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
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IL
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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"
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This wall may come out also.
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The main wall to be removed
� is here
leave header there to divide
ceilings
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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.