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36-185 (16)
898 BURTS PIT RD BP-2021-1243 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36- 185 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: KITCHEN RENO BUILDING PERMIT Permit# BP-2021-1243 Project# JS-2021-002067 Est.Cost: $9000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JIM R BOYLE/ASAP PAINTING, INC. 107689 Lot Size(sq.ft.): 31232.52 Owner: REYMOND WENDELIN K Zoning: Applicant: JIM R BOYLE/ASAP PAINTING, INC. AT: 898 BURTS PIT RD Applicant Address: Phone: Insurance: P O BOX 241 (413) 586-8010 WC HADLEYMA01035 ISSUED ON:4/27/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:KITCHEN RENO 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. 6r '/ • Certificate of Occupancy Signature I Fce'hype: Date Paid: Amount: Building 4/27/2021 0:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner , l' Cli•? ,,, / 14 The Commonwealth of Massachusetts 09 l at Board of Building Regulations and Stan 6' `� FO M ICIPALITY Massachusetts State Building Code, 780`C �,„ ` �O<2j E Building Permit Application To Construct, Repair, Renova �ljsh a evise, Mar 2011 One-or Two-Family Dwelling �ti A.,q oF�T This2 Section For Official Use Only Aso ws Building Permit Number: �'a1"i�/ Date Applied: :111,66L A' tl,l 7 Building Official(Print Name) Signature D e SECTION 1: SITE INFORMATION 1.1 P op s •y Addre 1.2 Assessors Map&Parcel Numbers 89� lurl-s V,� 110 a 6 3 CQ I ci S 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.yO wnfgr'of Re ndelirl. \E mound F\octrice. r(b 0t0(0a Name(Print) U City,State,ZIP 898 uC P,A- q a d (Lk\3)-)a)-.tea rey rnond --e,r-►1tseg4)con ccs�-. No.and Street Telephone �J Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units l Other Specifyg\ 2 ne� Brief Description of Proposed Work':_Qm epde d (', e p 1 a e k l }r—he/'� cab /o d' C�ou o•I'e r opS. ) SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 000 _ 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ 0 Standard City/Town Application Fee I .Otb• 0 Total Project Costa (Item 6)x multiplier x 3. Plumbing $ 1 ,OCO, -- 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All F ��j Check No 1 Check Amount: Cash Amount: 6.Total Project Cost: $ q,OOO. -- 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Gs- `c�(Dg(i I('� a5lo`�Oa J►PYl ` License Number Expirationbate Name of CSL Holder PO (1 i a k I 1--) Russell cST List CSL Type(see below) N .and Street Type Description a 03 0:J Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling Ci /Town,St ZIP M Masonry RC Roofing Covering WS Window and Siding ,�/ I' }�t SF Solid Fuel Burning Appliances I'b .5 g r3SVb OeS 1 Qn&e'L. n-Con(eF , I Insulation Telephone LiEmail address D Demolition 5,,22 Registere• Home Improvement Contructqr1HIO Vr-h r1 •,nc erat .enier C. 1 9 535o 10 i 1 o I aocia M ht- L• 1� HIC Registration Number Expiration Date HIC Company Name 4 C Registr t Name (f'O a k' tV Fussell `Sr. AesiQr, (�4%k11en-Con(Pplc_ n-Q* N .an S reet Email address a � (qa o1O�5 (�t3)58b 3566 Ci /Town, ate,ZIP Telephone SECTION 6: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 building permit. Signed Affidavit Attached? Yes No . ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize J t r e\ P . ob I to act on my behalf;in all matters relative to work authorized by this building permit application. USE,r1c1e..ttr \- Re_,..„110 r, ya�a aoa Print Owner's Name(Electronic Siature) ate SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. j t,M . c.) (:;1.