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44-063 (3) 949 FLORENCE RD BP-2020-1042 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:44-063 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Above ground pool BUILDING PERMIT Permit# BP-2020-1042 Proiect# JS-2020-001770 Est.Cost: $600.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use croup: Homeowner as Contractor Lot Size(sa.ft.): 14853.96 Owner. MOLITORIS zoninjz: Applicant. MOLITORIS TIM AT. 949 FLORENCE RD Applicant Address: Phone: Insurance: 95 PARK HILL RD EASTHAMPTONMA01027 ISSUED ON:4/8/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-ABOVE GROUND POOL 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 4/8/2020 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Departrrient use only, City of Northampton Status of Permit: Building Department Curb CuttDriveway Permit f A 212 Main Street SeweriSepjic Avafiability Room 100 Water/Well Availability E' Northampton,MA 01060 Two Sets ofStntctural glans phone 413-587-1240 Fax 413-587-1272 PioVSlte Puns Other 5pecify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 Property Address thi section to be compiet d by office Map _,_.d Lot Unit Zone Overlay District <X. Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT I 2.1 Owner of Record: � r iz / ;i-i svl�; 1��r ! l i t .t �Jtz't: Name(Print— ) Current Melting ess s 2 Telephone Signat 2.2 Authorized Anent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION GOSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee r 2. Electrical (b)Estimated Total Cost of (/ Construction from 6 /t ACVL 3. Plumbing Building Permit Fee �� F(y/�(,`Jlo 4. Mechanical(HVAC) 5.Fire Protection QOK 07 6. Total=(1+2+3+4+5) <;a -: ; Check Number '1 This Section For Official Use Only Building Permit Number: de! qz- Dated: Signature: Building Commissionerpnspector of Buildings Date EMAIL ADDRESS(REQUIRED;EITHER HOMEOWNER OR CONTRACTOR) MAP 3 0 2020 DEPT.OF DUII_DIM-7 INSPECTIONS ��NORTHAMPTON, f,1A 01060 S�ction A. ZONING Alt Information Must Be Completed.Permit Can Be tented Due To Incomplete Information \ Existing Proposed Required by Zoning 'this coltmur to be f lkd in by -.-" Auitdirrg S�rartmart of Lot Size Frontage Setbacks Front Side L: R: L: R. Rear Building Height Bldg.Square Footage of Open Space Footage (Lot area minus bldg&payed rkin) ff of Parking Spaces �✓ 1 'S Fill: V (wiume&1-mation A. Hasa 5 tial permit/Variance/Finding ever been issued forlon the site? NO DONT KNOW 0 YES 0 IF YES,date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW © YES Q IF YES: enter Book. Page anti/or Document#; a B. Does the site contain a brook,body of water or wetlands? NO DONT KNOW 0 YES IF YES,has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained 0 Date Issued: C. Do any signs exist on the property? YES O NO 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 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 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. lo viV Fv tY 17 SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicablel New House r--J Addition Replacement Windows Alteration(s) ❑ Roofing M Or Doors Accessory Bldg. ' Demolition ❑ New Signs 111 Decks 10 Siding(D1 Other 1d1 Brief Description of Proposed Work. , i wi ri lf( 6 - t..... Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Ga.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 I. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank i City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, ,as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date 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. Pnnt Name � r Signature of tTwter! gent Date SECTION S-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Meme of Licenso Holder license Number Address ExpkaEion Dale " Signature Telephone 8 Realstered Home Improvement Contractor Not Applicable 0 Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.M,§26C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit wig result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... ❑ No...... 0 City of Northampton Massachusetts nWARTMMT OF nusLDzxG IxspscrZoms { �. 222 Mai. Street •Municipal Building d c' aorthmpton, 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("H1C"). M.G.L.Chapter 142A requires that the"reconstruction,alteration,renovation,repair,modernization,conversion, improvement,removal,demo tfan,or construction or an addition to any pre-existing owner-occupied buitding containing at least one but not more than four dwelling units....or to structures which are aogacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that en14 must be registered T of Work:_ Y & tv clL,it'ru 3 f�1 , y�,. �,� YID ! > r i� Est.Cost: _ Address of Work: 2D r"1 d 1 1ht:.e kb..... 71,42t .t 't'2r 1 Wi n'�`z4,) I 0f(}(p p, r Date of Permit Application: _:i f eta _C 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 o of the above property: DatLi f Owner Name and Signature """i City of Northampton Massachusetts �? DEPARZMMT OF BUILDING INSPECPION8 at k 212 Main street s municipal suildinq ', -a- Northampton, Mil 01060 y Massachusetts Residential Building Code Section I IO.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 I O.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 i„ Massachusetts + t ZCPAR72NNT OF BUILDZNG INSPECTIONS {, � 232 Main Street -Municipal Bnildinq NorthwWton, Ida 03060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40,S54,1 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: ��tt{t� � (j}jl�{'`�'�•df.('ry J�y �J✓�� r ,/�,y %}� �J J�J (Please print house number and street name) _T ° Is to be disposed of at: V/� /J (Ple a print name and location bf facility) >�1 y ? Or will be disposed of in a dumpster onsite rented or leased from: J (Company Name an dtidress) Signature of Pe mit 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 oflndustrialAccildents I Congress Street,Suite 100 Boston,MA 02114-2017 www.masxgov/dia '/Yorkers'Compensation Insurance Atlidavk;ButldeiWContractors/Electricians/Plumbers. TO BE FILED WITH THE PERAIIMNG AU7710RITY. Applicant Information Please Print L"ably Name(Busim&Organization/individual):_ CL/y1 Al2 d f Ult'j Address:__�i o� "'jrFtICidi"J p� City/state/Zip: , k'7�>j f dyl l l�iv lJ,l) t11 Phone#:__ U� Are you an employer?Check Ike appropriate boa: Type of project(require ft 1.❑1 am a employer with^employees(full and/or part-time).* 7. ,a-New construction 201 am a sole proprietor or partnership and have no employers working forme in $,Q Remodeling any capacity.[No workers'comp.insurance required.] a homeowner doing all wotk myself,tNo workers'comp.insurance required.)t 9• ❑Demolition 4.�❑1 am ahomeowner and will be hiring contractors to conduct all work on my property.1 will 10 D Building addition ensure that all contractors either have workers'compensation insurance orate sale 1 1.❑Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions S.Q 1 am a general contrtutur and 1 have hired the sub-contractors listed on the attached skeet. These sub-contmetars have employees and have workers'comp.insurances 13.0 Roof repairs 6. We arc a corporation and its officers have exercised their right 14.©Other � � gh[of azenmption per h1GL c 152,§I(4),and we have no employ",(No workers'comp.insurance required.] .Any appiimnt that checks lwx B l most also fill out the section below showing their workers'compensation policy information f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. ?Contractors that check this box must attached an additional sheet showing the nerve of the sub-contractors and state w'bether or not those entities have employees If the sub-contractors have employees,they must provide their workers'comp,policy number. Iota an employer that is providing workers'compensadon insurance for my employees. Below is the policy and job site information, Insurance Company Name:____ Policy#or Self-ins.Lie.#:` _ 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 MGI.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 Ute form of a STOP WORK ORDER amid a fine of up to 5250.00 a day against the violator.A copy of this staterpersy"may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ida hereby certify sinderthepAM,4 and penalties of perltrry that the information providedd above is true and correct. t•e �✓ __.f'^1 '_�—___ .--�atC: .? ty�,_err �c,�-.z'.:7 f:� Thome k /?. • 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 Heakh 2.Building Department 3.CStyfTown Clerk 4.Electrical Inspector 5•Plumbing Inspector b.Other Contact Person:,_ Phone#