32A-059 (5) 68 UNION ST BP-2019-0992
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map.Block: 32A-059 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categorv, ROOF BUILDING PERMIT
Permit# BP-2019-0992
Proiect# JS-2019-001635
Est. Cost: $8000.00
Fee $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License.
Use Group: KEVIN NETTO CONSTRUCTION INC 1317
Lot Size(so.ft.): 15681.60 Owner. NETTO KEVIN C&JOVITA B&FRANK M NETTO&MARY M NETTO
Zoning, URC(100 / Applicant.- KEVIN NETTO CONSTRUCTION INC
AT. 68 UNION ST
Applicant Address: Phone: Insurance:
90 Southampton Rd (413) 527-3168 Workers Compensation
WESTHAMPTON MA01 027 ISSUED ON:3/13/2019 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF
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 OccuoancV Signature:
FeeTvpe: Date Paid: Amount:
Building 3/13/20190:00:00 $40.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck-Building Commissioner
RECEIVED
Department use only
City of North Impt n 2 201 k-welay,
it
,af Building De rtm nt NAR 1 Permit
212 Main tree`� �(�. Room 00 Derr llabiliryNorthampton, ITer.arr*oN.rnnouctural Plans
phone 413-587-1240 Fax 413-587-1272 P"Sho Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION 3P t 9-qql
1.1 Property Add This nation to be completed by 011110111Map ���+� Lot 0s%gUnit
68 Union Street Zone Overlay DM1nct
Om at District Co DNbNt
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED ADEM
2.1 Owner of Record:
Kevin C. &Jovita B. Netto 90 Southampton Rd.,Westhampton,MA. 01027
me(POM) cuaem Mallmg adaresa: 413-527-3168
Telephone
2.2A ±Amant'
Name(Poet) Current Mailing Address'.
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by cormit appliclunt
1. Building $8,000,00 (a)Building Permit Fes
2. Electrical (b)Estimated Total Cost of
Construction from 8
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
8. Total=(1 +2+3+4+5) Check Number 7
This Section For Official Use Only
Building Pemril Number: Date
Issued:
Signann 3- 13-2aq
BuileNg Conmluldnwnmpeclar M Buildings Date
EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Most Be Completed, Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
His column to be BIIea In by
Building Dsp snow
IAA Sim
Frontage
Setbacks Front
Side L:-R:- L: R:_
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(W area minus bldg&paved
♦of Parking Spaces
Fill:
(volume&1—soon)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document A
B. Does the site contain a brook, body of water or wetlands? NO O 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 O
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 O
IF YES, describe size, type and location:
E. Wel the construction activity disturb(Gearing,grading, xcavation,or filling)over 1 acre or is d 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.
SECTION 5,DESCRIPTION OF PROPOSED WORK fichwk all applicable
New House ❑ Addrdon ❑ Replaoemm�t Windows Ageratlo*&) p Roofing p✓
Or Doors E,
Accessory Bldg. ❑ Demolition ❑ New Signs [Ol Decks 117 SNling[O] Other[Oj
Brief Description of Proposed SWI,rFaengmof.lm&wva bemcr.&It,imtell uaw ebi.o,e
Work'.
X X
Alteration of ewsfing bedroom_Yes_No Adding new bedroom Yes
Attached Narrative Renovating unfinished basement Yee No
Plans Attached Roll -Sheet
on.If New house and or eddHlon to existing housing-Complete the followina:
a. Use of building,One Family Two Family Other
b. Number of rooms in each family unit. Number of Bathrooms
c. Is Mere a garage attached?
d. Proposed Square footage of new wnsWction. Dimensions
e. Numberofstodes?
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 1 D ft.of wetlands?_Yes _No. Is construction within 100 yr. floodplain_Yea_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 7s-OWNER AUTHORIZATION-TO BE COMPLETED=
OMPLETED WNEN
OWNERS AGENT OR CONTRACT`OORR AP(PLI�ES FOR BUILDING PERMIT
1, �$� .\ `1a.\ .as Owner of the subiect
properly Kevin C. Netto Ce4struction, Inc.
hereby authorize
to my behalf, in all matters relative to work authorized by this building permit application.
Signature\\ Ovmer Data
1, alt"\TG� 1V Y] as Owner/Authorized
Agent hereby declare that the etffiemente and information on the foregoing application are true and accurate,to the e%—S olmy knowledge
and belief.
Signed under the painsand Penalties of perjury.
Pd
Signature OwnerlAgent Dale
SECTION S-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Kevin C. Netto
NYIM W LYMIY XdWr'
Lioervie
Kevin C. Netto CS0S001317
Adda Expiration Data
90 Southampton Rd., Westhampton, MA. 01027 12-02.19
Sign" p raleptwrw 413-527-3168
t l.-
9.Realetered Nemalmprovenrnt ConlYplor: Not Applicable ❑
Y*XvrQ-
Comparry Name Registration Number
013945
AtldreY o x
Expiration Date
Telephone 5a`t 3\1nA 07-09-20
SECTION IP WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.o.152,1 25C(8))
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 VY....... 99 No...... ❑
City of Northampton
Massachusetts
' �� D&PAR1f9a1T OF BDILDING ZABPBClZOAB
x
212 Main strwt • INnicipal Wilding �s
s..thup , m. 01060 fy p0�
AFFIDAVIT
Home Improvement Contractor Low
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of connections 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,alteretion,renovation,repair,modernization,conversion,
improvement removal, demolition, or construction of an eddibon to any preexisting 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:tjthe homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work, \M;5NJpN\ Est.Cost:
Of
Address of Work.
Date of Permit Application: \-\'q
1 hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
Job under$1,000.00
N[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 perjury:
1 hereby apply for a building permit as the agent of the owner:
Date Contractor Name HIC Registration No,
OR:
Notwithstanding the above notice, 1 hereby apply for a building permit as the owner of the abo roPerry:
--!)A\-
Date Owner Name and Signature
City of Northampton
•.+f Massachusetts yis v'cA�
bc
'I. L9TAa9ffilT OF 01I ici lftilan, S
zaz wvn sth. .x, M 01 wuuna
xorcn..ow., w ovoso
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: M�
(Ple ee pdn nem nd to n of cility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signa Ire of Permit Ap 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
I Congress Street,Suite 100
Boston,MA 02114-2017
Bnumis ass gov/dia
W11 orkers'Compensation Insurance Affidavit: Builders/Conimcwr%/Eketricians/Plumben.
TO BE FILEH WITH THE PERMITTING AUTHORITY.
Aoolic lot Information Ple se Print Legibly
Name(Busimss/O ganirmialludividued):Kevin C. Naito Construction, Inc.
Address:90 Southampton Road
City/State/Zip:Westhampton, MA. 01027 phone 4:413-527-3168
Are yos ss emplorW.Ch"am.ppmprbg has: Type of project(required):
LO l ami employer with
3 empl".(flland/m pen-time)I 7. ❑New constriction
2.❑lememile propriemrmlerowrshipmd leve lw employees Woking formein g, ❑Remodeling
any capacity.[No woken comp.insurance restated
1.❑ wk
l am a homwner doing all womyself[No wokers come p.insumnereunited J q. [1 Demolition
4,111 am a homeowner and will be hiring enumerators no wnit.,all work on my pmen
py. 1 will 10 L]Building addition
ensure drat all convectors entreat have worker'compemvion imonmsm are mile II.❑Electrical repairs or additions
propunms with no employees. 12,❑Plumbing repairs or additions
5❑1 am a general contmomr and 1 have hired tho s l,-oam e o s lined on the attached sheet.
'Ifiesesubcomracmrs have employe.and hove wokers'on, m.et 13.❑y Rswfrepairs
6.❑We are a corporation and in ofheers have exemimd Heir right of exemption Per MOL c- 14.❑O(her
152.00),andwehaveswemplamose, [Nocookers'comp ^%m'anw requirW.l
'Airy applicem that checks bas NI most also fill am the section below showing their worlen compensation polity information
I norneowners who submit this andavit indicating Indy are doing of work and then him outride contractors must submit a new andun milwasing such.
:Coa.m that Check this are mum attacheda^additioal shat showing the aama of the sulhx nmmctorsand stale%hoar of not those emits.have
employees. If the suarcontrxmrs have employees,they most provide their worion'wrap.policy number.
l am an employer that is providing worken'rompensadon insurance for my employees Below is rhe poficy and job site
informadoa
Insurance Company Name:AIM Mutual Insurance Company
Policy q or Self-ins.Lie,M:WCC-500-5008057 Expiration Date:03-02-20
Job Site Address:68 Union Street City/State/Zip:Northampton, MA 0106(
Attach a copy of the worsen'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 fora of a S I OP 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 shiderdrepidirismadpienapser ofperjury that the Informadon provlded above Is urge and correct
Shan Date- �NAVA
Phone N:413-527- 168
Ofjhdal use only. Do not write in this area,to be completed by city or town ofllcial.
City or Town: Permit(License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone It: