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Porch stairs 113'0"/
have a 9"tread -----
and a 7 1/2" rise.
at
Bedroom
■
Proposed Renovations, 1st Floor:
A ��,F„► in 1. Remove rear chimney to make space for a
laundry room.
V _..13'5"► 2. Replace existing kitchen window with a
larger window.
Deck 3. Install a new bathroom off the master bedroom.
.-...... We wish to remove
l_-► ------.A;----_: this chimney to make ;---' " 4. Renovate the front entrance and foyer so as to
space for washer provide 2 hours of protection in case of fire. This
— and dryer.
ry f o will include installing fire-resistant doors and hanging two layers
` 12 a ► of 5/8” Type X sheetrock on the walls and ceiling of the foyer.
,' ,15 2 ► 5. Resurface front fireplace and add hearth.
®® I 6. Block off the basement staircase (in the kitchen) to allow
r.
/ I. more room for a refrigerator and oven.
_° U 7. Build a closet underneath the front stairs.
8. Add faced R21 insulation to ceilings.
ICabinets/
/ Counters
.`►
Deck 1,
L_,. , i
Kitchen
tl1 1.l,. i We wish to replace the existing
rn II 1 window with a larger window.
i We wish to block off the
existing basement stairs �
to make more room for a refriger'at r 15'0"►
and oven.
- 9 ►...:._ 113'3"► 14'8"1
■
rn
A O
114'9"I
/�
// Living Room
w -
at n
■ (D A J?
\\ ,\,$)
41Z 5-1
Dining Room -
m
We wish to build cn
fire-resistant a closet underneath
door this front staircase.
• 1
45'3"I
I 4
+ y
N
. I (1
2 — I �,i ' 19 8"► A.
o
fi
■ . �. We wish to add this
13'6'► ( bathroom off the
a, i ,I. The sheetrock master bathroom.
jbehind the stairs
Dotted layer _ ,.. ¢ will be Type X We wish to resurface this N v
■
indicates 2 layers j I ''''''''''-.1 1': 5/8"sheetrock fireplace and add a hearth. ° I
of Type X 5/8" I ,r,4';" Well block the open flue
sheetrock . .- with 2 layers of 5/8" 1
Type X sheetrock and well
Foyer ceiling __ 1------4- renovate/update the
will have 2 layers ventilation system.
of Type X 5/8" y 17'2"■ 115'9"/
sheetrock . Dotted layer
indicates 2 layers fire-resistant
of Type X 5/8" door Bedroom
sheetrock v
'f o
v i v °
arsassi
�•••■
t
fire-resistant.
We wish to renovate the front entrance door
and foyer so as to provide 2 hours of
protection in case of fire. This will
include installing fire-resistant (�
doors and hanging two lavers of `714
5/8"Type X sheetrock on the
walls and ceiling of the foyer.
41 Conz Street Northampton, Massachusetts ����Naf wassAcy '
First Floor Val9\0)\
4� FREDERICK 0V -
Jul 11 2008 J.
�/ DZIALO It No. 17657
°q 4to is7tA0A ��t
,
4/ //
........::::::�)
•
113'0"►
Porch stairs .----1
(9"tread, Back ...-.j
7 1/2"rise) Stairs m
Bedroom
Proposed Renovations, 2nd Floor:
13'x'► ,f C 1. Remove rear chimney to make space for a
laundry room.
43'5°► - I 2. Replace existing kitchen window with a
larger window.
Deck we wish to remove _ 3. Replace the rear window in the dining room
L-. - this chimney to make with a new window.
�; space for a washer 4. Install a new bathroom off the master bedroom.
I anddryer. 5. Renovate the master bedroom so that it features a loft
1 L and a cathedral ceiling. This entails removing the joists
1z 4"1 b 71 on one side of the room, doubling the center joist for
1-4 r/ structural support, installing floorboards along the
-- _- existing joists and replacing the loft window.
6. Replacing the two existing windows in the living room with
one 5' window.
f j-:
'----i 7. Resurface front fireplace and add hearth.
Cainets
counters/ 8. Add faced R21 insulation to ceilings and faced R15 to exterior walls.
ti in back bedroom and dining room.
Deck _ .".. 'I
�-• Kitchen ii
'j
_ y I We wish to replace the existing
�. 1I I window with a larger window.
45-811 413'3"I
® l
___________________ l'i .
rrelk /9'8"1
We wish to replace
the two existing windows ■
here with one 5'window. We wish to replace the existing e„
We wish to add this ,'
Living Room window here with a new window. `...0 Q
.0 bathroom off the
matter bathroom.
- .
\\\ a �It• ,,We wish to resurface this
/�_> s `fireplace and add a hearth.
11'2'5"/ 1 `
O�.
��fire-resistant Dining Room `t
7 46°"/ : /11'91
Dotted layer r ► i
indicates 2 layers 4,. "—TT —.- Bedroom
of Type X 5/8"
sheetrock —' Office
Foyer ceiling 1 -(' v' l�,,t ►% �. nave a�cathedral cclln9. o�y
will have 2 layers - '�» :� ;5 � r '6'1
of Type X 5/8' — '�---► - - -.
sheetrock i.. I - a -.■
The sheetrock s ,..;•• / '"� We wish to add a loft
to behind the stairs ...w =, I .'� / _ st this room. This center entail
closet. strengthening the center joist,
will be Type X T— c,.sr removing the joists above the
5/8"sheetrock ♦ �'' bedroom,adding a fading
13'S"► We wish to add this „4'
Dotted layer .90 bathroom off the - and access ladder and replacing
Y , the front window.
indicates 2 layers -"� master bathroom. 1
of Type X 5/8" -- " o_
sheetrock
We wish to resurface this _ Loft Detail
`fireplace and add a hearth.
We wish to renovate the front entrance
and foyer so as to provide 2 hours of . e,
protection in case of fire. This will d'... fire-resistant
include installing fire-resistant 4.6;',.. door
doors and hanging two lavers of A. 115 9
1181 TvpoX sheetrock oP the °- '►
walls and ceiling of the lover,
/ —. Bedroom
Office
OQ'� This room will -'.Pn
4.:; 16'8"► •
� ` have a cathedral celing. '-�y
rte.:... 411111111111111111=.... ^/
41 Conz Street, Northampton, Massachusetts /�
Second Floor ��1"
July 11, 2008
��, s
. I FREDERICK','044'
i1`k�0'' c. OZIALO
• No..1707
' ' ' 41 Conz Street
113elap r Northampton, MA $275,000
REAL ESTATE i � *IA '.;1.71 , A - s�', ��
i . � ,4„.46 . r4 ate ° c a
243 King Bisect, Suite 239 ° :"sr .1 .. IN � �. -- m . �
Northampton, MA O 1060 :w� _ `- II�t h® �`'ae�ir,. !�+
413-586-9111 Fax: 413-586-9112 .4,41-., . fi r 9 ,
Y
t v.delaprealestate.cam P.` ��
Listing Agent: Joanie Schwartz t t
i 1 1 i -#
it a ,
(H) Phone: � �
L x
Cell: 413-348-2348 s+�- ," .3 •:, i :. Y mow 2.
Home Fax: 4.. :
Email:joanie @delaprealestate.com !".-- - \
Directions: Rt. 5/10 to Conz -- - _
MLS#: 70713739 I - —`–
Walk to everything from this beautiful downtown 2 family in need of updates. Strong potential for commercial
zoning. Would make a great office building/condos. Large side yard, plenty of parking. Spacious rooms, eat-in i
kitchen &wood floors. Updated heat& electric. Low maintenance exterior. Being sold "as is".
Disclosures/Exclusions: Occasional water in basement. Friable asbestos in basment. j
1
Style 2 family Heat Gas hot water Oven/range GAs Lot Size+- .36
Year Built 1806 i baseboard Type Frontage+- _
Square Ft.+- 3014 1 A/C No Refrigerator Yes Map/Lot 032c,115,0001
Rooms 11 Hot Water Gas ! Dishwasher No Deed 8/2322/P-22
Bedrooms 5 Rental I Other Zoning RES for now
Baths 2 Water Source Public'l Cable Yes Assess. Value $300,900
Garage No Sewer Public I Fireplace No! Taxes/Yr. $3533
Exterior Vinyl { Title V N/A 'Wood stove No I School BriageSt,Kennedy,NGi;C,
Porch Yes Electric 100/2 panels Washer Kitchen Occupancy _ April 28th
Deck No I Roof Asphalt ; Location 1st fir I Outbuildings No
I Color White i Age+- 10 yrs !Dryer Kitchen
Construction Frame I Foundation Stone Location 1st fir ' Condo Fee N/A '!
I Floors Wood, carpet, vinyl , Bsmnt Exit Bulkhead Sump Pump Yes Assoc. Fee N/A
First Floor: Living room, kitchen. family room, 2 beds, bath
Second Floor: Living room, kitchen, family room, 3 beds, bath
Attic/Third Floor: Walk-up
Basement/Lower Level :
The information in this iistin was gathered from third party sources including the seller and public records.,MLSFI� e sclai n
The . g � i arc as si.cs„.fibers.�isc:air°�any end all
representations or warranties as to the accuracy of the information.
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HOME OWNER EXEMPTION ACECvOWLEDGEMENT
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
permits 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 penults and inspections are
made
•
f x y
I, " _ ;> �.� s _.� understand the above.
(Home owner/resident's signature requesting exemption)
I will call ko schedule all required building inspections necessary for the building permit
issued to me.
Date , ' '11,,`C-r
Address of work
location
(j C"
}
` �, '• / t om" /412e..._
r _ The Commonwealth of Massacl acserrs
Department of Indust'-ial_4ccidenrs
= Office of Investigations
:2:...--__-:.-_, 600 Washington Street
—" MA Boston, M 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers
Applicant Information Please Print Legibly
'Nam e (Business/Organizarion i I n d i v i d u a 1):
Address:
Ci*y.'State/Zip: Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
4. I am a general contractor and I 6. ❑New constrction
I.❑ I am a employer with ❑
employees (full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner-
ship listed on the attached sheet. 7. ❑Remodeling
and have no employees These sub contractors have
8. ❑Demolition
working for me in any capacity. employees and have workers'
9. ❑Building addition
[No workers' comp. insurance comp. insurance.:
required..] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.Cl I am a homeowner doing all work officers have exercised their 1 Plumbing repairs or additions
myself. [No workers' comp.
right of exe�liption per MGL 12.D Roof repairs
insurance required.] ' c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp.insurance required.]
"Any applicant that checks box#1 must aiso fill out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating 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-contractor 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: _
Policy T or Seif-ins.Lic.T: Expiration Date:
Job Site Address: ' City/State/Zip:
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 criminal penalties of a
fine up to 81,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORD ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cer to under the pains an.' .:Wallies ofperj that the information provided above is true and correct.
r
Signature: //_. _, /_ - Date: .. ' .
Phone#: _ ,�
IOfficial 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.Boar d of Health 2 ..Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6. Other I
1
i Contact Person: Phone T: ■
SECTION 3-CONSTRUCTION SERVICES
8.1 Licensed Construction Sunerrsor: I Not Applicable ❑
Name of License Holder:
License Number
address - Expiration Date
Signature Telephone
Reeistered Home tmnrovernent Contirac€ar ..wP� _..,_. w.w . ._, Not Applicable ❑
:omnanv Name Registration Number
.ddress Expiration Date
Telephone
ECTION 10-WORKERS'COMPENSATION•INSURANCE AFFIDAVIT(M G L.c. 152,§,25C(6))
corkers Compensation Insurance affidavit must be completed and submitted with this application. Failure tc provide this affidavit will result
the denial of the issuance of the building permit..
aned Affidavit Attached Yes ❑ No ❑
i1 ...Hom>v�Q er xempuon
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.CIVIR 780. Sixth Edition Section 10835.1.
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,von may be Iiable for person(s)
you hire to perform work for you under this permit.
The undersiened"homeowner"certifies and assumes responsibility for comp lance with the State Building Code,City of
Northampton Ordinances, S d Local Zoning Lawi.d State of M• ..•.usetts General Laws Annotated.
Homeowner Signature
J
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House n Addition n Replacement Windows Alteration(s) I 1 I Roofing I I I
II��II Or Doors [i
Accessory Bldg. L! Demolition ❑ New Signs [0] Decks f=] Siding 1=1 Other[C1]
Brief Description of Proposed
Work: .f u.. .oag—J1 ...P CAn Zan?
Alteration of existing bedroom . Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes Nc
Plans Attached Roll -Sheet
6a.•If New house and or.addition.to existina-housincl.complete thefollowino:
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 Ccnserraticn 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 EE COMPDETE>S VltifEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR 81;71 NGPERMIT
� / z / . . .
1, 1.. , as Owner of the subject
property /
hereby authorize 4./�/_ / �t _
to act c ' half, in.I mat-rs rei e to w./ I horize, y this building permit application., tne-e* / ' l*--/ 2.-o r
Signature of wner Date
I , 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. ,
Signeo under the pains and penalties of perjury.
i
I Print Na - i 4r
./_—_/
S;cn2 �ofCwner'Agent I
Section 4. ZONING i 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
LotSize ..__ _, _.._.. ___,.... .. _ ._...... ..._. __.:
Frontage ____. .._„.__ .._..___.__....,
Setbacks Front _..__
Side L._...... _..._: R:: L: ... .._.__ R: _.____ ____ .._._ _
Rear __.
Building Height
Bldg. Square Footage % __.
Open Space Footage __ I
(Lot area minus bldg&paved --.-
narldntr)
#of Parking Spaces — — °'°„'
Fill:
(volume&Location) -.---•-
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW Q YES Q
IF YES, date issued:-
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW Q YES Q„ ___
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO( DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Q , Date Issued
C. Do any signs exist on the property? YES Q NO cg
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. Will the construction activity disturb(clearing,grading, excavation, or filling)over 1 acre or is it part of a corm rOft plan
that will disturb over 1 acre? YES Q NO 0
IF YES, then a Northampton Storm Water Management Feimitfrom the DPW is required.
s Department use only
c\-------",:c.,'
�\',\City of Northampton Status of Permit
\1- �'v vBuilding Department curb Cut/Driveway Permit
°(�l /' �,%212 Main Street Sewer/Septic Availability
`�
'----\,...„....,,v.:‘,„ ✓ �0� �� oom 100 F/�aterlWeltAvadability
�,`: r N�rtham ton, MA 01060 Two Sets of Structural Plans
��� phorl `''-58� 240 Fax 413-567-1272 Plot/Site Plans
Fv Other Specify
A CA'IOPLxO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTI\hl: -SITE-INFORMATION
This section to be completed by office
1.1 Property Address:
41 C ' Map of Unit
[ j[' Zone Overlay District
,�` ,r 1 Elm
District CB District
SECTION 2-PROPERTY OWNS SHIP/All T HORIZED AGENT I
2.1 Owner of Record:
Name(Print) - Current Mailingx- ca...., /11)(110//e34
�t w Telephone
Signature V/3 �� 7 Sl
2.2 Autho zed A4ent:
F-PCiP(f I� V _ft' j)Z i a In . tD. i P[ecca�)-f. V`i e, I-la��i�(cl, �1 4
Name(Print) Current Mailing Address:
'74,..etc f � L} I �, 2�I 1 7 q 0.
Sig�iature / f Telephone
SECTION 3-!ESTIMATED CONSTRUCTION COSTS
Item I Estimated Cost(Dollars)to be Official Use Only
completed by permit aoolicant
1. Building ä)Bufldin Permit Fee
/4 enrb
2. Electrical (b)Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
Gzrr.
4. Mechanical(HVAC)
5. Fire Protection !�,( _
6. Total=(1 +2+3+4+5) Check Number 539 7 t /�
This Section For Official Use Only /
Date.
Building Permit Number Issued:
Signature:
-- — —
Building,C Gate
ommissioner/Inspector of builaings
File#BP-2008-1161
APPLICANT/CONTACT PERSON FREDERICK DZIALO
ADDRESS/PHONE 19 PLEASANT VIEW DR HATFIELD (413)247-5740
PROPERTY LOCATION 41 CONZ ST
MAP 32C PARCEL 115 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 53i?3 /�Q
Fee Paid
Typeof Construction: REPAIR BEAM&INSTALL REPLACEMENT WINDOWS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 17657
3 sets of Plans/Plot Plan
THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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
�; _ 2 0
Signature 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
r.
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
permits 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
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 to me.
Date
Address of work
location
4 Y
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:
City/State/Zip: Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling.
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp.insurance comp. insurance.
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
officers have exercised their 11. Plumbing repairs or additions
3.❑ I am a homeowner doing all work Plumbing P
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
I.Homeowners who submit this affidavit indicating 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: _
Policy#or Self-ins.Lic. #: Expiration Date:
Job Site Address: City/State/Zip:
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 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 fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
L,Sinnature: Date:
Phone#:
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.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address ‘7.7—ce,/,
/� Expiration Date
Signature ephone !/
9.Registered Horne.Improveinent Contractor .:'•' = Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
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 ❑ No El
11. - Horne Owner 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 108.3.5.1.
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
Y • r ,
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing n
Or Doors Ear
Accessory Bldg. ❑ Demolition DE New Signs [D] Decks [G7 Siding[D] Other[D]
g` rCS� 1
/Brief Description. Proposed ��
Work: ■_ s / _;�. _ J /�.r� � , _ 4o•t-Aey-'r 71 Z� .
/ _— /j 44cez'
Alteration of existing bedroom (Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes )( No
Plans Attached Roll -Sheet
6a. If New house and or addition to.existing housin g, complete the"following:
a. Use of building : One Family Two Family 3(/ Other
b. Number of rooms in each family unit: ,S Number of Bathrooms VeT
c. Is there a garage attached? /y&
d. Proposed Square footage of new construction. Dimensions
e. Number of stories? 2,
f. Method of heating? 2- Fireplaces or Woodstoves 2- Number of each 1
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes r4' �No..�Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade � i1.i ee?E_
k. Will building conform to the Building and Zoning regulations? L,-----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 FO- BUILDING PERMIT
1, .2 '„_ -"AC _ _ , as Owner of the subject
property " /
hereby authorize c r , / �! y- I.
to act on +�r ehalf, i all matters r �'"e o work au�:ized py this building permit application.
/s„ I i/�/Pf_ d/ f : .. '2
Signature o1iwner ! - - �' Date
I, , 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
ig a e of Owner/Agent Date
i
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 Departmen
Lot Size _____'__--__-__�
Frontage /----'-------------� /-----�- �----�---'------
Setbacks Front
Side
Rear
�__
Building Height �_-- r--- _�
Bldg. Square Footage '---� F--- �� �--- r---� �---1
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces ,---� ^---- ----'
Fill:
(volume&Location) �----------------�^— �-----------'----'
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
0
NO «~��� DONT KNOW v�� YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO �� DONT YES�~/ r-------------
IF YES:� enter Book Page | and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 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 Datebsued� �
v�� ' , � _________~
��
C. Do any signs exist on the pnnpe� ��property? YES �_/ NO ��/
r--------------------�-- '-----� --- - -�
IF YES, describe size, type and location:
D. Are there any proposed changes to or add tions of signs intended for the pnzperty? YES 0 NO (i)i
IF YES, describe size, type and location:
E. Will the construction activity disturb ring, grading on, or filling)over 1 acre or is t part of a common plan
that will disturb over 1 acre? YES ) NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Depattmentuse onty
City of Northampton Status of Permtt
Building Department CuthCutlDnvewayPermit
212 Main Street Sewertse'`trcAvailabilit
y ,
Room 100 Water/Weit Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 plot/Site Plans
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
Li( CcriZ Map Lot Unit
NI RI-4X', Zone Overlay District
c)(OO
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: y�>7 1 /
e4/2 L/Q Z Cif /t,
Nam Print) Current ng Address: /
Gg l b au C '� Y Telephone /
Signature �f/3 ,. , j
2.2 Authorized Agent:
r e c c e r ) c l C S. D 2.1 a L 1 /9 P/PQS a if/ 11ie,i Dr'
Name(Print) • Current Mailing Address: /.. -fie/e. ) /l Ct-
dair � � . ,.c _. ._.� A 1-/-7— 5 74 C
Signature / Telephone
SECTION 3-ESTIMATED CON TRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (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) Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2008-1161
APPLICANT/CONTACT PERSON FREDERICK DZIALO
ADDRESS/PHONE 19 PLEASANT VIEW DR HATFIELD (413)247-5740
PROPERTY LOCATION 41 CONZ ST
MAP 32C PARCEL 115 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
, ZONING FORM FILLED OUT r/
ee Paid U ..
Buildin. Permit Filled out
Fee Paid
Typeof Construction:_Renovate 2 units,incl.Kitchens; add 2 baths,replace windows,replace beam
New Construction _
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:_
Owner/Statement or License 17657
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOATION PRESENTED:
L./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
c3-77:42..a....._ 7 ,-......-9 0 7/1 1108'
Signature of Buil ing 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.
41 CONZ ST • BP-2008-1161
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C- 115 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2008-1161
Project# ' JS-2008-001710
Est. Cost: $20000.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: FREDERICK J DZIALO 17657
Lot Size(so. ft.): 15507.36 Owner: BOUCHER GERARD A
Zoning:URC Applicant: FREDERICK DZIALO
AT: 41 CONZ ST
Applicant Address: Phone: Insurance:
19 PLEASANT VIEW DR 413) 247-5740
HATFIELDMA01038 ISSUED ON:6/ /2008 0:1 i »l
TO PERFORM THE FOLLOWING WORK:REPAIR'o AM & N . Ft'LL REPLACEMENT
WINDOWS
VISIBLE FROM THE ST ET
POST THIS CARD SO IT IS
Inspector of Plumbing Inspector of Wiring D.P.W. 1 ilding;_ spector
Underground: Service: Meter:
Footings:
Rough: Rough: I ous•. Foundation:
Drivewat final:
Final: Final: x.
Rough Frame:
Gas: Fir•'iIle I artment Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY T '` CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. ::;
Certificate of Occupancy Signature: 4
FeeType: Date Paid: Amount:
Building 6/24/2008 0:00:00 $100.005399
•
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo