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43-175 (2) BP-2021-2154 422 PARK HILL RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 43-175-001 CITY OF NORTHAMPTON Permit: Addition PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2021-2154 PERMISSIONIS HEREBY GRANTED TO: Project# SCREEN PORCH Contractor: License: Est. Cost: 60000 WRIGHT BUILDERS INC 115196 Const.Class: Exp.Date:05/31/2024 Use Group: Owner: COOPER SCOTT R&SUSAN L Lot Size (sq.ft.) Zoning: WSP Applicant: WRIGHT BUILDERS INC Applicant Address Phone: Insurance: 48 Bates St (413)586-8287(116) MCC20020005342020A NORTHAMPTON, MA 01060 ISSUED ON:11/15/2021 TO PERFORM THE FOLLOWING WORK: EXPAND SCREEN PORCH 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: V 1 II Fees Paid: $390.00 212Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner File #BP-2021-2154lea " c1-� —" APPLICANT/CONTACT PERSON:WRIGHT BUILDERS INC 48 Bates St NORTHAMPTON, MA 01060(413)586-8287(116) PROPERTY LOCATION 422 PARK HILL RD MAP:LOT 43-175-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $390.00 n 0 Type of Construction: EXPAND SCREEN POR H J✓�Y1, New Construction Non Structural Renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: J Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan MajorProject: Site Plan AND/OR SpecialPermit 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 \ vio/A,1 Si_ ature of Building Official 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. OuLs--,& P L,A 1JS I HECEI VED ts The Commonwealth of Massachusetts NOV 8 7121 , ) OR .(t)7 Board of Building Regulations and Stan ds MUNICIPALITY Massachusetts State Building Code, 780 MRDEPT.OF E,U,«,,,;c;rt,,T MM;T,c,;LiSE NORTHgMFTON ;q i,, Building Permit Application To Construct,Repair,Renovate r Mar.2011 One-or Two-Family Dwelling �n This Section For Official Use Only Building Permit Number: ►�fr-''-I--.J5-9 Date Applied: 66\011••• 1 II ° - 1 I 6 1 Building Official(Print Name) Signature I Da e SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers L122 Pal it If,ii rzo€.&2 (3 115-001 1.1 a Is this an accepted street?yes 70 no Map Number Parcel Number 1.3 Zoning Information:. 1.4 Property Dimensions: W S P Sckty` porc,ln 371, 131 SL t 12 R.6 3 s c f 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 clo, go' M. 15' is , /hive go ' 20' /79ivv 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public It Private 0 Check if yea Municipal 151 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 5vSuA -t Scott Cooper Noc4k4,4,0 w , /Y)A 81O((a Name(Print) City,State,ZIP LIZZ Va.(14 I1 't 12oae31- 413-511-9o(50 Scoop36-covite4,f. 4..e4 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) X Addition J Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify: Brief Description of Proposed Work2: eyea.114ii Al SCrc e- Po rc.In IV X 17 6 ". Tie i n fox2 add;,i r1ew Si_rcevl P«ntl$_J SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check Nob 2,7.2heck Amount /" CAI Amount: 6.Total Project Cost: $ (p o, 00 O 0 Paid in Full 0 Outstanding Balance Due: (9.50 per 1I,c"oo SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS_ /15/ftv 5/3 /gy `liar 3 Clrahact t( License Number Expiration Date Name of CSL Holder List CSL Type(see below) N8a 5-w,‘e 54roz No.and Street Type Description 3 el�h a r Q p p U Unrestricted(Buildings up to 35,000 cu.ft.) (L✓\ /, m R Restricted 1842 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 802-2.33- f/ocZ RCruvJut eve} 13..;141ery. toss I Insulation Telephone Email Yddress D Demolition 5.2 Registered Home Improvement Contractor(HIC) AY 6-3( 2 &d e+g NI+ 6 4 1(1,4 5 C. Jil)1 Q,$i a , g N f HIC Registration Number Expiration Date HIC Cb[n any Name or HIC RegistrantName 4l9 ces 54 rV{ _ bow.), i t l u r:,sy f -8 /d<.s. coon No.and Street Email address No(Je,gake1, ini o1o(ov Y/3-s867-8a8 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 4 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 Lv 404 13',;tdtr5 Sri C. to act on my behalf,in all matters relative to work authorized`by this building permit application. '( ate- Caa Nope( ///4/2a.21 Prin Owners Name(Electronic Sign/5tAsavi re) 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 theA best of my knowledge and understanding. x AA,A4 . 14,C dunuM- �4.19/14 . S � 0. 0 //l /a o as Print Owner's or Authorized Agent's ame(Electronic Signatur ) 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.) rjt I a W Habitable room count l� Number of fireplaces 3 Number of bedrooms S Number of bathrooms 4`/z Number of half/baths I Type of heating system G/4-5 Number of decks/porches I- Type of cooling system kytt441 o c Enclosed 1 Open '! �' 3. "Total Project Square Footage"may be substituted for"Total Project Cost" Grp fis IG6+^"I urcm ":\ The Commonwealth of Massachusetts c -----?�„ Department of industrial Accidents • =?�1 s 1 Congress Street,Suite 100 „ Ma.. 9c,..) ' Boston, ,lf.-102114-201.7 t was, B�►�)4:mass,(;o►/dia 11urkers'(rumpensatiun Insurance Affidavit:Buildersl(`ontractorsfEkctriciinsiPlumbers. 14)Bt.11Ll_i)%V fill f 11t:PIR)II I I'I\(:AI'iIH)RI'1'Y. Applicant information h 13 Please Print Ieiib Name(Busine-sx't)rganvstion lnderidm:nl)' (fit/i r y h•+ t,t )a.e f S Z n c_... Address: 4/a /3,cje 5 S4r'c,e_4 City/State/Zip:iv,r+(ae.e,plar,, ma o to fv o Phone 4: yf 3- 9a 3 - 2 s 7 0 Are�uu an cni ik re?('heck the appropriate Mrs. Type of project(required): LIN I am a eritplo:L er tt ith ZO enoployocs Oa and aw part-tiro►t-' 7. 0 Nero eot➢.It uita t1 2.0 I am a Note proprietor or parentasltnp and have ru,emplotns.vturkuu tor no.,:on 8. 0 Rl'mgefl'[777_ urt3 capaertt-[Nu turker.'comp.trtsurano_: nyruinall 30 I an a h maa n r doing all stook m sal(.t o mirrcomp_kx'comp_otr,urartee r yuar.-d-[ 9. El Dettoolitivai r_ 1021 Building addition 4.0 I am a R htUt its and a all he hiring altr our-@u entodutct all vt44k un rmx propt:rtt.. I M ill ensure that all contractor.either hate vtoal.en.-evenfears:tirrau utiurant:L it are st,le I In Electrical rt:pJnrs or additions proprietors ttith no i,tnplateo.. 12.0 Plut,thin ire-pairs or addilicttt. 50 I am a general contractor and I boo.:hared the sorb-ce ntractora lira all ono the aitat.{ictl daces.. 13ORoofr42patrs. Thew sub-cuntrrceor.lase eanploxee}and Iratr-wta tas'cornp.insurance_: 14.DOtht:➢_SCre.ee'. )orck 6.0 wrr are a L.-imputation and its oaken hal.a evaciacd thou rigidof exemption tion pa NI(rt.c. 132.1)44),and sac hate no tmipluaacs.IN"motion.'comp.insurance reyuiroJ.l e X l at vt S i O 1/t •Any applicant that rhea..box a I rant al+..o till tout tote ri tieat to luu showing that Ivutktrs'ount{xnaatitl*policy infuriation. +Ilonocutancr%mho submit this at Jan it irtdncaiinuu tlte-t an:&int:all stork and then hire uuWde oatiraesors,ntaJ submit a no*tiff(dat it audit atone,a.ln. :Contractor.that check this lox mnusa attached an,:lUutlunal sh itt shta Inn the name of tin sub-contraction and state NILLYbcr cm not tituse anotic.,lra•.e einplo±nca If the sub-ouniracters hat.eurgnluwtv..[Huy roast pnusidc their uorkars`champ-policy manbctu I ant an employer that is providint;workers'compensation insurance for my employees. Below is the polity and joh side• information. Insurance Company Name: A A/ �M /r to„,„( T/15 Co • Polieti or Self-ins.Ltc. zr: MCC— ace) - a 000 53 q- Zo70 At Expiration Date: 3///2 7-- Job Site Address: y2Z Pet,k N:It acKecf C'ity/Stite.Zip: /V•rf&4NhPEon, Al/¢ 0t0CP 7, Attach a copy of the workers'compensatisa 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 S 1,500.00 andlur one-yearimprisonment,as well as civil penalties in the for»of a STOP WORK ORDER and a tine of up to S250.00 a day against the violator.A copy of this statement pray be foray arded to the Office of Investigations of the DIA for insurance coverage verilicaliun. I do hereby certify o A j il i.,ins and penalties(Oil-Piny that fhe informati+n pro idid above 6.true and comet Signature: �V%4 1) i :: l(/l)Z o Phone 1l3- fZ3- 232o Official use only- Do nut write in this area,to be completed ht'city or town official City or Town: Permit/license Al Issuing Authority'(circle one): 1.Board of Ilealth 2.Buildingi Department 3.('it},'Toni Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other contact Person: Phone 11: CITY OF NORTHAMPTON SETBACK PLAN MAP: 141 LOT: 115- 001 LOT SIZE: 8.1-a aC'C.5 3 7/, a 3 t 5f f f REAR LOT DIMENSION: L103- N N REAR YARD oZ PA'✓l 5 ez a a ,lase-cJl- SIDE YARD 5` ►r'v‘ SIDE YARD 15 ' r`' FRONT SETBACK 0 m'r FRONTAGE 12 1- (O 8 ' i I K 2104 S.87 W E t1e!l1.Q iv n, ;1 n/, -, 1 Northeastern Cos Trarmitaion Company 'Ct.t a th �, Book 1094. P•, 470 ,�l 80.000 Sq. Ft �! .— Plon Book 28, •... 2e �� • 1 .837 Acres S 4iV s` 44 "IA— vacs ewer smocks*, - ‘41.. 57�"-'a Brent .1 Adrian \ �- Jr t Existing Home Norman F Milan, Jr. �--g �(4• • 11 Zo. \ f Book 2309, Page 199 di. '+te anrui \` Plan Book 28, Page 43 al' Rp1p '% ti - • �`'�' �,� , \ Screen porch expansion ,¢,,, ` 13'x 13'-6" 2 370.907 Sq. Ft. 8.515 Acres '' v. 4 %,s‘p It,. 6 , i )1 Rh' TA 6 1, a� lJ °a .4 82.942 Sq, Ft i .% J I ',049 Sq. Ft. 1 .904 Acres , - m * (b 36 Acres .9' 3 4, (.1., `a j - 169,553 Sq. Ft S. 00 1 I 3.892 Acres v. t i 501Q4. ,551 5p. Ft 267,23' , 45'32"ff r 1 Ar•rwit .,se . -- ':17.711 71 City of Northampton _ :o t4AM >o� `5 S'. ,, M S. C f�- ''� Massachusetts mow? 4�. I } �' w t.( • DEPARTMENT OF BUILDING INSPECTIONS y; ` '� ,1 212 Main Street • Municipal Building JH cs. \b yY4� Northampton, MA 01060 `PJ'bti, �^'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: N1F1 The debris will be transported by: Name of Hauler: 130,0" V),c.k. I e 5 l c v C,IG r--i C.c.C Signature of Applicant: Date: ///tiz i ___.----"'vl WRIGBUI-01 KAYLA ' hOmoom CERTIFICATE OF LIABILITY INSURANCE 9AT3/1/2 D/YVYY) �� 3/1l2021 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 NANTACT Kayla Marie Drinkwine Phillips Insurance Agency,Inc. PHONE FAX 97 Center Street (A/C.No.EXI):(413)$94-5984 I(A/c,No):(413)592-8499 Chicopee,MA 01013 ADORI SS:kayla©phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:EMC Insurance Companies 21415 INSURED INSURERB:A.I. M. Mutual Ins.Co. 33758 Wright Builders,Inc. INSURER C: 48 Bates Street INSURER 0: Northampton,MA 01060 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. INSRL TYPE OF INSURANCE INSD SUBR POUCY NUMBER POLICY EFF POLICY EXP LIMITS 1MM/DD/Yl'YY) IMMroD/YYYyI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 I CLAIMS-MADE X OCCUR 6018616 3/1/2021 3/1/2022 DMGSEOERa EorZ ance) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X I POLICY X /28-r LOC PRODUCTS-COMP/OP AGG $ 2,000,000 I OTHER: EMPLOYEE BENEFI $ 1,000,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO 6Z18616 3/1/2021 3/1/2022 BODILY INJURY(Per person) $ OWNED ^SCHEDULED AUTOS ONLY _ AUTOSp Ep BODILY INJURY(Per accident) $ AUTOS ONLY A AUTOS ONIJLY (PBOaaT ntgAMAGE $ 1 $ A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE 6J18616 3/1/2021 3/1/2022 AGGREGATE $ 5,000,000 DED X I RETENTION$ 10,000 3 B AND EMPLOYERS'COMPENSATION YIN X STATUTE PER ERH MCC-200-2000534-2020A 3/1/2021 3/1/2022 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ (MandatoryyIn NH)EXCLUDED? N N/A 500,000 E.L.DISEASE-EA EMPLOYEE $ II yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES`ACORD 101,Additional Remarks Schedule,may bo attached If more spaco Is required) Florence Bank is listed as Additional Insured where required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE lorence Bank THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN F F Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Florence,MA 01062 AUTHORIZED REPRESENTATIVE /9N42-1,-"2 . IMF I_ ACORD 25(2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD