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17A-144
BP-2022-0741 212 CHESTNUT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17A-144-001 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-2022-0741 PERMISSION IS HEREBY GRANTED TO: Project# Contractor: License: Est. Cost: WRIGHT BUILDERS 065521 Const.Class: Exp.Date:01/25/2024 Use Group: Owner: BROADBENT, JACKSON M. &MOORE, AMELIA S. Lot Size (sq.ft.) Zoning: URA Applicant: WRIGHT BUILDERS Applicant Address Phone: Insurance: 48 Bates St 413586-8287 MCC20020005342021A NORTHAMPTON, MA 01060 ISSUED ON:06/24/2022 TO PERFORM THE FOLLOWING WORK: INTERIOR RENOVATIONS TO KITCHEN AND BATHROOMS 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 • JI 1 r _52 cs- i I � Fees Paid: $1,392.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner ✓ 11Lrrk P t vt-S AC__ I/ f)(17 ? 1 The Commonwealth of Massachu etts .Li' Yt ' ' Board of Building Regulations and S an JUN j FO Massachusetts State Building Code, 80��p �0� U ALITY T Building Permit Application To Construct,Repair, e44 ' a R ised ar 2011 One-or Two-Family Dwelling gMpTON NjsP c7.• pA This Section For Official Use Only a o��,o s Building ermit Number: 60—a`�—" ?�/ D to Ap lied: J El!1 Jl� `KOSS G-23-aoz-z Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 212 Chestnut Street Florence, MA 01062 17A 144 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: URA Single Family 22,025 100' 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 20' 55' 15' 24.5' 20' 75'+ 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public l Private 0 Zone: _ Outside Flood Zone? Municipal El On site disposal system ❑ Check if yes® SECTION 2: PROPERTY OWNERSHIP' 2.1 Ownerl of Record: Jack Broadbent&Amelia Moore Florence, MA 01062 Name(Print) City,State,ZIP jacksonmbroadbent@gmail.com 212 Chestnut Street (978)793-3299 amelia1121@gmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building® Owner-Occupied 0 Repairs(s) ® Alteration(s) I8 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2:Jnterior renovations, and exterior painting. Kitchen remodel and bathroom updates. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 152,973 1. Building Permit Fee:$ Indicate how fee is determined: 0 Standard City/Town Application Fee 2.Electrical $ 17,016 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 14,500 2. Other Fees: $ 4.Mechanical (HVAC) $ 29,750 List: 5.Mechanical (Fire $ 0 Total All F es Suppression) , �. Check No�,Q tick Amours#� �I ash Amount: 6.Total Project Cost: $ 214,239 0 Paid in Full 0 Outstanding Balance Due: 4,239/ 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 Name of CSL Holder 97 Federal Street PO Box 503 List CSL Type(see below) lJ No.and Street Type Description Belchertown, MA 01007 U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances (413)586-8287 sbarrett@wright-builders.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 101536 6/25/2024 Wright Builders, Inc. HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 48 Bates Street nwright@wright-builders.com No.and Street Email address Northampton, MA 01060 (413)923-2870 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 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:OWNER1 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) Cate 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.) 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 2 Number of half/baths 0 Type of heating system Oil Number of decks/porches 2 Type of cooling system Forced Air Enclosed Open 2 3. "Total Project Square Footage"may be substituted for"Total Project Cost" CITY OF NORTHAMPTON SETBACK PLAN MAP: 17A LOT: 144 LOT SIZE: 22,025 REAR LOT DIMENSION: 95.6 LF REAR YARD SIDE YARD No changes to existing footprint. SIDE YARD FRONT SETBACK FRONTAGE 100' City of Northampton MassachusettsSid * DEPARTMENT OF BUILDING INSPECTIONS �`• 212 Main Street • Municipal Building yvti., I' CD, Northampton, MA 01060 J j -a 0'°� 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: Casella Waste Systems or Western Recycling 686 Main Street 205 Old Boston Post Rd Holyoke, MA 01040 Wilbraham, MA 01095 The debris will be transported by: Name of Hauler: Associated Building Wreckers or J&J Trucking 6Vj II Signature of Applicant: !' Date: 6/15/2022 The Commonwealth of Massachusetts > !l. Department of Industrial Accidents 1 Congress Street,Suite 100 • #; Boston, MA 02114-2017 wi14kmass.got/dia 11 tinkers'('urnprnsation insurance Affidas it:Buildcrsi(bntractorsiElectriciansiPlumbers. TO Rt FILEI)W fail TILE_rERMMI F l IMt:AUTHORITY. �t Applicant information Please Print Legibly Name 4Busin ss,thrani7ation'InJ1\7 1): Wright Builders, Inc. Address: 48 Bates Street City/State/Zip: Northampton, MA 01060 Phone#: (413)-923-2870 Age you m employ,re?