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24D-064 (10) BP-2023-0600 22 PERKINS AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24D-064-001 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-2023-0600 PERMISSION IS HEREBY GRANTED TO: Project# PORCH RENO 2023 Contractor: License: Est. Cost: 99481 CHRISTOPHER JACOBS 60475 Const.Class: Exp.Date: 11/10/2024 Use Group: Owner: MURPHY EDWARD J&AMY HENRY-WILFONG Lot Size (sq.ft.) Zoning: URB Applicant: BARRON &JACOBS Applicant Address Phone: Insurance: 420 NORTH MAIN ST 413-586-8998 WMZ80080063652022A LEEDS, MA 01053 ISSUED ON: 05/09/2023 TO PERFORM THE FOLLOWING WORK: RENO PORCH,NEW SIDING AND WINDOWS 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: 651\401--/ Fees Paid: $650.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner 1 , The Commonwealth of Massachusetts 4( Board of Building Regulations and Standards ' FOR tria 9 /MUNICIPALITY Massachusetts State Building Code, 780 c R cl0 USE Building Permit Application To Construct, Repair, Reno'vaC4O:,Demolish a Revised Mar 2011 One- or Two-Family Dwelling , 17-,, j This Section For Official Use Onlyo Building Permit Number: pn. a 3-ate Date Applied: , : AI S7) 9 �3 Building Official(Print Name) Signature 0 to SECTION 1:SITE INFORMATION 1.1 Properly Address: 1.2 Assessors Map&Parcel Numbers 2, F k-krNs Avc, Z"I U 6 V 1 l.la Is this an accepted street?yes k no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 4--S S \v, pxn (`e5 ,5V) " y,i LA Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) n.,0 L1t\c,tY,y-- 40 i 5,iiy� Front Yard Side Yards J 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 Zone? Public[7g Private 0 Check if yes Municipal I�On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: EANJavcl x ��� IQ k1.�,.,f'.10 s (%/C PC wok, k, Name(Print) 3 City,State,ZIP y-)-- Pe,r --.v.s ke.i. 1?5' }-1-1.1-11 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Owner-Occupied 1Y' Repairs(s) p Alteration(s) SI Addition 0 Demolition w Accessory Bldg. 0 Number of Units I Other 0 Specify: Brief Description of Proposed Work2: 0 i-.. 1,J.c11J c' iJNi( S.vr•^ tYlc.by_A 0 Qil.1^i oh" ,1'i r /AAA • • (w LDJa rc ,ele.Vie\\A SALc. k n.aar1.e, ILL . 1r s. NiQy Suds ♦ a rill- • I . 1 . �.. w. •, . _.. ‘ <xi art. } 0\ V'w. 'Plt Irr .0--ipsi vJOV 1 siS ."-Apc Wi ree4.1ti• Q-c_,Q „LA_ cry fast ec' ulr— eD(.6.-.-• SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ ov)-) g\ 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ �� 0 Standard City/Town Application Fee , 0 Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees: $ Suppression) 1� Check No.3`/J5l Check Amount: 06°Cash Amount: a 6. Total Project Cost: $ \� "\$\ 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C -\ S �]Ac.gib S License Number Expiration Date Name of CSL Holder U List CSL Type;(see below) \7,0 N "/\� No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) L-e-44 f1 0 ( J R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 1V0 vyrc.... �y4 �bS. c- I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) ItOtl y1 40 I bays/CNN- k"i-Gkc.a10S 1 SOc.�.-�tsj kYN-- HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name (%& Ste• ivsko bf Y ra►N o v 1:ov d0. ,-x - -Lv N and Street Email adMess 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 Y YOtr- 4-1 e,,.a\o.5 to act on my behalf,in all matters relative to work authorized by this building permit application. � -\vlAng.ii-• o - cto 15 Print Owner's Name(Electronic Signature) Date 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 is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) ate 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',edrooms 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" SIGNATURES By signing below,you agree to items A, B and C. DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPA ES. A. Alternative Dispute Settlement(Arbitration Clause): The Seller and the uyer hereby mutually agree,in advance,that in the event of a dispute concerning this Agreement,the parties shall submit su h dispute to a professional, state-approved arbitration service(cost,if any,to be paid by the submitter)prior to either pa proceeding to legal action in the courts. B. BAUM this agrellIMINIEW owner of record. are hereby authorignIMMIV Jacobs Associates Inc.to act' as your authorized agent in all matters pertaining to the building permit application C. This is a binding Agreement. You may not cancel it except as stated. r Agreement covers and supersedes all conversations,statements and agreements,expressed or implied,betwe •- part'-s,t age, s or representatives. A I I OAM1 3/70 P 0 2:7-, You,the Buyer,may cancel this transaction F IN cr ' / nat, at any time prior to midnight of the third 0 business day after the date of this transaction. �� 3/.)0 -o- —3 See the attached notice of cancellation form BuyerI)itf / for an explanation of this right. IF Seller retains an equal right to cancel. Barron&Jacobs Representative Die Contact Information Office Manager: Sandy Scavotto Office:413-586-8998,x102 © Chris Jacobs, President CT HIS#0554397 Cell phone:413-250-6677 Office phone ext: 100 Home phone:413-665-9113 O lesha Gomillion. Senior Designer Cell phone:413-923-7003 Office phone ext: 104 MA Construction Supervisor License 060475 MA Home Im•rovement Contractor 100809 CT Home Improvement Contractor 518617 Purchase Agreement Page 18 of 18 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): �)O '..' ,- Ck !S [��� � } Address: LAW City/State/Zip: L &S pAA( O\o`S') Phone #: ►-�1 -S$'C� X�'° Are you an employer?Check the appropriate box: Type of project(required): tip am a employer with \Q employees(full and/or part-time).* 7. ❑New construction 2.0I am a sole proprietor or partnership and have no employees working forme in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.0I am a homeowner doing all work myself[No workers'comp.insurance required.]' 9. 0 Demolition 10 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.: 13.❑Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A N My\e`\ Policy#or Self-ins.Lic.#: (o 3)(O6-'Z D Z-'Z pc Expiration Date: I k 12-0 2 Lj Job Site Address: 2,2-- ir-). \e•( .1e S City/State/Zip: O\oLO 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$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided ab ve is a and correct Signature: ( ,'" L'' l— \ Date: 5- Phone#: L 7 ' V1.1 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.CityfTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: / DATE(MM/DD/YYYY) A�ORD CERTIFICATE OF LIABILITY INSURANCE 03/03/2022 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 Adina Edgett,CISR NAME: Webber&Grinnell (A/CONE No,Ext): (413)586-0111 FAX No): (413)586-6481 8 North King Street E-MAIL aedgett@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# _ Northampton MA 01060 INSURER A: Main Street America/MSA 29939 INSURED INSURER B: NGM/MSA Barron&Jacobs Assoc.Inc. INSURERC: A.I.M.Mutual/A.I.M. 33758 420 N Main Street INSURER D: INSURER E: Leeds MA 01053 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 03/24 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 ,INSD WVD (MMIDD/YYYY) (MMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 A MPT8049D 03/09/2023 03/09/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY FRO JECT n LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: EPLI $ 10,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ _ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 1,000,000 B OWNED X SCHEDULED M 1 T8049D 03/09/2023 03/09/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) Medical payments $ 5,000 UMBRELLA LIAB OCCUR _EACH OCCURRENCE _$ _ B EXCESS LIAB CLAIMS-MADE CUT8049D 03/09/2023 03/09/2024 AGGREGATE $ DED X RET000 $ ippilizs COMPENSA STATUTE OTH- ER PLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.fCHACCIDENT $ 500,000 C OFFICER/MEMBERExCLuoED? N NIA lLVMZ80080063652022A 03/01/2023 03/01/2024 (Mandatory in NH) °$' E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/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 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit was issued with the condition that all debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L c. 111, s. 150A. The debris will be disposed of in: c1\\ -enCAA Name of Wasted acility Address of Waste Facility 111.5 Debris: As a condition of issuing a permit for the demolition, renovation, rehabilitation or other alteration of a building or structure, M.G.L. c.40 s. 54 requires that the debris resulting therefrom shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L.c. Ill s. 150 A.Signature of the permit applicant, date and number of the building permit to be issued shall be indicated on a form provided by the Building Department and attached to the office copy of the building permit retained by the Building Department. If the debris will not be disposed of as indicated, the holder of the permit shall notify the building official, in writing,as to the location where the debris will be disposed. 780 CMR—6th Edition Signature of Permit Applicant Date Commonwealth of Massachusetts It Division of Occupational Licensure Board of Building Regulations and Standards Const� f6fi1S rvisor .y CS-060475 fillak— [*aires: 1 i/10/2024 CHRISTOPHOR R) 4' r. 420 NORTH MAIN$ - LEEDS MA 0,534 , r? r4 O- Commissioner d pp c4 Vf K. v wri(.,%�j� THE COMMONWEALTH OF MAC," SETTS Office of Consumer Affair and Business Regulation 1000 Washington Street - Suite 710 Boston.Maasachusetts 02118 Horne Improvement Contractor Regr ation Type Qxporation Eiepi Cation imam BARRON&JACOM A.MOCIATES INC Expiration 06/22/2024 420 NORTH MAIN STREET LEEDS MA 01063 update Address and Return Card THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs r.Busine s Regulation Regrtraban vapid for individual use Dory before tite HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE..;Orpotalron Office of Consumer Affairs and Business Reguratrbn Registration Expiration 100D'Newington Siren -`.uile 710 10O5O9 0112Z2G:1 Boston.MA O_'r116 Biz R=.O'c S JAZ-..CE.AG:OCIATE.r..INC. CHR1LTO014ER dACIIB: 420 NORTH MAIN rTREET LEM:.MA 01053 Under,^,ecrelrr Not valid wit signature , w •i hi / r .\ i i imimit,...—...-- ..,..,``.),__,,,... t....T1'' f` ` 1 . i }.� /4 ,tom • / , H 4� . •, ''''',.'::-;':::j; it rITrrrI _ ',Ole- is ' tr� p '.;().,.,.. / 11111111 _ .„.rtii, ,, , „„ r-f-Tf- r_fr-_,,- i Li_,, -;. _ ��" / .IJIJiiIJ ; a'1 1 , E 1 '„....,.. - a- /... / ///, /,; _, .„..._ ,. 4..,,' 1, , ,„..... /.../i...../, , ./' , J ,, i Via,.,;,,,,,, ;, .., '� K� 1 �'k ' a; .11 . • 1 °aa r_sip; __116, - f _ �< • y1 �ti , a v—_mu�� 1 v7 4 j� . / . � 4L:i 'ems } r ° .; f;r \ _C C-1 S'\q---F-5YJI