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31C-026 (7) 53 FORD CROSSING BP-2019-0190 GIs#: COMMONWEALTH OF MASSACHUSETTS MalxBIoc : 31C-026 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADD BATH BUILDING PERMIT Permit# BP-2019-0190 Project# JS-2019-000314 Est Cost $22400.00 Fee: $145.60 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor. License: Use Group: MARKBONDE 169228 Lot Siae(sa.R.): 4486.68 Owner: BAILER LINDA Zoning: Applicant. MARK BONDE AT. 53 FORD CROSSING ApplicantAddress: Phone: Insurance: 205 PARK ST (413) 535-9529 0 WC EASTHAMPTONMA01027 ISSUED ON.811412018 0:00:00 TO PERFORM THE FOLLOWING WORK .CREATE A FULL BATHROOM IN BASEMENT 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: FeeType: Date Paid: Amount: Building 8/14/20180:00:00 $145.60 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only oqAPPLICAJT10 City of NorthamptonStatus of Perm": Building Department Curb Cuvomrewey Permit 212 Main Street SevenSepoc AvailabilityRoom 100 Water/WellAvallabi Northampton, MA 01060 Two Sets Of Structural Plans hone 413-587-1240 Fax 413-587-1272 PlobSBe Plans Omer$peatyTO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 Property Addrear This section to be completed by office 5-3 ry2D �yi�l/ Map / ish Lot 0a` Unit Zone Overlay District Elm SL District CB Diatrict SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: W!`Apn c� Kfc� 73 �u¢1 �I�nSSII�L Name(Pnra) Curren[Mailing Atldress 413 535 — "1421 Telephone Signature 2.2 Authorized Acant: 1� 112.1cND� dCcSR2K 'S I Name �(PriMI Current Mailing Adtlreae: n y Signature t� Telephone 5,z R —2- -` SECTION 3-ESTIMATED CONSTRUCTION COSTS hem Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 8 3. Plumbing Building Permit Fee a 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) a. Check Number This Sectlon For Official Use Onl Building Pent Number: Date Issued: Signature: U Buing Commissioner/Inapeolorof Buildings Date mS' 6 6z @ CHA2ff/L , /'jLT EMAIL ��ADDRESS(REQUIRED; EITHER HOMEOWNER OR NTRACTOR) Section 4. ZONING All hdomlation Must Be Completed.Permit Can Be Denied We To Incomplete Intonation Existing Proposed Required by Zoning This cdumn m be filled in by Bmlding Le runm )At size Frontage Setbacks Front Side LR: Is_R_ Rear Building Height Bldg. Square Footage % Open Space Footage % (Inc area minus bldg a paved A of palling Spaces Fill: volume a lmulion) A. Has a Special Permit/Variance/Finding ev been issued for/on the site? NO � DONT KNOW E7 YES O IF YES, date issued: IF YES: Was the permit recorded at the(Pr of Deeds? NO © DONT KNOW (Pr 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 &—';�S O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © 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(deanrg,grading,excavati or filling)over 1 acre or is K pan of a common plan thatwilldisbtiovertacre? YES NO IF YES,then a Northampton Strum,Water Management Permit from the DPW is required. BECTON b DESCRIPTION OF PROPOSED WORK(Check all malleable) New House ❑ Addit ion ❑ Replacement Windows Alteradon(a) Q Roofing Q Or Door. ❑ Accessory Bldg. Elm Deoligon 103New Signa ]OI Dwks IE7 Sidingll7] Otherlaar— Brief Desorption of Pmposetl Work: lOFATE A )I ����/��w1 -XiASEJi P.T[I � —FVAAMME '+ �MBit ��.- Alteration of existing bedroom_Yes_� /(Jo Adding new bedroom_Yes Attached Narrative Renovating unfinished basement _Yes _No Plans Attached Roll -Sheet se.It New house and of addition to Weting housing. eomglete the followtrim a. Use of building:One Family. Two Family Other b. Number of mors in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new constmdion. Dimensions e. Number of slopes? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type ofconstmction i. Is construction within 100 ft.ofwetlands?^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. L Septic Tank_ City Sewer_ Prvete well_ City water Supply_ SECTION 7e-OWNER AUTHORIZATION-TO BE COMPLETED WHEN 55�L OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT LlA4-1F� as Owner of the subject ,1 Property hereby authorize qAPqe �nAlbts t a n my behalf' all mage relative to work authorized by this building pedant appl' on. 0 Si nature of 17� � Oate I, 2>` NDS ,as Owner/Authorized Agent hereby declare that the statements antl information on the foregoing application are true antl accurate,to the best of my knowledge and belief. Signed under lh s and penalties of perjury. P&K L) D£ Print Name C�rli signatu /Agent ogre City of Northampton ..' - Massachusetts A+• ..' srO� fi V 'I rnPm:s S 08 ]mZ uulcl r eul dIa 212 Mai. .ti»t . , ve 010 BuiltliM C �\ Nazthmpto., MA 01060 Sya, a,��1J 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"reconstruction,alteration,renovation,repair, modernization, conversion, improvement,removal, demolition,or construction of an addition to any preexisfing ownereccupiedbuilding containing at Mast one but not more than four dwelling units.—or to structures which are adjacent to such residence orbuildinJ'be done by registered contractors. Note.if the homeowner has contracted with a corporation or LLC, that entity mast be registered. Type of Work: IC�F,�' Est.Cost: 7 [x� a Address of Work: 5sT6th' )C 2 e—1 Ak 1�v— l 2i k-�f�►.A PTT) Date of Permit Application: I 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 owner-occupied 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 UNDER 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 perm as the agent of the owner: \ ct; P tl-�-� 1 ('9122 Date Contractor Name HTC Registration No. OR: Notwithstanding the above notice, 1 hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton / Massachusetts Hui aaPAB4fhT`T OF BlZrWMG ZBSP ZGBS Maii 212 v 9the •lWnivipsl lAlnq � Noxthamplon, !A 01060 C� 3'Olo Debris Disposal Affidavit In accordance of the provisions of MGL c 40, 554, 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: 53 taep �ro6slr 16- (Please print house number and street name) Is to be disposed of at: `�API.'FiEcK�_u Nrr ryTH AM�' U'� (Please pont name antl location of facility Or wit be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signalutb ofPermit 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. SECTION 8-CONSTRUCTION SERVICES 8.1 Licenaed Con CUM Suowisor: /Not Applicable ❑G7 / ( ) C/ Nomad License Holder [ - bt�DC ( �— ^7 5Pos n License Number Ada ST to suI}W1PiUyuJ 1 �A 1 -2 20 E Pratlon Date '1 dlK LATS X35-9529 sign.. Telephone 9.RealaWed Hawo,Il linnewt Con!rorXor: Not Applicable ❑ Name nn,s:lZyCTtQ2J � !at.6 _45 Company Name Regisirabon Number Adtlrress r�—,� E1pmlion Date Telephone_413 b35�9529 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.p.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 builtlin pe21L Signed Affidavit Attached Yes....... No...... ❑ �Ls The Corrrmonweahh of Massachusetts Department oflntlwh4alAccidents I Congress Street Suite 100 Boston,MA 01714-2017 www!mass govl&a Ulki-kers'Compentation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE PILED WITH THE PERMITfENIG AUTHORITY. Aoolican[Information !7 Pleagg,Print L obl Nome(Busiress/OrgauvatioMrdividual): 'p5 Aft �h5.��ft_5�T1('S A 1 Address: City/State/Zip: Phone#. L{ Are you an employe'i check the appropriate bon: Type of project(required): L[9rs�.aemp1oyewth 7. []New constriction 2❑I am a sole proowor or financing arca have no employees working for me in g_ Rpitsm—weling anv esp eft,fNo workers'mmp.insuarec rcquiredJ l❑Iamalemeowmrdoingallwnrkmywlf[Noworkerswmp.insmanccrequiad.lt 9. ❑Demolition 4.Ell ama Mmcoats will behiring contactors to verifier all work on myproperty. Twill 10 EJ Building addition e mart comae that ell cma airier have workea'wmpmaatiomnaaraiaemarc rile 1].❑Electrical repairs or additions pmprictoa with nn employees. 12.[]Plumbing repairs or additions sE]l amagencre .onnacmrand l have Mos the subcontiaotoa basion the atached shttl. The.subconcesorshave employees ab have cokere'oomp.'msoraneeJ I3.❑Roof2 Pairs 6.Disease eco tlonanditn officers have exercised theirrihl ofew tion 14.00ther ryora g rip per MGL c. 154,$1(4),end we base no employ«s.INo workery comp.ins ae requimdl •Any applleunt that checks box#1 must also 011 out Me section below showing their worked compensation policy intbmution. t limn:awners who submit this andavit indicating they are doing all work and then hire outside contractors most submit anew affidavit indicating such. lConhaeoa that check this Iroz must attached an additional sheet showing Me rum,of the sub-coinmeters and sate whether or willing,entities have employees. Ythe subconbacmn Mw mployees,they mmt pmvide their werom'comp.policy rather, I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and joh site information. _ Insurance Company Name (lzmr-LlFR.`.J _ Policy N or Self-ins.Lic.#: y :j�j �rol4 L){� Expiration Date:_a� �, t Job Site Address 5'�J i-e2D 6 �L)r city/state/zip: K) f, NilfriON t4pt 6I06d Attach a copy of the workers'compensation polity declaration page(showing the policy number and aspiration 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 impnsontient,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.A copy of this statement may be forwarded to the Office of Investigations of the DLA for insurance coverage verification, l do hereby ceWy under thepa ns andly naltiss of feedury that the information provided abve dois nue ancorrect siynarthe �, � ,�-j3Qm, Daze `�6 ' 6-19 Phone# LA 12, g2el-21 7(, Oficial use only. Do not write M this area,to be completed kv cfty cr town official City or Town: Permit/License N Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone N: CL B L E D EXISTING STORAGEPROPOSED EXISTING ROOM OBATH 0 BASEMENT FLOOR PLAN BONDE CONSTUCTION / LINDA BAKER, 53 FORD CROSSING, NORTHAMPTON, MA 413 535-9529 CL L E D EXISTING STORAGE PROPOSED EXISTING ROOM 0 BATH 0 <-- UP BASEMENT FLOOR PLAN BONDE CONSTUCTION / LINDA BAKER, 53 FORD CROSSING, NORTHAMPTON, MA 413 5-45-9529 CL B L ED EXISTING STORAGE PROPOSED EXISTING ROOM O BATH 0 BASEMENT FLOOR PLAN BONDE CONSTUCTION / LINDA BAKER, 53 FORD CROSSING, NORTHAMPTON, MA 413 535-9529 12 1G EXISTING IST. FLOOR 0AN 1/2' NR RUCK GRADE FIBERGLASS 2 X6 STUDS VINYL FLGIX PRES. TREAT PLATE SUMP PUM SECTIONAL VIEW BONDE CONSTUCTION / LINDA BAKER, 53 FORD CROSSING, NORTHAMPTON, MA 413 535-9529 12 10 EXISTING IST.FLOOR OAM 1/2'MR ROCK GRADE FIBERGLASS 2 X4 STUBS VINYL FLOOR PRES. TREAT PLATE SUMP PUM SECTIONAL VIEW BONDE CONSTUCTION / LINDA BAKER, 53 FORD CROSSING, NORTHAMPTON, MA 413 535-9529 H", OAM 1/2'NR ROCK GRADE FIBERGLASS 2 XI STUDS VINYL FLOOR PRES, TREAT PLATE SUMP P SECTIONAL VIEW BONDE CONSTUCTION / LINDA BAKER, 53 FORD CROSSING, NORTHAMPTON, MA 413 535-9529 H DAM 1/2'MR ROCK GRADE FIBERGLASS 2%0 STUDS VINYL FL PRES. TREAT PLATE SUMP PUM SECTIONAL VIEW BONDE CONSTUCTION / LINDA BAKER, 53 FORD CROSSING, NORTHAMPTON, MA 413 535-9529