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32C-305 (6) BP-2023-0376 1 VALLEY ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32C-305-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0376 PERMISSION IS HEREBY GRANTED TO: Project# 2023 ROOF Contractor: License: Est. Cost: JUSTIN KASUNICK CS-110035 Const.Class: Exp.Date: 05/10/2024 Use Group: Owner: ROCHE GARCIA PABLO A& CARRIE Lot Size (sq.ft.) JUSTIN KASUNICK DBA COMPASS PAINT Zoning: URC Applicant: PROPERTY MANAGEMENT LLC Applicant Address Phone: Insurance: 10 BRAEBURN RD (413)522-4126 46 WEC AMOYUO SOUTH DEERFIELD, MA 01373-1103 ISSUED ON: 04/03/2023 TO PERFORM THE FOLLOWING WORK: REPLACE GARAGE ROOF 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 DrivewayFinal: 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 r 6 )19 Cgi 1 IP Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner A o The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR V9. Massachusetts State Building Code, 780 CMR MUNICIPALITY (V ! USE �uilding Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 .z One-or Two-Family Dwelling This Section For Official Use Only Buildjinn Permit Numbers -W23- 037 Date Applied: 4E-ui/J 7Z-53 .//' - 5o 3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers ►-3 IAl S , 1.�a �A ,AAA ol060 32C -3Q5-- co l 1.1a Is this an dccepted street?yes t' 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: Zone: Outside Flood 7,one? Public i Private❑ Check if yes Municipal 1Z'On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 1 Ownec.'of ecord: Name(Print) City,State,ZIP 6gi3r io - /094 Gary itM, 0L01 ,Q. ` KAA;1- (►ah� No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) d7/ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify: Brief Description of Proposed Wo 2 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 2 5 o z,A' 1. uilding Permit Fee: $ Indicate how fee is determined: 2.Electrical $ tandard City/Town Application Fee 0 Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ if Check No./U// Check Amount: Nv Cash Amount: 6.Total Project Cost: $ Z'7 U 3 a'Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 6S- 1100 3 S -1/O/ Zq .1�h'SI�M 1 t ; License Number Expiration Date Name of CSL Holder /' io A Vim\ ` .(\ 9 List CSL Type(see below) No.and Street �'11 rt' �U Type Description vA n I U 1�13 U Unrestricted(Buildings up to 35,000 cu.ft.) 1"v Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances Li1Z(' �- @ t^• Ll1M I Insulation Telephone Emailss D Demolition 5 Registered Home I provement Contractor(HIC) �+ti9kg�, �O/Zd c/ v�5� a I �w HIC Registration Number Expiration Date HIC Com �n N me or HIC Re strant Name 1D A P'JSvao4? w,) ( z1frL C van n55pOar eW. ' kljYV, No.and S e mail address 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 El/ No ❑ 'SECTION 7a: OWNER AU ATION TO BE COMPLETEl`1 WH N OWNER'S AGENT OR CONTRACTOR API'I,1 RMIT I,as Owner of the subject property,hereby authorize 3J\11)a ) - KA5u‘h' to act on my behalf,in all matters relative to work authorized by this building permit application. 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 istrue and accurate to the best of my kno 'ge and understanding. ro . !( 5uNvW, Z/VZ3 Print Owner's or Authorized Agen 'am- 1 o ' _'_ - -. 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.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" Sh\ The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street.Suite 100 • alr 4, TI..r .. Boston.MA 02114-201.7 '^: www.rnass.gov/dia ' urgers'Compensation Insurance Affidavit:Buibiters/("untractors&FkctriciawJPlumbrrs. 10 BE FILED WITH.17IE PI:RJIITI'IN(;Air!II )Rfll'. *nnlicuut Infurm:Alig s � (� � Please Print l.eeihly� Name Ilivaincss(keanlratton-Individual): VI)0j5 J v I l\ 1 Y�1-q. I Aey,„A Addn�:_ () 0 Y ne-',1"er) �� 1 City/State/Zip: S).ey-.(41 . f\ik 0 3 ri tic u: "11 ; S 2 2 _A 1t Avers elmw1p6yer"t•hark the appnhpriatc hot: 'l� pc of project(required): t.f 1 ant a employ with / cuq.lotces elulE and ea hart-tined 7. O Neu. construction u i am a rule proprietor or psurtnership and hate no employ ix.working tor me in 11. a RemodrlIn any capacity..[No workers'comp.insurance required-1 9. D Ikinolitio n ;.j I am a honk-ounce doing all work myself.[No uurka.'cutup_insurance requited.] 10 Building addition •LQ 1 am a honrtoutuer and will Ise kiting omit:roots to conduct all wank ion no puupetEy_ 1 will u9sure that all cuiiti actor,cider lurk a minkets'compensation Sid urancc a ate.axle l i.Q Electrical repairs or addition proprietors with no employees.. 12. Plumbing repairs or additions Is I am a ganaal coratr actor and I hat c hired the whcontsaelu9s fisted on the attached:du:et_ 13 Root repairs I hc.c:sub-contractor,Irate employee+and lute workers'comp.9murancc. ti.D tv I:are officers a collimation and Itcers hate csci c'i.cd dean right of cscnrption per\ it N _c_ 14.0 Other I!_'_L I1 dlr.and st c bate no employees.[Nia worker.'carp_msuranec rcquilcd.l 'Any applicant that chocks hot c:I inn:i also till out the section hclow shokt ing their%rwkat compensation pollee information. +domed»t 9w-rt a ho subunit this attwktt it tndieaimg fires arc doing all work and then hire outside contractor.mist submit a new at lidat it indicating much. :Contractor dint cheek Ihr.Ix•.must attached an addational>heet slx•u ing the name ed the sulk-contractors and state whether it not Nurse amities hate cr9rplo2cca_ It the sub-cotitraetot s hate...mipIutces.they must prat tdc then utrkcrs'comp.polity number_ 1 ant an employer that is providing nsurAers'compensation insurance for sty employees_ Below is the police•and job site information. iasutrutcc Company Name: Av dL /...4:\dj, h.- Policy#or Self-ins.Lie.#: Kb t ) ? /9'ioJ"16 Expiration i ate:1 /1/r/5 Job Site Address' 3 ('VL -f' City�ii'State Zip: /1d/14/1l(I /14/< r0/0 6 C Attach a copy filthy workrrs)kurnpeusaliun pullet declaration page(r honing the policy number and(itpirat n date). Failure to secure coverage as required under MGL c. 152.§25A is a criminal violation punishable by a line up to$1,500.00 andior one-year imprisonment,as well as civil penalties in the term of a STOP WORK ORDER and a tine of up to$250.00 a day against the t iolator.A copy of this statement may be forwarded to the Oilier;of Investigation of the DIA for insurance cot cram c verification. 1 do hereby certify antler re burins and pe tics of per-tr hat the inJarntation provid ed above ove is true and correct. • Signature: ``'--1 /wit / Date: zI Phtnle#: Or- 5-// `/716 U(JiciuI use only. Do not write in this area.it,be completed by city or lain ojliciaL I its or Tom,IL Permil7_icense 11' Issuing.tuthorilt (circle one): 1. Board of health 2. Building Department 3.('its?fussn Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Plume#: AC f aK/ CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDO/YYYY) 02/05/2023 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 SUBROGATIONIS 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 BIN INSURANCE HOLDINGS INC/PHS NAME: 46507827 PHONE (866)467-8730 FAX (AIG,No,Ext): (A/C,No): The Hartford Business Service Center 3600 Wiseman Blvd E-MAIL San Antonio,TX 78251 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Hartford Fire Insurance Company 19682 Justin Kasunick DBA Compass Point Construction INSURER B: 10 BRAEBURN RD INSURER C: S DEERFIELD MA 01373-1103 INSURER D: 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD IMM/DDIYYYYI (MM/DD/Y YYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) MED EXP(Any one person) PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE POLICY PRO- LOC PRODUCTS-COMP/OP AGG JECT OTHER. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) _J ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) •HIRED NON-OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) _ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- MADE AGGREGATE DED RETENTION$ WORKERS COMPENSATION x •PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY YIN E.L.EACH ACCIDENT $100,000 A PROPRIETOR/PARTNER/EXECUTIVE NI A 46 WEC AMOYUO 07/12/2022 07/12/2023 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $100,000 (Mandatory in NH) If yes.describe under E L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION For Informational Purposes SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 10 BRAEBURN RD BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED S DEERFIELD MA 01373-1103 IN ACCORDANCE WITH THE POLICY PROVISIONS. �AU(THORIZED REPRESENTATIVE UGL/J LLZOLF�u ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD City of Northampton Massachusetts ,� DEPARTMENT OF BUILDING INSPECTIONS tiif 212 Main Street • Municipal Building g 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. The debris will be disposed of in: s � il'd d /1/dv �� Location of Facility: 114(1)) �L/n, 3 I � � n� � `� vy/liPilk) &Aro The debris will be transported by: Name of Hauler: a W n55 9°1 ())1‘)'Hl IAA 6 M /-' Signature of Applicant: ��/Z7j Date: � 3 Z3 Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Re l lations and Standards Constctitliton Srvisor •t•ti :F CS-110035 iipires:05/1012024 JUSTIN T KP UNICK 10A BRAEBURN ROAD SOUTH DEER5IELD MA 01373 if3 rb• ›to v i). ./ • rR r