18D-053 (17) River Run
Condominium
80 Damon Road • Northampton, MA 01060
September 11, 2014
To whom it may concern:
I request that that you grant a mofification to waive the reqirement for control
construction for the project located at 80 Damon Rd Unit 1101 Northampton, MA
because the work is of a minor nature, will not affect health, accessibility, life and
fire safety, or structural requirements and is impractiacal in that the cost of
control construction is considerable when coompared to the cost of the proposed
work
Res y
R e rdizo ni
ARA Construction
on Behalf of River Run Condominiums
Classic Management • P.O. Box 585 • East Longmeadow, MA 01028
Phone: 866-684-4944 • Fax: 413-526-9683
From: 09110/2014 14:13 #519 P.001 /002
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www massgov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
ADDHeant InLormation Please Print Legibly
Name(Business/Orgmizadornndividual): (`i�Jt:JZ !�(.t h1 Cy`ti/D 0-4 i W"«rr S
Address: C/cam �lG S S, e a,g,
CitylState/Zip: F. L_vi uk-_e c� d'�Q.✓,��if' Phone#:
Are you an employer? Check Yfie appropriate box: Type of project(required):
1.U 1 am a employer with 3 4• ❑ I airs a general contractor and I 6. ❑ New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed an the attached sheet. 7. [0-Ramodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
w for mew any capacity employees and have workers'
�kmg P ty 9. ❑Building addition
[-No workers'comp.insurance comp.insurances
required.] 5. ❑ We are,a corporation and its 10.❑Electriczl repairs or additions
officers have exercised their 11. PAsmbin repairs or additions
3.❑ I am a homeowner doing all work g Pa
myself.[No workers'comp. right of exemption per MGL 12.0 Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp,insurance required.]
"Any applicant that checks box#1 must also 01 out the section below showing their workers'compensation policy information.
tHo meowners who submit this affidavit iadicath�t they at doing all work and then hire outside contrwwrs must submit a new affidavit indicating such.
=Contractors that check this boot west attached an additimal skeet sboaing the name of the sub-contractors and state whether or not dose entities have
employees. Ef the sub-coot wtors have=Vloyea,they must provide their workers'comp6 policy mrmba.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
In / n
Insurance n,
ce Company Name:I V n>�a r be,44 t0"V...
Policy#or Self-ins.Lie.#: Expiration Date:
kA^A i p�
Job Site Address: o [ City/Stateaip: Q _ /few
d °fir
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 MOL c. 152 can lead to the imposition of criminal penalties of a
fine up to S1,500.00 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 cerdfy under the pi penalties ofperjray that the information provided abov is ttrue sad correct_
✓
Date:
Phone
Of trial 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 S.Plumbing Inspector
6.other
Contact Person- Phone#:
t'd Z£L6999£6b un-dMAId BLZ:60i,180deS
City of Northampton 212 Main Street, Northampton, MA. 01060
Solid Waste Disposal Affidavit
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.
r��1
Address of the work: 3a Dp�)GJj
The debris will be transported b �,�Asi
Th :p Y
The debris will be received by:
Building permit number:
1
Name of Permit Applicant
lL���
Date Signature of Permit Applicant
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Su ervisor:+ Not Applicable £
Name of License Holder: ,V�`y� A'
License Number
Address Expiration Date
Signature Telephone / J I I q
...........
9.Re istered Home Im�rove ent Contractor: Not Applicable £
�.53g�
Com an ame Registration N tuber
Cwt 1 �5
Address �] nY) n�I rp i Expiration Date
1 - J 1{� � Jul, �111V� 1' p` Telephone L
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 17N Rome Own'er.Exemptiot!
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 ❑ Replacemen Windows Alteration(s) ❑ Roofing
Or Doors
Accessory Bldg. E-1 Demolition � New Signs [O] Decks [Q Siding P] Other[E3]
Brief Description of Proposed
Work: fil
R�: a► i
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa, if NeIW.house and"or"addition to existin housiln com fete the Ilowin
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?_ m
d. Proposed Square footage of new construction. Dimensions
e. Number of stories? I�XI&I KIC
1
f. Method of heating? �:J C-Jr,iI 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 aryd Zoning regulations? Yes No.
P
I. Septic Tank City Sewer .�J/ Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I�1 ri1-" 1`� s ( , as Owner of the subject
property
R
hereby authorize Lauth to ac t on my behalf, in all matters relative work ized by this building permit application.
Signature of Owner Date
A Z2� 1 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 and the pains and ena ties of perjure.
W-A ALOR,Z j \
Print Name
Date
Signature of Owner/Agent
^.
.
Section 4. ZONING All.Information Must Be Completed. Permit Can Be Denied Due To Incomptete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Setbacks Front
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&pav d
of Parking Spaces
(volume&Location)
A. Hasa Special Permit/Variance/Finding ever been issued forlon the site?
NO 0 DON-r KNOW 0 YES 0
IF YES, date issued:'
IF YES: Was the permit recorded at the Registry ofDeeds?
NO 0 DONTKNOYY 0 Y[5
IF YES: enter Book Page, and/or Dncument#
�� ��
B. Does the site contain abrook, body of vvaterorwetlands? NO �~��� DONTKNO\� �~� YES k~�
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs tobeobtained �~\ Obta�ned x-� Date |ssued�.
�~� �~� '
C. Do any d ��signs YES ��/ NO t=��
�
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 0
IF YES, describe size' type and location: �
E. Will the construction activity disturb(clearing, gradingexcavation, orfiUing)over 1 acre orisd part ofa common plan
'
that will disturb over 1acre? YES NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
-'
� �
I- - —` I ; e arfinent use onl
Ity of Northampton Status of Permrt
5Ep Z rZd�4 .� uilding Department curb Cut/Dri�ieway Perrrttt
212 Main Street Sewer/SeptioAvai�ab[Ilty '
i g
tons ions 100 Water/We1[Avatla`billty
Electric F' I f J1060
ampton, MA 01060 Two Sets of 5#ructural Plans
phone 413-587-1240 Fax 413-587-1272 Plotl$ite Plans
.Oder S eci
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Pro er Addres This section to 6e completed by office
1 Lot Unit
V \
U tic
.. Y
verla District
Elm St;:Distnct - -..- CB District = -
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: p '
Name Print) Current,Maiii g A.�drfs:
Telephone d
Signature
2.2 Authorized ent:
Name(Print) Current Mailing Address:
.All
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS.
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building gLj (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of COO
Construction from 6 `"`
3. Plumbing �Q Building Permit Fee
� L�J
4. Mechanical(HVAC)
5. Fire Protection
6. Total=0 +2+3+4+5) I Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector'of Buildings Date
File#BP-2015-0282
APPLICANT/CONTACT PERSON ROBERT ARDIZZONI
ADDRESS/PHONE 7 LAKESHORE DR HOLLAND (413)531-4841
PROPERTY LOCATION 80 DAMON RD#1101
MAP 18D PARCEL 053 000 ZONE GI(88)/SC(12)/WP(12)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 64d. ,elf/.+'P')
Fee Paid
Typeof Construction: REPAIR FIRE DAMAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 051547
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO TION PRESENTED:
pproved 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
em lition D
ur
Signa e of Building Officia 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.
80 DAMON RD#1101 BP-2015-0282
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18D-053 CITY OF NORTHAMPTON
Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2015-0282
Project# JS-2015-000481
Est.Cost: $100000.00
Fee: $600.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT ARDIZZONI 051547
Lot Size(sq. ft.): Owner: FOOTE ROBERT T JR&
Zoning: GI(88)/SC(12)/WP(12)/ Applicant: ROBERT ARDIZZONI
AT. 80 DAMON RD #1101
Applicant Address: Phone: Insurance:
7 LAKESHORE DR (413) 531-4841 WC
HOLLANDMA01521 ISSUED ON.911512014 0:00:00
TO PERFORM THE FOLLOWING WORK.REPAIR FIRE DAMAGE
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 Siiinature:
FeeType: Date Paid: Amount:
Building 9/15/2014 0:00:00 $600.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner