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15B-044 172 CHESTERFIELD RD BP-2019-1483 GIS#: COMMONWEALTH OF MASSACHUSETTS Mau:Block: 15B-044 CITY OF NORTHAMPTON Lm-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category:Dee k BUILDING PERMIT Permit 4 BP-2019-1483 Proiect 4 JS-2019-002397 Est.Cost:$12000. Fee:$78.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MATTHEW KOZUCH 106644 Lot Size(so.fn) 135471.60 Owner: DORIT ROBERT L&GILLIAN M KENDALL Zoning:URA(100 Applicant. MATTHEW KOZUCH AT: 172 CHESTERFIELD RD ApplicantAddress: Phone: Insurance: 6 HIGH ST (413)570-3279 0 FLORENCEMA01062 ISSUED ON.6/27/2019 0:00.00 TO PERFORM THE FOLLOWING WORK:NEW DECK BOARDS AND NEW 8X16 DECK, ADD SCREEN IN PORCH ON DECK 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 It Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Demarlment 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: FeeTyoe: Date Paid: Amount: Building 6/27/2019 0:00:00 $78.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File k BP-2019-1483 / n APPLICANT/CONTACT PERSON MATTHEW KOZUCH ADDRESS/PHONE 6 HIGH ST FLORENCE (413)570-3279 O •[i PROPERTY LOCATION 172 CHESTERFIELD RD MAP I5B PARCEL 044001 ZONE URA(100 THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid /1 Building Permit Filled out I V6 Fee Paid �' Tvoeof Construction: NEW DECK BOARDS AN X16 DECK,ADD SCREEN IN PORCH ON DECK New Construction Non Structural interior renovations Addition to Existine Accessory Structure Buildine Plans Included: Owner/Statement or License 106644 3 sets of Plans/Plot Plan THE§OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF MATION 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 127- ZON Si ire 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. Y City of Northa pt ECEI V -t t�i oIP "it Department use only Building Dep me t utf vemiay Pemlit (, 212 Main S reet Be r/Se is Availability Room 1 0 1 JUN 2 5 201 at rAWe Availability Northampton, A 0 060 r Sets f Structural Plans phone 413-587-1240 ax 410,58 ,INSPe r��lpDNNaqSite laps NONTNAMPiON.MA Ot a er S fy APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 Property AA�tddmss. 1 C j Q , This ssction to be completed by office TZ ues6r UIW Map Lot 0 I 7 Unit Zone Oveday District Elm St.District Ca District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: 11 11 V Name Cunera MailingptltlJpisyrt M telephone "J{ O,CT _iLAI Signal 2.2 Authorized Anent: 1 k07i Name(Print) p Cunem Mailing Address: ►�.� A� yr z, •3-it.4 e-93 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed bv permit applicant 1. Building Z 000 (a)Building Pend Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit I" 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Num r Date Issued: Signature: L-Z-7-709 Building/Commission/erllnspeclor of Buildings Date ��1^�ZutY�i,1Kt'tOO. Ca F'( @ ei EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proopp. Required by Zoning This column to be filled in by NIA Building Depertmem Lot Size __._. ......--_ Frontage Setbacks Front Side L R:_.. L: R: _ -- Rear Building Height Bldg. Square Footage % Open Space Footage ..... % (Lot area minus bWg&paved #of Parking Spaces Fill: volume&Laratioo A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW e/ YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW (2rYES 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 0 YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained © , Date Issued: C. Do any signs exist on the property? YES 0 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 er IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,2x ,cav3U2rL 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 applicable) New House ❑ Addition ❑ Replacement Windows Altera ❑ Roofing ❑ 01 Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks II,< Siding[0] Other[M Brief Description of Proposed k 1 I / I ` r� � 1 � � 1 Work: Acw ec Iooarjs and new &' klb )rck W) SCfeety- i Pd�D� 'n Alteration of existing bedroom_Yes No Adding new bedroom Yes No i erj Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Sa.ff New house and or addition to existina 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? 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 AGENTORCONTRACTOR APPLIES FOR BUILDING PERMIT I, NotOFfC �nCf1-'- as Owner of the subject property hereby authorize 1 finr^, luk-y t1I la Z,C� to act o my behalf,i matters relative to work authorized by this building permit application. Signature fo�flr 1 ,I e 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 p}ins an penalties o�f(plerjury. Signature of Owner/Agent f �� Date , SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Sunevlsor: Not Applicable 13 Name Name of License Holder' hkw k IkeLyc. [ . - 10(w, - T Umnse Number Cp 1�te�. Sk k/ZS 2-V Morass pp Expiration Date Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ I3-q W-+ Company Name Registration Number Address Eviration Date Telephone SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(Ill c-152,%2SC(G)) 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....._ O No...... ❑ City of Northampton Massachusetts .c DEPARTNCNS OF BBILIIZNG ZNBFSCTZONS � 212 rain Btraat • Municipal Building F. + f Northampton, Mx 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"rectmstruction, alteration, renovation,repair, modernization, conversion, improvement,removal, demolition, or construction of an addition to any pre-existing owneroccupied 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 re0stered contractors. Note:If the homeowner has contracted with o corporation or LLC,that entity must be registered. Type of Work @...J Est.Cost: ' 2� 000 Address of Work: 1 -1-L Ctieq�ed Date of Permit Application: 1012/�Q 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 RESPONSIBH,ITES 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: ro/Zy /I I K-A-� koZ , 17 ( ZO - 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 4' IQ Massachusetts of s DEPARTdffiiT OF aurMu G INSPECTIONS ElY lLin rtha • apm 01l Building xosthampion, 1q1 01060 1 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 110.85.1.3.1 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. City of Northampton Massachusetts „� k t DSPABT!ffiiT or BMWINS ZNSPBCTZONS l 212 wan $haat :Mnicipal Building + aortl,ampcn, [ 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 constructionworkbeing performed at: I�Z ��'er! 1 'U Itor (Please print house number and street name) Is to be disposed of at: (Please print name and Ibcation of cility) Or will be disposed of in a dumpster onsite rented or leased from: 1 F�t`N� tJe 4C ac_.k" (Company Name and Address) M� �4 �- �-- /i-( A 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 Department of IndushialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-10177 www.mass gov/dia VNI others'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lozibly Name(Business/OrgmizatioNlndividua0: Ak0. o-t—c- Address: (p t 5� 5 k City/State/Zip: Florence f oa*ZPhone#: `113 341 -eFg3 Are you an employer?Check the appropriate hut: Type of project(required): I.❑1w a employer with conloyas(full andtor pan-dma.e 7. C)New construction 2.LET--/soleMMemrorparmenhipmtdhav m=ploymswotkiW formem S. C]Remodeling any capacity.[No workers'rump.insurance mr,wro l.] 3❑1 am a homrowner don all work myself[No workers'comp.ursmance mgdmd.]' 9. ❑Demolition 4.❑I am a hommwn aM will be tirag comractms to condmtall wwkon my pr . I sort 10❑Building addition creature out all aoatmctors atha nave woikerscoenlmam mpsation cc or are soll.❑Electrical repairs or additions proprietress with no employee'. 12.❑Plumbing repairs or additions 5.[]l am agroad contractor and l have hired the sub-ccntmcton listed on the amched area. 'Flex tors su -eontrnahave emes Mas' smml3.❑RoofrePairsployeand have wocomp.io cet h.❑Wemra coryomdonand..Mr.havicexrmiwddeurightofexempeonper MGLc 14. [her t. LCk 152,d 1(4),and we have no esplayees.[No workers'comp.assurance requuM.] 'Any applicant arm amass box N must also fill out the smarm below showing Meir workers'compensation policy mfvoration. t Homroworrs who submit die affidavit rukeseng thry are doing all work and then hire outside contractors must submit a new affidavit wdirating such. :Contractors that check dis box must award an adMtional storm showing are name of are subconoaatan and state wheder or not those entities have employees. Ifthe sub-contractors have employees,they most provide area workm comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M 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. Ido hereby certify under thepains andpenaldes ofperjury thm the information provided above is true and correct Sienalure: �l � Date: CP /Z—`{/1 R Phone#:t{�J 3N� OffQ� 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 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 tmstee 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 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)camels),address(es)and phone number(s)along with their certificate(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 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 perniNicease 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 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. #617-7274900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia 612612019 City of Northampton Mail-172 Chasterfeld Rd Permit zoning drawing 1 P (11Kim Carson <kcarson@northamptonma.gov> 172 Chesterfield Rd Permit zoning drawing 1 message Matt Kozuch <mjkozuch@yahoo.com> Tue, Jun 25, 2019 at 5:40 PM To: "kcarson@northamptonma.gov" <kcarson@northamptonma.gov> Hi Kim, Hope this gets to you in time. Matt Kozuch i https:flmall.google,com/maiVu/04ik=28605a627&view=pt&search=all&permthid=thread.f%3Al637350206954191%3&simpl=msg-f%3A1637350206954191963 113 612 612 0 1 9 City of Northampton Mail-172 Chesterfield Rd Permit zoning drawing �Y amu . I https'.//mail.google.wrWmaiUWU4ik=28605c862]&view=pt&search=all&permthld=thread-W/.3A163]350206954191963&slmpl=msg-f%3A163]350206956191963 213 612612019 City of Northampton Mail- 172 Chesterfield Rd Permd zoning drawing Sent from Yahoo Mail on Android hffps:llmail.gc le.mo maigu107Ik=28605c8627&vie —pt&search=all&permthitl=thread-f%3A1637350206954191963&simpl=msg4 3Al637350206954191963 3l3 L � s ��� I I o e I8 ISr �('a Pose go C-Ux 1 0.4 ?c n �a art a4 �NAr,:&S 36 h 51 —faxG I�` �z)zxlo — P� Z.XIOCL� �lAY� 3 0.M0� oisEs vse PT 101, 0( Jl laf's "orj �o house, DTTIZ. -6 Ied5e.r6k P 6x6 r os4- ` i (3) j,fxojj fief S61ro �S r 21 h i i r h