18C-141 (30) INSULATE WALLS R-21 EXISTING GARAGE
INSULATE CEILING R-3
RIGED INSULATION ON FLO❑
AIR SEAL FLOOR AND CEILIN 8X12 LIVING ROOM
2X6 WALL STUDS
ANDERSEN WINDOWS .28 U FACTOR
L L
112" SHEETROCK
ANDERSEN SLIDER .28 U FACTO
VAPOR BARRIER
112" PLYWO❑ OUSE WRAP
ADJUST STEP WHEN NEEDE
BONDE CONSTUCTION / LATHROP COMMUNITIES 413 535-9529 ` y�,' c �A�q�P�E 7--�•
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
UT Boston,MA 02111
www.mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): Bonde Construction
Address: 205 Park Street
City/State/Zip: Easthampton,MA 01027 Phone.#:
413-529-2176
Are you an employer?Check the appropriate box: Type of project(required):
1. I am a employer with 2 4• ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [Grikemodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers' 9 ❑Building addition
[No workers'comp.insurance comp•insurance.t
required.]
5. ❑ We are a corporation and its 10.❑EIectrical 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#1 must also fill out the section below showing their workers'compensation policy information.
t Homcrowners wbo submit this affidavit indicating they are doing all work and then hire outside contractors retest submit anew affidavit indicating such.
$Contractors that check this box inns€attached an additional sheet stowing the nowt of the sub-contractors and state whether or not€hose entities have
employees. if the sub-contractors have eniployees,they must provide their workers'camp.policy number.
lam an employer that isproviding workers'compensation insurance for my employees Below is the policy and job site
information.
Insurance Company Name: Travelers'Insurance
Policy#or Self-ins.Lie.# 3B985388UB Expiration Date: 3/13/2815- 2_0k 6
Job Site Address: L gtop-,T City/State/Zip: Cy_-T M PTC�t1/[✓(
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 tb Date:cerfi under the pains and penalties of perjury that the information provided above is true and correct.
�L
Si ature: —
Phone#: 413-529-2176
Official use only. Do not write ill 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 8-CONSTRUCTION SERVICES
8.1 Licensed Construction�Supervisor: Not Applicable ❑
Name of License Holder:- l ,� b(-7 7 5-S
License Number
Address Expiration Date
5 VArZJ
Signature Telephone
9. Reoistered Home Improvement Contractor: Not Applicable ❑
J�'rs".l r I Irs t 2 E
Companl Name Registration Number
Address y-� L4%3 53 5-,1151 Expiration Date
AiA Y \y P I H(V Telephone -6—
SECTION 10-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...... ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied 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,provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition 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 person who constructs more than one home in a two-year period shall 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
responsible for all such work performed under the building permit.
As acting Construction Supervisor 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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) FPr Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs M Decks [❑ Siding ff:]] Other[A
Brief Description of Proposed
�Nn
Work: SQC L_Q`,'E.` s DL r L o't 1 AxT_ , 't-A(D D 11 L V I- -c►-1 �1
Alteration of existing bedroom Yes L---N-o Adding new bedroom Yes L--'No
Attached Narrative Renovating unfinished basement Yes `-No
Plans Attached Roll -Sheet
sa. If New house and or addition to existing housing, complete 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. floodplain 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 APPLIES FOR BUILDING PERMIT
as Owner of the subject
property
hereby authoriz
to act on my b hal in all mattes re tive rized by this building permit application. �-
Signature of Owner Date
I, 1fisdL C) \ as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
�Dt � C7t1 C�
Print Name
Signature of Owner/Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(I.ot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special'Permit/Variance/Finding ever been issued for/on the site?
NO (D DON'T KNOW O YES O
IF YES, date issued:
IF YES: Was the it recorded at the Registry of Deeds?
NO DONT KNOW O YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO er---DON'T KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES 0)0\1 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 0
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading, excqyakm, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YEE O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
Wit`° 'ty of Northampton Status of Permit:
r ' ilding Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
U L MAY 13 2015 ( Room 100 Water/Well Availability
ort ampton, MAO 1060 Two Sets of Structural Plans
Electric.Plumbing&Paomeqp 87-1240 Fax 413-587-1272 Plot/Site Plans
Northampton, A 01060
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION 7
1.1 PPrroort,v Address: This section to be completed by office
D
�
olS � � �� .���� Map Lot Unit
Zone Overlay District
Elm St.District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
1� ^N CZ0 Q (:f jb M Al u K)17'Y
Name(Prin Curre t Mailing Address-
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Ll
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total= (1 +2+3+4+5) 1 -7060 Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2015-1108
APPLICANT/CONTACT PERSON MARK BONDE
ADDRESS/PHONE 205 PARK ST EASTHAMPTON01027(413)535-9529 Q
PROPERTY LOCATION 28 CRABAPPLE LN-680 BRIDGE RD
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
Tyneof Construction: ENCLOSE& INSULATE REAR PORCH&REMODEL KITCHEN
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
INFORIV ATION PRESENTED:
`•f{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
0 * * lay
Signature of Building Official Date
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.
28 CRABAPPLE LN-680 BRIDGE RD BP-2015-1108
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-2015-1108
Project# JS-2015-002092
Est.Cost: $17000.00
Fee: $102.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MARK BONDE 67758
Lot Size(sq. ft.): 1497897.72 Owner: LATHROP COMMUNITY INC
zoning: Applicant: MARK BONDE
AT. 28 CRABAPPLE LN - 680 BRIDGE RD
Applicant Address: Phone: Insurance:
205 PARK ST (413) 535-9529 O WC
EASTHAMPTONMA01027 ISSUED ON:511312015 0:00:00
TO PERFORM THE FOLLOWING WORK:ENCLOSE & INSULATE REAR PORCH &
REMODEL KITCHEN
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 Deaartment 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 Sienature:
FeeType• Date Paid: Amount:
Building 5/13/2015 0:00:00 $102.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner