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38B-088 45 LYMAN RD BP-2018-1038 GIs#: COMMONWEALTH OF MASSACHUSETTS MaR.Block: 38B-088 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-2018-1038 Proiect4 JS-2018-001881 Est.Cost: $2550.00 Fee: 540.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: NEWMAN'S CONSTRUCTION 64690 Lot Size(sp. ft.): 10062.36 Owner: KOTKERZANE Zoning: URB(100)/ Applicant. NEWMAN'S CONSTRUCTION AT. 45 LYMAN RD ApplicantAddress: Phone: Insurance: 697 BRIDGE ROAD (413) 586-0273 WC NORTHAMPTONMA01060 ISSUED ON.411212018 0:00:00 TO PERFORM THE FOLLOWING WORK.STRIP & SHINGLE PORCH ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeTvoe: Date Paid: Amount: Building 4/12/20180:00:00 540.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner .#� pepartmenf Use.Bnly rn� t�,+ . r - 'r1 CityLN�h hamp onStatus afPem}BuildOGib:0ydDnva21StreetSewerina- icAYai a'6ill y` r ''}'a. a Room 100 GVaterNtfe7EA+iaila'61iy { x Northampton, MA 01060 Twc,Setta€Sty, ctural phone 413-587-1240 Fax 413-587-1272 Pfo`tlSrteiPl na s ern -w o APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION I -SITE INFORMATION L 7.7 Prooerty Addresz Q '.,I This seetmn to becoom{plleetted by office M'ap Oa UN€ �j �Oistnct COOatrlcf SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 1 zanL �[t'T1�t 2 °f$� Name(Print) Cult Mailin Address: 7 a - sao Telephone Signature 22 Authorize d A� curt: 1utv q/E�✓Ht/t-7y 697 �rt•i�S f !/C "SECTIO Cument Mailing Address: Syn -/o93 Telephone -ESTIMATED CONSTRUCTION COSTS Item Estimated Cast(Do liars)to be SSo ed Official Use Only completed bermilaccident b 1. Building Building Pe Fee 2. Electrical (b)Estimated Total Cost of . Construction from 6 3. Plumbing Building ermit Feo o / 4. Mechanical(HVAC) U /y 5. Fire Protection 6. Total=(1 +2+3t4+5) Check Number This Section For Official Use On! Date Building Permit Number: Issued: Siguature: Building Ce ssionedinspector of Buildings Date Section 4. ZONING Atl Information Must Be Ccmpleted.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This mlwm to be filled in by Building Department Lot Size 1 - ! 1 i Frontage Setbacks Front C� -1 Side L:=i R:E= Rear Building Height I Bldg,Square Footage Open Space Footage (Lot area minus bldg&paved con ) #ofParking Spaces L-1 -- Fill: volume&Location) — A. Has a Special Permit/Variance/Firoil ever been issued for/on the site? NO C) DONT KNOW YES 0 IF YES, date issued:) IF YES: Was the permit recorded at the egistry of Deeds? NO O DONT KNOW C YES Q IF YES: enter Book `��� Page and/or and/or Document#I - _j B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW O YES Q IF YES, has a permit been or need to be ob'ained from the Conservation Commission? Needs to be obtained O Cbtamed Q , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size,type and location: D. Are there any proposed changes to or adcitions of signs intended for the property? YES © NO IF YES, describe size, type and location: E. WII the construction activity disturb(clearing,gradi i excavation,orfilling)over 1 acre or is it partof a common plan that will disturb over 1 acre? YES O NC IF YES,then a Northampton Storm Water Management Permit from the DPW 1s required. 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 [Q Siding[01 Other(0] Brief Description of Propos ✓'ti etl Work: r� YL .O ' -f'�' �OOr a6 i r^sT4 f— ntw ,4•�p T Alteration of existing bedroom_Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement _Yes _No Plans Attached Roll -Sheet Sa If New house and or addition to existing housing complete thefollowing: a. Use of building:One Family--/ Two Family Other It, 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 heaorg? 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 contomt to the Building and Zoning regulations? Yes_No. 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 ,as Owner of the subject property hereby authorize to act on my behalf,in all matters rela5ve to work authorized by this building permit application. Sig nature of Owner A Data I //��LGli/J vp�-,1Z as Owner/Authorized Agent here y� clare tat the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the p ins and penalties of perjury. l ��r� �J Print Na e Signature of Own it Da SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ,�1r ��'� 7) Not Applicable u£ ♦ p Name of License Holder: CJ �f<(J,rwtktj /rC �6 L6 LQ Dense Number rk Address Exp D to /711 SF - /os3 Sign Telephone 9.Registered Home irm rovementContractor: _. _ Not Applicable E NFW>+7M✓f �a✓+s ✓c Fr o N/ _ / Ll oZ 67 Company Name (� o Registration Number A97 �/ YL"YJ ,, a ,l�aloFl✓,, Address ^.a ` Expira n Dat �/! oll Teieph,ne rr6'101 -K 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....... E No...... E 11.-`Home Owner Exemption The current exemption for"homeowners"was extended tc include Owner-occupied Dwellings ofone(1) or two(2)families and to allow such homeowner to engage an individual for fire who does not possess a license,provided that the owner acts as supervisor.CMR 780 Sixth Edition Section 1083.51. Definition of Homeownen Person(s)who own a parcel cf 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,attaced 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"homeonmer"shall submit to the Building Official,an a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building Detroit. As acting Construction Supervise r your presence or the led site will be required from time to time,during and upon completion ofthe work for which this permit is issued. Also be advised that with reference to Chapter 152(V'ork rs'Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)ofthe Massachusetts General Laws Annotated,You may be liable for persons) you hire to perform work for you under this permit. The undersigned"homeowner'certifies and issu nce-csponsibllity for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws atd State of Massachusetts General Laws Annotated. Homeowner Signature, _ The Commonwealth ofMassachusens Department of Industrial Accidents Office of Investigations - 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibbir 1 Name (Business/Organization/InclM dual): Address: F,y7 /-Srt�'/Jyt KGC City/State/Zip: Ot u. D dt &66 Phone #: ,!gz '/B`F� Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4� EJI am a general contractor and I 6. F-1Newconstruction ''''''rrrrrr,,,,,,//////employees (full and/or part-time).' have hired the sub-contractors 2am 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 workers9. ❑ Building addition [No workers' comp. insurance comp. insurance.t 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 1 L❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.L�"Rocf repairs insurance required.] t c. 152, §3(4), and we have no employees. [No workers' 131-1 Other comp. insurance required.] 'My applicant thztchecks box#1 must also fill out the section below showing thea workers'compensation policy infomuhon. tHo meowners who submit this affidavit indicating they are doing all work and Nen 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 wheNer or not Nose entices have employees. If the sub-contractors have employees,Ney mustprovide 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. Lie. #: 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 a pains and penalties of perjury that fhe information provided a7bo is hue and correct. Si afore: Date- official 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 � Massachusetts OQ ➢EPARTMENT OF PUILDING INSPECTIONS212 Main Str9et • Municipal BuildingNorthpton. MA 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXENIPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeo•Nner 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 persons) 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 to called to inspect work at various stages, which include foundation/footings (before backfill),sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) 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 inspected. If the homeowner hires other trades to perform vcr' (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 I, 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 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: `/� �Y .OJ The debris will be transported by: The debris will be received by: Building permit number: Name of Permit Applicant Date Signa re of Permit Applicant rainsFll Page No. of Pages NEWMAN'S CONSTRUCTION �h 697 Bridge Rd. -. 1244 Nortltampton, MA 01060 ` --;'"'' 41&556.1093 +- - PROPOSAL SUBMITTED TO a PRONE&, _ 5a907 aTPEEZ JCB NAME 5 L rri,Hv 't o.ech l2ooc cIN,STATErrdZIP Copt JOS LOCATION o awr {av0 10 (3106,0 S a.M;�— ANOXITECT DATE OF PLANS .M.S PHONE We hereby submX sp�ecifi�catior a and estimates for sd c• zo :aT � a ►ay�vt5 650 (? FI RFx. OJI t>x),tu��(+o�r pb s•4� %rS�etl R\ ore t r u w . 2/ f��L art 2(�XYS. $ 2 PVLS �. srezip ba _t,.�cllinlray►+szvt{— ..c+M�irKh+� tK 5urz�ecLS _ ((�� �.,s'��ll B,IUw.�✓t�vn S�tV?. �' c'.? ��ta�;,.. q c�S 42fc`�.V�'Y2.ial ..... l o \ We propose Mroply to furnish material and lab 1mplete in accordance with above specifications, for the sum of: "r u.�ivl 7' LVL �JYICJC12fLk v T OJ jc)c dollars($ aS�d' �� 1. Payment to be ma follows' at 5 zn3 o a Dnl �t u o M 1� ahl All material is guaranteed to be as spec0ied, All work to bs compleletl in a woM1manlike Aufh011Zed cording to stantlartl p2ctices.Any solration or deviation Pon,above specifiwtlons invr oly nns will g nor.cobe e.-.led only upon wrNen ortlers, antl will become on e.,a Signature Owrye over an above Ibe estimate. All agreements conbrgent upon strikes, amitle,to or dalays beyond aur mnrcd.Owner to cony fire,wmaeo and other necessary insurarra . Note:This proposal y be Our workers are fully mveretl by Workmans Compensation insurance. wiNdonan by us it not accepte vl[hin � days, P1CCP}ItAttCP Of i✓CO�IOS11 —rhe above prices,specircanens /L antl copddions are satisfactory antl are hereby accepted. Von are authorized Signature V" to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature