17A-09545 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:
rVU —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
ftBuildingPermitNumber: ,— 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
iMassachusetts
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 ofMassachusetts
Department ofIndustrial 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. Remodelinganycapacity.[No workers'comp.insurance required.]9. El Demolition3Iamahomeownerdoingallworkmyself.[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 repairsesesub-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 ofthe 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 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 to$250.00 a
day against the violator.A copy ofthis 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 fp 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,CICNAME:
rimmins/Graveline Insurance Agency,Inc. I q/CNo Ext): (413)283-8378 FAX
AIC No: (413)283-2556
1382 Main St. E-MAILADDRESS: sscrivner@cgins.comL
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
ANYAUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY Per accidentr
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.
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