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29-059 (9) 62 GILRAIN TER BP-2019-0001 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block:29-059 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit. Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Catceorv' Porch Enclosure BUILDING PERMIT Permit# BP-2019-0001 Pro ject# JS-2019-000001 Est.Cost:$14500.00 Fee:$94.25 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor. License: Use Group: EDJAZAB 050099 Lot Size(sa.IT): 20995.92 Owner: BELMONT JOSEPH&ABBY SARITA GIBER BELMONT Zonine: Applicant: ED JAZAB AT. 62 GILRAIN TER Applicant Address: Phone: Insurance: 9 SHEPHERDS HOLLOW (413) 222-4910 O LEEDSMA01053 ISSUED ON:7/5/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-BUILD 18X15 SCREENED PORCH WITH ACCESS FROM HOUSE THROUGH GARAGE 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 ft Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: O_ 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 Sienature• FeeTvpe: Date Paid: Amount: Building 7/5/2018 0:00:00 $94.25 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File 4 BP-2019-0001 (A)ST APPLICANT/CONTACT PERSON ED JAZPB ADDRESS/PHONE 9 SHEPHERDS HOLLOW LEEDS (1.i 3)222-4910 0 PROPERTY LOCATION 62 GILRATN TER MAP 29 PARCEL 059 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMI.APPLICATION CHECKLLU EN SED REQ TRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid TypeofConstruction: BUILD 18X15 SCREENED PORt4tTMTH ACCESS FROM HOUSE THROUGHNd"[�-S GARAGE /J OTE ' IArxa NN-t.- 8(2H S PIAN New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 050099 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9RMATION PRESENTED: Approved_Additional permits required(see below) l 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 D 0 /�.✓I�✓` 7 S t C Signature of 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. z , CC`�r� Department use only City of Northampton status of Pemlit: Building Department Curb veway Permit 212 Main Street Sewer/Septic Availability 1 4 Room 100 WaterlWell Avaaaejlity Northampton, MA 01060 Toro Sets of Structural Plans �� ..� phone 413-587-1240 Fax _ WkIiii UNH tlHl BN103d$NI DNIDi APPLICATION TO CONSTRUCT,ALTER, REP IRR NOVATE OR DEMOLISH ON OR TWO FAMILY DWELLING e(oa z - inr SECTION t -SITE INFORMATION 1.1 Prooeriv Address: a� w ��^ ctio to be completeds by office /'� Tta tz t� A J a9- 9 2 G1 Lrl^ I N of Unit T_LOtzrK4 Ce. (�/\/� 010 6C Zone Overlay District r r Elm SL District CB Dietrid SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: JDsCPH ar.u� ABBE`( 6t=.LVY o "7 62 G1L(Ls'I1J TGA Name(Print) Current Mailing Address'. Telephone Signature 2.2 Authorized Agent: E-D 3PUAb SNL"b2H)LleU 1ioL1, 0 Noma(Print) Current Mailing Address: t41'5 - 222 W9 1 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Oficial Use Only com leted by permit applicant 1. Building 3 i 50 o (a)Building Permit Fee 2. Electrical \ d p'O (b)Estimated Total Cost of Construction from 6 3. Plumbing .V Building Permit Fee 4. Mechanical(HVAC) `7 O 5. Fire Protection 6. Total=(1 +2+3+4+5) rj00 Check Number This Section For Official Use Only Date Building Permit Number. Issued: Signature: Buildiry Cwnmissmier/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) a Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This ca Tran to be filled in by Building Dei,so mem Lot Size Frontage Setbacks Front -- --- Side L `Zo. R:-150 ''. L: 20 R. 0 Rear.. "1J .30 _... Building Height 13(4. 13%, Bldg.Square Footage % -- Open Space Footage _. . ca (Lot area minus bldg&paved edict,) k of Parking Spaces NA .N is _ Fill: O _ ivolumc&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO (2) DOMT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW © 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 O 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 excavation,or filing)over 1 acre or is it pan of a common plan that will disturb over 1 acre? YES O NO J& IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition © FRpI.a.,..mentWindows Alteration(s) RoofingDAccessory Bldg. EDDemolition Signs [Ol Decks [p Siding IO] Other[Ell Brief Description of PrSsposed Work'. �iU tLD ISX15 SCRt;[N LJ 'PO RCIA W1141 PCCCSS FRO" {.{OV SL THM1ZOVG II Cr GL Alteration of existing bedroom Yes_�e No Adding new bedroom Yes k No Attached Narrative Renovating unfinished basement Yes >cNo Plans Attached Roll -Sheet ea.If New house and or addition to existing housing: complete the following: a. Use of building One Family N1 Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? Yc _ d. Proposed Square footage of new construction. 270 'SR F t Dimensions 1 3 X 1 CJ e. Number of stories? I L Method of healing? NONE Fireplaces or Woodstoves NO Number of each_ g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction WO 00 -FRAMC 's r—(Zi -biz Gti I. Is construction within 100 ft,of wetlands?_Yes 'A No. Is construction within 100 yr. floodplain_Yes X No j. Depth of basement or cellar floor below finished grade K A. 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 AUTHORVATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, .,)05� � �jL � rt10� ` as Owner of the subject properly hereby authorize LD JF ZAQ to actbehalf, in all matters relative to work authorized by this building permit application. - 7 01 Signtur o e Data naa I, r tJ �3n ZA3 ,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 Tthe pains and penalties of perjury. !ED J�ZAOj Print Name `. Signature of OwnedAtehq Date SECTION 6-CONSTRUCTION SERVICES 8.1 Licensed Construction onviso�Superr: Not Applicable Name of License Holder: 1—.V P-ZA C5 F L- 050099 9 License Number SN �rNtnvs NJLLDti/ y� 2- zo Address Expiration ate `�A LIl3 " zz_z - Hqi Signature �i Telephone 9.Registered Home Improvement Contractor: Not Applicable D LAli3C,-i WSTOW C r,,Pprtt 51 (oe� 10 Company Name Registration Number -ri N S7. 5 ( I8Iif Address 11 \\ LA 13 yq Expiration Date HAU LE.% Telephone 5-3 SECTION 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....... 11 No...... s City of Northampton " Massachusetts 1®t D DEPARTMENT OF BUILDING INSPECTIONS ' 312 Nein Street 4 Municipal Building $y Northampton, NA 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.C.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an 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:!f tire homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: R D D � T i D N pF 5 CR et1N1C+7 T'of2C0 Est. Cost: �l`A ,nSOO Address of Work: (0Z r� l LRA I � �"E.YZ , r LO R UN CE N W 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.C.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 petjury: I hereby apply for as building permit as the agent of the owner: CS-F L-Q 57009`7 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 i City of Northampton Massachusetts �•'.. i .� DEPARTMENT OF BUILDING INSPECTIONS � 414 Main Street • Municipal Building 26s Nortluun rcn, MA 01060 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 l 10.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 Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Nein Stzeat •Municipal Bvilainq ZJ \ - Northampton, M 01060 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: 62 Gs LA-1 J Imo. 'FL ID MAX, (Please print house number and street name) Is to be disposed of at: VP' LL6 -( T r=LvCUN6- , ���, a�� njtj (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signature of Pprmit 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. nIN The Commonwealth ofMassachuseffs _ Department of Industrial Accidents 3 $ 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.govildia \Corkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITFIN'G AUTHORITY. Applicant Information Please Print Leeibly Name (Businebs'O gang AlioNmdividuaq: Address: City/State/Zip: Phone#: Abalone.employer?Check the appropriate box: Type of project(required): L❑I am a employer with employees(fiill and/orpart-time)' 7. ❑New construction 2.®]am a sole pmprictororpormarship and have no employees working fortnein 8. ® Remodeling anyeapacity_INoveorkers comp_insunnu acquired.] 3❑l am a homeowner doingall work movaelf _ , ❑Demolition I No workers comp normal �` 9 4-❑1 am n hommw rs,and will be hiring contractors to conduct all work on my property. 1 will 10❑ Building addition ensure that all convncros either have Workers'eompenaadon insurance or aro sole I1.❑Electrical repairs or additions proprietors with no employees 12. Plumbing repairs or additions 5[]1 am a generalcontractor nd I eempl employees have crkers co p incurd on insurance: attached sneer 13.E]ROof repairs These submntmdors have employees and have workers temp_insurevce.: 6.❑weer�erntpomtionanditsomccshmecxacisWthnrnghtofexemptionporMGL c 14-00ther 152.§10fandwshnvenoemployses-ps wodmrs'romp_insumnccrequired] Any applicant that checks box#1 must also fill out the section below show Ing their workers'compensation policy information. t Homeowners who submit this serves it indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tComraemn that check this box inuit attached an additional sheet showing the name of eye sub-connacton and state whether or not those entities have onployeu Ifthe sobeoviractors have employees.they must provide their workers comp policy,number. tam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self Ins.Lic.#: Expiration Dale: Job Site Address: City/Stride/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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 enactor 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. /da hereby c�erjti untie?\{�he�pains andpenalties ofperjurythat the informationprovided above is true and correct Sienature: `-U 'j.J ` Date Phone#: 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#: i 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 of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee clan individual,partnership,association or other legal entity,employing employees. However the owner ofa dwelling house having not more than three apartments and who resides therein,or the occupant of the 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.§25C(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 ofpub]ic 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 sub-contractor(s)name(s),address(es)and phone numbers)along with their certificate(s)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, if an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Indusmal Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retained to the city or room 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. Citv or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the 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 piormtllicense number which will be used as a reference number, In addition,an applicant that must submit multiple permiVlicense applications in any given year,need only submit one affidavit indicating current policy information(ifnecessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be 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 I Congress Street, Suite 100 Boston, MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia 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 ofa 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 of the 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,§25C(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 my of its political subdivisions shall enter into any contact 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. Iran 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 remmed to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should yoo have any questions regarding the law or ifyou 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 ofthe affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proofthat 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(ix,a dog license or permit to bum 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 Fmm Revised 02-23-15