31A-121 (2) 5 JEWETT ST BP-2019-1070
GIs N: COMMONWEALTH OF MASSACHUSETTS
Ma xillock:3 I- 121 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:BASEMENT RENOVATION BUILDING PERMIT
Rmh a BP-2019-1070
Proiect N JS-2019-001737
Est.con:$14966.00
Fee:$97.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: VAL SHEVETZ- OAK RIDGE CUSTOM HOME BUILDERS INC
087690
Lot size(sa.ft.): 11238.48 Owner. COHEN BATYA&NICOLE HAMER
Zoning:URB(100V Applicant. VAL SHEVETZ- OAK RIDGE CUSTOM HOME BUILDERS
INC
AT: 5 JEWETT ST
Applicant Address: Phone: Insurance:
PO BOX 63 (413)374-9236 WC
EAST LONGMEADOWMA01028 ISSUED ON.•4/312019 0:00:00
TO PERFORM THE FOLLOWING WORK.BASEMENT RENO
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: Qih Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certfcate of Occuoancy signature:
FeeTvpe: Date Paid: Amount:
Building 4/320190:00:00 $97.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
QuesttaP N6`'�
File#BP-2019.1070 D065 -Tats oiM P 7
APPLICANT/CONTACT PERSON VAL SHEVETZ-OAK RHX'iE CUSTOM HOME BUILDERS INC
BATH
ADDRESSIPHONE PO BOX 63 EAST LONGMEADOW (413)374.9236
PROPERTY LOCATION 53EWETT ST
MAP 31A PARCEL 121 001 ZONE URBf100V
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
CLOSED REQUIRED DATE
ZONING EM FILLED OUT
fee Paid
Building Permit Filled out
Fee Paid
TynoofCo ction: BASEMENT REN
Now Ccnstmmion
Non Stm rural in 'or LenovilljQns
Addition to Existing
Accessory Structure
Building Plans Included,
Owner/Statement or License 097690
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF)RMATION PRESENTED:
✓Approved_Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Pmjem: 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
_Odaer 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 Smmr Water Management
_Demolition Delay
`k-&V '41-4111
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.
D liu�er (c¢iYiO
Department use only
City of Northa on states f Pe it
..> Building Depa ant MAO 2 7 c D - y Permit
212 Main Str t Sewer/ eptiC veilabiliry
Room 100 I A affability
Northampton, MA 10�6°T°°Brnmwr.ne a=cn
p rv°PTHnI.irTOn. MrorSets of S dural Plans
phone 413-587-1240 Fax Plot/Site Plans
Dow specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Pr ertyA ,dress.I This section to be completed by office
j 7ewt .5d , Map S 1 71 Lot 12% nit
Zone Overlay District
Elm St.District CS Distict
SECTION 2.PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
�aII /
Ra�un �utt
1 a 'ole nweR S Jewz� _S4_
Name ) Curtem Maii
9sn r ��m39
Telephone
Signature
2.2 Authorizetl AoeM: / / /�
ue�i
Name(Pri d) Current Mailing Address:
yr337e, 9-)3�
Signature 2Telephone
SECTIO TED CONSTRUCTION COSTS
Item 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 Fw ^�
4. Mechanical(HVAC) (�
5. Fire Protection
8. Total=(1 +2+3+4+5) fO6 7S Check Number
This Sectlim For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Canmissionerlln ipector of Buildings Date
VAL SHV 7rz 2 VA H O0 COW,
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This whim b he WIWI is by
Building Dcpemnc t
Lot Size
Frontage
Setbacks Front
Side L:- L .. R:
Rear
Building Height
Bldg.Square Footage % - i
Open Space Footage
(lar area minus bldg&paved
#ofParking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O 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 O 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 a6f 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 acbvity disturb(Gearing,grading,excavation,or filling)over 1 acre or ie 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 S DESCRIPTION OF PROPOSED WORK tcheck all aoolicablel
New House ❑ Addition ❑ Replacement Windows ANeration(s) ®" Roofing ❑
Or Doom El
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [tom Siding[01 Other[0]
Brief Description of Proposed KPa..a
Work' [345 er.,. a.t, R in+f
Alteration of scaling bedroom Yes Y'_No Adding new bedroom_Yes No
Attached Narrative Renovating unfinished basement xx es No
Plans Attached Roll -Sheet
Ba. N New house and or addition to efdatlrlg housing,complete the following:
a. Use of building One Family_Z( Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
S
d. Proposed Square footage of new construction. SAO Dimensions .75 7 X 6 �y
e. Number of stories?
f Method of heating? 6w. Fireplaces or Woodstows 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
i
I. Depth of basement or cellar floor below finished grade 7 %
it. 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/ L.O `+ . as Owner of the subject
propel~ ,, D /' I 1
hereby authorize ✓C Le /7
to act on my behalf,in all matters relative to work authorized by this building permit application.
36
i-SgredwilfiffOviner
Date
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 antl penaltiespf perjury.
t1al S�pvG T/G
Print Name IJ
gnatumof Owren a Dale
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Superr isor: Not Applicable D
Name of License Hold ar I/�%(.r' SW/.(rj_ /✓51— 0876 t
License Number
6 E. �owt ,00ew� Y14 orals 7/i�/9
Aodrosa
Expiration ate
s j 7 q�
Signature Telephone
9.Registered Home Improvement Contractor. Not Applicable D
o �a?K 9 .2 y 6
Comisanv Nam Regisbafion 14 ber
O
13o47 (,2y #0 o-La 9 -o
A dress / Expiration Dgft
Telephone v1/V7Y?.2
SECTION 111-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L 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 building permit.
Signed Affidavit Attached Ves....... No...... D
City of Northampton
Ql `
Massachu5ettstseutnmar or eozaozM znsrrrrzoers:lz Main aft»c • MYn Ito av;la;lp t
NorNa t:n, w 01060 6
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 most be registered as a Home Improvement Contractor("HIC').
M.G.L.Chapter 102A requires that the"reconstruction, alteration,renovation,repair,modernization, conversion,
improvement,removal, demolition, w construction or an addition to any preexisting 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: RPAw_o!/agAi ow Est Cost: /`1/0 !70 ( 7 S
AddressofWork: S JeL'J-e74 /.S4. 7ff.cwr dSON. /7 // D/6(,o
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):
_ owner
occupied
not ownerccupied
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 RESPONSIBH.ITES 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.
-.3-4Z711.7 11a45L e/z- /S9_2 L/ 4
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
.r}f � Massachusetts
DSPARSTRN4 OF BDIDDING ZN6P1CT10NS
212 win Street • municipal Building
Northerpton, M 01060
Massachusetts Residential Building Code
Section 110.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 110.125.1.3.1
Any homeowner performing work for which a building permit is required shall be exempt from
the licensing provisions of 780 CMR 110.R5, 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.
__ City of Northampton
Massachusetts �
A, z
LEPARIMLNS OF BUILDING INBZCTXONS
212 win atr«t *e icl"l auilft,i
NerNav ., x 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
s jaw # -5�. N9v m
(Please print house number and street nameA
Is to be disposed of at:
USK} }fa:� N
(Please pant naTp and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
aftfnature of Perm i pplicant r 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.
The Commonwealth of Massachusetts
UWAVorkers'
Department of Industrial Accidents
1 Congress Street,Suite 100Boston, MA 01114-10177www.mass.gowWh;Compensation Insurance Affidavit:Builders./Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Prin Le bl
Name(Business/Organizatiowlndividual): e
Address: Fatly 63 '�1
City/State/Zip: G Iqv7- Phone#: y133J J5Z
ArcywmwsplyW.chamkdacpp riuebox: Type of project(required):
I.Jjp am u employer wit I errWloyea ffulladtm part-wol'. 7. []New construction
2.❑lamewlepmMetmorpemershipmdmvcaoemplomsworking formem g. ❑Remodeling
any capacity.[No workers'comp.insurance requited,]
J❑I am a homenwncr doing all work myself[No w roma'com,uaumace required]' 9' ❑Demolition
4.❑I..hnmenwn,T and writ be hums, oaclots m emdum.11 work out 10❑Building addition
con r pmperty. 1 will
sure tat an convactors cithm lave wnrkeri<omperaalion-...mance or are sole I1.❑Electrical repairs or additions
propdnors wit a,employees. 12.❑Plumbing repairs or additions
5 Ism.gen,—1 somctuad l havehited the subemma s lord m the aterLed sheet 13.�Roof repairs
These sub,muamms love employees,and have wwlceri comp.imurancv
6.❑We area cm,xaa ien amiits offices have exe.wal thea right.fexerepdon pe MGL c. 14.[–]Other
152,§1141,and we have no employees.[No wwkets'comp.ussumove t me,l.]
"My applicant tial checks box pl must also fill out to section below showing @air workers'compensation policy�rmah-
'Homeowmrs who submit tis oamava urdicmm,try ore doing all work and then hue omside conmemrs mmt submit o new affidavit indicating such.
<Contrwmrs that check Nix boa must attached anaddam al shoe showing rhe name of the wh-conmctme and state where,or not Lose eabbes have
employees. If to subconmctors have employees,they must provide rhea workers'comp.policy number.
/was art employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site
information /J
Insurance Company None-
Policy
on e-Policy Mor Self-ins.Lic.#:(,(.e S-3j 5-38 69lf-038 Expiration Date: -7z/ T
Job Site Address: 5 3City/State/Zip:
Attach a copy of the workers'compensation policy declarlition page(showing the policy number and ex atlon 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 pains andpenaldes of perjury that the information provided abuse correee
Signal Date: 377
Phone#: y/7 ?74 923 4
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: PermitfLicense#
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#:
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 smite 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 ajoint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,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 smtes 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 your situation and,if
necessary,supply subbcontrecmr(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 confirmation of insurance coverage. Also be sore 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
self-insurance 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
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 permit/licenw 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.When: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 etc.)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
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel.#617-727-4900 ext 7406 or 1-877-NIASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
I
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HOMEIMPROVEMENf CONTRACTOR
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VAL SHVETZ
VALSHVETZ
a1 OLD WESTFIECDyiM--,
WEST SPRINGFIELD,MA 01089 UndereeaeterY
commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Constr Ad"rvisor
CS-087690 I /
A Eafires: 07/08/2019
VAL ASHEVlZ
POBOX E
EAST LONGMEADOW.��jp S
Commissioner C4 ���`�
IS' 7'
Bas ent hatch door
Entertainment Area
25' 7" x12' 2"
in
N
Fig
llway
6' 11" x 8' 3" Staircase to stay
unfinished as is
® Storage unfinished
9' 9" x 13' 0"
Stairacase area
8' 3" x13' 0"
Bathroom
6' 11" x4' 6"
F�Or Louis Hasbrouck<Ihasbrouck@northamptonma.gov>
5 Jewett St
Louis Hasbrouck<Iasbrouck@northamptonma.gov> Wed,Apr 3, 2019 at 3:47 PM
Draft To:vaishvetz@yahoo.com
Val,
Does the job at 5 Jewett St include a new bathroom,or is it already there?
Louis Hasbrouck
Building Commissioner
City of Northampton
Town of Williamsburg
(413)587-1240 office
(413)587-1272 fax