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29-325 (2) City of Northampton ' Massachusetts W � A DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building �y � Northampton, MA 01060 jr,�Vjp M. J. Homes, LLC Vitaly Dzhenzherukha 431 Springfield St. am, MA 01001 September 7, 2018 29-325 Dear Mr. Dzhenzherukha, I visited the property at 333 Acrebrook Drive on September 7, 2018. 1 observed work on that property being performed contrary to the provisions of the Massachusetts State Building Code, 780 CMR section R105.1; a building permit has not been issued for that property. In accordance with 780 CMR section R115, 1 have issued and posted a stop work order effective September 7, 2018. Work on this property cannot resume until we issue a building permit. The permit fee will be doubled and there will be an additional $50.00 fee to remove the stop work order in accordance with the City of Northampton ordinances Chapter 174, section 5. You have the right to appeal this action under 780 CMR section R113. Please contact this office as soon as possible. Our telephone number is 587-1240 and our office hours are Monday through Friday, 8:30 am to 4:30 pm, excepting that we close at 12:00 noon on Wednesdays. My email address is: Ihasbrouck(a_)northamptonma.gov. Thank you for your cooperation in this matter. Louis Hasbrouck City of Northampton Building Commissioner Ihasbrouck(a)_northamptonma.gov A"�"d- .CS &17L. C ps r ;F- City City of Northampton Status of Permit: Department use only Building Department Curb Cut/Driveway Permit y 212 Main Street Sewer/Septic Availability L y { 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,ALTEFJ, REPA , ENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 29 3 -�5 1.1 Property Address: This section to be completed by office Map Lot Unit 333 Acrebrook Drive Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Vitally Dzhenzherukha 130 South Park Terrace, Agawam, MA 01001 Name(Print) Current Mailing Address: 203-449-5809 11 Telephone gnat 2.2 Authorized Agent: Vitally Dzhenzherukha Vitally Dzhenzherukha Name�t) � Current Mailing Address: Vitally Dzhenzherukha Si nature 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 � u U v 2. Electrical I b 6-D (b) Estimated Total Cost of / Construction from 6 3. Plumbing �3 Building Permit Fee 4. Mechanical (HVAC) •X� 5. Fire Protection 6. Total = (1 +2+ 3+4+5) Check Number T ' Section For Official Use Only Date Building Permit Number: Issued: Signature: ( I Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) u��, - yq, OD c ►� =i ��. �. �- 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 .59 .59 Frontage - Setbacks Front Side L: R: L: R: 0 Rear Building Height Bldg. Square Footage 968sq % 968sq Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces 2 2 Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW Q YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW Q 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 Q YES 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 © NO O 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. Will the construction activity disturb(clearing,grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO Q 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 ❑ Replacement Windows Alteration(s) ✓❑ Roofing Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [ (I Other[0] Brief Description of Proposed L Work: ,�d,�� (AS if J F-f�F1 �,�[l t'1SDlf`'t 1'�t'Vl.�c"�(. 12iii: Alteration of existing bedroom Yes XX No Adding new bedroom Yes XX No Attached Narrative Renovating unfinished basement Yes XX No Plans Attached Roll -Sheet If New house and or addition to existinghousing, complete the following: a. Use wilding : One Family X Two Family Other b. Number of r sin each family unit: 5 Number of Bathrooms c. Is there a garage att ed? NO d. Proposed Square footage o w construction. N/A Dimensions e. Number of stories? 1 f. Method of heating? 0 Fireplaces or Woodstoves 0 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 c truction 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 N� 1. 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 1, U � ��A LIr1PYl7[ I�1,�1 as Owner of the subject property Vitaly Dzhenzherukha hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. G Signature q0rwner Date as Owner/Authorized Agent hereby declarbAhat 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. �'1"6 Z�dA41 t Print Name C Iq1T Signature of Owner/ Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ 1 Is-7 3q Company Narrie Registration Number l3 o 5vOfk NY- MOO(z 3 3 3 am Address A n Expiration Date Ap.r,Jon, Iy�A- 6,(a Telephone QL3_LW 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...... ❑ City of Northampton r' Massachusetts i� DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building yJ6 O Northampton, MA 01060 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 pre-existing owner-occupied 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 a corporation or LLC,that entity must be registered Type of Work: �� j'� t��j(,�_ Kf�!ISS 41sld.iM Est. Cost: n Address of Work: 3 33 r1S,A- 1✓�(1�( I� r� 14i1A Date of Permit Application: I(�I(a 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 permit as the agent of the owner: \ Date Contra or Name HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above roperty: I0ha� Date Owner NaMe and Signature The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 �~ www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information `L Please Print Lep_ibly Name (Business/Organization/Individual): �! 1-�w,� OLVOZ�eyuoklc, Address: City/State/Zip: wq M Owtl Phone#: �3_ggq—SSd Are you an employer?Check the appropriate box: Type of project(required): I.E]I am a employer with employees(full and/or part-time).* 7. ❑ ew construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in $, &Remodeling ny capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3. 1 am a homeowner doing all work myself[No workers'comp.insurance required.]t 10E] Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.1YE lectrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.M I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F2koof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then 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 whether or not those entities have employees. If the sub-contractors have employees,they must provide 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.Lic.#: 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 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 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 DIA for insurance coverage verification. I do hereby certify under the pt a penalti perjury that the information provided above is true and correct. Signature: ✓ Date: AT& Phone#: 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 �� N", j ' Ar DEPARTMENT OF BUILDING INSPECTIONS �. 212 Main Street •Municipal Building Northampton, MA 01060 ss . 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: (Please print house number and street name) Is to be disposed of at: (Please print nam0a d location of facility) Or will be disposed of in a dumpster onsite rented or leased from: 'J5 (Company Name anddd ess) Signature of P it Applicant or r 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.