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Copy of 212 Chestnut Street Building Permit AppThe Commonwealth of Massachusetts Board of Building Regulations and Standards Massachusetts State Building Code, 780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a One- or Two -Family Dwelling FOR MUNICIPALITY USE Revised Mar 2011 This Section For Official Use Only Building Permit Number: Date Applied: Building Official (Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 212 Chestnut Street Florence, MA 01062 1.2 Assessors Map & Parcel Numbers 17A 144 Map Number Parcel Number L l a Is this an accepted street? yes no 1.3 Zoning Information: URA Single Family Zoning District Proposed Use 1.4 Property Dimensions: 22,025 100' Lot Area (sq ft) Frontage (ft) 1.5 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 20' 55' 15' 24.5' 20' 75'+ 1.6 Water Supply: (M.G.L c. 40, §54) Public ® Private ❑ 1.7 Flood Zone Information: Zone: Outside Flood Zone? Check if yes® 1.8 Sewage Disposal System: Municipal On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIPI 2.1 Owner of Record: Jack Broadbent & Amelia Moore Florence, MA 01062 Name (Print) City, State, ZIP jacksonmbroadbent@gmail.com 212 Chestnut Street (978) 793-3299 amelial121@gmail.com No, and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WOW (check all that apply) New Construction ❑ Existing Building ® Owner -Occupied ❑ Repairs(s) ® Alteration(s) IZ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work2:lnterior renovations, and exterior painting. Kitchen remodel and bathroo updates. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials Official Use Only 1. Building $ 152 973 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee ❑ Total Project Cost' (Item 6) x multiplier x 2. Other Fees: $ List: 2. Electrical $ 17,016 3. Plumbing $ 14,500 4. Mechanical (HVAC) $ 293750 5. Mechanical (Fire Suppression) $ 0 Total All Fees: $ Check No. Check Amount: Cash Amount: ❑ Paid in Full ❑ Outstanding Balance Due: 6, Total Project Cost: $ 214,239 $214,239 / 1000 = 214.24 214.24 x $7.00 = $1,499.68 (Rounded up $1,500.00) SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License (CSL) CS-065521 1/25/2024 Steven Barrett License Number Expiration Date List CSL Type (see below) U Name of CSL Holder 97 Federal Street PO Box 503 Type Description No. and Street U Unrestricted (Buildings up to 35,000 cu. ft.) Belchertown, MA 01007 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) 58&8287 sbarrett@wright-builders.com I Insulation D Demolition Telephone Email address 5.2 Registered Home Improvement Contractor (HIC) Wright Builders, Inc. 101536 6/25/2024 HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 48 Bates Street nwright@wright-builders.com No. and Street Northampton, MA 01060 (413) 923-2870 Email address City/Town, State, ZIP Telephone SECTION 6: WOREERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. a 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 ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property, hereby authorize Wright Builders, Inc. to act on my behalf, in all matters relative to work authorized by this building permit application. Jack Broadbent and Amelia Moore 6/15/2022 Print Owner's Name (Electronic Signature) Date SECTION 7b: OWNEW 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. Wright Builders, Inc. 6/15/2022 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.tnass.gov/oca Information on the Construction Supervisor License can be found at wrvw.mass.gov/dps 2. When substantial work is planned, provide the information below: Total floor area (sq. ft.) 2;923 (including garage, finished basement/attics, decks or porch) Gross living area (sq. ft.) 1.815 Habitable room count 3 Number of fireplaces 1 Number of bedrooms 3 Number of bathrooms 9 Number of halFbaths 0 Type of heating system (ail Number of decks/ porches 2 Type of cooling system Forced Air Enclosed Open 2 3. "Total Project Square Footage" maybe substituted for "Total Project Cost" CITY OF NORTHAMPTON SETBACK PLAN MAP: 17A LOT SIZE: REAR LOT DIMENSION LOT: 144 22,025 95.6 LF No changes to existing footprint. FRONT SETBACK FRONTAGE 100' SIDE YARD City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 CONSTRUCTION DEBRIS AFFIDAVIT OR 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: Casella Waste Systems or Western Recycling 686 Main Street Holyoke, MA 01040 The debris will be transported by: 205 Old Boston Post Rd Wilbraham, MA 01095 Name of Hauler: Associated Building Wreckers or J&J Trucking Signature of Applicant: � °� Date: 6/15/2022 Tlae Commonwealth nftllttssaeltrtsells 15ferrtttt`tlt ewl of 1`tidiistizial Aecldeitt's 1 Cotigixess Street, Sitite 100 Boston, AIA 02114®2017 tl~IVIV.lttfli.N.gul' tt'orlters' Compensation Insurance Affidavit: Bui tlerw t'nittractorstElectrician.sfi}luniberi. TO BE FILED WITH '1'BE 1rlsRM11 1'ING AtIT1101100I'Ya AlsLSlicant lrrii�rnsatian Please Prirrt Leibi� tarot~{i�>35�tt���r�a�a„i�,ti�t1`1t„�����e��it Wright Builders, Inc. kddl&ess. 48 Bates Street +L'ity/State/Zip: Northampton, MA 01060 Phone #a (413)-923-2870 Are you nu entphtr}'er? � 6k rise rrppa�utEetar 6wr►. t. X I stet a etiyiluyc�r tit"th 22tPrtll :taEd,'�,s I+itrt-tieEMy.� ? hart a aUie Ixuprietm ur Itartncrship an,l have nu enfant}pus, working for nu in any capacity. [No wurkecs' ecitmp. imuramv mNuimd.] 3. l:ant a homwwricr doing all aattEk: myielf. (Alps workors' ciart:p. imuranee required.) .rl 1 ant a 9tusra�wat�ttirasi�i ta:sll be lurtttg edFrirt.tetwri ro ,tiscrdtict all 5't'ork +its tat: IarulicrCy. I w'tlt VjLiaIllat all coldrelum eirlser i1wrot wua claL uei4l cmaiauri itt.',uramV or ara sole pruprietaata will% no elr,pluyeca. i ant :r general contractor ansl I Ixsk^c lts`nEi the awls-eutsiraetuts listed on tlr: aitami,ecl street_ Titese Tula-uonuaewrs Ixate ermplu} cct anti Imve tti^utkera' eur mp. iEtsttranec.a tl.® W{. arc :'t t'4bIlAilm".'YS31114 iirld it.4 officers haw Ykirl`13ei1 tl]ilr right ikt i:Sl`EYII>tHtPSi Ik'•r Xt{.BL l'. I=i�. � l(^#), anti tt'c ita4ti nu t�rttlmlw��es. [:vo iVtatkcr:i' ciattila, inst+ranee rcyt;iti:cl.l'' rypse of project (requiredy Newconstrut.t!oil Ii. Remodeling`r. ® Demolition 10 Builatinur addition 11 x Electrical repairs or additions 12. Plumbing repairs car ailtlitions. 130 Roof repairs 14.Q©tlter 'skit}^ appliewtt that eItceks Lxrx trI tmt3rt Aso till uu[ tltr. yratiomt telwtie showing their tttmkETs' a:untpa.msatiun Iiwlicp infstrtnuEiarm_ f Etartneovats�ts ta^lru sttlaimt tits atlialrttat mt�lieatinl!, they, arc Eidtaim� all to^urk and rlt,�m Hire utttaiJe itvttir.te[urs imttyt sstbtttit a netia� aft'i+.lav'it arsicttitag att;:la. lCuntraaw—& that cluck ails hoax imus7 atlizrelwd all armitiunal sheet slwkvinp titu natne of die sutreantt s rein ante stars wlte l,er tit not dtuuse colitis: lt;Av eiripluyec . If the sub-euntraaurs frave employees, they lotus[ provide their workers' awtnp. pulilq number_ 1,�ri+r rrrr cYrrrt►�trl�a�!" t/rert fs trrrrrFr"aftrr,� rrrrr#€�rs' crrrrrtrernsrrttr�tr trrsrtt�tnre for ar�ti eraritrto)tees. B'ee`r Es tlieprateq rrrtrd}ah sFte irr,�r�r"E+rrrctterrr. Insurance Company Name: A.I.M Mutual Ins. Co. - Ptalicy # tar Setf ins. Lic. 46 MCC-200-2000534-2021 A Expiration Date:. 3/1 /2023 liab site, r�elclrtsss: 212 Chestnut Street statca`Z.ip; Florence, MA 01062 Attnclr n co[sy of the rs^rrt trrs' cctnrlsretrsnti�trr ptrlc�' deeIarntitst? Isa�e (slrrr�vin� the istaiicy ntrrrrlser nrrd exlrit atian dt�te}. Failure to secure coverage as required anger t4 GL c. 152, §25A is a criminal violation punishable by a title: up to 451,500.00 atlsrl?'or one-year insprisonment, as well as civil penalties its the form of"a STOP WORK ORDER and a time of up to 250. a slaty a;rainst the: violator. A copy of this stattesttent may be forwarded to the Office of Investigations of the DIA for irssurarsce .oAl erauc verification. f do lrrrehy eert#)'+ under tlre t` � iraltl�s ofar��r�rrr�F ttr,td ttr� Fnrfizrrrrtrt�arr JrruvXried above Is trite artd correcL q fp / �t�c%1 rrsc* errrfl. 1?a rrrrt rprrtcr ier ter rlr�rr; trr trr5' r�nrtrtctc�rf Fir} E:itjr tar tvl�rr r�,,�/1cr�tA_ 4'ity trr'i'+JEvrr: 1'ernrltfLicettse # lscrrin� Atrtlrority (circle crrrc): 1. I#nnrd of lieultlr 2. liuiltlirs� DeprrrtnreirC 3. {`it�'1'1'arsrt C'Icrk 4. Electrical Insl�ectesr° +. i'lnnrhn� IirstrCctctr fi. t}tlrer f_'Ofrtatt Perst]rr: Phone ##. �.--, WRIGBUI-01 KAY ACOROm � CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 2/28/2022 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 Phillips Insurance Agency, Inc. 97 Center Street Chicopee, MA 01013 INSURED Wright Builders, Inc. 48 Bates Street Northampton, MA 01060 rn\/FRA(�FS CFRTIFICATF NIIMRFIR Kayla Marie Drinl t): (413) 594=5984 kavla(fthillipsim ne rance.com EMC Insurance Com Massachusetts Emplc ies 592-8499 v 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 L A TYPE OF INSURANCE X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR ADDL p SUBR D POLICY NUMBER 6D18616 POLICY EFF DD 3/1/2022 POLICY EXP DD 3/1/2023 LIMITS EACH OCCURRENCE $ 1'0003000 DAMAGE TO RENTED PREMISES Ea occurrence 500,000 MED EXP An one person)10,000 PERSONAL B ADV INJURY $ 110003000 GENERAL AGGREGATE $ 210003000 GENT AGGREGATE LIMIT APPLIES PER: X POLICY❑X jE� �LOC OTHER: PRODUCTS-COMP/OPAGG $ 21000,000 EMPLOYEE BENEFI 1,000,000 A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS A�T OS ONLY AOT OS ONLY 6Z18616 3/1/2022 3/1/2023 COMBINED SINGLE LIMIT Ea accident 1/0005000 $ BODILY INJURY Per person)$ BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 6J18616 3/1/2022 3/1/2023 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X RETENTION $ 101000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY EXCLUDED? ECUTIVE (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A MCC-200-2000534-2021A 3/1/2022 3/1/2023 X STATUTE OERH E.L. EACH ACCIDENT 5002000 E.L. DISEASE - EA EMPLOYE $ 500,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) r`FRTIFIr:ATF FJlll r1FR 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 ;0 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD