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44-059 107 OLD WILSON RD a BP- 2011 -0227 GIS #: COMMONWEALTH OF MASSACHUSETTS MMp Bloc 44 =-059 CITY OF NORTHAMRTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cate BUILDING PERMIT Permit# BP- 2011 -0227 Project # JS -2011- 000389 Est. Cost: $28000.00 Fee: $168.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MARK BONDE 67758 Lot Size(sq. ft.): 26136.00 Owner: ROBERTS LORRAINE M Zoning: SR(100)/IWP Applicant: MARK BONDE AT. 107 OLD WILSON RD Applicant Address: Phone: Insurance: 205 PARK ST (413) 535 -9529 () WC EASTHAMPTONMA01027 ISSUED ON- 912012010 0:00:00 TO PERFORM THE FOLLOWING WORK.- ENLARGE & ENCLOSE DECK TO 3 SEASON ROOM 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 MAYBE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 9/20/2010 0:00:00 $168.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner File # BP- 2011 -0227 APPLICANT /CONTACT PERSON MARK BONDE ADDRESS/PHONE 205 PARK ST EASTHAMPTON (413) 535 -9529 () PROPERTY LOCATION 107 OLD WILSON RD a� a c MAP 44 PARCEL 059 001 ZONE SR(100)//WP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: ENLARGE & ENCLOSE DECK TO 3 SEASON ROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 67758 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF,QRMATION 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 Signa re of Building fficial 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. �0 City of Northampton_ �0 BuPlOing Department Y2 Main Streetti Room 100 Northampton, MA 01060' phone 413 - 587 -1240 Fax 413 - 587 -1272 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 office Map Lot Unit "I G' Zone, Overlay District BIri1 St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record I D Ci L Name (Print) Cu rre ailing Address: Y . Telephone Signaturac 2.2 Authorized A , Name (Print) Current Mailing Address: �.� i lk V A 0� 4L3 535- -G,5tq Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTIQX COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Buifding'PermitFee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) va Check Number This Section For Official Use Onl Building Permit Number: Date issued: Signature: Building Commissioner /inspector of Buildings Date ^ Section 4. ZONING AtI. 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 Lot Size ' Frontage Setbacks Front E0 117E Rear ILI Building Height Bldg. Square Footage Open Space Footage % (Lot area minus bIdg & paved # of Parking Spaces (volume & Location A. Has Permit/Variance/ Finding ever been issued for/onthe site? �� �� NO ��' OON7KNDVV «_� YES x�� /P YES, date issued: IF YES: Was the it recorded a1the Registry of Deeds? NO DONTKNOVY 0 YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water orwetlands? NO DON7KNOYV v�� YES IF YES, has permit been or need to be obtained from the Conservation Commission? Needs tmbeobtained »�� Obtained »r� Date|ssued'| \ �_� �~� ' 'L_________-| C. Do any signs exist on the property? YES «�� NO |F YES, describe size, type and location: | D. Are there any proposed changes toor additions of signs intended for the propert 0 y� YES NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, gradingexcavation, nr filling) over 1 acre orioit part nfo common plan that will disturb over 1acre? YEGK � NO K�k �� �� 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 Windows Alteration(s) Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[] Siding [0] O er [CI] Brief Description of Proposed 1 2 Work: es'� 6.�F C�� S�1 I +Lr DEL .. J f5AA o4J �Qrj Alteration of existing bedroom Yes _L/No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes l,-' Plans Attached Roll - Sheet sa.. If "dew t�ou t d ror at cll� 0iflt zi t111 61IS111— 6 -� lefe 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? y 1 j � , � d. Proposed Square footage of new construction. b { 1 ` 'Dimensions e. Number of stories? 1 f. Method of heating? Wire "'"'_= � ��t E Fireplaces or Woodstoves Number of each b g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction Woo t7 �2/A�'l i. Is construction within 100 ft. of wetlands? i Yes No. Is construction within 100 yr. floodplain Yes / No j. Depth of basement or cellar floor below finished grade 5C V46 " :Mw— k. Will building conform to the Building and Zoning regulations? ---- Yes No. I. Septic Tank City Sewer �� Private well City water Supply V SECTION 7a -OWNER AUTHORIZATION, TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING' PERMIT as Owner of the subject property hereby authorize - jE 5 Cb a>5 to act on my behalf, in all matters relativ au orized by this building perm' application. zz i g of Owner Da I, H 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. Print Name ?(vvi Signature of A nt Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor � Not Applicable ❑ Name of License Holder: ��'� CI,Q ,atc fir. -� ca �1 —�� License Number Address Expiration Date Signature Telephone Aealrecl ,ritihrigri Not Applicable ❑ Company Name Registration Number Address Expiration Date � ._ �� \ \ �•} ; V Telephon 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....... La-� No...... ❑ The current exemption for "homeowners" was extended to include Owner- occupied Dwellings 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 Edition 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 structures. A person who constructs more than one home in a two -year period shall not be c a homeowner 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. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature . T The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investia ations _ 600 Washington Street Boston, MA 02111 www.mass gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/PIumb.ers Applicant Information Please Print Le> ibly Name ( Business / organization /Individual): Pr1z:Y1_ w' t7 Address : City /State(Zip: lk 06V TPhone. #: -11 --ZM, Are you an employer?. Check the appropriate'box: T ro' .. a genera contractor a nd I � e of p roject 1 ( � uir 4 � 1.0 I am a employer with �� l 6- ❑ New construction employees (full and/or part-time)- * have hired the sub- contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet 7. ❑ _Remodeling ship and have no e�loyees These sub - contractors brave. 8. ❑ Demolition working for me in any capacity. employees_and have workers' 9 ❑ .Bbil addition _. comP_ incnranc-.: #._.. [No worleers =4 IO_ Electrical required] 5. ❑ We are a corporation and its ❑ repairs or additions 3.0 I am a homeowner doing all work of havexercised their I1-❑ PIumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12: ❑.Roof repairs insurance required_] t c: 152, § 1(4), and we have no o workers' 13.[- Pfther jtnt!SY } emp loyees. �. comp. insuranc required. ] . 'Any applicant that checks box #.1 mist also fill out the section belowshowiag *_*workers' compensation policy information: t Homeowners who submit this affidaviHndicating they are doing all work and than hire outside cont actors must submit anew affidavit indicating such. IContmctors that check this box must_attached an additional shed showing the nine 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: ' TVA(e ASR t rf -C) a-b Policy # or -ins. Lic. #: =4 1 3 - I 1 d 7 Expiration Date: 1 Job Si Address: iQj 6!_-n 1, li- s6h� City /Sta&Zi p: 'TL4r.S�,fJ('�'. l Attach a copy of the workers' compensation policy declaration pae'(shtrwing the p94cy number and ezpirahon date). Failure to secure coverage: as required under Section 25A 'of MGL I52 can lead to the imposition of cri l penalties of 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 S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Bvestrsatioris of the'] for insurance coverage verification w... . I do_hereby cc the par'ns of perjury thatthe urformation provided. zbove._is�rue_aad correct `} n Si lure: ate- _ Phone# t2: _ 2-1 _ . Official use only. Do not write in this area, to be completed by city or town official City or Town: PermitUcense # Issuing Authority (circle one): 1. Board of Health 2- Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 4 6. Other Contact Person: Phone #: HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation /footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper �ermits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. .(Home owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued tome. Date Address of work location 4CA 4EW Constructio pesign Policy No# (Liability) MP420651 Frock & Perras Ins Agcy. Mark Bonde 413 527 -5520 Gen. Contractor Policy No# (Wk's Comp) UB-8139B27 -7 -07 General Liability Dates 8 3 Workers Comp -13 -2010 To 3-13-2011 Frock & Perras Ins Agcy. Gary L Kostek Policy No# (Liability) MP064863 413 527 -5520 Plumbing Policy Nog (Wk's Comp) WC064863 General Liability Dates 6 -227-2010 04 To 6 27 -2011 Workers Comp Chaffee Helliwell Ins Agcy. NRB Exteriors Inc Policy Nog (Liability) CP49710701 413 536 -0751 Roofing policy Nog (Wk's Comp) WC8 738203 General Liability Dates 6-07-2010 - 9 -2 0 Workers Comp 010 To 3 -19 -20 Urban and Sons Insulation Co. Inc. McClure Ins Agcy. Inc. Insulation Policy No # (Liability) CPA018807913 413 536 -0751 Policy Nog (Wk's Comp) WC873820 General Liability Dates 6-07-2010 - 9 -010 To 3 -09- -2011 Workers Comp Aaron Morin Policy No# (Liability) 2008X0180 Meyer Agcy. Aaron Heating & in Policy No# (Wk's Comp) 2008W6194 413 582-0332 General Liability Dates 31-19-2010 - 232010 To 3 -23 -2011 Workers Camp Kurt Mengel Policy No# (Liability) Ross Ins. Agcy. Inc. Policy No# (Wk's Comp) WC20-20-001319 -01 413 536 -8380 Electrician General Liability Dates 6-02-2010 9To 02 -2011 Workers Comp SETBACK PLAN MAP: LOT:_ LOT SIZE:a REAR LOT DIMENSION ; REAR YARD SIDE YARD SIDE YARD b r� r" i FROM SFTEACK ; i FRONTAG INDICATE LOCATION AND DIMENSIONS OF HOUSE, GARAGE, ADDITIONS OR ACCESSORY BUILDING. HE SURE To t INCLUDE FRONTAGE AND LOT SIZE (SQUARE FEET OR ACRES) v 780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS APPENDICES S� CONSUMER INFORMATION FORM - "SUNROOMS" Massachusetts State Building Code (780 CMR 61013.2.2) The Massachusetts State Building Code (780 CMR) includes provisions to ensure that houses and house additions meet energy efficiency standards. This supplemental CONSUMER INFORMATION FORM is to be filed as part of the building permit application when a builder /contractor or homeowner, constructing/installing a house addition with very large percentage of glass to opaque wall, seeks to utilize a special energy conservation exemption option for "sunroom" additions to an existing house (780 CMR, 6101.3.2.2). This FORM is not intended to prevent a homeowner from selecting a "sunroom" of any size, configuration, orientation, form of construction or percent glazing, but rather is only intended to assist homeowners in becoming aware of some of the important energy conservation and year -round comfort considerations involved in selecting and utilizing a "sunroom" addition. The connection of "sunroom" structures to residential buildings may create comfort and energy consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the main house. In the selection and construction/installation of "sunrooms ", included below is a non - required, open -ended list of product and design considerations that a homeowner may wish to consider before actually constructing/installing a "sunroom ". It is recommended that consumers carefully review these options with their designer, builder, or contractor, in order to minimize potential energy consumption and/or house discomfort issues. In addition, the qualifications and reputation of the company or individuals to be hired are important considerations. PRODUCT AND DESIGN CONSIDERATIONS RELATED TO "SUNROOMS" • Solar Orientation and Natural Shading • Type of Glazing • Insulating value • Solar beat gain • Frame materials • Glazing to frame sealing and gasketing materials/ seal durability and/or weather tightness of the sunroom • Adequate ventilation - Operable windows and fans • Applied Shading Systems • Insulation level in floors, walls, and ceilings • Possible Sunroom isolation from the main house via a wall and/or door or slider • Heating and Cooling Methods: Efficiency, Zoning and Controls Homeowner Acknowledgment The Massachusetts State Building Code, 780 CMR 6101.3.2.2, requires that the actual property ownLr (not the owner's agent or representative) acknowledge receipt of this CoNsumm INFoRMAnoN FORM prior to issuance of a Building Permit for a project that includes "sunroom" additions to an existing residential building. In accordance with this requirement, the undersigned hereby acknowledges that she/he has read the information in this document concerning surna�n comfort and energy conservation. Sigriature of Actual Building Owner Date Print Name Addresg of Permitted Project Owfier A (if different than project location) , )wner's telephone number 3/23/07 (Effective 4/1/07) 780 CMR - Seventh Edition 1027 s Q C l) `} UN e�<eym. i�l/ o� G 2a e ` '2 Sfd d� a iG�GcJ Re4 (a �fve 3oNo �he iPa e�� W a t L S a (U t 0 Al IC -TOM POO M Ce ,�e�d - YJ2 &� / Z - Iej 07 d S " r oe eja �P e 57 /ea ce, /✓ e ,v gq sec. .5 6 v cri- le 4 e- - f� 1a Pet �,t arCC!/�l le am� j J -U\) s" tzi r O D z C tz:j Zu M H m O Q z -i M m T TT H O O z z tD m --� -�, a C O O fu CJJ - - , J fU -70 0 F F ]> N tv r _-{ r o0 O z 0 � 3 t� Ul • CA pp ^� �' fU 0- `O 1 1 W R "J W O� W m > 00 r I m �O I D 0 H 0 z td F 0 D Z C m t� ;o I 1 Hm m 9 Z C- M T /tJT UI H T N Q Z bd m n , 1 V c z) C D CJJ V V D f �J d HH T Z T v I m C "' ti H - i U z no W �l W Q� W 00 m F m 'D < 0 D H Z s bd r O D Z C d �7 M H i X- Z M T T /V T/v H /V 0 Z bd m n ` 1 V H /� 0 V 1 v --u 0 D r iL7 d C4 HH O Z /V tj ox C y ti fT1 z Cil R !U W 1 "I W ON W m 00 r I m < F— D 0 ►--4 O Z t � C1 , tDd r C t ❑ D fn Z C a Ci ;J ro a M '—' x H m o y m N ^ D x C) ! ~ V1 O ❑ Q° �' c ro m w C4*, —I M C ,v N r M C) n T � T \ N Zf H /V ❑ ❑ z m nj CD r n � r n rq VI Z t'1 ❑ 2mO D r Z� m DZ � �-, � r 7 0 Ox � 04 Zr d r ;u �rl rn M a \n` 1- ° z y o fA3 -�O A (© V I r Ab Ul 00 R) \ C R c �. 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