18C-141 (46) 53 FIRETHORN-680 BRIDGE RD BP-2017-1462
QIS4: COMMONWEALTH OF MASSACHUSETTS
MppBBlock: tSC- 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:KITCHEN&BATH RENO BUILDING PERMIT
Permit 4 BP-2017-1462
Project# JS-2017-002430
Est. Cost: $9000,00
Fen:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: MARK BONDE 169228
Lot Siae(sn. Ru: 1497897.72 Owner: LATHROP COMMUNITY INC
2gting: Applicant: MARK BONDE
AT: 53 FIRETHORN - 680 BRIDGE RD
Applicant Address: Phone: Insurance:
205 PARK ST (413)535-9529 0 WC
EASTHAMPTONMA01027 ISSUED ON:S/I612017 0:00:00
TO PERFORM THE FOLLOWING WORK:KITCHEN RENO
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 it Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: OiE 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 6/16/20170:W:04 $65.00
212 Main Street,Phone(413)587-1240,Fax:(4B)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-1462
APPLICANT/CONTACT PERSON MARK BONDE
ADDRESS/PHONE 205 PARK ST EASTHAMPTON (413)535-9529 Q
PROPERTY LOCATION 53 FIRETHORN -680 BRIDGE RD
MAP 18C PARCEL 141 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PEyetera APPPtt ATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid / ,�✓J-y
Building.Permit Filled out �V�/
Fee Paid
Tyoeof Construction: KITCHENVNO
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 169228
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFQRMATION 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
Demolition Delay
6I t6Il7
Signature of Buil.mg 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.
<< Department use only
4 City of Northampton Status of Pewit:
Building Department Curb CuVD ivevaty Permit
,/ avl�" 212 Main Street SewerfSepsc Availability
`/,, Room 100 WaiadWeil Availability
Northampton, MA 01060 Two Sets of Structural Plana
phone 413-587-1240 Fax 413-587-1272 Piot/Site Plans
j Other Specify
PP
/LIC/ATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Proven/Address: Thissection to be completed by office
631---S24 V S. Map / d(/(,/ Lot / 7 ( Unit
\\ts r'^Hpr kAVvriNi r 0-AR Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
yA Owner of Record; yy++
';Se •-7 % Wr bzcnt
\c *E � • I.JkST'1 / at
N- Prod) /� Current INgA ?n
"� mho 13- 801
1\i Telephone
Sig -.rte
2.2 A prized Agent'
-Dr 6-4,Js a ;It til5 TQ 617
Name(Print) Current Mating Address:
`— c.*-A-k�ts' rck.t, 4 41/ 625—ci57, 7
Signature Teiertrone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
I. 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 LO
'7��q
6. Total=(1 +2+3+4+5) 906 — Check Number �3'J�) /C
This Section For Official Use Only
Building Permit Number Date
Issued:
Signature:
Build-mg Commissanerinspector of Buildings Date
Section 4. ZONING AU Information Must Be Completed.Permit Can Be Denied Due To Incomptete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks prop{,
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage 70
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&L.ocaton)
A. Has a Special nnit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW O YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry f Deeds?
NO O DONT KNOW YES O
IF YES: enter Book Page and/or Document It
B. Does the site contain a brook, body of water or wetlands? NO 0---DONT KNOW 0 YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained V , Date Issued:
C. Do any signs exist on the property? YES O NO Q.__
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. VMI the construction activity disturb(clearing,grading,(e'x�cavation,or filling)over I acre or is it part of a common plan
W
that wag disturb over 1 acre? YES O NO —`
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTIONS DESCRIPTION OF PROPOSED WORK{check all aoollcablel
New House ❑ Addition 0 Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition El New Signs 101 Decks (0 Sidingf l Other Ka'
Brief Descrip nyf Proposed
Work: T-01Gl) t lei i .4f)UF efstoileaE'T` J-rJ~filhu _ Nr-tth
Alteration of existing bedroom Yes Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement n Yes >
Plans Attached Roll -Sheet
ea.If New house and or addit onto exisUno houeina,complete the following;
a. Use of building:One Family Two Fancy Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of newconstruction. Dimensions
e. Number of stories?
# 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 SewerPrivate welt City water Supply
SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT O`CONTRACTOR APPLIES FOR BUILDING PERMIT
4 C ,as Owner of the subject
property
hereby authorize Lib( r.b`f r ct' kr-10 to
to a my behalf, in aatleers relative to work authorized by this building permit application.
1Z -t
Signature of Owner Date
M Mac.
-X4-4a_t-, r ,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.
Mac --FDYN,bp
Print Name
� tti Iz--i-7
Signature of Ownerrggent Date
SECTION 8-CONSTRUCTION SERVICES
g.l Licensed Construction Supervisor: Not Applicable ❑
Name of Gnome Holden Lylti7k rontay. E (4?-Ob77
License Norther
_ 5Ovate -sr. n ZJfJ) A 1.- 7 -1 �3
Address Expiration Date
1nc1ta---_ t-2, 529-t 76
Signature Telephone
9.fleaisigred Home ImorovemeM Contractor Not Applicable Cl
(3C5fft1E (C3k) T2�S�Io/.,) /bnZR
Company Name Registration Number
206 RIZ 6 -1-19
Address ,,�--�-� Expiration Date
�k itt�i" I i SO•s) HA Telephone 413 63 -2174
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.152,§25C(6p
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 0
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 18835.1.
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 he
respnnsibk for all such work performed under the building hermit
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,von may be liable for persxm(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,Cay 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: 63 hi aCji ,1 l NJ
The debris will be transported by: —0)-)KIT)P (c» 2ur
The debris will be received by: VAu-cit ?r-x{«,1 --
Building permit number:
Name of Permit Applicant Otra �k-)n SDC
CP— U-17 tE
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
_ Department of Industrial Accidents
*
t fOfce of Investigations
c..,t
irlars
1 Congress Street,Suite 100
?e!_I3 Boston,MA 02114-2017
"b % www.mass.govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information - Please Print Legibly
Name(Business/Organization/individual): t.r�f" C{tu� ._t.3Cn(3tJ
Address: t os 47Acac. ST. .tT P'Cnk . 0%01-7
City/State/Zip: GA --14 fr l yl i-'lA ótz,7 Phone#i: 4Y3 c214Q--Z] 7-6
Are you an employer? Check the appropriate box: Type of project(required):
1.la am a employer with ` _- 4. ❑ I am a general contractor and 1
employees(full and/or part-time).' have hired the sub-contractors 6. ®New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Q REmodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers' 9. a Building addition
[No workers' comp.insurance comp. insurance.t
required.] 5. 0 We are a corporation and its i0.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 2.0 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 must also fill out the section below showing their workers'compensation policy inhumation.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contactors that chock this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. Ifthe subcontractors have employees.they must provide their workers'comp.policy number.
l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site W.
information.
Insurance Company Name: ( 12Ru ate S —
Policy#orSelf-ins. Lic. #: OB- �7113Q ,. - • Expiration Date: 3-'1,,-1,3-
Job Site Address: 53 'I"S is'n1[18.1.1 City/Siate/Zip: 11/4k,QZf4tMkt't f25tsdr A61iO6b
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 perjury that the information provided above is true and correct.
Signa;me: "'11&cj.�t_/' c� L'y<ryt c P Date: jp -/ Z ^1 7
Phone#: (f 113 5-.3 1- 57.4q
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/Cown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
119Sar
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