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17A-129 (4) 8 FOX FARMS RD BP-2020-1147 GIS#: COMMONWEALTH OF MASSACHUSETTS MW:Block: 17A- 129 CITY OF NORTHAMPTON i Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: KITCHEN RENO BUILDING PERMIT. Permit# BP-2020-1147 Project# JS-2020-001929 Est.Cost: $33500.00 Fee: $335.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MARK BONDE 67758 Lot Size(sq.ft.): 25264.80 Owner: LIPKIN-MOORE ZACH Zoning URA(160)/ Applicant MARK BONDE AT. 8 FOX FARMS RD Applicant Address: Phone: Insurance: 205 PARK ST (413) 535-9529 O WC EASTHAMPTONMA01027 ISSUED ON:5/21/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-KITCHEN RENO 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 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 Occupancy sit ns,ture: FeeType: Date Paid: Amount: Building 5/21/2020 0:00:00 $335.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner y\ Department use only City of Northampton Status of Permit: Building Department *4y Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability t Room 100\ ,i,,,�no �6Water/Well Availability Northampton, MA 01060 ?na� Two ets of Structural Plans phone 413-587-1240 Fax 413-587T,' PI t/Site Plans -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 8 Fox Farm Rd. Map Lot / Z% Unit Zone Overlay District Elm St. District CB District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Zach & Surbhi Lipkin-Moore 8 Fox Farm Rd. Name(Print) Current Mailing Address: 603 566-7249 ore Telephone Signature 2.2 Authorized Agent: Mark Bonde 205 Park St., Eastham,nton,, MA 01027 Name(Print) Current Mailing Address: 413 535-9529 Signature Telephone SECTION 3- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) J(`�, 5. Fire Protection ✓✓ 6. Total = (1 +2 +3 +4 + 5) $33,500 Check Number This Section For Official Use Only Building Permit Number: a- G..`l / DateIssued: Signature: Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ✓❑ Roofing Or Doors r7l Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [01 Other[0] Brief Description of ProposedRemodel Kitchen: Replace plumbing fixtures, remove 1 non-bearing wall, tile, Work: c:abinPts, floors, ijpdat . PI (Itrical, paint and trim. X Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. If 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? 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, Zach Lipkin-Moore as Owner of the subject property hereby authorize Mark Bonde to act on my behalf, in all matters relative to work authorized by this building permit application. 4*-.W At 5-19-20 i gnature of Owner -, Date Mark Bonde 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. Mark Bonde PrinNa44—?Cn le 5-19-20 Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Mark Bonde CS-067758 License Number 205 Park St., Easthampton, MA 01027 1-2-22 Address Expiration Date w/L� 413 529-2176 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Bonde Construction 169228 Company Name Registration Number 205 Park St., Easthampton, MA 01027 6-1-21 Address Expiration Date Telephone413 529-2176 SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) 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....... ❑ No...... ❑ City of Northampton Massachusetts 44 DEPARTMENT OF BUILDING INSPECTIONS T ' 212 Main Street • Municipal Building y� cam Northampton, MA 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 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: Remodeling Est. Cost: $33,500 Address of Work: 8 Fox Farm Rd., Florence, MA 01060 Date of Permit Application: 5-19-20 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 RESPONSIBILITES 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: 5-19-20 Mark Bonde 169228 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 Ilk . , ( .'! )- T - DEPARTMENT OF BUILDING INSPECTIONS * 212 Main Street •Municipal Building Northampton, MA 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: 8 Fox Farm Rd., Florence, MA (Please print house number and street name) Is to be disposed of at: Valley Recycling (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: Bonde Construction (Company Name and Address) 14L?tee 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 Industrial Accidents I Congress Street, Suite 100 O Boston, MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name (Business/Organization/Individual): Bonde Construction Address: 205 Park St. City/State/Zip: Easthampton, MA 01027 Phone#: 413 529-2176 Are you an employer?Check the appropriate box: Type of project(required): 1.E]I am a employer with 1 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ✓❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10E] Building addition 4.[:][am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.[]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[:]Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Travellers Policy#or Self-ins.Lie.#:UB4KO5380A1842G Expiration Date: 3-3-21 8 fox Farm Rd., Florence ,MA 01060 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: r'lr'd' --?omdP Date:4-6-20 Phone#: 413 529-2176 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#: t Q IL 0 Note:This drawing is an artistic Designed:4/11/2020 interpretation of the general Printed:4/20/2020 appearance of the design.It is AO`O not meant to be an exact rendition. 1 Lipkm-Moore.kit All(no dims) Drawing#: 1 1462' 35;" 62-4111 8" V � y i ii wj I i This wall may come out also. O O r i M The main wall to be removed � is here leave header there to divide ceilings i LO i �IN I i M i ' 32111 A 1 35 2.. 7&1" 146-21" All dimensions size designations This is an original design and must Designed:4/11/2020 given are subject to verification on not be released or copied unless Printed:4/20/2020 job site and adjustment to Ft job 2020 applicable fee has been paid or job conditions. 1 order placed. Lipkin-Moore.kit Architecture Drawing#: 1 I No Scale.