23C-094 •
v
..F _ '
I
I a
I
I all
Nor= -- vommul•Iml sr-, -- wimilloormase -- - 11 1111
t 'll
r
r
0.1.11 Q i ,-...._
01 ..._ ........
MIMI III
.. �°
,/
-,,,..:_____.
11 111
J
\Tire turafin
Allillire, inrii"
Air 1 , ' ,
111
2 I'
�
7 f
i i 1
Doors to replace tambour
Doors even with Cabinet above
refrigerator
7
r - L - --
ss
1t —
1
I t
� Q'
00 `I o0
I
11
E •
- _ _ ____ vewthi:
•_., • iii• _____. < :
___77-,-....-7,-..L.:..t.—_,_ _z-- ,.. _,.._ •
et 111
■
'r __--___, _.
- The Commonwealth of assaclusei s
Department of Industrial Accidents
O ffice of Investigations
600 Washington Sayer
_ Boston, M4 02111
.1 www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/ Contractors /EIectricians /Plumbers
Applicant Information PIease Print Legibly
N ( Business /Organization/IndividuaI): C,
Address: q,0 i4 ` eN s
City /State /Zip: Ze \ O\Oal Phone #: y\ b- PS 01- 3 \\0'2,
Are you an employer? Check the appropriate box: Type of project (required): I am a oene�al contractor and I
1 _ � I am a employer with y 0 - 6. � New construction
employees (full and /or part - time).*
have hired the sub - contractors
2. ❑ I am a sole proprietor or partner - listed on the attached sheet i- ❑ Remodeling
and have no employees
These sub-contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers' 9 Building addition
[No workers' comp- insurance comp. insurance.* `
required-] 5 - Q We are a corporation and its 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all worms officers have exercised their 11.0 Plumbing repairs or additions
myself. o workers' comp_ right of exemption per MGL ep
y [ 1_ Roofr airs
insurance required.] t c. 152, $1( @), and we have no
employees. [No workers' 13.in Other \ , st‘_Cob, %
i comp. insurance required.] \ \ "`b0k3J
*Any applicant that checks box =1 waist also fill out the section below showrg their workers' compensation policy infu.n ition.
T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors trust 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.
I am an employer that is providfmg workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: j\\ Cj
Policy # or Seif-ins. Lic. #: \)%i Expiration Dater' e�`y - \a
Job Site Address: \�►'t r Y�∎� \S • City /State/Zip: ete.:�L'Q ‘ M\ 010\0
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can Lead to the imposition of cr ninal penalties of a
fine up to S1,500.00 and/or one -year imprisonment, as well as civil penalties in the forni of a STOP WORK ORDER and a fine
of up to 3250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DLA for insurance coverage verification.
I do hereby err under the pairs , penalties of pedury that the information provided above is True and correct
Signature: it Date: C1- \\
Phone )
I Ofi r cial use only. Do not write in this area, to be completed by city or town ofjzciaL
C ity or Town: Permit/License Is suing Authority (circ one):
1. Bc trd of Health ?. Building Department 3. City /Town CIerk 4. Electrical Inspector 5. Plumbing Inspector ,
I 6. Other
1
1 Co rimer Person: Phone T:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervi 1 Not Applicable ❑
Name of License Holder ; 'e�NVN Q., M \
License Number
adcress Expiration Date
3igna
Telephone
k R inter :€ ante esa b a�c€r;r -f -- Not Applicable ❑
:omoanv Name - Registration Number
ddress Expiration Date
Telephone%al-3 \ \c
ECTION 10- WORKERS' GOMFENSP LOH :WSUJRANCEAFFIDA GL 't52
rorkers Compensation Insurance affidavit must be completed and submitted with this application_ Failure to provide this affidavit will result
the denial of the issuance of the buying permit..
gned Affidavit Attached Yes $ 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 posses s a license, provided that the owner acts
as supervisor. CNIR 780. Stith Edition Section 1083.5.1.
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-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 ofEmployers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, von 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
l'f illL /
4w71
- - k.mpedga sa eued puo mired s - ozsn t/9__:S
_
e6payaouy £w jo sav ?u: m - a8"E' 9114 pie a are unaea4 Supftiol.T VD unge tuoh ua
� pre 4c a `s d r ay
P• 2itDtA�11d/3ssunO 58 ` \Q `� • 7
*R'2Q aMP2u&j
/1- a �� -ma -. ,�
'uorzzoti de *wad 5u nq sag Kt; pr u oe4112 1!J9PA • 0 1 . r . - saws/ ne u ' - Ate: uo rp- ee al
•\.. - � w.,;3 a fiectine fe^
taladaei
palms aq. aumo se '
aqua •
-- • + . .' :�` - =". _ x . i C;NU11.� 5
IIddnS A4am 40 — PM al—eVei S . _ i 0%a8 t
ON Sax 4= WW2 FOO 6 OPirg NI a =Ms= In+a 11
acei55 pac,'sjug PAooag Jodu telfaa XI r-mtuirse4 4 -r
ON San u d 1d gQ um" OOEpn.as: Si 'ON VOA G a 7 4 COL ur-n in uo •'-,
uopngse= ao D l If
i pa4pene m►al uJo3 Mieua •.,'" ssew. - =sendt.Lrao uopeeu2suD .iEmr3 - 5
Ipso 30 Jagt:rnN . sa'oksi0OMro LBuAeauie tnaaAr
Lsa!ns tv Jaga:anN '3
suoss are G - uoxin.,s i1 ANAL as
� mDOj 3Atn5c FesD�id "?
.DPene a6e►n5 8 slatq s) 'S
cluawillEG jD iscitanti un AS1121 tPea e! SWIM PO -lag j V
_tamp . Agtaag O1 • _ dA 4+u ed Duo : 6seppq AI esn -
• : A � ?r � 1 3 '� 7li � gol}• ��'°�.�.�°��?P, �?Q:p??�= x - .�af;1�� �9
say, ;ueumC.+�Q Ruearz abs vuad mugeu A91 '.I5
t
e� "7— so saoo awu o'w�py oN _ �� stor 6u a uo
- may is eoaa --. kepa
I
satm° MI &Eras DI =pea Lad storm uo bona 0 -1 a.E kips-moot,
Suyo°ki 1 0 (s )uoperars 1 sMopum }uewadeiGess 0 e>�pY 0 esaoy w aN
cane:Meet Re Pete. .• • C SSOdO d =0 tOLL6re3S : -_ NO _
1
1 _d SZO£ - 60Z - £ 16
2'd S202202£Z171 :Ol o n e N '0 umeN $OZ LO 11 !0 deS
9 078 - S$S -E1b -T d 83131S 2 3SG3d9H1a : H cra -,ra TTM r
Section 4. ZONING I Alt Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This coin= to be filled in by
Building Department
, ..,. 7 . Lot Size _ J
Frontage _ ____ -
Setbacks Front
Side L :` . = R:_ L_ R
Rear
Building Height
1 1
Bldg. Square Footage j
Open Space Footage
(Lot area minus bldg & paved
manor¢)
# of Paridng Spaces
Fill: �_
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO ► DONT KNOW 0 _ YES 0
IF YES, date issued:: i -
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES
If YES: enter Book Page ;` and /or Document it
B. Does the site contain a brook, body of water or wetlands? NO f DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO A
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 i►i®
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 wiinuiuFi plan
that will disturb over 1 acre? YES 0 NO C
IF YES, then a Northampton Sto aTer IC anagemen Permit from the DPW is required.
(�rR U wr...aw y. ..� ..w v..
1 Its SSW
SEP -1 -2011 07:04A FROM:ETHEREDGE & STEUER P 1- 413-585 -8406 TO : 14132033025 P.
Sep 01 11 07:08a Kevin C. Netto 413 -203 -3025 p.1
le, RECEIVED City - =
Building Department ` Crib Y?eft it
SEP 212 Win Street sehieid5ep$cAvaaata4tty - ' - -
" � Room 100 ws r A iabrrty. ` .. _ - .- (I
Nor mptOn, M 01060 ' S eL;_Ol s t n tdtra) > P = _
hOn ! 413587 -1240 Fax 413-.567 -1272 ytotAite Plans : _
APPLICATION TO CONSTRUCT, ALTO, REPAIR, RENOVATE OR DEMOU5H A ONE OR TWO FAMILY DWE. JI G
This section to- beconpieted by office
1.1 Provenly Address:
.P Lot U
alto* Cooley (Attic!
•
- 1.i it. o
SEGfON2 -PRO ETIY s hAi fAR D-A{a i _:-
s-rz
2_1 Owner of Retard: ,
Name ( R i o ) / Gwent Mailing Address J 8T ../
a• L - .11 - T
22 . IA •
Z • -
Name ri nt) ci ,
�.'3- �13.b43
Ite..
Taieptsan8 -
S�gnatu
Egtena d x.031 to be L s r = . ,- 43111IdE - V , 5$ O � i .
Item comnieted b y Pertr it aooiceet l - -
1. Budditg i SC) G h � - '. - _ .
2 Electrical ott fmrndfi)
:3uil s+g Permit.l='ee
3. Plw7tbn4 - •
4- Mechanical (HVAC) - ,5 . on
S. Fir F�rat ection Chetitrttsnber
6. Total= (1 +2 +3 + +5 )
- -Frei - • , . Fot.�sciait)Se i
i
• m ete-
r
Building Pe �����i/��
-
ter
...e e Clu e
7,,,,,,,,/,,,,oi, _45,,,
128 BAKER HILL RD BP- 2009 -0888
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23C - 094 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- 2009 -0888
Project # JS- 2009 - 001299
Est. Cost: $70000.00
Fee: $425.60 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: KEVIN NETTO CONSTRUCTION INC 001317
Lot Size(sq. ft.): 88252.56 Owner: ETHEREDGE EDWARD D & SUSAN M
Zoning: URB(100)/ Applicant: KEVIN NETTO CONSTRUCTION INC
A 128 BA * HP I RD
Applicant Address: Phone: Insurance:
90 Southampton Rd. (413) 527 -3168 Workers
Compensation
W ESTHAMPTONMAO1027 ISSUED ON :5/8/2009 0:00:00
TO PERFORM THE FOLLOWING WORK: CONSTRUCT 16 X 38 ADDITION (MSTR
BEDRM,4 SEASON ROOM W /ROOF DECK)
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: fi
Rough: 7 -1 - Cy a Rough: '7/ i► House # Foundation: C K �' e i
! 0t r Driveway Final: �A . ,. ` ,19'
Final: Final: j
Rough Frame: OK a7 6 7i0 /DO (S
r
Gas: ' °E F Department Fireplace /Chimney:
Rough: 9,6-01 6--0 , . Oil: Insulation: or /of 09 Lost i_
Final: i(),/,. 09 4moke: Final: OK /O' 6 ? --s&I
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy ; signature:
- fi
FeeType: D ate aid: Amount:
Building 5/8/2009 0:00:00 $425.60
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo