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32C-286 (10)
BP-2022-0285 114 WILLIAMS ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32C-286-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0285 PERMISSIONISHEREBYGRANTED TO: 2022 RENO 2 FAMILY TO 1 Project# FAMILY Contractor: License: Est. Cost: 21493 KEITH G ROY CONSTRUCTION INC CS063810 Const.Class: Exp.Date:09/08/2022 Use Group: Owner: DIRENZO BROWNE, LUKE &GRAZIELLA Lot Size (sq.ft.) Zoning: URC Applicant: KEITH G ROY CONSTRUCTION INC Applicant Address Phone: Insurance: 54 MAINLINE DR SUITE E (413)485-7533 WC9082 78 1-00 WESTFIELD, MA 01085 ISSUED ON:03/25/2022 TO PERFORM THE FOLLOWING WORK: REMOVE WALL TO MAKE 1 FAMILY, INSTALL BEAM. NEW WALL TO CONCEAL UTILITIES FOR 2ND FLOOR, NEW FLOORING, REPLACE LALLY COLUMN IN BASEMENT 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: Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: • 'V : y2 - • I Fees Paid: $143.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner File #BP-2022-0285 Z— D R APPLICANT/CONTACT PERSON:KEITH G ROY CONSTRUCTION INC 54 MAINLINE DR SUITE E WESTFIELD, MA 01085(413)485-7533 PROPERTY LOCATION 114 WILLIAMS ST MAP:LOT 32C-286-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $143.00 Type of Construction: REMOVE WALL TO MAKE 1 FAMILY, INSTALL BEAM. ,NEW WALL TO CONCEAL UTILITIES FOR 2ND FLOOR, NEW FLOORING, REPLACE LALLY COLUMN IN BASEMENT 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: JApproved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR SpecialPermit With Site Plan Major Project: 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 !IV Signal, re 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. lr C G M-11 73 r. o The Commonwealth of Massachusetts z `�I c` Board of Building Regulations and Standards FOR . ,/ N Massachusetts State Building Code, 780 CMR MUNICIPALITY S =Build tng permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 m One-or Two-Family Dwelling Nu' This Section For Official Use Only tnig n it Numb:r:6P--Zo7 2 -02$5.- Date Applied: r)3I 2.3 Zo 2.-2_ LOA- - T /_,10., Building Official(Print Name) Signature Dat SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 1 N tint 1 I i CLYN S 5N-r-e"-ek l.la Is this an accepted street?yes 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 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: LAK-e-- Brow at IjociAryvvytoy, , 1-tA (')1 ()Uo Name(Print) City,State,ZIP IN tA ►iIicurS st-ee- qX5-7( '-t,r No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction ❑ Existing Building 0 Owner-Occupied 112/1Repairs(s) �Alteration(s) /ddition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: , e_ Brief Description of Pro osed Work': q_e„,-..,,,_ uet11 -t'L -+ -wt0t1 2 Vuw•,�4-ti 1/1w. . 6(.4d 60.4 p (..)4 t/ AA; pr�v.4 .-5. z'�'.ZZor (3_,,.., _,„Ji 4( .Z)r 7 limit- Ad-cif Ple-e- h#1-4.51` `FlOalta- ( A T ( 4 c e- / G 74, l4-ti..n i •, ec�-9.-..17.4.474— SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ -Z' 413 - 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ' ❑Standard City/Town Application Fee SID ❑Total Project Costa(Item 6)x multiplier 6.- x 21...5. 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Totat All Fees: $ c� 6,11.3 y Check No2552 t Check Amount:- /(13.-- Cash Amount: 6.Total Project Cost: $ Z' N ❑Paid in Full 0 Outstanding Balance Due: • --Y s+e voo kj rDC t Cow-) SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) � CS-( 3&I 0 o416h 1 ac a ' 16 ( • KO t 9 License Number Expiration Date Name of CSL Holder `� List CSL Type(see below) U 544 Thal a1ir Drive No.and Street Type Description U((� U Unrestricted(Buildings up to 35.000 Cu.ft.) R 76 Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 4I3-Vtg5-753 i p -,ute !(9co C Struc titmt W I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) I/g1'1,5� � 0113 0 1020.?3 t�-In G- Roy C( 5truci+tm,-r._,n�� HIC Registration Number Expiration Date HIC, ,1Company Name or HIC Registrant Name _�- rr ti Ana;n'v' v c \f c A(s ( "Email r by(OVIS C'1t i 0) .(41,1 No.and Street Email address We.Skc e c1 ot02(.5 u 13-145-75's 3 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 14....6 44\ U to act o y beh lf,in all matters relative to work authorized by this building permit application. 2i/2®L?- 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 con ' ' this application is true and accurate to the best of my knowledge and understanding. 3122`2-L� Pri er's or Authorized Agent's N (E ctronic 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. 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 dQ,n N M/�� .,Ky.. ti. Massachusetts c ' DEPARTMENT OF BUILDING INSPECTIONS CF)• 212 Main Street • Municipal Building Northampton, MA 01060 j'5k*, �.ti' 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: 13 C (l LA C C i e1 cl C Ubcga The debris will be transported by: Name of Hauler: _k.c)R Signature of Applicant. Date: 3(Z 7/7J • .0•,/ KO-4071/740W1 -a 144' .1)4e?'r/?4/11,i-f•) ,113,{1 Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: 188456 KEITH G.ROY CONSTRUCTION,INC Expiration: 07130/2023 54 MAINLINE DR SUITE E WESTFIELD, MA 01085 Update Address and Return Card. SCA 1 A 20M-05/17 ‘49. office of consumer ki t pafaxas ie ago(ation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Rig lira Expiration Office of Consumer Affairs and Business Regulation 188456 07130/2023 1000 Washington Street -Suite 710 KEITH S.ROY CONSTRUCTION,INC Boston,MA 02116 KEITH ROY 3 BRAYTON DR SOUTHWICK,MA 01077 Undersecretary Not valid without signature • • • Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Cons lfiar t pervisor CS-063810 fires:09/08/2022 KEITH G ROY 54 MAINLINE DRIVE SUITE E WESTFIELD MA 01085 Commissioner Of0.844 torConAni '' The Commonwealth of Massachusetts Department of Industrial Accidents 9. Office of Investigations "i >• 1 Congress Street, Suite 100 Boston, MA 02114-2017 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Keith G. Roy Construction, Inc. Address:54 Mainline Drive Suite E City/State/Zip:Westfield, MA 01085 Phone #:413-485-7533 Are you an employer?Check the appropriate box: Type of project(required): 1.2 I am a employer with 6 4. n I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New onstruction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. I. 'emodeling ship and have no employees These sub-contractors have 8. MI Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. 9. ❑ Building addition required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions m self. [No workers' comp. right of exemption per MGL yP 12.0 Roof repairs insurance required.]t c. 152, §I(4),and we have no 13.❑ Other employees. [No workers' comp. insurance required.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employee& Below is the policy and job site information. Insurance Company Name:Selective Insurance Policy#or Self-ins.Lic.#: WC9082781 Expiration Date:5/14/2022 Job Site Address!14 Williams Street City/State/Zip:Northampton, MA 01060 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert. he pains and penalties of perjury that the information provided above is true and correct. Si nature: DatejZZ I_ Phone#:413-485 7533 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: KEITGRO-01 CHRISTINE '44C-0121:70 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 4/14/2021 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). PRODUCER CONTACT Christine Sullivan NAME: Phillips Insurance Agency,Inc. PHONE FAx 97 Center Street (A/C,No,Eat):(413)594-5984 (Am,No):(413)592-8499 Chicopee,MA 01013 ADDRIEss:christine@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance 12572 INSURED INSURER B: Keith G.Roy Construction,Inc. INSURER C: 54 Mainline Drive,Suite E,Rear Bldg INSURER D: Westfield,MA 01085 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MMIDDIYYYYI (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR S2399511-00 5/14/2021 5/14/2022 DAMAGETORENTED 1,000,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 _GEM_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT X LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: EPLI $ 100,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) _ ANY AUTO A9108142-00 5/14/2021 5/14/2022 BODILY INJURY(Per person) $ OWNED X SCHEDULED AUTOSRREE�� ONLY AUTOS WN BODILY INJURYD (Per accident) $ X AUTOS ONLY X AUTOS ONLY ((Perr od-rent)AMAGE UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE OTH- ER WC9082781-00 5/14/2021 5/14/2022 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE I N L.E. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I 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 Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE i ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ■ i _ 1 I 1- ■ - ■■■II ■■ ■ , ■ ■ - II III ■■ 1 I I . ( _ _ I jil - o) -_rol) imp ' (2 ,110 i rvaidvo. . Igii. m : & : WV1� Egin ,. 1 ■ --1I.. IIIIL--rimr r _ 1-- • - Nil MI- II _ • ■ ■ I ummuipiread. 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