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24D-292 (12) BP-2022-0366 152 CRESCENT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24D-292-001 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-2022-0366 PERMISSION IS HEREBY GRANTED TO: Project# SUMP Contractor: License: PRO TECH WATERPROOFING Est. Cost: 30000 SOLUTIONS 095913 Const.Class: Exp.Date:04/29/2022 Use Group: Owner: CHAPUT CHRISTOPHER R Lot Size (sq.ft.) Zoning: URB Applicant: PRO TECH WATERPROOFING SOLUTIONS Applicant Address Phone: Insurance: 864MONTGOMERY ST (413)533-8217 WMZ-800-8006530 CHICOPEE, MA 01013 ISSUED ON:04/12/2022 TO PERFORM THE FOLLO WING WORK: INSTALL DRAINAGE AND SUMP 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: I II Fees Paid: $195.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner The Commonwealth of Massachusetts t i! , ,,, Board of Building Regulations and Stan rds APR _ 8 FOR; Massachusetts State Building Code, 78 CM 202 IUIS4LITY DppBuilding Permit Application To Construct,Repair,R ctyate r __Rev ed far 2011 One-or Two-Family Dwelling -T1-14 nON��q ofi.�soONS This Section For Official Use Only `" Buildin Permit Number: 6' .13" C((i.3 Date Applied: ' 00 s //7 LI- 11- ZOZ-a Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 152 Crescent Street, Northampton MA 01060 24D 292 1.1 a Is this an accepted street?yes X no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 4965.84 52 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 IR Private 0 Zone: — Outside Flood Zone? Municipal GA On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Christopher R Chaput Northampton, MA 01060 Name(Print) City,State,ZIP 152 Crescent Street 413-813-8604 crchaput@yahoo.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building g Owner-Occupied cit Repairs(s) ER Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': Basement floor removal, install drainage and sump (existing electrical). replace floor SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 30,000 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee 0 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 Ncro. 6 3'i Check Amount: 'g6Cash Amount: 6. Total Project Cost: $ 30,000 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CSL#95913 4/29/2022 Gill Gilpatrick License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 864 Montgomery Street No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) Chicopee, MA 01013-3822 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-533-8217 protechwaterproofingsolutions@gmail.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Co�ntracttorL,/�(_k 1 (�tIIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 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 .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 Gill Gilpartick to act on my behalf,in all matters relative to work authorized by this building permit application. Christopher R Chaput 4/5/2022 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. Gill Gilpartick 4/5/2022 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. 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 „, Massachusetts w - w DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building S� Northampton, MA 01060 ssl ,• �e� 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: Marion Excavating, 749 New Ludlow Rd, South Hadley, MA 01075 The debris will be transported by: Name of Hauler: Pro Tech Waterproofing Solutions Signature of Applicant: Gill Gilpatrick Date: 4/5/2022 CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD Site Plan attached SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE The Commonwealth of Massachusetts Department of Industrial..4ccidents 6'1 I Congress Street,Suite 100 Boston, MA 02114-2017 ° www.mass.gov/dia Workers'iCompenstion Insurance Affidavit:Buiklers.ContractorsfElectriciansfPlumbers. TO RE FILED WITH THE PERMITTING AUTHORITY. Amilicant Information Please Print LeEibls Name Ic3ibuics.v(krllaation Individual r. Pro Tech Waterproofing Solutions Address: 864 Montgomery Street City State'Zip: Chicopee, MA 01013-3822 Phone#: 413-533-8217 Art you an emplirk CI. k lir appropriate but I iif prujrtJirtluired): .E3 I am a Lim/I.:rya With crripioyeri(full and or part-tinict 7_ Cj New construction I am tr sole wuprId0 tpogitiethop and have 310 ernpkYyeri working for rne m8. 0 Remodeling airy capacity_(No uuriters'comp.insuannet requanat) ii tJ9_ Demolition I tun ti liornecvwniz&my siork myself.[Noworkers.'clam.insurariev 10 El Buildeng addition 4.[3 I ani a homeowner and orl.1 hiring coatrooms to conduct all work on ray property. I vi ill ensure lind all contractor.either has c Vourirn:courperoation insuranceot are iiE3 Electrical repairs or additions proprietors with no cinplo yet's_ 12.0 Numbing repairs or additions era a yencrul contractor and I have hired the sith-contractuii.bitted on the=achedTht ahea C Roof aith-euntractura love employe:eh and have comp.inataratine,: B repaiN 14.210thei Sump install Es.:3 an Laorporielort and sti offiters havex.s..tnd then tilthl tilexerniatitin per?AGE_e. 15..11.10 1.and wc havc employees.[Nu.*littera camp,insurance required.) An arpin.:.ant that checks.box I mug also till out the-section shoss nag their W1.760.7.-: ton Eit-imeowncri.who atithrut thia affidavit milicatitig they are doing all work and dim hire outside mu at autirml a nu x allialat it inditaiting IiL :Contra:tor.that check this btri.must attached an additional alieet showing the name of the raih—..:eaitra,Acri and tate Whole-ut not thin esitthin.havoc eirployeeN If the Stib,::litnraCt11%,11.2k e einplOyeeti.they rails!pruvide their workers'txririp paha:, minthet — I am an employer that is providing worAers"compensation insurance for my employees. Below is the pohey and job site information. Insurance Company Name: HUB International New England Policy#or Self-ins.Lie.#: WMZ-800-8006530-2021A Expiration Date: 5/29/2022 Job Site Address: 152 Crescent Street citystste,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 MGL e. 152,*25A is a criminal violation punishable by a tine up to$1,500.00 andOr one-year imprisonment,as well as civil penalties in the forrn of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investiations of the DIA for insurance cover-age verification. I do herch t•t-rili under the pains and penah'ies ofperjury that the in jOrmation prtivided above is true and correct. Gill Gilpartick 4/5/2022 SIL.matut c: Date: 413-533-8217 Phi,rtc Official use only. Dr,not write in this area,to be completed by city or tou-n official City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.('its'Town Clerk 4.Electrical Inspector 5.Plumbinc, I us pet:tor 6.Other Contact Person: Phone#: City of Northampton Massachusetts r } w ; DEPARTMENT OF BUILDING INSPECTIONS• �- a 212 Main Street • Municipal Building Northampton, MA 01060 Syi. 1 HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert full legal name), born _ (insert month, day, year), hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns 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 home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this day of , 20 . (Signature) —NOTE— THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED. BUILDING LOCATION ACCURACY IS NOT GUARANTEED 44't NOTE: GARAGE SUBJECT TO EASEMENTS AND RIGHTS OF WAYS OF RECORD. r ` I ' 1 o 0� I � w �r I 1 if) lI Q N ,.. o 3 i #152 o U Z O O I I -J U I I I t • X I tYO m a i BOOK 2629, PAGE 191 PLAN BK. 26, PG. 77 I I t � I I 52'± CRESCENT STREET TO: APPLIED MORTGAGE SERVICES CORPORATION & LAWYERS TITLE INSURANCE CORPORATION TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES, EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR COMMUNITY #250167 � p -NOTE- RC ,--LQX . 1 THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY SURVEYOR: AND DOES NOT CONSTITUTE A PROPERTY SURVEY -MORTGAGE LOAN INSPECTION PLAT- 4` cti, NORTHAMPTON, MASSACHUSETTS o= RANDALL z F, :, PREPARED FOR E. . IZER v) ; CHRISTOPHER R. CHAPUT f35032 SCALE: 1"=20' SEPTEMBER 1, 2006 \' ('ti ° HAROLD L. EATON AND ASSOCIATES, INC. REGISTERED PROFESSIONAL LANO SURVEYORS 152 Crescent Street, Northampton - Basement Floor & Sump Project 2022 Existing downspout drain to existing underground drywell t Sump Existing Pit Home Existing Basement Front Yard { } Existing Garage Existing Driveway r.—.N PRO-WAT-01 MMATZ AcoRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) kft...../ 4/5/2022 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 License#1780862 CONTACT NAME: Monique Matz HUB International New England PHONE FAX 96 Shaker Rd (A/C,No,Ext): (A/C,No): East Longmeadow,MA 01028 MEss:monique.matz@hubinternational.com INSURER(S)AFFORDING COVERAGE NAIC# __ INSURER A:Cincinnati Insurance Company 10677 INSURED INSURER B:Associated Industries of Massachusetts Mutual Insurance Compan 33758 Pro-Tech Waterproofing Solutions,Inc. INSURER C:Accredited Specialty Insurance Company 16835 864 Montgomery St. INSURER D: Chicopee,MA 01013-3822 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 IMM/DD/YYYYI (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR EPP0593018 10/16/2021 10/16/2022 DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _ $ 2,000,000 POLICY PEa LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO EBA0593020 10/16/2021 10/16/2022 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOS ONLY X AUTOS BODILY INJURY(Per accident) $ X HIRED ONLY X NON-O ONEDD PROPERTY DAMAGE (Per accident) $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE EPP0593018 10/16/2021 10/16/2022 AGGREGATE $ 1,000,000 DED RETENTION$ $ B WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N WMZ-800-8006530-2021A 5/29/2021 5/29/2022 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes.describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Snow Removal 2CUPMA17S010702600 10/16/2021 10/16/2022 Each Occ 1,000,000 C Snow Removal 2CUPMA17S010702600 10/16/2021 10/16/2022 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/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 Christopher Chaput THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P P ACCORDANCE WITH THE POLICY PROVISIONS. 152 Crescent St Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ?-,99/45-T ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington gtreet - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration a� Type. Corporation PRO-TECH WATERPROOFING SOLUTIONS,INC. Registration 144335 864 MONTGOMERY ST Expiration: 02,01l`1023 CHICOPEE, MA 01013 Update Address and Return Card.