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24C-078 (10) 12 MASSASOIT ST BP-2020-1197 GIS#: COMMONWEALTH OF MASSACHUSETTS MV.-Block:24C-078 CITY OF NORTHAMPTON , Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:Porch Repair BUILDING P E RM I T Permit# BP-2020-1197 Proiect# JS-2020-002005 Est.Cost: $40000.00 Fee:$260.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ROBERT OBEAR 086260 Lot Size(sg.ft.): 15942.96 Owner: FALLON JONATHAN M&LAURA A Zoning: URB(100)/ Applicant. ROBERT OBEAR AT. 12 MASSASOIT ST Applicant Address: Phone: - Insurance: 47 W CHESTNUT HILL RD (413) 367-2424 O WC MONTAGUEMA01351 ISSUED ON:6/19/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-SI DING,FRONT PORCH REPLACEMENT, REPAIR TRIM AND DOOR 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 Si(Tnature: FeeType: Date Paid: Amount: Building 6/19/2020 0:00:00 $260.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck--Building Commissioner [A)nfT)PG 00 IPLAp5 Department use only -"� City of Northampto\ Status of Permit: •rr' Building Departmoht' �, Curb Cut/Driveway Permit �. 212 Main Streit Sewer/Septic Availability t. Room 100J�/!� v ater/Well Availability Northampton, i A OSA \- o Sets of St ructural Plans phone 413-587-1240 -q2 Sfe Plans- l 0 Other' Specify APPLICATION TO CONSTRUCT,ALTER, REP TE R DFMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION / Tihis sectiui-,to be coiifiai�`-u by 0-11lue- 1.1 Property Address: �)�//� �`1 i2 ivlassosit Street Map c; -lV Lot v Unit Northampton, MA Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: fohn + Laura gallon 34 A cast Main St.,Millers Falls,MA. 018 4 9 Name(Print) Current Mailing Address: Telephone Signature 0 be ction Com an Inc. A Cast Main Street, Millers j ails, MA. p13 4 Q Name Current Mailing Address: 1 Sig ature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS �.-1 Rein C$tlllld t@U I.rUJt(DUlldl b) LU UB VIIIUaI VJC VIIIy completed by permit applicant 1. Building t{D 000 (a)Building Permit Fee � ...- 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee [j � J 4. Mechanical (HVAU) i� 5. Fire Protection 6. Total = 0 +2+3+4+5) A 40 00.0 — Check Number //This Section For Official Use Only Building Permit Numbe : 6®, �/ "/ Date Issued: Signature: Building Commissioner/Inspector of Buildings Date FMAII AIlnil !RF(IIIiil 1=1T41F10 WnRAI=nWIVFR it1R (_f1NT0Af_TnP1 rprtinn 4. 70NINr. All Infnrmntinn Wmt Rc rmmnlotorl Permit fan Ra naniarl niio Tn Inrmmnlcatc Infnrmatinn Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks wont Side L: R: L: R: Rear Building Height Bldg. square Footage Open Space Footage % (Lot area minus bldg&paved pal-king) #of Parking Spaces Fill:(volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW O YES IF YES, date issued: IC VCG: \A/O� the 't recorded t the D t.-aa f rlcc s? n a�.a. ra u.a u�� permit ria,irruuu at L C$i:aL ui va.a_w. NO O DON'T KNOW O YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW © YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained U Obtained O , Date Issued: C. Do any signs exist on the property? YES © NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO e 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 ® NO O 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 Alteration(s) Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition I New Signs [p] Decks [[] Siding [p] Other[dJ Brief Description of Proposed Siding replacement,front porch replacement and repair to trim and door of shed Work: Alteration of existing bedroom Yes x No Adding new bedroom Yes x No Attached Narrative Renovating unfinished basement Yes x 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? A Drnnnc-4 Cnnarn fnnf nno of nous nnnetnierfinn llimon�innc 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, as Owner of the subject property Obear Construction Company, Inc. hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. CCE ATTA4N (ONTRACT Signature of Owner Date l (Robert Gear for 06ear Construction Compan ,Inc. 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. �f 'alvlf.u U, viyi�c� ui wc� N � w Nei�ausw vi Ncijiii y. oLert Print Na 5121 02 0 Sign ure o Owner/Agent Date SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder Robert Obear License Number A7 11Vact (.larA1zctvKit Hill Rnarl AAnntariiia AAA (11 A�;1 r-c, nocncn Address Expiration Date 07/10/2021 Telephone 413-537-5953 9. Registered Home Improvement Contractor: Not Applicable ❑ Ob earConstructioniC ompan ,Inc. Company Name Registration Number 3L1 A East Main Street, Millers Falls, MA. 0134 q 152593 Address Expiration Date Telephone 1 09/11/2020 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 DEPARMENT OF BUILDING INSPECTIONS ai 212 Main Street • Municipal Building _r .Aii Amini 'rM++........r:.�,.. 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: Repair,renovation Est. Cost: $40,000 Address of Work: 12 Massasoit Street,Northampton Date of Permit Application: 05/27/2020 I hereby certify that: R-4--don is not repimd-r—the .vll—ing reiw' 0): _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 NOMI: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: // .lf� Date 05/27/2020 ontractor Name Obear Construction Co,InPIC Registration No. 152593 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 DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •' Municipal Building P 4 r. Northampton, MA 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 sti"uutllres nixessury to suU11 use wid UI farm suuaure . A Person Wllu Constructs wort; thiol unc 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.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 A c _ DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street a Municipal Building �a 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: 12 Massosit Street, Northampton (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: Amherst Trucking Service,Hatfield,MA (Compa y N e and Address) C2;---ji.ro f 0-4 Anl *4 vIyi myth'- — . , -- If, 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 Gommonweatth oimassachusetts Department of Industrial Accidents h Office of Investigations 600 Washington Street uv��ii�1 In Vblll www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name(Business/(>rganization/individual): Obear Construction Company, Inc. Address: 34A East Main Street City/State/Zip: Millers Falls, MA. 01349 Phone#: 413-537-5953 Are you an employer?Check the appropriate box: Type of project(required): LE I am a employer with 10 4. ❑ i am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.[__1 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g, E]Demolition working for me m any c ppac.I Y: employees and have workers' [No workers' comp.insurance comp. insurance.# y U Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E]Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other renovation comp. insurance required.] e l:, t,y, ,.�.W�..eel,.,..•t.i., f it. ,rh- - 1� �, lt,_ ,.k. �, l:, �{ ...., ,, t Homeownea•s who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Cont actors 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. Tf the sub-contractors have employees,they must provide their workers'comp.policy number. I ane an employer that is providing workers'compensation insurance for nep employees. Below is the policy and job site inforneation. Insurance Company Name: Employers Mutual Casualty Policy#Or Uci;ins.Lic.#: 5H6738218 LxprrNl1V11 Datc: 5R//20 20 Job Site Address: 12 Massasoit St., City/State/Zip:Northampton,MA. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the Dl&fgrjnsurance coverage verification. I do hereby certify u aims and penalties of perjury that the information provided above is true and eorrect. Si nature: Date: 05/07/20 Phone#: 413-537-5953 Ofj"icial 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#: 11 11 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 a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee 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." IVI%JU U11apLe1 I J2,132Jq-tU)GIJU SUILCb LI1aL 1.CVCI-y KUM UI"IUCaI IICCII&IIIg KgC11C�' MIs11 WI/1111U1U 01C iMUMIUC OF 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 atiidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),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 i nd'u'utriaul A wiuei Sh—.lA you h--,...any questions.regarding the 11:'.^.a .-If—,yvu.v.'giiued t^v^vbtw:u u i.^iri:'ru' 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 permittlicense 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, piease do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Uo.,s*.,, WA A All 1 1 � t,On, ivj4%. V-A A 1 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia 0 car Obear Construction Building Design interior Design Construction Management MA 01]40 Tel:411.iM1l.la51 a.-on Fallon Residence 12 Massasoit Street Northampton,MA H v Ink— JUne 16,2020 114"=1.0' 0 re-install existing post and railings to 2nd floor 0 2 Simpson deck ties per code New Porch 0 Green=2 x 8 framing(&, 16"O.C. 0 Cyan=double 2 x 10 beam A-1