18C-141 (20) REMOVE 04/
SCREEN
WALL AND
INSTALL
6' WALL,
INSULATE A(.s e, /vL'-ps'r L,
DOOR
AND
WINDOWS.
Pt 7 A\Q SFA L-
EXPAND cp4x-K
FROM 3' t
TO 4' EXISTING PORCH
EXISTING HOUSE INSULATE
EXISTING GARAGE. EXISTING
WALLS
AND
CEILING,
12 ' X 7 ' - 6 " PORCH REMODEL
/ LATHROP
COMMUNITIES
B❑ NDE CONSTRUCTION 529 - 2176
SECTION 8-CONSTRUCTION SERVICES
8.1 Ucensed Consb ctton Supervisor: Not Applicable ❑
Mme of Ue m i'67-7 5 2
license Number
Zn S t->A km. ST. m,�'Tt-4 J4M Sit ht+0A OV)Z-7 L Z;
Address Expiration Date
J* :�L,A\o
Sioature Telephone
9.ftllhM Hom Inwrovsment Cor#ractor: Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone t3 5Za 2.S Z6
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.Gi.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.
ned Affidavit Attached Yes....... I(Y' No...... ❑
11. - Dome Owner Exemption
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The current exemption for"homeowners"was extended to include Owner-occugU Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,urovkbd that the owner acts
as super-vigor,CMR 7„80, Ma Edition Section 108.3.5.1.
Deft ddm of Homeowner.Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A pgreon who constructs more than one home in a two-year rrgM shat!not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
resnonalbiie for ail such work mz%rmed un&r the buitdhrg Pew
As acting your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,You may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
The Commonwealth of Massachusetts
Department of Industrial Accidents
6;p
Off ice of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dta
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Avvlicant Information Please Print Legibly
Name (Business/Organization/Individual):_ ��
Address: ,c-
City/State/Zi :Clef-1 IJ 1 C)Z Phone#: 413
Are you an employer?Check the appropriate box: Type of project(required):
1. %am a employer with 1 4. [:] I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. t[ modeling
ship and have no employees These sub-contractors have g. E]Demolition
working or me in an capacity. employees and have workers'
g Y P h'� 9. E]Building addition
[No workers' comp.insurance comp.insurance.:
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp.insurance required.]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
t 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: 1 2.A"1 E-LP_P :f? —
Policy#or Self-ins.Lic.#:0�, - S( ?;q1327_- 7--071 Expiration Date: 3 3 1 L)
Job Site Address: `� ,L�S_ 1.) �:IJ• ICE-M IJAi?MIJ, City/State/Zip: h"-f M+--1J -
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 airs andpenalties of perjury that the information provided above is true and correct
Signature: Date: -
Phone Li f)? '-
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Section 4. ZONING Art Information Must Be Completed.Permit Can Be Denied Due To Incomplete Infatuation
Existing Proposed Required by Zoning
This cdumn to be filled in by
Building DMar im
Lot Size
Frontage
Setbacks Front
Side L: R L R
RM
Building Height
Bldg.Square Footage %
Open Space Footage %
¢A area minus bldg&r paved
pwkuW
#of Parbng Spam
Fill:
vdume&t watiatl
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Regist of Deeds?
NO O DONT KNOW YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q— YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained O , Date Issued:
C. Do any signs exist on the property? YES a NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO Q.
IF YES, describe size, type and location:
E. Will the con on aci k disturb( ng,grading,a n,or filling)over 1 adze or is it part of a oDmmon plan
that will disturb over 1 acre? YE: NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPPED WORK(check all annifcablel
New House Addition Replacement Rindows Alteration(s) Ea' Jftoofino ❑
Or Doors !U
Accessory Bldg. ❑ Demolition ❑ New Signs Ali Decks Siding Other jC1
'Brief Description of Proposed � ►.1c7 k%'fz#-1" -+- 'JJJ4-JA U_ CAF315 r L.1 G-}LTS, t, W meal f3/1-
Work: fa t E---
Alteration of existing bedroom Yes_ ter No Adding new bedroom Yes 1✓` No
Attached Narrative Renovating unfinished basement Yes ___Iz=-No
Plans Attached Roll -Sheet
ea.11 Now house and or addition to odpAna housing, comRiete,the following:
a. Use of building:One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr, floodpiain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? -Yes-No.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPUES FOR BUILDING PERMIT
I'` ` �' 7 �(' -t---
property 1 ,as Owner of the subject
nY
hereby authorize
to act on my behalf,in allymatters relative to work authorized by this building permit application.
..
Signature of OVtsisr Date
as Owner/Authorized
Agent hereby declare that the statements and information on the fi or�eg ►o ng application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
Si ature of er/Agent - - Date
uspattirwIt use only
City of Northampton 811"of Permit
1 Building Department Cul/Drirntway Pem�it
D 212 Main street Sews/Septic Awe y
OGT 16 201 Room 100 WSWWd A
rthampton, MA 01060 T0wa Sets of Shictural Puns
�tbt 587-1240 Fax 413-587-1272 PkttlSite PW=
�1aCtrio'FlumtIrI
amP o&ti A�i060
Outer spAcify-»
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Pronsriv Addroes: This section to be camplsted by ofd
ASP57Al> � Map Lot Unit
Zane Overlay mbia
Etwr ftt.W cB
SECTION 2-PROPERTY OWNERSHIP/AUTHOFMD AGENT
2.1 Owner of Record:
LA. rQ= C�O 1` ,,. txa � 1' Z tic '-,Z4> .
Name Current Mang Address:
Telephone
Signature
2.2 Authorized&W:
(game(Print) Current MaEng Address:
41p,-'� f29 '21*1 I
f3i Telephone
SECTION 3-&jlUM 200BUCTI{NI COSTS
Item Estimated Cost(Dollars)to be Official Use Only
by mtit a icard
1. Bu#dhg (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 0
3. Plumbing EtNding Pennit Fee
4. Mechanrs(HVAC)
5. Fire Protection
S. Total= 1 +2+3+4+5 Check Number
This SSecNon For Official Use Only
Date
Building Pwmit Number Ikied:
Signature:
SwIdng CommissionerflnepeoW of Buildings Date
File#BP-2015-0441
APPLICANT/CONTACT PERSON MARK BONDE
ADDRESS/PHONE 205 PARK ST EASTHAMPTON (413)535-9529 Q
PROPERTY LOCATION 680 BRIDGE RD-4 ASPEN LN
MAP 18C PARCEL 141 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: CONVERT 3 SEASON ROOM TO LIVING AREA
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 67758
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
pproved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received& Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
on Delay
Signa ure of Building Official
1�ate
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
680 BRIDGE RD-4 ASPEN LN BP-2015-0441
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18C- 141 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2015-0441
Project# JS-2015-000808
Est. Cost: $15000.00
Fee: $90.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group_ MARK BONDE 67758
Lot Size(scy ft.): 1497897.72 Owner: LATHROP COMMUNITY INC
Zoning: Applicant: MARK BONDE
AT. 680 BRIDGE RD - 4 ASPEN LN
Applicant Address: Phone: Insurance:
205 PARK ST (413) 535-9529 O WC
EASTHAMPTONMA01027 ISSUED ON.10/1712014 0:00:00
TO PERFORM THE FOLLOWING WORK.CONVERT 3 SEASON ROOM TO LIVING AREA
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:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department 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.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 10/17/2014 0:00:00 $90.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner