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22B-069 (2) CITY OF NORTHAMPTON � OFFICE OF THE TREASURER 212 Main Street, Room 305 Northampton, MA 01060 Telephone:(413)587-1296 Fax: (413) 587-1289 Kristine A. Bissell Kristen J. Yezierski Treasurer Assistant Treasurer October 15, 2018 Jericho Commercial Construction LLC 874 State St. Springfield, MA 01109 To whom it may concern, Your check, number 1291, in the amount of$390.00 payable to The City of Northampton, was not honored by your bank. Your check was returned due to non sufficient funds. The City of Northampton's Building Inspectors Office has been notified of your unpaid status. Any check that is returned by the bank to the City of Northampton as unpaid is subject to a fee of $25.00 per check. You may make your payment of$415.00 by cash in person or by cashier's check or money order, payable to the City of Northampton at the following address: Treasurer City of Northampton 212 Main Street, Room 305 Northampton, MA 01060 Sincerely, Kristen J. Yeerski ECOPY VAINIV FEE 41 city of -PeoplesBank oc� 15 2o1$ tattllamptoo EASuR Notice Date: -2018 Account Number: 1053731113 CITY OF NORTHAMPTON DEPOSITORY ACCOUNT Current Balance: 18, 946, 701 .E 212 MAIN ST STE 305 NORTHAMPTON MA 01060-3112 RETURNED CHECK CHARGE NOTICE The enclosed check(s) that were deposited to your Inst' l Interest Analysis account have been returned. Please deduct the amounts listed below from your account balance. If you have any questions concerning this notice, please call us at (413) 538-9500 . *061000146* NSF 10/10/2018 CO 4901370368 '- 0 ru This is a LEGAL COPY of rLnn your check.You can use it C3 *0610001,46S, NSF '7 04/26/2016 -0 the same way you would rn C3 4126377744 �q use the original check. C) " im Er C3 TNn s is a LEGAL COPY at LrArZ RETURN REASON - A C3 r�l your MGM YOU=use it mt'A t 29t tho. , m. ay)(01.1woum Or ru NOT SUFFICIENT 17�- F9 use Me wiol"al 040k. .0" FUNDS M ru RETURN REASON-A C-30 r'- NOT SUFFICIENT "F4 0 C3 JV FUNDS ru r, C3 & C3 r%- C3 DOLLAAS We— CM KI C3 c(3 MW911ITFIELD BANK C3 rq ru ro" 3�-vat"- 60 6=1 11*00 12 9 Iu' 41:211,,8746041: 698400095L.N' 100000039ouu"' 41: 2118 ? 16041: G98 ?000954110 1291 11,00000 3 9000,11 ZIN W 1211 330 Whitney Avenue, Holyoke, MA 01040 413.538.9500 bankatpeoples.com Printed on LENDER Member FDIC/Member DIF RecKled Raw City of on,I Louis Hasbrouck<Ihasbrwuch@nmrthamptonma.gov> 83~85 Spring Street 1 message Louis Hasbrouck^|haebmuok@northomp0nnmu.gov> Sun,Sep 1O.2D18o|2:21pK8 Tb:]ehchoQmg@gmmiiomm Cc: Daniel VYasiuk<dwasiuk@nohhamptonme.gov> Greg, I've received the permit application for 83'O5Spring Street. As I said when we met at the house,the permit fee is doubled because work started without a permit,and there is a$50 fee to remove the stop work order,The permit fee, based on the estimated cost of work is$390.Doubled, plus the$50 fee;total o83O.You paid$3BO; balance due,$44O. The description of work does not include mold remediation.Based on the water damage to the building,you need to remove sheetrock and test for mold.As much sheetrock as necessary must be replaced to ensure remediation and safe indoor air quality.Certification that mold has been effectively remediated is required before the walls are closed up.Additionally,the building must beinspected bythe Northampton Health Inspector before the walls are closed. An electrician must certify that the building wiring has not been damaged by water. The water leaks in the basement must be addressed,including waterproofing,sump pumps,ventilation and dehumidification. Please send a check for the balance of the permit fee($440),and also provide a detailed,room by room list of the work tnbe performed. Louis Hasbrouck Building Commissioner City ofNorthampton Town ufWilliamsburg (413)587c1240office (413)587'1272fax 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 a joint 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 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 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. If an 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 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 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 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 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 Form Revised 02-23-15 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 a joint 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 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 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 sub-contractor(s)name(s),address(es)and phone number(s)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 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 Iicense 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 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 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)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 1 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 The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia v Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information A Please Print Le ibl Name(Business/Organization/Individual): r Address: PArVaE: /l ) City/State/Zip: Phone#: ' -�� il/ Are you an employer?Che k the appropriate box: Type of project(required): I.E]I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.Dfam a sole proprietor or partnership and have no employees working forme in $•IVemodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.F_1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10E]Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12. P umbing repairs or additions 5.M I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13OOf repairs These sub-contractors have employees and have workers'comp.insurance.$ LJ� 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14'Leg tether `7 L� 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 isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/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 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 penalties of perjury that the information provided above is true and correct Signature: 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#• City of Northampton Massachusetts '{t r .G DEPARTl&NT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building y Northampton, MA 010601` 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: PL-3. C4 ` C (Please print house humber tnd street name) Is to be disposed of at: (Please print name an ocati-on of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) SignaturJ of Permit Appffcant 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. City of Northampton Massachusetts5 m DEPARTMENT OF BUILDING INSPECTIONS 212 Main street • Municipal Buildingc3- Northampton, MA 01060 § 11�� 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 Massachusetts DEPARTMENT OF BUILDING INSPECTIONS " 212 Main Street • Municipal Building Northampton, MA 01060 14 AFFIDAVIT Horne 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 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. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: Est.Cost:�ab Address of Work: I VOct A. Date of Permit Application: 160 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 ermit as the agent of the owner: yyyyyy- r �j.. [ (�U,k) 't Vatt Contractor Nam 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 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Su ervis r: Not Applicable ❑ Name of License Holder: '< ) O / License Number ( -L,/7 Igo Address Expiration Date /,zil Lt�—� 7409. Signature fTelephone 9.RealsbmW Hom kwfovement Gor*tractw: Not Applicable ❑ Company Name Registration Number n��r C.1 U . Address Expiration Dade T Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))_7 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....... f No...... ❑ SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable} New House F-1Addition F-1Replacement Wyrfdows Alteration(s) ❑ Roofing Or Doors [fid Accessory Bldg. ❑ Demolition ❑ New Signs [I3] Decks [C] Siding jI Other[E3] Brief Descr' tion f ProposedS Work: Alteration of existing bedroom Yes�No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement es No Plans Attached Rall -Sheet sa.ff New houseand or addition to exiStIng hoils ln ete the followl ": a. Use of building: One Family Two Family Other b. Number of rooms in each family unit: cam. Number of Bathrooms_ _ c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions 91 e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Com liance. Masscheck Energy Compliance form attached? t 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_ "r Private well City water Supply SECTION?a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby a orize auk `—� to act on behalf, in ll afters Itive fo work a6thdrized by this b ilding permit applicatio . Signatur of weer Date29 191F�_ 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. Print Name Signature of Owner/Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Denied Due To Incomplete Information Existing Propos WqLirbd ty Mg This column to be filled in by ent lug. Lot Size _. Frontage ._...._ _.......-._ ... _ _-".." ..- _, _-.-_ _....._.. -_ .... Setbacks Front F _•_.••- SideL. ..........._ R:----_. ... L:' ._. '; R ...... Rear Building Height Bldg. Square Footage """" Open Space Footage (Lot area minus bldg&paved a parking) #of Parking Spaces " Fill: volume&Location _. . _..., _...."-. _...":_ .. _....-...-._ _._-... ..._. .... �..,.. _...- A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DON'T KNOW er YES 0 IF YES, date issued:: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON-r KNOW & YES 0 IF YES: enter Book Page; and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW Q YES 0 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 0 NO ef IF YES, describe size, type and location: _.... .........v _..... .... .. _. "- _.._". 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, excay6tion, 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. City of Nort amp on rtm nt : 1 Me n tre a A DEPT.of A o 060 RT - ax 413-587-1272 4 A 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 Lot' R Unit (.0 zone overlay Di.trlct Elm St District CB District SECTION 2 PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: ILI Name(Priv Current Mailing Address: LAA 11A- Telephone i 11 Signature V i 2.2 Authorized Agent: A44- 00 Na a(Pri Current Mailing Address: ` (.-7!9,- j 73 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building fa (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Perm e � o Oa 4. Mechanical(HVAC) sfi� WO3`� 5. Fire Protection iEt 6. Total=(1 +2+3+4+5) Check Number I This Section For Official Use Only ate Building Permit Number: Issued: Signature: Building Commissionedlnspector of Buildings bate i 2,r Ji&09"-4� @ 9 Ovu 1, c ax� EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) File#BP-2019-0329 Q C h e c/G APPLICANT/CONTACT PERSON JERICHO COMMERCIAL CONSTRUCTION LLC ADDRESS/PHONE 11 PEARL ST SPRINGFIELD PROPERTY LOCATION 83 SPRING ST MAP 22B PARCEL 069 001 ZONE URA(100)/WSP(100)/WP(100)/ 00, U� THIS SECTION FOR OFFICIAL USE ONLY: -1v� PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid ZAA Building Permit Filled out Fee Paid Typeof Construction: REPLACE FRONT DOORS,WINDOWS, SIDING AND ROOF New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 022613 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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.