18C-141 (37) City of Northampton
�V Q
Building Department
Plan Review
212 Main Street
Northampton, MA 01060
INSULATE WALLS R-21--\ EXISTING GARAGE
INSULATE CEILING R-3
RIGED INSULATI❑N ON FLOOR
AIR SEAL FLOOR AND CEILIN 8`X12' EXISTING
LIVING ROOM
2X6 WALL STUDS
ANDERSEN WINDOWS ,28 U FACTOR
1/2" SHEETROCK
\--
ANDERSEN SLIDER ,28 U FACTO
VAPOR BARRIER
1/2" PLYW❑❑ OUSE WRAP
ADJUST STEP WHEN NEEDE
B❑NDE CONSTUCTI❑N / LATHR❑P COMMUNITIES 413 535-9529 Lv4vr \N,5P k LAw4v;�
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City ofNortha.mpton 212 Main. Street, Northampton, Na 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 171, S 150A.
Address of the work: t js2C-" L,.\3 ,
The debris will be transported by: Alju-ZN VC ' JjrAdjAJ1-'-
The debris will be received by: USA.. _�•�
Building permit number:
Dame of Permit Applicant �-,r,
• v �►
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Date Signature of Permit Applicant
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Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leeibiy
Name(BusinessAOrganizationitndividual):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):
1.0 1 am a employer with 2 4. [] I am a general contractor and I
employees(full and/or part-time).
* have hired the sub-contractors 6• El New construction
listed on the attached sheet 7. ❑Remodeling
2.❑ 1 am a sole proprietor or partner-
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 ❑ g
required.) S. E] 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' 13.0 Other
comp.insurance required.)
*Any applicant that checks box#1 mut also fill out the section below showing their worker'compensation policy infomntion.
t Homcbwnas who submit this atlidavit indicating they ate doing all work and then hire outside contractors must submit a new affidavit indicating such.
;Contractors that check this box mist attached an additional sheet showing the name of the wb tors and state whether or not those entities have
employees. if the sub-coatractors have employees,they roust 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: Travelers'Insurance
Policy#or Self-ins.Lie.#: 3B985388UB Expiration Date: 3/13/2W4 zO 1
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.
Ido hereby cerci under thepains andpenaldes ofperjury that the information provided above is true and correct.
Si azure: ate:
Phone#: 413-529-2176
Dfficiai use only. Do not write in this area,to be completed by city or town offtciaL
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
it
—]SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: �A Fmk l-�- tol p a 66-111�1
Ucense Number
P05 A> Ilk
Address f Expiration Date
Signature Telephone
9.Reaistered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
Address ] Expiration Date
Telephone 413 `'ZlZ1Zs
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....... 111—' 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 fob 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
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SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition [� Replacement Windows Alteration(s) r.-me' Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs U:T Decks (❑ Siding M Other[A
Brief Description of Proposed
Work:
Alteration of e)dsting bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. if New house and or addition to existing housing complete the followinq:
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 �1� 22Qt•2i7F'
to act o behalf, in all matter relative to work authorized by this building permit application.
J � 1 �.
Signatuhlf Owner Date A
to
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.
H"
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Print Name
e
[�Signatur o er/Agent Date
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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 %
(Tot area minus bldg&craved
parking)
#of Parking Spares
Fill:
volume&Location
A. Has a Spe.pitif Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW O YES O
IF YES, date issued:
IF YES: Was th rmit recorded at the Registry of Deeds?
NO DONT KNOW Q YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW O YES 0
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 O NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading,excayArlon,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.
S�'�'�.�.+w.
w
Department use only
Northampton Status of Permit:
[FEB
uilding Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability—3 t_' is Room 100 Watermell Availability
Northampton, MA 01060 Two Sets of Structural Plans
DEPT:OF F3UII_t;Ir.G NPne
t. , �41 587-1240 Fax 413-587-1272 Plot/Site Plans
NOaT}iA,rdPTON,
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
1- " racy r -ss V--r-r 66 . �"a+�
Name(Print) Current Mailin4ddress:
.__.--._.. lam. 1`�i ~84
Telephone
Signature
2.2 Authorized Aaen
Name(Print) Current Mailing Address:
non ac�=h LA 15 5 3 ea— OA 5 TA
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit 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=0 +2+3+4+5) r -r Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner inspector of Buildings Date
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File#BP-2016-0974
APPLICANT/CONTACT PERSON MARK BONDE
ADDRESS/PHONE 205 PARK ST EASTHAMPTON01027(413)535-9529 Q
PROPERTY LOCATION 1 ASPEN 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
Typeof Construction: REMODEL KITCHEN,ENCLOSE&INSULATE REAR PORCH
New Construction
Non Structural interior renovations
Addition to Existine
Accessory Structure
Building,Plans Included:
Owner/Statement or License 67758
3 sets of Plans/Plot Plan
THE FOL ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN O 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
5Dey
b re of Buildi
Sing gOfficial 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.
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I ASPEN LN-680 BRIDGE RD BP-2016-0974
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-2016-0974
Project# JS-2016-001656
Est.Cost: $17000.00
Fee: $111.00 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. 1 ASPEN LN - 680 BRIDGE RD
Applicant Address: Phone: Insurance:
205 PARK ST (413) 535-9529 O WC
EASTHAMPTONMA01027 ISSUED ON:2/5/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL KITCHEN, ENCLOSE & INSULATE
REAR PORCH
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 2/5/2016 0:00:00 $111.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner