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17C-150 (4)
106 HIGH ST BP-2017-1464 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: I7C- 150 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:window replaced BUILDING PERMIT Permit# BP-2017-1464 Project# JS-2017-002435 Est. Cost: $10000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RONALD BOYKO 100528 Lot Size(sq.ft.): 4704.48 Owner: KASPER MICHAEL F&MARY LUCE Zoning:URB(100)/ Applicant: RONALD BOYKO AT: 106 HIGH ST Applicant Address: Phone: Insurance: 35 SPAULDING ST (413) 695-6359 AMHERSTMA01002 ISSUED ON:6116/2017 0:00:00 TO PERFORM THE FOLLOWING WORIGREPLACE EXISTING DH WINDOWS (11) WITH PELLA ARCHITECT 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 4 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 6/16/2017 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE ORM7 DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 6P— / 7—(YC& 1.1 Property Address: Ile section to be completed by office kQ�Q ,rJ'a* 'tom Map / //�L Lot ig° Unit C—DZi CC-/ Art Pr O t£Yo2-- Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: et 0(0�--. Mi‘etse atJb IhACM V-Paria tDcc, ¶z rD . ce My---- Name(Print) C went iling Address Telephone Signature 2.2 Authorized Agent: Name(Print) 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 1071 000 . 60 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 Arial This Section For Official Use Only Building Permit Number: Date Issued: Signature: Signature: / f �] 61tb+( 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: R: Rear Building Height Bldg.Square Footage 9 Open Space Footage (Lot area minus bldg&pased parking) N of Parking Spaces Fill: ()plume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? 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 O YES O IF YES: enter Book Page and/or Document ft B. Does the site contain a brook, body of water or wetlands? NO © DONT 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 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 O IF YES, describe size, type and location: E. WII the construction activity disturb(clearing, grading,excavation,or tilling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YEE O NO i($1 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 ❑ Replacementt indows Alteration(s) n Roofing C Or Doors ICJ Accessory Bldg. ❑ Demolition ❑ New Signs C] Decks CI Siding E] Other[Ey Brief Dees�ccription of Proposed Worictb'RE:PLA E 'hCvcift uG .Pai}l. .13C65 X.\t/JrHn /11Akteittr iEC1 . t-.- ("1"(S&LIS Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea. 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 kpi NT OR CONTRACTOR, APPLIES FOR BUILDING PERMIT r J'r 1A.7 IA , as Owner of the subject property r, J hereby authorize - ratk\Pt-l.1�. C7 to act on my behalf, iiny`all maatters relative to work uthorized by this building npermit application. Signatu of Ower 1 /(l Dae IP) I 9.211. I, NL \1 5Ltpe.1 ,as Owner/Authorized Agent he (,N by declare that file statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. J Signed under the pains and penalties of perjury. Mart{{ Ka,Sper Print Name 4..A A t 1►r, 0 I • Signature• Owner/ gent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed ConstructionSupervisor: Not Applicable ❑ Name of License Holder: O434-t--- --pp �_ (Y1L,J� CS - ✓as / License Number Ss S).\ &-C - (n& [AAA- 61002-- 3L 1101E - address Expi tion ate 463 60 95— a 369 Signature Telephone 9. istered ome Impro ment Contractor: Not Applicable C Qo,3 "e:oj o l g 133 Company Name Registratio Number as S;ParU1A-1\) .. st - lbSP&1 thi4 61002-- Rip aoi7 Address Explrati 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(I) 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 10835.1. 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 he required from time to time,during and upon completion of the work for which this permit is issued. Also he 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 lases and State of Massachusetts General laws Annotated. Homeowner Signature �,.A The Commonwealth of Massachusetts :tea— Department of Industrial Accidents .re Office of Investigations 0 Mal— I Congress Street,Suite 100 / Boston,MA 02114-2017 S'� www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(13usiness/Organization/Individual): A-1.4 -1 ,r/\io Address: 35 sp[ .uUnw�. K. City/State/Zip. h&Q,1 MA Phone #: -j—J 3 (J}S b 359 Are you an employer?Check the appropriate box: Type of project(required): I.D I am a employer with 4. D I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. D New construction 2X I am a sole proprietor or partner- listed on the attached sheet. 7. D Remodeling ship and have no employees These sub-contractors have g, D Demolition workingfor me in anycapacity. employees and have workers' P ry 9. D Building addition [No workers' comp. insurance comp. insurance. required.] 5. D We are a corporation and its 10.0 Electrical repairs or additions 3.D I am a homeowner doing all work officers have exercised their 1 I.D Plumbing repairs or additions myself. [No workers' comp. right of exemption per MOL 12.0 Roof repairs insurance required.] ' c. 152, 61(4).and we have no employees. [No workers' 13.D Other comp. insurance required.] _ *Any applicant that checks box ft l must also fill out the section helms showing their workers compensation policy information. +Homeowners who submit this affidavit indicating they are doine all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet shoving the name of the sub-contractors and state whether or not those entities have emplo'ees If the sub-contractors have employees.they must provide their workers comp_policy number. l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy d or Self-ins. Lic. 4: 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 MGT 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 ce ify oder the p ins and penalties of perjury that the information provided above is true and correct. Signature: ' t•, , Date:(113/40/7 Phoned: •41-1-3 el 12359 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#: Roy 1assacadsetts Teas^^+e Errs aorn os 3s 'dry RegUat -T rns ecse: CS-100528 — onsr.cr: on Suoer'v scr RONALD J BOYKO 35 SPAULDING STREET AMHERST MA 01002 --- .-? 0310912018 _ _ -- r 1 �Ae F`a�rzraz�tarvea/2 c Y ao ac4u:ells Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston., Massachusetts 02116 Home Improvement Contractor Registration Registration_ 148133 Type: Individual Expiration: 9/9/2017 Tr# 270726 RON BOYKO RONALD BOYKO 35 SPAULDING STREET AMHERST, MA 01002 - ---- - Update Address and return card.Stark reason for change. scat aomcswAddress _ Renewal Employment s Lost Card Taxa ,Office of Consumer Affairs& Business Regulation License or registration valid for individul use only iHOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ix Registration. 145133 Type: Office of Consumer Affairs and Business Regulation a, v Expiration: 9/912017 i thsdual 10 Park PJa6B ite 5E10 s s� Boston,SA 0211 RON BOYKO / 1 RONALD i) YKO 55 SPAULDING` STREET Dudersecrctary \ ,� l`ot valid nit i ut AMHERST, MA 01002 signature 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: IN!) c+ ( . uQ& cE MA- 610(o 2 The debris will be transported by: --Pp A-t f) - ' 'yL The debris will be received by:<1.0 J or-Av1nf1 ca Building permit number: Name of Permit Applicant auline27,62-) Date Signature of Permit Applicant Ron Boyko, Contractor CHENT COPY 35 Spaulding Street,Amherst,MA 01002 Michael and Mary Kasper 106 High Street.Florence,MA 01062 CONTRACT or AGREEMENT between above noted Contractor and Client Overview:To to remove eleven(11x)existing storm windows,eleven(flat existing double-hung windows and replace with Pella Architect series Energy-Star rated custom double hung windows. Scope of work required by Client: 1.) To prepare pians and documentation for obtaining required permits for work per below 24 Remove existing storm windows,repaint exterior trim 3.) Remove interior trim,existing double-hung windows,drill lambs and inject foam insulation into rough opening 4 Install new Pella windows,replace trim,paint as required 5.7 Remove aluminum storms to recycling center,remove wooden double-hung sashes to landfill. Cost Estimate:10,000.00 USD Permitting,planning: 100 Materials 7300 Labor 2600 10000 Payment Schedule:2(Two}Payments 1.} Payable at signature this agreement:$3000 material advance 2.) Balance payment:$7000 upon completion of above to scope of work and inspection by City of Northampton Inspection Services l2acL .ki Michael -ndior -ry Kasper, ywner (Date , Ron Bo` a,Contractor Date .. . . .. ,vr:2 rk, +fir tali