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49-035 342 GLENDALE RD BP-2020-0795 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:49-035 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ALTERATION BUILDING PERMIT, Permit# BP-2020-0795 Project# JS-2020-001379 Est.Cost: $20000.00 Fee:$130.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sg.ft.): 70131.60 Owner: DIBRINDISI JOSH Zoning:- Applicant: DIBRINDISI JOSH AT. 342 GLENDALE RD Applicant Address: Phone: Insurance: 342 GLENDALE RD (413) 552-6344 O FLORENCEMA01062 ISSUED ON.111612020 0:00:00 TO PERFORM THE FOLLOWING WORK.-ADDING DECK, WINDOWS, SIDING, ROOFING 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 1/16/2020 0:00:00 $130.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2020-0795 APPLICANT/CONTACT PERSON DIBRINDISI JOSH O ADDRESS/PHONE 342 GLENDALE RD FLORENCE (413)552-6344 PROPERTY LOCATION 342 GLENDALE RD MAP 49 PARCEL 035 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Tvpeof Construction: ADDING DECK WINDOWS,SIDING, ROOFING New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFRMATION 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 L WE& SlI1 �o gnature of Building Official U0 Date IF 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. Department use only City of Northamptgn ,� Status of Permit: �. Building Department 212 r<��i b Cut/Driveway Permit I 4 212 Main Stre�t t eywer/Septic Availability 1 Room 100 ✓Q Wa`tir ell Avalilability � `!! Northampton, MA 010,60 N ,3 Two S sof�ructural Plans phone 413-587-1240 Fax 4t3- -1272 2 lot/ to PI 6S r Oth Spe fy APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENO hrI 14011_IS A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 3 yd 6L Q,l1ClU,e. Map Lot '� Unit Inr(z"ic C AA /-( d(06 j Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: _1 SI 3 . G- vide, Ajj (Print)./ re t 63 qLj �&__ - Si 2.2 Authorized Agent: Name(Print) Current M dress: � c� e Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant li.-.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 -0 6 0 0 Check Number This Section For Official Use Only Building Permit Number: 69—BUJ_70 Date Issued: Signature: IT IV Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 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 of tze lam'e Setbacks AM ,A �Tde L: R: L: R: N110517 Building Height Bldg. Square Footage /V % Open Space Footage % (Lot arca 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 (2�- DONT KNOW ® YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DON'T KNOW 0 YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO a DONT KNOW ® 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 C) IF YES, describe size, type and location: 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, excavation,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 inflows Alteration(s) Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [06 Sidin�] Other[Q Brief Description of Proposed , Worlf4ppENNIIIINIJIMIM Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6 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 behalf,in all matters relative to work auth this building perm—itapplication. MW Signature of Owner Date I, —TQ5t-'o'4 as Owner/Authorized Agent hereby declare that the statemytsaninformation on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penaltiey. Prin7Na,)e Sig ture of ner/Agent Date City of Northampton ' rl Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 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"). M.G.L.Chapter 142A requires that the"reconstruction,alteration, renovation, repair,modemization, 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: Address of Work: 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.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: 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 City of Northampton P. X5,5 Massachusetts c, DEPARTMENT OF BUILDING INSPECTIONS `'' 212 Main Street •Municipal Building yeti cD 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: Vet I 11(zV AeLl I (n (Please p nt name and locatioA of facilit Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Sigifature 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. The Commonwealth of Massachusetts Department of Industrial Accidents s 1 Congress Street,Suite 100 a Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information h I Please Print Le ib Name (Business/Organization/Individual): S t 6r ikA t, S I Address: 3 Ll a Gl eAd ciA e 1l�d City/State/Zip: 60re,c D I o6a Phone#: L//3 Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.[]1 am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.[OI am a homeowner doing all work myself.[No workers'comp.insurance required.]r ✓� 10 D 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.E]Plumbing repairs or additions >.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ repairs re airs These sub-contractors have employees and have workers'comp.insurance.t 6. We are a corporation and its officers have exercised their right of exemption 14.❑Other ❑ rpop per MGL c. 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. lam 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.#: V Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation Jolicy 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 ce fy under the pains and penalties of perjury that the information provided above is true and correct. Si ature: Date: /of ,- ' Phone#: Lf 1 �"ZC7 Oficial 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#: ABRASIVES 8c TOOLS, INC. abrasivesandtoolsinc.com 1-800-322-1304 fax: 1-800-615-8270 -� CV T J -1 —� o > 9j ' 1 `° 't Milacron 3M Ceratip Titan Wikus Mitutoyo Dotco Guhring Radiac Tyrolit Mitsubishi Regal Duramill Cleco Dynabrade Abrasive Belts Vitrified & Diamond Cutting Tools Turning & Milling Inserts Air Tools Discs Grinding Wheels Carbide & HSS Drills • Saw Blades Measuring Inst. Scotchbrite Segments End Mills Burrs Coolants Serving New England Since 1944 A A65RASIVES & TOOLS, INC. abrasivesandtooisinc.com 1-800-322-1304 fax: 1-800-615-8270 r-- f( `+i lJ I � II i s I i !! i � O , C) , r r Z —; C) r CIO i i m i W Milacron 3M Ceratip Titan Wikus Mitutoyo Dotco Guhring Radiac Tyrolit Mitsubishi Regal Duramil/ Cleco Dynabrade Abrasive Belts Vitrified & Diamond Cutting Tools Turning & Milling Inserts Air Tools Discs Grinding Wheels Carbide & HSS Drills • Saw Blades Measuring Inst. 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