22D-102 (3) 149 RYAN RD BP-2017-1346
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:6lock: 22D- 102 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Bath reno BUILDING PERMIT
Permit# BP-2017-1346
Project# JS-2017-002234
Est. Cost: $21000.00
Fee: $130.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MARK BONDE 67758
Lot Siae(sa. ft.): 36329.04 Owner: SUPRENANT RICHARD D JR&GLORI
Zoning: URA(100)/WSP(100)/ Applicant: MARK BONDE
AT: 149 RYAN RD
Applicant Address: Phone: Insurance:
205 PARK ST (413) 535-9529 O WC
EASTHAM PTON MA01027 ISSUED ON:5/23/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:BATHROOM RENO ** NO WALL MOVED OR
REMOVED
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:
FeeTvpe: Date Paid: Amount:
Building 5/23/2017 0:00:00 $130.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-1346
APPLICANT/CONTACT PERSON MARK SONDE
ADDRESS/PHONE 205 PARK ST EASTHAMPTON (413)535-9529 Q
PROPERTY LOCATION 149 RYAN RD
MAP 22D PARCEL 102 001 ZONE URA(100VWSP(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paideil m
Building Permit Filled out '1 1P)/O ,t/ U
Fee Paid yr !!// /(6 ,(
Typeof Construction: BATHROOM REN I ��//-��///1\
New Construction Millir I �i
Non Structural interior renovations L _
F _ _ --� f` V
Addition to Existing `,
Accessory Structure
Building Plans Included:
Owner/Statement or License 67758
3 sets of Plans/Plot Plan
THE FLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
F MATION 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
clay
e id/fie-
3'-22 i7
Sign mr ui ng al 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.
Department use only
City of Northampton Status of Pemit
Building Department Cuib Cuvorivewey Permit
r 212 Main Street SewedSeptic AvegabiGly
ti Room 100 Water/Well Availability
'..• Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-5874272 Plot/Site Plans
Other Specify
APRGCATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Addams:
This section to be completed by office
i'.IC4 2:1(ftta Map IA yr Lot `o; Unit
--L
JQ '♦cAC. ( k 4 Zone Overlay District
Elm St Mulct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
&I Owner of Record:
► F QEM * \ l PAC '{fa4 %cA
N- e(P- l j CurrutAlliltg Atltlpc§-, 4 4014. C.?
l
7a
Telephone
Signature
22 Authorized Anent:
aka�>t��G ` 5 Ra{G
Name(Print) Current Mailing Address'.
` ii' 564 -Li 66
Signatu a Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by peon!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) c a',(AO Check Number _.8.10.21,
s' 2"T
This Section For Official Use Only
Date
Building Permit Number Issued:
Signature: _, ..-�...
Building Commissionernnspector of Buildings 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 Depanment
Lot Size
Frontage
Setbacks Front
Side L: R: L:_.._R:
Rear
Building Height
Bldg. Square Footage `b
Open Space Footage
(Lot are,minus bldg&paved
parking/
got Parking Spaces
Fill:
(voome&UR tion)
A. Has a SpeciglPermit/Variance/Finding ever been issued for/on the site?
NO GY DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the pe t recorded at the Registry of Deeds?
NO DONT KNOW O YES O
IF YES: enter Book Page and/or Document tt
B. Does the site contain a brook, body of water or wetlands? NO �NT KNOW O YES O
IF YES,has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 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 U NO O
IF YES, describe size, type and location:
E WO the construction activity disturb(G wing,grading,e cavation,or filling)over 1 acre or is it part of a common plan
that vaik disturb over t acre? YES NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
RECTION 5-DESCRIPTION OF PROPOSED WORK(check all asolkabie)
New House Addition Replacement Windows Altoration(sj Roofing
Or Doors
Accessory Bldg, Demolition New Signs [ ] Decks [ I Siding[ I Other( I
Brief De- i.tion of Propose. —
Work: erb4. L. .4...i• ja: "'ti_ ta— .,i lots �._ii t. . o 4&
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Sa.If New house and or addition to existinft housina. 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 la-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERSvAGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 21,LAA SLIOZO4 pit i1— ,as Owner of the subject
properly
hereby authorizeyyy��� k F•i�r--
to a y ,i -tiers relative to wodc authorized by this building permit application.
Signature of r -`/ r^{��-� Date
t, Ik ,>�-� '-s)0LS ,as Owner/Authorized
Agent here y declare that tthhih statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains a nasties of perjury.
MAS— - w��
Print Name ki
Signature o
O r ent Daaar-1-7
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: 11-1 ck �`?A.& L& i -k tc,2ci•-$CE
The debris will be transported by: uot' ro parr()oc t
The debris will be received by: \/AtL.E{ �.F C_Y CA--t►1/43 tr
Building permit number 1
Name of Permit Applicant M isr , JY
6—v6i i t 1L 4,
Date Signature of Permit Applicant
,Zs, The Commonwealth of Massachusetts
Department ofIndustrialAccidents
i� '� O9ice of Investigations
e. V0s 1
1 Congress Street,Suite 100
�
�h Boston,MA 02114-2017
www.mass.govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information - Please Print Legibly
Name(Business/Organizatio&lndividual): -r5n.}5;, . (r ettJ aj"r_oc- }ft L) _
Address: ao4 'T w C �r
z
City/StatetZip:EACHq.t.�1F -04 4 } i A- 0� hone#: 4G 5c19 -Z1Z Cs
Are you an employer? Check the appropriate box: Typeof project(required):
4. I am a general contractor and I P
t.6ya employer with �_ ❑
employees(full 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- 13-Kremodeting
ship and have no employees These sub-contractors have 8. ❑Demolition
workingfor me in anycapacity. employees and have workers'
apo tY i 9. ❑ Building addition
[No workers' comp. insurance comp. is
required.] 5. a 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 12.0 Roof repairs
insurance required.] r c. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required]
'Any applicant that checks box al must also till out the section below showing their workers'compensation policy information.
r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
IConaactors 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 subcontractors 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: j(?pe-lca ��11 _
Policy#or Self-ins. Lie. #: _ Expiration Date: 3 3- 1',
Job Site Address: t4C\F-1 t,.:. ... City/State/Zip: ' r {-tC eHA,ObtOZ-
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 mid 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 j r ,r the pains and penalties of perjury that the information provided above is true and correct.
Sigmanae: / J,. *ns. t.7 .r Date: '� 5R^1
Phone# k�3 —'1.f-11p
' 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):
t I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other 3
Contact Person: Phone#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not`Applicable ❑-r
Nems or Ucanea HOMer;�. ,p2�.: ;� t�� CS
License Number
rp ♦ • 2 c i ♦ GJ. is♦�IC1� ..._..
Address Expi . ion pate
I r_..l ii/WASIP C v e —2i ..
Signature Telephone
9.RRealatered HoyeImorovemeot Conhactor: Not Applicable C)
• 2 a
Conman ,NN�anic Registration Number
rTv
Address Expirat on D
•
p„ 552.4 737(3•
• w�X� ' X Teta one
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152,§28C(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 buildinnggyennit.
Signed Affidavit Attached Yes GY No.,.... ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwelhnts 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 780, Sixth Edition Section 108,3.5.1.
Definition of Homeowneg Perron(s)who own a parcel of land on which hetshe 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 pot be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official that betshe shall be
responsible Tor aR such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time 10 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 hath)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 _.. _