31C-081-008 UNIT#9 Gin)lr BP-2022-0850
117 OLANDER PHASE 1 COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
3 1 C-081-008 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-2022-0850 PERMISSION IS HEREBY GRANTED TO:
Project# BASEMENT RENO Contractor: License:
Est. Cost: 49872 LUX RENOVATIONS LLC 047809
Const.Class: Exp.Date:07/22/2023
Use Group: Owner: MELINDA DARER MITCHELL&
Lot Size (sq.ft.)
Zoning: Applicant: LUX RENOVATIONS LLC
Applicant Address Phone: Insurance:
60 SHAWMUT RD 781-821-0060 XWS57350449
CANTON, MA 02021
ISSUED ON:07/20/2022
TO PERFORM THE FOLLOWING WORK:
BASEMENT RENO
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.VV. 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 .>2
Fees Paid: $324.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
' ' -E-71/
---,...., .„..s.40 1 1
The Commonwealth of Massach setts
Board of Building Regulations and •.tan rds�Ut 1 9 F R
Massachusetts State Building Code 780 MR 2022 I ;PALITY
_ SE
Building Permit Application To Construct,Repai , i 0A ish a Revis d Mar 2011
_
One-or Two-Family Dwelling a�'ii,�Mnro,c NSpFCri
This Section For Official Use Only 0'00
0
Building Permit Number:60-,4.) ` IS—0 Date Applied: ___07A;LO i9( .-.
_
i .44‘
Building Official(Print Name) Signature �) Da e
SECTION l:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
//?- 04.INikt U-v64- 9
1.1 a Is this an accepted street?yes y 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:
Public12�Private❑ Zone: _ Outside Flood Zone? Municipal�On site disposal system 0
Check if yesl7
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
/►tiol',rwzf*n s, L 2z-tz I—i1 4v44d `; • o/06.,
Name(Print) City,State,ZIP
11q- 0 Lotiv,i12, 1' 9Z? gym 46 1 :?o /
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) B`' Addition ❑
Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify:
Bri ascription of Proposed Work': i2 'r 2z �-f2cx ni �ieS e , --( e
V'f so gvt t)(f /� 2c.clv'L�, K w' -1C� pZL .zr�sh 're,Ce r:5-[
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ tf/S I. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ yZ 0 Total Project Costa (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $ i
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:
t$t
� Check No.i� 1 Check Amour*VI
6.Total Project Cost: $ Y/. grZ 0 Paid in Full 0 Outstanding Balance Due:
c� T.�rr City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS '' i(Rse
212 Main Street • Municipal Building �' r°a'`
Northampton, MA 01060 30%1.
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS, ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR, ETC.
1. Building Permit Application signed by legal owner and filled out
by owner or authorized agent.
2. One set of plans and specifications of proposed work(Digital and hard copy).
3. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate (new /replacement windows).
7. Home owner's License Exemption Form (if applicable).
8. Note any Special Permit requirements (if applicable).
9. Energy Code —all new construction(Gut/Rehab) requires a HERS Rater Affidavit
10. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton.
o
I
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction SupervisorLicense(CSL) D!!
�'�'t7Z fI- /Xoti+*gr///�� License Number ( Expiration Dat 3
Name of CSL Holder !/
3 , k`tyl_ �% List CSL Type(see below)
No.and Street / Type Description
/71/l/lS Al �,-,,.Y U Unrestricted(Buildings up to 35,300 cu.ft.)
/ R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC . Roofing Covering
WS Window and Siding
aiI*1'
' SF Solid Fuel Burning Appliances
?fS104)," 4iliJe�C�1 ��` — I Insulation
Telephone Email address D Demol(ition
5.2 Registered Home Improvement Contractor(HIC) 139-I5'3 2. v.2_.
HIC Registration Number Expiration Date
HIS Comwy Name or HIC Registrant Name n
No.apµd Stre.t Email address
(litin, ./14 A Q2o?l 98 I 'a?‘" o 6(‹)
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 CI 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
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest er ins and penalties of perjury that all of the informatiori
Coon ' ed in this application is true and ac urat the st of my knowledge and understanding.
1i NOV/ ?/q A`Z
Print Owner's or Authorize gent's Name(Electrpnic Si attire) 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.govldps
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
•
Department of Industrial Accidents
1 Congress Street, Suite 1011
Boston,MA 02114-201 7
WWW.mass.gov/dia
Walkers' Compensation Insurance Affidavit BuildersiContracturs/Electricians/Plumbers.
HE I ILL')‘1 all'I HE PERMITTING AUTHOR'1 .
Applicant Information Please Print Lemibis
Name t BusinessiOrgainzatiom Indriidual Zpg R
Address: ‘a .c=c3-441--)ri-r v I
City/State/Zip: 6,4, 4,4 ,,„2, Phone#: 4e/ 67c7
Any..se employer Cheek the ajritli.ut
l'y pe or project(required):
ity(-un a employer with& mrpioyees fait andor pan-time * 7. 0 New construction
2.0 lam a sok propriesuror puthership and have no employees working for me in 8la.Rernodeling •
anyapait, [No workers'comp.neutron= respurni]
9. Demolition
3 lam a hurrnowner doing all work myself.[No workers'comp.insurance oxplinal.]'
I 10 CI Building addition
4.C3 lam a Itturintstmer and will be hirin unirJi.'tur oLxisiduct all work on my proverty. I will
C11.11.1re that all contractors tither have*mkt&comperrialion utAsraricr or'are 11.0 Electrical repairs or additions
proprietors with no elnpluyetN_
12.0 Plumbing repairs or additions
5 lam a uv.taiol contractor and I have hired thr sub-cutitruciors listed on the=ailed theet.
13.0 Roof repairs
These siih-e.:sitraelins 1171INV erripLoyem and have workers'comp.insurance.;
14. Other
6.0 vire art a corporation and its officers-have exercised their right of exemption per MGL c.
152,§1.011„and we hark no employees.[No waken'ecrup.insaranee required.]
'Any applicant that cheeks Iva a must also Idl out the setAion below show in g their workers'compensation policy information.
1'Homeowners who subuut this atfatuvit m41aea1 airy are doing all worst and then hme outside contra:haft must submit a new affidavit indiinting such.
:Contractors that check this box must attached an additional sheet showing the name at&sub-connactors and state whether or nut those entities hat,
employees. lithe iub-cordrufors have etnployees.they mum provide their workers txmip.policy number
ant an employer that is providing worAers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: C:1532/4, dlize/_..57-ore/ /
Policy#or Self-ins.Lic. #: NS S.4.345e4/4/ Expiration Date: S-11.i-/
Job Site Address: / -44f 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 MGL c. 152,§25A is a criminal violation punishable by a fine up to S1,500.00
anikor one-year cm rinment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S2.50.00 a
day against th tolator. A cop of this statement may be ti,r..k arded to the Office of Investigations of the DIA for insurance
coverage ye flexion.
I do hereby ' " rind e ins and penalties of perjury that the injOrmation provided above Lc true and coned
.00001°.'
- Date:- 147%
Phone#: (31 • : 0
Official use only, Do not write in this area,to be complaed hy city or twin officiaL
City or Town: Permit:License#
Issuing Authority(circle one):
I. Board of Health 2. Building Department 3.Cityrroun Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
r 212 Main Street • Municipal Building �ygpaSKAdOf
Northampton, MA 01060 �c�EY., ��^f.
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: �v• -►Ps�,'Z
Location of Facility: Seifie-19x1';-- P eft .
The debris will be transported by: t -r"s7' A-14
Name of Hauler:
Signature of Applicant: _ Date: -� `�/ /2Z
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS - x
212 Main Street • Municipal Building
Northampton, MA 01060syyti -)‘ti
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)
Darer,Mitch&Melinda
117 Olander Dr Unit 9
CONTRACT Customer Name Northampton,MA 01060 Customer Signature 60
OWENS SKETCH Contract Date 845-709-7061 -845-304-5616 Sales Representative Signature 9,1.4 .C
CORNING . Customer Phone Contract Price .$4'Z°
ATTACHMENT — yl17 y
1 2 3 4 5 6 7 8 9 10 11 12 13 14 IS 18 19 20 21 22 23 24 25 26 27 28 29 30 34 35 36 37 38 39 ....p...' 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
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29 w; -, gz •5'`'"35 16« P.c. 0.r. P 5 x �,Vfrt
j -� --. L1LHLL±I' H- - .' - I'
3B �6 �itAg.{,eSj r o f �� �.1 t r + L }— a s_ r t
4
yeliek
/g/ N 1
30 l 1 i i 1- 1- -- -
,
NOTES: Each box equals one foot unless otherwise noted.This sketch is a good faith
representation of the work to be done, it is understood that all dimensions
derived from this sketch are approximate,and that all locations of outlets,light
fixtures,plugs,jacks and/or switches are subject to change if necessary.
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Supplement Card
LUX RENOVATIONS,LLC. Registration: 137943
D/B/A OWENS CORNING BASEMENT FINISHING SYSTEMS OF NEW Expiration: 02/04/2023
ENGLAND
60 SHAWMUT RD
CANTON,MA 02021
Update Address and Return
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Supplement Card before the expiration date. If found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
137943 02/04/2023 1000 Washington Street -Suite 710
LUX RENOVATIONS,LLC. Boston,MA 02118
D/B/A OWENS CORNING BASEMENT FINISHING SYSTEMS OF
NEW ENGLAND
•
PETE MONAGHAN 4
60 SHAWMUT RD J� .4/e
CANTON,MA 02021 Not without signature
Undersecretary
rOwens Corning Basement Finishing Systems
CORNING
of New England
Darer, Mitch&Melinda
117 Olander Dr Unit 9
Contractor / Agent Authorization From Northampton,MA 01060
845-709-7061 -845-304-5616
I, /4;(CIeG I -8'Jf /I cill rer authorize Owens Corning Basement Finishing
Systems of Boston to sign the building permit application on my behalf,to perform the work at:
vt&ZIGLe1t • elccreir (0 ei,(e eon
mei [ v4a . 14,rer C Lai,
Home Owners Signature: LLf/ ,1_5-, 6 "-------
Date: ' -
ti�" I
Project Manager Signature: TWA
� /
Date: 2 iir-2
60 Shawmut Road • Canton, MA 02021 • Phone: 781-821-0060 • Fax: 781-821-8552 • www.ocboston.oatn
_,........44 LUXRENO-01 _ MBOI7YUL
ACORCP DATE(11MDO/YYYY)
�� CERTIFICATE OF LIABILITY INSURANCE 5/25/2022
'Hil 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.
IMPQI2TANT: If the certificate holder is an ADDITIONAL INSURED,the poticy(ies)must have ADDITIONAL INSURED provisions or be endorsed. .
If Ski ROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this I rtificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUC R i NAM PGT _
Gordon Atlantic Insurance PHONE FAX
306 Was
1pington Street WC.No.Ere;(781)659 2262 (uc No)_(7_81)659-4725
Ci
Norwell, A 02061 � A�,
�D ORESSc...— -
mSuNEN4)AfT0R0119 COVENAOE -_-- NAIC r
INSURERA:American Fire and Casualty 24066
INSURED INISURETDD;Green Mountain Insurance Company,Inc. 20680
i Lux Renovations,LLC Dba Owens Coming Of New England ;INSURER c:The Ohio Casualty Insurance Company 24074
60 Shawmut Road !efa D:Ohio Security Insurance Company 24082
Canton,MA 02021
jINSURER 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR IADDL SUER POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE LINSO I WVD. POLICY NUMBER ryM DD/YYTp ryM/DpryyYn UMRe
A X I COMMERCIAL GENERAL 11ABI[TY EACH OCCURRENCE RENTED_� �,�_ 1,000,000
CLAIMS-MADE X OCCUR IBKA57350449 9/512021 9/5/2022 DAMAGE T ,* : 100,000
MED EXP(My one cotton) ,$ -_. 16,000
PERSONAL a ADV INJURY $ 1,000,000
GEM_AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE __4.$ 2,000,000
j POLICY 1 X I,E& LOC PRODUCTS-COMP/QP S;4#-_._.. 2,000,000
I OTHER: _1
B
AUTOMOBILE UABLITY f COMBINED SINGLE LIMIT $ 1,000,000
ANY AUTO _ )20041276 4/4/2022 ! 4/4/2023 BODILY I JURY1Perperson.0;
OWNED (— .SCHEDULED
• AUTOS ONLY x AUTOS I 1 BODILY INJURY(Per acciden L$
X �IRED i 1 PROPERTY DAMAGE 1
I AUTOS ONLY X I AUTOS ONLY I ` (Per accident} --,-----_.
$
• C X I UMBRELLA LIAB 1 X'OCCUR I 1 LEACH OCCURRENCE _-!_) 1,000,000
EXCEssuAs i CLAIMS-MADE' 1US057350449 9/5/2021 9/5/2022 1��EGATE 1,000,000
I { I
DED X I RETENTIONS 10,000: 1$
0 !WORKERS COMPENSATION 4 X PERETUTE j 0TTH-
AND EMPLOYERS'LIABILITY
MANY PROPRETOR/PARTNER'FJ(ECUTIVE ER
YI /N 1 XWS57350449 5/24/2022 5/24/2023 El.EACH ACCIDENT I; 1,000,000
MFICER/MEIIMBER EXCLUDED? !.1 N/A
andatory n ) E.L.DISEASE-EA EMPLOYEEI 1,000,000
u yes descr 0e under I I 1,000,000
DESCRIPTION OF OPERATIONS belo# El DISEASE-POLICY LIMIT S
I I
i
i
.DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,AddItlonal Remarks Schedule,may be attached K mom space Is requited)
CFRTIFIre rG Melt own