23A-241 (7) BP-2024-0736
49 MANN TERR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23A-241-001 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-2024-0736 PERMISSION IS HEREBY GRANTED TO:
Project# BASEMENT RENO 2024 Contractor: License:
Est. Cost: 65000 RIVERBEND DESIGN LLC CSL105654
Const.Class: Exp.Date: 04/20/2026
Use Group: Owner: L DEFIER()JENNIFER
Lot Size(sq.ft.)
Zoning: URB Applicant: RIVERBEND DESIGN LLC
Applicant Address Phone: Insurance:
PO BOX 60370 413-923-1553 AWC4007036448
FLORENCE, MA 01062
ISSUED ON: 06/11/2024
TO PERFORM THE FOLLOWING WORK:
BASEMENT RENO -ADD BEDROOM, BATH, LAUNDRY AND COMMON SPACE
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/Chi
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: 7
2.
Fees Paid: S423.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
çE1VED
u . 7 2024 The Commonwealth of Massachusetts
4 7 iBoard of Building Regulations and Standards FOR
MUNICIPALITY
DHApermiT OF ONO1n1:-PFG
T1oNs Massachusetts State Building Code,780 CMR USE
i t Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
f'Ihi Section For Official Use Only
Building Permit Number: 6 P•• 7-- 7 30 Date Applied:
4-0 ii•-),a,..,
i '---z /.,-11-2.62.11
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 69 Mann Terrace 1.2 Assessors Map&Parcel Numbers, 4,,
1.1 a Is this an accepted streerr yes_A no �S/4 -4" T
_Map Number 23A _
Parcel Number 241
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District URB _ Proposed Use R-3 Lot Area(sq ft) 8276 _ Frontage(ft) 65
1.5 Building Setbacks(ft) tS1U!ix 6-f 1P e -C.,ua^`u�'F "
Front Yard Side Yards I Rear Yard
Required Provided Required Provided Required Provided
10 20 15 3 do F30
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Private❑ Zone: — OutsideChec f1_ood�e? Municipal On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Recq�d:
SG►.)NNFt vQ�i4R0 I1.o(LV - ( C710 Z
Name(Print) City,State,ZIP
* fAr4-0 0 T.ritgAe-t_ 4G-615-1812, le.0 Pi ka-Devecnoi)ziy.i...A.(AAN
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building► Owner-Occupied 0 Repairs(s) 0 , Alteration(s) Addition 0
Demolition 0 Accessory Bldg.0 Numbcr of Units Other ❑ Specify:
Brief Description of Proposed Work2: Coo gar 11)PL1L c Jr elf:i . .- \x to L )
`AD!tCif_. e 1 -' A, ty i- t 1- gevitfactAx. I Co nr� __t� 52 (4_ 8 (AIkutx y 1
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs. Official Use Only
(Labor and Materials)
1.Building $ 40100 0 1. Building Permit Fee:$ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ 7, 00 V 0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ i 0 f OD Z 2. Other Fees: $
4.Mechanical (HVAC) $ 9c,0i List:
5.Mechanical (Fire $ Total All Fees:$
Suppression)
Check No. Check Amoun : 313 Cash Amount:
6.Total Project Cost: $ 6 5 00 D ❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
•
5.1 Construction Supervisor License(CSL) I� —105(0 t `'i1/2D2o26
License Number Expiration date
Name of CSL Holder
1�1 n l0?-U`-D` '` �n List CSL Type(see below) U -
No.and Street y(--- Type Description
OC t n ' Ni / 1 U Unrestricted(Buildings up to 35,000 cu.ft)__.
1�tJ u` 1 V V b R Restricted l&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
. c wt @ (—we,-6e:v.v. hwnt5 SF Solid Fuel Burning Appliances
4{tS`CQ3_t553 I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 186 / Ds /
b S (;-►) (-LC— HIC Registration Number Expirati Date
-(IC C• .< y Name or HIC Registrant Name
I S( 1. c Q C k.t)Q 0 et?)( (7037o Jc.Mq rwecteoS-hc"eS
rLed Street Email address
a4)e AA d(o6L 41-`113-IZ.3
own,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.4 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 24 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 : rtc' lam!_ C-XAAPJ
to act on my behalf,in all mutt rs relative to work authorized by this building permit application.
_)ens, \ e IC— 0 O 6 1 6-7 12 oZet
Print Owner's'ame(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.
eptatAr.) 06/q1gA
Print Owner's or Authorized Agent's Name(Electronic Signature) Oat
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.massov/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
`may 4 jf
Massachusetts
s g, DZPaR T Or BUILDING INSPECTIONS
A, 212 (lain Street • Municipal Building (ii
.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: ipvp TeAt L4iL- 1021)0 124cycL
Location of Facility: 2 li 'i v 0..p di N tuv-�,
The debris will be transported by: R VA tir. / '''
Name of Hauler: --SAP/VC—
Signature of Applicant: Date: 6/-/ /c-)t
4%
'`.,,.„, The commonwealth of.1lassachuset►s
"�.,t,--„y Department of industrial Accidents
":" - '' 1 Congress Street,Suite 100
` �P Boston. MA 02114-2017
' wn:mass.Ro%/diu
%%token'('ompensation Insurance Affidasit:Builderv('ontractorsfEIectriciansQPlumber .
to BE 111.1 1)w I I II 1111. I'f.R1111 I I\(; 11 1110R111.
AnnGeaat Information Plea Print l.eeibls ��//,I ee''
Name ilfusincs.t>t ansvau,.n hulttidual>' �t�.A (Qcjk6.,J Lt,L "S �� , Ct ttAij
Addre.': \ k Q.AJ.1,ftc-AWA bQ._ 111
city State Zip: f 0&1 0A- O4 Z_- Phone :: "[,1. -----12 ' 1 C
krr.uu an.mpkt..r.'I tii.k ih. appr.priatr hot:
I. pr of project(required):
(earn a.rnpk s.- .,itn , enapioycca thin and oe part-woei.•117. Ness construction
I atn a.u::rr..inutor or pawn.nil.p and hase no etitpkryia,war.uw ICI:ne as K. Remodeling
any tap.ily.i to*.niter.•.whip.iitawaeiva ruxiiwed.i
9. Demolition
t❑I ant a h..no.only dump all...irk m.,clt.1!....w.,rk.t. ins lour urance nyun.xl I'
4.0 I am a homw rhea and will he hiring to eetnduei all work on my mown!, will
1() ]Building addition
..o
.mar.that all..+rumour cithet has.wurkes.'..mp,.usaiw.n trauianc.or aril soi. 1 I 0 Electrical repairs or additions
impact..n.o ith au crt>pfuyek.
12.0 Plumbing repairs or additions
,0 I am a it miss%..ntra.tot and 1 his.had the.uh-..mistier 1i.i.d on the attained.h..> 130 Roof telfdlr,
l k:a.sub.untr....tut.LA:.iaplu}.t.>iri:ha..w.aLi>'.uaip..a rasfu.
r.rA w.an:a t.•r `r.t>:a.r.arill ill otti.cr. u%c cta.n.d tat.a nE ht of I:t.rnpi..m pet\ttit..•
14.0Odict
{`..,11t4k and w.1.a..no..0 krr....t\.rwi.ra..wup.rnantatk.r.yuued.i
•.1ny apph.mt that eh vA.hit"I must al..i illi U4t Ilk'X'.tIUn i\IUw shim usy their...Aker,'.onnp.ns:MAon puh'4 utternauun
'Ikiin.uwrl.la w1W aubnul utii,a11kA.t it iadi.annit Ihi.y art dewy ail walk and auto but Wtud►.4nlia.tW a uinii.ubuul a new alli.a%ii aaliwung.Mli.
:(.nnractoro that.h..A tit.box mum arta.ts d an alJiuorwi.beet.how mg the natn..d die.uh-..mtraarx.and state w hcther or not t Ito...v t.ti.s haw
employe.. It tin.sub-contractor.ha...nq•luy eel.they ilium pro.id.thar *Laker.'wail.psh.y nunih.•r
I am an employer that is providing r►•urtie rs'compensation insurance for my employe". Below is the policy and job site
information.
Ire urance Compan%Name R k( ` KOv Pit.... 1 J✓ —
Policy u or Self-ins. Lie.»:I •-400` t036 l-!8— Iapiration Date: 65I6I / o2.5
Jots Site Adds ess:41_a 3 __ j tit'State'Zip. c L iLll MA' O lt62.--
.lttach a copy of the workers'compensation policy declaration page(showing the policy number and etpiration date).
Failure to secure cos erage as required under M1(,L c 152. .25A is a criminal siolation punishable by a tine up to S1.5(X).(Xi
aril or one-year imprisomnent..2a++ell as cis penalties in the form of a STOP WORK ORDER and a tine of up to 5250.00 a
day against the stolator. A copy of this statement may be forwarded to the Office of In%estigattons of the DiA for insurance
coseragc %criticaui.n
I du hereby certify tier the pains and penalties of perjury that the information provided above is true and correct.
SIL't>atut. ' Date 6/7/,--2f
phone u: 41 3 --R23 ,(553
IOfficial use only. Do not write in this urea,to be completed by city or town official
city or l ow n: Permit 1-icrnse t+
Issuing.%uthority Icircle noel:
I. Board of Health 2.Building Department 3.( 0.-1 owu Clerk 4.Iaectrical Inspector S.Plumbing lnspector
6.Other
Contact Person: Phone 4:
Aco O® CERTIFICATE OF LIABILITY INSURANCE DATE`MM°°"YYY)
05/21/2024
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 Isaac Eutsler
NAME:
Encharter-MA PHONE (800)675-6695 FAX (800)754-1602
(A/C,No,Ext): (A/C,No):
Encharter Insurance LLC E-MAIL leutsler@encharter.com
ADDRESS:
25 University Drive INSURER(S)AFFORDING COVERAGE NAIC
Amherst MA 01002 INSURER A: Main Street America Ins.Co. 29939
INSURED INSURER B: AIM Mutual Ins,Co-ARWC
Riverbend Design,LLC INSURER C: Traveler Cas/Surety Co of Amer 31194
151 RIVERSIDE DR INSURERD:
INSURER E:
FLORENCE MA 01062-2721 INSURER F:
COVERAGES CERTIFICATE NUMBER: exp 2025 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 ADDLSUBR POUCY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDDIYYYY) LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAGE $ 1'000,000
RED
CLAIMS-MADE XJ OCCUR PRM SESO(Eaa urrrence) S 500'000
MED EXP(Any one person) $ 10.000
A MPP8665G 04/24/2024 04/24/2025 PERSONAL&ADVINJURY f 1,000,000
GEM_AGGREGATE LIMIT APPLIES PER: _GENERAL AGGREGATE $ 2,000,000
POLICY JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000
Data Compromise'
OTHER: S
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO BODILY INJURY(Per porson) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
S
UMBRELLA LIAB OCCUR EACH OCCURRENCE S
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY STATUTE ER
Y/N 100,000
B ANY E CLUDEEXECUTIVE Y N/A AWC-400-7036448-2024 05/01/2024 05/01/2025 E.L.EACH ACCIDENT $
(Mandatory
OFFICER/MEMBERnNH) EXCLUDED? 100,000
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S
If yes,describe under 500,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
HERS Professional Liability Occurence 1,000,000
C 107599865 03/15/2024 03/15/2025
DESCRIPTION OF OPERATIONS I LOCATIONS I 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
fildIMMIMMIMINNINO ACCORDANCE WITH THE POLICY PROVISIONS.
/11111.111111.1111111116, AUTHORIZED REPRESENTATIVE
O 1988-2015ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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