35-278 (4) 90 WOODLAND DR BP-2016-1145
GIs #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35 -278 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-2016-1145
Project# JS-2016-001971
Est. Cost: $7459.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RENAISSANCE BUILDERS 013302
Lot Size(sq. 1): 37722.96 Owner: LAZZARINI ZITA
Zoning: Applicant: RENAISSANCE BUILDERS
AT. 90 WOODLAND DR
Applicant Address: Phone: Insurance:
P O Box 272 (413) 863-8316 Workers Compensation
TURNERS FALLSMA01376 ISSUED ON:3/30/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPAIR WALL DAMAGE FROM CAR
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 3/30/2016 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1145
APPLICANT/CONTACT PERSON RENAISSANCE BUILDERS
ADDRESS/PHONE P O Box 272 TURNERS FALLS01376(413)863-8316
PROPERTY LOCATION 90 WOODLAND DR
MAP 35 PARCEL 278 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid P
Building Permit Filled out
Fee Paid
Typeof Construction: REPAIR WALL DAMAGE FROM CAR
New Construction
Non Structural interior renovations
Addition to Existing -
Accessory Structure -
Building Plans Included:
Owner/Statement or License 013302
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOR N 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
Demolition Del
S n e o uildi fficia 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.
Department useonly
City of Northampton Status of Permit:
`- —� Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
R , JaQ�6 Room 100 Water/Well Availability
j � _ orthampton, MA 01060 Two Sets of Structural Plans
1 ---phdne 4 3-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
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 Property Address:
(In r)od kv-141 T)r I L)'q-- Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Addres
le�Cy: 01 -- 1�3 10
Telephone
Signature
2.2 Authorized Agent:
�e,f�GL car�e: ,i �s^`� �I ! e-►x �J'�, �1 r�r..r��r� S r,.j IS ; �'. H
Name(Prin Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building / (� * (a)Building Permit Fee
2. Electrical "T I (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total=0 +2+3+4+5) O c9 Check Number
This Section For Official Use Only
BuildingPermit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings 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 Department
Lot Size f;. )
Frontage
Setbacks Front
Side L: R: L:. R:
Rear
Building Height ,
Bldg. Square Footage ? % "�
Open Space Footage %
(Lot area minus bldg&paved
parking)
r
#of Parkin 0
Spaces r
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recordedat the Re istry of Deeds?
NO 0 DON'T KNOW YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW YES
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 exist on the property? YESa 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:
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 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding[O] Other[ j
Brief Description of PpSp�sed (�. 1
Work. }�»_i:0A r-�, Tc-)! ? ('Of 11 ��CO� COY �1)mt-., (It :�OL4t' (�d�� r�e"-_s 1-O(�.c ce( k ("lo'n-13a't
Alteration of existing bedroom Yes—X No Adding new bedroom Yes X_No
Attached Narrative Renovating unfinished basement Yes _ (, No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, Complete the following:
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. 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 FOR BUILDING PERMIT
I,Zi « La'Zz-car Y"l - �� :_E_ � �C>��fei'C 5 ('Jt r� ,r 3� a�� >C�d �t 7(1� f').as Owner of the subject
property
hereby authorize0-
to
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
t1-1 V e,e_Y- +V 0 0-vd 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.
�,C-e-le r' L
Print Name
�2� C14
=�1 dai �lr
Signature of Owd*/Affent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
2
Name of License Holder:`� 1 '.��1 -t"� 1( N._F_�11��C�i L• 3 ` J��.
License Number
Address Expiration 6ate
I1 3 3iix�
Si nature telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
r
am`
Ad re s c� �y Expiration ate
Telephoneg(a,'C�lo��—Q �^
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.......X No...... ❑
11. - Home OwnerExemption
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
The Coinnwnwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,M4 02121
W)VW.MWSs.0,oV/&
Workers' Compensation Insurance AffidaAt: Builders/Contractors/FIectricia-ns/P lumbers
Applicant InformationPlease Print LepsiblN,
Name (Business/Organim io-n-d—nd-i'vi dual): ta>u L_ D t=,=�_s
P
Address: /--N 2_7 Z_
City/State/Zip:TUV- V1fV- 5 F-C-44A ��3ihoneX: q13 - 96 3
Are you an employer?Check the appropriate box:_ Type of project(required):
I.X I am a employer with F7 4, 7 1 am a general contractor and 1 6. 7 New construe-don
employees(full and/or part-time).* have hired the sub-contractors
2.7 1 a=a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have S. Demolition
working for me in any capacity. employees and have workers'
[No workers' comp,insurance comp.insurance.:
Z, 9. Building addition
required] 5. 7 We are a corporation and its 10.[1 Electrical repairs or additions
I am a homeowner doing all work officers have exercised their* 11.7 Plumbing repairs or additions
myself. [No workers, comp. right of exemption per MOL 12TI Roof repairs
insurance required.]I c.-152, §1(4),and we have no
employees.[No workers' 13.7 other
comp.insurance required.]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
'r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such,
zContractorz that check this bco.m=attached an additional sheet showing the name of the sub-oontmaors and state whether or not those entiti=have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an emplai)er that is providing workers'compensation insurance for my employees. .Below is the policy and job site
tnformazlon.
bisurarice Company Name:__ IASVY 3,Y) U_ Cc
Policy 4 or Self-ins.Lic. �C)C) 400 f q?GAJ 2,06-Expiration Date
Job Site Address:90 City/State/Zip:} I Or e r-r..-e L "n 10(o.-z
Attach a copy of the workers' compensation policy declaration page(showing thie 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-yew imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of'up,to S250.00 a day against the violalor. Be advised that a copy of this statement may be forwarded to the Office of
Investigations-s of the DIA for insurance coverage verification.
I do hereby cern der rhe pains andpenalties ofperjury th to information provided above is true and correct
Sirarnature- (�A
Phone (4 1 3
Official use Only. Do not write in this area, to be completed by city or tomin offlciaZ
City or Towa: 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 Per-son: Phone
Renaissance
Builders
PO Box 272, Turners Falls,MA 01376
Phone(413)863-8316; Fax(413)863-9712
www.renbuild.net
March 25, 2016
Denice Hallstein
90 Woodland Drive
Florence, MA 01062
Scope of work for repairs to front wall of home at above address to correct
damage from car.
Remove and replace siding on front face.
Remove and replace one garage door track.
Reframe on overhead door and replace king and jack studs on both sides.
Install new double 9" LVL headers.
Replace aluminum door trim on both overhead doors.
Reinstall salvaged overhead doors.
Replace all damaged drywall on interior.
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MIR
77 77
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Replace
-
header for
this door.
75
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Renaissance
Builders
P.O. Box 272,Turners Falls,MA 01376
(Q l 3)863-8316,Fax(d 13)863-9712
www.renbuild.nct
To: Louis Hasbrouck
Building Commissioner
Northampton, MA
certify that we are the Owners of the property located at 90 Woodland Drive,
Florence.
We hereby authorize Stephen Greenwald of Renaissance Builders, 390 Main
Road, Gill, MA 01376 to submit a building permit application on our behalf for the
repairs to our attached garage.
We agree to conform to all applicable laws of the town and state, and we believe
the work proposed to be in compliance with all zoning regulations and the
Massachusetts State Building Code 780CMR.
Signature of Owner:
Printed Name:
i
i
Date:
Signature of Owner: S-
Printed Name: Pvt
, 1
Date:
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
1 401"triictiiiii
License: CS-013302
STEPHEN J GREOM
390 MAIN RD a
Gill MA 01354
)i itV A A
J,,�,,,, -,,�►�,. Expiration
Commissioner 08/17/2017
Unrestricted - Buildings of any use group which
contain less than 35,000 cubic feet (991 m3)of
ei;closcd space.
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For DPS Licensing information visit: www.Mass.Gov/DP$
AFFIDAVIT FOR DISPOSAL OF DEMOLITION DEBRIS
Supplement to Permit Application
As a result of the provisions of MGL c. 40, s54, I acknowledge that as a condition of the
issuance of a 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.
I certify that debris resulting from this demolition will be disposed of as listed below:
Job Site Location: 9n)no A )ail(� hr i (i e- 0 r e-0 C tit-Lcl 0
Name of Permit Applicant: Renaissance Builders
Disposal Facility: F & G Recycling
Address of Facility: 15 Mullen Rd., Enfield. Ct 06082
IF SAID FACILITY IS OTHER THAN WHAT I HAVE LISTED, I CERTIFY THAT
I WILL NOTIFY THE BUILDING OFFICIAL OF THE CORRECT LOCATION OF
THE SOLID WASTE DISPOSAL FACILITY WITHIN TWO MONTHS OF THE
DATE OF THIS APPLICATION.
5W3V�We of AlIpfiff-ant Date
Renaissance
Builders
PO Box 272, Turners Falls,MA 01376
Phone(413)863-8316; Fax(413)863-9712
www.renbuild.net
March 25, 2016
Louis Hasbrouck
Building Commissioner
212 Main Street
Northampton, MA 01060
Louis,
Enclosed is a permit application to repair the front wall of home located at 90 Woodland Drive,
Florence. Zita Lazzarini own's the building. Stephen Greenwald is the project manager.
Also enclosed is:
❑ A scope of work describing the project
❑ A photo showing the location of repair
❑ A signed Owner Authorization Form
❑ A Workers Compensation Affidavit
❑ A Demolition Debris Affidavit
❑ A HIC Registration Affidavit
❑ A copy of Stephen Greenwald's CSL
❑ A check for$65.00 for the permit fee
Please call Stephen at 413-772-9430 if you have any questions regarding the project. Please send
the permit to our office.
Thank you, `
Shari Libby
Renaissance Builders