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22D-031 (8) 129 RYAN RD BP-2019-1223 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:22D-031 CYfY OF NORTHAMPTON Lot, -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category:BARN BUILDING PERMIT rtnh# BP-2019-1223 proim# JS-2019-001978 Est.Cost:$5000.00 Fcc $77.0 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor: License: Use Grow THOMAS MALONE 055236 Lot Size(sq ft.): 54450.00 j7hner; MALONE THOMAS P&PETER A CABANIOL Zoning: UPA(100)/WSP(100y Applicant: THOMAS MALONE AT, 128 RYAN RD ApplicantAddress: Phone., Insurance: 128 RYAN RD (413) 885-9038 WC FLORENCEMA01062 ISSUED ON."9019 0:00:00 TO PERFORM THE FOLLOWING WORK:NEW BARN 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 Frome: Gu: Fie Deoartmenr Fireplace/cYimasy: Rough: 0111. Insulation: Flaah Smoke: Flow: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occuoancv Siaosture: FeeType: Date Paid: Amount: Building 5/3/20190:00:00 $77.00 212 Main Struck Phone(413)587.1240,Fax:(413)387-1272 Louis Hasbrouck—Building Commissioner File N BP-2019.1223 APPLICANT/CONTACT PERSON THOMAS MALONE IL— L�{FRU I ' ADDRESS/PHONE 128 RYAN RD FLORENCE (413)885-9038 PROPERTY LOCATION 128 RYAN RD �EUT 51. MAP22DPARCEL031 001 ZONE URA000)fWSP(]0O)/ C� THIS SECTION FOR OFFICIAL USE ONLY: PERMIT I A KLI ENCLOSE REQUIRED DATE ZONING F Fee Paid r Ij Buildin2 Permit Filled out Fee Paid TvneofConstruction• NEW BARN New Construction Non Sttucdual interim renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 055236 3 sets of Plans/Plot Plan THE/FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN RMATION 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 Pennit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: §_ Finding Special Permit Variance* Received R Recorded at Registry of Deeds Proof Enclosed _Other Permits Required: _Curb Cut from DPW Water Availability Sewer Availability _Septic Approval Board of Health Well Warr Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee _Permit from EM Street Commission Pemit DPW Storm Water Management Demob on Delay Z�z 5-3-Z0Ig Si of Building Official Dam Now: 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. PIAN g /e ctrOnicar& Yw ludoN Department use only 6NOLL03tlBNl ON101 NIOI rth mpton Status or Permit .> Building Dep rtment Cum CuVDmeway Permit �- .A &01 pE UW2 ain treat Sewer/Septic Availability t Ro ml 0 WaterMell Availability x Northam on, A01060 Taw Sets of Structural Plans r Uf40 ax 413-587-1272 Plot(Site Plans v Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 Property Address: ` This section to be completed by office Map �a.D Lot 031 Unit Zone Onrlay District Elm St.District CS District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: 1 " Uaj "/��1 CLy\. Conan\ 5n9 �A) Telephone Signature 2.2 Authorized Apent: �Ci/d fw \ ml,�(X p- Na�r(�P.�..,, current Mailing Address: Signatu� Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Oficial Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from B 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) q 5.Fire Protection 6. Total=(1 +2+3+4*5) C) Check Number el -7 This Section For Official Use Only Date Building Penni[Number. Issued: p Signature: Building Commissioner/Inspector of Buildings Date �-U 'T,@ CA\rvay\L .nL� EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) A Section 4. ZONING Nl Information Most Be Complete . Permit Can be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column m be filled m by Building Department Lot Size Frontage Setbacks Front Side L:--- R:,.—._ L:,—., R:,._.._.._ Rear Building Height ------"-' Bldg.Square Footage -'_-- --- % Open Space Footage _.. Irn.minus bldg a P. _ ,.. ennn -- #of'Parking Spaces Fill: volumea Wutim A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q 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 0 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 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(clearing,gradin a cavallon,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,men a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors 13 Accessory Bldg. ❑ Demolition ❑ New Signs [Ell Decks [O Siding[o] Other[ Brief Description of Proposed L ` `� Q �(-N Work: �7�` V Alteration of existing bedroom_Yes_No Adding new bedroom Yes No Attached Namatvo Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea.N Now house and or addition to existing housina. 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 consWction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance, Masscheck Energy Compliance forth attached? K 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 confoml to the Building and Zoning regulations? Yes No. I. Septic Tank_ CitySewer_ Private well City water Supply_ SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS t_AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Xyl m� as Owner of the subject proPem hereby authorize Lee_ to act on my behalf, in all matters relative b rk authorized by this building permit application. -- LA- lin - 19 Sign4neofoki Date I, 1 m g as Owner/Authorized Agent reby 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 Nany-� p/ signatu of Owner/Agem Dare a SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Nooty t'AppliiccaO able Nam.of License Noldx: L iS �( 3 b License Number Address Expiration Dale \A , k)..l-- i tltw f' U (Ob Z Signature Telephone U 9.Registarad Nome Improvement Contractor. Not Applicable ❑ 16'1 S-riS Company Name Registration Number \ u-O6 a0 Addre\ss /� 1�. Expiration iration Dat 1 A 4^ (Q e r 1.1,11 At Telephone SECTION 10-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 pent. Signed Affidavit Attached Yes....... ❑ No...... ❑ City of Northampton Massachusetts c DKAAR ffiiT Or BUILDING INSPBCTIONS 212 Nain StrBBt • Municipal Building C� NorNa ten, M1 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. Prim to perforating work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.C.L.Chapter 142A requires that the"reconstruction, alteration, renovation,repair, modernization,conversion, improvement,removal, demolition, or construction of an addition to any pre-exisfing 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: ntA\Z 4"r\ � ,E,st..Cost: ,.t,� Address of Work (L Z.. zlif ulA 11 W`I— 610 Z 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): _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 I42A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER TRE 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: Lk-L) -t CA 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: -2G �I k �j,Ylt.nnrts 'fir.�cyL Date Owner Name and Signature City of Northampton Massachusetts DEPARTMENT OF BBIDDING IBEb il,U 8E 2t2 M— Ihz • Idn 010 Builtli,y `d a�Nornnampton, !Oi 01060yp- Massachusetts Residential Building Code Section 110.115.1.2 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 110.115.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.115, provided that if a homeowner engages a person(s) for hire to do such work,then such homeowner shall as 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 r a Massachusetts '` DBPAR90HGT or BVZLVING ZNSFE=ONs tr 212 win St •Municipal auildin, North v tcn, I 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: (Plea a print nam�td locati of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Sigiature 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 Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass-gow'dia Wworkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Bminms OrgmizatioNlndividua): Address: "A City/State/Zip: ��(�f(/t-C. (' Vk(*'L Phone#: Ak�—T1 -qCW'( Are you ea employer'Cheri the appropriate hoe: Typey-Jof project(required): � m I. laaemployerwiot employees fall and/or Part-time).' 7, New construction 2 lamenle pnpdmm orpmmership and have oo nmpbyees working foreseen y clmniry. [No woers'comp.mo mace motional1 8. Remodeling rk 3 LeI am s 1V wording all work myulf[No workers'comp,immune,requved.l1 9. ❑Demolition 4.❑l am a homeowner and will be hiringtractors to conduct all work nm 10❑Building addition caswo my sale IwJl we thatmlconmcmrs either have womkm'compensatinn wuncearam sok 11.[]Electrical repairs or additions Mon.with res tarsal. 12.❑Plumbing repairs or additions 50 1 e general wnpactar end I hese loved the sub-canmzcurs fisted an tee.toaned sheet. Theseae sub-cnmmcmrs have employces and nave workers'wrap.inamncc. 13.[]Roof repairs 6❑Ws are a caryorauon aM its oR en have exerciud they fight of exemption per MGL c. 14.❑Other 152,;1141,and we nave m rn,pbyees.[No wmkeri comp.thsunurce required.) (\ 'Amy applicant N.t chwks bo.#I must also fin ou the section below showing 0cerwarkerscompensation policy infarmuion. t Mamww.in who submit this affidavit indicmmg they ore doing all work and Wen hire onside ommuctars must submit a new affidavit indicating such, lCentrauurs that check this box must attached an additional sheet showing•the name of the sab-wntentars and state whether ar mwt those entities have employec� If the sub eonuacmrs have employees,they must pmvlde their workers comt.pohev number. I am an employer that is providing workers'compenou don insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins.Lia#: 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,p25A 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 thepains aanddppenalldes ofper�jury that the information provided above is ourrr and correct Siana[ure' �/ �c — D t A JL —Ae Phoned: �- 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#: 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 represematives 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 152,025C(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 your situation and,if necessary,supply sub-contractor(s)name(s),addresses)and phone numbers)along with their cenificate(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 sure to sign and date the affidavit. The affidavit should be rearmed 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/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/liceme 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 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 I-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia MR. I IIIIIIIIIIIIIIIIIIII I � IIIIIIIilllllll„ _ _� _ - :................... .1 101 __ : ° �+�� /���'�. � � . . . y%\�\ . y . . � � . . , /yam$�, �/ � \ � , y © � � . �\���� � \ . � . . . . . %\\ �� � . . ., : -- _ �; �, _ ,,� == �. , i ioi i n n�����i�������������� - -,. .,_ �1��'IIIIIIIIIIIIIIII�� _ _ --- – �'��IIIIIII�I��III��� �.– — �- -- i�uo�ioi�iii�iui IA =I � �_ �_ � � _� � SII �• ��, � � � :; �1 -I - 513/2019 City of NoMampton Mail-128 Ryan Rd City Of �NorUeampton Kevin Ross <kross@northamptonma.gov> 128 Ryan Rd 1 message Kevin Ross <kross@northamptonma.gov> Fri, May 3, 2019 at 9:22 AM To: Tom Malone <tom@rainhome.net> Good morning Tom, Your plan for the new barn has been approved by zoning. The estimated cost seems low. Could you please give me a new number and then there will be an additional fee for the permit once you give me that number. Any questions let me know. Thank you, Kevin Ross Local Building Inspector 212 Main Street 587-1240 Northampton,MA 01060 Fax 587-1272 kross@northamptonma.gov https://ma4.goggle.wrrdm!VuWikXc393b23db&vsev---pt&search=all&permthid-thmada%3Ar9315112901983735525dsimpl=msga%3Ar921455219... 1/1