\\ �- as \ada Print Owner's or Authorized ent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) _(including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms _ Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" *�;I � ichen Kitchen Concepts&Design Center,LLC houzz 4111 oncepts P.O.Box241 ""\""` �n__ oo 1711�11iffifNod E Min '- 2,020 2019 2018 2 r)1 7 c\1 f ,,()1,1 BBB. Hadley.MA 01035 0241 2 0 2 0 '1i1L'6i4i1l'1I1I I42I'a g91:1fJ1JL*J..Ilaef g1:111''8a111:1: nccuemic'' DREAM.c DESIGN a DELIVER - OlI51NE5S CONSTRUCTION SUPERVISORS LICENSE Recognized by the Commonwealth of Massachusetts as a Supervisor. Superior knowledge of Massachusetts laws and code are mandatory. Testing and years of experience are required to receive this license. lir Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConstruCtio i tipervisor CS-107689 pires: 10/25/2021 JIM R BOYLE: •.,,; f. PO BOX 241 r r i :' 1 -^ 01 HADLEY MA 035 I i "11 '`()1S'5 :1O� Commissioner A,,,c.. ri! - License #- CS 107689 HOME IMPROVEMENT CONTRACTORS LICENSE Required for remodeling existing property. .i?''r (r,N,,eat ra4z ni,rr aia.afiiseeli Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:LLC Rnaistr Lion Expiration 193350 1011012022 KITCHEN CONCEPTS&DESIGN CENTER LLC JIM R.BOYLE 117 RUSSELL STREET ti,'e4.�`•tr4i,. HADLEY,MA 01035 Undersecretary License #-180308 All licensing information can be obtained through government agencies. Insurance coverage binders and references are furnished upon request. • Office: (413)586-3506 • Fax: (413)586-8051 • Email: design@kitchen-concepts.net City of Northampton HAMyjr� S /, Massachusetts �?°' rr * ".,, 'l. s DEPARTMENT OF BUILDING INSPECTIONS fA: 212 Main Street • Municipal Building Northampton, MA 01060 rffrir 40‘ CONSTRUCTION CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: 8�.irnDs-6R Location of Facility: The debris will be transported by: Name of Hauler: Gm\I-1E.RSA" 11> Signature of Applicant: VA-c-) ()Doe._ Date: The Commonwealth of Massachusetts iii l.= Department of Industrial Accidents j ; 1 Congress Street,Suite 100 �;=__4E Boston, MA 02114-2017 „.L . wwwnrass.gor/din Workers'('ttnipe tsat Insurance Affidavit:Builders/('ontractors/Electrician+/Plumbers. to lit. 11Ll I)\%IiII I HE PERMITTING ACT-1101t111 Aaalicaat Information -( Please Print l.c.,ibl♦ Name(BusinesslOrganization lndntduai): PLS ftp CPalf +l tr Q _ ___i--rlc, Addtess:PO C:So j ay k ) 11-1 Ru5 s e.y --re...81- City/statc/Zi . d 0 10 3 5 phone#: (4 t ) 5 8 to-80 I 0 Are yaa an eatplwev!Cheek ttte appropriate boa: Type of project(required): 1.4 I am a eapluyor with 1 a employees(full and or p ti-tanne-i• 7. 0 New construction '0 lam a sok pn>irrktur or peAncnhip and have no employ cc%Norking fur me in 8. O Remodeling any capacity_(No*takers'comp.insurance rt yuired-l 9. 0 Demolition AO I am a honwvwnet doing all work myself (No wuktT%.coan;r.m>uranc rcyuned.I" 10 a Building addition 40 I am a humans ncr and*ill be hiring contractor to conduit all*iv I.on my property_ I w ill ensure that all e`awuracton either hale workers"cutnee'nasaiaun uettaraasx or an:stale' l i a Electrical repairs or additions praopnd ur with no employee.. 12.0 Plumbing repairs or additions SCi(am a general cunt:actor and i Juke hand the Nub-0.nm actor%hst,d on the attached%bed. 13 CI Roof repairs These subcontrnetors lust empluyces and fuse woolen'cusp unurance 6.0 we arc a corporation and it.Akers lase exercised then neht of a tcoaption per WA-c. I4.❑Odiet I}2 et1(4).and sac hose noctr 1uyccs.[Now rLis'coma.insuranceicquirodi 'Any appheant that chinks hot a I mast also till out the section below aIana rug their w or►at compensation policy inlunnatiun. r Ilaarneuwners who submit this adulasu indicating they arc doing all whorl.and tarn hie outside contractors anaast submit a new affidas it indicating such 'Contractor that cbcc'lk this but must attached as additional shut Aria in.tlac Dame oldie lub-cururactors and wlretbcr or not those mimic.hose employees. It the tub-etmtrxtura lute employees.duly must provide their workers'comp-policy number. i am an employer that is providing workers'compensation insurance for my employees.ees. Below is the policy and job site information. Insurance Company Name: 31 r ‘__3 E FA a fY r C a S Sr. cp . Policy#or Self insLic.#: 1 I-)CiJLA q.410Cp Expiration Date: t I < 1 I a o a► a Job Site Address: 89 8 `JuriS c--);\- R.....v City/State/Zip: of e NC2 , �Z o I C(pa Attach a copy of the workers'compensation policy decl miser page(shooing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,rt25A is a criminal violation punishable by a fine up to S I,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 S250.00 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 hereby tiff•trod th i ins and penaltiesof perjury that the information provided``above Is true and correct Si_"nature: ) I� Date: "i v)l a )aci Phone.: (J '1 1�) O 1- 20/0 • OJrcial use only: Do not write in this area.to he completed by city or town official ('ih or Town: Permit/License# ° Issuing Authurih is:ircle one): I. Board of Ilcalth 2.Building Department 3.('iisiTown Clerk 4.Ekctrical Inspector 5. Plumbing Inspector 6.Other I Contact Person: Phone#: ,aco CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) ‘.......-/ 02/04/2021 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). PRODUCER CONTACT Barbara Van Mourik NAME: Finck&Perras Insurance Agency Inc. PHONE (413)527-5520 FAX (413)527-5970 (A/C,No,Ext): (A/C,No): 6 Campus Lane E-MAIL bvanmourik@finckandperras.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Easthampton MA 01027 INSURER A: Main Street AmericaAssrCo 29939 INSURED INSURER B: NGM Insurance Company 14788 ASAP PAINTING INC INSURER C: PO BOX 241 INSURER D INSURER E: HADLEY MA 01035-0241 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2012104677 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 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. INSR TYPE OF INSURANCE AWL SUER POLICY NUMBER POLICY EFF POLICY EXP LTR INSD,WVD (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,000 CLAIMS-MADE � OCCUR PREMISESO(EaEoccurrrence) $ 500,000 / MED EXP(Any one person) $ 10,000 A MPB49466 05/05/2020 05/05/2021 PERSONAL&ADV INJURY $ 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 X POLICY PRO- 1,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ _ OTHER: I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ _(Ea accident) ANY AUTO BODILY INJURY(Per person) $ 100,000 B - OWNED N/ SCHEDULED M9B49466 06/20/2020 06/20/2021 BODILY INJURY(Per accident) $ 300,000 AUTOS ONLY ^ AUTOS X HIRED �/ NON-OWNED PROPERTY DAMAGE $ 100,000 AUTOS ONLY _ AUTOS ONLY (Per accident) $ f UMBRELLA LIAB _OCCUR EACH OCCURRENCE $ - EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 B OFFICER/MEMBER EXCLUDED? Y N/A WCB49466 01/31/2021 01/31/2022 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ASAP Painting,Inc ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD l to en Kitchen Concepts&Design Center,LLC *RF ti II* '7,71r IN E 6471Cale 4ho oncpris P.O.Box 241 iu cu �H �N iE Hadley, BBB MA 01035-0241 I I WINNER WINNER,WINNER FINALIST FINALIST WINNER CREDITED DREAM•i DESIGN m DELIVER BUSINESS April 22, 2021 City of Northampton Building Department 212 Main Street, Room 100 Northampton, MA 01060 Subject: Building Permit 898 Burts Pit Road, Florence To Whom It May Concern: Enclosed please find our building permit application and payment for the building permit for 898 Burts Pit Road, Florence, MA. If you have any questions, please contact me at(413) 586-3506. Thank you, Luca h w L 8rawn. Luann L. Brown Executive Administrative Assistant :11b • Office: (413)586-3506 • Fax: (413)586-8051 • Email: design@kitchen-concepts.net