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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 OfM it f AuroMosLEwRu1T SAME war i mfru AN7NJIC COOLY WWII..pram f lOS s:TELAILED !DOLT IMAM VI ear.msrrai $ Mi AJ 10S our TOS OD Pal•ONNEEI Vet WAMAGE NJ rob oar Al TOS WLr US/ADIAUIa (WCII! bICMOCCIJINENCY arose um CLAM6Mse ASC/ECATE } yEn F ,remvrEw s r{� I isearltaE0100IreASAT10N SZB B�it$6G61.1-21 SO4.2'021 6.4,20Q2 X ISTA1u1t I IEN ANowrLaMOLwaam ���IIIYYY ANrrYOwETOWN!!114PJLEPSLmx (�1 wA EL$AQI ACCOENT $100070 9RCMAIDATRE CCLLDED7 u M001~010yl) EL CIUME-GEApLCrtri$100.000 s brnoMnad unlr r Ai,SCEw u�Enwear6er,r EL OSEAee-roucrLMT $500000 110111BPIEN BEOPBAAT1arR?LO AIOW$BNOaf(An0UD1E L AfdArld arsr Ida Ask,urn M raEtlrr M rare rrpps r wr♦1 ) C AT ICATE HOLDER U..ATION SHOULD ANY OF TIE MOVE OElcUDD POUCBBR BE CAROLLED BEFORE TIE E]/OAT10N DATE TIBBEOF. 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