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25C-101 (3) BP 2022-1078 37 GRANT AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25C-101-001 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-2022-1078 PERMISSIONIS HEREBY GRANT I TO: Project# 2022 EGRESS STAIRS Contractor: License: Est. Cost: 10400 ALISHA PHILLIPS 106378 Const.Class: Exp.Date:02/26/2024 Use Group: Owner: TUPPER WALTER, MICAH& LAURA LINDLEY Lot Size (sq.ft.) Zoning: URB Applicant: AXIOM LANDSCAPE & HOME IMPR o VEMENT LLC Applicant Address Phone: Insurance: 40 PINE VALLEY RD (413)320-9669 WCC-500-5020083 FLORENCE, MA 01062 ISSUED ON:09/01/2022 TO PERFORM THE FOLLOWING WORK: REBUILD REAR EGRESS STAIRS TO 2ND FLOOR 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 VIO ATION OF ANY OF ITS RULES AND REGULATIONS. Signature: f tiikao >2 - 3)0,TTi Fees Paid: $67.60 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner —O 'lr-1l ,o c� n o s ,;a C3gi The Commonwealth of Massachusetts ; - Board of Building Regulations and Standards FOR Massachusetts State BuildingCode, 780 CMR MUNICIPALITY 'J� `fir' USE Q Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: B(U 2.2_- /07 2 / Date Applied: Wa-ViI) ^0 5 ./// ' 9. 1-20zz Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 37 Ci•rAnlr /4 ✓a- . 26c. -10I- bOJ 1.1a Is this an accepted street?yes x no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: U iv .13?a-u-r-- 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: Publicy� Private❑ Zone: _ Outside Flood Zone? Municipal�f On site disposal system Cl/"l Check if yes SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: M 1CFI h W ALTER norehArnp+off 1'1i 01OCD() Name(Print) City,State,ZIP 37 esrA f)t 11V e, 4l3-S-is-s.:1931 M,cAH CALTe7e eg m4,i.e,,1 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 0 Addition Demolition 0 Accessory Bldg. 0 Number of Units 'Ather 0 Specify: Brief Description of Proposed Work :7P e4 o i Jot d f f x c k sag r e..53' SA.'rf 49 2.+1 FA.r LILA F IS (YiSti y, Lc A//l d.l,,,W' I /e / ) C w//yLce —S i rnx- foci+efini: SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1 V gi G G 1. Building Permit Fee: $(07 4-!1? Indicate how fee is determined: 2.Electrical $ i 1 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: Slake ks, Check Nclah $ Check Amount:0,' Cash Amount: 6.Total Project Cost: $ i 0,Li1,00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 3 CS / f)!� 3 78' y ( t S I, 1l 1 A l i 1 f S' License Number Expiration ate Name of CSL Holder 1 I 0 P,n� 1,�� 1Ey List CSL Type(see below) No.and Street ! �TType Description LO �� o f O�� C / Unrestricted(Buildings up to 35,000 cu.ft) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances egia - 340-9UP? OM00lI,414 and Ann e'Lk9 I Insulation Telephone Email address 9 ma,1/ ,C pfh D Demolition 5.2 Registered Home Improvement Contractor HIC) / 7'14/e (o a0�3 6I Seiiipe- 9� Flame ho r ro v e.rn n� 4 LC- HIC Registration Number pi anon Date C Comp( ame or plc Re strant Na c 40 Y;nED Vq 11ey � �A„IdM�AN Q� tio,n �c ,� ij r�o.and Street / Email address I—I-014LLC F MA olotik,z i113 -3da-9Gf1 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 ❑ 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 /P./sA I� Qf 4 i!/t �7-� to act my behalf,in a matters relative to work authorized by this bu' ding permit application./ S/a. a- Print Owner's me(Electronic Signature) ►kite 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 ap 1' • n is true and ate tot best of my knowledge and understanding. f/Zy/Zz Print Own or Authorized A nt'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 contrac,or (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.tnass.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 SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD 15 1 _ SIDE YARD lO otief ie SIDE YARD d FRONT SETBACK I FRONTAGE City of Northampton Massachusetts * I4 DEPARTMENT OF BUILDING INSPECTIONS1,40 S 212 Main Street • Municipal Building Northampton, MA 01060 'rPA' �t ' 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: V 0.f t C C_�i f � 7 The debris will be transported by: p Name of Hauler: 1,1m f-1 j r(A/e-mQfri C� Signature of Applican . Date: (/ Z Z Z The Commonwealth of Massachusetts e Department of Industrial Ac cidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 www.rnass.goi/din 11 otters'Compensation Insurance Affidavit:Builders/Contrattorsitlectriciansfriumbers. , 1 "10 RE El LED WITH'IRE PERMITTING Al1i-MR.11s. Applicant Information Please Print Legils t NameOlutaness'Orstinantion•ladtvidunly.4,0,„_...........b s-c_,Q1.The__ _t- /-Z.,2fIrnfpay_e_fai.n. - Address: 4/0 Pt/1 e., Vcriley ---4)c2.4/ „., City/State/Zip: r-L.PK_Efic ...E.... Mil 0106Z Phone P: 11/3- Art!inn an employer?Cheek the appropriate dol.: Type of project(required)! i '74 i..z i.inpk.0,,,witih () tiorioyo. (full lind'ey parttime:I.' 7. CI New construction 20 I alit dirge proprietor or partnership and ha-it.:MO etnploym:s Wutking tor roe in K. 0 Remodeling ally espociry.NO WOrikerS.'comp.insurance required] 9. Ei Demolition 1 ilil 3 hornsurriarr doing all work my:self.[No‘,..art,,ira:'comp ituurafte moaned]' 1 o D Building addition DI ain a horhoawner and wdl he hiring saintracturs to CS/Call:I nil work.on my primary. 1 twin ensure that all eararacuira either illalit:walkers'ear ipensanun Omura-tee or are sole I.i C Electrical repairs or additions proprietor&with riv implvynew I IL]Plumbing repairs or additions 5 I am a general curaracror and I have hired the mita-contractors limed LIn the it achod sheet. I 3.C]Roof repairs These sub-4:0317410.01:laas,e ernpluyirvs and}save winters'q.,0411r.insurance.:‘ I 4. 40ther ti.D‘S'n axe a iorporatiun and its officers have clereised their nghi of esanpoort per WI..c. 151*1(41.and we hi VC On iannliryeer..[Nis wOliittS‘L'Oelp,insurance required] *Any amticard thar chocks box r 1 anise aLsn fill nut the Set:(Kkri below showing Clem a orkers'compensation policy inforinatino. /Itoitieuwoces who ninon this atiutiv.,it imaheaung they are ilattig all wink and then hue outside eLin 'BUM subrint a new atTiaoir ightni.21701 fULit, k:Ontractori:that cheek 1/11:a hoe mutt it wiled in-;:xiditional shect..h,.awing the name of die sub.contriletors arid:stint whether Or not those tonne*have Litlillklycc. If are so h-conunetors hate employ ees.I itey tuna pro,id,-their workers'euirp policy.number. 1 am an employer that is providing worAers compensation insurant e for mi.employees. Below is the policy oral job Aite information. insurance Company Name:/ . LIM _TIALEL/61________ Policy#or Self-ins.Lie.ri,00--e— —57-15- 6C22 DO 3—A oaf 4 Expiration Date: Job Site Address: 3 7 0,PA (Ft A ve. iFL 0 to 6-0 Attach a copy of the workers'c-orripensation policy declaration page(showing the policy number and ipIrad n date). Failure to secure coverage as required under MGL c. 152, §25A.is a ernuinal violation punishable by a fine up to SI, 00.00 andfor one-year imprisonment,as well as CIS 1 t pentthies in the form of a STOP WORK ORDER and a fine of up to 50.00 a day against the violator.A copy of this statement may be forwarded to the Office of investigations of the DIA for in imtrice coverage verification, /do hereby certifi on r the pain' 1 ' . perjatry that the Infortnation provided above is trne d eorreet. Sizbature: ph,,u,r.-: /1 1,3_ 6-is'&- 5-c-?.?Cp Official use only. Do not write in this area,w he completed by-city at town offleittL City or Town: Permit/License N , Issuing Authority'(circle one): !, I.Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical inspector 5. Mouthing Inspector t ft.Other I f'contact Person: Phone#: , 1 AC RD CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYY) 4/21/2022 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 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 CONIACr Sarah Premo NAME: Clayton Insurance Agency, Inc. PHONE (413)536-0804 FAx 413)s34-1674 (A/C,No,Ezt): (Alc,No): 1649 Northampton Street aEliess: spremo@claytoninsurance.net INSURER(S) AFFORDING COVERAGE NAIC# Holyoke MA 01040 INSURER A:Safety Insurance Company INSURED INSURERS AIM Mutual Insurance Company Axiom Landscape And Home Improvement LLC INSURER C: 40 Pine Valley Road INSURER 0: INSURER E: Florence MA 01062 INSURERF: COVERAGES CERTIFICATE NUMBER:2022 MASTER 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 EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACII OCCURRENCE $ 1,000,000 DAMAGE TO RENTED i 100,000 A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ HMA0028548 1/11/2022 1/11/2023 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 n PE 6 n LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 5907002 1/11/2022 1/11/2023 BODILY INJURY(Per accident) $ AUTOS AUTOS NON OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accidenl) $ - UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE (� E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? I I N/A B (Mandatory in NH) RCC5005020083 4/17/2022 4/17/2023 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) JOB: CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF NORTHAMPTON THE EXPIRATION DATE THEREOF,NOTICE WILL BE DEUVEIED IN BUILDING DEPT. ACCORDANCE WITH THE POLICY PROVISIONS. 212 MAIN STREET, #100 NORTHAMPTON, MA 01060 AUTHORIZED REPRESENTATIVE Michael Regan/FMT f?'.Gur.r .('cam ti ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)