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16B-006 Y � BP- 2010 -0906 GIS #: COMMONWEALTH OF MASSACHUSETTS 16B - 006 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category BUILDING PERMIT Permit # BP-2010-0906 Project # JS- 2010- 001341 Est. Cost: $2500.00 Fee: $48.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KEVIN NETTO CONSTRUCTION INC 1317 Lot Size(sa. ft.): 12980.88 Owner: KING BLANCHE A Zoning: URA (100) //RI Applicant: KEVIN NETTO CONSTRUCTION INC AT: 110 BRIDGE RD Applicant Address: Phone: Insurance: 90 Southampton Rd. (413) 527 -3168 Workers Compensation WESTHAMPTONMA01027 ISSUED ON :411612010 0 :00 :00 TO PERFORM THE FOLLOWING WORK.- 12 X 20 SHED 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 4/16/2010 0:00:00 $48.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo File # BP- 2010 -0906 APPLICANT /CONTACT PERSON KEVIN NETTO CONSTRUCTION INC ADDRESS/PHONE 90 Southampton Rd. WESTHAMPTON (413) 527 -3168 PROPERTY LOCATION 110 BRIDGE RD MAP 16B PARCEL 006 001 ZONE URA(100)//RI 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: ERECT 12 X 20 SHED New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 1317 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF¢RMATION 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 IL " 4 1 S 1 /0 gnature of Buil ng 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. Department use only City of Northampton Status of Permit: Building Department Curb CuttDrivewayPermit 212 Main Street Sewer/Se ticAvailabili Room 100 Water/WeltAvailabiiity ; Northampton, MA 01060 Two Sets of Structural Plans phone 413 -587 -1240 Fax 413 -5$7 -1272 Plot/Site Plaits Other Specify 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 �\ O Map Lot Unit Zone Overlay District Elm St District CS District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record Name (P Current Mailing Ad e : Telephone Signature 2.2 Authorized Agent: Y'ypvYvr Q_ . Name (Print) Current Mailing Address: 4�� • y1� - 5az 3��c'8 nature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermit applicant 1. Building OO (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� a l a b f Check Number 7/214 1 This Section For Official Use Onl Building Permit Number: Date Issued: Signature: Building Commissioner /(nspector 6 Buitdmgs - Date 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 Lot Size F rontage Setbacks Front Side L: R: ....... L: R:, Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg & paved Darking) of Parking Spaces Fill: I (volume &I-ocation) A. Has a Special Permit /Variance / Finding ever been issued for/on the site? flo� NO DON KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON KNOW 0 YES 0 IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wettands? NO DON7 KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 Date Issued: C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO IF YES, describe size, type and location: E. XAMI the construction activity disturb (nearing, grading, nyravation, or filling) over I acre or is it part of a common plan that will disturb over I acre? YES 0 NO 10% 'ley IF YES, th6n Northampton St&ffi M5 nf Permit from the DPW is required. SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ tt Or Doors Accessory Bldg. Demolition ❑ New Signs (pj Decks (M Siding (0) Other (01 Brief Description of Prop sed Work: ��9.�atexl� Alteration of existing bedroom Yes _�_ No Adding new bedroom Yes �_ No Attached Narrative Renovating unfinished basement Yes X_ No Plans Attached Roll - Sheet 6a. If New house and or addition to existing housing, cornplete'the following: f a. Use of building: One Family Two Family Other i 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 WHIN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Ae as Owner of the subject property ` hereby authorize to act on my ehalf, in all matters relative to work authorized by this building permit application. Sign re of Owner Date i, Y \'\1 . as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my 7657edge and belief. Signed under the pains and penalties of perjury. e.►�� C . Vie. Print Name gnature of Owner /Agent Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor \` Not Applicable ❑ Name of License Holder : , t)XSM1 .� czg�z>nm License Number Ad 4 �� Expiration Date I nature Telephone 9. Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Clot) -���. b�oa-� '►- \o -aoNC--N Address Expiration Date Telephone A\'J -5a`� -3�b 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....... 2 No...... ❑ `Home Exemption. 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 51 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 -vear period shall not be considered 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 Atutotated. Homeowner Signature The Commonwealdi of Mrssachuse-s Depa,' of �r_dus ia. _ ccsder:ts "w 0 ffice of 1nreszz ix j'� 600 TT aching on Street == Boston, 314 02 111 rvww_mass gov/dia Forcers' Compensation Insurance ffldaNit: Builders !ContractorsiEIect�icians /Plumbers A Information Please Print Le--ibIy - Name (B- sines'Organiration/Endividual): �( y \C1� �Et � � � -r► C. -- Address: St:: City /State,'ZiP: M'1Phone. --: u1 \3•�c'��- 31�'E� re you an ernplover? Check the appropriate box: t T ype oject (required): II I amt a emalayer witit 4. Q I am a prleal contractor and I enmiovecs (full and/or part tee)_ have sub- contractors construction t7 T _ _ , � Tested or :he a�c4ed S- - odems t soy.. proprietor or pa. - cr- ' sL g, i have no p loyees These sub-contractors have g- Ej De mo,'i - don t z g for me um an capacity. employees and have woti:...°ms o wo ' 0 Bin] addition ENO workers' co =. - c.uce c: rm. insurance. regale j f. (� We are a corporation and its 10_n Eler -�caI r. ,airs or addmors =. I am a homeowre; doing all worst officers have exercised their 11.� Plumo repairs or additions zgvself [No work, -,s' comp- right of exemption per 11ZGL 12 Q Roof repairs insuran required -] t c. I i2, § F1(4), and we have no employees. [No work.°ts' 1= Orher ` corm. insurance requirec-ij - — _ v apau nt at caeca nor n . misz ago out me scaan traow mowms tb= wor=S' coxapersa]3on policy -- Rorreowne s who submit this affidavit mairasmQ they are doors aE wceic and tet hire outside contactors must submit a new affidavit mdicaldng such Canuac urs that cacck tbis box mustatached an additional she--. sbowmz the name of the sub-c==== and state wiled= or not those c ddes'nave cr,rploye=.s. If the subroncactol :=ve crpioyew, they crust provide rhea wonk=' cam. policy nuranc I am an amp lover that is providing workers' conzp ensario a ==rance for m employees Below is the polite- acrd job sire information. Lnsar ace Copraan_r ?dame: 4k%\ G - Policy =# or Self -ins. Lic. : ��,�q"j �j$$� Expiration Date: a ''01 - cam-..© 1\ Job Sire Address: City'Statezip:_� - - - Attach a copv of the worm' co ensation policy dechiration page (showing the policy number and e_-piration date). Failure to secure cove: age as required under Sermon 25A of MGI, c. 152 can lead to the imposition of crirr final penalties of a tine up to SI ,500.00 and/or one -year i=risonment; as weL as cif; -2 penalties, in the form of a STOP WORK QRDE? and z of ;m to 3350.00 a day a ` r airst 6e violator. Be advised that a copy of this stat-emeat may be forwarded to the Oizdce of Invest`sations of the DLk for ms ance cove-aze veriicarion. I do hereby cerdfy under the pains and penalties ofpe ury that the Injorrnazian provided above is true and correct — al `zr ruu i,ate: Phone #: ��� -�J G`l : b UFJICUU use 0211th, �Uu riot wrzte zn VZZY area, to be conTLered by cin or town oJfxiaL City or Town: ��� v { f E r �� E t fi `�. , ti a i i e f i a � L ` h No's 'moo `�..�.`