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30A-042 (2) BP-2024-1150 13 LEXINGTON AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 30A-042-001 CITY OF NORTHAMPTON Permit: Addition PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2024-1150 PERMISSION IS HEREBY GRANTED TO: Project# 2 STORY ADDITION 2024 Contractor: License: Est.Cost: 320000 Alexander Lane 117411 Const.Class: Exp.Date: 05/04/2026 PARKER, JEFFERY MOYCE ELIZABETH MARY Use Group: Owner: GRAY Lot Size (sq.ft.) Zoning: URB Applicant: ALEXANDER LANE Applicant Address Eh= Insurance: 57 Prospect Ave. 9174704122 NORTHAMPTON, MA 01060 ISSUED ON: 09/23/2024 TO PERFORM THE FOLLOWING WORK: CONSTRUCT 2 STORY ADDITION POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector l;nderground: Service: Meter: Footings: Rough: Rough: House# Foundation: I final: Final: Final: Rough Frame: 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: Fees Paid: S2,400.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner rREcE1VLu , :..-IT -q-d t SEP — 5 2024 t )FPT,,OszF nun DING INSPECTIONS Tl a Commonwealth of Massachusetts FOR i �A',tr?ON.MA01060 lard of I3uildlttg Regulations and Standards MUNICIPALITY • Massachusetts State Building Code, 780 CMR USE Building Permit Application To Construct.Repair.Renovate Or Demolish a Revised Mar 2011 (hm'-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 401C-"Ai— //g-T) Date Applied: dvt1._5 , 17'17 __ 9. Z3-zQzy Building Official(Print Name) Signature bate SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assess(Lrs Map& Parcel Numbers 1 3 L€Attli i2N fie. — 30 A �.__�_. Li �..�_._ 1.la Is this an accepted street? no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: A4 �IE ;J1-r.c, It t156 �20.0-7 Pr oposed District Use Lot Area(sq fl) Frontage(11) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 10 IC 1 5- I S a,0 3r, 1.6 Water Supply:(M.G.L c.40.154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: — Outside Flood Zone? Public Er Private 0 Municipal B(-n site disposal system 0 Check iryes° SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: .J'e1•42 11•1 T -Lr1.0c-F PAt:r�ca.f TAASX kc `t 14CAA o►OS)- Name(Prim) f City.State.ZIP' o. 1.6.11>��a�u. b.v31 -_!�1 cttg;, t4►r a g•.�,►;t. and Street Telephone 3 Email Ado . SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building l Owner-Occupied 0'1 Repairs(s) 0 Alteration(s)El Addition B—J Demolition Pr Accessory Bldg.0 Number of Units I Other 0 Specify: Brief Description of Proposed Work=. =. -_ . .___ „!.:, C sit.44t..,1 _ • • �- ..St • • .. i e . - 'x . '�tirilki'At .._ - . .. !. . errs .L�IC1�PL ' . p,r' k. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 130 u 0O0 1. Building Permit Fee:S Indicate how fee is detepnined: 0 Standard City/Town Application Fee 2.Electrical $ `'S t 0 00 0 Total Project Costa(Item 6)x multiplier______x__________ 3. Plumbing $ a a )0 Oo 2. Other Fees: $___ 4. Mechanical (HVAC) $ v 0 t0 O0 List: 5. Mechanical (Fire l Suppression) $ — Total All F $ � D Check No. bUAheck AnloLin j_` -Cash Amount: 6.Total Project Cost: S 3101000 0 Paid in Full 0 Outstanding Balance Due: 1 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor'License(CSL) l kcn5e Nu ber . ivt�n Dale Name of CSI_I older ((�� �n 4-DA.Ser f/CE list('SI.Type Ore below) U ._- No.and Street _---------_._.---.__.._ Typo Ocurigion (.1 to 35,000 cu.II.) 4A-'MRel•lptJ A OY0Q0_ It Restricted lea Family Dwellinyt City/Town.State.ZIP ! M Masonry RC 'Roofing Covering WS Window and Siding /� t�t.ta SF Solid Fuel Burning Appliances t�A �)F At td4�G`�r�ov12 I Insulation clephone E +I address creel I) Demolition 5.2 Registered Home Improvement Contractor(HIC) ,����� t' -�� I lle Registration Number Ex iratan Date I lIC Cc y Name or I C Registrant Name Nand Street I n+..+I address t� Ci 1-own,State,ZIP T Tele hone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) Workers Compensation Insuramm 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 ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIESnn FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Pkoaw Yer t_ - to act on my behalf,in all matters relative to work authorized by this building permit application. 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) Dyne 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 Homt4lmprovement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. I42A.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.govidps 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.) a+0 ' Habitable room count Number of fireplaces --_ Number of bedrooms Number of bathrooms .� Number of halt7baths Type of heating system '[•fi .; i' eyw:,e t+^f s Number of d ks!porches Type of cooling system/;�:. Enclosed Open 3, "Total Project Square Footage"may be substituted for"Total Project Cost" SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 45 a icense111411 umber Ex iration Date Name of CS Holder U S� f 2 MO(' List CSL Type(see below) • No.and Street T U Description �llAit� n Ac- O Unrestricted(Buildings up to 35,000 cu.ft.) ll'own,State,ZIP Restricted l&2 Family Dwelling Cit y ) M Masonry RC Roofing Covering WS Window and Siding (1 SF Solid Fuel Burning Appliances (� `1'?oL( ''+- a� �Ay�1'�S���V� �o•rs�3�+t °�^• 1 Insulation Telephone Emairaddress e— D Demolition 5.2 Registered Home Improvement Contractor(HIC) tL 'ides...1)Eft 4'417 HIC Registration Number Expi ion Date HIC Company Name or HIC Registrant Name `l n(� a\elCaky. Sa 1s..4 No.and Street ` Emil address �a rbvJl TA 0lc)(#0 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 .Er 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 ' 15U A- CD^5 . Il�.�.3( 6J=-2 to act on my behalf,in all matters relative to work authorized this building permit applica on. .* 7 Pi . Da ci iv /20)<c Print Owner' Name(Electronic Signal(' Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest u er tl e pains and penalties of perjury that all of the information contained in this application is true d a to the best of my knowledge and understanding. 4t1ifr,, Print Owner's or Authorized 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. I 42A.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" r ,-----.N ® CERTIFICATE OF LIABILITY INSURANCE [DATE(MM/DD/YYYY1 09/11/2024 T .ERTIFICATE 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, ItIMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. IIf SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on his certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: FINCK&PERRAS INS AGCY PHONE FAX 6 CAMPUS LANE (NC,No,Ext): (A/C,No): E-MAIL EASTHAMPTON,MA 01027 ADDRESS: 2RNJK r INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: A/ 1 AMI RI(AN INSURANCE COMPANY SAGEBUILT CONSTRUCTION LLC INSURER B: INSURER C: INSURER D: 57 PROSPECT AVE INSURER E: NORTHAMPTON. MA 01060 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 5DDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD\YYYY) (MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ -- CLAIMS MADE El OCCUR. DAMAGE TO RENTED $ - PREMISES(Ea occurrence) MED EXP(Any one person) $ _ GEN'L AGGREGATE LIMIT APPLIES PER. PERSONAL&ADV INJURY $ GENERAL $ . AGGREGAT❑PROJECT ELOC E POLICY PRODUCTS-COMP/OP AGG $ $ AUTOMOBILE LIABILITY COMBINED SINGLE $ LIMIT(Ea accident) - ANY AUTO ' ■ OWNED SCHEDULE AU)OS BODILY INJURY $ AUTOS ONLY (Per person) I '— NON-OWNED BODILY INJURY $ HIRED AUTOS ONLY — (Per accident) AUTOS ONLY PROPERTY DAMAGE $ (Per accident) - EXCESS LIAR UMBRELLA LIAB H OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ . DED uRETENTION $ $ WORKER'S COMPENSATION AND PER OTHER EMPLOYER'S LIABILITY STATUTE UB-1W142803-24 09/05/2024 09/05/2025 ANY PROPERITOR/PARTNERJEXECUTIVE Y/N E L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED/ (Mandatory in NH) n N/A E.L.DISEASE-EA EMPLOYEE S 100,000 H yes,descr,be under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT IS 500,000 I DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) I I IIS RI PLACES ANY PRIOR C'ER'ITIICA I I:ISSUED TO'HIE C'I'.RTIPICA'I'E HOLDER AFFECTING WORKERS CI IMP('OVI[RAGIE. CERTIFICATE HOLDER CANCELLATION CITY OF NORTHAMPTON Y. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL B DELIV D ATTN: BUILDING INSPECTOR IN ACCORDANCE WITH THE POLICY PROV 212 MAIN ST,SUITE 100 AUTHORIZED REPRESENTATIVE NORTHAMPTON,MA 01060 )Or( OR r� i TIONA'All tw,n ACORD 25(2016/03)(Rev.09-18) The ACORD name and logo are registered marks of ACORD 1988-2015 ACOR C Pk sA g���s�reserved. CITY OF NORTHAMPTON SETBACK PLAN 5c.c.skSa 0.16-a MAP: 30 A- LOT: ) 9-4t. LOT SIZE:_AV,VSt?s'• 6 REAR LOT DIMENSION: �,G 1 REAR YARD 1".8 k°, Y oo� SIDE YARD ,� sb Qt SIDE YARD S IS � t � it k I' I t � FRONT SETBACK 4O FRONTAGE 10 . • .;;,. City of Northampton Massachusetts L:, �<< ,1/4 111111111rt �y DEPARTMENT OF BUILDING INSPECTIONS '. Ili 212 Main Street • Municipal Building �O , : )::\' Northampton, Ma 01060 +4. , :,,.__; : 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: • Location of Facility: Atl A WO•At arR The debris will be transported by: t\ , Name of Hauler: 413 s.0 p/s#c.;' rt,e,o. (,reit„1.1x.m.1 J Signature of Applicant: Date: +1,}4 DArI CERTIFICATE OF LIABILITY INSURANCE (MWOOrryrrl osrosno2a 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 pollcy(les)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 net confer rights to the certificate holder in lieu of such ondorsomont(s), PRODUCER FINCK&PERRAS INSURANCE AGCY INC CONTACT NAME. 080$1515 PHONE (413)527 3000 "FAX 6 CAMPUS LANE 1~C•No.Est) _ INC.No) EASTHAMPTON MA 01027 EMAIL ADDRESS; INSURERISI AFFORDING COVERAGE IMICa INSURER A• Hanford Underwriters Insurance Company 30104 kYSURED INSURER B: SAGEBUII T CONSTRUCTION l LC INSURER C • 57 PROSPECT AVE NORTHAMPTON MA 01060.1625 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 NOTIMTHSTANOING 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 AFFORDEO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOMI MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE ADOL SUM POLICY NUMBER POLICY EFF I POLICY EXP LIMITS LTR INSR Sh/D IMWODYYYYI IMMIDD/Y YYY) COMMERCMI GENERAL LIABILITY EACH OCCURRENCE S1 000.000 CAMAGE TO RENTED (CLAIMS-MADETOCCuR PPEM ESI ascna+awel Si 000.000 X General Liability MED FAR Iers ore Persal, $10.000 A 08 SBN1 AV7BYU 01/10/2024 01/10/2025 PEPSO':AL aADM INJURY S1.000 000 GE NI.AGGREGATE LIMIT ARRAS PER GENERAL AGGREGATE S2,000.COO POLICY I y PR6 1 Loc. P!tCOUCTS-COMPrOPAGG $2,000,000 OTHER ,• LL�� AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT IEaacaaeM) ANY AUTO BODILY INJURY(Per wad`, .�ALL OWNED-SCHEDULED AUTOS AUTOS BO`YLY INJURY Icier acabvl ^�Ha1EO NONCA'AD PROPERTY DAMAGE AUTOS AUTOS !Per balder() OCCUR LUB EACH OCCURRENCE EXCESS UAB MAD ` S AGGREGATE E LIEU RETENTIONS WORKERS COMPENSATION PER OTH AND EMPLOYERS'LIABILITY STATUTE ER ANY YIN E I EACH ACCIDENT PROPRIETOR,PARTULR/EXECUTIVE CrrICERMEMBEREXCLUDED' C N/A EL DSEASE-EAEMPLOYEE (MafdatO5,In NH) H yss.eescroe under E L DISEASE-POLICY LIMN DEYR PT•D'4 Or OPERATIONS be,* A Employment Practices Liability 08 SBM AV7BYU 01/10,2024 01/10./2025 Each Claim Lund $25.000 Annual Aggregate Limit 525.000 Insurance DESCRIPTION OF OPERATIONS/LOCATIONSI VEHICLES 1ACORD 101.Aedrbooal Remarks Schedule.may be alIached if more space Is requr.dl Those usual to the Insureds Operations CERTIFICATE HOLDER __CANCELLATION__ For Informational Purposes SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 57 PROSPECT AVE BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED NORTHAMPTON MA 01060-1625 IN ACCORDANCE WITH THE POLICY PROVISIONS. • AUTHORIZED REPRESENTATIVE (0 1988.2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD