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36-048 (3)
28 WINCHESTER TER BP-2021-1459 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:36-048 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING P E RM I T Permit# BP-2021-1459 Project# JS-2021-002420 Est. Cost: $11000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JASON BALUT 106321 Lot Size(sq. ft.): 14418.36 Owner: Corie Baker Zoning: Applicant: JASON BALUT AT: 28 WINCHESTER TER Applicant Address: Phone: Insurance: 21 SPRING MEADOWS (413) 374-2925 SOLE PROPRIETOR SOUTH HADLEYMA01075 ISSUED ON:6/8/20210:00:00 TO PERFORM THE FOLLOWING WORK:STRI P & SHINGLE ROOF 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. o Certificate of Occupancy Sit;nature•I • � .52 • (P1 ' FeeType: Date Paid: Amount: Building 6/8/20210:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner The Commonwealth of Massachusetts / /1/ Board of Building Regulations and Standards z '14a11 If Massachusetts State Building Code, 780 CMI ,,T .i ,/MUN �eALITY 0� / Building Permit Application To Construct, Repair, Renovate Or`te'- ' 1 a ?ifeviss Mar31011 One- or Two-Family Dwelling - ��ti' sR : This Section For Official Use Only qo,so�°'Us � Building Permit Number: 43a.Q1. %S-/ Date Applied: �'*< , 4vi,-)1Z> /Z. 6-8.zozi Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 AssessorsAap&Parcel Numbo 9 oYif in�.,nches-kg. -FfttC Le a 1.1 a Is this an accepted street?yes a/ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(II) 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 El Private 0 Zone: _ Outside Flood Zone? Check if yes❑ Municipal 0 On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' y' 2.1 Owner'of Record: CO►ri c nvre iLe__ 14t4i- 01C)(0a-. Name(Print) City,State,ZIP I t,cai nGCv )-rrmcD 1/3_6)a(D 5/ 75— V�'�7�7a Imo .,,,f No.and Street Telephone Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) p11 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify: Brief Description of Proposed Work': 'S-Ift.e 5.1.431es t- pi ltroek r ,ASj4N new rI1t4,4 6: IS SQ sV►mgieS SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ Li l000 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (FireCtILM $ Suppression) Total All F� An Check No. V Check Amount: Cash Amount: 6. Total Project Cost: $ i i ,000 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) `1�t1 C>B)Lj License Number Expiration Date Name of CSL Holder `J('f.n Iht°a `? List CSL Type(see below) No.and S et Type Description ' NI,� U�� U Unrestricted(Buildings up to 35,000 Cu.ft.) Ic 7 R Restricted 1&2 Family Dwelling City/Town,State,ZW M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances L{i3 31y otus y,t wr ►15/1, (till I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) trnScnn �jt�l�i 1)%77 S -it-�� HIC Registration Number Expiration Date HIC Company Name or HII Registrant Name No. d tre1).1 ill et, �;w j,, S (fa)0 1u r �i' r•S►'t.(i/ri et S )1 (f+ d\ f 04 GI 07S y olC�ot� Email address CGU City/Town,State,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 .0 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 to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date 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. CCArt''c:30401, 20.01) Print Owner's or Authorized Agent's Name(Electronic Signature) ate NOTES: I. 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" City of Northampton +t�;a{:i.\'.?rp Massachusetts tffJDEPARTMENT OF BUILDING INSPECTIONS �+• 212 Main Street • Municipal Buildingca. Northampton, MA 01060 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: Location of Facility: Cotsetcr hot Luke, The debris will be transported by: Name of Hauler: 'b,The tory,. Con5iYt o,n Signature of Applicant: Date: The Commonwealth of.%lassachusetts I =; ft Department of Industrial Accidents =; .;.== `A 1 Congress Street,Suite 100 11—'• `� Boston, MA 02114-2017 "i.,4 fi` wwIe.mass.gov/dia 0. 1l urkers'Compensation Insurance.tf iidas it: Builders/Contractors/Ekctrkians/Plumbers. 10 BE 1-ILli)%%1111 1 11E PERMITTING All'HORTIA. :applicant Information Please Print Legibly Nan a il3uslc.,,t ti...,n✓.ru..tn Inds tdual): V.$-5cn t_ t h, Address: r)l pep of rn e4 A `) Cirtit'State/Zip . +' N_Haag All} p OS Phone#: 371 -919d5 Are sun an rntpIu er'Chark the appropriate hot: Type of project(required). I. 1 am a employ«with _crtspdoyecs i lull asd'or part-um t• 7. 0 New construction 2121 I am a sole proprietor or pantnershup and hate no ctnpkoyat's w or k trig for me to S. 0 Remodeling any capacuy.[No workers'comp.wurancY naymnmi.j 9. ❑ Demolition 30 I am a homeowner don all matt mytelf {Hu workers'comp.insurance rrurrt.j.4.0 I am a homeowner and wall be hiring contractors to conduct ail w oak on my property. I will 10 0 Building addition w ensure that all aaaattaetoes either have workers'cmarpematton etsunowt.or are sole I I 1:1 Electrical repairs or additions pi orpncturs V.ith no employees. I2.❑Plumbing repairs or additions $.0I am a ucucral contractor and I has c hard the sub-contractors listed on the attached sheer I IN Roof repairs these sub-contractors base e^rnpluyear,and has c workers'comp.tnsatmCe.• 6.0 we are a corporation and its officers have exercised then right of exemption per MU c_ 14.0 Other IS2..11i1.and we hase no employees.(No workers'caanp.insurance required" •An applicant that checks box is I mug also fall out the section below showing that works'compensation pulley information ' lkmscvwttcrs who submit this afleekes it ins/scat:nu they ant doing all work and then lure outside contractors rs must submit a new al:idas it nsdreaung sow h 't ontractors that check this but must attached an additional sheet show rn:the name of the sub-eontraek,rs and state w heth er or not those entities hase •tpi,.scc, It the .,l,conlraeuts hase emrlo.ee,.thus must pmsrde t'„ .,nrker,'esrrnr tonnes number I am an employer that is providing workers'compensation insurance for my employees. Below is the police•and Job site urloornrattnn. Insurance Company Name: Policy#or Self-ins.Lie. #: Expiration Date: Job Site Address: City/State'Lip:_ _, attach a copy of the workers'compensation polky declaration page(showing the policy number and expiration date). Failure to secure coverage as requited under MGL c. 152. §25A is a criminal violation punishable by a line up to S 1.500.00 andior 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 certify nder the pa' s and penalties of perjure that the informatieon provided above is true and correct. Signature: I' - 1"t-4 I Phone#: 3/y 01945 Official use only. Do not write in this urea.to he completed by city or town officiaL City or Town: Permit/License Oi Issuing Authority (circle one): I. Board of health 2. Building Department 3.('its."l own Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Oilier ( )ntact Person: Phone b: z. Commonwealth. Massachusetts (��J. BoDivfe toa o BuildingisionofPro Regulatinalons andLiceRsure Standards Constructiordf e,$>g4� `1 &2 Family CSFA-106321 ' ; i 4 f �ic..p i re s: 12/08/2022 JASON S BA UT 21 SPRING MEADOWS' , SOUTH HADI..E)' MA 010 Orr L.i, '�O,S " ll :1 adV�S", Commissioner daga p. Wemt.16;L, .TP nv,,,,,ro42�� /6'irYJa4.,-. .P//J TA • Office of Consumer Affair§&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration gmackti20 178677 05/11/2022 JASON BALUT •. JASON BALUT c'"i°f I/dy„p�l` 21 SPRING MEADOWS SOUTH HADLEY,MA 01075 Undersecretary ___—..•...,N BENNPRO-03 LLANDRY ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) kir./ 4/1/2021 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). License#1780862 CONTACT Linda Landry PRODUCER NAME: HUB International New England PHONE 413 275-1642 FAx 413 538-6010 79 Lyman Street (a/c,No,Ext):( ) WC,No):� South Hadley,MA 01075 Miss,linda.landry@hubinternational.com INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:Atlantic Casualty Insurance Company 42846 INSURED INSURERB: Bennett Properties LLC& Jason Balut INSURERC: 21 Spring Meadows Rd. INSURER D: South Hadley,MA 01075 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WV() POLICY NUMBER -1MM/DD/YYYY) (MM/DDIYYYYL LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _t___ 1,000,000 CLAIMS-MADE X OCCUR L261002173-3 2/24/2021 2/24/2022 DAMAGEES(TO Ea RENTED � i 100,000 PREMIS ooaxrertce MED EXP(Any one person) S 5,000 PERSONAL&ADVINJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PAC°T 1 LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ COMBINED S AUTOMOBILE LIABILITY (Ea accident)INGLE UMIT S ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED (Per acci dent)AUTOS ONLY AUTOS ONLY )) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ - $ WORKERS COMPENSATION PER I OTH- AND EMPLOYERS'LIABILITY STATUTE ER ._.-__ YIN ANYp PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ (Mandatory in NH)EXCLUDED? N I A EL.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below _ _ E.L DISEASE-POLICY LIMIT_I DESCRIPTION OF OPERATIONS/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 Jason Balut ACCORDANCE WITH THE POLICY PROVISIONS. 21 Spring Meadow Rd South Hadley,MA 01075 AUTHORIZED REPRESENTATIVE ?"9-- ----- ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BENNETT PROPERTIES LLC PROPOSAL 21 SPRING MEADOWS SOUTH HADLEY MA 01075 (413)374-2925 DATE:5/14/21 28 WINCHESTER TERR FLORENCE MA Description strip all existing shingles from roof remove all plywood install new CDX plywood to roof install new aluminum drip edge install ice and water barrier and synthetic underlayment replace all flashings install new counterflashing to chimney install 30 yr architectural shingles install new ridge vent with cap shingles provide dumpster,clean job site and remove all waste $11,000 $3500 due prior to job with balance of$7500 due on completion of job bl f054 r aeilk 4 3306 5- 15 - ot1 441-lie kv----- az....„.:;--p .,.., 5_1 1 s,)„?../ TOTAL DUE