17A-212 (5) 126 NORTH MAPLE ST BP-2016-1452
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map6lock: 17A-212 CITY OF NORTHAMPTON
Lot -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2016-1452
Project# JS-2016-002494
Est. Cost: $11000.00
Fee: 540.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: EUGENE BATTISTONI 104608
Lot Size(so. DX 25918.20 Owner: SZAWLOWSKI JOHN R&DORIS E TRUSTEES
Zoning: URB(100)/ Applicant: EUGENE BATTISTONI
AT: 126 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
534 Market Hill Rd (413)549-2693 Workers Compensation
AMHERSTMA01002 ISSUED ON:6/8/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE GARAGE ROOF AND REROOF WITH
RUBBER ROOFING
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 ft 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 6/8/2016 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
11 Department use only
t4",.` \ City of Northampton Status of Permit
�w" Building Department Cult Cut/Driveway Permit
ickc
\ 212 Main Street Sewer/Septic Availability
j` Room 100 Watermell Availability
r Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
•PPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
/aG ,r / ' je c Map Lot Unit
�V /'/ r Zone Overlay District
INCC 10 recce_ 12/4 D/a5Z) lElm SL District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
N. 2.1 Owner of Record:
\ • 5��e_
Tar;s 5zRu7lowS�
Name(Pont) Current Mailing Address:
Telephone -cg
Signature x-/-7 s< 9 730
2.2 Authorized A/gent:/ /� /� L /� p //,J�Oj/Oad..
�/�/fi.S4' ( ®n i.: l-Cr4 A-,y -wC fit ✓/7.arle "" ///ep /(AI.GrT1/A�`
Name(11 n Current Mailing Address:
._ 9/3 .5-5/ 026 9_3
Signal Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
t Building (a)Building Permit Fee
Z Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5 Fire Protection // pp . N
6. Total=(1 +2+3+4+5) Check Number ah_4.95 4€10
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: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
Frontage •
Setbacks Front
Side L: R: L: It:
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?
v
NO O DON'T KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW V YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O Date Issued:
C. Do any signs exist on the property? YES O 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,e cavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 0-CONSTRUCTION SERVICES
i.1 Limn onstruetl•n Su•:rvis r r. Not Applicable !
Name of License Holder . . ; 5
pt13 t 7
s License/umber
s3 4tifitg Lh// El , 4S7-71/1-vrvo q-ti - 17
Address_ Expiration Date
tn. W/5. V902d 93
•sig . - Telephone
• R• •"=ter• Home ,•pavement Contractor: / Not Applicable !
1.11
Company Name RegistretioT Number
9 /Zrka,&-1-/ • it M 7-I'1 i6
Address104-64;69.7
i Expiration Date
��//e (tel)/$ / 1 I .1 . —� Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c 102,§25C(S})
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.
d)einition 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 buildtoe 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 app$cable)
New House ElAddition ❑ Replacement Windows Alteration(s) I I Roofing IK Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [DI Decks [q Siding ICI] Other[CO
Brief Description of Proposed y6 ,6.
Work / / Oa... 6 : v /.,.: . 72. i,u� ,C.M¢(//
Alteration of existing bedroom ' Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes .—Ro
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing. 6omplete 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. Masschedc Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 t 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 f City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, ,as Owner of the subject
property ��JJ
hereby authorize y,.. 4 5- /Ili
to act on my behalf, in all matters relative to work authorized by this ilding permit application.
Signature of Owner Date
I, e .ease - ,as Owne6uthorized
hereby sec.re at t e statements and information on the foregoing application are true and accurate,to the best of my kn edge
tl belief
Signed under the pains and penalties of perjury.
L vleaf, gr 44-.‘S le
Print Name
47, / _ _
Signatur±f:J-r/Agent Date
SThe Commonwealth of Massachusetts
x= Department ofIndustrial Accidents
.1= Office of Investigations
1 Congress Street,Suite 100
"t.— I Boston,!L4 02114-2017
www.massgov/dfa
Workers Compensation InsuranceAffidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information / / Please Print Legibly
Name(Business/Organization/Individual): ['s .�/I-(� 10,A) i l n DtI J� .✓9 'G
Address: C3 di 4/ 4-
City/State/Zip: lyJ/4j7 /44- 0/Uo Z Phone#: CF(3 slit, 6 13
Are you an employer?Check the appropriate box: Type of project(required):
I.Q"fam a employer with q 4. ❑ I am a general contractor and I
employees(full and/or part-time).• have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 9 Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees aid haveworke&
[No workers' oxfp. insuralce comp.insurance.F 9. Building addition
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Pytimbing repairs or additions
f. [No right of exemption per MGL
ml� [ torte. 12. Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees [No workers 13.❑Other
comp.insurance required.]
*AM mg cal the checks bar#1 must almfill cut thesadion blow Saving their warka$mnpauelim policy infanMicn.
t Homeowners who submit this affidavit indicating they are doing all work and then him outside contractors must submit a new affidavit indicating such
k:ontractors 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-molt eeteafnrveerplo/ees,May must prwidethdr worker&carp.policy number.
I am an employe that is providing worker& compensation inaurancefor my employees Below isthe policy and jab Ste
information. ,�
Insurance Company Name: n Ve/QF1 c �yy (j
Policy#or Self-ins. Lic.#: 7P fa B 6 /? /7891 - f-[ftxpiration Date: P —ZS /6
Job Site Address: I ua N. 01.4,4p,10 City/State/Zip: Nor _ vy//fow / 0/060
copy Attach a py of the workers compensation iorn policy declaration page(showing thepolicy number and 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 cerci er the pains d of perjury that the information provided above is true and correct.
Signature: s /43/41, Date: to —/—/6
Phone#: V/3 57,19-2G e
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#:
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: 12,6 A7 itotap/e SY F-7o.
The debris will be transported by: l,/gyfir 17 i . -y
The debris will be received by:
Building permit number:
Name of Permit Applicant
6 — 1— LC ao
Date Signature of Permit Applicant
ProposalPage"" of Pages
BATTISTONI CONTRACTING, INC.
534 Market Hill Road
AMHERST,MASSACHUSETTS 01002
(413)549-2693
RtOPOSAL SUBMITTED TO: PHONE DATE
Ms.Doris Szawlowski 413-584-9730 413-588-8837 May 16,2016
STREET JOB NAME
126 North Maple Street 126 North Maple Street
CITY,STATE AND Zn CODE JOB LOCATION
Florence,MA 01060 Florence,MA 01060
ARcmrEcr I DATE OF PLANS CSL License #003175 NIC License #104608 I 300 PHONE
We hereby submit specification and estimates for.
Garage roof:
Removal of existing metal roof and rolled roofing from garage roof.
Installation of'A"fiberboard mechanically fastened to roof deck.
Installation of black rubber roofing system fully adhered.
Installation of flashing.
Replacement of Texture I-11 siding where roof meets shed side walL
Price: x11,000.00
Note_Building permit fee is not included in price.
We propose hereby to furnish material and labor—complete in accordance with above specifications,for the sum of:
dollars(8 ).
Payment to be meatus follows:
One third deposit,remainder due upon completion 7
All material is guaranteed to be as specified AU wort to be ccmpkW m asw
4 a hnadhc Authorized 410111 -
=meter accwdimg to standard mosses.Any duration or deviation from above spalfianons Si — �
involving ra costs will be executed only upon written orders,and will become Caen !fie
es a /� •,
charge ova and above the estimate All agreentam contingent upon stairs,accidents or
delays beyond m mod. Owns t
to try fire,tornado and other necessary insurance. Ow N This proposal may be
workers are fitly covered by workman's Compensation Insurance. Withdrawn by us if not accepted within 15 days.
Acceptance of Proposal -The above prim,specificationsA /
and conditions are satisfactory and are hereby accepted. You are SignatureOr _ /
•
authorized to do the work as specrfr PaymentI be mak as outlined
above.
Date of Acceptance: r025— Signature Signature
City of Northampton
a• pyo, Massachusetts
A _
a I
DEPARTMENT OP BUILDING INSPECTIONS
t'r "! 212 Main Street • Municipal Building 0. s
\ Northampton, MA 01060 111.E.. 1000�c
LOUIS HASBROUCK
BUILDING COMMISSIONER Effective July 1, 2015
Phone: (413)587-1240
Fax: (413)587-1272
Residential One and Two Family Building Permit Fees
http.//www no rtha m pton roe qcv/702/B u i l d i nq-Department
Fees for work not listed will be determined by the Building Department
Any work beginning before a permit has been issued is subject to double fees and a stop work order removal fee
Hours of operation are typically Monday thru Friday 8:30 to 4:30, Walk-In hours are closed at 12:00 pm Wednesday
Permit Fees are paid to the CITY Or NORTHAMPTON CHECKS OR MONEY ORDERS ONLY: NO Cash or Credit Cards
Checks or Money Orders Must Be Submitted with the Application or it will not be acted upon
To Be Processed,Applications Must Be Complete and Include ALL Required Attachments
All Applications Are Subject To Zoning Review. The Weekly Filing Deadline is 12:00 pm (noon)on Wednesday.
Building applications-Require a plot plan,floor plans, elevations, structural and energy information as appropriate
Sign applications- Require a photo of the existing elevation and a photo shopped placement of the proposed sign
Applications may be subject to Central Business, and or Historic and Demolition Delay reviews
It is the Owner's responsibility to verify property bounds and conservation issues
COMPLETE DEMOLITION Accessory Structure $30.00
One or Two Family House $75.00
NEW CONSTRUCTION All Occupied Floors per sf $50
%Floors,Walk-In Attics, Basements,Garages per sf- $20
Decks, Porches, Canopies, Porticos per sf $20
NEW ACCESSORY STRUCTURE Free Standing Decks $20 per sf, Minimum $50.00
Shed up to 200 sf zoning review $30.00
Shed over 200 sf $20 per sf, Minimum $35.00
Tent over 200 sf $30.00
Above Ground Swimming Pool $40.00
In Ground Swimming Pool $75.00
REPAIR, RENOVATION,ALTERATION$6.50 per$1000 of estimated cost(rounded up) Minimum $65.00
SIGNS Wall Sign for Home Occupation $40.00
SPECIALTY PERMITS Roofing $40.00
Siding $60.00
Non-Structural Door&Window Replacement $40.00
Solid Fuel Burning Appliances $40.00
Sheet Metal $25.00 with building permit on site; Otherwise $50.00
SOLAR Roof Mount- $75.00
Ground Mount up to 8kw or 100%of demand $75.00
Ground Mount up to 200% of demand $100.00
Ground Mount over 200% Use the commercial rate calculator
OTHER SERVICES Request For Zoning Determination $30.00
Home Business Review&Registration $30.00
Replacement Permit $30.00
Contractor Change $30.00
Temporary Certificate of Occupancy $75.00
Additional or Requested Inspections $75.00
Removal of Stop Work Order $75.00
Information and Instructions
Mass: hchusats Genera Laws chapter 152 requires al employers to provideworka5 cornpeisaion for their employees
Pursuant to this statute,an employee is defined as°...every person in the service of anther Hander ay contrast of hire
express or implied,oral or written.°
An employer isdelined as"an individual,patneship,asscdaion,a rporaion or other legs edity,or aiy two or more
of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shell not baarse of such employment be deemed to be an erployer."
MGL chapter 152, §25C(6)al 90 stab that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)stars-Neither the commonwealth nor any of its politica subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presaged to the contrasting authority.'
Applicants
Plems fill out the workers' oormpensaion affidavit completely, by checking the boxes that yply to your situation and, if
necessary, supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
iiuib sor partners,aerct required to raryworkes corr'peusaion insuraxe If an LLC or LLP does hate
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Induaria Accidents Should you hateaiy questions regarding the law or if you ae required to obtan aworker&
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permitllicense applications in any given year,need only submit one affidavit indicating current
policy infomietion(if necessary)aid under"kb SiteAddress" the apliett should write all [cations in (dty or
town)." A copy of the afidaiit that has been off idaily starved or narked by the dty or town nay be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The DepatmeM's address,telephone aid fax numbs:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel. #617-727-4900 ext 7406 or 1-877-MASSAFE
Revised 7-2013 Fax# 617-727-7749
www.mass.gov'dia
City of Northampton
MP,
Massachusetts
e-
(11 a I�G � DEPARTMENT OF BUILDING TIONS S ,4
212 Main Street a Municipal al BuilBuildingips
i
lr'
Northampton, MK 01060ryPi ,iR
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her
construction supervisor. The state defines"Homeowner" as, " Person(s) who owns a parcel on which
he/she resides or intends 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 home owner."
The building department for the City of Northampton wants any person(s)who seek to use the home
owner exemption, to act as their own construction supervisor, to be aware that by doing so you
become responsible for compliance with state building codes and regulations. The inspection
process requires that the building department be called to inspect work at various stages, which include
foundation/footings (before backfill). sonotube holes (before you J. a rough building insoection
(before work is concealed). insulation inspection (if reauiredl and a final building inspection
The building department requires these inspections before the work is concealed, failure to secure
these inspections can result in failure to obtain a certificate of occupancy until the work can be
insoected.
If the homeowner hires other trades to perform work(electrical, plumbing&gas)the homeowner will be
responsible to make sure that the trades hired secure their proper permits in conjunction to the building
permit issued, and that they get their required inspections. Failure of the individual trades to secure
the permits and inspections as required can DELAY the project until such time as the proper permits
and inspections are made
understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit issued to me.
Date
Address of work location