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24C-073 (5) 48 MASSASOIT ST BP-2019-0281 GIs#: COMMONWEALTH OF MASSACHUSETTS MV.-Block:24C-073 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Bath reno BUILDING PERMIT Permit# BP-2019-0281 Proiect# JS-2019-000471 Est. Cost: $30000.00 Fee: $195.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Group: MARK BONDE 67758 Lot Size(sq. ft.): 16117.20 Owner: GENGLER DAVID W&KAREN M OLSE Zoning:URB(100)/ Applicant: MARK BONDE AT. 48 MASSASOIT ST Applicant Address: Phone: Insurance: 205 PARK ST (413) 535-9529 () WC EASTHAMPTONMA01027 ISSUED ON:9/10/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:BATH 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# 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 9/10/2018 0:00:00 $195.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0281 APPLICANT/CONTACT PERSON MARK BONDE ADDRESS/PHONE 205 PARK ST EASTHAMPTON (413)535-9529 Q PROPERTY LOCATION 48 MASSASOIT ST MAP 24C PARCEL 073 001 ZONE URB(]00) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST E OSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildina Permit Filled out Fee Paid Typeof Construction: BATH RENO New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 67758 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION 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 Signature of Building 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. FR-ECEIVED f1 Department use only City of NorthampLntL!7� S2%Vof P rmit: Building Departm Curb Cut/D vewaPermit A, •: 212 Main StreeAvai bility OF SUILDIN IN.-AyRoom 100ORTHAMPTO . ateMWII A ' Illty �• Northampton, MA 0 Two Sets of Structural Plans phone 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 Map C Lot Unit Zone Overlay District Elm St.District CEI District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record:: fIMIJII 6.tgf� r6 p.SS 5vt t° 15T Name(Plrint) / Current M�'ailing�dStLe &,,T Telephone Sign 2.2 A th riz Agent: Name(Print) 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= 0 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) ,,.., 1 ��� �� � ' -<< . . � _._ _. � � _. ,�, Ott► �-� :.';�J� ' _ ..... ... i _ P .. .. 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 Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW ® YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO G�ONT KNOW ® YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained ® , Date Issued: C. Do any signs exist on the property? YES ® NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YESO NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excav06n,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO 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 ❑ Replacement Windows Alteration(s) Roofing Or Doors 1:1 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [O] Other[ / Brief Description of Proposed Work: '� Tt-j ...Fli>�L- _ 'L M PLl>itr , 1 C... '�(i���c' f�+l h►t' Alteration of existing bedroom Yes_{�le Adding new bedroom Yes Attached Narrative Renovating unfinished basement Yes _L1101" Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, 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 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize to act on my beh all potters relative to work authorized by this building permit application. 2LX r Signature of er _ _- Date I, C Off— NJI as Owner/Authorized Agent hereby d0blarethat the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed underthe pains and penalties of perjury. �1 Print Name i Signature of 16wrkr/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ / Name of License Holder: 1�I i Q�k �T N n e,� — y l0-7 -7 IS License Number 2�� �� A�r 4-t14 �i73 iN 1 .- Z 7,p Address � Expiration Date Signature I elephone 9.Realsj@%Mome improvement Contractor: Not Applicable ❑ �xc' �'�}.z��i�c�c�a� ► tom,�,2L� Company Name Re is ration Number Address Expiration Date 0 Telephone 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....... No...... ❑ City of Northampton " :;.. w Massachusetts 'F DEPARTMENT OF BUILDING INSPECTIONS a j 212 Main street • Municipal Building Northampton, 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"). NLG.L.Chapter 142A requires that the"reconstruction, alteration, renovation,repair, modernization, conversion, improvement,removal, demolition, or construction of an addition to any pie-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 building7'be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: �t� V a ► - Est. Cost: �d�(91)0� Address of Work: (A,9 � Date of Permit Application: G /„ 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: J� -7 14 U ! `7 ?f Datil Contract r Name HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Jr—) 4f'22j Date weer Name and Signature Y`. City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS T 212 Main Street •Municipal Building ^° Northampton, MA 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: (Please print house number and street name) Is to be disposed of at: OA-u,F�e F2r&g r f \j C_,, (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) b Signatur 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. f - _ � � k �t The Commonwealth of Massachusetts Department ofIndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aualicant Information Please Print Legibly Name(Business/Organization/Individual): Address: ,� `�r� 5"r City/State/Zip: Phone#: cA J:3 1; 2,1714 Are you an employer?Check- appropriate box: Type of project(required): 1. m a employer with employees(full and/or part-time).' 7. [:]New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $. EE11re—modeling any capacity.[No workers'comp,insurance required.] 9. El Demolition 3.E]1 am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 Q Building addition 4.[:]I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[:]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[:]Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: (V 1C L 1E S Policy#or Self-ins.Lic.#: ()I�)y K0 5`J V O Al (� 4 2,[-fxpiration Date: -,�jT� T Job Site Address: A 46-3A S 4)r S'r. KA 92T$LA4M City/State/Zip: 016 t6 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 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.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 pens of perjury that the information provided above is true and correct. Signature: 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): L ard of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector her act Person: Phone#: e .: .... p � , o � ❑ PR❑P❑SED ❑ CL O B H EXISTING R❑❑M Bath Remodel FL❑❑R PLAN B❑NDE C❑NSTUCTI❑N / DAVE GENGLER, 48 MASSAS❑IT ST, N❑RTHAMPT❑N, MA 413 535-9529 o W ❑ PROPOSED ❑ CL O B H EXISTING ROOM Bath Remodel FLOOR PLAN B❑NDE C❑NSTUCTI❑N / DAVE GENGLER, 48 MASSAS❑IT ST, NORTHAMPTON, MA 413 535-9529