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31B-105 Louis Hasbrouck Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 I request that you grant a modification to waive the requirement for control construction for the project at 33 Bright Street in Northampton because the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work. Thank you for your consideration. Respectfully, Kevin C. Netto Kevin C. Netto Construction, Inc 90 Southampton Road Westhampton, MA 01027 413 - 527 -3168 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ? 600 Washington Street • _�'�= Boston, MA 02111 www.mass.gov /dia - Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business / organization /Individual): Address: ©kQ �1�:�ere•�,c� G\O City /State/Zip: Phone - #: Are you an employer? Check the appropriate box: Type of project (required): 1. IM I am a employer with 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub- contractors 6. ❑ New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet 7. 0 Remodeling ship and have no employees These sub - contractors have 8. 0 Demolition working for me in any capacity. employees and have workers 9. 0 Building addition [No workers' comp. insurance warp. insurance.: required.] - 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required] t c. 152 §1(4), and we have no employees. [No workers' 13. ► / Other V� c. • comp. insurance required.] 'Any applicant -that checks box #1 must also fill out the section below showing their workers' compensation policy informraion. • t Homeowners who submit this affidavit in 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 number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A \ Policy # or Self-ins. Lic. #: \ZC.\accl�jes 1 Expiration Date: - 3 - 13 Job Site Address: 33v� h LAC . City /State/Zip t \\ Attach a copy of the workers' co nation policy declaration page (showing the policy number and expiration date). C) \Q b; Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal 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 ine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investieations of the DIA for insurance coverage verification. I do hereby certifr under the p pent:Min of perjury that the information provided above is true and correct. Signature: .7 Date: _ • Phone tk ��J - - - *'\‘ Official 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 Health 2. Building Department 3. CityfTown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: • • Versionl .7 Commercial Building Permit May 15, 2000 Independent .......47..-..,:. tru Engineering Structural Peer Review Required Yes 0 No • OI ERS.AGEIN7`'OR CTOR- P(.1 $ ,11o1i e.+r ljta- I, 1 °, as Owner of the subject property I hereby authorize f I ath act on my behalf, in all matters relative to work authorized by this buiiding permit application. Signature of Owner Date .,•(, c 1\1. at- . _N`4 , 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. Si • ned under the s : ins and . - . 1;:, of , ury. Print - 7 II� -y- Signature . Owner /Agent Date 1 0.1 Licensed Construction Supervisor.: Not Applicable ❑ i Name of License Holder :' y \ 1 I V.:. \3» License Number I qo � , ‘\ k ©' • I% - a = \A. I Expiration Date Telephone ;'SECtlON43 IiIP '4 - ; s . l `w a • ei,.. j c s -e .-. w.L ---u- -st ...., 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 ; No 0 r i Version1.7 Commercial Building Permit May 15, 2000 OCINTST*0 E 1130.04:7 dtieselis 9.1 Registered Architect I Not Applicable 0 t t Registration Number 1 Address 1 1 eq3iration Date Signature Telephone ' 9.2 Registered Professicin Engineer(s): 1 Name Area of Responsibility 1 I Address Registr Number . I Signature Telephone Expiration Date I I I Name Area of Responsibilty Address Registration Number I I Signature Telephone Expiration Date I Name Area of Responsibility 11 Address Registration Number 1 1 I Signature Telephone Expiration Date I I Name ' Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Not Applicable CI Company Name: Responsible In Charge of Construction r Address I I Signature Telephone I , Existing Proposed R by Zoning Vetsion1.7 Commercial Building Permit May 15, 2000 , - :;i:! ;3; t•lat -21,c e -.. i'v_:V.,2„.„- . J.- This column to be filled in by Building Department • Lot Size 11 Frontage I 11 Setbacks F ront r ---- 1 i 1 Side L: • 1 R-. 1 I --"' R: 1 .. 7 7 1 ! Rear L____.1 131111dmg height 1 1 ni - Bldg. Square Footage F-1 i 1 % I i I i i Open Space Footage , ._ (Lot area I minus bldg & paved / i j rn 1 „kin # of Parking Spaces 1 1 1 1 1 I , Fill: ',. i 11 (voiles:ie Location) 1 : A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO i DON'T KNOW 0 YES 0 ., , I IF YES, date issued: I I IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES Q IF YES: enter Book I 1 Pagel 1 and/or Document #1 ! B. Does the site contain a brook, body of water or wetlands? NO e DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q , Date Issued: 1 C. Do any signs exist on the property? YES 0 NO TO - IF YES, describe size, type and location: 1 1 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 0 • NO 021 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Version1.7 Commercial Building Permit May 15, 2000 SEI (i< a e i +� 35 O ,- Interior Alterations 0 Existing Wall signs Demol'it'wn ❑ Repa ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs 0 Roofing ❑ Change of Use [� other ❑ Brief Description ..: ( Enter a brief description here " v-`, S,-N-Q....� 'erccy a 'c 1 Of Proposed Work IRQ�j�.� i'cS °.bcxc'c> �,- `r,C�� 1 SECS SE$ttP1 -� K USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly Q Act .[� A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ . A 5 ❑ lB j ❑ B Business ❑ 2A 1 ❑ E Educational ❑ 2B 1 ❑ F Factory ❑ F -1 ❑ F -2 ❑ . 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ' ❑ 3B . . ❑ M Mercantile ❑ ' 4 R Residential M R ❑ R-2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ( ❑ U Utility ,- M Specify. I M Nixed Use ❑ Specify. S Special Use 0 Specify: '_ t - :: : : � 4 �"ml- �°.+ ,2:- .�' 4k :; - : I =. -- -! , i 1 )� t °'l Leit 2- f,rm *. b € ", 6` ;- y S - ' 1St Existing Use Group: I Proposed Use Group: I 1 E,dstipg Hazard Index 780 CMR 34) t Proposed Hazard Index 780 CMR 34): I r O� � a RFC t A BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION ''� � � ` J ■ k Cr < Floor Area per Floor (sf) 1 st � ., - �.. a� 2nd 1 1 -'A 3 r 3 j • �" `.- - �-, ` • v" s.n. . _ - vim' o Total Area (sf) t i Total Proposed New Construction (sf) r ~ 5' , t � Total Height (ft) . Total Height ft I l 7. Water Supply (M.G.L c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone I I Outside Flood Zone❑ Municipal ❑ On site disposal system❑ I RECEIVED Versionl.7 Commercial Building Permit Ma 15, 2000 _ Q 2012 ifY of Northampton - - �r -- APR B Tiding Department s -" is s ° ms - <, �'�` .. -r-- 12 Main Street i -7-'° -°i r c i- ., - - ^` DEPT. of BOWING INSPECTIONS Room "100 i : f � � k �-' " rNMnProN MA MOO orthampton, MA 01060 c . . - . �_ _ - . „..„4- phone 413- 587 -1240 Fax 413 - 587 -1272 g =£ ' = tea " ` ., " . . ,_. . " =- Viz: A -b.; :�. - _ . APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING - �1 - f ddfesz .E' �+",..¢ak r •.az = *-a fir\ #"��� v s C 5 wee �a ! g-...,_-.--,..,... ry cf - - � =is ON ROP._EE2 Mtit ORiZEDG SE;G.'in1 2.1 Owner of Recor \ ` Name (Print) ' . Current Wiring Address: O'\Q . 1 \) - - 3 \b Signature 1 110% , \ ` Q, Telephone - 2.2 Authorized A - nt Name (Print) Current Making Address: 1 Signature Telephone SECT OW3 ESTTM C ONSTRUCTrONCOSTS Item ' Estimated Cost (Dollars) to be . sst3nl - completed by permit applicant - .7,Z.7 - _— '_ �. _ i i 1. Building : \ ?_\13 u i idrrxi 4,- - a 2. Electrical > oral?. stjbf" r 3. Plumbing I {' y 4. Mechanical (HVAC) ` 4 5. FiteProfett`on 6. Total'= (t + 2 + 3 } 4 + 5) (Maack t�ucnber �Q .x is ecson o cr`ra1 se Dn _ - : "Signature _ Building :Comrs sss a pospeclori Suila S . ' :Date File # BP- 2012 -0868 APPLICANT /CONTACT PERSON KEVIN NETTO CONSTRUCTION INC ADDRESS/PHONE 90 Southampton Rd. WESTHAMPTON (413) 527-3168 PROPERTY LOCATION 33 BRIGHT ST "' 530 MAP 31B PARCEL 105 001 ZONE URC(100)/ C erai 14-6 l / . tr y r'' THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 54 d._ { 'S Fee Paid Typeof Construction: REPLACE FRONT DOOR & WINDOWS IN BASEMENT & PORCH 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 ! - • • lition Delay Sig . re of ilding 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. 33 BRIGHT ST BP- 2012 -0868 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31B - 105 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit # BP- 2012 -0868 Project # JS- 2012 - 001523 Est. Cost: $1860.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KEVIN NETTO CONSTRUCTION INC 1317 Lot Size(sq. ft.): 7492.32 Owner: NETTO KEVIN C & JOVITA B Zoning: URC(100)/ Applicant: KEVIN NETTO CONSTRUCTION INC AT: 33 BRIGHT ST Applicant Address: Phone: Insurance: 90 Southampton Rd. (413) 527 - 3168 Workers Compensation WESTHAMPTONMA01027 ISSUED ON:4/9/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: REPLACE FRONT DOOR & WINDOWS IN BASEMENT & PORCH 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 4/9/2012 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner