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30B-064 288 RIVERSIDE DR BP-2019-1382 GIS 9: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30B-064 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category: Porch Repair BUILDING PERMIT Permit# BP-2019-1382 Project# JS-2019-002222 Est.Cost:$1500.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JOSEPH SMITH 106326 Lot Size(w. ft.): 6316.20 Owner: GOBILLOT CHRISTOPHER&CINDY L C/O SPARE PARTS PROPERTY LLC Zoning: URB(I00U Applicant: JOSEPH SMITH AT. 288 RIVERSIDE DR Applicant Address: Phone: Insurance. 100 BROOKWOOD DR (413)530-0399 SOLE PROPRIETOR LONGMEADOWMA01106 ISSUED ON:6/3/2019 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE PORCH POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspectorof 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 Occuoancv Signature: FeeTvpe: Date Paid: Amount: Building 6/3/20190:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner File M BP-2019-1382 APPLICANT/CONTACT PERSON JOSEPH SMITH ADDRESS/PHONE 100 BROOKWOOD DR LONGMEADOW (413)530-0399 PROPERTY LOCATION 288 RIVERSIDE DR MAP 30B PARCEL 064 001 ZONE URB(100 THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid TypeofConstruction, REPLACE POAQH New Construction Non Structural interior renovations Addition to Existing: Accessory Structure Building Plans Included: Owner/Statement or License 106326 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: _Approved_Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Projece 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 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 Storm Water Management Demolition Delay -3- 2019 Signature of Building Oficial 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. r Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Once of Planning&Development for more information. L ECEIVED_ C a// U) /'L- Department use on City of Northam on Perm Building Depart nt YAY 3 C rive y Pe ms 212 Main Str BewerlS tic ailabiliry \ Room 100 ePT OF aUapINf.I _ . A Iabiliry Northampton, MA 1086 NbnrBnMP�oN. corral Plana phone 413-587-1240 Fax 413587-1272 PlovSite Plans Other Speciry APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION t-SITE INFORMATIOON 1.1 ProoerinvAddress 1jfs Rf✓e(Stdo or, Thi�s section to be//co�m1pl�plle�etee��d by office r-� ^4 oyeba Map Lot Unit TlOrP.nc Zone Overlay District Elm St District Ca District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: SO LhMi6ng4" Name(Print) Current Malllf.Y�/igq V-3:4} Telephone Signature 2.2 A h rized nt- r ,— DSWVN cSM�tk4'\ loo b`(D()tWbcAn NNAma rPn Current Mailing Address"is : - r53n-0�9`i ighatum Telephone SECTION 3-ESTIMATED CONSTRUCTION CO3T3 Item Estimated Cost(Dollars)to be Official Use Only completed by pennit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 8 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) ! /'Sao Check Number This Section For Offlcial Use Only Building PamNumber. Date Issued' p Signature: Building Commissionerflnspeclor of Buildings f l 1 Date ci,144 @ Wos-f'rl.ii EMAIL ADDRESS (REOUIREDJEITHER HOMEOWR OR C RA T R) :5a�on-Tn�ell t�nar'{- •saso�"7;del�a`�_ y •� Phone* V/-? S07' 6 Section 4. ZONING All Information Must Be Completed. Perms Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning Thio wlumn lobe filled iu by Building Deparonmr W Sin Frontage Setbacks Front Side G R:_ L: R:= Rear _- — -- Building Height -- —" Bldg.Square Footage °G -- Open Space Footage -. (Lot.minus bWg&paved pwim,e) N ofParking Spaces Fill: (wlume&L—b.) 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 disture(clearing,grading,excavation,or filling)aver 1 acre or is it pan of a common plan that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Ston Water Management Permit from the DPW is required. yellow ro.ne uonef z2iJt+ � r TI N DE IPTI F P OSED WORK check all a Iicable) New House ❑ Addition ❑ FRepl.acement Windows Alterations) ❑ Roofing ❑ s0Accessory Bldg. ❑ Demolition ❑ Signs [0] Decks [O Siding (0] OtherlOj Brief Description of Proposed Re�14CG �DIY� Work: Alteration of existing bedroom—Yes_No Adding new bedroom_Yea No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Ba. ff 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? d. Proposed Square footage of new construction. Dimensions e. Number of stories? I. 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. L 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, C- /9 b, /lPl / as Owner of the subject property L hereby authorizer` tiJ I/1 �� \ / to act on my behalf, in all ma rs alive to work authorized b building permit application. SIR. CdYs 1~('R L7` Signature of Oumer C L Date L `L� iQ� L .JI'✓L 1 l . as Owner/Authorized Agen retry d Clare that the statements a information on the foregoing application are true and accurate,to the best of my knowledge and belief. Si ned n the pains and pen of 'ury. Print me s'a 3 Si Owns of Own Agent Date SECTION e-CONSTRUCTION SERWCES 8A Licensed Construction Suoarvisor. / Not(App[licable 13 Name of Licenm Holdx-. License umber aa Se e{ n 9 /aozo Ad e - /xI�3-J:W-V3 r-r Eviration Date ature Te one Home Imorcarament Contractor: f Not Applicable O it /53`i 3 I Cowni Na Ge rJ19! 1 ' 1 Registration N bar Addreas - r, 441 r��111 Expiration Date d Telephon /* 3v �V SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152,$25C(8)) Workers Compensation Insurance affidavit must be completetl 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...... 16/ 11ave AJo �r-�1� acs 0C k\-"V,q c) c m� Dr r'L bus/ 76SS . V y - Address : ia© brdokLjocia or. 1,0n3naeakQ1 MA 01)Ob City of Northampton ✓� Massachusetts yJ,Po:F rl6PAR'1'MENT or Mo7LDZnG INseEC1'I0n5 zlz win curt a lLn 010 Building �. .. mpIA 010 heeon, 60 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 142A requires that the"reconstruction,alteration, renovation,repair, modernization, conversion, improvement,removal, demolition, or construction of an addition to any preexisting owner-occupied building containing at least one but not mare than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:ff the hom(etoo�wne`r has contracted with a corporation or LLC,that entity must registered Typeofwork: Re OJ�(n1��t_v, OT rr&\k- I'OVC" Est.Cost-.-/VL D(t) Address of Wmk: a�O Q jes-st r*. f0C. Date of Permit Application: ':501R�(� ll I hereby certify that: Registration is not required for the following resson(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 DITO 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 I hereby apply for a building permit as the agent of the owner: S a ao�9 sem ed, 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 Massachusetts `? ' 4d DSP.ViTlMEBT OF BDZLDZM ZNS =ZOBS MaStreet * ` f 212 in Street a M icipal Building • T� Bortha ton, 191 01060 i 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 I10.R5.13.1 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 Q Massachusetts neeaaafasz or =WxNc zxseacsroxs 1\\� 212 wan S[r t .Huniaip.l eviaainq aercnaspeen, a 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 �� R,-Vef,jtJe Or (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: t� . h Uc,,s-f e— (Company Name and Address) "L 14 � SI ature of Pe In it 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. �A c �\ The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 01114-1017 wwwalass.gov/dia WWorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Informationle-ase Print Legibly Name(Business/OrgmizatioNltdividuai: /'�//Ar V (•J'.(:��� Addfess: /M rte t jtr:l&4 Dr, CityistBtezip: L Phone#: H o- 99 Are dew k it?Chetlsme propriate boz: Type of project(required): 1. I em a empmycr with employees(Poll mNor port-time).' 7. New construction 2.Fj I arae sok gopietor or moment,and have no employees wor,mg fm mem 8. Remodeling any capacity.[No workm'com,imumce mituired.l J❑I am a l ommwner Ming all work myself.[No workers'camp.imutmne.,.d.]' 9. ❑Demolition af-]1 am a homeowner and will he hiringtractors to conduct an work on m 10 Building addition ran yproprrry. twill roo me our an rontmctm eiNm have workers'compensmimv Nsmmaemone sok 11.0 Electrical repairs or additions 'romemr with,w employes. 12.❑Plumbing repairs or additions 5[3 1 um ugerwnl conancmr and 1 have himl as aub-covtr cors lisnd on We mrowhM shcc new sub-omnumm have employees and have workers comp.insumnee.t 13.E]ROof repairs b.[-]WexacoryomuonmdiuoRmhaveexmuedWwnghtofexemptin MGL,,. 14.❑Other rWc7�anl 'e'�G 152,§l(4).mill we have oo employers.Mo worker'comp.imurame reyubed.l `Any applicant that ohecka box#1 must elan,fill out the vection below showing dieb worlmn'compensation it,infishal on. t Hommwner who submit this aff tavit indicating Nry are rotation work and then hire outside,mmueuaa must submit a new affrlm,a iMicatmg such. :Convectors that check Nis Ina must mmched an addiuooal sheet showing the name or the subrrnanemrs and state whether or not thow entities have employs . Ifthe sub-conracmrs have employer.they must provide Mev workers comp.Nlie,number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insumncc Company Name: � `G ry{/ (JI-�s/�)Gr/75 (-s•M`" /F1� JL4✓C, Q I ���CS s Policy#or Self-ins.Lic.#: n \ Expiration Date: �.g Job Site Address: ;tg,-T Mile ruAr Dr City/Slate/Zip: / /,/ Attach a copy of the workers'compensation policy declaration page(showing the polity number and espiradon 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 veriion. 7 do hereby r fy under the pains dpen fies f erjury tbot t i arm on provided ab ve R noun correct Si nature: u are. /9' Phone#: - Offic al use only. Do not write in this area,to he completed by ility or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityrrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: •' Contractors Invoice Jai / i OESGRIPTION OF WORN PERFORMED Y � a s � WE r Mm"S - I Y ' m. two a�I tP�M � !� _ ►_ _ 55 rip r i,.r1 t Li r A VT!', C-J -i 14 OP IA W r YIc IA } W �(J a - z i W aP/ s a u Swna�v fl�ddnS1 1f,,6,EXAJI X 711,h, i� H xr�,l, x� tire - a 2 ,13 9 ')-1od u 4,"; p rl'ytjlln.1 a7u7Jo1 j V ttK -O- ,b -0 Vs AJ �J kcJ ale, U o An 5 � 20 '9" s� S ZI ' 0 5/31/2019 Clty of Northampton Mail-Fw:Fwd:Receipt from nCourt C111118J�rBtm P srs Kim Carson<kcsrson@north mnptonma.gov> Fw: Fwd: Receipt from nCourt 1 message Jason Tindall<jasontinde1120@yahoo.com> Fn, Ma Reply-To:"jssontindell20@yahoo.com"<jasontindell20@yahoo.com> To:"kcerson@norlhamptonma.gov"<kmmn@northamptonma.gov> Sent from Yahoo Mail on Android ----Forwarded Message— From:'Jason Tindall'<jasonlindell20@yahoo.com> To:"jshmp22@gmail.com"<jshmp22@gmail.com> Sent:Fn, May 31,2019 at 12:58 PM Subject:Re: Fwd:Receipt from nCourt Kcarson@northamptonma.gov Sent from Yahoo Mail on Android On Fn,May 31,2019 at 9:45 AM,Joe Smith <jshmp22@gmail.com>wrote: This should be it —Forwarded message From:<cuslomeiservice@ncourt.wm> Date:Fri,May 31,2019,9:43 AM Subject:Receipt from nCourt To: <Jshmp22@gmail.com> Your Receipt» Paid To Name: Office of Consumer Affairs and Business Regulation-HIC Registration Program Address is 501 Boylston Street.Suite 5100 Address 2: City: Boston State: Massachusetts Zip: 02116 Payment On Behalf Of Applicant Name: Joseph E.Smith,Jr. Description Convenience Fee A Registration Fee-Reapplication $3.53 Guaranty Fund Fee-0 to 3 Employees $2.35 Receipt Date: Invoice Number: Total Amount Paid: 5/31120199:43:16 AM EST 588da53c-4382-4a42A1dcl-15e38eeffeb89 6 X56, BY ht4)sl/mail.google.mo maiVu/O1ik=28605c862]&view=pMseamh=all&permMid=thread-f%3A1635u681382]8265111&simpl=msg-P/e3A16350681382... 112 5131/2019 Cly of Northampton Mail-Fw:Fwd:Receipt from nCourt (Billing Informationai nt Information First Name Joseph e Last Name Smip Account Number ****'****-6483 Email Jshmp22@gmail.com Street 100 brookwood or City Longmeadow Slate/Terntory MA Zip 01106 Important Information>> Please vent'the information shown above.Your payment has been submitted to the location listed above. Powered by nCourt. Please call 888-283-37571f you have any questions regarding this information. htpisa/mall.google.wm/maiVul07ik=28605c86278view=pt8eeamh=all6permthid=thread-f%3A16350681382782651118simpl=msg-f%3A16350681382... 2/2