44-067 (3) B P-2021-2089
993 FLORENCE RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
44-067-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-2089 PERMISSIONIS HEREBY GRANTED TO:
Project# ROOF Contractor: License:
Est. Cost: 10000 AARENS HOME IMPROVEMENT 98625146988
Const.Class: Exp.Date:02/09/202206/02/2023
Use Group: Owner: RHOADS SUSAN D& MARK D
Lot Size (sq.ft.)
Zoning: SR/WSP Applicant: AARENS HOME IMPROVEMENT
Applicant Address Phone: Insurance:
P O BOX 5 (413)667-5684 6ZZUB5R85561-1-21
HUNTINGTON, MA 01050
ISSUED ON:10/27/2021
TO PERFORM THE FOLLOWING WORK:
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.
Signature:. I
e; f . >2 3.-)9Au,
Fees Paid: $40.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
II, The Commonwealth of Massachusetts
4 .- Board of Building Regulations and Standards FOR
/ Massachusetts State Building Code, 780 CMR MUNICIPALITY
_ USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Buildin Permit Number: g0"J"I Mg9 Date Applied:
EUpJ ! f,Os� /-7,2 j0"21,-2ozi
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
*3 F/are4cce /l
1.1 a Is this an accepted street?yes X. 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❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Slisc..4 , ej c1S Fie env1 ce, ,,1 4 O/O(,?
Name(Print) City,State,ZIP
3 r�/eat ce Rct' 6'tom" 0 R 3d S'v e•-nou rKj.a s 0 co..ti r' .N.44e f
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction El Existing Building 0 Owner-Occupied 0 Repairs(s) 12l. Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': Re , R«o✓.c exv-r1,g (2) l�ya`S - rva iL�
/Lt. /1 .sec.. "4s/,1 �/� ih 04 /
,L `✓ LOz✓eJ� 6 ' Peel-, Py.,, cat�,�a—
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ /O O�0 1. Building Permit Fee:$ Indicate how fee is determined:
/ 0 Standard City/Town Application Fee
2.Electrical $ 0 Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All F��A )�
Check No101 1 Check Amount: 4I0 Cash Amount:
6.Total Project Cost: $ 10 !9� 0 Paid in Full 0 Outstanding Balance Due:
Northamptonof 1
City Massachusettsy ,
oa'Hrr!rTok OF $UII.DI V t�� �'
J!,,v DEPARTMENT
EPART SCrge t y 0106i� '—----
2 T�i Aa r
the
d - ,‘ t/"- 21 �or i O C T 2 6 2021
DFPT,OF nUILDINC,IP}SPFCTIdNS
NORTHAMPTON.Ma owso PROCEDURE FOR OR OBTAINING Ag U 1LDtN G PE
Q NON
1 &2FAMILY DWELLING, App S, POOLS,DKSS, ACCESSORYSTRUCTURES,
FENCES, GROUND MOUNTED AR ETC.
b owner or authorized agent.
d filled out Y
legal owner an hard copy)
signed by work. (Digital and
Permit Application sign of proposed I. Building citations P set backs.
2 One set of plans and specifications
structure(s) and
of proposed lcks.
Lion P and signed by applicant.
applicant.
3 Site plan with loco Affidavit filled out signed by app flit Insurance
Debris Affida out and g roof of Liability 54. Construction D Affidavit filled
Registration and p
Insurance
Compensation a copy of CS Liven ment windows} applicable).
5 Worker's to (new 1 replace Homeowner Of aPP 10
6. Contractors mustionsupply Compliance Certificate signed by
ation Comp filled out and g applicable).7. Energy Conservation Exemption Form ents(if aPP
license permit requirements g Home Owner's special
Conservation andlor P
Consery applicable). licable} permit
9. Note any tica if apP with
Permit(it apP fees paid ( Dept. be submitted Driveway and Sewer entry land applicable).
Building Affidavit to
Water a W I private a HERS Rater
11. Proof of DP require permit-Public land by will req of Northampton.
12.Trench Code - all new construction The City
Energy form of a check made payable to:13. Stretch rmit
application before issuance of permit.
in the
apP the appropriate fee
14. Please provide
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 96P.6
/`t//4 R ;/1.) License Number Expirat► n Date
Name of CSL Holder /
List CSL Type(see below)
gk
No.and Street Type Description
/ rn� ®���J U Unrestricted(Buildings up to 35,000 cu.ft.)
7"4-7.4-11�frJ�� R Restricted 1&2 Family Dwelling
City/Town,Stato ZIP M Masonry
RC Roofing Covering
WS Window and Siding
n�,._ SF Solid Fuel Burning Appliances
029 1 cia r'et2a ca4 ,v-vre �. Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Exp' ion Date
HIC Company Name or HIC Registrant Mine
No.and Street Email address
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...........❑
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 ,4.¢� --A4 e d J�.•��vei7.t c�t,/L
to act on my behalf,in all matters relative to work authorized by this building permit application.
g(s-p97,12 X 4 6a,Ps
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.
Print Owner's or Authorized Agent'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. I42A.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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
The Commonwealth of Massachusetts
Is=
__; • Department of Industrial Accidents
=_I:---170,�' 5I CongressStreet,Suite I00
_ Boston,MA02114-2017
,;, wwtv.�rrass.gov/ilia
11 urkers'(bmpeosatioa Insurance Affidavit:Builders!('ontractors/ElectriciansFPlwnbers.
TO BE FILED W CfH THE PERM I-17M;At THOlttlA.
Applicant Information Please Print Ledhly
Name I HUstnessr(arganization Individual I: A 4 Re ivy f 7max-roc �r
Address: /3x 3--
City/State/Zip: .7 /0t.# eyes-0 Phone#: 5 3 ? ——_
Are yin am a player!Check lite.pprm fmiese ban: Type.f (required):
Items employer soli employees thin amd ur pu n-lane►-' 7. CI New construction
20 I am a sole proprietor or prrtecnluip and have no employees working for me in 8. 0 Remodeling
any capacity_(No workers'comp.rerraooe -]
)n I am a homeowner doing all wink myself.[No smothers'comp_insurance required"' 9_ Demolition
4.0 I am a lamncvuwner and will be luring crrractoxs to oviduct all work on my prupetty_ I will
10 CI Building addition
emus that all contractors either have wutkers'compensation ihwrane ur arc sole i 10 Electrical repairs or additions
tin' `` 'souk oo "' 12.0 Plumbing repairs or additions
c 0 I am a genYal cwrtrscNr and I lase hued the sub-contractors hated on the attached sheet_ 13 Roof repairs
these sub-contractors have employers and have workers'comp.hnnuraoce.;
14.[3Other
60 N.area corporation and its officer have exercised their night aexemption per M(iL c.
14.;it 4).and we have no employers_[No workers'comp.insuranc requited.)
*Any applicant that checks boa u1 arm she fill out the section below showing their wasters'aortpe-aaanea play auforartrn
+Homeowners who submit this affidavit indicating they are eking all work and then hire outside camtracfora mint submit a aew grail:wit i dieming such
:Coatracttua that cheek this lox mint attached an additional sheet showing the name of the sub•caai actors and state Whether or out dhow amities have
antployrts. If dor sub-ciatrao ors have a ,Ioynes.they mint pwvidc their wa tend snip.policy number.
1 XIS an employer that is pnwitling wasters'compensation ion insurance for my eat Reim.is the policy and job site
information.
Insurance Company Name: ZcN`i�—',I _
Policy#or Self-ins.Lie.#: 27'U L3 S 5 5- /— /- 02/ Expiration Date: S/Y/v?..?
Job Site Address: City.StateZip:
Attack a copy of the workers'compensation policy decoration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152.§25A is a cariminal violation punishable by a fine up to SI,500_0O
andtor 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 011itv of Investigations of the DIA for insurance
coverage verification.
1 do hereby cord • the pains and penalties of perjury that the information provided above is true and caned
Signature: — -- Date: f c3-,-^2 — /
Phone#:
Official use only. Do not write in this aream,to be completed by city or town official
City or Town: Permit/Licease#
Issuing Authority(circle one):
I.Board of Health L Building Department 3.('it 1Tawa Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
ag,•CN�MY>p SAS,... ....SAC
4': Massachusetts ��`'" g►- '�
(A-4:
A- =�.�{ *g'' DEPARTMENT OF BUILDING INSPECTIONS
`d.
\\ • 212 Main Street it Municipal Building v�... .C1
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 61 993 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: &:=t lr'6
The debris will be transported by:
Name of Hauler: .
Signature of Applicant: Date: /0-26 �a2/
;-O Ea af,Go w a 8 Susus�ss.Reg:eat5c' commonwealth of Massachusetts .
HOME IMPROVEMENT CONTRACTOR Division of Professional Licensure
TYPE:Individual Board of Building Regulations and Standards
Registration Expiration Construtt�tt�upervisor
146988 06/02/2023
AAREN HAWLEY CS-098625 E�cpires:02/09/2022
D/B/A AAREN'S HOME IMPROVEMENT
• AAREN D liAlNLEY
2 KNIGHTVILLE DAM ROAD
AAREN D.HAWLE_Y /2 P.O.BOX 5 £
2 KNIGHTVILLE DAMROAD 4„,,,..Y4.ii.60 ' HUNTINGTON MA 01050
HUNTINGTON MA 01050 ,; Undersecretary /,..
�fJ/15.1.O'
Commissioner A.G••f�f 'G--
+ 1
t .
From: Greylock Insurance Agency mail-server@csr24.email B ",.
Subject: COI:Town of Easthampton
Date: October 26,2021 at 9:32 AMA`"
To: adh09@comcast.net
Please find the attached certificate of insurance.
Mary Benjamin
Greylock Insurance Agency
413-729-6090
mbenjamin@greylock.org
www.greylockinsurance.com
Accint CERTIFICATE OF LIABILITY INSURANCE OA lit e.IooAT•r
10128+2021
THIS CERwPICATE is ISIUED AS A MATTER OP INFORMATION ONLY AND CONFERS ND RNaNTS UPON TIE CERTSPICATE HOLDER.THIS
CERTIFICATE 01312 NOT AFIMMATIVE.Y OR NEOAIVE.Y AMEN.EXTEND OR ALTER TILE COVERAGE A►IOROSO BY THE POLICES
EE..CMI. THIS CERTIFICATE OP INSURANCE DOES NOT CONSTITUTE A CONTRACT SETYIEEN THE ISSUING NMJRRIIq.AUTHOR
REPRESENTATIVE OR PRODUCER MN THE CERTIFICATE HOLDER.
NPORTANT: I the oAlca s holder 1.an AOORIONAL INSURED;the poMylba)must Aare AOORIONAL INSURED prorisions er be endorsed.
I SUBROGATION IS WAVED.sulfa*to De terns and narrations of thf policy.certain policies nsy require an endorsement A stateroom on
Ytis osAEoate does nd cor1M Aphis is M o4Iode holder in Mu of such sndoaemoMts).
/n0011ES M harry R 8enanfn
Insurance Agarcy stale �.113.7294090 Isar Yak 413.58&870e
P111NBid MA 01202-0603 • robslumnEssarbCA O
IIREIR ONA//0MN00011tlVWE AMC
uo.nrE 1103779 0100101 A:AlbsAe Plolsclon'nonfarm Co 41380
MUM "Ea101"p1 1IIf1BNNs:Anson2uNdl Vausnoe Ca 40142
PO omen's
Box Home5 Improvement
1.4101111311C
Huntington MA 01050 lasUaA 0
lost E
COVERAGES CERTIFICATE NUNSER:1710216093 REVISION N MMI:
THIS S TO CERTIFY TWIT THE POLICES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE MIMED NAMED ABOVE FOR THE POLICY PERIOD
BDICAIED- N01W!1HSTANCOR ANY REOURENENT.TEAM OR CONDITION OF ANY CONTRACT OR OTHER DOGUENT WTH RESPECT TO WHICH THIS
CERTFICA1E MAY BE ISSUED OR MAY PERTAIN. RE BEER NCE AFC CREED BY THE POLICES DESCRIED PORED IS SUBJECT TO AU.THE TERMS
EXCLUSIONS AND commons OF SUCH POUCES-LAIRS SHOWN MAY HAVE BEEN REDUCED BY RMD CURIA
Etta TIMEM■aDUMNBE r.m PQKTDA1IAlA nJI owrit L S
A X C MUM OAL IMAM uleL T 1621:040310 7/1102021 7111 2 $sou
.400
ICLA MDAIA E o 0U Ut 111110Amt. ......rs. b$10Q COD
r✓ NSW art,aria .3 5 400
RRaffiIAL LAW EASY $500 0:0
7��Ee11��-LL ACCJ!WV-IA POR - E ALA MI j 1 000000
I PoUC1, L R sHOF 20UCIS-cAGo t 1 000000
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C AT ICATE HOLDER U..ATION
SHOULD ANY OF TIE MOVE OElcUDD POUCBBR BE CAROLLED BEFORE
TIE E]/OAT10N DATE TIBBEOF. NOTICE FILL BE OEUYEIED M
AC00E/ANCE FERN TIE POLICY PROVISONE
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