18C-044 (3) 711 BRIDGE RD BP-2018-1335
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18C-044 CITY OF NORTHAMPTON
Lot: -001 , PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permh: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorv:Deck BUILDING PERMIT
Permit# BP-2018-1335
Proiect# JS-2018-002374
Est.Cost$4500.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use croup: Homeowner as Contractor_
Lot Size(so.R.): 10846.44 Owner: TATARO JASON
zoning:URB(100)/ Applicant. TATARO JASON
AT: 711 BRIDGE RD
Applicant Address: Phone: Insurance:
711 BRIDGE RD (413) 695-6286 0
NORTHAM PTONMA01 060 ISSUED ON.612112018 0.00:00
TO PERFORM THE FOLLOWING WORK BUILD A GROUND LEVEL DECK- 16X22 -
DETACHED FROM HOUSE
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector or 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 Occuoancv signature:
FeeTVDe: Date Paid: Amount:
Building 6/21/20180:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File q BP-2018-1335
APPLICANT/CONTACT PERSON TATARO JASON
ADDRESS/PHONE 711 BeJDGE RD NORTHAMPTON (413)695-6286 Q
PROPERTY LOCATION 711 BRIDGE RL'
MAP I8C PARCEL 044 001 ZONE URB(I 00)/
THIS SECTION FOR OFFICIAL ,7SE ONLY:
PERMIT APPLICATION CHECKLIST
E:yCLOSED REQUIRED DATE
ZONING FORM FILLED OUT [( t/J
Fee Paid
Building Permit Filled out ^V,
Fee Paid
TvpeofConstructiom BUILD A GROUND LEVEL DECK- 16X22-DETACHED FROM HOUSE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON ?
IN(F RMATION PRESENTED:
_Approved_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 Delay �J
O'ti- �/�-�C✓ 6 Zt
Signature of Building Official 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.
RECEIVED
parbnent use only
- -- City of Northampto 1 JUN I ;'=1�4fPeeBuilding Departure t ay mla
212 Main Street vail bdityDEPT OF BUILDIRoom 100 NORTBAMPTilab iry
�I Northampton, MA 01 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 PloVSile Plans
Other specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH AA ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This aectlon to be completed by office
7// j3R.,052 wA"O Map Lot O -14 Unit
/L, rflo o 0J1z,nf ^'4 u/6C-u zone Overlay District
Be St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner,of Record:
3'0S,1� Tk)sNlio 7/l 11, `Oqe Ra
Name(Print) Current Mailing Address:
Ll/J G 9S- 6 c S E,
�� relepnone
Sig re
2.2 Authoraed Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed bennitapplicant
1. Building 1// C o 0 (a)Building Permit Fee
2. Electrical L (b)Estimated Total Cost of
Construction from 6
3. Plumbing Q Building Permit Fee I
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+q+5) L .SOJ Check Number
Ll 70
This Section For Official Use Only
Building Permit Number IDssued.
Signature:
Building Commissionedinspector of BuiMirgs Date
J7IMILO -2 T
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing liroposcd Required by Zoning
This colunm m h filled In by
aunding rkpanmem
1. 1 Size
Frontage
Sctbacks Front
Side L:_R: L:_R:—
Rea
Building Height
Bldg.Square Fooluge
Open Space Fooragc 9
(Int anon minus bldg&paved
arkin
#of Parking S acts
Fill:
(volume&Incvion)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO ® DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document#
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
IF YES, describe size, type and location:
E. Wil the construction activity disturb(Gearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre9 YE: O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required
SECTION 5-DESCRIPTION OF PROPOSED WORK/ohack all aoolimblel
New House ❑ AddlBon ❑ Replacement Windows ANendianfa) ❑ Roofing ❑
Or Doom ❑
Accessory Bldg. ❑ Demolition ❑ New Signa p] packs "' Skiing 0) Othei-Cfl
Brief De`yption of Proposed n
Work' ASV LO A 1C , I " 11P4/41, 1` IY �(eXLq � 1)E�-l+-y. 1 ren Nwl•�
Alteration of existing bedroom Yes X No Adding new bedroom Yes >6 No
Attached Narrative Renovating unfinished basement Yes >C No
Plans Attached Roll -Sheet
se. K New house and or add tO existina housing. complete the followlna�
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 healing? 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 welland.?_Yes No. Is construction within 100 yr. Floodplain iYes 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, as Owner of the subject
property
hereby authonze
to act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, 7�fcn 'Y1910a*' ,a OwnulhorEed
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the te of my knowledge
and belief.
Signed under the pains and penalties of perjury.
•J Sw. >rr-o
Print e
Sig N of nedAgem Date
SECTION 6-CONSTRUCTION SERVICES
8.1 Licensed Constmetlon Suoerviaor: Not Applicable ❑
Name of Usenee Holder:
License Number
Address Expiration Date
Signature Telephone
9 Realctered Home lmorovement COMfeetar: Not Applicable ❑
Company Name Registration Number
Address Expiration Data
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.152,5 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in Its,denial of the issuance of the building permit.
Si nec Af cavit Attached Yes....... ❑ No...... )5C
City of Northampton
.> MassachuaeGta v s e�
DEPARITEBT OF BUILDING INSPECTIONS Z
212 Main street a Municipal Building
\.,. Normau,tnn, . 01060 rrhh. P�
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the`mconstruction, altemdon, renovation,repair, modemizahon,conversion,
improvement, removal, demolition, or construction of an addition to any preexisting owneroccupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:If the homeowner has contracted with o corporation or LLC,that entity must be registered
Type of Work: Est.Cost:
Address of Work: _
Date of Permit Application: .
1 hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law(explain):__.__
Job under$1,000.00
_Owner obtaining own permit(explain):_
_Building not owneroccupied
Other(specify):_
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
TINDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
Date Contractor Name HIC Registration No.
OR:
Notwithstandi hove notice, 1 hereby apply
/for
�a building permit as the owner of the above property:
fo
O ^SOh
Date Owner Name and Signature
City of Northampton
Massachusetts
1]212e inS OF BOILD G cip S ,1G g ,s cD
212 lLin etveet •NunYci 1 Buildin
NoitM1empton, !A 01060
Debris 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.
The debris from construction work being performed at:
7// 8(i 0,3t (tcvkn
(Please print house number and street name)
Is to be disposed of at:
VOLLcY V,v, xed.:)q
(Please print name and location of facility)
Or will be disposed of kr a dumpster onsite rented or leased from:
(Company Name and Address)
` �;) ^ 6 -1d' ' 2-,/F
Si re of Permit Applicant or Owner Date
If, for any reason,the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
City of Northampton
',.
IMaaachuaetta :2
1 x
212a ins of sazs ici rxsracrroas
212 Nein rtr • Municipal auildi,g \ J
xorNu@!o4 NA 01060
Massachusetts Residential Building Code
Section I IO.R5.1,2
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.
Section I IOR5.1.3.1
Any homeowner performing work for which a building permit is required shall be exempt from
the licensing provisions of 780 CMR 110.85, provided that if a homeowner engages a person(s)
for hire to do such work, then such homeowner shall act as supervisor.
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
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�\ The Commonwealth of Massachusetts
Department of Industrial Accidents
e I Congress Street,Suite 100
is Boston,MA 02114-2017
www.massgov/dia
\Yorkers'Compensation Insurance Affidavit:Builders/Contraeters/Electricians/Plumbers.
TO BE FILED WITH'I HE PERMITTING AUTHORITY.
Applicant If ti Please Print Legibly
Name(Business/fbganiratioNlndlvidual):
Address:
City/State/Zip: Phone#:
Are you an emploreR Cheek the appropriate box: Type of project(required):
1❑1 not a employer with—employ es(full ardor ona time) 7. C]Nev,construction
3❑l am a sole propdetur or panoerslop and have no employees wodring for me in 8. n Remodeling
y iI, [No workers'wmp.insmanse requiem1 1}.J{
J Iamahomcowmr Join all workm self rkers corped I' 9. Demolition
ga r Mo wo P�muramr minor
1[]l am a nmreowner not will he hiring comreaors to contact all work on my fastens Iwill 10 Building addition
ensure dm all conaacmrs either lave woders compensation insurenw or am w4 11 Electrical repair or additions
,rommtms win w employees. 12.[]Plumbing repairs or additions
5rj 1 am a general commctor sd I nave limit the suFconoactors listed on me ameM1ed onset.
These sulwnonaters have employees and lave workers'wmp.insurance. 13�Roof repairs
6F]We ata wrp0mtion and its ORcers M1ave cxcmisuJ treird�t ofexcmprion per MCLa 14.❑Other
"";I4),andwehavetwemple,res. N—mcers'coun, or mncereyormil
`Ary applicant that checks box#I most 4150 fill out the section below showing their workers wmpensation policy information.
s Honsowtars who submit this affidavit indicating they are doing all work and then hire ouLide comtadors must submit a new 4Rditen indicating such.
lCmuram rsthat check this box most sttached an additional sheet showing the name of the sub-wNactors atM state wbNrer er net llmse amities leve
employws. If the out- rsraacto s base stunmec,they must provide their workers'comp.policy number
lam an employer that U providing worhers'compensation insurance for my employees. Below is Me policy and job sae
inf srmatlotr.
Insurance Company Name: __ _i.,_ _
Policy#or Self-ins.Lic.#: Expiration Dale:_
Job Site Address: City/Smite/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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby cc der thepains and penahtes of perjury that the information provided above Is nue and coffee[
Signature Date G /y— 20
Phone#: s
Oficial use only. Do not write in this area,to be completed by city or town officiat
City or Town: Permit/License#
Issuing Authority(circle ane):
1.Board of Health 2.Building Department J.CityiTowa Clerk 4.Electrical Inspector 5.Plumbing Inspector
G Other
Contort Person: phone ft:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as".-every person in the service of"it.,under any contract of hi re,
express or implied,oral or written."
An employer is defined as"an individual,partnership,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 deceased employer, or the
receiver or trustee ofan individual,partnership,association or other legal entity,employing employees. I lowever 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 be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal ofa license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence ofcomp8nnce with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence ofcompliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),addresses)and phone numh;r(s)along with their certificates)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,an,not required to carry workers'compensation insurance. Ifan 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 ofinsumnce 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
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
set Finsurance 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
ofthe affidavit for von to fill out in the event the Of?ice of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/icense number which will be used as a reference number. In addition,an applicant
thin most submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in_(city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proofthat a valid affidavit is on file for future permits or licenses. A new a0idavit must be filled not 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 bum leaves ere.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax# 617-727-7749
Revised 02-23-15 www.mass.gov/dia