10B-010 (3) BP-2024-1105
48 AUDUBON RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
10B-010-001 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-2024-1105 PERMISSION IS HEREBY GRANTED TO:
Project# BATH RENO 2024 Contractor: License:
Est. Cost: 49027 CHRISTOPHER JACOBS 60475
Const.Class: Exp.Date: 11/10/2024
Use Group: Owner: TRUSTEE ROGERS WILLIAM F
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: 08/29/2024
TO PERFORM THE FOLLOWING WORK:
BATH RENO ON 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 VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: /7Z
Fees Paid: $375.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
r_s
The Commonwealth of Massa, [ OR
. L` " i F
Board of Building Regulations a d SMassachusetts State Building C%de, Q ICIPALITY
>� USE
Building Permit Application To Construct, '..air9 vate Or I3er h a Re ised Mar 2011
One-or Two-Family Dw' '44.. 1 nt,
;1, Or
This Section For Official Use • 4 nroy fn, �
Building Pe it Number: ��c��-� l D�j Date Applied: 44 o, 00ys
i
�,,� .1/7 AP 6-z9 zozy
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
tig POSkks 02, - o%o - oo1
1.1 a Is this an accepted street?yes X no Map Number Parcel Number
1.3 Zoning Information: 1.4 Propert Dimensions:
‘(9-S- . S V. f-'TO %
Zoning District Propose se Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft) VV3 c\e- 0..Y-,a� .cp , .5>
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:
Publiclid Private❑ Zone: _ Outside Flood Zone? Municipal On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 O rler'of Re ord:
\mow. S 1xi4x-5 ,MPr
Name(Print) City.State,ZIP
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building0 Owner-Occupied ti? Repairs(s) 0 Alteration(s) sa Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: 122�MZ c& \ Q.k‘s � Seer- . cM,Cor" ‘0"-L, del.
'i AN-4k .trko c o trkwJ CJTS&- 3 fE[. , .
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I. Building $ 'AOPV03— 1. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2. Electrical $ �j,CM ❑Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ S, COO 2. Other Fees: $
4. Mechanical (HVAC) $ vZS List:
5. Mechanical (Fire $
Suppression) Total All Fees b
Check No.6(v}Check Amount: Cash Amount:
6.Total Project Cost: $ t p ----T 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) •
3� 5 () Q6 `t'� 1 do I
Cyr ,r\S• License Number Expiration Date
Name of CSL Holder List CSL Type(see below)
y-1/0 I . iV\a tr St .
No.and Street Type Description
M� _ Unrestricted(Buildings up to 35,000 cu.ft.)
��
1 O\ R Restricted I&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
�" SF Solid Fuel Burning Appliances
dA� 10 ce it t4&r bt'y V S I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) (ODT0c1 b I
? YY Y\ , j am HIC Registration Number Expiration Date
HIC Comm-1v Name or HIC Registrant Name •
RIZ N. fah St.-• 140 bGYYO✓\a a'.d'15 c�cw
No.and Street Email address
(VW. c �nS'S titb-..1 b—r \
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 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 TGYYOv.. 'f Jo jley
to act on my behalf,in all matters relative to work authorized by this building permit application.
Sat" 0 �, t�`e'' `'Print Owner's me(Electronic Sign ) 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 io ed Agent's Name(Electronic Signature) Date
NOTES:
I. 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"
SIGNATURES
By signing below,you agree to items A. B and C.
DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES.
A. Alternative Dispute Settlement(Arbitration Clause):The Seller and the Buyer hereby mutually agree. in advance,that in
the event of a dispute concerning this Agreement,the parties shall submit such dispute to a professional,state-approved
arbitration service(cost,if any,to be paid by the submitter)prior to either party proceeding to legal action in the courts.
B. By signing this agreement,you,as the owner of record,are hereby authorizing Barron&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. This Agreement covers and supersedes all
conversations,statements and agreements,expressed or implied,between the parties.their agents or representatives.
You,the Buyer,may cancel this transaction Buyer [gate
at any time prior to midnight of the third
business day after the date of this transaction. g-
See the attached notice of cancellation form Buyer Date
for an explanation of this right. c,��
Seller retains an equal right to cancel. ( l (� /
Ban-on&Jacobs Representative Date
Contact Information
Office Manager: Sandy Scavotto
Office:413-586-8998,x102
IX) Chris Jacobs,President
CT HIS#0554397
Cell phone:413-250-6677 Office phone ext: 100 Home phone:413-665-9113
0 lesha Gomillion,Senior Designer
Cell phone:413-923-7003 Office phone ext: 104
MA Construction Supervisor License 060475 MA Home Improvement Contractor 100809
CT Home Improvement Contractor 518617 •
sue.
Purchase Agreement
Page 24 of 24
The Commonwealth of Massachusetts
_�. Department of Industrial Accidents
Office of Investigations
_='s'_ Lafayette City Center
2 Avenue de Lafayette, Boston,MA 02111-1?Sll
,err""' www mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(BusinesyOrganization1indiviJua11: ?Vs.,/et teN Y 0\05
Address: L2A t• / S*
Ci t3- `S`'+`15
Are you an employer?Check the appropriate box:
q Type of project(required):
1.� I am a employer with 1 4• 0 I am a general contractor and I ❑
employees(full and/or part-time).* have hired the sub-contractors 6 New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ARemodeling
ship and have no employees These sub-contractors have g. 0 Demolition
working for me in any capacity. employees and have workers'
P Y 9. Building addition
[No workers'comp. insurance comp. insurance.
required.] 5. 0 We are a corporation and its 10. Electrical repairs or additions
3.❑ I am a homeowner doing all work otuicers have exercised their 1 I.p.Plumbing repairs or additions
myself. [NoP workers comp.
right of exemption per MGL
1_ ❑Roof repairs
insurance required.] c. 152.§t(4).and we have no
employees. [No workers' 13.0Other
comp. insurance required.]
'Any applicant that checks box'Si must also fill out the section below showing their workers'compensation policy information.
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: k. \• IA• {V\J kiet\ ySlKa+—w Lo .
Policy w or Self-ins. Lie.#: tnl tNA.%$Ob 00(02)(4 2O . . PC Expiration Date: 5 it 1?�
Job Site Address: Lk% A\ bOv— City'State/Zip: Lir2s46.. PAA 0
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 pa' ndpenalties of pedury that the information provided above is true and correct.
Signature: C% �./s v _ Date: O'
r21-1
Phone#: `kV2 C V tal°
Official use only. Do not write in this area,to he completed ht'city or town official.
City or Town: Permit/License #
Issuing Authority(check one):
lOBoard of Health 2U Building Department 3.DCity/Town Clerk 4.0 Electrical Inspector 5E'lumbing
Inspector 6.0Other
Contact Person: Phone#:
A� DATE(MM/DD/YVVV)
CERTIFICATE OF LIABILITY INSURANCE 34/,1/2C24
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
NAME:
Alera Group Inc PHONE (413)586-0111 FAX (413)586-6481
Mr.Exit: (Arc,No):
8 North King Street ADDRESS: adina edgett@aleragroup corn
INSURER(S)AFFORDING COVERAGE NAIC a
Northampton MA 01060 INSURER A. Main Street Amenca Assurance Company 29939
INSURED INSURER 8: MSA Insurance Company 11066
Barron&Jacobs Assoc Inc INSURER C: A I M Mutual Insurance Co
420 N Main Street INSURER 0
INSURER E:
Leeds MA 01053-9714 INSURER F:
COVERAGES CERTIFICATE NUMBER: Exp 03/25 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 ADDL-SUBR- POLICY EF POLICY EXP
LTR TYPE OF INSURANCE INS() WVD- POLICY NUMBER (MMIDDIYYYY) (MM/DD/YYYY) LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1.000.000
MAGE TO RENTED
CLAIMS-MADE XI OCCUR PREM PREMISES(Ea Irr.rrence_ S 500,000
MED EXP(Any one oersonl S 10.000
A MPT8049D 03/09/2024 03/09/2025 PERSONAL 6 ADV INJURY s 1 000 000
GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE s 3 000.000
POLICY PER° XI LOC PRODUCTS-COMP/OP AGG S 3.000.000
OTHER EPLI s 10,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
(Ea accident)
ANY AUTO BODILY INJURY(Per person) S 1.000.000
B — OWNED >( SCHEDULED M1T8049D 03/09/2024 03/09/2025 BODILY INJURY(Per acadern) S
AUTOS ONLY AUTOS
XHIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY X AUTOS ONLY IPer academ'
Medical payments S 5 OCO
UMBRELLA UAB OCCUR EACH OCCURRENCE S
B EXCESS LIAR CLAIMS-MADE CUT8049D 03/09/2024 03/09/2025 AGGREGATE s
DED X RETENTION S 10.000
WORKERS COMPENSATION PER OTH.
AND EMPLOYERS'UABIUTY STATUTE ER
v r N 500.000
L' OFFICER/MEMBER EXCLUDED')ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA WMZ80080063652024A 03/01/2024 03/01/2025 E L EACH ACCIDENT S(Mandatory In NH) E L DISEASE-EA EMPLOYEE S 500.000
If yes desCAbe under -- - 500.000
DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES IACORD 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:
("\ Lt-) ('-A-'\(,l,‘
Name Of Waste-Ir'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. Ills 150 A Signature of the permit applicant.
date and number of the building permit to be issued shall he 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
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AS-IS VIEW PROPOSAL VIEW
SCALE - 1/2" = 1' SCALE - 1/2" = 1'
SCALE: AS STATED DRAWING TYPE: CLIENT INFO: DRAWING PHASE:
SHEET: BATHROOM ROGERS RESIDENCE
1 REMODEL DATE: 01.25.23
DRAWN BY: J. IRWIN
70 OLD SOUTH STREET,NORTHAMPTON,MA 01060
ALL DRAWINGS.PUNS.& DESIGNS ARE PROPERTY OF BARRON&JACOBS.INC.
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SCALE: AS STATED DRAWING TYPE PROJECT CLIENT INFO: DRAWING PHASE:
SHEET: BATHROOM ROGERS RESIDENCE
2 REMODEL DATE: 01.25.23
DRAWN BY: J. IRWIN
70 O SOUTH STREET,NORThAMPTON,MA 01060 ow
ALL DRAWINGS.PLANS,& DESIGNS ARE PROPERTY OF BARRON&JACOBS,INC.