23A-040 (23) 52 MAPLE ST BP-2019-0560
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mg.-Block:23A-040 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-2019-0560
Proiect# JS-2019-000913
Est.Cost:$3500.00
Fee:$100.00 PERMISSION IS HEREB Y GRANTED TO.-
Const.
O.const.Class: Contractor: License:
Use Grout): RONALD BOYKO 100528
Lot Size(sa.ft.): 20603.88 (,owner: WELTER DIANE J&ALEX GHISELIN
zoning GBLIOgZ/ Applicant: RONALD BOYKO
AT.- 52 MAPLE ST
Applicant Address: Phone: Insurance:
35 SPAULDING ST (413)695-6359
AMHERSTMA01002 ISSUED ON:11/14/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 6 REPLACEMENT WINDOWS
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 Signatprg
Feenge: Date Paid: Amount:
Building 11/14/20180:00:00 $100.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
� r City of Northampton Status of Permit: µ
r ' Building Department Curb Cut/Driveway Permit
A 212 Main Street Sewer/Septic Availability.
x
Room 100 Water/Well Availability.,.
�► Northampton, MA 01060 turalPlbns,
phone 413-587-1240 Fax 41 -587 P ns
_ CEN
t er Spe �� er
APPLICATION TO CONSTRUCT,ALTER, REPAII I, RE OV69 OR RET@MSH ON OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Pro ert Address: NORTHnnnnTON,m,TWmeection o be completed by office
Map Lot ��V Unit
Zone Overlay District
�cJ ►�1 C�
I'D 6 2
Elm St.District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Curr nt M cling Addres
Telephone
Signature
2.2 Authorized Agent: l
'S C—L%,) Pr �l E
Name( ri.t) Q Current Mailing Address:
Signat re Telephone
SECTION 3- ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 43.6 M0 (a) Building Permit Fee
use
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) #q6 02OF!
5. Fire Protection 1-11
6. Total = (! +2+3 +4+5) Check Number
This Section For Official Use Only
Date I
Building Permit Number: Issued: l�
Signature: 11/13/�8
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) .4 `�/k/,�
n fit. 4(do `rcr7j, — ca,CCcd-� «��
Gva �► �
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ ReplacemenWindows Alteration(s) Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [❑ Siding Qom] Other[Q
Brief Des r' tion of Propose
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. 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 OR CONTRACTOR APPLIES FOR BUILDING PERMIT,
> �
I, I k — as Owner of the subject
property "� --
hereby authorize
to act on
my behalf, in all matters relative to work autholized by this building permit application.
Signature of Owner Date
I, , as Owner/Authorized
Agent hereby declare that 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.
P' 64'4cb
-�
Print Name
� r i
Signature of Owner/Agent �" 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 °/e
Open Space Footage °Ic
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for;on the site?
NO O DON'T KNOW O YES O
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#
B. Does the site contain a brook, body of water or wetlands? NO O DON'T 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 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 O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: ,`• Not Applicable ❑
Name of License Holder: CJ i on6 �
License Number
O6Qa0
Address Exp4ation D e
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
k-) E>c3vkc t L09 \3 3
Companv Name Registration Number
Address
ExJpira Dates
Telephone"3 �
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...... ❑
97he
�.; Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement.Contractor Registration
Type: Individual
RON BOYKO Registration: 148133
35 SPAULDING STREET Expiration: 09/21/2019
AMHERST,MA 01002
Update Address and return card. Mark reason for change.
SCA? s: 20M-05,111
❑ Address El Renewal_❑ Employment El Lost Card
/its�r.irrrnoirrrrri�/,r r/^ll r.r.lrrr�rr.i�ll�
Office of Consumer Affairs&Business Regulation
-- ? HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
�_�. TYPE:Individual before the expiration date. If found return to:
`�=* ?�.•- Registration Expiration Office of Consumer Affairs and Business Regulation
148133 09/21/2019 10 Park Plaza-Suite 5170
O n, 02 16
RN BOYKO Bosto
RONALD J.BOYKO
35 SPAULDING STREET i_
AMHERST,MA 01002 UndersecretaryNot valid without Signature
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations an~ Sndards
Construction Supervis
CS-100528 Exr. ; 03/09/2020
RONALD J BOYKO
35 SPAULDING STREET
AMHERST MA 01002
Commissioner t/"`
The Commonwealth of Massachusetts
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 Legibly
Name (Business/Organization/Individual): 1 T'-26-Vo
Address: JS PdkQ lQa_ ���l NMke"1`W) A-. D i potz—_-..
City/State/Zip: Phone #: `03 6qs 63 S 9
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ 1 am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.W(I am a sole proprietor or partner- listed on the attached sheet. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.F] Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself No workers' comp. c. 152, 1 4 ,and we have no
y [ p. § O 12.❑ Roof repairs
insurance required.] t employees. [No workers'
comp. insurance required.] 13.0 Other
*Any applicant that checks box#I 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 their workers'comp.policy information.
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 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 r 'y under thepains and penalties of perjury that the information provided above ' true and correct.
/
Si nature: Y Date: c.
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#:
�.,. --Z ., .... .....,....r, ...,..
Massachusetts �<
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street •Municipal Building
Northampton, MA 01060 qty �1
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: eqS l449YVIV-�Ok) $-� SY4-r"L
1. a
(Please print name and location facility)
r
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
AL- (SL, I 1I , q-
Signature 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.
a
Ron Boyko, Contractor CLIENT COPY
35 Spaulding Street,Amherst, MA 01002
Alex Ghiselin Work Location: 52 Maple Street, Florence MA 01062
Home Address: 164 Riverside Dr., Flocence MA 01062 Rear Apartment
CONTRACT or AGREEMENT between above noted Contractor and Client
Overview: To to remove five (5x)existing storm windows,five(5x)existing double-hung windows and replace with Pella 250 series Energy-Star rated custom
double hung vinyl replacement windows.
Scope of work required by Client:
1.) To prepare plans and documentation for obtaining required permits for work per below
2.) Remove existing storm windows, re-paint exterior trim
3.) Remove interior trim, existing double-hung windows, drill jambs and inject foam insulation into rough opening
4.) Install new Pella windows, replace trim.
5.) Client will remove aluminum storms to recycling center, remove wooden double-hung sashes to landfill.
Cost Estimate: -Z"G
Permitting, planning: 100
Materials 1900
Labor 1500
3500
Payment Schedule: 2(Two) Payments
1.) Payable at signature this agreement: $750.00 material advance
2.) Balance payment: $2750.00 upon completion of above to scope of work and inspection by City of Northampton Inspection Services
AC' " J, rDla, t
Alex Ghiselin' O er Date
Ron Boyko, Contra or Date