Loading...
32A-241 (3) 115 BRIDGE ST BP-2019-1197 GIs#1 COMMONWEALTH OF MASSACHUSETTS MV--Block:32A-241 CITY OF NORTHAMPTON I'm;-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildine DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category:renovation BUILDING PERMIT Permit BP-2019-1197 Proiect 4 JS-2019-001943 Est.Cost:$26550.00 Fee:$172.00 PERMISSION IS HEREBY GRANTED TO. Const Class: Contractor. License. Use Group: Homeowner as Contractor_ Lot Simsm.ft.): 130244.40 Owner: MINETT NANCY Zoning: SC(81)/URC(19)/ Applicant. MINETT NANCY AT, 115 BRIDGES Applicant Address: one: Insurance: 15 BROMPTON RD (515)428-3180 O GARDEN CITYNY11530 ISSUED ON.4/I9/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.REPAIR DECKS, MOVE LAUNDRY ROOM, ADD NEW BATHROOM, ALTER BEDROOM 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: Driveaay Pant: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: 9L 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 Occuoanty Signature: FeeType: Date Paid: Amount: Building 4/29/20190:00:00 $172.00 212 Main Street,Phone(413)587.1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner ° 1< File M BP-2019-1197 O vC15T) a -F APPLICANT/CONTACT PERSON MINETT NANCY � '` -• W t5' 00yyw(—�; 1 v, ADDRESSIPHONE 15 BROWTON RD GARDEN CITY (515)428-3180 0 N0�5 ` `� _.c£�`" �r PROPERTY LOCATION 115 BRIDGE ST W%0 VE��' 'V�C Q MAP32 PARCEL241 OQI ZONE SC(81)/URC(19V � THIS SECTION FOR OFFICIAL USE ONLY PERMIT APPLICATION CHECKLIST CL D REQUIRED DATE N FI T E Fee P ' Building Permit Filled out z Fee Paid Tvreof Constmctl= REPAIR DECKS MOVE LAOM. W BATHROOM.ALTER BEDROOM New Construction _Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sea of Plans/Plot Plan THE FOL OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO TION 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: _Curb Cm 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 Stora Water Management lition Delay y Z4- Signature opouilding 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 lk Development for more information. L43 Department use only - rtc City of Nort Permit: Building De Km fECEIVE m CN Driveway Permit 212 Main tr s r/ pgc Availability R�Wm 00 W ter ell Availability Northam on, 102 5 9019 T Se of Structural Plans phone 413-587-1240 ax 13272 PI usit Plans DF�T OF BUILDING INSPFCT fter S ecify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION llJ��� T 7 1.1 Pronerry AddressG: . This section to be completed by office 115 Brlda4 f*reEfMap �a Lot 1-51291f1-51291f Unit �Off'('ICIM oft ►er2 r OlOfoO Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: a M 'Innt-t IS 6rornEt-on Rd 6zxf- en City f!Y Name( Current Meiling Address: I 1 D30 TTeephone Si store I Agent: Name(Print) Curent Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated!Cost(Dollars)to be Official Use Only completed loam 1. Building 1%6w (a)Building Permit Fee 088 v 2. Electrical ( 5 U 0 (b)Estimated Total Cost of I Construction from fi 3. Plumbing ajr $'p 0 Building Permit Fee 4. Mechanical(HVAC) q,$ iqqh id+'nc� Fri lec 5. Fire Protection 6. Total= 1 +2+3+4+5) Check Number s Tide Section For Official Use Only Building Permit Number. Issued ed: Signature: N H.-20X1 Building Commissionerllnspedor of Buildings Date (1ml'fielf @ e ./7ef EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Fw"IF VDt44e IElINF;, tC' .:.'_Y,rN=E L3G CO avT'C. 'V r Fl e. ore, (G I I udn i( � 6r I , wr � CP pmcs! : $Oot. "'4'•VT �'S 114 . ".L:bitCbdG:ai,y1 �. r,. •. 04 vri E' t".Ftr r"iLtioA\1EUNDL-Rfr V ,,,. pl w. :r 2,1!141ur, n¢q'9U Ic `�i_ ... 1c M1"r, -- .... r l}A C; !/,Q* Section 4. ZONING All Information Mud Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This M.to be filled in by Building Depamaent Lot Size Frontage Setbacks Front Side L R: L R: Rear Building Height Bldg.Square Footage % Open Space Footage 'x (Id area mines Wit&paved pationg) #of Parking Spaces Fill: .dame&Lacalion A. Has a Special Permit/Varianoe/Finding ever been issued for/on the site? NO O DONT KNOW Q/ YES O IF YES,date issued: IF YIS: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW (a' YES O IF YES: enter Book Page and/or Document A B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES 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 Q IF YES, describe size, type and location: D. Are there any proposed charges to or additional of signs intended for the property? YES O NO Q' IF YES, describe size, type and location: E. Will the construction activity disturb(rrAg lBring, grad ing,(�e,x�cay ation,or filling)over 1 am or is it pan of a common plan that will disturb over 1 acre? YES V NO V IF YES,then a Northampton Storm Water Management Permh from the DPW is required. i u i i t.p, lu SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacemem Windows Aneratlon(s) Rooting Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [D) Deeks Otq SItlYp(O] Other(pJ Briefprion of Proposod Work: �,. :�ck.Sy Mom rnom,. LICU nPu1 h�tt-hroomy cxltelr bss oetr.j Alteration of emoting bedroom_LYes_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 existina housing. Complete the following: a. Use of building :One Family Two Family Other It. Number of rooms in each family unit: Number of Bathrooms a Is then:a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stones? I. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? It. Type of Construction I. Is construction within 1001!.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, , 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. d/aireu /yl• /rli�Pl�- -- Panthe7 S' nature ellw I 1 c�l I X11, CP" v .; 04 Wig ':UC: e\^ :f< , -IL 1,;(Tra�q"u i"'�oulErt� 'vi r AOLP H SECTION 8•CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of Llcenea Holds Doense Number Address Erplredon Date SIgraWm Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Atldress Expiration Dale Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.O.L c.152,;250(8)) Workers Compensation Insurance affidavit must be wmpleted and submitted with this application. Failure to provide this affidavit volt result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... 9' No...... ❑ i I I :I4 � i tY - 1st City of Northampton +rr -"" Massachusetts r }}-, DEPAR31ar or Burros; rsaparrrogs rlc' 212 Min Street . Hunicipai Building aor bnm, oa, IN 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 riot 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 o corporation or LLC,that entity must be registered. Type of Work: Est. Cost: Address of work: Its krr d#z 50`r'eefy In# Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): Job under$1,0M.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�nhlereby apply for a building permit as the agent of the owner: l7�n � Contractor Name HIC Registration No. OR: Notwithstanding the above notice,II hereby apply for ,,a�building permit as the owner of,,/ *y the above property: 4 /t/ r(4,`JCY /1 ,tT 7T ce are dnd Signal= , i ..�,mr.. �,ra ..�. u , t,�ts:.Y 9Lt i .6.': :x � _:,:.aJi, ' r-ar r, . � r:.,,.:. 6.,n,• a l : , •i^-4_lrJi' {,'I atr—:C::'t. Yf2r. ��^I ;,1 _. .11.!.d$1h1I i.Lr9 WT, 41'!' PIc Ku E I'P !,OV 1,101;O/W 1NGh"li.: 'Ai 10 .Ult 1 ate L'.; la 1 i0t'1'-TI! 116 t`,'l;f // : t LF.111 e !:'+.:r" a .•`: =l if, 01J.r=ICTOY,d UA '4:,M't ,44111. ^1: E✓L,l',It r,IIF/? ItOKM INr., e A r; dfILSK OVI 1110t 14A.'.ai V?IIf Klt, C I ;'eC7.. e[1.1 :',J.S:�:<'i'l3.HKf0 _ . _ _ ICD III;'I fl Pyj K. 11,111.1': Gn,g1P ,,,, q.1H a.,:,ChOJ' - p 1, ,w A O .lh,1 t. Bi_.. 4r6Sfo,r ' 1 1.,�� �.� �.:Ilp rrl ,'i0Ul1qI 111Ar.U . . pll iii,r':t" •. }{- +t j0 ld 1 .:,v.: . a:;4L;ameuY it h^u1:g Fbfglc ln , GUA1, ., aivp urot p y1. t C,?Ts\ Y}UT.ryYPP4���1U.�.i..iY City of Northampton ' Massachusetts i DLPART!ffi!T OF BUILDING XX9PaC7I0N8 212 Win Stz t • Municipal puLldlnq North pt=, W 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKN0WLFDQEN4E.NT 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 persons)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 foundationtlootings.(before backfill). sonotube holes (before pour) a rough building inspection (before work is concealed). insulation inspection (if required)and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result In failure to obtain a certificate of occupancy until the work can be 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 DELAY the project until such time as the proper permits and ins chonss arrreelpadee I, —1 '/, ,/i'%% understand the above. Home wn r/ ident's signature requesting exemption) I 1111 ca schedule all required building inspections necessary for the building permit issued to me. Date_�-� 4-/9 / Address of work location 1 QW66 • I _ .. lY.'J'• F,-!} F I 'Pi4 , mJaiOil ,,, 1=4 q:�l! b... :i 12210� ,. n� '.l L'Irfy r. N Sr . L -10 Oq y l.r,, In r, .ja i...; v.:, ;L Lr-. •n ? (!'If •_ . >mm W15MMW k• W Q W! MY=til` ; n.P . , . ,,•ctT o -11 fZIFf?yb`Tse r , i.) 4;- 6 i r. N {• NM "��'y;,:,�r b It . rr ;.�:�pr, ,ur3 >,?•- 3c1 , .'fl��, P<: r,G 7St .. . . _ ,i , . '7i , •Ulb!'.L , uU(2 ,. � t >,1 .•IUU tet. : r. . .<d i +:'.o: .,o-:3 � i_� '. IC , n Cip^ �-•. �.0 '�a. . ,,r,J C:> 5r, ^ ..:. d r' > 0Q /".�P.L 4>_ .. 'lb• • ""} . troy`; , M ANY I IMF City of Northampton r-k Massachusetts DSPxaTTf&NT OP aUZLDING ZNSP6CTIONS Ni. 212 Nein sheet. Municipal Building .,. , Northn ton, NA 01060 Massachusetts Residential Building Code Section I IO 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 I IO.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 l 10.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 (Inability 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. qjr'Jisy SLP uvu% {_ 1 - :JLoc,Mul r -r 1.. .- !, -,• r.:;l rui)Io-r , t^ f'JP:q• '"wcDO un v . v JT T VON .,c :r,::. 1 M0 c a qP tq r, lifs p•^,-. Ll .c (/ .. n , f ,I„ +<. j,Mq cap, y/ ; U y Mq nWU to q nta �. lig, m•a.; Lc. 6l. ..'1 . •. �'1•Lz,crvr.•pon Lnh•.-moo llxT 'I k!. e' • rr, r yx;l ti..'>cuel,. LLn,� rr . .,�� h _ci; m, r ... !'i' ,nqf; � .0 !., laccf''_ ((. W u- nr r r 1• r ,1r, flrn o- J.V.' Y]➢ fit( ' r :I,r�'. 4V ! .. ..�, dWA. ., r uP W i/.I!C'rP ) ,. 1'Ky b1. ip• n r,)GriF. Oahu:'� , . LCLLIi' 17y 1'. ,:furl( U f' "Sl "IL f;[L 'J;Jj Ju P, rnUC01, 1r1.' .. J ;, ..it W. 'n rt� r 4u; 1 � 't. •r l...;n f:I-u C.• ,. R , .•fG rn i ... ,J, r• -,r 1;1"jl . . . :_ . .. ";.c 1 1 F'.crsrljrf F 1-f "{':lin.., r{IIqCf,..•n •C City of Northampton -•"- Massachusetts DSPA 2%UU f OF eDILDIXD INBPB=0NS ux wtv street a Municipal Building Borthanpton, HA 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: .(e A,-' wee 5-reef (Please print bOuse number and street name) Is to be disposed of at: ALL12iQ/I1Dfo/1 fog-s.li.� �c fi;� n (Please nt name and n aclllty) Or will be disposed of in a dumpster onstte rented or leased from: (Company Name and Address) e � gnat 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. I'll !Jjf� Uc ,12 MI", A ^.VJGL O" bc I 'OlI6 • UG- c .�G rj 31 UZ j ;]q[fl Ot 7tS C, a. 71 1C- The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.govldta U11 urkers'Compensation Insurance Affidavit: Builders/Co Ut tore/Eimtticians/Plumben. TO BE FILED WITH THE PERMITITNG AUTHORITY. Applicant Information Please Print Le ibl - Name(Business'Orga:dcatiwllndividW): Address: /r�f0/h0{a/l /Porro/ -4 City/State/Zip: l /1r,S3o Phone#: % s?g'3/80 A.you an taperer?Chet th<approPdau boa: Type of project(required): I.O l am a employer with e"h ees(full ar:Nor part-time)! 7. ❑New construction 2.❑I mea Ne poprieroror partneMipmd have memplayees working famein 8. ffAemcdeling any ,capadtY.(Noworkers'cane.insummec rtyuird.l 3.❑I am a hommwnrsddng all wak myedf.INo warken'coop.irmumrwe regdrd.l r 9. ❑Demolition 4.12K—a hommwner and will be faring eonlractav to cadw all wak on my pmpeny. I will 100 Building addition ensure amt all hatom either have wake.'caryenmtion inm.tweasre vohe 11.Btlectrical repairs or additions pmpietas with nn employm. 12.Bhumbing repairs or additions 5.E]l am a gened ovueeta ad l have hired the vubcmuaclomhetd on the aaached a I3Roof re These,ub tmctam have mgloyeev and h .ave waker%aarry.fie.e.e Pmrs 6.❑We meuan fi.andira office.have exemmed their right d'exemption per MOL,. 14.00ther 152,§I(4),andwehavenoenV1oyevi Moeorke.'comp.insurancer Wfie .] *Any applicant the checks box Yl mum also fill out the section below showing their workers'oompematim policy idorrwion. t Homeownetv who submit this affidavit um icating they are doing di wodc ad then Nre outride wnhactort must submit a new affidavit iditedng suc,. tCmtnctas that check this box mum attachd an additional ahem showing the woe d the v.b-omha.ors and swt,xhoher-�ar three entities have employees. If Ne eubcmha:tom have entployxs,they mw provide their waders'canp.policy number. I am an employer that is providing workers'compena non inmmnce for my employees. Below is the policy andjob site Lvotmadon. 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 MOL c. 152,§25A is a criminal violation punishable by a fine up m$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 I nvesd gations of the DIA lix insurance coverage verification. I do herebyjy under the pains andpjeudder of perjury Char dte information provideddabove is true and correct. 3igma1 M D r � /YnJn kits o;O/% __. . Ph t �#, 48- /Qd Ojffeial use only. Do not write in this area,to be completed by city or fawn official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CilyTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: cq 10, 110. 1� 't �ttl, ljll 111,11 lkp ( 'Pul, nn< 7rt ' .:Ji3 -Cv. 1,11,111— 'XI 1r, 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 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 trustee of an individual,partnership,association in other legal entity,employing employees. However the owner of a dwelling house having act 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 renewed of a license or permit to operate a business or to construct buildings in the commonwealth for my applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth net 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 Plena fill out the workers'compensation affidavit completely,by checking the boxes that apply in your situation and,if nccrs%m y,supply subs tractor(s)morels),addresses)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LI.P)with no employees other than the members or partners,are not requited in 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 fm oonf'imtation of insurance covemge. Also be sureto 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 OHIcWs Pieria 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/license 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 in the applicant as proof that a valid affidavit is on file for future permits in licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit trot related many business or commercial venture (i.e.a dog license or permit to burn leaves ere)said person is NOT required w complete this affidavit. The Deparuncnis address,mlephone and tar number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-7274900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-3-15 www.nms.gov/dia -11( I�.r 5:61Up� • : ur .dy f r. .j.It'. :11"r IN' I" np i u ri , _ . . fl.r. I .�r' .• 1 .� _ I1.. 1 •If' 1. tll (r 1 1.., n��r rl( . . .: �. / It>�:- •.i LaC h..i t�.:'J•I . .• rt 'u 6•r 1, r . i •_ v61'.r Tf.� lBMr. 1, .?e. 1 r �.. .y r �;: rl. _.e a :b 1•., I . I'i 'rt ': l :. '.to . ,.'.rl.r I U _ u11 .. SI. :. I 11 1171. 415 1 It d'. th. •:/` _ ' . ..! .6. -:411 r F r 6'LJT�. 41 ♦ : : it'llu r n ' 1 k,J. I �. � : I• I. . y .. WII At .._. 3 ..r ufr 5•.' If . .{Nr.Y3r fitly :'rL .:e 111+rtf.q•:•' 'f)e: 111 )" 4O� .Ny[n I � y ." .• . ... 1.. • ! t 6'd:U3', i. Y�t3: f r I 9 i'. ..:,rU'[ L. - r 11 Lt 11-111"C" Or, 11a'} i 1� t. : .• - .. : t Description of proposed work on 115 Bridge Street, Northampton MA, for building permit. First Floor: Estimate Renovation: Construction Cost--$3000.$f436permk-Fee • Remove wall between butler's pantry and closet. • Licensed plumber to Install gas and water for slop sink, washer and dryer and move existing baseboard heating(i*p*mt*pwm#). • Licensed electrician to install electrical connections for washer and dryer, new outlets and ceiling lights • Sheet rock and linoleum floor to finish room. Second floor: --Estimated Renovation: Construction Cost--$5000. • Open frame doorway from bedroom 1 into existing bathroom and install door, 2 steps and handrail. • Close existing bathroom doorway with sheetrock. • Move doorway to bedroom N2 to Bridge Street side and close existing hall doorway to bedroom 2. • Close access to"bridge" on second floor. • Frame new bathroom (9'8" by 7'5"). • Licensed plumber to install water and waste pipe for shower/tub, sink and as indicated (separate permit). • Licensed electrician to install outlets, lights and vent fan J. • Sheetrock and finish bathroom. Roof—Estimate$20,000--$ Cz-"7 � (K ( � • Replace missing and broken slate. E•c� c_�_,vix�c} �r� • Replace flashing. • Reattach existing gutters. Decks—Replace and Repair Existing Decks: Estimate$3000-$ 1i • Steps were removed from front deck of entrance door nearest driveway by previous owner; repair deck and rebuild steps and railing. • Steps for driveway entrance impinge on driveway; change configuration of steps to clear path for driveway near bridge/barn. • Check for leaks in second floor deck and repair. Siding—Replace wood clapboard with concrete clapboarde Appliances—Estimated Total Permit Fee-41W Replace Water Heater with High Efficiency Heating Unit-3507 New Shower/Tub-459- New Bathroom Sink4W- New Toilet-$t&- .. UI SLI { .L J it aK i Vim' °;FC ,tJ4 it4rofa ?{ AP �lj e /F)[. 41. .':PUt OWiw I i r;i 'a .46 {^Xn:zA7. IJJ -... S. } E.iU{" It, ,�6nL. ;:AOI ^c in iU?f .. t'_n [roe w: s [4P 't JJPGL x0 ;1$Ti,I R92 .{.n • y U ' ,.r'(I ry, t�e. 2 h. { . ,C'i. rep �'n:.:r -sleatee New Slop Sink--SIO- Gas for Relocating Dryer--69i E — .50 j Plof I°lar�- VE)SAM I i Al - ...... i ` W � Y ra• a i D 4 • K b G E Z N L �{l:•1 I Z i 1 / .srde 5 y fi /Ap i nD r�10`,� 2rd �-loor _ _ o .�. 9-f /l♦d ) f v 9 ! YIIYM Lltp� 8 � i a amen (1 ..n rel 1 � y i i a1-d p/11-y 1 ( NW9(3) t I 1( A 1 I e �e�cr5{ r � �y�xyo +�new Dco� .to v d#a11 wa L� - - — r4 Ru y ve axil) 4AND+N�G (,uR- u1PNd' 5econJ- Floor i DO,J 1CiJ1� 13507 -naH �e ooh �+�pvT� 'I bk�,c� 4/262013 City of No ampton Mail-Renovations @ 115 Bridge St City of Partltamiallm Kevin Ross <kross@northamptonma.gov> Renovations @ 115 Bridge St 2 messages Kevin Ross <kross@northamptonma.gov> Fri, Apr 26, 2019 at 1:18 PM To: nminett@optonline.net Good afternoon Nancy, I am currently reviewing your permit application for the renovation work at 115 Bridge St. I have a few notes: 1. Since you are altering the bedrooms, you will have to do hard wire smoke/co detectors wherever possible. 2. Will have to have mechanical ventilation in the two bathrooms(exhausl fans) 3. You can not have a door swing over a set of stairs, so you will have to have the door swing into Bedroom 1 and not into the bathroom. The only way you can have the door swing into the bathroom is to have a minimum 3' landing in the bathroom and then the stairs. Any questions feel free to contact me. Thank you, Kevin Ross Local Building Inspector 212 Main Street 587-1240 Northampton,MA 01060 Fax 587-1272 kross@northamptonma.gov Nancy Minett <nminett@optonline.net> Fri, Apr 26, 2019 at 3:03 PM To: Kevin Ross <kross@northamptonma.gov> Thank you Kevin. Understood. As a note—Hackworth Systems is servicing the existing hardwired fire and cot alarms. I will make sure they are aware of item 1. Thank you for your prompt review! Sincerely, Nancy Mineft Sent from my Phone [Quoted tela hidden] https://mail.google.com/maiVu/0?ik=6c393b23db&view=pt&search=all&peonthitl4hmad-a%3A 211023236842092018&simpl=msg-a%3A,l 9373696... 1/1