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17C-318 (7) 45 HIGH ST BP-2019-0162 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block: 17C-318 CITY OF NORTHAMPTON Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeorv:ADDITION BUILDING PERMIT Permit# BP-2019-0162 Project JS-2019-000271 Est. Cost:$36950.00 Fee:$290.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: STEPHEN D ROSS 079160 Lot Size(sp fi l: 12719.52 Owner: RECKHOW DAVID ALAN&WANAT CATHERINE GRACE Zoning: URB(100)/ Applicant: STEPHEN D ROSS AT: 45 HIGH ST Applicant Address: Phone: Insurance: 36 SERVICE CENTER RD (413) 584-1224 0 WC NORTHAMPTONMA01060 ISSUED ON.81912018 0:00:00 TO PERFORM THE FOLLOWING WORK.•ADD NEW FRONT PORCH, REPLACE 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: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Sienature: FeeTvoe: Date Paid: Amount: Building 8/9/20180:00:00 $290.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0162 �0 IL APPLICANT/CONTACT PERSON STEPHEN D ROSS ✓1 ADDRESS/PHONE 36 SERVICE CENTER RD NORTHAMPTON (413)584-1224 Q (r(J�Tz PROPERTY LOCATION 45 HIGH ST Hol (f MAP 17C PARCEL 318 001 ZONE URB000)/ � p op(c' 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: ADD NEW FRONT POR PLACE KITCHEN CABINETS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owned Statement or License 079160 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: Approved_Additional pemtits required(see helow) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance' 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 Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay rg / � � 8 9 t 0 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. 'Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. -if (?,4&& W4E4-1166WV y-X Department use only City of Northampton Status of Permit: ,a^ Building Department Curb CWDrivewey Permit �> 212 Main Street Sewer/Septic Availability_ Room 100 WaterlWell Availability__ Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 PlotlSits Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION I -SITE INFORMATION Z- 1.1 1.1 Property Address: This section to be completed by office Ft-Ok'E1.7CE Mei Map t7L' Lot ✓( V Unit (!5t04,2- Zone Overlay District Elm at District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: O\cs fol dA,x/ID Veuy-NoW GJ17A68t,v6 WXA)hT h Ilk 14 L-1 SV PFLOr-cNCt✓ AAA Name(Pr� �r Current Mailing Address- Telephone Signature 2.2 Authorized Agent, "i(lt6N D QOSS 3(v y6eyitE [C—NTE 42b Name(Print) Cument Mailing Address: p/UQfi{A,M P-TUAI F'r /k Ot OEj _ At3 • moi&*- I 7-zA- SWaturef Telephone SECTI N 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only complWd by permit applicant 1. Building S JffG (a)Building Permit Fee 2 Electrical G J V o (b)Estimated Total Cost of D Construction from 6 3. Plumbing / Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 04 6. Total=(1 +2+3+4+5) 471f 36 D . Check Number is Section For Official Use Only Date Building Permit Number: Issued: Signature'. Builtling Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doo s O Accessory Bldg. ❑ Demolition ❑ New Signs [OJ Decks [CJ Siding[OJ Other IQ Brief Description of Proposed Work: ;s.DP flEw t6OAYC P0ii l QE.QI.A4.E KIS[-t1EJJ GAPJI N��� Alteration of existing bedroom_Yes )� No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes __I, No Plans Attached Roll -Sheet as.If New house and or addition to existing housing, complete the following: a. Use of building: One Family Two Family Other o Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions it. Number of stories? L Method of heating? Fireplaces or W oodsloves 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 OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, DAvID il2ee y," as as Owner of the subject property hereby authorize Sic-.FN Ili D. 19055 Glz--AJGeAl- cO.J'72Ac1O2 to act o half,in all matters relative to work authorized by this building permit application. art Signature of Owner to I, -5 1�—f�k EA(J p. eOS'� EI✓EPA L- CU�PAC TOP, ,as Owner/Authorized Agent hereby declare that the statements and in ormetbn on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. STEP to eons Print nature OwnerlAge It Date Section 4. ZONING7 All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This comms m be fined m by Building Dwzmnmt Lot Size ,Zz1L flGR6A7 NO f I.NGE Frontage Setbacks Front Side L: it b R. k L: t R: Rear i3ox 1-50r Building Height L Z(o� No GHhUGb Bldg Square Footage Open Space Footage 1 p oX itt area minus bldg&paved 'ZZ 63 S� ZT�3 parking) 0Ptea/ aPeu, #of Parkin Spaces Fill: (volume&Loeatian) I" A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO � DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T 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 KNOWO 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 0 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 (G L 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 0 IF YES,then a Northampton Ste"Water Management Permit from the DPW is required. SECTION 8-CONSTRUCTION SERVICES 81 Licensed Construction Supervisor: Not Applicable ❑ Name of License Hold. STtPt-�C—rl� et ] ` ` L� License Number 36 5G-Qv�c� cr✓,�r� eo�D 2 /c7 Address Expirali Date /giQ— gnature Telephone 9.Registered Home Improvement Contractor,. Not Applicable ❑ 10TEPN ep t> , 4EA/I-1 tO ZrlciO/Z /S o 8 V7 Company Name Regist`atiop Numbe2 �r 3se G Pvlcrc cE1r,E,� PWD S 30 Address Expiration Date I)0C 1AAAAP_A0J MA 0I060 Telephone1ZZ4- SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(l 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...... ❑ lc) iFgot.>T 15'✓TeA4Y-- U�� 1 'SSIDE SE.TF�ALK 70.01 r43. 58 0 17C-081 83 206.57 177 .24 256 153 17C-082 17C-318 211 .21 7 z-sToeY 15 11 woo o H 12. 575.00 20 y 72. 32 48 5 City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste 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. Address of the work: The debris will be transported by: /V, C- The debris will be received by: Yid ems_ Building permit number: Name of Permit Applicant Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of lndustrialAccidents I Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.gov/dia %VW.rkeyrs'Conapenswthm Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information �p Please Print Le ibl Name (Business/Organizatioo/Individuap: //—a w ( Y Address: —37 jle-� City/State/Zip: r (U Phone#: y/3 Are you an player?Check to appropriate box: Type o���fproject(required): LE]1 aemployerwnh empleyees(fall and/or part-time).• 7, �W can ban 2 I am a sole impostor or partnership and have no employees working for me in $. Remodeling any capacity.[No workers'comp.insurance requind] 3j­1I am a homeowner doing all work myself[No workers'comp.insurance res ifed.]• 4 ❑Demolition 10❑ Building addition 4.❑lama homwwnerand will behiring comments toconduct all work onpro twill eruure mal all conhacmrs siker have workers'wmpenration ivswaviceor are solein IL❑Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions s❑I ran a general tamarack,and I have Idred the sul-comorou,listed on the attached sheet. I3.�Roof repairs These subcontauors have employees and have workati comp.commuter 6Fl Weareacuryoration and itsoRcers hrreexricised theirrighlofe.ernarm per MGL r. 14.❑Other 153,§I(4),and we have m employees.[Na workers'comp.insurance required.] 'Any applicant that checks box 41 most also fill out the section below showing their workers'compensation policy information. t Hommwners who submit this undiscriminating they are doing all work and then hire outside contractor,most submit a new affidavit indicating such. :Connectors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or red those entities have employces. If me sub-contractors have employees,they must provide their workerscomp,policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration 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 W$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under th�in�enalties of perjury that the informalion provided bare true and correct. Date l ph .. Official use only. Do not write in this area,to be completed by city or town offciaL City or Town: Permit/License# Issuing Authority(circle one): /.Board of Health 2,Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACC)R& CERTIFICATE OF LIABILITY INSURANCE ce�62 2p, ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED REPRESENTATIVE OR PRODUC ER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be en4omeE. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an enclormurtmL A statement on this certificata does not confer rights to the Certificate holder in lieu of such endo emen4s). CT PRODUCER nAoOCMRNEEBerybera Grynkievn¢ Webber B Grinnell B , (413)586-6 e North Ong Street Ne a . com INSUREBLERAPFORDINGCOVERAGE NAID Northam,kin MA 01060 INSUREPA, WeetAmenWNLibety 44383 INSURED INSURERS. AI.M.Mutual Stephen Ross SEUREERC: Ann Kim Clairtmonr 36 GENXv Center ROBC INSURER B Northampton MA 01060 MSURERF COVERAGES CERTIFICATE NUMBER: EXP 7/1119 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 WtlICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS TS TYPE OF INSURANCE PYFUCYNUMaMm EN DM'W MWWM'W LIMITS Xox c RSKLGENER.LUAIuu1Y BA.HoccuRRENCE S 1,000,000 C-MSMADE O OCCUR PREMISES ESAPIn SCR S 100,000 MED EXE L,,one RAPIP S 16000 A 8KW58371783 W/01/2018 03/0"2019 PERSONYLSADVINJURY s 1,000000 GENT AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE s 2,000,000 PoLICv O RECUT D LOC PRODUCTS COMEOPAGG S 2,000,000 TRER ALTOMOBLISLIABILITY COMBINEDBIN L LIDSg ANYALTO VOLLLGY4INJURY LPM Firm,) a AUTOS ONLV PoHOE6 LED BODILY INJURY rywemmn0 g HIREDNO AUTOR ONLY TOB ONLY am4enl A E s JHUSIBRELLS UAB H GUR EACHOCLORRENCE s EXCESS USE CWMbMADE AGGREGATE g j DED I I RETENTION s s WORKERS COMPENSATION X aEATVTE OTM ANI PLOYER UX UTr T ER B ANPIL OOPRIETONPARTNERIEXECVTIVE ❑ NIA WMZ80080065462018A 0]/01/2018 0]/01/2019 LEACH ACCIDENT g SODWO IMmeabG lI'ARI E%cwoeD± EL.EACH DISEASECIDENTLovEE s x00,000 IDESCRIPTIONOFOPER0NSMlox E.L DISEASE-POLICY LIMIT 5 500000 A11 I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES 1ACORD 101,AW genal Ralnarks BCOWUIa,SAY Oe named if men S,is nyuin CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN "For OSurance Into OFj,-- ACCORDANCE WITH THE POLICY PROVISIONS. 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