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17A-095 45 CAROLYN ST BP-2020-0880 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-095 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERFI)CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:demolition BUILDING PERMIT, Permit# BP-2020-0880 Proiect# JS-2020-001504 Est.Cost: $25000.00 Fee:$75.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: NU-WAY HOMES INC 013693 Lot Size(sq.ft.): 7100.28 Owner: NU-WAY HOMES INC Zoning: RI(100)/URA(100)/WSP(l00)/ Applicant. NU-WAY HOMES INC AT: 45 CAROLYN ST Applicant Address: Phone: Insurance: 10 WHITE AVE (413) 563-0085 EAST LONGMEADOWMA01028 ISSUED ON:2/10/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-DEMO HOUSE 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 Occupant signature: FeeType: Date Paid: Amount: Building 2/10/2020 0:00:00 $75.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner � -Gly File#BP-2020-0880 wuaY's Tr1 vSF APPLICANT/CONTACT PERSON NU-WAY HOMES INC ADDRESS/PHONE 10 WHITE AVE EAST LONGMEADOW (413)563-0085 PROPERTY LOCATION 45 CAROLYN ST MAP 17A PARCEL 095 001 ZONE RI(100 /)URA(100)/WSP(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildina Permit Filled out Fee Paid Typeof Construction: DEMO HOUSE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 013693 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: V Approved Additional permits required(see below) 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 1 Signure of Building Official UV 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. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability ` Northampton, MA 01060 Two Sets of Structural Plans .� phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office U� ���}2 p /[.��„ Map t1714 Lot 0 Unit a,' y Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: rV U —U1 Na t) Current Mailing Address;,./ ),S�,3 � �D Telephone Signat e 2.2 Authorized Agent: ,1,,,v K/l f-�l-�v�c�e io LA, 7R OUe, Z: cgjv- hi/w ora • Name(Print) Current Mailing Address: V (f y13) 6W--oc>FS Signatu Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 00 4. Mechanical (HVAC) �V, 5. Fire Protection 6. Total = (l +2+3+4+5) Gn Check Number This Section For Official Use Only ftBuilding Permit Number: ,�— O Date Issued: Signature: /�z ('J Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be tilled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces --- Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DON'T KNOW YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO 61 DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO may, IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES I0 NO V IF YES, describe size, type and location: ��V"``���� E. Will the construction activity disturb(clearing, gradingavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q 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) ❑ Roofing ❑ Or Doors E] Accessory Bldg. ❑ Demolition New Signs [O] Decks [[] Siding[O] Other[p] Brief Descript�kn of Proposed Work: ►)f✓►10 (?-k 'QX i 51'VL"4 / e!q_P Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes 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 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 zc as Owner/Authorized Agent hereby declare that the statements and iVrmation on the foregbtfig application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. 44, Print Na Signa ure r/Age Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: ..}t�11A.) //" " 'V�Z� cs—o / 36 3 License Number 10 wh, � f9ue . �� 1Atj4 1cU�-- P4f4 Ad ss - Expiration Date js�3--oo�s- Signa re Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone 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 buildin2 permit. Signed Affidavit Attached Yes....... No...... ❑ City of Northampton i Massachusetts z � DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building �f Northampton, MA 01060 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: ysC kq�ZVt s7-. (Please print house ber and street name) Is to be disposed of at: V/?-// ! '- •2.37 �i9-STl-�.�►��p,� Pall' rU o rz ase printpbme an L. ation of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Sign ure Permit Appli aor caner D 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 Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): I.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction ❑1 am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t -I.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 L❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs ese sub-contractors have employees and have workers'comp.insurance.t 6. We are a corporation and its officers have exercised their right of exemption per MGL c. 14.E]Other 152'01(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job 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 to$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. I do herebyKc_e?Wy under the pains enalties f p ury that the information provided above is true and correct Si nature: 4Date: -3 ,2v2 Phone#: 5 S Official u.se 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#: Syringfte ld 47 Warehouse Street Springfield, MA 01118 .Abatement, Inc. springfieldabatement(&gmail.com 413-250-4331 Fax 413-734-6119 January 23, 2020 Mr. John Handzel Nu Way Homes, Inc. 38 White St. East Longmeadow, MA 01028 Dear Mr. Handzel: Springfield Abatement Inc. was contracted to perform asbestos abatement at 45 Carolyn Street, Northampton, MA. The abatement was completed January 22, 2020 Should you have any questions or need further information feel free to contact me directly at 413-250-4331. Thank you, '-.q Jennifer Keefe Project Manager/Estimator Springfield Abatement, Inc. 47 Warehouse St. Springfield, MA 01118 413-734-6172 nationalgrid 40 Sylvan Rd Waltham MA 02451 January 22, 2020 45 Carolyn St Florence MA 01062 RE: Service Removal for Building Demolition. To Whom It May Concern: This letter is to confirm that,per your request; National Grid has verified that there is no electric service to the structure located at 45 Carolyn St, Florence MA. If you have any questions or need further assistance, please feel free to contact me at (508) 691-6722. Sincerely, l7"Vli M essver Order Processing Rep Electric Order Processing nationalgrid GD6 a Gas- of A Mlftvm Omww" Date: Monday, 13 January, 2020 To Whom It May Concern: The address listed below has had the gas service(s) disconnected and is now ready for demolition. ADDRESS: 45 Carolyn St TOWN: Florence STATE: Massachusetts Sincerely, Marie Compere Marie Compere Senior Resource Deploy Admin Clerk / ' DATE(MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE �� ovzs/zo2o 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 policy(ies)must have ADDITIONAL INSURED provisions or 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(s). RODUCER CONTACT Sara Scrivner,CIC NAME: rimmins/Gravel ine Insurance Agency,Inc. I q/C No Ext): (413)283-8378 FAX (AIC No: (413)283-2556 1382 Main St. E-MAIL ADDRESS: sscrivner@cgins.com L P O B.X 905 INSURER(S)AFFORDING COVERAGE NAIC# Palmer MA 01069 INSURERA: James River Insurance Co. INSURED INSURER B Nu-Way Homes Inc INSURER C 10 White Avenue INSURER D: INSURER E: East Longmeadow MA 01028 INSURER F: OVERAGES CERTIFICATE NUMBER: 2019 GL 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH 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. TR TYPE OF INSURANCE INSD WVD POLICY NUMBER MOLDY EFF MOL DY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000,000 CLAIMS-MADE � OCCUR PREMISES MAG�TOEa occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A 00084084-0 08/06/2019 08/06/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- ❑ LOC PRODUCTS AGG $ 1,000,000 OTHER: JECT $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident r $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N ISTATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-FA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) 45 Carolyn St.,Florence MA 01062 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main Street AUTHORIZED REPRESENTATIVE Northampton MA 01060 �/� .i/xL�� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD