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23D-156 (6) • f1.0 TERR BP-2007-0160 GIS#: COMMONWEALTH OF MASSACHUSETTS /**1414K42?4,44156 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2007-0160 Project# JS-2007-000237 Est. Cost: $3400.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: S E Sulenski 101718 Lot Size(sq.ft.): 23086.80 Owner: PATENAUDE BARBARA M Zoning: URB Applicant: S E Sulenski AT: 150 MAPLEWOOD TERR Applicant Address: Phone: Insurance: 103 South Street (413) 532-3630 Workers Compensation HOLYOKEMA01040 ISSUED ON:8/10/2006 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & 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. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 8/10/2006 0:00:00 $25.0016164 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 4, " , �� ity of Northampton , 4e • W y, •max Uilding Department u �, V 4 212 Main Street SrlS �" `A:-'r, ` - ,-." � '` Ou �... tttir.. ...,, ,to .t ��'�,, v� 1 0 20 Room 100 P fortha`rnpton, MA 01060 Ewa se �; " \' --phon oti3- 7-1240 Fax 413-587-1272 tea, ,ttm r, s ,` X APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION:1 SITEINFORMATION r M "x Tfais eet�o tabe completed b a ee r "•r?t - 1.1 Property Address: y-n: - q • ' O 1 1 1&1�ALWL Al�a�t L. .�,," -.s.'C�. -" ',,' - C,.n a�' ,v '. UtR*;', A ,r: wyra7+ L. .,a w n 3 !,Ifnet.xap • 1..1c Wortkavn�tbh) Vnri, 010Iac; '�,1v� . - - , �.y � . , L y ^�"1'�Exr;�`�T`��j^ -�' �+ .+ce'��j�'e.^� �V-x"-a �.. �t+s` -�v s„�' I s�� SECTION2-PRO„P_ERTY OWNERSHJP/AUTRORIZED AGENT 2.1 Owner of Record: 1.urba v-a., Tati W au_ (2., 1SD l i trif�le Uiooc `i-eUJ'ae 4-,Name(Print) Current Mailin Address: Ja Telephone Signature S e I- Sa91 2.2 Authorized Agent: S=r . �u1�itJSKt t�e�rl►v9 ��clirtla f`'c = )D3 Soa./.lt. 5r. di iJ a/Z. h-,� a/iLJD Nam- (Print) Current Mailing Address: ! : qui _�i� • v ✓r„c.. • xi/3- 53a'- 3 G,3-c� Si_. :ture Telephone SECTION_1-ESTIMATED:CONSTRUCTION.COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 7:4a;Buildin Perrriit Fee 2. Electrical <b):Estimated Total Cost -Construe orrfront:(6) 3. Plumbing Building Permit;Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) 8 goo• d% Check Number J / e O Section-For'Officialtise•:O:nly BuildingPermitNumber. _ - ., stied: Signature: Building Commissioner/Inspector of Buildings Date 7 Section 4. ZONING • All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage ' ' Setbacks Front , Side L: i R: L:L____I R: Rear ! i Building Height Bldg.Square Footage % Open Space Footage % , (Lot area minus bldg&paved I parking) . #of Parking Spaces ' Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW 0 YES 0 IF YES, date issued:! IF YES: Was the permit recorded at the.Registry of Deeds? . NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page: and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained 0 . , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 4. SECTION 5--DESCRIPTION OF PROPOSED_WORK-(check all.applicable) New House ❑ Addition Replacement Windows Alteration(s) ❑ Roofing k)( Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [0 Siding[O] Other[C]] j Brief Description of Proposed N./ Work: Stirs trDDt Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet y...t ..-.max yi,-��+,-� ^H,.+-� .�.,rw.:,..c .;i.;,•i= "'ti '� � "k� .:�'�f`°'x 4':� c'�"._�x�r .r-,w"'� s„aGif leSfel.OUS a to �tlditlar o-extsllnv4-A4U c cant fete a auirarct: a. Use of building:One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a OWNERAO'AORIZAtIONTOBECOMRLETED WHEN 01NNERS AGENT.o R CONT tACTOR AP CIE SFOR:BUILDING PERMITu-Inn Ira -?GEkVt)n 1.A 12, , as Owner of the subject property hereby authorize &Act )sKL. 1 14)3 Si dCwq Co to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner - -- - Date ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent Date • SECTION 8 CONSTRUCTION'SERViCES • 8.1 Licensed Construction Supervisor: n Not Applicable 0 Name of License Holder: S Daa g �0 License Number 103 S.ol� Strt�C v - aa- a006 Address Expiration Date �c k{o1i h- rt, D10yo Signature Telephone g Regtsfe�ed iome rorcemeiatotracto Not Applicable .0 S. E . lrvs Sidiivs Co - to/dig Company Name Registration Number • 103 (9- aor> Address ,�y II__ Expiration Date u--°c kit h a.. ©lD t/D Telephone ills • SECTION_10-°WORKERS'<COMP_ENSATION,INSURANCE. iFFIDAVFF(M.G L.c..1i52,1§;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 air No 0 The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature 4-(tl/Jf pj• • + ` . y,`iE Cris of �.�rrrfI u.m}�foii t — ?if hykr ;4 $$assAc}incrtts- tr� DEPARTMENT OP BUILDrrc INSPECTIONS 4 212 plain Street Municipal BuildinG ?' orthampton, Mass. 01060 r' WORK EIZ'S COMTENSATION ENSURANCE AFED)AVlT • $$ , __ okro _ 't 9clt.o of • _StJ.z.rt,�skr__.`t�opFisz9_t SldirL'S • (i ccnsxxcrmi tics)• , . h ith a principal place of business/residence at )03 tii S.ctt al.r1C�� h,fi. 6/DL/D (phone) &/J3 -s3a (so Jcity/cLat.c�rip) ` • do hereby certify, under the pains and penalties of perjury,- a i ( ) I am an employer providing the following worker's cofnocns::bon cover-age for my :- employees working on this job: * Qx,z Co/ (Insl>_r-n Conp ) (Policy Number) (r:�pirstior, Date) • • ( ) I am a sole proprietor, general contractor or homeowner (circie one) and have hired the contractors listed below who have the following worker's compensation policies: f , (NIIIDc of Co„r ctor) (InRrsnc Colnoaryi?cuc; Nun± ) (Expl iuo P.Date) (Name of Contrctor) (lnssraoc;. Comoaany PoLic Nuzac_r) (L»ir;on Date) • (Name of Coun- ci ,) (Insurance. Compaoy/Policy N:urbcs) (Expircion Date) • (Mame of Contractor) (Lasuranca Company/Policy Numbs) (Expirtion Daft). (.a.ch,:4driocsl eseetif neo t.•y eo anew&inforcu,60o pezainins to.tr eoccrson) ( ) I am a sole proprietor and have no one working for me. ( ) I art.a home owner performing all the work myself: NOTE:plc=.s4 vfio employ pc-ions w cis c• rcpau ds JE;;,of not tnoce then trm tmit,in u',vds the bou oow-oc-ands oc on the p-oun6 z9ptutea.r3 the eo t ax C"=e-.lry ones G od to t c i csploycs uoGe the weetcel c -.p,-...,ion Ac(GLi S?n 1(S)).o pptic000 try•bootbormeo..-ccr fat ti.lcz=e cc pains r=y c,-rdm«th, ',pi csaau of en ctiloy.c under dsn W oe'eds Coce>yomaLaon A-. I y.oda-a.net tha a copy of thf.mrcweos m.y b.foc rd.d ao tine D po doe of Lap aviJ Acadcs3'OtGo.of b'°°°for th. coYexse vc4Geiioo cud tra r f:iliac to socurc'oovc- tides section 25A of hiOL 157 eta Teal to the imposition of cimia'r P`"•uic coasi:.ing of a rise or tp to S 1500.00 u+d/or iryoa of up to ace yr...-end c vit pmatio in be Iona of.Slop Work Ordc and• a=ors l oo.0o a day at-jtiast Inc. For dcp..-txr ontr Pcrmit Numbcr _. 1, tp: Lot Siguttcum of Lic /Pc,- tiucx 1.)3te _. . F, eft � 4r, 1441.1 — =n,1�— �I � ..�,�i► �"1 ,t1ilassacf�usetts =_ I= CC......�Y�-'1LL _`.,. DEPARTMENT OF BUILDING INSPECTIONS , =�fi�= /_��, INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supc: .'isor. The stale defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work(electrical, plumbing& gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work . location • 1 • ACORQM CERTIFICATE OF LIABILITY INSURANCE 06/13/2 06) PRODUCER (413)536-0804 FAX (413)534-7874 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Martin J. Clayton Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1649 Northampton Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P. 0. Box 989 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hol yoke, MA 01041-0989 INSURERS AFFORDING COVERAGE NAIC# INSURED Sulenski Roofing And INSURERA WESTERN WORLD INSURANCE COMPANY Siding Co. Inc. INSURERS: Safety Insurance 103 South Street 'INSURER C: AMERICAN HOME ASSURANCE Holyoke, MA 01040 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR IANSRU POUCY EFFECTIVE POUCY EXPIRATION LIMITS TYPE OF INSURANCE POUCY NUMBER DATE IMM/DD/YY] , DATE IMM/DO/YYl GENERAL UABIUTY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,000 PRFMICFS(Fa nrr rwnrpl CLAIMS MADE X OCCUR NPP971670 06/04/2006 06/04/2007 MED EXP(Any one person) S 1,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY( I ECT I I LOC AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) 1,000,000 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS 1610306 (Per person) B X HIRED AUTOS 01/01/2006 01/01/2007 BODILY INJURY $ X NON OWNED AUTOS (Per accident) X COMPREHENSIVE PROPERTY DAMAGE $ X COLLISION (Per accident) GARAGE UABIUTY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LWBIUTY EACH OCCURRENCE $ 0 OCCUR CLAIMS MADE AGGREGATE $ 0 $ DEDUCTIBLE $ RETENTION $ 0 $ 1 I I WC STATU- OTH- WORKERS COMPENSATION AND X TORY I IMITS , ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 100,000 C ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? WC8932443 12/31/2005 12/31/2006 E.L.DISEASE-EA EMPLOYEE $ 100,000 ff yes, describe under E.L.DISEASE-POLICY LIMIT $ 500,000 SPPECC IAL PROVISIONS below - OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS e. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ __ - DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY _ _ OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 10,e1/1t, Harold Clayton Jr /MEG a ACORD 25(2001/08) FAX: (866)280-9621 ©ACORD CORPORATION 1988 • . ?vie _67 t.t Board of Building Regulations One Ashburton Place, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 06/22/1945 Number: CS 022840 Expires:06/22/2008 Restricted To: 00 JOHN R RIGALIS 103 SOUTH STREET HOLYOKE, MA 01040 Tr.no: 23480 Keep top for receipt and change of address notification. DPS-CA1 C: 50M-04/05-PC8698 , ,./,,,././.<4.46 =14-Nr =�,1= Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 101718 Type: Private Corporation Expiration: 6/29/2008 S.E. SULENSKI ROOFING & SIDING, CO John Rigalis - ___ 103 South St - - --_ --- Holyoke, MA 01040 —___ ._--__ _ Update Address and return card.Mark reason for change. DPS-CA1 w 50M-04/05-PC8698 E Address Renewal 11 Employment 11 Lost Card ✓ize -670mrrwou..eaza of./�aaaac/au sea Board of Building Regulations and Standards License or registration valid for individul use only =_ L HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration 1,01718 Board of Building Regulations and Standards Expiration: 6/29/2008 One Ashburton Place Rm 1301 Type: Private Corporation Boston,Ma.02108 S.E.SULENSKI ROOFING&SIDING,CO John Rigalis 103 South St Holyoke, MA 01040 Deputy Administrator Not valid without signature