('hark the appruprulr box: Type of project(required): I.®I aiil a cltq Lik er av wh 22 en g U vices 1'(a and or pare-titucl• 7. New construction 2f:I I am a sole pnrpriclu m Rshur and Ina'vc nu clriplutices nutting fur me in $_ Lx!Remodeling rt}capacity.[Nu uurLcrs'cannp.insurance required" 3�I am a luntuu t im is ncr doing all mutscl .(Nu tors'conga.insurance ngwrnJ " 9. El Demolition 10 0 Building addition I.o tam a(unwotncr and nil!he hiring cvmntrac`Iuraio ca'nduct all acrt on run property_ I will cnsun that all contractors cinlucr hat c vcoit.ers-compensation insurance cM arc sole 11. Electrical repairs or additions proprietors v.1[11 no employee 12_0 Plumbing repairs or additions 30 I am a general cuntraciur and I hr..:hired[the sth-contractors listed on the attached sheet. 13❑Roof repairs Ihex sub-contractors!vac plu,. -s aunt hcus.c nutters'camp.utsunmcc.' 14_Q Other F. �1 c arc a cutpuration and its uftiecrs has c exercised then right ut exemption per SAIL c- 1'3,2_.i 1(4)-and m c hair is,emplinees.I Non utters'ecsnp.insurance required.] 'Amp applicant that chcsks box+TI:rani alx,till)out the mxiiatar l+elus slum ins°their uurtcrs'con it aatiun putay information.. t Ilssntcomutrrs uhu submit this,aftidav it imliicatunc tine'arc ditintr all mutt and dimhire outside contractors must submit a new,atdidav in in licatitneuh. tstuck ' untracturs that check this hot.must attachsc,d an additional sheen shins the name of the sub-cururactors aal.stale*hi:thcr or not hone altrtlic ira4e employees_ Winn:sub-con trarncws haw curb"ccs.t3tcy tvusn prus uric uurters`comp_puke}number. I am an employer that is providing worAers"compensation insurance for my employees. Below is the police'and job site information. insurance Company Name: A.I.M Mutual Ins. Co. Policy#or Self-ins.Lic.#: MCC-200-2000534-2021A Expiration Date: 3/1/2023 Job Site Address: 212 Chestnut Street City?StaterZip: Florence, MA 01062 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MCA_C. 152,§25A is a criminal violation punishable h} .1 line up to SI.500.00 and+or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and line of up to S250.00 a day against the violator.A copy of this statement nnay be forwarded to the Office of Investigation!,of the DIA for insurance eo erage verification. i do hereby certify under the i allies ofperjury that the information provided above is true and correct- Sit nature: / Date: �(///ZO/ZZ Phunc (413) 586-828 Official use only- Do not write in this area,to be completed by city or town official (its or Tossn: l'ermitil ieense# Issuing Authorit (circle one): I. Board of health 2.Building Department 3.('ity'Tussn Clerk 4.Electrical Inspector 5. Plumbing luspeclur 6.Other ( outset Person: Phone#: WRIGBUI-01 KAYLA ,d►coRo 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 CONTACT Kayla Marie Drinkwine Phillips Insurance Agency,Inc. PHONE 413 594-5984 FAX 413 592-8499 97 Center Street (A/c,No,Ext): ( ) I(ac,No):( ) Chicopee,MA 01013 nDORIESs:kayla@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:EMC Insurance Companies 21415 INSURED INSURER e:Massachusetts Employers Insurance Company Wright Builders,Inc. INSURER C: 48 Bates Street INSURER D: Northampton,MA 01060 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 INSR WVD (MM/DD/YYYYI (P1M/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 6D18616 3/1/2022 3/1/2023 DAMAGES(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 X POLICY X PRO- LOC 2,000,000 JECT PRODUCTS-COMP/OPAGG $ OTHER: EMPLOYEE BENEFI $ 1,000,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) X ANY AUTO 6Z18616 3/1/2022 3/1/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS��N BODILY INJURY(Per accident) $ AUTOS ONLY AUTO ONLY (Peer PROPERTY DAMAGE A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE 6J18616 3/1/2022 3/1/2023 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N MCC-200-2000534-2021A 3/1/2022 3/1/2023 STATUTE ER 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 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 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD