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37-090 (7) 319 ROCKY HILL RD BP-2020-1246 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:37-090 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:ACCESSORY APARTMENT BUILDING PERMIT Permit# BP-2020-1246 Project# JS-2019-002015 Est.Cost: Fee: $100.00 PERMISSION IS HEREB Y GRANTED TO: Const.Class: Contractor: License: Use Group: STEPHEN YOSHEN 88490 Lot Size(sq. ft.): 628570.80 Owner: THEBERGE STEPHEN Zoning. Applicant: STEPHEN YOSHEN AT. 319 ROCKY HILL RD Applicant Address: Phone: Insurance: P O BOX 41 (413) 695-78010 CUMMINGTONMA01026 ISSUED ON:6/19/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-NEW ACCESSORY APARTMENT 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 6/19/2020 0:00:00 $100.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner )^ Department use only �i City of Northampton Status of Permit Building department Curb CuUDriveway Permit 212 Main Street Sewer/Septic Availability JU Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans P PT phone 413-587-1240 Fax 413-587-1272 Plot,/Site Plans Other Specify'UNi LIGATION 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 3q T Lot D Unit Zone Overlay District � 7� -1z.. Elm St.District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORiZED AGENT 2.1 Owner of Record: v Name(Print) s Current Mailing Address: Telephone Signature " - 2.2 Authorized Agent: yq j�q yj Name(Print) Current Mailing Addre : e Signature Telephone SECTION 3-ESTIMATED CO STRUCTION COSTS Item Estimated Cost (Dollars)to be Official Use Only completed by permit applicant 1 Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from(6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 160 5. Fire Protection 6. Total =(1 +2 + 3+4+ 5) Check Number This Section For Official Use Only Building hermit Number 44L&4 C Date Issued: Signature: 6 1 o Building Commissioner/Inspector of Buildings Date C h a� ��� . ...... ....___.. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aaalicabiel New House ❑ Addition Replacement Windows Alteration(s) Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[0] Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom—,_ Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roil Sheet 66I onAdexitfina houMho. complete,the following- a. Moult'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 ? 1 to act on my be4)f, in all matters relative to work authorized by this building permit application. Signature of Ow e r "` r 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 tqe pains and penalties of perjury. Print Name Signature of Owner/Agent Date t� SECTION 8`-CONSTRUCTION SERVICES 8.1 Licensed Construction SuRe r: Not Applicable 0 -' lam{ t Name of License Holier: i(O `-' 0151"d License ZN ;er Adds Expiration Date Signa e eiephone 3 (� s Lri 9.- •st re , r im rova r` nt Cosa r, Not Applicable 0 Com an Na a Registr ion Nu7a,er ©� ?L AOJZess Expiration Da e r i i� lelephone 6 2sb J f . SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affidavit ust be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildipj permit. Signed Affidavit Attached Yes....... No.-- O The cuiTent exemption far"homeowners"was extended to include Owner-occupied Dwellin6 of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Fdition Section 108.3.5.1. Definition of 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 strictures.A Person who constructs more than one home in a two-vear period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building 01"I ial,that heishe.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 tithe,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 Clialiter 153(Liability of Employers to Employees far inJuries°trot resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for,person(s) you hire to perform work for'you tinder this permit. The undersigned"hotnecTwner'certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local."honing Laws and State of Massachusetts General Laws Annotated. Homeowner Signature City of Northampton � Massachusetts DEPARTIZNT OF BaILDING INSPECTIONS s" l"- �a 212 Main Street • Municipal Building e 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 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 hascqwith a corporation car LLC,that entity must be registered. Type of Work: Ltf43% Est.Cost: Address of Work: Date of Permit Application: C1 I hereby certify that: Registration is not required for the following reason(s): Work excluded by (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.SEF NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of periwy: I her-by a ply for a buildingJpeAit, r--,gentof`the r: I Vol Date Contrac c� ?vamc I{IC Registratic�nNo. 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 Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building A Northampton, MA 01060 F In accordance with Chapter 40, Section 54, every city or town shall require, as a condition of issuing a building permit for the demolition, renovation, rehabilitation or other alteration of a building or structure, that the debris resulting from such demolition, renovation, rehabilitation or alteration be disposed of in a properly licensed solid waste disposal facility, as defined by section one hundred and fifty A of chapter one hundred and eleven. Any such permit or license shall indicate the location of the facility at which the debris is to be disposed. If for any reason, the debris will not be disposed of as indicated, the permittee shall notify the issuing authority as to the location where the debris will be disposed. The issuing authority shall amend the permit to so indicate. The debris from construction work being performed at: Ir (Please print house number and street name) Is to be disposed of at; or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signature of Pe pplicant 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 Workers' ov/dia 1'!orkers'Compensation insurance Affidavit; Builders/Contrictors/Electricians/Plumbers. TO HE ITLED WITH THE PERMITTING AUTHORITY. Allplicant Information Please Print Le Bibi Name(13usinc�stOrganixatianfln(tividual): Address:�> City/State/Zip: 4 ', Phone#:� Are you an employer".Check the appropriate box: Type of project(required): I.❑I am a emplover with employees(full andior part-time).* 'J. New construction 2.1M i am a sole proprietor or partnership and have no employees working (or me in $, ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition ?.®I am a homeowner doing all work myself.[No workers'comp.insurance required.] 10 E]Building addition 4❑1 am a homeowner and will he hiring contractors to conduct all work on my property. I will ensure that all contractor-,either have workers'compensation insurance or are sole I I.[]Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs These sub-contractors have employees and have workers'comp.msurdnLv.t 6❑We area corporation and its officers have exercised their right of exemption per MOI.c. 14.Q Other 152,§1(4),and we have no employees.[Ivo workers'comp.insurance required.] *Ary applicant that checks box#1 must also fill out the section below showing their workers compensation police inlbrmation. t I•lomcowners 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 member. i am an emplityer that is prot,iding workers'compensation insurance for mV en:pinrees. Below is the policy and job 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 verificVon. I do herebr certft er he td pe alties of perjury,that the information provided ah ve is rue and correct. Signature: ZADate: Phone#: 3 0 Oficial use only. Do not Jrite in this area,to be completed hp 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: i'ltfsne : Steve Theber e g \ 319 Rocky Hill Rd, Florence MA 01062 JON 7 8 2026 ' f nFPT of Attn: N�RTHgti1�oN MSpFCTI Louis Hasbrouck AOjos°Ns Building Commissioner City of Northampton June 5, 2020 Dear Mr. Hasbrouck, Attached are the necessary documents to amend the building permit for 319 Rocky Hill Rd in Florence. I authorize changing the Licensed Construction Supervisor to Stephen Yoshen (CS#088490). All the best, A---, Steve Theberge