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31C-032 (8) 119 MOSER ST BP-2019-1121 GIs 9: COMMONWEALTH OF MASSACHUSETTS MV.Block:31 C-032 CITY OF NORTHAMPTON Lot: .001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category Porch Enclosure BUILDING PERMIT Permit n BP-2019-1121 Proiect 0 JS-2019-001822 Est.Cost:$8000.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO. Const. Class: Contractor: License. Use Group, MARKBONDE 67758 Lot Size(sn ft.), 0.00 Owner. DERMAN ERIC aping: Applicant. MARK BONDE AT: 119 MOSER ST Applicant Address: Phone: Insurance. 205 PARK ST (413) 535-9529 O WC EASTHAMPTONMA01027 ISSUED ON:4/10/2019 0:00:00 TO PERFORM THE FOLLOWING WORX:ENCLOSE AN EXISTING PORCH BY BUILDING 2 WALLS UNDER EXISTING ROOF 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 4/10/20190:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File k BP-2019-1121 APPLICANT/CONTACT PERSON MARK BONDE ADDRESS/PHONE205 PARK ST EASTHAMPTON (413)535-9529 Q PROPERTY LOCATION 119 MOSER ST MAP 31 C PARCEL 032 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICAT ECKLIST ENC OS D REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid TypeofConstmctiom ENCLOSE AN EXISTING ORCH UILDING 2 WALLS UNDER EXISTING ROOF New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included Owner/Statement or License 67758 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO)kMATION PRESENTED: pproved_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: § Finding Special Permit-_ . Variance" Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Cub Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Pemit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Stonn Water Management �Demolition Delay � ZD I J Sign rafe—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. Department use only City of Northampton Slaws of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability ..�. Room 100 WaterNVen Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Sp dy APPLICATION TO CONSTRUCT,ALTER, EPA R, RENOVATE OR DEM LISH ONE OR TWO FAMILY DWELLING SECTIONI -SITE INFORMATION APR t 0 7019 &l? 9-//d. 1,1 Properly Address: Ise Ion to be completed by office pFaT.CF PUII➢W G INSPFCT' NoaTHn.,I ,rnaoroso Lot Unit Zone Overlay District Elm St.District Ca Dlatrict SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: I\C� Mh�FIZ S . Name(Print) m Mailing A dress' Telephone Signatur p 2.2 Authorized Aeerd: �� 05 t o ZIC r Fas-HAM PT211 (P Name rint) Current Mailing Atltl2ss: Liu 535- u5zy Signature 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 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number: IIsssued: Signature: /—'O w't? Building Commissionedinspector of Buildings Data 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 'Itis column to be filler in by Building Department Lot Size Frontage Setbacks Front Side U R:, L:_R: Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot arca minus bldg&pavM ,king) #of Parking 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 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, xcavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicablel New House ❑ Addition ❑ Replacement Windows Alteration(s) E] Roofing E]or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [D Siding[D1 Other[i,e/ Brief Description of Proposed Work: 'gigO- xr, AMW `ZOILD11W­ ZW/AL4,; ONDFFP f�l57/A(Cr�Lt�. Alteration of existing bedroom_Yes t/ No Adding new bedroom Yes " No Attached Narrative Renovating unfinished basement Yes V-190 Plans Attached Roll -Sheet Ba. If New house and or addition to existing housing, complete the following: a. Use of building :One Family Two Family Other to 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_ CitySewer Private well City water Supply_ SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FFOOR�BUIL�DING PERMIT as Owner of the subject property hereby authorize to act an my lr all m el o w authorized 6 mit appli on. ' oz/9 SignatbrwOTOwner Date I, "Ag-KVDF ,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. ,&—Pr _ J�I,&— Pr nt int Name _ SAN 2 0 4-y Signature at Owner/Agent Data SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone 9. Realetered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone 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...... ❑ SECTION 8-CONSTRUCTION SERVICES 8.1 I.Icensed Conatnuction Supervisor: Noott Applicable 0 Name of Licence Holder: Ir� y t-' II License Number 6105 �Qk 157 -rASPr ,*j OA ( - Z - -LO Address Expiration Date �h 1o � 5 95zq Signatu Telepfione 9.Registered Home Improvement Contractor: NotApplicable 0 LI T)F CSN2' 7C?i 01J 1 (_I 7.n Company Name Registration Number ,2oS rck e,-7. nvr , 01a fol Iq Address Expiration Date Telephone SECTION 1Q-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....._ M-' No...... ❑ SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ RementWindows Alteratlon(s) Roofing 0, Accessory Bldg. ❑ Demolition ❑ New Signa [0I Decks [[7 Siding[p] Other[DJ Brief Description of Proposed Work: Alteration of existing bedroom_Yes_No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea. 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? it. Proposed Square footage of new construction. Dimensions e. Number of stories? E Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? In Type of construction I. Is construction within 100 ft. of wetlands?^Yes _No. Is construction within 100 yr. floodplain_Yes_No T 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 i City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 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 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. Print Name Signature of Owner/Agent Date ell The Commonwealth of Massachusetts Ips _ Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 0211 4-2 01 7 w„ www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(BusinesdOrgmimtioNlndividual): WAele7ent'5CiF Address: 'BIOS e-v<' ST City/State/Zip: Ok M7 Phone#: ?J 17Z�-ZI7 Are you an employer!Check the appropriate box: Type of project(required): LCg1*`mm aemployer with�employees(full andlorpan-time)• 7. ❑New construction 2.❑1 am a sale proprietor or paMership and have no employes working fur me m $. ❑ Remodeling any capacity.[Noworkers compinsuranm required) 3T11aa homeowner doing all work myself lNowmkers'emn,insurancerequired.]` q. Demolition aura 4.❑1 am a homeowner and will ba hiring contractors to conduct all work an my property_ [will I O❑Building addition .am that all contreaors either have workers'compensation lmm.or are sol, 1 L❑Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.[]1 am a general contractor and I have hired the subcontractors listed on the coached sheet. 13.E]Roof repairs These sub-contracmrs have employees and have workers'comp.mu mne• t--I� l4.©6her 6.❑We area corporation and as oficers have ewosodthca,, A.fes.,tum per MGL c. ('LY'j L'kj� �j lyfl 152,§I(4),and we have no employees.IN.workers'romp.instm nce required.] *Any applicant that checks Irox 41 must also fill out the croon below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contraaors must submit a new attidava indicating such, kbnmwors that check this box most attached an additional short showing the name of the subconhadms and state whether or not those terries have employes- If the submntmch s have employees,they most provide their workers camp.polity,number. lam an employer that u providing workers'compensation insurance for my employees. Below is the policy and job site information. _ Insurance Company Name: ll%zW 5U fXS, — Policy#or Self-ins.Lie.#: L) LA K 06 SOA l 9 4 )i�r Expiration Date: '' tt Job Site Address: CIq MDSEQ STI City/State/Zip: �7fCg)4p' �C3f7 3r 1`-I� a()b(] 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 cent under the pains a�ndpenalties ofperjury that the information provided above is true and correct. Siena�y (( Date Pho #� Ojjicial 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.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: v Massachusetts j DEPARTMENT OF BUILDING SNRPECTSON6 S,y 212 Nein Skeet .Municipal Builtl ng [- Northampton, Mr• 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: (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 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. ` Massachusetts ?'�® a ,f DEPARTMENT OF BUILDING INSPECTIONS 212 Main etx t •M Iclpal eu>lG ng Northe ton, H 01060 ✓r"ry 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�off,at: 0#,LLE`{ IC�(SIU AA)(r' (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: YaJDE l r)A]A-Ak 2cno l) Impany Name and Address) `vf N-qV7 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. The Commonwealth of Massachusetts N, ( Department oflndustrialAecidents I Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Rorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumben. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/OrgmintioNludividual): Address: City/State/Zip: Phone#: Arc you an employer?Cheek the appropriate box: Type of project(required): I.❑I am a employer with employees(full andlor pati-tem)I 7, []New COnalIDCtion 2 am asale proprietor or pnnemhip and have no employees working for me in $. ❑Remodeling any capacity_Mo workers'comp.insurance, required.] 3.❑T am a homwwne,mm,all work mywlf ps.om kers'comp.insu xacc om o d.l' 9. ❑Demolition 4.❑I am a horommar and will be hiring contractors to conduct all work on my property. 1 will 10 ❑Building addition ensure that all contractors either have workerscnmpensation insurance or are sole II.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5 1 hgeneral contractor and 1 have hired the subnnaactlisted on the attached sten. Theesea sub-contractors have employees and have workers'cn comp.insurance 13QRoof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c 14.[]Other 152,kl(4),and we haven employees.Mo workers'comp Instancerequirod.l *Any applicant that checks hoe bl most also fill out Nc section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside commons,most submit a new affidavit indicating such. t2marra tors that check this box most snechad an additional shoor showing the time of the sub-comsat]ss and state whclher or not Nose crames have employees. Ifthe sub-contractors have employees,they must provide Neu workers'comp.policy munber. I am an employer that is providing workers'compensation insurance for my employees Below is the policy andjob site information. Insurance Company Name. Policy#or Self-ins. Lie.#: 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 ahepains and penalties of perjury thin the information provided above is true and correct Signature: Date' Phone#: Oj,cial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License M Issuing Authority(circle one): 1.Board of Health 2.Building Department 3,Cityffown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone h: Massachusetts c A s DWM21Dstrr OF BUILDING INSFECrIONS r 212 Nein Street a Municipal Building 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 pm-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 budding"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity most be registered. Type of Work: Rt.t Est. Cost: Address of Work: IQ ER S )ed1-IA la PTi O G i Date of Permit Application: LA 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: 1-i-g- 1n, _Epo-of 1 b9 Z9 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 Q_ Massachusetts A i - DEPARTDffirT OF BOS ING INSPECTIONS _rp 212 Naim Street • Municipal Bu 1l , i .T Northampton, M 01060 J 'rq. 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.R5.1.3.1 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.