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25A-060 (7) NOTICE TO PROCEED To: CDT Construction Date: / � .� -Z`e) ,2000 158 North Maple Street Florence, MA. 01062 Project: Jane Barcomb 13-15 Hubbard St. Northampton, Ma. You are hereby notified to commence work ip accordance with the Agreement date: j j -.21 - , 2000, on or before k�, C r /_ 2000 and you are to complete work by ,,)),I'a r 2001 BY: Title: Receipt of above NOTICE TO PROCEED is hereby acknowledged by: k� This the day of U1 n IQ 2000. By: Title: rV4-V C ��►^+`��- r 4KttAMp�, t4 e Crzt-� of Wort 4alliptor 9 B �asaacE(nsrtta' m DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT F, (licenscrlpermittee} with a principal place of business/residence at: (phone#) (street city/stalrl�p) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) (Expiration Dare) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (E)piration Date) ,, (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Adich additional shoot if necxaucy to nwJude infornuuou pertaining to all ooaradon) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing alt the work myself. NOTE:please be aware that whilo homeowners who employ persom to do maim..== c=studion or repair work on a dwelling of not more than throe units is which the horn eowner resides or on the grour,6 appurtewat thacto ace not eco=lly ooandered to be employem under the w orkeez oomp=s4m Ad(GL152,ss 1(5)),application by a homeowner for a license or permit may evidcnoe the legal status of an employer under the Workeet Compamatioa AcL I understand that a copy of thin atatemrni may be f%vmxded to the Dcpwt=cd of Iodcuhid Aocidea&Offioo of Insurance for the covaagc verification and that failure to sm=cov rngo under section 25A of MGL 152 can Iced to the imposition of criminal penalties eomisting of a fine of up to S1,300.00 and/or mmmpriso�of up to one ytw and civil p=shcs in the form of a Stop Work Order and a fine o(3100.00 a day against the For d P r�use 0131Y Pcrmit Number Niap# Lot# y��. Signature of Licensee/Permit tee ECTIgN 8-CaN�NSYRNJCTION!N SERY,ICI1 1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: pC;2,� License Number Add s Expiration Date Signa re Telephone " Not Applicable ❑ 1 Company Name Registration Number Address Expiration Date Telephone SECTION 1Q WQAKIIERS'COMPENSATION"INSURANCE"AFF1 "ft(M.Q L ,152,§:25G(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. .igned 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 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 a. CTIO T D OPO a 'c b e I: New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet 0 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. Mascheck Energy Compliance form attached? �. 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 AU7HOR12AT10N,-'T BE COMf:"L�1=t) WHEN OWNERS Ad J 'htRACTOR APPLI ,SW D1NG PERMlT as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. "Signature wner Date as Owner/Authorized Agent Cz hereby declare that the statemen s and information on the foregoing application are true and accurate, to the best of my knowledge and belief. igned under the pains and penalties of perjury. rint me Date Si er/Agent A Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % 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? NO DON'T KNOW _ YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES 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 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property?YES No IF YES, describe size, type and location: A City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587.1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION i SIT FORMATION 1.1 PropertyAddress: Jl rr / SECTION PROPERLY OWNERSHIP, AUTHORIZED AGENT. 