31A-057 ARTICLE 21
PERMANENT UTILITIES
21.0 The Owner shall pay all utility company charges for hook-up of electric,telephone,cable,
water and sewer.
ARTICLE 22
22.0 Any notice,approval, consent or other communication under this Agreement shall be in
writing and shall be considered given when delivered personally or mailed by registered or certified mail,
return receipt requested,to the parties at the addresses indicated below(or at such other addresses as the
parties may specify by notice to the others pursuant hereto).
If to Contractor,to it at:
CHAGNON BUILDING& REMODELING LLC
91 Stockbridge St..
Hadley,MA 01035
If to Owner,to them at:
Jan and Patrice Sabach
262 Crescent Street
Northampton,MA 01060
ARTICLE 23
TERMINATION
23.0 If the Contractor shall:
(a)be adjudged bankrupt,
(b)persistently or repeatedly refuse or fail,except in cases where extension of time is
provided, to supply enough properly skilled workmen or proper materials to perform
the work,
(c)persistently disregard laws, ordinances, rules,regulations, conditions of any public
authorities having jurisdiction over the WORK,or
(d)be guilty of material violation of this Agreement,
then the Owner shall be entitled,upon seven(7)days prior notice,unless the Contractor shall cure
such violation during said seven(7)day period,to terminate this Agreement and take possession of the Site
and all materials and equipment thereon and finish the WORK by whatever method Owner may deem
expedient.
ARTICLE 24
GOVERNING.LAW,EFFECT
This Contract shall be construed and enforced in accordance with the substantive law of the
Commonwealth of Massachusetts without giving effect to the conflicts or choice of law provisions thereof,
and shall have the effect of sealed instrument.
This Agreement executed on the day and year first written above.
Contractor
CHAGNON IPUILDING/&REMODELING i..Lc
By l/
It's esid t
Owt�£L-
Contractor initials: tG Owners Initials: ��
Page s of 1 t Copyright®2013 Chagnon Building 8 Remodeling LLC
Cnaeed on 112V2013
Sabath Ofte Addieoa Contract 12 29 13
City ofNorthampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Afficlavf
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: �� ,v7�
The debris will be transported by:
The debris will be received by: IA41leV ecyG
Building permit number: L( `
Name of Permit Applicant C(Y4&ZA-"
1 /
Date Signature of Permit Applicant
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an enrizyee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An ernpkper is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the.foregoing engaged in a joint enterprise,and in chiding the legal representatives ofa deceased employer,or the
receiver or trustee of an individual partnership,association or other legal entity,employing employees. However the
o-NNwr of a dwelling house having not more than three apartments and who resides therein,or the occupant ofthe
dsye lliig house of another who employs person to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
.NMGL chapter 152,§25C(6)also states that"every state orlocal licensing agency shall withhold the issuance or
nne-Aul of a license orpermit to operate a business orto construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage nquimcl."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance ofpublic work until acceptable evidence ofcompliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary, supply sub-contractor(s)narne(s), address(es)and phone rrunber(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
enployves, a policy is required. Be advised that this affidavit rmy be submitted to the Department of Industrial
Accidents fur con Gimation ofincurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Departmmnt of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
conpensation policy,please call the Departimert at the number listed below. Self-insured companies should enter their
:r=1f insurance license nunber on the appropriate lip.
Cit-v or Town Officials
Tease be sure that the affidavit is complete and printed legmloly. The Department has provided a space at the bottom
of the affidavit foryouto fill out inthe event the Office ofIrrvestigatifln has to contact youregardirf-the applicmt.
Please be sure to fill in the permitllicene rnamber which will be used as a reference number. In addition,an applicant
that i st submit multiple permi licrose applications in any given year,need only submit one affidavit indicating current
policy information (if necessary)and under".lob Site Address"the applicant should write"all rations in (city or
to am)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proofthat a valid affidavit is on fife for fiture perrnits or licenses. A new affidavit mist be filled out each
sear. Where a home owner or citizen is obtaining a license or permit not related to any business or eonmercial venture
(ie.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Of ofInvestigation would Ike to thank you in advance fur your cooperation and should you have any question,
please do not hesitate to give us a call
The Department's address,telephone and fax number:
The Commonwealth oflassachusetts
Department of 1tidustrial Acciderrts
UMce of Investigations
I Congress Street, Suite 100
Boston,MA 02114-2017
Tel #617-727-4900 ext 7406 or 1-877-NlASSAFE
Re-6sed -2413
Fax#617-727-7749
www.mass.gov/da
The Commonwealth ofMassachusetts
Department oflndustrialAccidents
Office oflnvestigatians
1 Congress Street,Suite 100
t Boston,JZ4 02114-2017
www mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
hicant Information Please Print Le
v _6q d'&Vt/ 7✓c//G��f � k iYd 3 LL/t acne(Bin riesstargar ationlzdiid l}:
L dress: ,//
°'State/Z" : /�/ 0`� d`1 Old Phone#: %3
Are you an employer" Check the appropriate box: Type of project{required):
f 4. I am a general contractor and I
l. I am a ernpbyer�i'ith _ ❑ g 6. Q New construction
employees(fullarWorpart-tone).* locoed sub-contr tors
I am a sod proprietor or partner-
These on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. [�Dermlition
` work' for rr3e in a ca ac employees and have workers'
n5 p iLy. 9. Building addition I
[No workers' comp.insurance comp•insurance.-
required] 5. ❑ We are a corporation and its 10.❑Electrica.lrepaas or additions
— officers have exercised their 11. P airs or additions
I am a horrreoixner doing all work ❑ > repairs
tiyself. [No workers' comp. rigli of exemption per MGL 12.0 Roofrepairs
urartce required.] t c. 152,§1(4),and we have no
employees. [No workers' 13.n Other
i comp.insurance required.]
"nn v applicant that checks box=1 must also fill out the section below showing their workers'compensation policy information.
€- u a ners who submit this affidavit indicating they are doing all work and then hire outside cmtractor s must submit a new affidavit indicating such
-C Ux s.s�ztors that check this box must attached an additionalsheet showing the name ofthe sub-contractors and state whether or not those entities have
Ifthe subcontractors have employees,they must provide their workers'comp.policy number.
V_
lain in a n employer that is providing markers'compensation insurance for my employees Below is the policy and job site
information.
Itsat.r:e CompanyNatne: rL U.
Policy 4 or Self-ins.Lie.#: d001 W 17gOS Expiration Date:
Job Sie Address: 0%j cgos c,, sker'l CitylState/Zip:AA?
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
I;aihze to secure coverage as required under Section 25A ofMGL e. 152 can lead to the irnpositionofcriminalperralties ofa
fn-,e tr,)to S 1,500.00 ardor one-year irrprisormnent,as well as civil penalties in the form of a STOP WORK ORDER and a fine
ofi to 5250.00 a day against the violator. Be advised that a copy ofthis statement tray be forwarded to the Office of
Iits7est*ations ofthe DIA for insurance coverage verification
Y do hereby certify u er the pain and penalties o information provided above is true and correct
S�,an e: Date: /
Phone 4:
r-Official use anty. Do not write in this area,to be conrleted by city or town official.
$1 City or Town: Perrmt/Ucense #
'i
a
hi acing Authority(circle one):
�# 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
f 6. Other
Contact Person: Phone ll:
SECTION 8-CONSTRUCTION SERVICES
!� 8.1 Licensed Construction Supervisor: Not Applicable ❑
i Name of Licerue Holder:
I f License Number '
/trd C)(0 3 5-
Aidress Expiration Date
Si ature Telephone
S.ReOstarod Norm IrrrprpMM KJ COAracMr: Not Applicable ❑
i
Company Name Registration Number
I � S7r/ /.3flcjc.,P
molev
Address �— Expiration Dafte
I —
I � 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...... ❑
11. -Home car Exemion
The current exemption for`homeowners"was extended to inchde Owner-occupied Dv*IH es ofone(1) or two(2)lannhes
and to allow suchhorneownu to engage anindividualfor 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 ofbnd on which be/she resides or intends to reside,on which there
is,or is intended to be,a one or two famUy dwelbr g,attached or detached shutures accessory to such use and/or farm
structures.A person who constructs mare than one home in a two-yearvedod shaD not be consiidend a homeowner.
Such`homeowner"shall submit to the Building Official,on a form acceptable to the Building OiliciaL that he/she shaU be
responsible forafi such ewrk performed under the buildups pert.
As acting Construction Suyervisoryour presence on the job site will be required from time to time,during and upon
completion ofthe work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers' Corpensation) and Chapter 153(LiabilityofEnployers to
Employees for injuries not resulting in Death)ofthe Massachusetts GeneralLaws Annotated,you may be liable for person(s)
youhire to performwork for youunder this permit
The undersigned`homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
North>arnpton Ordinances,State and LocalZoning Laws and State ofMassachusetts General Laws Annotated.
Homeowner Signatun
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition [D' Replacement Windows Alteration(s) �'� Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks (Q Siding[p] Other[p]
Brief Description of Proposed `/ ,
Work: "%dr�r. yk C0='-"f9 &'ZGx 'i /h' x 6`61' 110Mt°
Alteration of existing bedroom Yes 4"—No Adding new bedroom Yes 4--No
Attached Narrative Renovating unfinished basement Yes !/-No
Pians Attached Roll -Sheet
8a.if New house and or additi o to existMa housing.compie Ow foibwina: i
a. use of building:One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms_
I c. Is there a garage attached?02
� � n
d. Proposed Square footage of new construction. / �f Dimensions
I a. Number of stories? d
f. Method of heating? %h3A Fireplaces or Woodstoves Number of each
9. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction 60"
i. is construction within 100 ft.of wetlands? Yes D�_No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
R /
k. Will building conform to the Building and Zoning regulations? Yes No.
!. Septic Tank City Sewer � Private well City water Supply t�
iii SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I
Gam° P 5�61ff _ as Owner of the subject
i property
hereby authorize
c �3 6>v
to act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
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.
Pint Name
Segnature of Owner/ (t Date
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zorimg
This colmm to be filled in by
Building Dqwftrrrt
Lot Size .....
Frontage 72
Setbacks From
R: R
Side L; L F
Rear F-7
Building Heigi-A F-1
Bldg Square Footage
6,ri % 1113eb- 4
Open Space Footage %
(Lot area mian bldg&paved ----------
parkiw
#ofParking Spaces
FRI-
(vb.&Locati,,) ----- ----
A Has a Special Permit/Variance/Finding ever been issued fbr/on the site?
NO 0 DON'T KNOW YES 0
IF YES,date issued'
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 'YES 0
IF YES: enter Book Page i and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO (7r DON'T KNOW YES
N.011 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 e)dston the property? YES 0 NO
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 a
IF WS,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 O N
0 %V
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
City of Northampton
Building Department
,jAN 2 12014 212 Main Street
Room 100
hampton, MA 01060 .
phan4'(3=587-1240 Fax 413-587-1272
pf
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 compieWd bye
'q& C`(� $C ti J� Map Lot Unit
Zone Overlay okm ict i
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED T7
i
2.1 Owner of Record:
f�A�rr c �i4n1 5413 � cX d C�Qt 5 C f/y� 5r�;/fir � iii/ �v:�;1
Name(Print) Current Mailing Address:
y13- 7a7-
CC,4,"A Telephone
Signature If
22 Authorized Anent•
z
I Narne(Print)/ Current Mailing Address:
--' 11/.3 667-6 ?Ft�
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
I Item Estimated Cost(Dollars)to be Official Use Only
completed by rmit applicant
1. Building j pQO "� (a)Building Permit Fee
/ D
2. Electrical (b)Estimated Total Cost of
/X00 Construction from 6
13. Plumbing /� Building Perrrdt Fee
I
4. Mechanical(HVAC) J
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 CommissionerAnspector of Buildings Date
i
File#BP-2014-0827 law U`L
APPLICANT/CONTACT PERSON GARY J CHAGNON
ADDRESS/PHONE 91 STOCKBRIDGE ST HADLEY (413)259-6785 n
PROPERTY LOCATION 262 CRESCENT ST
MAP 31A PARCEL 057 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out q:q pa
Fee Paid
T_ypeof Construction: CONVERT REAR PORCH TO HOME OFFICE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 060175
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO N 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
e lit' D y
re of Buil ing Off ral 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.
262 CRESCENT ST BP-2014-0827
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 3 1 A-057 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-2014-0827
Project# JS-2014-001418
Est. Cost: $17000.00
Fee: $102.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: GARY J CHAGNON 060175
Lot Size(sq. ft.): 6490.44 Owner: SABACH PATRICE&JAN
Zoning:URB(100)/ Applicant: GARY J CHAGNON
AT. 262 CRESCENT ST
Applicant Address: Phone: Insurance:
91 STOCKBRIDGE ST (413) 259-6785 WC
HADLEYMA01035 ISSUED ON:21312014 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONVERT REAR PORCH TO HOME OFFICE
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 2/3/2014 0:00:00 $102.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner