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10D-016 (2) ��o{s BP-2022-0421 183 MAIN ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 10D-016-001 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-2022-0421 PERMISSION IS HEREBY GRANTED TO: Project# 2022 RENOVATION Contractor: License: Est. Cost: 24720 JONATHAN TOSCH 116108 Const.Class: Exp.Date: 10/08/2024 SHAHAR HAIM TRUSTEE THE HAIM SHAHAR Use Group: Owner: LIVING TRUST UTD Lot Size (sq.ft.) Zoning: OI/URB/WP Applicant: JONATHAN TOSCH Applicant Address Phone: Insurance: 312 AMHERST RD (630)902-1627 PELHAM, MA 01002 ISSUED ON:04/26/2022 TO PERFORM THE FOLLOWING WORK: kitch& bath reno apmt 2 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: 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 ' 1 � . '1 • Fees Paid: $321.00 212Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner ii I - -- _4.- • ,111 Jl cv v I `~' The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR a , . _ Massachusetts State Building Code, 780 CMR MUNICIPALITY USE a Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 One- or Two-Family Dwelling I This Section For Official Use Only Building Permit Nber: Qu 0^ ca/ Date Applied: WeLitit.-) 1/ 55 //; 1-Z5-ZD2Z Building Official(Print Name) Signature Date SECTION l: SITE INFORMATION 1.1 Pr�opgFty���s� � 1.2 Assessors Map& Parcel Numbers O` l .0 G C,A � 10 P w D- 6/ ( 1.1 a Is this an accepted street?yes J no Map Number I arcel Number 1.3 Zo Information: 1.4 Property Dimensions: c/ .S / /06MIM � (Q 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: Zone: Outside Flood Zone? Public 1r Private 0 Check ifyes❑ Municipal WOn site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 11rr* I Ififneet- QAL-pn I G� 7/3 77 Name(Print) City,State,ZIP in rnW NA- WA1/ 4/3 244 200 111011Velide*r 06 ti -1 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Gd Owner-Occupied 0 Repairs(s) 0 Alteration(s) Addition El Demolition M Accessory Bldg. 0 Number of Units a Other 0 Specify:_ Brief Description of Proposed Work': 'ore-14EM AN. SIM, 1LE/Iro VA-9WI0. 74 we_ auT iit f??Ft . NCW teA1AV E71. A/ IC'/te-0-E�. A/- 4 frc y t '1 "L Tit 1/k. FO�¢, v/V11, �Yr4_/_(-VA/f f? T. ktre N ^ il. Qi i ' _ 6 r/rt ti( 0 n�►w/k. SFr ►tt.?v c S vf4- 6 f' f - SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ lift W I. Building Permit Fee: $ Indicate how fee is determined: ee�� 0 Standard City/Town Application Fee 2. Electrical $ �ZC., 0 Total Project Cost3 (Item 6)x multiplier x 3. Plumbing $ (orrQ►d 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees: $ Suppression) l Check No. (n I I Check Amount:ON I Cash Amount: 6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due: 7 • SECTION 5: CONSTRUCTION SERVICES 5.1 ConstructionSupervisor License(CSL) !/G/O D `e 4 J0ofrim ' 71 f License NumberO ipiron Date Name of CSL Holder g AMIf 6A a-et_ List CSL Type(see below) No. and Street Type Description P WI II Ai i fA 6 /0 0 2 U Unrestricted(Buildings up to 35,000 cu. It.) �_ � ! R Restricted 1&2 Family Dwelling City/Town,State,LIP M Masonry RC Roofing Covering WS Window and Siding p SF Solid Fuel Burning Appliances al0 [�� ��•27 /o wl. TO.f'C�f t -n m'Afs-,( 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) JaUA Whig nif HIC Registration Number Expiration Date H Company Name or HIC Registrant Name ilt f2 AAI't .S'T /Zb A Jw o rdrupe_CM4/G. (os tat" e MA Oioo A 6';0 tee ,/ 7 Email address City/Town,/ `(/ 9 State,t ZIP i` 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 Al. 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 to act on my behalf, in all matters relative to work authorized by this building permit application. b(A(AI J'ft4fm. k. 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. d0A/k1a64 A/ riFC ' 6¢i6 S 2 Print Owner's or Authorized Agent's Name(Electronic Signature) ate 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" • The Commonwealth of Massachusetts r zurr,mon Department of Industrial Accidents .... im 1 Congress Street,Suite 100 ' -I= Boston, MA 02114-2017 ,•,.... , www.mass.govidia . - t -- Vv4ok er s'('ettnpenstt don Insurance AMdavit:Builders/ContractortifElectriciant/Plumbers. TO at:FILIED WITH THE PERMITTINC AUTHOBITIt`.. Applicant Information Please Print Legibly Name i LI usinessiOrsanin tic.rmi ludo idua I}: 'to s e14---- CArMira"i'lqaitd Z4-c— Address: ?/.2_ Atftt//'6-7.4 7 Iva— ., City/State/Zip:"Et,iii/Kr/14 4- 0 i*0 2, Phone P: ;..t1 f 0 2,_ /447 Art you as entpkryte Cheek the appropriate bus: Type or project(required) i.E3 I am a employer with eintsioycea(lull anitor part-tima' 7. a New construction 20 I am 4 suk proprietor or partnership and he nu employers working for me in K. 0 Remodeling any capacity. No workers'comp.insurance retpared„, 9. 0 Demolition Ian'a honivawnevacal all work myself.[No worioers'comp.insurance required y 100 Building addition 4,1"3 I am u hurnookner and will be hiring ounttactuts to conduct all work on racy property I will ensure that all contractors either have workers, woven:ninon insurance or an:sole 11.0 Electrical repairs or additions proprietors with no employee% 12.0 Plumbing repairs or additions C:1 I am a general contractor and I have hued the sub-contractors hated on the attached sheet pasthaw 3.173 e sub-contractor% en la-as and ve workers"com in p. surance.; 1 Roof repairs n. We a a corporation and as offiss ce base outwit:est thew nErla ar exem h4tl,plum per c, 5r 14.C3Othee re I!l2..§WO.and we have no employeca.[No workers'comp,insurance remain:1j •Any applicant that cheeks bat at must ateo rill out the Peewit below shoes in their si utters'compensation pulley information I fanneowners who submit this affidavit iradicating they are Joon;all WW1(and then hire outside contractors mint submit a new aftielas it nal mitimistiels ',.t.,ontractors that check this boa must attached an adehtional sheet show ing the name of the sub-esattraelors and state whether or nut those entities have employee, lithe soh-contractors/sass'employee .the-.1141A iv tys id,:thew wotteri"comp,policy number I am an employer that is providing workers"compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie. #: Expiration I3ate: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under!AGE e. 152, §25A is a criminal violation punishable by a tine up to S1.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$25000 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA far insurance coverage verification. I do hereby certify r the pains and penalties of perjury that the information provided above is true and correct. Signature; I)ate Atfikr_lt, 51 Z.2 Phone r: 0 0 10.L.- /42 7 . . Official use only. Do not write In this area,to be completed by cif,or town official it or Town: Permit/License# Issuing Authority (circle one): I. Board of Health 2. Building Department 3.City/Total'Clerk 4.Electrical Inspector 5. Plumbing Inspector i).Other CtItti AO Person: Phone#: City of Northampton `'„, g Massachusetts �4., 4,.... `'(,; hi w x 4 „ ' DEPARTMENT OF BUILDING INSPECTIONS w. n Street • Municipal Building, �Ja 212 Mai w ii,,*,- 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 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. 4 The debris e disposed of in: Location of Facility: W4T__ The debrisfransported by: Name of Hauler: AAftFrier? 7 l- vC-& ('v(_ Signature of Applicant: Date: ai 4r .,...77:ew frotil,,,w/ete_oecedif 0/..,30:eicia-Orilerie/4-- Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration roAke4k-ii,‘ Type: individual Registration: 202809 JONATHAN TOSCH Expiration: 08/11/2023 312 AMHERST ROAD Update Address and Return Card. Wo" „,_ . __ 3A 1 0 20M-05117 A telailfintialifitire'VA'arlyalkusAcresosltettutttlion HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:individual before the expiration date. it found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 2028a, 08/1112023 1000 Washington Street -Suite 710 JONATHAN TOScH , 1, Boston,MA 02118 .......tc. : i‘: ) JONATHAN ft" , Btli' / i• ° 2 312 AMHERS4D,0A / 5/ ,e,,,,,...(a i 4s/.4,,,i4.• PELHAM,MA Undersecretary OIDIGZ, .-', :• Not valid without signature qtr..6,96, Commonwealth of Massachusetts \‘/C Division of Occupational Licensure * - Board of Building Reuulations and Standards -II t• ConstciAon *.'N,., isor CS-116108 --: lEit_pires:10/08/2024 JONATHAN 1OTOSCH 312 AMHERSet ROAD ..,,7 AMHERST Mit 01002 ' :0- ,'A .... , ., ,' •,:e. .._ :'•••II 1.- ,3D 0/.1Nri,':.1:3 /,/ ,--, Commissioner dail K. YErnift;L, A ^ '-1 Y DATE(MMIDD/YYYY) �w...+�,. CERTIFICATE OF LIABILITY INSURANCE 04/01/22 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 NAME: Martha Chase Dale A Frank Insurance Agency,Inc. (A/CNo.Ext): 413-665-8324 FAX No): 413-665-1280 PO Box 455 E-MAIL Sunderland,MA 01375 ADDRESS: info@DaleFranklnsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: RPS-Atlantic Casualty INSURED INSURER B: Jonathan R Tosch INSURER C: Commercial INSURER D: 312 Amherst Road Pelham,MA 01002 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE CLAIMS-MADE OCCUR PREMISESO(Ea o(ccu RENTED $ 100,000 MED EXP(Any one person) $ 5,000 A L261002635-0 08/26/21 08/26/22 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ - OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _AUTOS ONLY _(Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ - EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN CITY OF NORTHAMPTON ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED NTATIV ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1,65 "(i' lit/rC G- E/1t/t( IP to r v/LFT._ er wo'UC e4pftr— laCFv€' 47 I I "14(v Or L6� " A ? 2 LA-S7 4 pnl -.1 ,.o,_l 7ff4 ti 701 c44( CM'd nAtc'?I i/i- Goa poL az_7