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25-022 (2)
141 RIVERBANK RD BP-2018-1377 GIs#: COMMONWEALTH OF MASSACHUSETTS Man:Block:25 -022 CITY OF NORTHAMPTON Lot: .001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Cateporv:chimney rebuild BUILDING PERMIT Permit# BP-2018-1377 Project# JS-2018-002438 Est Cost $6800.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Groum: BRYAN ALOISI 073513 Lot Size(sp. ft.): 5445.00 Owner: REARDON ANN C Zoning: Applicant: BRYAN ALOISI AT. 141 RIVERBANK RD ApplicantAddress: Phone: Insurance: 107 ROCKY HILL RD (413)427-2457 0 WC HADLEYMA01035 ISSUED ON:612212018 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVAL OF EXISTING CHIMNEY & DAMAGED PLASTER, RECONSRUCT BOTH 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: FeeTvoe: Date Paid: Amount: Building 6/22/20180:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File k BP-2018-1377 APPLICANT/CONTACT PERSON BRYAN ALOISI ,. ADDRESS/PHONE 107 ROCKY HILL RD HADLEY (413)427-2457 0 PROPERTY LOCATION 141 RIVERBANK RD MAP 25 PARCEL 022 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT AP ON CHECKLIST CLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T eof Construction: REMOVAL OF EXIS IMNEY&DAMAGED PLASTER RECONSRUCT BOTH New Construction Non Structural interior renovations Addition to E istine Accessory Structure B ildine Plans Included' Owner/Statement or License 073513 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFPRMATION 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 Portability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management -DPIQqition Delay � O ' wilding O�/c) 1 Date Note:Issuance of a Zodfng 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 stria standards of MGL 40A.Contact Office of Planning&Development for more information. 09010 bW'N01JY1tlH LtlCN SN01193d Department use only City of Northa ton Status Ps it r' Building Depart ent 8102 1 2 wey Permit 212 Main Str et Sews' "i Availabildy Room 100 ell A isilability ) Northampton, MA 0lOd@ A I�C 314tir of rudurel Plana \`Y phone 413-Odt-1240 Fax4 - Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH//AL�ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION l7 Y_ d 3.7 1.1 Property Address'. I /J 11 This section to be completed by office l y I Al,At- Map ox Lot 0 fid— Unit Zone Overlay District �6f� ( Elm St.District C8 District SECTION 2-PROPERTY OW NERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: rJ +inn �eARc�nl /517 Z,-/ Name ring Current Mailing Atltlress. FNYI �e �- L1W Telephone Signature 2.2 Authorized Alai F� '` p� At-IOLD. A1of51 ID7 Gac�u AW al. Name(Print) Current Mailing Aromas'. - 1&,w A .r dl/ /{/3- 4z7 -L L/ SrgnatLte Telephone SECTION 3.ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Oficial Use Only completed by pe"it applicant 1. Building }68�, C,0 (a) Building Permit Fee 2. Electrical (b)(b)Estimated Total Cost of _ Construction from 6 3. Plumbing Building Permit Fee `( l� 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number f 5 This Section For Official Use Onl Date Building Permit Number. Issued: Signatur Builtling Cammi nedlospector of Buildm Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) r Section 4. ZONING A4 Information Must Be Completed.Permit Can Be Denied Due To Incomte pleInformation Existing Proposed Required by Zoning This column in be filled in by Building Dcpamment Lot Size Frontage Setbacks Front Side L R: . L:_ R: Rear Building Height Bldg.Square Footage Open Space Footage % - - d-raareaminusbids&paved addn J #of Parking Spaces "--- (volume Ye Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DON'T KNOW ® YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW ® YES O IF YES: enter Book Page and/or Document N B. Does the site contain a brook, body of water or wetlands? NO ® DON'T 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 © NO 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 O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. f SECTION S DESCRIPTION OF PROPOSED WORK(check all aoolicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ ii��TT Or Doors Accessory Bldg. ❑ Demolition lu New Signs [0] Decks [E] Siding [0] Olherl Brief D scription 9f Prgpused / 1 n / work: rMOV ,I n L �Nuf ('�-Iw—eii�e74nc✓ [/l�M�sd O(aS kn/ Ybi f�cCans><rvU wl v F Iiia Alteration of existing bedroom_Yes d`_No Adding new bedroom_Yes No Attached Narrative Renovating unfinished basement Yes _X No Plans Attached Roll -Sheet sa. If New house and oradrtltioo to existing housing, complete the following. a. Useofbuilding One Family Two Family Other b. Number of roams in each family unit: Number of Bathrooms c. Is there a garage attached' No 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 I. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes_No, I. Seebc Tank_ CitySewer_ Private well_ City water Supply_ SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ce4 f BAaC/nrr- as Owner of the subject property 2 , hereby authorize / � to aalf, in all maaa relative to work authorized by this building permit application. ct o/n��r��'beh Signature of Owner Date I, /lryRK A�0151 as Owner/Authorized Agent he eby 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. RrNAA ll l�f� � Fit t Name — Igoe re of OwnerlAgent Data SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: 7T�� pp Not Applicable ❑ Name of License Holds YL/AN D. Alai-, I C5- 073513 License Number G M,t 6165- Address _T Expiration Dam ,Q`� ' 7 2457 Mgn ure Telephone 9.Reaistered Home Improvement ConVacfori Not Applicable ❑ 11 R 77Z Coan Nam/elSTII NL"rLL(ox'! ' RegaW�/�n�ZbQr 15( 6 f 14C Address// n / Expiration Date 107 �[/re[ 1��'//N/ AIA. r/ O�O�.r Telephone 3r7-4f 7 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-- . A No—_- ❑ City of Northampton Massachusetts r DEPARTMENT OF BUILDING INSPECTIONS 212 Mein Street Municipal Building '� C ` NortLamptan, Ma 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction ofan addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Nate:If the homeowner has contracted with/a corporation or LLC,that entity must be registered. Type ofWork: lVAt r¢'G'�N1CIN (RLL,�I L '' II IEsIIt. Cost:11 Address of Work: 14( htV' ice- lM,, d Mar+L,wf�6 M-i Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): _Job under$1,000.00 _Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: ili`l h AIM11 151r 414 6 �Y- 119772 Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton Massachusetts DOF BUILDING INSPECTIONS 212 main S 212 Main Street • Municipal Building Northampton, !A 41060 Massachusetts Residential Building Code Section 110.R5.1.2 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. Section 110.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner shall act as supervisor. 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. City of Northampton 55 '• .SS •�f Massachusetts I s G DEPARTMENT OF BUILDING INSPECTIONS i \ 212 Main Street •Municipal Building C* NortM1amp tnn, M.l 01060 M1�I;jla Debris 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. The debris from construction work being performed at: 1,41 �Vw' &«LV rgacY (Please print house number and stretet name) Is to be disposed ddLLof at: / r1, warnCf r/o01hZ}5 �e'{ri land £G.c r J `°n drrlI and, A,4 (9/SIS (Please print name a d location of facility) Or will be disposed) of in a dumpstte�r onsite rented or leased from: -H�A151 �h5tlyi�tep (•G /pC� 'l (Company Name and AAdddreess / 1�.lt gm iii ' i �16IL21 4 Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts Department of Industrial Accidents 7 Congress Street,Suite 100 Boston,MA 02714-20777 www.mass.go oidia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. AoDlicant Information y� //'' q Please Print Legibly Business'/Organization Name: A�j 115,1 Len 6 5 6 a'A Address: 7oGLH 4111 Aad IIT— City/State/Zip: 41A f� 0 .� Phone 9: y'I3 1"127 —21157 Are you an employer?Check the appropriate box: Business Type(required):tG 1. I am a employer with_ employees(full and) 5. ❑Retail or part-time).' 9. ❑Restauram Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7, ❑Office and/or Sales(incl, real estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] 8. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right ofexemption per c. 152,§t(4),and we have 10.❑Manufacturing no employees. [No workers'comp.insurance required]' 4.❑ We are a non-profit organization,staffed by volunteers, I L❑Hey dth Cp/ar�e II / I with no employees. [No workers'comp. insurance req.] 12.0 Other Ca H3Trve-�to ry (A)I �?Vzc�r` 'Any applicant do,checks box#1 must also fill our the section below showing thdr workers compensation policy i omonation- '9f[heci—honn hoLhave exempted themxlves,M1ut the coRomtion M1u other employees,aworkcn'rnmpensa[ion Wheyrsrequved and such an organiranion sM1ould check box#I. I am an employer that is providing so kers'cocaperesatio hour /or my employees. tBlelow is the policy informadarx Insurance Company Name: AQI a/U C^ 'A19dCl2`� �M�lN �j�r'CG'F itYHLfI!/t �h$Ujorm \/ Insurer's Address: S 1 7Y'• T City/State/Zip: AMP 14 9A 6Id6 Policy#or Self-ins.Lia# Expiration Date: / 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 ofcrimine]penalties ora fine up to 51,500.00 and/or one-year imprisonment,as well as civil penalties in the Form of STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations ofthe DIA for insurance coverage verification. I do hereby certify,under the ins andpenalties ofperjury that the information prm4dde�d ave is true and correct Sienature: Date: / 6 ZO Phone#: -' Z Official use only. Do not write in this area to he completed by city or town of ficial. City or Town: Permit/Liceme# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licens 6.Other Contact Person: Phone#: wwis now.gay/dig 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 ofthe foregoing engaged in ajoint 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 ofthe 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 deemed to be an employer." MGL chapter 152,g25C(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 your insurance company's name, address and phone number along with a certificate 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. Hart 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 ofthe 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). A copy of the affidavit that has been officially stamped or marked by the city or town maybe 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 www.mass.gov/dia Fona H.evisrd 02-29.15