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17B-013 (10) 384 BRIDGE RD BP-2021-0029 GIS#: COMMONWEALTH OF MASSACHUSETTS MW:Block: 17B-013 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Deck BUILDING PERMIT Permit# BP-2021-0029 Project# JS-2020-001447 Est. Cost: $8000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MATTHEW KOZUCH 106644 Lot Size(sa.ft.): 9408.96 Owner. VANDECARR DOROTHY Zonine: RI(100)/RR(100)/ Applicant. MATTHEW KOZUCH AT. 384 BRIDGE RD Applicant Address: Phone: Insurance: 6 HIGH ST (413) 570-3279 WC FLORENCEMA01062 ISSUED ON.7/812020 0:00:00 TO PERFORM THE FOLLOWING WORK.12X8 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# 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 Silinature: FeeTyAe: Date Paid: Amount: Building 7/8/2020 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner EIV —D ZOn.'YI Appro"It yn P- - 44 q JUL - 8 2020 The Commonwealth of Massaepusetts FOR Board of Building Regulations an;c��a; _ FOR 1 INP,INSPFCTIONS A Massachusetts State Building Code, ONMA 0100 USE Building Permit Application To Construct,Repair,Renovate Or Demolish a --Revised Mar 2011 One-or Two-Famil},Dwelling 01 4 This Section For Official Use Only Building Permit Number. Date Applied: Cu) o5s -7-$"ZOZO Building Official(Print Name) ignawre Date SECTION 1:SITE INFORMATION 1.1 Property ddess: 1.2 Assessors Map&Parcel Numbers i•�� c0�3 1.1a Is this an accep ed street?yes_ no Map Number Parcel Number 1.3 Z`i g�ormation: 1.4 Property Dimensions*. Zoning District Proposed Use Lot Area(sq ft) Frontage(0) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided A-IV t--10 Zo zC; See dQ i rt ce 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Gr"" Private❑ Zone: _ Outside Flood Zone? Municipal disposal y Check if yesD al On site di sal s stem ❑ SECTION 2: PROPERTY OWNERSHIP 2.1 Owner'of Record: ( , f V.A &V r ��oM {�✓7 i✓c Ne/'Keo w, &�, Ak e/O(P d Name(Print) I City,State,ZIP I 3U N't) (f No.and Street J Telephone Email Address �— SECTION 3:DESCRIPTION OF PROPOSED WORK'-(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition E3Accessory Bldg.❑ Number of Units Other ❑ Specify: C Brief Description of Proposed Work': SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) 1.Building $ 1. Building Permit Fee: S Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee O Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: S.Mechanical (Fire $ Su ression) Total All Fees:$ $ Check No.A�Check Amount: U Cash Amount: ti.Total Project Cost: $ � ' ❑Paid in Full 13 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS -/06c, q 25- �e 1``a c7,L) \- License Number ` / Expiration Date Name of CSL Holder V I 5` ��`- List CSL Type(see below) 67 No.and Street V T Type Description C--:t Or tvL Ce ® �O Z U Unrestricted(Buildingsu to 35,000 cu.fl.) """��,,, R Restricted M2 Family Dwelling City/Town,State,ZIP M Ma-sonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered home Improvement Contractor(HIC) Z HIC Registration Number Expiration Date HIC Company Nae or HIC Registrant Nacre No.and Street \� Email address Ci /Town,State,ZIP Telephone SECTION 6: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...........E3 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize a-� K&Z✓e. to act on my behalf,in ali m ers relative to work authorized by this building permit application. /A2o Print Owner's Name(Elec Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at %vww.ntass.g,ovioca Information on the Construction Supervisor License can be found at w,-wnv.mass.gov/dus 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basementlattics,decks or porch) Gross living area(sq.ft.) Habitable room count Dumber of fireplaces Number of bedrooms Number of bathrooms Number of halfibaths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of Massachusetts Department of IndustrialAccidents 03HEM 1 Congress Street,Suite 100 11;6 EY Boston,MA 02114-2017 www.massgov/dia M-orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information i ` Please Print Lembl Name(Business/OrganizationMdividual)11: , Address: 6 S 1 City/State/Zip: �(D r e&ce t'M 4b& 2 Phone#: Are you an employer?Check the appropriate box: Type of project(required): l.�am a employer with 2 employees(full and/or part time)- 7. E]New construction 2C]I am a sole proprietor or partnership and have no employees working for me in $. E]Remodeling any capacity.[No workers'comp-insurance *�-J 3.0 I am a homeowner doing all work myself[No workers'comp.insurance required] 9. ❑Demolition 4.M 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10E]Building addition ensure that all contractors either have workers'compensation insurance or are sok 11.Q Electrical repairs or additions pr°p°`tnrs with no employees. 12.E]Plumbing repairs or additions 5.a 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-coonactors have employees and have workers'comp.insru14ance.t 14.�.E6ther Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 152,11(4),and we have no employees.(No workers'comp_insurance required.) 'Any applicant that checks box#1 mast also 511 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. t Insurance Company Name: L t ef� ✓ al Policy#or Self-ins.Lic.#: \)U C Z—31 S"QP 2-41 Expiration Date: /( 2 Job Site Address: Z g,I b.t )S 4 '" City/State/ZipC: t lO re iLc O l®6,>,— Attach ,>,—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 pain and penalties of perjury that the information provided above is true and correct: Signature: " l Date: q Lo "2 Phone M 3`1 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#: -6q q 41' CITY OF NORTHAMPTON SETBACK PLAN MAP: I I-G LOT: 0 [ '� LOT SIZE: S 1� 3 REAR LOT DIMENSION kFARYARD ^rs�d /�ro 12-- SIDE ZSIDE YARD �© �\ SIEGE Y1R11 -z,4 I FRONT :LIBACk "1 D FRONTAGE- -____ _ RDICATE LOCATION AND DI ME NSI ONS OF 11 OLS E.GARAGE.ADDITIONS OR ACCESSORY BUILDING. HE SURE TO INCLUDE FRONTAGE AND LOT SIZE(SQUARE FEET OR ACRIZS) �bcrrn� The City of Northampton � Building Department g P 212 Main Street Northampton, Massachusetts 01060 Phone (413) 587-1240 Fax (413) 587-1272 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance with the provisions of MGL c40, s54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, sl 50A. The debris will be disposed of in: `I Cas �v V oj-T A Location of Facility c, c clx, Eats tci 1V The debris will be transported by: Name of Hauler N\ " --)' Signature of Applicant: Date: -� Za 10. Do any signs exist on the property? YES NO IF YES, describe size, type and location: Are there any proposed changes to or additions of signs intended for the property? YES NOy IF YES, describe size, type and location: 11. Wilt the construction activity disturb (clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan of development that will disturb over 1 acre? YES NO Z,-' IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 12. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION This column reserved for use by the Building Department EXISTING PROPOSED F..EQUUUM BY Lot Size ZONING `3 S-93 A///` Frontage 7,5- 1 N /+ Setbacks Front 1-0 13 a Side L: - �� i R: i'_� L: �� R: S�� IL: R: Rear 59 Kcor , 97 ' Building Height 151 AA Building Square Footage %Open Space: (lot area minus building ft paved parking #of Parking Spaces 2 Z- #of Loading Docks Fill: (volume Et location) 13. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. -Date:_ Applicants Signature —, NOTE:Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits from the Board of Health,Conservation Commission, Historic and Architectural Boards,Department of Public Works and other applicable permit granting authorities. W:1Docw=tslFORMS\onVnal%uilding-hupectoAzo=g-pmwt-Application-passive.doc 8/4nM N 1 R File# MP-2020-0049 ) � j� a1 gym,-TL APPLICANT/CONTACT PERSON VANDECARR DOROTHY naAX14- �5 ADDRESS/PHONE 384 BRIDGE RD (512)731-7657() PROPERTY LOCATION 384 BRIDGE RD MAP 17B PARCEL 013 001 ZONE RIO 00)/RR(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ZONING FORM FILLED OUT 11- OS ED REQUIRED DATE Fee Paid .Building Permit Filled out Fee Paid Tyaeof Construction: ZPA-ADD DECK TO BACK OF HOUSE New Construction Non Structural interior renovations Addition to Existing Accesso Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION 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: $ Findin- 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 ,;4 /kj"�z (�zgLo Signature o 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. i * Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact the Office of Planning& Development for more information.