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42-178 (7) -7:7 o 2�v �/ � a ��f �� �� .� .<< _ _ ����.. �, .. � -° , �. i a a w � v ..£f . . ✓: +wa °� G �.00E"�� �,,° � � L "� �� ., f_�� r` :: � r �� �!- r �c_. *. �*. } � .. i . , v I I oil City of Northampton Building Department Plan Review 212 Main Street NorthamPtOn, MA 01060 ff���s o; � 6e�r � eG �s�lt" l000r gob 14 :3 'Olrdoe" o4.,e c-A 7 9 Itylo %60� A-4_ 6:160 r- L Guidelines for Registered Contractors Page 1 of 3 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer Affairs and Business Regulation N Home > Consumer Rights and Resources > Home Improvement > HIC Registration> Guidelines for Registered Contractors Guidelines for Registered Contractors Do I need to register?G.L.c.142A,§1 You must register if you are an individual,proprietorship,partnership or corporation that solicits,bids on,or performs residential contracting on an already existing one-to-four unit,owner-occupied,residential building,as a contractor or subcontractor,unless meet one of the exemptions listed here: Exemptions:G.L.c.142A,§14 • the Commonwealth or any of its political subdivisions; • any school,public or private,offering as part of a vocational education program courses and training in any aspect of home construction or home improvements; • electricians,plumbers,architects or any other persons who are required by law to attain standards of competency or experience(take a test,and/or have experience)in order to obtain that license—and who are working exclusively within the scope of that(active)license.This exception does NOT apply to Construction Supervisor Licensees,who must also obtain a Home Improvement Contractor registration in order to perform residential contracting work; • persons dealing in the sale of goods or materials who neither arrange to perform,nor perform directly or indirectly any work or labor in connection with the installation of or application of the goods or materials; • any owner personally doing residential contracting work on his own home; • any individual who performs construction related labor or services for a home improvement contractor or subcontractor, for wages or salary and who does not act in the capacity of a home improvement contractor or subcontractor, • any contractor or subcontractor who woks on one residential contracting project or undertaking,by one or more contracts,where the total price to the owner is less than$500,provided,however,that the contract is not in an amount less than$500 for the purpose of evading c.142A; • any person who engages in the business of a home improvement contractor o subcontractor won other than a full-time basis,and who has earned in gross revenues less than$5,000 in the previous 12 months; • any person acting as a contractor or subcontractor who is enrolled as a full-time student in a secondary school or college with degree granting authority from the government of the state in which the school is located,enrolled for the preceding and next academic term in the same or equivalent school,and provided that at least 213 of whose employees are also so enrolled,and whose gross revenues are,or are anticipated to be,less than$5000 from residential contracting worts; • persons who install any or all of the following:central heating,A/C systems,energy conservation devices,or provide conservation services on behalf of a public utility under a program approved by the commonwealth; • any contractor or subcontractor who works exclusively in the following home improvement areas:landscaping;interior painting or wall covering;finished floor covering including but not limited to carpeting,vinyl,tile,non-structural hardwood;fencing or freestanding masonry walls;above-ground swimming pools;shutter or awning installation;ground level patios,or asphalt driveway installation and maintenance. Registration must be renewed every TWO years.You can find the application form online at: www.mass.aov/consumer or you may request one by contacting the Office of Consumer Affairs,10 Park Plaza, Suite 5170,Boston,MA 02116,(617)973.8700. What work is covered? Residential contracting is defined as'the reconstruction,alteration,renovations,repair,modernization,conversion, improvement,removal,demolition or construction of an addition to any pre-existing owner-occupied building containing at least one,but not more than four,dwelling units designed to be used as a residence or dwelling unit,or to structures which are adjacent to such residence or building."So any wok you do involving this description requires that you have a Home Improvement Contractor registration,unless the work or your status as described in the exemptions allows you not to be registered.G.L.c.142A,§1 So I register and pay the required fees,and get a registration.What happens then? • If you are advertising your services,you need to put your registration number on all of the advertisements-including advertising by way of signs or lettering your car or truck or signs placed on a customers property,and advertisements placed in newspapers,telephone directories,magazines and web sites.G.L.c.142A,§13(c) http://www.mass.gov/ocabr/consumer-rights-and-resources/home-improvement-contracUhic... 6/8/2015 e-A, / 7g 74 / 7 , 2 0 I 3 e The Commonwealth of Massachusetts Department of IndustrialAccidents H R Office of Investigations d 1 Congress Street, Suite 100 Boston,MA 02114-2017 M } www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Letibly Name (Business/Organization/Individual): QG✓ Address: City/State/Zip: 6 P Phone#: C,y3�G ��6-3 10 Are you an employer?Chec the dppropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.X 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 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152,§1(4),and we have no / 13.®Other employees. [No workers' �M !`l6GT comp. insurance required.] 'Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t 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 th pain and i erjury that the information provided above is true and correct Signature: Y Date: Phone# ���� 6 ��✓�76 3 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 Ucense Holder: 19Z&,✓ G.5 o " 6 7 3 License Number ' r �oN/zo f,C_ Address Expiratio Date�- �3 J-T,03 Si nature Telephone 9 Restllstered Home lmproyement Contractor: Not Applicable CeG1--c, I WX J241 /" Company Name Registration Num 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...... ❑ 11. - Home 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding[0] Other[�] Brief escrip' n _�Posed Work Alteration of existing bedroom Yes_ No Adding new bedroom Yes >C No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Shee 6a. If New house and or addition to existina housing, complete the followina: 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? I. 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 Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES � FORBUILDING PERMIT �1, / aA".,, -, 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. 6/8/Zola' Signature of Owner Da et 1, (:57-"� d ,da'!2. ,as Owner/Authorized Agent hereby declare that t 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 4;ZAZ"-? Signature edAgent 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 Q Building Department Lot Size Frontage Setbacks Front Side L: R: L: y 7nR: Rear �36 0 .3 fJ�15 Building Height Bldg.Square Footage f 7so z 2 Open Space Footage % Q� (Lot area minus bldg&paved 79' 220 490 ✓v �� arkin ✓ #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO � DONT KNOW O YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW © YES 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 O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O 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 O 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 O NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. p � E WF, City of Northampton i Building Department " . 1 10 2015 s p � � 212 Main Street Room 100 Electric,P umbing&Gas InspedioN rthampton, MA 01060 Northampton, MA 0 060 -587-1240 Fax 413-587-1272 F_ X APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: f� This section to be completed by office l q to 6,G>7 clad� Qc Map Lot Unit 0 V` -�1.!llwu� A Zone Overlay District Elm St.District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: �. Ce,AJ ffiade Lk-( e_a� l G164-1�0/ J A, 1&0 ► D 46a Name(Print) Cu e t ailin ddress: Telephone Signature 2.2 Authorized Aaent: Name(Print) Current Mailing ddres : x/3 ,67-J74 .3 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only m leted by rmit applicant 1. Building (a)Building Permit Fee a D . O C? 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) so 5. Fire Protection 6. Total=0 +2+3+4+5) / p Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2015-1279 APPLICANT/CONTACT PERSON GEORGE W PETERSON ADDRESS/PHONE 111 COUNTRY RD HUNTINGTON01050(413)667-5763 () PROPERTY LOCATION 196 GLENDALE RD e MAP 42 PARCEL 178 001 ZONE 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: CONSTRUCT 720 SO FT DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• - Owner/Statement or License 086736 3 sets of Plans/Plot Plan THE PL ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION 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 el Sig o wilding ficial 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. 196 GLENDALE RD BP-2015-1279 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:42- 178 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Deck BUILDING PERMIT Permit# BP-2015-1279 Project# JS-2015-002344 Est. Cost: $21600.00 Fee:$144.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: GEORGE W PETERSON 086736 Lot Size(sq. ft.): 81021.60 Owner: PEARSON JEFFREY&MARLENE Zoning: Applicant: GEORGE W PETERSON AT. 196 GLENDALE RD Applicant Address: Phone: Insurance: 111 COUNTRY RD (413) 667-5763 O HUNTINGTONMA01050 ISSUED ON.611212015 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 720 SQ FT DECK 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 6/12/2015 0:00:00 $144.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner