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31B-108 (4)19 BRIGHT ST BP -2017-1106 GIs #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31 B- 108 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category shed BUILDING PERMIT Permit k BP -2017-1106 Pmicet# JS -2017-001886 Est. Cost: $12000.00 Fee: $84.0 PERMISSION IS HEREBY GRANTED TO: Const Class Contractor: License: Use Group: Homeowner as Contractor_ Lot Size(sq. ft.): 3789.72 Owner: KATZ MICHAEL D & CATHERINE I& JENNIFER ANN & JOSHUA DAVID Zonin_: URC(I00)/ Applicant: KATZ MICHAEL D & CATHERINE I & JENNIFER ANN & JOSHUA DAVID AT: 19 BRIGHT ST Applicant Address: Phone: Insurance: 19 BRIGHT ST NORTHAMPTONMA01060 ISSUED ON:4/6/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:10x16 shed** FINAL INSPECTION REQUIRED** 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, FeeTvpe: Date Paid: Amount: Building 41620170:00:00 S84.00 212 Main Street, Phone (413) 587-1240, Fax: (413) 587-1272 Louis Hasbrouck — Building Commissioner File A BP -2019-1106 APPLICANT/CONTACT PERSON KATZ MICHAEL D & CATHERINE I & JENNIFER ANN & JOSHUA DAVID ADDRESS/PHONE 19 BRIGHT ST NORTHAMPTON PROPERTY LOCATION 19 BRIGHT ST MAP3IBPARCEL108 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT TV FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON I ORMATION 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: Special Permit _ Variance - Received & ariance" Received& Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Septic Approval Board of Health Water Availability Sewer Availability 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 Signature of Building Official Date Note: Issuance ora 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. CRY of Northampton Q�Q\� Building Department 212 Main Street 4Q - Room 100 Northampton, MA 01060 v phone 413-587.1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1, -SITE INFORMATION This section to be completed by office 7.7 Property Adores h-fWdT Map Lot Unit �,{.r� Zone Overlay District Elm St. District CB District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT .t ee'r of Record: q t - Name Pri p Cur n a� 11 in) &-� — d Telephone`Z IDttT L Y1 Signature 2.2 Authorized Agent: Name (Pnuo Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Nam Estimated Cost (Dollars) to be Official Use Only completed by permit ae2licant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 6. Fire Protection 6. Total=(1+2+3+4+5) 1 Check Number 't' This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings 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 Bvitding UeP,a*nnt Lot Size Frontage ��—�— Setbacks Front Side Rear LC_i R:�� j-7 L:L:ZlR:L1 i Building Height Bldg. Square Footage Open Space Footage (60[ area ntlnus bldg & Invud arkin¢) # of Parking Spaces FiiL (vo(umc R Location} _ �....... .J , A. Has a Special Permit/Variance/Findin er been issued for/on the site? NO © DON'T KNOW YES O IF YES, date issued:[—= IF YES: Was the permit recorded at the Registry of Deeds? NO © DON'T KNOW O YES Q IF YES: enter Book F— I PageLy7 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 © Obtained O , Date Issued: G Do any signs exist on the property? YES O NO GKI 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 (Gearing, grading, ex alien, or filling) over 1 acre or is it part of a common plan that wilt disturb over 1 acre? YES O NO IF YES, then a Nonhampton Storm Water Management Permit from the DPW is requirad. SECTION S- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑JAdition ❑ ReplacemontWindows Atteratioo(s) ❑Roofing er DoorsAccessory Bldg. molition ❑"New Signs [O] Decks Siding [O] Other [E7] Brief Description of Proposed /t�}& 1 J ,1 _ j r� ituitl Work: /^ �P Alteration of existing bedroom _Yes _ No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Fill -Sheet pia. f New house anti or idditioth to exlstln= hour o "com tete-the folio in `: a. Use of building: One Family Two Family Other b. Number of rooms in each familyy�unit:� Number of Bathrooms c. Is there a garage attached?–AO— ttached? I d / /A d Proposed Square footage of new construction. J t/ Dimensions! t©x Ap or e. Number of stories? 1�l f. Method of heating? � Y 16 Fireplaces or Woodstoves Number of each g. Energy Conservation ICompliance. , Messcheck Energy Compliance form attached? h. Type of construction /A/FM'[/Y1Pie r Is construction within'` 1100100 ft. of wetlands? ✓ No. Is construction within 100 yr. floodplain _Yes Y No j. Depth of basement or cellar floor below finished gradei k. Will building conform to the Building and Zoning regulations?7 Yes ^. No. 1. Sepflc 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 , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature Owner Dale }/of as Owner/Authorized Agent hereby declare hat the statements and information on the Foregoing application are true and accurate, to the best of my knowledge and belief. Sign under the pains and pe atties of perjury. Print Narye, Signafure of OwnerfRgent � _�—� SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Andras. Expiration Date Signature Telephone % Realsteied Home'Imurovomeat Contractor ,',y , , ;.�,- _ = I Not Applicable ❑ Company Name Registration Number Expiration Date SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (Ni C. 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 buildine permit. 11. - Home,O.wner Exemption The Current exemption for "homeowners" was extended to include Owner -occupied Dwellings of one (1) or two(2) families and to allow such homeowner to engage an indiyclual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of 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 andf or faun structures. A person who constructs more than one home in a two-vear period shall not he considered a homeowner. Such "homeowner" shat! submit to the Building Official, on a fond 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 maybe liable for persons) you hive to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with fit State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature 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. fi Address of the work: The debris will be transported by: The debris will be received by: Building permit number: Name of Permit Applicant I%rliG ma-147qeOZ / Date Signature of ermit Applicant The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 7 Congress Street, Suite 100 Boston, MA 02114-201 7 low wsimmass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/OrganizatioMndividuai): _,_ _ Are you an employer? Check the appropriate box: Type of project (required): i ❑ a employer with 4. [] I um a general contractor and I 6. Q New construction employees(full and/or part-time).- have hired the sub -contractors 2. I am a sole proprietor or parmer- listed on the attached sheet. 7. [] Remodeling ship and have no employees These sub -contractors have g, Q Demolition working for me in any capacity. employees and have workers' 9. F1 Building addition workers' comp. insurance required.] req coos P . insurance t 5. [) We are a corporation and its 10.[3 Electrical repairs or additions 3. Q I am a homeowner doing all work officers have exercised their I IQ Plumbing repairs or additions myself [No workers' camp, right of exemption per MGL 12.0 Roof repairs insurance required.] t e, 152, §I(4), and we have no 13.0 Other employees. [No workers' Any a,acau that checks beset most also fill an the section bckw showing flair workers' comperosienpoliay Infomw[ion. t smoeowrrers who submit Otis affidavitindoodaeg ny are doingall work caddies hireonsidecontractorsmust submit a new mandator indicating such. =Contractors that cheekthis box must attached an additional sheet showing the name of the sub -contractors and state whether or not chair entities have employees [flat sub -contractors have employees, they must provide their uorkers'.1 policy number. I am an employer that isproviding workers' compensation insurancefor my employees. Below is thepolicy andjob site information. Insurance Company Name: Policy b or Self -ms. Lic. Expiration Job Site Acklms: _ City/Smte/Zip:i i, 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 ease 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 fore 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 the pains and penalties of perjury that the heformailon provided above is true and correct Official use only. Do not write in this area, to be completed by city or town o(fieial. City or Town: Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone 4: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for thein employees. Pursuant to tris statute, an employee is defined as "...every person in the service of another under any contract of hire, , 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 a deceased employer, or the receiver or notice of an individual, parmership, association or other legal entity, employing employees. However 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 of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance 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 of compliance 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 yew situation mid, if necessary, supply sub-comractor(s) name(s), address(es) and phone numbers) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an 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 confimnation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be rumored 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 self-insurance license number on tine 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 of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant, Please be sure to fill in the permitlicense number which will be used as a reference number. In addition, an applicant that must 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 proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out 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 bunt leaves etc.) said person is NOT required to complete this affidavit, The Office of investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Departim nt's address, telephone and fax number The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tei. # 617-727-4900 ext 7406 or 1-877-MASSAFE Revised 7-2013 Fax # 617-727-7749 vvww-mass.govldia City of Northampton Massachusetts DEPARTMENT Or BUILDING INSPECTIONS 212 Hain Street + Hunacipal Su Il .ng Northampton, MA 01060 Chuck Miller Assistant Commissioner HOME OWNER EXEMP—DON ACKNOWLF.DCi MENT The State of Massachusetts allows the homeowner 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 person(s) 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 be called to inspect work at various stages, which include The building department requires these inspections before the work is concealed, failur . to secure these inspections can resuit�ty 'lure t itt a ific a cu an until the work can be ns ec If the homeowner hires other trades to perform work (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 pD AY the project until such time as the proper permits and inspections are made I, ri understand the above. (Home owner treside s signature requesting exemption) I will call lttto�schedule all re�quiirre-dd building inspections necessary for the building permit issued to me. Date K,li�i ( ��2 Address ;Illh l