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25A-070 (5) CS-013668 KENNETH IN LYNDS 71 RESERVOIR RD LEEDS MA 01013 07/24/2015 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR registration: 136677 Type: -Expiration: 8/14/2016 Individual KENNETH WILLIAM LYNDS KENNETH LYNDS 71 RESERVOIR RD. LEEDS,MA 01053 Undersecretary 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. Address of the work:' The debris will be transported by: ����h 1 �° �� '0 � The debris will be received by: Building permit number: Name of Permit Applicant a Date Signature of Permit Applicant City of Northampton S�5 ; S� f Massachusetts vti i GJ{{ 4y y DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building y Northampton, MA 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State Massachusetts allows the homeowner the right under OCMR 108.3.4 to act as his/her construction ervisor. The state defines "Homeowner" as, " Pe on(s) who owns a parcel on which he/she resides ntends to be, a one or two family dwellin attached or detached structures accessory to such u and/or farm structures. A person wh onstructs more than one home in a two- year period shall not be sidered a home owner." The building department for the I mpto ants any person(s) who seek to use the home owner exemption, to act as their otion upervisor, to be aware than by doing so you become responsible for complit building codes and regulations. The inspection process requires that the building e called to inspect work at various stages, which include foundation/footin s before bac e holes before our a rou h building inspection before work is concealed insulatio ns ecti if required) and a final'ibuilding inspection. The building department requires thes inspections b ore the work is concealed, failure to secure these inspections can result in fai re to obtain a ce 'ficate of occupancy until the work can be inspected. If the homeowner hires other tra es to perform work (electrica , lumbing & gad) the homeowner will be responsible to make sure that e trades hired secure their prope ermits in conjunction to the building permit issued, and that the et their required inspections. Failu of the individual trades to secure the permits and inspection as required can DELAY the project until s h time as the proper permits and inspections are mad 1, understane above. (Home owner/r sident's signature requesting exemption) I will call to sched e all required building inspections necessary for the building permit issued to me. Date Address of w rk location 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 A Please Print LeLxibly Name (Business/O anizati on/Indivi dual): Address: • C y a City/State/Zip: Z A�— . V a 3 Phone #: ! �7 `� 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 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2.9q I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g, ❑ 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.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions 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.F-1 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHo meowners 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 nder the ains and p nalties of perjury that the information provided above is true and correct. Signature: Date: et r r Phone#: %�� is'Jf! --JQ Va 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: �, CS-0/ License Number o VS J /a Addresir O/f Expration Date . n ure Telephone 9. Re istered Home Im'rovement Contractor,: _ , �:� Not Applicable £ ti � . L- Cdr 1• Z �3G � 77 Co'imbany Name Registration Number d. ox i1clep 7z A ew a o7 Vz. f— /(/—If. Address C)/,o 173 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...... £ ©� - Home Owner Exem tion The curren�exeion for"homeowners"was extended to include Owner-occupied Dwelli one(1) or two(2)families and to allow such ho�780, o engage an individual for hire who does not possess a ' se,provided that the owner acts as supervisor.CMR th Editi on Section 108.3.5.1. Definition of Homeowner:Per s)who own a parcel of land on whi e/she resides or intends to reside,on which there is,or is intended to be,a one or two a dwelling,attached or ched structures accessory to such use and/or farm structures.A person who constructs more one ho a two- ear period shall not a considered a homeowner. Such"homeowner"shall submit to the Building O on a form acceptable to the BuiIdin Official,that he/she shall be res onsible for all such work performed uiadEr the buirding ivernut. As acting Construction Supervisor presence on the job si 11 be required from time to time,during and upon completion of the work for whic is permit is issued. Also be advised that with r rence to Chapter 152(Workers'Compensation d Chapter 153 (Liability of Employers to Employees for injurie of resulting in Death)of the Massachusetts General Laws otated,lyou may be liable for person(s) you hire to per work for you under this permit. The unde ed"homeowner"certifies and assumes responsibility for compliance with the S Building Code,City of N mpton Ordinances,State and Local Zoning Laws and State of Massachusetts General aws otated. Homeowner Signature. t SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors 7; X I Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[O] Other[0] Brief Descrip'on of Propo `d �. O,� kv o� Ao � � G�.,�,� Work: �[ --,a' ' Alteration of existing bedroom Yes No Adding new bedroom Yes _]f, No Attached Narrative Renovating unfinished basement Yes No 0.- '-J" Plans Attached Roll -Sheet sa If Nevii ''ouse and or addlfo n to exlsting houslnd, complete the followit : Q 7v –)6—a. Use of building: One Family Two Family Other '} b. Number of rooms in each family unit: 'w7'w7 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 X Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT .4f,_4C_ p as Owner of the subject property her orize act n my alf, ' all tters relative to work authorized Ty this building perm application. ignature f Owner Date as QWW/Authorized Agent hereby declare that the statements an information on the foregoing appli do re true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. y 411114 Print a e ) w A 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 P)epartment f..y Lot Size �! —..__._._..w.....� s_...._�.._.._ .____....� s Frontage Setbacks Front Side L:'...._...._..= R: R:',....._ LF Rear Building Height ' Bldg.Square Footage - - _.._. ---_..._ % Open Space Footage % (Lot area minus bldg&paved t i parking) #of Parking Spaces (•---_- °` Fill: € (volume&Location) --- --�--�-- -°--°--!--------------._..--`.° A. Has a S ecial 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 DONT KNOW ^ - YES ! IF YES: enter Book I �' Page - —£ and/6r r 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 l Obtained l0 , Date Issued: C. Do any signs exist on the property? YES Q NO 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 common plan that will disturb over 1 acre? YES Q NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. P � €lepartment use onl�r City of Northampton Status ofPermtt '` Ql i t Building Department CUrB Cut{Dnuewny Perml# f OCR 2 0 ZOA 212 Main Street SewerlSepticAyaifaF�thty Room 100 �IVater/IAIeliAvailabllitq Inspections Northampton, MA 01060 Twa Sits of5tructural Plans plumbing&Gas p Northam ton,MA 01 13-587-1240 Fax 413-587-1272 Plot/Slte Plans Otherz5pecify . 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 ProDertv Address: Map Lot Unit Zone Overlay Distr►ct 1���` CB District District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ame(Print) Curre ailing JM ress: o Telephone Kgnature 2.2 u honzed A ent, NSA(Pr t) Current Mailing Address: 2d L S' ture j Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be p Official Use Only completed by ermit applicant 1. Building spa. (a)Building Permit Fee 2. Electrical l� (b)Estimated Total Post of / Construction from 6 3. Plumbing ./ Building Permit Fee 4. Mechanical(HVAC) �(� ooll 40 5, Fire Protection 6. Total=0 +2+3+4+5) �. Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commiss loner/Inspec tor'of Buildings Date File#BP-2015-0447 APPLICANT/CONTACT PERSON KENNETH LYNDS ADDRESS/PHONE P O BOX 448 LEEDS (413)584-9282 PROPERTY LOCATION 18 HUBBARD AVE MAP 25A PARCEL 070 001 ZONE URB(l00)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: RENOVATE 2ND FLR BATHROOM ORCH REPAIR RM*tA1--E GARAGET DOOR New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 013668 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: roved 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 uildmg 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. 18 HUBBARD AVE BP-2015-0447 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 25A-070 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-2015-0447 Project# JS-2015-000827 Est. Cost: $8675.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KENNETH LYNDS 013668 Lot Size(sq. ft.): 5270.76 Owner: MAILLER WILLIAM D&LEE MAILLER-PHYLBORN Zoning: URB(100)/ Applicant: KENNETH LYNDS AT. 18 HUBBARD AVE Applicant Address: Phone: Insurance: P O BOX 448 (413) 584-9282 WC LEEDSMA01053 ISSUED ON.10121/2014 0:00:00 TO PERFORM THE FOLLOWING WORK.RENOVATE 2ND FLR BATHROOM,FRONT PORCH REPAIR,NEW GARAGE DOOR 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 10/21/2014 0:00:00 $55.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner