16C-003 (17) BP-2024-1559
334 SPRING ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
16C-003-001 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-2024-1559 PERMISSION IS HEREBY GRANTED TO:
Project# WOOD STOVE 2024 Contractor: License:
Est.Cost: 14500 ALISHA PHILLIPS 106378
Const.Class: Exp.Date:02/26/2026
Use Group: Owner: LANGMUIR JONATHAN
Lot Size(sq.ft.)
Zoning: WSP Applicant: AXIOM LANDSCAPE &HOME IMPROVEMENT LLC
Applicant Address Phone: Insurance:
40 PINE VALLEY RD (413)320-9669 WCC5005020083
FLORENCE, MA 01062
ISSUED ON: 11/22/2024
TO PERFORM THE FOLLOWING WORK:
ALTERATIONS TO WOOD STOVE INSTALLED BY OTHER CONTRACTOR
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:
Final: 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: $109.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
f.-...>-----,
4 The Commonwealth of Massachusetts N `�
.LItUJ
Board of Building Regulations and Standards 0y I�1i lUN1 lPALlTY
Massachusetts State Building Co e, 780 CMR 20
(9Q SE
Building Permit Application To Construct, Repair, R vat[ 'OF , coolish a , Rev' ed Mar 2011
One-or Two-Family Dwelling ,),,"^/:;:,"
p� This Section For Official Use Only "17 °" I'
G"Building Permit Number: • '.1 Date Applied: ./
_,94_7-Iti� iL—?� y _ �/zZ
Building Official(Print Name) Si lure Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
3111 Sp/ Sfiifi itmeli .cr (leak 34/9 p,, Z98" l4 -0v3 -oci
1.la Is this an accepte street?yes 2( no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions: •
I Get- ) /0
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
too ' 3 ' 4' 7Sr'
1.6 Water pply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Dis osal System:
Zone: Outside Flood Z ?
_
Public Private❑ Check if yc Municipal On site disposal system 0
SECTION 2: PROPERT OWNERSHIP'
2.1 O f Record: Ff� L �," o/a o 2
1 ppy�,0 b/ Lq,/hNi/ ♦•nht
Name(Print) City,State,ZIP
3311 Sl St4,�/ `1►3- Z3�-�326 blAn ,,,u,i►►� •e 4 �.���
No.and Sired �/ Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s)X1 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: A 1tivSSM .- ES <'ua'..i / List,f/io/ b .0044- c.4.4. s'c ,
wk ay.;� � /Pio, nc �,,,.d fivt-c , s4 '., Gl /.`- j./sts
#;itC ,1l 9 �'/..- 4'Y4J a po W 14.4.1 ,.s7* ' bwr.et i�-
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building S 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical S ❑ Standard City/Town Application Fee gb
❑Total Project Cost'(Item 6)x multiplier x41 7 .
3. Plumbing S 2. Other Fees: $
4. Mechanical (HVAC) S List:
5. Mechanical (Fire S
Suppression) Total All Fees: I C7c1 �v
Check No.')..ktU Check Amount: Cash Amount:
6. Total Project Cost: $ ' 11
$'OO 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) C S— /d 6 3 IFS Z/ZY2-c)24
/t // t ti
"544 � c Pljlf f i�s License Number Expira ton D
Name of CSL Hol er
v r/ List CSL Type(see below)
u
I Pilot V 4 lft &I T B Description
No. and Street
FIU/Pti,? 4 010 Unrestricted(Buildings up to 35,000 Cu.ft.)
City/Town,State,ZIP 0/U G Restricted 1&2 Family Dwelling
y M Masonry
RC Roofing Covering
WS Window and Siding
�-q /f SF Solid Fuel Burning Appliances
- J /%AKl.tit/)g.d41, {/)100 ,/' 9/y19//.Cal I Insulation
Telephone Email address f D Demolition
5.2 Registered Home Improvement Contractor(HIC) y� y/t 7 OG
/t7rt 141 legure SCy i. R i� ^'/Ql,N4j 1e _ L� Inc Registration Number Expiration to
HIC Company Name dr HI Registrant Name �J
qv p,„d Lail/ g AXio h l,J94����ct .f e gd2S. o/!)
No.pnd Street Email address J
Phi/fecr '74 0/042 4//?-5ro%- S9$6
City/Town, tate,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 /4/t Sit 7' , A/./// S
to act on my behalf,in all matters rel ' o work authorized b his building permit application.
tuNtoSizot {.ten w+LAP" l( -2 g-"i
Print Owner's Name(Elect nic Signatu ) 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.
/4/14 "Tye la4/1y vl /9 29
Print 0 r' uthorized 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 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
SETBACK PLAN
MAP: LOT:
LOT SIZE: ) 4c '<-
REAR LOT DIMENSION:
REAR YARD 7-s- '
SIDE YARD 3 �G11S L SIDE YARD 7U
'1
♦
FRONT SETBACK I°°
FRONTAGE
The Commonwealth of Massachusetts
1 fit.=r Department of Industrial Accidents
_" I Congress Street,Suite 100
t•�.a } Boston, MA 02114-2017
'-..."...4'. www.mass.gov/din
Walkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
CO HE FILED WITH THE PERMhfl'flNG AlITHORIII.
Applicant Information Please Print Lett hi
Name 1 Businesx/Organtratiowindividual): A Y'l(!toil G/f ielekcl -f I . l Le klaa/ 6-
Address: it At, v41h ,,ol .5- 6 - 5-5'
cr
City/State/Zip: F/verc r '�-9 0/06 , Phone #: yl3 -
7
Are sou an employer?Cheek the appropriate hue:
v� Type of project(required):
I am a employer with.t_employees(full and'or part-tune).• 7. 0 Ne w construction
20 I an a sole proprietor or partnership and have no employees working for me in 8 Remodeling
any capacity.[No workers'comp.insurance required.]
9. 0 Demolition
301 am a homeowner doing all work myself.[No workers'comp.insurance r quirul.]"
10 0 Building addition
•t.Q I am a homeowner and will be hiring contractors to conduct all work on my property. I will
enNun that all cwntraetun either have workers'compensation uarurancc or are sole 1 1.0 Electrical repairs or;Additions
proprietors with no employees.
12.0 Plumbing repairs or additions
50 I am a cc neral contractor and 1 have hired the sub-cuntrncton listed on the attached sheet 13.0 Roof repairs
These sub contractors base employees and have workers'comp.insurance.'
6.Li we an a corporation and(ta officers have exercised their right of exemption per MUc. 14.1]MCI
152,§1(4).and we have no employees.[No workers'comp.insurance required.]
•:\ny applicant that checks box a I must also fill out the section below,shunina their workers'compensation policy information.
'Homeowners who submit this aflilasit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tC'untractors that cheek this box must attached an additional sheet showing the name of the sub-contractors and state w hotter or not those entities have
employees_ If the sub•cuntractors hale employees.they must pruside their workers"comp.pokey number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the polic{'and job site
Information.
Insurance Company Name: .-Si-re -Tvi sM,s.,c.e 6 syS h
Policy#or Self-ins.Lic.#: IV LL S(JOco 2 00' 3 Expiration Date: y/l 7/ZS—
Job Site Address: 33 9 Sp,Al S it t/ City/State/Zip: Fftie/4(—I 'v<1 0/142
Attach a copy of the workers'coe'pensation 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 S1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 pe Nlldes 'cry that the Information provided above is true and correct.
Signature: � l Duty. 0 I 1
f
Zq
Phone L//3 - SSc - C95 //0
Official use only. Do not write in this area.to be completed by city or town official
('its or Town: Permit/License#
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3.('its Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone 4:
ACORD, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
11/15/2024
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 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 Fe Trudell
NAME:
Clayton Insurance Agency, Inc. PHONE FAX
(413)536-0804 (NO,No)' t411)53e-7e7a
1649 Northampton Street nooRess: ftrudell@claytoninsurance.net
INSURER(S) AFFORDING COVERAGE NAIC#
Holyoke MA 01040 INSURER A:Safety Insurance Company
INSURED INSURER B:AIM Mutual Insurance Company
Axiom Landscape And Home Improvement LLC INSURER C:
40 Pine Valley Road INSURERD:
INSURER E
Florence MA 01062 INSURERF:
COVERAGES CERTIFICATE NUMBER:2024 MASTER 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 OTIIER 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 ADOL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSR WVR POLICY NUMBER (MMIDOIYYYY) (MM/DDIYYYY)
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000
GE
A CLAIMS-MADE [X OCCUR PRREM SESO(EaENTE occurrence) S 100,000
8NA0028548 1/11/2024 1/11/2025 MED EXP(Any one person) S 10,000
PERSONAL RADV INJURY S 1,000,000
GEN1 AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000
X POLICY JECT PRO- LOC PRODUCTS-COMP/OPAGG S 2,000,000
OTHER: S
—~AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000
(Ea accident)
A ANY AUTO BODILY INJURY(Per person) S
ALL OWNED X SCHEDULED 5907002 1/11/2024 1/11/2025 BODILY INJURY(Per accident) S
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE
X HIRED AUTOS X AUTOS (Per accident)
UMBRELLA LIAB OCCUR EACH OCCURRENCE S
~ EXCESS LIAB CLAIMS-MADE AGGREGATE S
DED RETENTION S S
WORKERS COMPENSATION X PER ERH-
AND EMPLOYERS'LIABILITY Y IN
STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE NIA
B E.L.EACH ACCIDENT S 1,000,000
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) WCC5005020083 4/17/2024 4/17/2025 E.L.DISEASE-EA EMPLOYEE S 1,000,000
It yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000
DESCRIPTION OF OPERATIONS r LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached 11 more space is required;
RE: 334 SPRING STREET, NORTHAMPTON, MA
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
BUILDING DEPT. ACCORDANCE WITH THE POLICY PROVISIONS.
212 MAIN STREET, #100
NORTHAMPTON, MA 01060 AUTHORIZED REPRESENTATIVE
U 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INS025 :11.f')
City of Northampton
/,6p„
��-_A Massachusetts �?'Ns .... c�
• W
t - 4• O^ DEPARTMENT OF BUILDING INSPECTIONS SI-
v • 'r.� '> 212 Main Street • Municipal Building 9v t,
,. yam`° Northampton, MA 01060 Sikh— %%
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: 0 f-f C t
The debris will be transported by:
Name of Hauler: 4Y/ w) r.Ay)$•C ef t Wow{ J� �o"%r.�hf"
P
Signature of Applicant: / Date: iy/e//2
y