Feoxun _
CUII.MALE OCCUR MED OP UsY 110 pemon) 5
PERSONAL 6 AOV NJURY S
GENERA-AGGREGATE $
EVL AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OPAGG $
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AUTOMOBILE LIABILITY )Ea amden S _
ANY AUTO BODILY INJURY IFe
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AL TONN F➢ - aCHEDULEO g0°ICY INJU ( Je Q 8
AUTOS PONDS °01
HIREOAlrt05 NONDVUNEO PROPE DAMAGE r
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UMBRELLA USE LYCH OCCURRE4CE S
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qp_DEEgOSL RyESTeENT OC— _ µ ST ♦ 5
pFgNyO EMPLp°�YEErRp6pF�pLIpApBILglpiVryEx - •. X (TORY LIMRs OER
LFFICppp 9gBER EXGIUOE°9 ECUTIVEYIH EL EAOH ACCI°ENT 5 _ 100000.Oo_
A RWM Ula AWCADO-]026393-201]A 101181201] 1011812019 - - -
(min at,, II Nx) EL°ISEASE-EA EMPLOYEE 1 10000000
KA IQ1#fl8fi6 "FERATONs xs— E L DISEASE.POLICY LIMIT s 500,000BO
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CERTIFICATE HOLDER CANCEI-LATION
City of Northampton
Attention:Bldg Dept SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
212 Main Street THE EXPIRATION DATE THEREOF, NOTCE WILL BE DELIVERED IN
Room 100 ACCORDANCE WITH THE POLICY PROVISIONS.
Northampton,MA 01063 � /�}//'J�
AUn100.1ZED REPRESENTATIVE
®1999-2010 ACORD CORPORATION.All rights reserved.
ACORD 26)2010105) The ACORD name and logo are registered marks of ACORD