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30C-033 137 CLEMENT ST BP-2019-1124 GIS#, COMMONWEALTH OF MASSACHUSETTS May'Bu k:30C-033 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categorv:Porch Repair BUILDING PERMIT Permit# BP-2019-1124 Project# JS-2019-001826 Est Cost- $4500.00 Fee' $65.00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor: License: Use Group: CLAUDIO GARRIDO 89458 Lot Size(sp. ft.): 13939.20 Owner: BOBBE META zoning? SR000)/ Applicant. CLAUDIO GARRIDO AT. 137 CLEMENT ST Applicant Address: Phone: Insurance: 140 NASH HILL RD (413) 268-9052 HAYDENVILLEMA01039 ISSUED ON:4/12/2019 0:00:00 TO PERFORM THE FOLLOWING WORK:PORCH REPAIRS 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 4/12/20190:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-1124 APPLICANT/CONTACT PERSON CLAUDIO GARRIDO ADDRESS/PHONE 140 NASH HILL RD HAYDENVILLE (413)268-9052 PROPERTY LOCATION 137 CLEMENT ST MAP 30C PARCEL 033 001 ZONE SR000)' THIS SECTION FOR OFFICIAL USE ONLY- PERMIT APPLICATION CHECKLIST N REQUIRED DATE ZONING FORM PILLED OUT Fee Paid Building Permit Filled out Fee Paid V- TypeofConstructiom PORCH REPAIRS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 89458 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 Pemtit DPW Storm Water Management Demolition Delay 6zH-)y-Z619 Signatt Ire 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. 1 r Department use only City of NortEI Vnr/NWV mrt Building Deeway Peart 2-12 Main AvauehiiiryRoom1 1 P019 WRobNorthampton, tructural Planphone 413-587-1240s •• I w INEPFC, on.enc ,,n. 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 offices Map a6 c' Lot 63 ::I� Unit Zone Overlay District Elm St District CS District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED RGENT 2.1 Owner of Record: MG-FA- 3b& 6 Name(Pont) Current Mailing Address: �/-2 X Telephone 'signature 2.2 Authorized Agent: KZ4 J), e< Do I sla (� � #-tlz yo- Name(Pd Cument Mailing AAdddress. �J q 0�13)J()�- Signatui Telepho SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permitapplicant 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 (1 +2+3+4+5) ,jC)0 Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissionerlinspector of Buildings r� Date V EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) f Section4. ZONING All Information Must Be Completed. Permit Can Be Dented Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size ..._... Frontage ....._ Setbacks Front _. . --.... ...... Side U R: L:. R: .._. Rear Building Height Bldg. Square Footage % Open Space Footage % _..... Ilut wren minus bldg&pavN arnr #of Parking Spaces -- ---- Fill: !volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DON7 KNOW O YES O IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES 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 0 NO O 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 O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. t SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement�W�,ndows Alterations) ❑ Roofing Q Or Daars Accessory Bldg. ❑ Demolition E:1New Signs [0] Decks [q Siding [0] Other[M Brief Description of Proposed Workpolco+ ' Alteration of existing bedroom_Ves—2�_No Adding new bedroom Yes —2L No Attached Narrative Renovating unfinished basement Yes �<, No Plans Attached Roll -Sheet ea.If New house and or addition to existina housing, complete the following. a. Use of building One Family Two Family Other b. Number of roams 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 I .ala 714— Ab S,6 as Owner of the subject property ! A hereby authorize I L AV 42/0 / fFKK [ OD to act on my behalf, in all matters relative to work ied by this building permit application. Signature of Owne Ap /�99 Date I r2A)Ao [ IlvCcYV 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. Pdnt Name Signature of 0 g Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: /�r�`/ �^ Not A/pp�licable�"��❑v,/s / Q( Name M License Holder `- "cA Oi"'}� VL' '��� `-'-� —i(J`LL •/l �(J License Number I Yo -/ Y2 �D ' w4yrD�niylL�� q • �Y/� Atltlres lExpiration ate g sigrla Telepha 9.Registered Homs Improvement Contractor Not Applicable ❑ Company Name / Registration Number �(�ON(�L' (�Gf . ����[[��))'����`''p�J 1010 Address �q Expmabon'Date� Ow Telephcn6'&aG 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....... X No-._. ❑ r City of Northampton Massachusetts I 'I D212 iUiMENT .. e. aura. i INSPECTIONS S 212 Main Street o Municipal Building Northampton, M. 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 of an addition 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:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: Est. Cost: Address of Work: Date of Permit Application: I hereby certify that: Registration is not required for the fallowing 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: OV/,9f.. 1,5866-1 . 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 -s City of Northampton � s Massachusetts ' 4 � DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street a Municipal Building F '9� Northampton, [ 01060 rl'yW �a 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 I IO.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 I IO.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 z s�� Massachusetts { I DEPARTMENT OF =LDING INSPECTIONS e T 212 plain Street Municipal Building �.. Northa ton, M 01060 !p-':yjfla 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: 19� C-4,06 q ry t '�'7-- (Please print house number and street name) Is to be disposed of at: 1 1A,PZ Y- P� 1�✓ ' lease print ame and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Sig er I 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 ofMassachuseltc Department of Industrial Accidents 7 Congress Street,Suite 700 Bacton,MA 01174-1017 www.mass.gnP/dia «orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information ��((�� PI ase Print Le ibl Name(Businessl/OrganizatioNlndividuap: � 7 rib 0 Address.— M/O ]t(.Q--5d aj2z Pl q yr City/State/Zip: Ly__ Phone#: os-2- Are you an employer?Chad the appropriate bm: Type of project(required): 1 [3 l am a couldn't,wan empleyess(fail mobig features) 7. ❑New construction 2.K1 an a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'camp.programers required] S. Remodeling 3.❑I am a homeowner doing all work Myself[No worker;comp_insurance required 1 9. ❑Demolition 4.❑1 am a homeowner and will he mMvaors rk being cnnaeaorstondugall work progeny. twill 10❑ Building addition ce ensure at all nonaeither have workers compensation inamanceoraam sole 11.❑Electrical repairs or additions ,reactors withno employees. 12.E]Plumbing repairs or additions 5.❑Iamegenmlcontmemrand l lemehred Mesubbponbaemrs Ostedoa mwMr'nachedshcen 1}.0ROOf repairs These sub-comcrs have employees and have workers om cp.mauran h- we are aco lion and its ofimers have exercised their oughtf exemption 14.❑Other ❑ rpomgoon per WGL c 152,g I(4),and we have no employees-[No woders'comp.assurance mquirN.] 'Any applicant Mat checks box kt most also Fill out rise section below showing are,workers compensation pelicy information- 'loom who submit this affidavit indicating They are doing all work end then hire omside contractors most submit o new of idmit indicating such - tConanemrs Mat check this how must atmched an additional sheet showing the name of the submmuctors and sm¢wheMer or an,those entities have employees. tribe sub-conandoc have cnployees,they must provide Meir workers'comp.policy umber. I am 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 Date: Job Site Address: City/State/Lip: 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, bs'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 atement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under fire ties gfpsyclury that the information provided above is true andel correct Si nature: — Dat in Phone#: f 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#: 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 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 ofthis 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-connacmr(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 maybe 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)and under"lob Site Address"the applicant should write"all locations in_(city or town)"A copy ofthe 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