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36-035 (2) 4 WINCHESTER TER BP-2019-1387 GIs s: COMMONWEALTH OF MASSACHUSETTS Map:Block:36-035 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category chimney rebuild BUILDING PERMIT Permits BP-2019-1387 Project s JS-2019-002229 Est.Cost $1120.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor: License: Use Group: BRYAN ALOISI 073513 Lot size(so.R): 11020.68 Owner: CRAFTS ROBERT T.@ RUTH A Zoning, Applicant. BRYAN ALOISI AT. 4 WINCHESTER TER Applicant Address: Phone. Insurance: 107 ROCKY HILL RD (413)427-2457 O WC HADLEYMA01035 ISSUED ON.61412019 0.00:00 TO PERFORM THE FOLLOWING WORK.REMOVE CHIMNEY TO ROOF LEVEL THEN RECONSTRUCTION TO ORIGINAL CONDITION 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: Houses 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 Occugancv signature: FeeTyoe: Date Paid: Amount: Building 6/420190:00:00 565.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File k BP-2019-1387 APPLICANT/CONTACT PERSON BRYAN ALOISI ADDRESS/PHONE 107 ROCKY HILL RD HADLEY (413)427-2457 O PROPERTY LOCATION 4 WINCHESTER TER MAP 36 PARCEL 035 001 ZONE THIS SECTION FO ICTAL USE ONLY: PERMIT A ATIO CHECKLIST E LOSED REQUIRED DATE ZONING FORM FILLED OUT J. Fee Paid Building Permit Filled out F Paid Of TvoeofConstru 'ore REMOVE CHIMNEX TO R09E LEVEL THEN RECONSTRUCTION TOORIGINAL CONDITION New Construction Non Structural interior renovations _Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 073513 3 sets of Plans/Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION 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 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 ,T 6-N - zolq 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. Department use only City of Northampton Status of Permit -> - Building Department Curb Cut'Driwway Permit 212 Main Street Sawer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01080 Two Sets of Structural Plans phone 413-587-1240 Fax 413587-1272 Plot/Site Plans Other Spedry APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION ✓ l� 7 1.1 Procell Address This eeetion to be completed by office Y c�rAm�s&• rr E C p M EM 3 Let n 3 Unit Nwe� NA 01on- R 2 P Owrlay District latrict CB District SECTION 2-PROPERTY OWNER! ) RRED AGENT 2.1 Owner of Record: Meradc•vlumuing ne na Nodham bn,MA 01060 �l WtNc9ESTER � tiR• Name(Pool) Lurrent Mailing Address' �� 6 NCE t m q1: OIO Signature R Telephone ) _ O -7,s— 2.2 Authorial Aeant: O e)?''1 R�� A�01S1 hla&p; 67 Roel Fli�� Rp Nam (Pdnl) Current Mailing Address: tinIDI,G r"ftbN 010 a J 41-7.' — 6 na Tekphona SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cast(Dollars)to be Official Use Only completed ermit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from e 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 1!F ire Protection 6Total=(1 +2+3+4+5) Check Number This Section For Official Use Onl Building Permit Numbs . Date Issued: / Signature: y- 4-z5q Building Commissionerdnspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. PermDe it Can Be nied Due To Incomplete Inrmananfoall Existing Proposed Required by Zoning This eolumn tu be fllm in by Buddin6 De ent Lot Size Frontage Setbacks Front - ---- Side U R: L: . . R:. Rear Building Height _ 77 Bldg.Square Footage % Open Space Footage ✓ , .,y f; ILm.minus bei a pad ji 1 #ofParking Spaces - Fill: volume a Louis..) 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 © 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,excavation,or filling)over 1 acre or is 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 Icheck all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(a) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs 101 Decks jp Siding[M] OMeer/rj//EQ Brief De wgrir: nption of P/,'fir poaiid / O rY )x7iA w.Mlwe ��•4+F� /�jK /.ple�8 .n /`9i n � Alteration of existing bedroom_Yes_No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement _Yes No Plans Attached Roll -Sheet ea M Now house and or addition to exlatina housina.complete the following: a. Use of building One FamilyTwo 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? 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_ City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I )k CRIT 1 S as Owner of the subject property ., I herebya nze �Ru Ft R IO L+J\ to act n my half,in all matter lative to work authorized by this building permit application. Signature of Om. Date I, L-V\N CA1��S S 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. . CR S pr` Name ,' , Signature o OwnedAgent V Data SECTION 8•CONSTRUCTION SERVICES 8.1 Licensed Constructbn SupaMsor: Not Applicable 13Name of License Holder R�'t/A. 0. 1d�5� eS- V79rs13 License N mbar iso AW11 All ,fid 111A . �� o�>3S AMdres� I Expiration D to h , V. �y/3)V27- 2ii ure Telephone 9.Registered Home improvement Contractor. Not Applicable ❑ 1IM2 IComRany NUN I /I // Registr'attiion Numbs FIN Address / 22 Expiration Date Q Q Telephcn 'J 2 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. Failureto provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... ❑ No...... ❑ I City of Northampton Massachusetts 1 DEPARTMENT OF BUILDING INSPECTIONS ,g 212 Win St[ tNuoicipal Builtling a T� Nonthampten, M 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- upied 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. Nate:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: (.�hjC///hl''�ICCf//-- //LP 11- Est. CosC Address of Work: .q W14"" 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 Aivari-RATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBIdTES 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: 5'1-g-I901' U91 Ces�»a.Ftro 4 IiCC• //977Z Date Contmc[or NameI 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 ✓f Massachusetts A 2 � PE'PM2fffiST OF BOILDINO IBSPSCTIONB 212 1 in $trout u l ieipal Builtl n9 �al �._ NarNa ton, NA 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.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 110.85, 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 t t DSPANTNNNT OF BUILDING INSPECTIONS 212 Min ii cwt ..ieiP i NurNamPton, . 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: tat .d �1 ,A� 1#4 Dr4,04- (Please print name and locaticiript facility) Or will be disposed of in a dumpster onsiteAnted or leased from: 1 !G� /r�/5! L�. fr✓a11%e'3� ( ompanyy Name and AdDdresls) g r of Pel App icant or Owher 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 ofMassaehusens Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 01114-2017 www.mass.gov/dia Wil.rken'Compensation Insurance Affidavit:Builders/Cootractors/Eledt iciaos/Plumbers. TO BE PILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibl Name(Business/Oeganixation/Inddibividual):: -///Jr Address: 4617 cAl A;; City/State/Zip: Phone#: 4127 W-E7 Areyonanevployer Cheak the pdatebsc Type of project(required): 1.13 I am a employer with emplorea(full mo/or parvtina)• 7. ❑New construction 2.❑I am a sole pmprierororpavoership mdhave no employees working barriers 8. ❑Remodeling any cnpucity.IN.workers'comp.matmnce rrywimil] 3E I..homeowner duan At work myself IN.workeri camp.wsmaoce regw • 9. Demolition 4.❑I m a homeow= will k hog mm w cmdmtea woroo mr propmY. ]will 10 Building addition rnvne mat ollcontractors either have warkm'compematiun imumtmemare sok 11.❑Electrical repairs or additions proprietors an no employees. 12.[]Plumbing repairs or additions 50 lama geamalconRMtorami Ihave hanto amad esub-cokers 1n theatmched sheet. obese euh-caauactors mve employem mad h..e workers Co.,cop.imumoce: 13.[]Roof repairs h.❑We are a coryomtion mtl iu oR ers have exemisdmMeir right ofexemptioa pert MGL c. 14.❑OtherdhowL 152.31141.and we have no employees.[No wotk 'comp.announce retained] 'Aay applicant that checks ber al must also fill out the union below showing them workers'compensarion policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new at idavit indicating such. :Cennamurs that check this has must amched an additional sheet showing the time ofthe sub-conhacmn and store whether or not those entities have employees. If th<•sub-ttmtmcmra have employees,mq must provide meh workers'come_pnkey number. I am an employer that is providing workers'compensation insurance for my employees. Below&the policy andjob site informanOM1 Insurance Company Name: Policy It or Self-ins.Lic.#:�AjK//(A,�,S'��3 T Expiration Dater / Job Site Address: / 4,we City/State/2ip:� ////////////,,/// ; Attach a copy of the workers'compensation policy declaration page(showing the policy number aad xpintion date). Failure to secure coverage as required under MGL c. 152,425A 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 ce fy under rhe pains andpemdi ies pfperjury that the informadou provided above is true and correct. Si nature: Y47- 29f7 /�� u Date 1f11,t P1j Phone#: X[747 ^ Z /S7 OJrcial use only. Do not write in[his area,to be completed by city or town official. City or Town: Petmit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department J.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 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 ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or tmsiee 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 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 man=" 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(sk address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(ITP)with no employees other than the members or partners,arc 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 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 permitAicense number which will be used as a reference number. In addition,an applicant that must submit multiple pernmOicense 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 I 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.tnass.gov/dia