38B-191 36 MANHAN ST BP-2016-1570
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:38B- 191 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)14/�
Category: KITCHEN RENO BUILDING D( ■'zRI I 1 IT
Permit# BP-2016-1570
Project# JS-2016-002681
Est. Cost:
Fee:$227.50 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
use Group: KEVIN NETTO CONSTRUCTION INC 1317
Lot Size(sq.ft.): 5140.08 Owner: SOLIWODA ROBERTA I TRUSTEE
Zonine: URB(1oo1/ Applicant: KEVIN NETTO CONSTRUCTION INC
AT: 36 MANHAN ST
Applicant Address: Phone: Insurance:
90 Southampton Rd. (413) 527-3168 Workers Compensation
W ESTHAMPTONMA01027 ISSUED ON:6/30/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:KITCHEN CABINETS & TOPS, PATCH WALLS
WHERE NECESSARY
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 6/30/2016 0:00:00 $227.50
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
N.
Department use only
� �` - City of Northampton Status of Permit
�<Ni1 � //' ' Building Department Curb CWDriveway Permit
212 Main StreetSewer(Septic AvailabilityRoom 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
ophone 413-587-1240 Fax 413-587-1272 Plot/Site Plans _
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
t0 M14R\CIS., Map Lot... Unit
Zone Overlay District
Elm St.District _i,..._ CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Charles Bowles / 120 Hockanurn Rd.,Hadley, MA 01035
Name{ /'rarripw
Current Malting Address:
`fe — / v/i a _ Telephone
22 Authorized Agent' ' Cf IJVI
Kevin C. Netto a -Cl1/4C) xj.y` p, \�'�. ♦ . ",wi4
Name(PnnCi / Current Mailing Address:
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=(1 +2+3+4+ 5) Check Number G 66 7CO
This Section For Official Use Only
Date
Building Permit Number:
Issued: �( //'
Signature./ a _ Lrr/ — r� a / ill
( � Budding Commissioner Inspector of Buildings Date I
Section 4. ZONING MI Information Must Be Completed, Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
• &Wing Dcpanmem
1,01 Size
Frontage
Setbacks Front
Side. L: R: I: R:
Rear
Building Height
Bldg.Square Footage
Open Space Footage (4
OM arca minus bldg&paved
parking)
11 of Parking Spaces
Fill:
(volume&t.«-aa„m
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW e YES O
IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES 0
IF YES: enter Book Page and/or Document tt
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW 0 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 0
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 O
IF YES, describe size, type and location:
E. WIN 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? U
YES O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION S.DESCRIPTION OF PROPOSED WORK(check all aDDlicable)
New House D Addition ❑ Replacement Windows Alteration(s) [1 Roofing ❑
Or Doors ❑
AccessorycBldg. ❑ Demolition EI New Signs (OI Decks [O Siding(CI Other(a
Brief
Work:`t'4 ,aon of Proposed
a'FQre C'1GNW\
°c‘stSicrs.'sighSt.N.'cs�NSL\acei£� [1ec Y5S"''bp]Cy
Alteration of existing bedroom Yes \/ No Adding new bedroom Yes f No
Attached Narrative Renovating unfinished basement Yes V. No
Plans Attached Roil -Sheet
be.If New house and or addition to existing housing,complete the following.
a. Use of building: One Family Two Family
b. Number of rooms in each family unit: Number of Bathrooms
G. 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
1, Septic Tank City Sewer Private well City water Supply
SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR, APPLIES FOR BUILDING PERMIT
I. C.stlia C NTiT>�C as Owner of the subject
Property
hereby authorize y\re -
to act on my atlers relative to work authorized by this building permit application.
NO-att..."\b
Signature t� �,P,,.1`� Date
I, C ,{Vt) ,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.
_ gt%Ne..1\1€\ a
Print Name � / Mme.,,._
rrA nt I t \Data,,-\to
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES 1
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Noir � �+ < .N�Ee _ Qctt- \'l
License Number
titais
Address f Expiration Date
V-. C ' -% flems
Signature Telephone
9,Registered Home Improvement Contractor: Not Applicable O
Company Name Registration Number
sfin Shsessagides. is in a
Address Expiration Date
ink>t Telephone \3 1%\bYa
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c. 152,§250(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit vnll result
in the denial of the issuance of the building permit.
1 Signed Affidavit Attached Yes ,a No O
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 7h1, Sixth Edition Section 78$351.
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 shalt be
responsible for all cswh 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_
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: -4.p NI•va; 1
The debris will be transported by: `r yvh e_.t', ('nom �
The debris will be received by: \f a\\Qy \L�
Building permit number:
Name of Permit Applicant
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
, Department of Industrial Accidents
ryba
. Office of Investigations
SIr 1 Congress Street, Suite 100
_T;
T/ Boston, MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):Nen •
Qyl ,etiyk �.-hC
yy�gi_t�cK�cy
Address: tilC") nic'xs..a\''M :sCN -(`] -_...
City/State/Zip:: i �ht 1)\Q-d•L Phone#: ‘--\\3 %Z\-%C A'
Are you an employer? Check the appropriate box:
contractor and I Type of project (required):
L� I am a employer with A. ❑ I am a general
employees(MI and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ 1 am a sole proprietor or partner-, listed on the attached sheet. 7. S Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers
90 guildine addition
[No workers' comp. insurance comp. insurance.:
required.] 5. ❑ We are a corporation and its 100 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.) ` c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other-,_
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they arc doing all work and then him 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:i\\N\ NV.ay.,) \ . �►v��a _.
Policy# or Self-ins. Lic. #; \uCC- 507:1 - ri�f`s6.RtJ51 .,_ Expiration Date: -ra...\ \ _.._
Job Site Address: . .c) M ''c vt''R CitvIStatet2ip:, Q\fib
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 DR for insurance coverage verification.
I do hereby e ify under the pains and penalties of perjury that the information provided above is true and correct.
Si_nat. re: a Date: \oab.-\\O
Phone#: C\\'3-`Sa1,-�t\\D't _....
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#: .__