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24B-079 (19) 73 BARRETT ST-APT 5/59 BP-2017-0522 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24B-079 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Coleman:Deck BUILDING PERMIT Permit ti BP-2017-0522 Project# JS-2017-000853 Est.Cost: $1400.00 Fee:$100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: . JONATHAN DEVINS 083221 Lot Size(so. ft): 785822.40 Owner: HATHAWAY FARMS TOWNHOMES LIMITED PARTNERSHIP('70 SPEAR MANAGEMENT ,Zoning:URC(iOO)IWP(7)/ Applicant: JONATHAN DEVINS AT: 73 BARRETT ST- APT 5159 Applicant Address: Phone: Insurance: 26 OLD SAWMILL RD (413) 801-8985 WC BELCHERTOWNMA01007 ISSUED ON:10/25/2016 0:00:60 TO PERFORM THE FOLLOWING WORK:BUILDING A DECK OFF OF REAR OF APARTMENT 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: FeeTvoe: Date Paid: Amount: Building 10/25/20160:00:00 $100.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0522 Q avNt APPLICANT/CONTACT PERSON JONATHAN DEVINS blur ADDRESS/PHONE 26 OLD SAWMILL RD BELCHERTOWN (413) 801-8985 1 ,Ms PROPERTY LOCATION 73 BARRETT ST-APT 5159 MAP 248 PARCEL 079 001 ZONE URC(WO11WP(7)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid b fo Building Permit Filled out Fee Paid TypeofConstrnction: BU1LDDIG A DECK OFF OF REAR OF APARTMENT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildin¢Plans included; Owner/Statement or License 08322 3 sets of Plans/Plot Man THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: ✓Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:8 Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project Site Plan AND/OR Special Permit With Site Flan 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 Pennit from CB Architecture Committee i._Permit from Elm Street Co •- -ion Per DPW St on Water Management Demolition Delay ter .. lO -3/ -71‘ Otis 0. le 12, Signature of Building Ofticr'at 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, / /1-"-&:-`.(.1-- = -" � , Versionl.l Commercial Building Penni?May I5,2000 / `1 Department use only ity of Northampton Status of.Remit oc„ t 8 ' J wilding Department Curb Cut/Driveway Permit - �"'.!"` :2„ 212 Main Street Sewer/Septic Avm'Iat:Wy. iRoom 100 Water/Wel Availability` `'',9 Northampton, MA 01060 Two Sets of Structural Plans e 413-587-1240 Fax 413-587.1272 Piot/Site Plans Otter Specify APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 properrtly Address: .a This section to be completed by office 73 rret+ -SHeet Map Lot Unit `a 1?.-c IAD-pi a0, Oilaw4assex• apaef.,,e t S41 Zone Overlay District - Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT vs 1 2.1 Owner � Ya4 of Record: � ry+ NAT4 g 'rn.3 I04Jplwrke5 L? Name(Print) Current Mailing Address: Signature Tatty/me 2.2 Authorized� Agent: '//M�44✓ .✓CV//V3 a6 Old .SQ..An i/7 R044, ee�c4eternad Name(Print) Current Mailing Address: gi"2 493 -So/- 9T 0:5-- Signature Telephone SECTIO STIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 117 /V00 (a)Building PermitFee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection _ ,(/ > 6. Total=(1 +2+3+4+5) Check Number q 32 g 79arl N roVl This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspeclor of Buildings Date VersionL7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition 0 Repairs 0 Additions ❑ Accessory Building Exterior Alteration 0 Existing Ground Sign❑ New Signs❑ Roofmg❑ Change of Use❑ Other g Brief Description Enter a brief description here. B.;la;".? o .aa ct off of (C4 of avneilae^f. Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE _ USE GROUP(Check as applicable) _ CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 0 A-3 ❑ to 0 A-4 0 A-5 0 18 0 r_. B Business 0 2A 0 E Educational ❑ 2B ' 0 F Factory ❑ F-1 0 F-2 0 2C ❑ 111311 h Hazard 0 _ 3A 0 I Institutional 0 I-1 0 1-2 0 1-3 0 38 ❑ M Mercantile 0 4 0 R Residential ❑ R-1 ❑ R-2 0 R-3 ❑ 5A ❑ S Storage ❑ S-1 0 S-2 ❑ 58 I 0 U Utility ❑ Specify: -... . M Mixed Use 0 Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34):. . _.. . .. _. .. .._. _ Proposed Hazard Index 780 CMR 34): . SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1' r 274 3m 3rtl 4tl 4t Total Area(sf) Total Proposed New Construction(at) Total Height(ft) Total Height ft 7.Water Supply(M.G.L,c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public 0 Private 0 I Zone Outside Rood Zone❑ Municipal 0 On site disposal system❑ Versionl.7 Commercial Building Permit May 15,2000 S. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side La,...._R: L:__R: Rear Building Height Bldg.Square Footage Open Space Footage (tut 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? NO . DON'T KNOW 0 YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO . DON'T KNOW O 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 • NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property 7 YES © NO O 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 wilt disturb overt acre? YES O NO ill IF YES.then a Northampton Storm Water Management Permit from the DPW is required. Versiont.!Commercial Building Permit May IS,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: _ Not Applicable 0 Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name .._ .. Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number _i_.._.._..._..__ Signature Telephone Expiration Date 9.3 General Contractor .. . . _ Not Applicable Company/Name: /l JON4IMd ,y%.yNS. ResponsTie In Charge of Construction ..�.— tQ4 . Ofd a.rGM/hi/[ RPd Pc/cAcrlow✓ MA 0/007 Address .. 4 YtJ- ele ne ture Telephone Version!.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No O SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Grei4 > #40#41-5 J,F.�u5/a 5, f44.441 X" FII(1-10110144y Pemba Owner of the subject property hereby authorize'' � Ca%1 ' girt-5 to act on my all matters relative work authorized by this building permit application. //// 0,7,46 Signature of er .�.—.—...—.. Date I,I. PNcAlIevaTt riAO. , 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. Print Name oro07r4 Signet/ OwnerlAgen rate SE ON 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor Not Applicable 0 Name oft-teens°Holder tL4#z✓ 'f _PcHNS 65- C)83 a a7_I _. . License Number pact S4- . ff 4)14 ic4hrtew.✓ MA 01°67 Sao Address E> ate gilL,1) V/an hoc—etas Si re Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(8)) 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 budding permit Signed Affidavit Attached Yes . No 0 ��, 2240 � .\_.... 1 L 1 1 5151 /7 5186 5787 I.TTTt. ±1 41525165 SI / ITTD = L. @3 5160 1 . 1 �5_ 5155L� r 5157 Oh � , 11 _.,. .. ,- __ 16 "__ _ 5159 5158 laundry -- 5154 & Lp 5187 ..,. 5151 5556 storage -. •m - .-� SIFti 3161 1 6..� _ ..--rte .�-� ____...._.�- 91G2 -- "�� �.� - 180 1 /�� �� 6199 6195 --- 5169 5570 171 517 173 Si�a� StY `21126 SnhF � . 5161 '1 /// I /1 rH 5164 5165 5166 78 5179 , A _1- u 3 1 6200 6201 r 1 - 6204 I1� _....6202 62321' 9fig R�efis'� � ; J a/art q erg ;: S DFSIGN.__1,G.R._ _____._--_______—____ °RAFTING: u Al. JOHN G. RAYMOND, F.E. ......___ _.........__ 45 AESTVIEW TERRACE CHECKED _J.G.R. ___......�_ ..,......__-__..�_ EASS'AAMPTON, MA 01027 _._._....__._.—__._.._.--___..,....__ APPROVED'. 10.E _ 'SSNS J9/e/r 4.5 C hejwN IQ- o(/ + City of Northampton Building Department 1 Plan Review U 0 !Nt 272 Main Street t - Northampton, MA 01060 a yto r:c=.. leei t,.-ty,, �j311x�eRe5T , l ,; 4 Y f/471f/ 4 �r „e».s� I ' j I awd if Soa.a.2, l, 1 Ugly. //47-147 51 ! ( i j _� ( I i M e, I it EL) r z j � !C 46144 . �. {�o�hf�e ; is ec�,1•�, tY a7 flee bo a,r� 2 lt,_ rge- egg eats -.,,ar elects'', i .! k< //r / ..i r8 t ,e 4Q S Qre&$ LUC t r1C .11.E Inc comnronweatrn ofynassacnuserrs -- ` Department of Industrial Accidents —.- eft=;_I _s Office of Investigations I Congress Street, Suite 100 sho =i"r_I=a, Boston, MA021I4-2017 �'•�_�� www.mass.gov/dia Workers Compensation I nsuranceAffidavit: Buiide-s&Contradors/EledridansIP[umbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): /4.,•ry a sJa/ 'jCmu �afctelJi/�n v.s j- _ Address: 375" so, hr dye Sf-/ City/State/Zip: �t j tw A..fk 0(50f _ Phone #: VX?- Se' -! 'as" _ Are you an employer? Check the appropriate boa: Type of project (required): 1. ►1 I am a employer with 10 4. 0 I am a general contractor and I employees (full and/or part-titne).* have hired the sub-contractors 6. ❑ New construction listed on the attached sheet. 7. 0 Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers 9. 0 Building addition [No workers' camp. instance comp. insurance. required] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing ail work officers have exercised their ILO Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGI, 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employe% [No workers' 13.® Other_Vk<e buitcrin comp. insurance required.] *Any a,pliean that Checks box#1 rest also fill out the motion beim showing trier worked conpntsstion policy irnarraim. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. CContraotors that cheek this box must attached an additional sheet showing the name of the sub-contractors and slate whether or not those entities have employees. If the sub-ccnracters ha✓eenployees,they must providetheir workers' carp.policy number. I am an employer that is providing workers' compensation insurance for my enployees Below is the policy and job Ste information. Insurance Company Name: {4 ZN) /y,,,.{wc,•[ _„ ,_,,, Policy#or Self-ins. Tic. #: WMZ.- $h0- 800(c10a - 3016 A Expiration Date: 7pG/u1017 ._ Job Site Address: 7314wrctl- S}retlf fit) Pit. City/State/Zip: A4zfl)anpiorJ Mfl 01000 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature: -/ Date: /0/t7 !6 Phone •. Y/3-5rf6 - /YPS I _.a,_ , Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): I.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector b.Other ac4 a CERTIFICATE OF LIABILITY INSURANCE DATE MMOD"rv'' Ip,,,i' 10/113/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ins)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PROOUCER riAc°NE�'Y Michael Bonacorso Bonacorso Insurance Agency, Inc. PH �� „(782)439-3200 FAX -� Bo1-<xait133*-nzoa 10 Cedar Street ApDp sml.chael@bonacoraossLa.cam Unit N 32 IN$VRER(Si AFFORDING COVERAGE NAM* Woburn NA 01E101 INSURER AIM Mutual ... __-- _ — ..Il. —_ INSURED IxSURFRe_ _ _ _ Hathaway Farms TaxMaaoe, LP INSURER c: C/a Spear Management Group _ —_�_— ,- 575 Southbridge Street r- rosuRErs E: Auburn MA. 01501 INSURER F: I COVERAGES CERTIFICATE NUMBERFL1532703828 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDRfONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. __ TMA Ap _ pq,�y ELFT tNt1 TYPE OF INSURANCE Ill/ YIYe POIJCYNUMBER M IEWOD WYII LIMITS COMMERCIAL GENERAL LIABILITY I I EACH OCCURRENCE I$ ___ 1 CLAIMS-MADE I .OCCUR I PDRETAJ°E51OTREotHurtroal.41 - ___ MED ENP THYM 1, PERSONAL 8 ADV m_ s ____ _ NL AGGREGATE LIMIT _ -� „_ pR APPLIES PER AGGREGATE IS -_,,,,. I- POLICY LJ.JSCf Lj LOC LPRODVCTC-°CMP/OP MIG „Y I OTHER'. I 1 I AUTOMOBILE LIABILITY I COMBINED SINGLE R !.NA $ � BODILY INJURY Pee ANY $ 1 ALL OWNED f—I6CNEDDLED 1 eWRYiNJUIiT(Par *,ant} b Z.. HIRED AON-0YMEn PRnPERtt OPfI,AGE y 1 HIREDAUTOSC�AVTO Px L_ — UMBRELLA LIAB i,,, I OGWR y'-S EACH OCCURRENCE_ i__ _ EXCESS DAB CLAIMS- OE AGGREGATE IS CJ C DEP IRETENTIONE5 1 DKERS COMPENSATION ! IAS=EPTUTE LI,ER ANDIIS___—�_— EMPLOYERS'CLAMMY”,ZANY PRCPRIETOREARTNERDXEIATIVE TNM EL EACH ACCIDENT _I S 500 000 ;OFFICER/MEMBER EXCLUDED' I A IMFee ton in __.1 NMIMS-800-9006102-2GSSA ! //26/2016 i 7/26/2017 EL DISEASE-EA.EMPLOYE S 0 50 000 ILy beu 1 DESCRIPTION OF OPERATIONS below HEI DISEASE-POLICY LIMIT,S 500,000 I DESCRIPTION OF OPERATIONS i LOCAnmtNS!VEHICLES iAOORD 101,Actaeon*,Renee*schetluie.mar M IMALLed N most ewe if noniron CERTIFICATE HOLDER CANCELLATION SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 210 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Northampton, MA 01060 AUTHORIZED REPRESENTATIVE 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 2512014/01) The ACORD name and logo are registered marks of ACORD INSO2Soodan Information and Instructions Mdss1'uu92(ts Genera Laws Gupta 152 rerptires al employes to provi de workers' compensation for that employees Pursuant to this statute,an employee is defined as`...Way person in the service of another under any contract of hire, express a implies,or or written." An employer is defined as"an individual,patnetip,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint 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 shall not because of such employment be deemed to beat enploya." MGL chapter 152,§25C(6)ase 9atesthat"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)states"blether the com x,nweSth nor any of its eolitica sdldivisonss'dl enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance regtire entsof this chapter hate beat presented to the contracting aunty.' Applicants REesefill out the workers' compenation afidaait completely,by checking the boxes that apply to your situation aid, if necessary,supply subcontractors)name.[s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LIB)with no employees other than the members or pains,at not repaired to carry workers compensation insurance If m LLC or LLP does have 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 Acddeils Should you haveay questionsregardirg the lair or if you ae required to obtain aworkes compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the apaopriate 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 permit/license applications in any given year,need only submit one affidavit indicating current policy Information Of necssa-y)ax under"Job Ste Address" the atplicant should write"SI locationsIn (city or town)" A copy of the affidarit the has been offidaly stamped or marked by the dty or town may 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 Department's address telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 Boston,MA 02114-2017 Tel.k 617.727-4900 ext 7406 or 1-877-MASSAFE Revised 7-2013 Fax it 617.727-7749 www.mass.gov/dia 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: 73 lot(en" <5bet/ eId,cJ D20 The debris will be transported by: irraffb., rce,viG,> The debris will be received by: A/, Je,✓:ccs Building permit number: Name of Permit Applicant ,/Z 44W ,, :i4.;res Date Signature of Permit Applicant lathmway Farms lIOWNHOMFS* N ORTHAMPTOHc A Commissioner Hasbrouck 10/17/16 Subject Request for Waiver I request that you grant a modification to waive the requirement for control construction for the Patio Deck at Hathaway Farms Townhomes 73 Barrett Street, Building 4, in Northampton because the work is of a minor nature,will not affect health,accessibility, life and fire safety,or structural requirements and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work. All work will be completed within the prescriptive requirements of 780 CMR. Thank you for your consideration. "Mass Amendments,sections 107.1 allows for an exclusion from control construction for this project' Respectfully, Jonathan Devins Operations Manager Hathaway Farms Townhomes 73 Barrett Street Mass CSL CS-083221 �3 Barrett Se eet,=20 3i Northampton.MA A Tel 413.386.14415 Fax 413.586 Si 38 TRS 8041439.(P185 A Email hachaaa thr o,Te rmmne.com 0 rkmiles.com PAGE NO 1 eveDoer Scrim.POB..,1,14 Fe r'.rhsngeSra .Pond., SINCE I940 All approved material re .tubi„ err/apFee. Merchandise d b purchased( tom h 1 ( , Middlebury. V uppt s u, . w - Ell Gee MILES IMILES;ohm 3 andmumb - d Fl d -m. rk Pm„F Fp : !Pommel all .SPFUNORDER LIFEA y„ - ITEMS ARE NRETURNABLE. ET RP WillimicimmtMaGaCilMtW F , , W,.t n afield.M rh a Arco11111(not p140 When I , him to,SERVICE•barge 4n 40 111 mil freeeun mu 7413 4n u4r e4Potoll free/4t,446 aeau BUILDING MATERIALS SUPPLIER °PIE'Mpmaanth until paid u.in.h ism ANNUAL RAI E or IND Customer No. Jon No. I Purchase Order No. Rato:anco 1 Tome clerk nate Time 500 870 5159 DECK PO 0 5159 5 DECK 1 2r 10T0) NET EOM LO 1U/ 4/16 9:13 Sold To Ship To Hathaway 8.4t150 DUE. DATE: 11/30/16 DOCK 345147/4 0/0 Spear Management Group In . TERM446G "^* `*'* 03 Barrett St. 02000 ' INVOICE * Northampton pton MA 01060-2506 ""*".'"+" (413) 586-1405 TAX 040 MASS TAX F. SHIPPED QRDERE• UM SKU DESCRIPTION UNI'T'S P'ICE PER EXTENSION 1 EA 7682271 2 7/8 HEADLOK FASTENERS 50 PK 1 17.66 /EA 17.66 I 1 EA M8845 MILW HAMMER BIT 3/4" X 4" X 6" 9.20 /EA 9.20 ( 26 EA LUS2S 22X8 JOIST HANGER ZMAX 50/BX 26 1 .11 /EA 28.86 3 BX 101250 10X 1 1/2 STRONG DRIVE SCR 1008X 1 11.05 /BX 33.15 1 1 EA 3559211 BOST 12D GALV FRAMING COIL NAIL 1 75.99 /EA 75.99 PARTE C12P120DG 812 GALC 10 EA MH MISC BULK HARDWARE ITEMS 10 1.89 /EA 18. 90 10A MH MISC BULK HARDWARE ITEMS 10 _75 /ER 7.50 10 4 EA MH MISC BULK HARDWARE ITEMS 10 2.69 /EA 26.90 1 EA 448PT 4X4X8 PRESSURE TR/PINE 1 9.631/EA 9.63 2 EA 21016PT 2X10X16 E1 PRESSURE TR/PINE 2 28. 967/EA 57.93 1 EA 2108PT 2E10E8 01 PRESSURE TR/PINE 1 12.306/EA 12. 31 1 EA 21010PT 2%10X10 E1 PRESSURE TR/PINE I 17.039/EA 19.04 7 EA 21012PT 2X10X12 E1 PRESSURE TR/PINE 7 19.596/EA 137.17 3 EA 21014PT 2X10X14 E1 PRESSURE TR/PINE ., 22.862/EA 68.59 2401 *' N100NT CHARGED TO STORE. ACCOUNT ** 553.38 TAXABLE 520.83 Received NON-TAXABLE 0.00 (ANDREW "MAC" STEV) SUBTOTAL 520.83 OCT 4 20(6 -. . . .. TAX AMOUNT 32.55 hiOaVIR Fanl 3 AINAWAY FARM::: 1 TOTAL AMOUNT 553.3E 0.88 1YY?x42¢04 _.__- ._ .-. X [M /• - v 1.10 __ .) -47' d or Sf/ °9 vn0 d 'D1- r pr,-, ri J d/ b.-7 So/ / Z _.1d icy T7 y -eo j".'F5- 72- sk/°9 _i ? 4 '9/-1 t a. 1 5-1? , d (DUOS spy? 77ja0/ 7�d7 � +d y; , ci-09 s 4 4, jedac5��,/V )7)1/2 '' O! X coS r 51. 1 9 u0 SRb7 01r .L ' ?rod n FT) a+ �i X h 11_ n I dd' ZI 0)tr-, L/ �______ c )71:7 04,1- P a7 T7 Y °+ i t u h �. cic' City of Nora'ammo,. F —� O ,h I Building Depen"o Ptah Review �-g . 212 Main Sire(' Y ,,fQ Northampton r+iA .)$06: .1 d' d La 1 N\ i oi- d ° Je „ ; . a 50 ,,,i ,,, ,-; r ),-) r< p v il0J 2 -1.: I r to ' oi. enJl „ t V ) 1- at-,01}7 — _ 00 _II go t ., Ormse-o/, ��t ,����� s� � 4, 515 44 d v0$ LPOy;JoN _Ls J..1ti8 SL