23A-039 (8) Welcome Home Green Building `rora healthierhome&Planet!'
JULIAN TV15TA Po Box 106, Worth gton,A43, Te/413138 f33� email w)�reen6ui�(nS@ve)-izon.net
CONSTRUCTION CONTRACT pp r,
This contract,dated � _is b and tween the followin �O ne L+ Igslet ' �)S 0 in
Address—
/C City `Mate _Zup _
Tel: _ ,Contractor: _ Stree__ _ G _
City ; ! State n14-Zips Tel:_ ;�'�'.l'' S C_ �Ce �P–/Ecs,–,
1. GENERA
This contract is for the following work and materials to be performed by the contractor on the property 4ddress above.The
project is generally described as follows:-_ � (i_C"&� cl w i`—
r- 1, r
11 Change orders and modifications shall be ir1 iting and shall become part of this contract.
1. PRICE
The total price for the work agreed upon is
Timely payment by owner of all sums due under this contract is of the e ence to this co tract.
The parties agree to the following schedule of payments:4.Initial pay ent ? —
2. PROGRESS PAYMENTS:
Stage of work date expected am unt
a.
b.
B. Contractor may cease operations if any progress payment is not made by Owner as required herein,and proceed to
collect any balance due with any legal remedy.Any past due bills for more than one month,will be subjected to a 5%
overdue monthly fee unless agreed otherwise.
3. STARTING AND COMPLETION PROyISI NS
The work will begin on_�`� and will be completed,absent unusual circumstances
on c
4. PERMITS AND APPLICABLE CODES;COMPLIANCES WITH LOCAL LAW —
A. 11 wo to be done nder this co tract will be in accordance with the building codes presently in force in the City of
A�v A. Contractor sh 1 obtain all necessary permits and pay all required permit and plan fees from the down payment.
B. Contractor shall at all times comply with the laws of this state regarding mechanic's liens.
5. SPECIFIC REQUIREMENTS FOR MATERIALS AND WORKMANSHIP
A.This contract will be completed by Contractor in a good and workmanlike manner,using good quality materials.The
parties agree upon the following materials specifications and work description,together with any plans or specifications
incorporated herein: — — --
6. HIDDEN,CONCEALED and UNFORESEEABLE CONDITIONS: The parties agree that in the event Contractor
discovers a condition requiring an extra cost that they shall proceed as follows: Contractor shall notify Owner verbally
at once to expedite agreement as to charge to correct or cure such conditions,and provide a written estimate as soon
as practicable.The parties must agree to such extra charge,or agree to a resolution method,or this contract may be
cancelled by either of them.For purpose of this section,a" hidden,concealed and unforeseeable condition" shall
mean a condition not readily observable to a prudent contractor inspecting the subject property for the purpose of
performing this contract.
7 WARRANTIES: The work of contractor,including materials and labor,shall be guaranteed for a period of
cli years,during which period contractor shall at his own expense correct any defect arising from his work.
Owner has no action at law or in equity against contractor after said date,
OWNER: CONTRACTOR: _ J
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�, �eicome Xome
&een Bmww for a healthier home &
planet !
Po Box 106, Worthington, MA. 01098 Tel: 860-690-1000, whgreenbuilding @verizon.net
Commissioner Hasbrouck Date:6'2'15
Subject: Request for Waiver
I request that you grant a modification to waive the requirement for control construction for the `Washer and
Drier installation at 56 Main Street, apt 108, in Northampton because the work is of a minor nature, will not
affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of
control construction is considerable when compared to the cost of the proposed work. All work will be
completed within the prescriptive requirements of 780 CMR. Thank you for your consideration.
"Mass Amendments, sections 107.1 allows for an exclusion from control construction for this project"
Respectfully,
Julian Traista
Po Box 106, Worthington, MA. 01098
tel: 413-238-5336 or
mobile: 860-690-1000
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
�--
Address of the work:
The debris will be transported by:
The debris will be received by:
"B i ina
B Id ,, permit number-
Name Name of Permit Applicant E)Rf./av l raw
Bute Signature of Permit Applicant
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual,partnership, association,corporation or other legal entity,or any two or more
of the.foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deerned to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s), address(es)and phone number(s) along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of industrial Accidents
Office of Investigations
1 Congress.Street, Suite 100
Boston,MA 02114-2017
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 7-2010 Fax# 617-727-7749
www.niass.gov/dia
The Commonwealth of Massachusetts
Department of IndustrialAccidents
." Office of Investigations
- I Congress Street, Suite 100
+ Boston,NIA 02114-2017
www.inass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lezibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: Phone#:
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. 0 I am a general contractor and I
employees (full and/or part-time).* have hued the sub-contractors 6. New construction
2,, I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have S. F_j Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp.insurance comp.insurance.$
required.] 5. F_� We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4), and we.have no
employees. [No workers' 131-1 Other
comp.insurance required.]
;Any applicant that checks box#1 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 wheflier or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp,policy number.
Jam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
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 pains and penalties of erjury that the information provided above is true and correct.
" (/ `. 1
Signature: {%`- " _ .. . Date: _ ..
o Phone#: J C 1 l� Q 0
Official use only. Do not write in this area, to be completed by city or town offrcial
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 Sug�ery/iso)/:�i �ff� Not Applicable !
Name of License Holder: �K d ,((��
/,�f � / License Number j i
Address Expiration Date
Signature Telephone
9 Registered Home Improvement Contractor: C Not Applicable
Company Name Registration Number
k6 /r Gpl�rl&
Address 6el (� Expiration Date
Telephone
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 108.35.1.
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) ❑ Roofing ❑
or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding [01 Other[IZQ
env �-
Brief Description of Proposed A-kf 0/ �1�1 v C0gA1v1- C
Work: 6'G'
Alteration of existing bedroom Yes e�'� No) Adding new bedroom Yes o
Attached Narrative Renovating unfinished basement Yes _No
Plans Attached Roll -Sheet
6a. If Newhouse 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 authorize
to act on my behaatters re ative to work authori d by this building permit application.
Signature of Owner Date
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 1penall of er u �0.
7 Pri 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 %
(Lot 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 DON'T KNOW YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
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, excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
1-
o
eel
Department use only
City of Northampton Status of Permit:
C= �Q Building Department Curb Cut/Driveway Permit
cv 0 z 212 Main Street Sewer/Septic Availability
N co Room 100 Water/Well Availability
E Northampton, MA 01060 Two Sets of Structural Plans
a o phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
fa .0 Other Specify
6
ATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMO
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address:
► K (,f��ry. ��
� � <— L �" �C Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: 1v�at� �1vJat J ��
Name(Print) Curre iling dd Sr— A f i-y/0 /�
j Telephone��,
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Addr s:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building co (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=0 +2+3+4+5) Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2015-1193
APPLICANT/CONTACT PERSON JULIAN TRAISTA
ADDRESS/PHONE P O BOX 106 WORTHINGTON01098(413)238-5310
PROPERTY LOCATION 56 MAPLE ST-UNIT 9108
MAP 23A PARCEL 039 001 ZONE GB(100)/
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: RENOVATE ROOM FOR LAUNDRY CONNECTIONS
New Construction
Non Structural interior renovations
Addition to Existing -
Accessory Structure
Building Plans Included:
Owner/Statement or License 092029
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INYOJUMATION PRESENTED:
Approved 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
Dem elay
Si rep Building Officia 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.
56 MAPLE ST-UNIT#108 BP-2015-1193
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23A-039 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-2015-1193
Project# JS-2015-002262
Est. Cost: $2250.00
Fee: $56.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JULIAN TRAISTA 092029
Lot Size(sq. ft.): 64904.40 Owner: NORTHAMPTON HOUSING AUTHORITY TOBIN MANOR
Zoninfz: GB(100)/ Applicant. JULIAN TRAISTA
AT. 56 MAPLE ST - UNIT #108
Applicant Address: Phone: Insurance:
P O BOX 106 (413) 238-5310
WORTH I NGTONMA01 098 ISSUED ON.61412015 0:00:00
TO PERFORM THE FOLLOWING WORK:RENOVATE ROOM FOR LAUNDRY
CONNECTIONS
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 6/4/2015 0:00:00 $56.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner