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16C-009 (3) BP-2024-0384 296 SPRING ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 16C-009-001 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-2024-0384 PERMISSION IS HEREBY GRANTED TO: Project# windows 2024 Contractor: License: Est. Cost: 4000 JOEL ZIMMERMAN 074318 Const.Class: Exp.Date: 02/01/2025 Use Group: Owner: M ROSSETTI STEVEN J&LISA Lot Size (sq.ft.) Zoning: WSP Applicant: JOEL ZIMMERMAN CARPENTRY Applicant Address Phone: Insurance: 340 WEST STREET 413-695-7742 SOLE PROPRIETOR NORTH HATFIELD, MA 01066 ISSUED ON: 04/05/2024 TO PERFORM THE FOLLOWING WORK: REPLACEMENT WINDOW 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: f/E Fees Paid: $40.00 • 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner - /; 41117 �. The Commonwealth of Massachusetts''':``; �` Board of Building Regulations and Standards , ��� FOR/ '0.): �> �q CIP,A(IITY Massachusetts State Building Code,780 CMIt'- :`'q:.>,„r;`�t��m Building Permit Application To Construct,Repair,Renovate Or Demo'hs n, 4isedfriar 2011 One-or Two-Family Dwelling l' 0,- T on For Official Use Only Building Permit Number: a ' Date Applied: 1 )10 ass //�Z L-y ZZy Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 PropeEty Address: 1.2 Assessors Map&Parcel Numbers Jpr t C l.la Is this an accepted street?yes k 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: Public 0 Private❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 !Owner'of Rec d: $ . K05, t. DT' i F(0,--E-46e (4q. ©(o GZ Name(Print) City,State,ZIP 9-9(' Sp1iv1.9 S --e-eT Yr, A7 3( ( 5ro55r77 GZ( 4lAa,l .eci No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Di Owner-Occupied 111 Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.❑ Number of Units Other ID Specify: lM,r%Ague Brief Description of Proposed Work2: R., pia.c t A / p(d r',a,.i/C G N-,r G✓•/-e h csrt..90 z-?pl e 94 2.-e4 Q Ook-6(e fY � IM,n d,....,4'et Fart...- -il 5hyc •iy yr -Yq SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I.Building $ kQ a0, a 0 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All F Check No. &leck Amount: Cash Amount: 6.Total Project Cost: $ ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) T GS- 1,7V3let. - !- .2.0�5-- tJ d•e z ,/N✓1,P l,, am License Number Expiration Date Name of CSL Holder D l 0 0 tc List CSL Type(see below) (.4 34(0 li✓f57 S 7r•eYT 13-5— No.and Street Type Description UM (`T 4 4 7 /)4.I� 4 O e, r^ R Unrestricted 1 (Buildings up toel 35,000 cu ft.) b �1: I (�(1 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding � ,( SF Solid Fuel Burning Appliances G [/3 uQ5— 77472. Jh z,...i 7yd ©r,„te.57 I Insulation Telephone Email address n t T D Demolition 5.2 Registered Home Improvement Contractor(HIC) 12$ 92-Q ‘4- J 0 e-1- Z i M F'7-r/ en*" /7 e.,7 se _ HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 347"0 t v.ty7 5 Tre-e7 Sk7krt 3'o f�►yln r '''trr No.and Street F. il address Po r-rA (-fg7IS'. (( /na olog 6//) ('Q'r' 77y2 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 171 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 1 2 ,°,rye/►.1 gyp/re?P� to act on my behalf,in all matters relative to work authorized by this building permit application. 7cv- 1 095t 77 ; Ap,,1 1 ; 024( 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) 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" t The Commonwealth of Massachusetts w ! Department of Industrial Accidents "` 1 Congress Street,Suite 100 ' - ki si - Boston, IA 02114-2017 Y wwynass.gov/iliaat.-_. Jw %linkers' Compensation Insurance Arndar,it:Buikleri►ContractorsiElectrieians/Plumber.. I 0 tit.FILL°WITH THE PERMIITlti(;AUTHORITY. Xpltlicatit Information / Please Print Le_ibls Name IBusiness organisation Itulrstduali:.._ T0.�I Z r'/YI✓h-P/ 77 C el1'r ,4 ee 7e' I/( Address: 7 7o .77 _._5 7 ('ity. State Zip: lror7'k ilet7 /1-et Ctirlq- lAd'Phone#: 4/17 (9 F— 72y `2....__.. Sr..sou an emph.srr:'it dank tdr appropriate hot: Type ofproject(required): nI am a.mpkrytr with a __ ._ employees OW and or part-time).• 7. 0 New construction 2( 11 am a sole proprietor or pnrtnerskup said have no cmpliycxs working for me in K. Q Remodeling !`-'any capacity.(Nu workers'comp.insurance requital.) 9. Q Demolition 30 I am a twinsaswnei doing all work myself.)No workers'cone.nuuraace required.)' 4.0 I am a homeowner and will be lratng cuntracturs to conduct all work on my property_ I will I CI Building addition eo emure that all corm-actor,lather base workers'compensation amurance or are sole i 1. Electrical repairs or additions paapniturs with no employees. 12.0 Plumbing repairs or additions 50 I am a lac nisi contractor and I hose hard the sub-contractors listed on the attached suet- 13 Roof repairs These sub-ccmtradort have employees and Ivor workers'comp.rmurancc.• 14.00ther lI✓'1/It0'4""If6. We arc a commotion and its officers has a exercised then nght of-exemption per 1tU;l c. .114%r*.4'f 152.i it4).and we have no employees.(Vu wuhrr,'comp.in seine required] •Any applicant that checks box a 1 must also till out the section helms shaving their workers'compensation policy information. 'Homeowners who submit dos affidavit ensbcattng they are doing all work and then hue outside contractors must submit a new afficlas it indicating suwh. :Contractors that check tars box must attached an additional sheet showing the name of the sub-ccuutracturs and state is be her or not those manic,has e employee" If the sub-contractors have e.1raplosces.thin must plotidc their workers'.romp policy number I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and jot site information. Insurance Company Name: Policy a or Self-ins.Ltc. a: - Isom,:inn) Rec. Job Site Address: CttyrStatc Lip. Attach a copy of the workers'compensation policy declaration page(showing the policy Dumber and expiration date). Failure to secure coverage as required under MGL t:. 152,§25A is a criminal violation punishable by a tine up to SI.50 0.00 and.''or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a day against the violator.A copy of this statement trrry be forwarded to the Office of Investigations of the DIA for tnsur:a,iec coverage sentication. I do hereby certify ander the tins and penalties of perjure that the in frrntotion provided above is true and correct. Signature f12L0••"''y✓ 1 f,:; f+ f' / - Z0 2-c.r 9 Phone 4: �,/3 '7 -- 77,-/Z Official use only. Do not virile in this area.to he completed by city or town official I ( its or Town: Permit:license# Issuing authority (circle one): I. Board of health 2.Building Department 3.('ity/Tossn Clerk 4. Electrical Inspector 5. I'Iun.bint; Inspector 6.Other ( ontact Person: Phone#: City of Northampton aH,M o� •5 Si`' Massachusetts �k , ,1.r , Ii, 4 , DEPARTMENT OF BUILDING INSPECTIONS y 212 Main Street • Municipal Building ,) c, „ ' Northampton, MA 01060 '�J l,�<‘� 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: Xi t: 61�j74 c,'17c., Q d: Location of Facility: V ci I(-Py r-eC>e%".r 141,f7I1, )Y„4 frttf 0to(0 The debris will be transported by: Name of Hauler: CJ 0-et G' `'n'41-ffn'l�'' Signature of Applicant: / 1-I. Date: 4i_j____L__ 7 0 2 y JOELZIM-01 LZAPKA ACORO CERTIFICATE OF LIABILITY INSURANCE DATE 4/3/20/YYYY) 13/2024 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 Whalen Insurance Agency CNo,�:(413)586-1000 AX,No 413 585-0401 71 King Street (��p�L (- )`( ) Northampton,MA 01060 ADDRESS:info@Whalenlnsurance.com - - NSURER(s)AFFORDING COVERAGE NAIC S POURER A:Utica First Insurance Company _ 15326 INSURED POURER B: Joel Zimmerman DBA Joel Zimmerman Carpentry INSURER C: PO Box 225 POURER D: North Hatfield,MA 01066 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 ADOL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE NSD m.D POLK:Y NUMBER DORDD/YYYY) IIMYDDIYYYYI UNITS A X COMMERCUU.GENERAL LNBuITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X occult ART-3000449320 8/13/2023 8/13/2024 FRREMAI3E3 ENTED oca, nce) 50,000 MED EW(My one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GERI.AGGREGATE Limn'APPLIES PER: GENERAL.AGGREGATE $ 2,000,000 X 1 POLICY Ta LOC PRODUCTS-COMP/OP AGG $ 2,000,000 IOTHER: $ AUTOMOBILE LIABILITYacc COLIMPIED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ NON-OWNED PRpp�y(�MWJ AUTOS ONLY ,_AUTOS ONLY (rr+a+Md) S $ A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAR CLAIMS-MADE ULC1455168 1/31/2024 1/31/2025AGGRE GATE $ DED RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'UABILITY YIN STARE ER ANY PROPRIETORIPARTNER/EXECUTNE EL EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) El DISEASE-EA 9e4pLOYEE $ If yes,describe under 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 issued as evidence of insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ty P ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main Street Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. r Commonwealth of Massachusetts U Division of Occupational Licensure Board of Building Regutat ons and Standards C ails � 05-074318 'i ires:02►001/2025 JOEL D ZIMf RMAN PO BOX 225 f. ritill NORTH HATY? LD MA 01056 :r yFJf.Lk d;S 3' ^..,,,,,..1....:.,— -4_ i .1' j.f!_ i-.. ,...., u.aw.n.t:i Jaap... It. v.sr:.�.�.. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Individual Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 128929 06/08/2025 Boston,MA 02118 JOEL ZIMMERMAN D/B/A JOEL ZIMMERMAN CARPENTRY // C JOEL D.ZIMMERMAN % // fitilf,',- r= - ?,�''' 340 WEST ST ,(.-"40(a-/ A' NORH HAYFIELD,MA 01066 Undersecretary Not valid without signature