2.1 Owner of Record: ame(Print) Cur r\e�t Mailin Address: Tele hone Signature 2.2 Authorized Agent: N me rint) _ Current Mailing Eames— *natur93 Telephone SECTION� °'�ES'»I>1�ATE'Ib G�NSTRUC"I"IQN''��5T5''. . Item Estimated Cost(Dollars)to be Officrah C)se Onl , completed by ermit applicant _ a BUS g _ 1. Building ���� O Idir� Perrr�tt F � 2. Electrical (b) Estimated.Total Cost of Construction fr m. f 3. Plumbing BuElldin PermitfF 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 +3 +4+ 5) Check turriber Th"sSec#i !iCffflcil UswI ; t Build'ing'Permit Number V Cte lssuec Signature: >lull(�r� ;'Comrtlissiorrerltnspect©r cf.Buildirfgs ! Pate,,` f .I 13 HUBBARD AVE BP-2001-0561 G1S#: COMMONWEALTH OF MASSACHUSETTS Map.Block:25A-060 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category:roofing BUILDING PERMIT Permit# BP-2001-C-761 Project# JS-2001-087 Est.Cost: $12000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: CDT CONSTRUCTION 130152 Lot Size s_._1c.8.1: 8973.36 Owner: BARCOMB JANE M&ALLEN F Zoning:URB Applicant. CONSTRUCTION AT. 13 HUBBARD AVE Applicant Address: Phone: Insurance: 158 NORTH MAPLE ST_ (413) 585-8677 Workers Compensation FLORENCEMA01062 ISSUED ON:12111100 0:00:00 TO PERFORM TII, FOLLOWING WORK:STRI P & SHINGLE ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing I:, hector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: ,h: House# Foundation: Final: Final: Rough Frame: Gas l_,. a Department Fireplace/Chimney: Rough: 011: Insulation: Final: Final: THIS PERMIT MAY W :ZI:VOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES A'—, REGULATIONS. Certificate of Occupar si nature• Fee Type: eipt No: Date Paid: Check No: Amount: Building 12/11/00 0:00:00 3379 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo ✓/� �omrmwouaea/�i o�'./f/laavaclauaella , BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR r F. Number: CS 030382 Birthdate: 01/02/1946 I Expires:01/02/2002 Tr.no: 14054 es cted To: 00 ROGER A LEMONDE PO BOX 759 i WILBRAHAM, MA 01095 Administrator ��ie�omr,+anuir¢/�o�../�aaoac�i.+aatla HOME IMPROVEMENT CONTRACTOR Registration 113676 Type - INDIVIDUAL Expiration 07/07%01 Y ROGER A. LEMONDE 330 GLENDALE RD ATLBRAHAM MA 01095 ADMINISTRATOR ,..,tu;:.;,t,�,,.,.-,z,;..,,,}.>,i.,r,,.n >„. _>di+?,,x hMit>ej;ji „i,.i:,., ..:; .,;;s.r.kr_.,..•a;;C '�K,:,.;�:,. ,. ,.... �O e - $ d Massachusetts' m DEPARTMENT OF BUILDrNG INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 ORKER' CONTE ATION INSURANCE AFFIDAVIT (IicenseeJpermittee) with cipal place of business/residence at: P (phone#) G?'� �— (strCCUCity/state/ap) 3 do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) (Expiration Daze) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Numbcr) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additioml sheet ifneocssuy to include information pertaining to all ooatrn ) Am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:pl=w be aware that while homernvnera who employ pasom to do mainlcnatrcr,ooastructionor repair work on a dwelling of not more thaw truce units is which the homeowner resides oc oa the grounds apprutenant thereto are not gc=dly coandered to be employes under the worker`s o=pcnsation Ad(GL152,ss 1(5)),application by a homeowner for a license or pertnd may evidence the leg&!status of an employer under the Workeet Compensation Act I undassand that a copy of this statement may be forwarded to the Departnm of Industrial Acadw&Oi$oo of Imur*noe for the coverage verification and that failure to secure coveago under section 25A of MoL 152 can lead to the imposition of aimi-I penalties Consisting of a 1mC d up to and/or impaiso�of up to one year and civil pcn&Wcs in the form of a Stop Wodc order and a f=of 5100.00 a day For departmiattt use caty Fr Permit Number L - Map•#-----Lot# LicenseelPermittee .A 40 SCTlONB-CUNSTRUCTION SERVICES .1 Licensed Construction SuDetuvislo r: Not Applicable ❑ C s' 0, Cat 3�yZ.. Xame of License Holder :� �.�-'f��L �C�ll� License Number Address /- Expiration ate Signature °,Telephone ol €Ei4 ..E.. .. . 11� cable n me Registration Number ell 1 r Ad ess f�° `` Expir n Date Telephone �Ll� 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 building permit. igned 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 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 Ordinance to and Local Zoning Laws and State of Massachusetts General Laws Annotated. r r� Homeowner Signature U 4 C- .{. ) l_- f' r° _CTION 5- DESCRIPTION OF PRQP0SED WORK(check.all applicable) New House ❑ Addition ❑ Replacement ndows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: Alteration of existing bedroom Yes `f No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes `�No 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. Mascheck Energy Compliance form attached? 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 OW RS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT -11 as Owner of the subject property here authorize to act on my behalf, in all relative to wok authorized by this building permit application. }z Signature of Own6 Date l as Owner/Authorized Agent hereby declar at._ e statements and information on the foregoing application are true and accurate, to the best of my knowledge and b ief. igned under jie pains and pen Kies of perjury. ign tine'" Oym /Age r D Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Perm it/Variance/Findin ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO V DON'T KNOW YES 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 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: City of Northampton r#r x s Building Department 212 Main Streets k Room 100 g Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 rt ? =a APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1- SITE INFORMATION 1.1 Property Address: This section toco ;be mpleted,by office Lot° Unit gone f3verf � st � Etm St. District ri t. SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current ailing Addr s: Telelfhone Signatu /r-- 2.2 A (iz d rint urrent MAddress•l/'��y� ��/ e� ��✓ S ur Telephone 54a—N3 - E IMAT D 'ONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit 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 t9 I 6. Total = (1 + 2 + 3 +4+ 5) Check Number This Section For Official Use Only Building Permit Number. Date Issued: Signature: Building Qom missionerllnspector of Buildings Date 13 HUBBARD AVE BP-2001-0603 GIS#: COMMONWEALTH OF MASSACHUSETTS Qap:Block:25A-060 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:windows replaced BUILDING PERMIT Permit# BP-2001-0603 Project# JS-2001-1082 Est.Cost: $2200.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ROGER LEMONDE 113676 Lot Size(sg.ft.): 8973.36 Owner: BARCOMB JANE M&ALLEN F Zoning:URB Applicant: ROGER LE M O N D E AT. 13 HUBBARD AVE Applicant Address: Phone: Insurance: P O BOX 759 (413) 596-6979 WILBRAHAMMA01095 ISSUED ON:12129100 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL REPLACEMENT WINDOWS & DOORS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 12/29/00 0:00:00 2207 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo O�'CH�P'o CrztV of Xort4auipton z f Jl�lassachusctts n" DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street • Municipal Building o�y s e Northampton, MA 01060 January 23, 2001 Greg Komer Department of Labor and Workforce Development 165 Liberty Street Springfield, MAO 1103 Subject: 13-15 Hubbard Ave work without permit Mr. Komer, I have attached a copy of the building permit that Mr. Roger Lemonde took out after he was discovered working without permit. The only permit that he took out is dated December 29, 2000, there were no previous permits by him for that location. Sincerely, Anthony Patillo Building Commissioner City of Northampton 13 HUBBARD AVE BP-2001-0603 G1S#: COMMONWEALTH OF MASSACHUSETTS ''Map:Block:25A-060 CITY OF NORTHAMPTON Lot: -001 Permit: Building Catel;orv:windows replaced BUILDING PERMIT Permit# BP-2001-0603 Project# JS-2001-1082 Est.Cost:$2200.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ROGER LEMONDE 113676 Lot Size(sq.1): 8973.36 Owner: BARCOMB JANE M&ALLEN F Zoning URB Applicant: ROGER LEMONDE AT. 13 HUBBARD AVE Applicant Address: Phone: Insurance: P O BOX 759 (413) 596-6979 WILBRAHAMMA01095 ISSUED ON.12129100 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS & DOORS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: 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 sienature: Fee Type: Receipt No: Date Paid: Check No: Amount: ` Building 12/29/00 0:00:00 2207 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo