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07-017 (11) 360 NORTH FARMS RD BP-2020-0788 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:07-017 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2020-0788 Project# JS-2020-001369 Est.Cost: $1700.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ROBERT HUNTER 88742 Lot Size(sg.ft.): 11238.48 Owner. FIVEASH KATHERINE Zoning: RR(100)/WSP(100)/WP(91) Applicant. ROBERT HUNTER AT: 360 NORTH FARMS RD Applicant Address: Phone: Insurance: P O BOX 10432 (413) 575-1097 WC HOLYOKEMA01041 ISSUED ON:1/9/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-ATTIC INSULATION 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: FeeTVlpe: Date Paid: Amount: Building 1/9/2020 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner SGC /oil City rr/ � p� Cit of Nort am r Bulldinq Dep rtm 9 20�.3:z" av pen-('.3t 212 Main S eet a Rt3t3rT1 �l! Northampton, r phone 413-587-1240 13- APPLICATION TO CONSTRUCT,ALTER REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1,9 Prczr£�t3dr Thi,Section to be completed by office 360 North Farms Rd, ot v arae—..�m._.,� �. vu•;l f'strict Northampton MA 01062 Elm r E�tric;>> . bstr`s LTION 2 M PROPERTY OSI NERSHIP;Al.iTHORIZED AGENT �Zj Croner of Record; Katherine Fiveash 360 North Farms Rd, Northampton MA01062__ ............- _ _ - . _ . Nerr -ii�'lint) Current MaiWig Addrass: Tek:phane Sigrtahut* 2. Robert Hunter PO Box_10432, Holyoke; MA 01041 Nerve nnt) C 3r. ,„P'lailo't3 l drirasc: __ 413-575-1097 _ Sigr is�: � pitnrse- SEIC TfinN 3 ESTIMATED t,3N T CTJ+ON lEen•i��.,.�,��.. .. Estimated Cast(Dollars)to be C3ftic;al Use Oni?; �, tt Ieted k_E� rtnit applicant # 1. Building 1700 4a,Building Pewis 2. Electrical (b)Est; fatee Tot l Cost of Cons tISYiLf' 3, F%mbing Building Pnaviii Fee 4. Mechanical(HVAC) 5. Fire Protection . Total = I t a 13+4+ i 1700 Ghack"4urrmer This Section For Official Use Orslv �2v r � Ia �E�tl�tira PertF t Numberae E <arrlln�a � , ,°s.t•r gate PRlpermits @ gmal . — r1?t EMAIL AC DRESS (REQUIR HOMEOWNER OR CONTRACTOR) §ECTI N; 2ESC ZIPTI 3N OF PROD W rh Ck fit a�tsiiratate} areawvww�w-..r.wnA.Mw j ate. .d.............m«...««.«.«.....w.....�r....r..a.......««m«....aa«,..wwwwww.�.i. New Addition Q Replacement Windows At Flteration(s) 7fto#ing Q Or Doors c3 Accessory Bldg. t,..a Demolition New Signs �,1::11 Decks cry siding(Cpj other[q] Insulation Brief De riptiionF Proposed Work­­Ivlass Save sponsored 400sf attic loose fill,cellulose. R22 Alteration of existing bedroom —Yes X No Adding new bedroorn Yes X No Attached Narrative Renovating unfinished basementYes X No Pians Attaches;Pofl 6a, 1f New Clouse alta ar,400tion e foIt0Ar► a. Use of building:tine Family _ Two Family m��Other b. Number of rooms in each farnily unit. Number of sathroorns_,__µ_ c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? r r g _ Fireplaces or Woodstoves Ik�le,ttiod o!heatirt '� Number of each Ener Conservation Compliance. Masscheck Ener Compliance� Energy p 9Y p to form, attached? i 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 r liar floor below finished grade k. Will building conform to the Building and Zoning regulations? —Yes No I. Septic Wank City Sewer� Private well_.._._.�.,_ City water Supply SECTION 7a-OWNER AUTl'ORiZA tl td TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMP I Katherine Fiveash property ., as Owner of the subject _�._ hereby authorize Robert Hunter to act on my behalf, in all matters relative to work authorized by this building permit application. Please see attached Permiot Authorization Form 3 Jan 2020 Signature of owner Gate: i, Robert Hunter as Owner/Arut7knolvmledge Agent hereby declare that the statements and information on the foregoing application are true anrf ar<cu ate, to the best of my and belief_ Signed under the pains and penalties of perjury. Robert Hunter Print Name 3 Jan 2020 signature of wnerfA ent tate SECTION'S-CONSTRUCTION S RViCIES 8.1 Licensed Construction Su er�rsr=�: Not Applicable 0 Robert Hunter CS88742 Name of Licons*H219LOr _ License Number PO Box 10432 Holyoke, MA 01041 1/16/2020 Expiration Date 413-575-1097� ��� � ; Signature t elepYone 1 , Iigax Irnpr t tC '... Not Applicable 0 Precision Remodeling, Inc. 152922 !! CcrmsAanydame Registratjcri Number 21 Roosevel Ave, 10/13/2020 Address - Expiration bate 3 � Holyoke MA 01040 7eleuho,r*a 413-575-1097 SECTION 10-WORKERS''COMPENSATION INSURANCE AFFIDAVIT M G.L,c.152,§2SC{fi}; 'a't eskers C:omperrsatiao Insiurance affidavit nrk,st be corripleie:arid submitte.o wiVl i this application. Failiure to provide this affidavit will result in the denial of the issuance of the buildmg permit. Signed Affidavit Attached Yes ...� No_ 0 City of Northampton klsshucas �� PARTME14 ° OF BUXLIJZNG INSPECTXONS 23:.2 Main Street Y Municipal Bioildi.ng FYO.L GT a:oy.>4:.�,t>. N:A 4:.060 AITFIDAVu liome Improvement Contractor Law Supplement to Permit Application The Office of C'onsurner A ffiairs and Business Regulation("0CA R")regulates the re.pstration of contractors and subcontractors performing improvement-,or renovations on detached one to four family homes. Prior to pe.rforrning work on such homes,a contractor must be registered as n I tome Inaprovernent Contractor("HIC"), M.G.L.Chapter 142A requires that the-reconstruction, altercation, 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 foarr dwelling units....or to structums which are adjacent to such residence or budding"be done by re itsterecl contrictors. .Nwle./f'the homeowner has a ontracted rtvth a corporation or GLC.that entity must he regiveretL 'Type of Work: Insulation [,,,sl, C 1700 Address of Work:___�Q North_Firms .Rd.,..___N_o_►kh.amq�pn�MA Date:of Permit application I hereby certify that: Registration is not required for the icbllowing reason(s); Work excluded by law(cxpl ain") _--..._ Job under$1,000.00 Owner obtaining own permit(explain): .._.. Building not owner-occupied ..........._Other(Specity). . _. OWNERS 01VI AINI` G 7141FIR OWN, PERMIT IT O ENTERING INTO{"ON1 ttA(',TS WITH t?NREGISTF RVID CONTRACTORS ORSUBCONTRACTORS FOR APPLICABLE 111O4'IE IMPROV is IENTVY+C RK ARL NOT ELIGIBLE FOR ANJ) DO NOT HAVE rl1O(.ItAM OR CUARAN i`Y FUND UNDER NI.G.i..Chapter 142A.SUCIi OWNERS ALS():SSI METHE Rt:tii ON*sIBILITES FOR At..l.,WORK PERFORMED UNDER T°tit IBUI .DING PERMIT.SLE, NEXT 11AGE FOR N1011F INFORMATION. Signed under the penalties of perjurY I''hereby apply for ra building permit as the agem of they o\vm,;r• 3 SCK 'Zu2o Robert Hunter 152922 flute Contractor ' +: 11!C Reoistnation No. OR: Notwithstanding the ;,ib>vc notice.1 hereby ;apply lor a buildino permit as the owner of the above property: x bzf;r Oi) ner Nanle aild Signature i Cita of Northmwpton DEPARTMENT OF BUILDING TNSPRCT IOWZ 212 Main Street •Municipal Building Nyurtlaavj>ton, MA. 01060 Debris Disposal Affidavit In accordance of the provisions of MGL.e 40, S84 I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this wilding Permit shall be disposed of in a properly licensed solid waste disposa€facility, as defined by MGL c 111. S 150A, It he debris from construction wore being performed at: 360 North Farms Rd, Northampton MA 01062 (Please print h©use number and street name} Is to be disposed of at: K&W Materials, 138 Palmer Rd, West Springfield, MA tr lease print name and I catican t: facititY7 Or will be disposed of in a dumpster onsite rented or leased from: 3 Jan 2020 ..._._.... ............ �icdr tore of 'ermit Applicant or C7wller 57 ie 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 rr,f` assach"Setts Department cr,f`lndustrli Aceidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mas&gosVdia Workers,Com,penetion insurance AfRdavit:BWWtrstContmdor tritian.vphunibom TO BE FILED WITH THE PERM111ING AI3Ti OPiTY. sant 1 o atlon P e N ( us , tirlbd«=iduat). Precision Remodeling,, Inc. Address: 21 Roosevelt Ave City/State/Zip: Holyoke, MA 01040 Phone#: 413-575-1097 Are you so employee Check the apprvprirtr teas: � Type of project(required): J Q t am a M&Ya with 6 {tszti wdl r �` h° 7. New construction 2.n 1 m s ask pmpsie sir pwtm6sy&gd bgvc err s'.vy m woricizg for ase m & Remodeling AnY CVK*.N workers'comp.iz� mq ) 9. ®Demolition 3.C3 I am a bomeowner doins oil work myself[No wtidxn*:oro,Lmumneen gWre&]t I0�Building addition #. l am g d a i116c biri»g cmttractaars to coc t all wa>1,oo my prop oly, 1 swill etMft tit#art ctm=ton xis have wi)rkm'compemaion i=o=e or at volre I LL]Electrical repairs or additions promiebom otitis W 12,®Plumbing repairs or additions 5. I=a geoaat=Wactor ad 1 btve hind die sub-cov=tw listed on the aasched 4m. t .�Roof repairs Tbese aubctmtractat�bawl eoWloye s and bavc waders'+�. m.s 5. Weaara 14.®flthcr 111.,5 latit]n capecasloa std iia otStxsr have ezerei�d their s9dbt of s~x pez iwtGL c .�... 152,1!(4).sand wre bays ne emok)yea.ltdta 'tmp, mquirad.] *Any ippilcant dot t beclos boas#1 sant"611 sot W smum below Aowig dseir woemn'tompumboo policy ntinetmrtift t ltamwwmn*M sidnit dela affidavit Wkating dwy ore droit all www and dsas We cowde coatradots mum amt a mw affidevsr indicating such. 'Contra s that cbg*ibis bas a mt sawbed an additkad ob at ahowiod deo casae otdo sib-*�end state w'be*wor not those=tit"!save —Pivytes, h"&e nb+ta!gore am*yers,that'mutt p wAda Wir wa&em'comp,polay owvber. I aM fib employer that Ripa o"xg wor ets'compensa don Insurance liar my emplopem Below is the potiry and job.site Information. Insurance Company Natio: Guard Insurance t Policy# PRWC014187 self-ins.Lic.�: Expiration Date: 16 December 2020 job SiteAddress, 360 North Farms Rd. City state zip:Northampton MA 01062 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 tip 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 s day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, I do hereby rertz;ft',under thtpails acid pen antes of perj r that the informadon provided above is true and correct sizn3ture. 3 Jan 2020 Phone#, 41 -575-1097 ~ Of crlial ease only. Do trot tsgtite In this areq to be completed by city or town of ctal City or Town: �Permit/l teems Issuing Authority(circle one): 1.Board of Health 2.Building Departir-cor 3.City![`o"Clerk 4.Electrical Inspector 5.Plumbing Inspector Cs.Other Contact Pterson° Pbrsne e Permit Authorization mass Save Form Site ID: 3596101 Customer: KATHERINE V FIVEASH I, k ,Q,n+0- V' V _GLS , owner of the property located at: (Owner's Name,printed) 360 N Farms Rd Northampton, MA 01062 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property, Owner's Signature: �12/y�i(/J�� i i Date: i FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Precision Remodeling, Inc. 20dec201 8 i Participating Contractor Date I I i Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Only City of Northampton � Massachusetts � c s DEPARTMENT OF BUILDING INSPECTIONS ; \ 212 Main Street • Municipal Building Orb Northampton, MA 01060 Property Address: 360 North Farms Rd,Northampton Contractor Name: Robert Hunter Address: 21 Roosevelt Ave, City, State: Holyoke MA 01040 Phone: 413-575-1097 Property Owner Name: Katherine Fiveash Address: 360 North Farms Rd. City, State: Northampton MA 01062 1, Robert Hunter (contractor) attest and affirm that the building I intend to insulate does not have any open air (knob and tube)wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit. Contractor signature Date 1nov2019 * I Mto JIVNe"'�Berkshire Hathaway or UAP Insurance Company - A Stock I ffl, Policy Number PRWC0141 pt Insurance "A GUARDCompanies Renewal of PRWC9385 NCCI No. (258-e Policy Information Page [1J Named Insured and Mailing Address Agency Precision Remodeling Inc THE DOWD AGENCIES, LLC 21 Roosevelt Ave 14 Bobala Road Holyoke, MA 01040 Holyoke, MA 01041-1900 Agency Code: MADOWD10 Federal Employer's 10 04-3317682 Insured is Corporation Risk ID Number 273479 [2] Policy Period From December 16, 2019 to December 16, 2020, 12:01 AM, standard time at the insured's mailing address. [3] Coverage A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation Law of the following states: Massachusetts B. Employer's Liability Insurance -- Part Two of this policy applies to work in each of the states listed in item [3]A. The limits of our liability under Part Two are: Bodily Injury by Accident - each accident $500,000 Bodily Injury by Disease - each employee $5(;0,000 Bodily Injury by Disease - policy limit $500,000 C. Other States Insurance - Part, Three of this policy applies to all states, except any state listed in item [31A. and the states of North Dakota, Ohio, Washington, and Wyoming. D. This policy includes these endorsements and schedules: See Extension of Information Page - Schedule of Forms [4] Premium The Premium Basis and, therefore, the premium will be determined by our Manual of Rules, Classifications, Rates, and Rating Plans. All required information is subject to verification and change by audit. (Continued on another page) C 0 Total Estimated Policy Premium 12,059 Total Surcharges/Assessments $403.00 Total Estimated Cost $12,462.00 1kTlER_NALU5YXX Page Information Page MGA PRWC0141.87 Date 11/1112019 WC 000001A MANOTE Issuing Office: P.O. Box A-H, 39 Public Square, Wilkes-Barre, PA 18703-0020 • www.guard.com M1 Office of Consumer Affairs and Business Regulation 10010 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: REMODELING, INC. egi152922 "` Expiration: ration: 10/1312020 P.O.BOX 10432. HOLYOKE, MA 01041 Update Address and Return Card. SUA 1 er 2(,M-0517 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. if found return to: Magill tration Exrsirat- Office of Consumer Affairs and Business Regulation 152922 10/13/2020 1400 Washington Street-Suite 710 PRECISION REMODEI.INC,INC. Boston,MA 02118 ROBERT R.HUNTER 21 ROOSEVELT AVE. t s HOLYOKE,MA 01041 Undersecretary Not valid Without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Suilding Regulations and Standards Constroction Supervtsor CS-088742 `xi3 res ^)1 1612120 ROBERT R HUNTER PO BOX 10432 HOLYOKE MA 41441 ? Commissioner