35-291 • Massachusetts Department of Public
Board of Bui Idiot; Ret:tiiatiotr+ and 'standards
Construction Supernsor License
License: CS 67758
Restricted to: 00
MARKS BONDE
205 PARK ST
EASTHAMPTON, MA 01027
Exptration. 1/2/2012
Trr- 12805
*%. BoaOriadtgliatiatio tan
HOME IMPROVEMENT CONTRACTOR
(44 57,)
'71"- Wit 0'i Registration: 154839
Expiration: 4/10/2011 Tr# 283917
Type: DBA
SONDE SONSTRUCTION
MARK BONDE
205 PARK ST
EASTHAMPTON, MA 01027 Administrator
\\ _
EXISTING HOUSE
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V '-' 3' -0 3/4" 3' -0 3/4"
3'- 0'X6' -S' _ T
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3' -0 3/4" I 2X10 P.T. 3' -0 3/4"
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20'
AMIE & DAVE GREEMAN 117 WOODLAND 586 -2571 FLOOR
RONDE CONSTRUCTION 205 PARK ST. 529 -2176 6 -21 -10
EXISTING EXISTING
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AMIE & DAVE GREEMAN 117 WOODLAND 586 -2571 SECTION
RONDE CONSTRUCTION 205 PARK ST. 529 -2176 6 -21 -10
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AMIE & DAVE GREEMAN 117 WOODLAND 586 -2571 ELEVATION
BONDE CNNSTRUCTION 205 PARK ST, 529 -2176 6- 21 -'10
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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.
(Ho owner /resident's signature exemption)
I will call t chedule all required wilding inspections necessary for the building permit
issued to me. \
Date �
Address of work
location
T
AZ N The Commonwealth of Massachusetts
Department of Industrial Accidents
p _ t = ' Office of Investigations .
= 600 Washington Street
1
Boston, MA 02111
,„ ...,,,,,44. -,___-
� , www.mass.gov/dia
-Workers' Compensation Insurance Affidavit Builders/ Contractors /Electricians/PIumbers
Applicant Information Please Print Legibly
Name ( Business /Organiiation/Indiviilnal) : `7r e ,` to N
Address: ZDS o f P+zu, -r- .
010 2-7
City /State/Zip:EA ptfrki' i Phone. #: r413 She( — Z.V1 6
Are
a employer with 1----- an employer? Check the appropriate Type of P box: e ro7 ect (' : /'
1. I a
. .
4. a g . ^ eneral contractor and I 6. ❑New coristtvction
- t� °"'
employees (full and/or part-time).* have hired the sub- contractors
2. Q I am a sole proprietor or partner- listed on theattached sheet. 7. 0 Remodeling
These sub - contractors have. -
ship and Have no loyees 8. Deiaoon
working for me in any capacity. employees and have workers'
[No workers' coj insurance inss ura # _ 9- w...: ="u "mg addi
_ caddition
required:] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
officers have their g repairs or additions
3.0 I am a homeowner doing ill work r 11. Plumbin r
myself [No workers' comp. lief of exemption per MGL 12:0Roof repairs
insurance required.] t c. 152, §1(4), and we have no .
employees: [No workers' 13.L Other
comp, insurance required.],
*Any applicant that check box #1 must also fill out the section below showing therworkcrs'. compensation policy information_
t Homeowners w h o subnvt this affidavit i n d i c a t i n g t h e y are doing all w o r k a n d t h e n hire outside c o n t r a c t o r s must submit a new affidavit indicating such.
:Contactors that check this box must.atiached an additional sheet showing the name of the sub=contractors and state whether or not those entities have
employees. Effie 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: if 1 -- 1 A.2t` 1 b( --D •
Policy # or Self-ins. Lic. #: l ""es — tj i 3G ? 2 - '7 — 07 Expiration Date: ? -- 1 '--1, '
Job Site Address: .117 LixxSPLPr►v P • City /State/Zip . t______ 4 - " " r �; , M : ii (��1 j
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 ofMGL c 152 can lead to the rmpos Criminal penalties of a
fine up to $1,500.00 and/or one- year imprisonment; as well as civil penalties in the form ofa 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 O.ffi'ce of
7iivestizatioris of the bLA forinsurance cove verification .. , _` . >_ _; . . .
_ I do hereby_ certify und theparns:andpenatties ofperju y that - the information provided b orrect -
•
S i n a i : a e: . t k : Dat 2 " . c . ,
Phone #: VC (, '3 S Zs-( _- 7 2;;,`.'
. .
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. City/Town Clerk 4. EIectrical,Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : - 1? AS 5 ,. "b17 L 6777 6
License Number
2.0 5 '--PAr2k 6T 4A Ni HA k - 2,- 2
Address Expiration Date
()AL fr}k441k -1
Signatur Telephone
8: Rigistids.Hie lrrieirc> �Carifisic _.., , , ,'g ' 3 E
��,,.r _,<a_ur'.. Not Applicable ❑
Compa ame Registration Number
2
Address Expiration Date
GA 0 2 i ! Telephone `"1 Z 2J R6
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.GL. 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 buildin permit.
Signed Affidavit Attached Yes No ❑
.. i4 SE E
I Irfm z ao 31
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 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 Annotated.
Homeowner Signature
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition 5' % Replacement Windows Alteration(s) ❑ Roofing EJ
Or Doors ❑
Accessory Bldg. ❑ Demolition El New Signs [D] Decks [I Siding [D] Other [0]
Brief Description of Proposed -
�
Work: _ i2 Fib ;�'r V, i ST]?`) t-- ,1J V(k -4-- Cie }=.gcrS c t ki
Alteration of existing bedroom Yes Leo Adding new bedroom Yes
Attached Narrative Renovating unfinished basement Yes /
Plans Attached Roll - Sheet
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
r .
I, DA\j ► t, l ,. I- (2.�kIu o , as Owner of the subject
property
hereby authorize M i ua_k. 6 t-4. ►7 1_
y
/t o act m behalf, in all matters relative to work authorized by this building permit application.
1 - - 10
Signature of Owner Date
I. ?+-v a , as Owner /Authorized
Agent hereby declare that the statements and informat on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of •
---0 (
Print Name
b r rte. ' �::
Signature of Owner / ' ge t _ 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 1 1 i '
Frontage
11 ii
Setbacks Front 1 60 I ! y p 1 I 1
Side L:= RI I L: 1 R: 1 , 1
Rear 1 l 1
Building Height 1 ~._ 1 1'
Bldg. Square Footage WE61 = % Vad 1 1
Open Space Footage %
I
(Lot area minus bldg & paved � 7 ( _ ? 1 1 1 i
z
parking)
# of Parking Spaces a * ._.
Fill: E 0 __.,__.. C) �
(volume & Location) i
A. Has a Specia Permit /Variance /Finding ever been issued for /on the site?
NO DONT KNOW 0 YES 0
IF YES, date issued:;
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book I P age l € and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO @DONT KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ® Obtained
, Date Issued
C. Do any signs exist on the property? YES 0 NO /
IF YES, describe size, type and location: I
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. Will the construction activity disturb (clearing, grading, exca on, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
. r1
City of Northampton "' 'e '
a
1-4 1
Building Department r x !Xi � i
212 Main Street - l 3 , 7
L`, Room 100 ,r_ ,
Northampton, MA 01060 .
phone 413 -587 -1240 Fax 413- 587 -1272 4 .
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE INFORMATION
This section to be completed by office
1.1 Property Address:
11'1 il■.1CSO LA -1V-ib Map Lot Unit
-zone' Overlay Distract
, 4— u)(aLr M C310(.90
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
v V v iij t..mv J 117 t tsuu ciQ 'Dr. F1 c
Nam int) Current Mailing _
v 1 11 3 -25
Address:
_ f f Tele phone
Signature
2.2 Authorized Agent:
iv4 A rz1- - Z 6 ,o E 7' 5 ��- T F,Ai'1 --l1�
Name (Print) Current Mailing Address: /1-r A 45 16Z:7
11? "2 , S 2C— '7 Signa Tele phone
SECTION 3 - 'ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building o® (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
t37,01)
4. Mechanical (HVAC) 602/
5. Fire Protection
6. Total= (1 +2 +3 +4 +5) 3 CDCir Check Number
This Section For Official Use Only
Date
Building, Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
C...)
File # BP- 2011 -0085
APPLICANT /CONTACT PERSON MARK BONDE
ADDRESS/PHONE 205 PARK ST EASTHAMPTON (413) 535 -9529 Q
PROPERTY LOCATION 117 WOODLAND DR
MAP 35 PARCEL 291 001 ZONE SR(100) / /WSP II
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Pe u'.. illed out
ee •aid 137,0 ' ' s•
Typeof Construction:_Deck Addition
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFQRMATION PRESENTED:
V 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
ignature of Building 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.
r
pm/ BP-2011-0085
GIS #: COMMONWEALTH OF MASSACHUSETTS
$a5 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- 2011 -0085
Project # JS- 2011- 000157
Est. Cost: $23000.00
Fee: $138.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MARK BONDE
Lot Size(sq. ft.): 33149.16 Owner: GREEMAN DAVID & AMY
Zoning: SR(100) //WSP II Applicant: MARK BONDE
AT: 117 WOODLAND DR
Applicant Address: Phone: Insurance:
205 PARK ST (413) 535 -9529 ()
EASTHAMPTONMA01027 ISSUED ON:8/9/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: Deck Addition
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 8/6/2010 0:00:00 $138.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner