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24D-149 (3) 18 FINN ST BP-2021-1187 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24D- 149 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOFING/SIDING BUILDING P E RM I T Permit# BP-2021-1187 Project# JS-2021-001982 Est.Cost: $36000.00 Fee: $140.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: THEODORE PONTZ 088788 Lot Size(sq. ft.): 4051.08 Owner: MASON INVESTMENT PROPERTIES LLC C/O JOSE M GONCALVES PORTER Zoning: URC(100)/ Applicant: THEODORE PONTZ AT: 18 FINN ST Applicant Address: Phone: Insurance: SOUTH HAD LEYMA01075 ISSUED ON:4/16/20210:00:00 TO PERFORM THE FOLLOWING WORK:REROOF AND NEW SIDING 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: l inal: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. I ICADii Certificate of Occupancy sit Hato +�a ' + • • FeeType: Date Paid: Amount: Building 4/16/2021 0:00:00 $140.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 1 Co onwealth of Massachusetts qP/� 5 Boar of B�ilding Regulations and Standards FOR 49OaMas :chuetts State Building Code, 780 CMR MUNICIPALITY ur...... o� "�� USE rr flo);,ttg.P_ermit Application To Construct, Repair,Renovate Or Demolish a Revised Mar 2011 --` ti;;'SPEcr, One-or Two-Family Dwelling A 07p6 p Nt7 Fis Section For Official Use Only Building Permit Number'. ii D 7—up.../Zs Date Applied: y`l v/.51,0 a/ //i2 z/-16-zezt Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 P'op�fA�rSs� 1.2 Assessors Map&Parcel Numbers ,� 1.1a Is this an-accepted street?yes f no _ Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of ✓as At/01411 np/o / /n45 5' Name(Print) City,State,ZIP f g Fi iv v ,S'/' �l3 55 a- bag/ C7$i C.,,,5 c,6 <<,601,) No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) Ell Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': - 2 0 u( A/Lf b to Cv., s tt?-Jv SECTION 4:ESTIMATED CONSTRUCTION COSTS ,� Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees ACheck No. D Check Amoun : Cash Amount: 6.Total Project Cost: $ g4uuu ❑Paid in Fiill 0 Outstanding Balance Due: %0Oe- fli 0 o a Siti P - 1O GC 4/15/2021 Details Licensee Details Demographic Information Full Name: ouTheMbrellrA Pc Owner Name: License Address Information City: South Hadley State: MA Zipcode: 01075 Country: United States License Information License No: CS-088788 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 10/15/2020 Issue Date: 3/23/2010 Expiration Date: 3/23/2022 License Status: Active Today's Date: 4/15/2021 Secondary License Type: Doing Business As: Status Change Reason: License Renewal Prerequisite Information No Prerequisite Information No Available Documents https://madpl.mylicense.comNerification/Details.aspx?result=3258bdf2-cd89-4bf5-b220-59b4e9650536 1/2 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Q Ug 7 5b �� c7R Po , L°S �m�iy �ea ll :tier License Number Expi ation to Nam f cL Holder pp List CSL Type(see below) b- No.and Sty QE t Type Description © h Unrestricted(Buildings up to 35,000 cu.ft.) City/Town, State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Email address D Demolition 5.2 Registered Home(�Improvement Contr ctor(HIC) 800 ?V7 C S/(Y) J) C'JNS'1p tic �C••v ��V �'r HIC Registration Number xpir tion Date HIC Company Name or UIC Regis am tae 1" 3 (A S- 7�0 pok, No.ai d Slreet 61 t 44 S c� l Email address *Z.Col ity/;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 0 No...........❑ 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 c l CAt) (b'& w ve‘GL_i . to act y,behalf,in all matters relative to work authorized by this building permit application. nt Owner's Name(Electronic Signature) Date SECTION 7b: OWNER'OR AUTHO D 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. 17013Y s (cA til c1 Lf`?--.2,( Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. 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 www.mass.Eov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths 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" City of Northampton zri 0sic y Massachusetts �� _ !, z . c all Yf 4? g DEPARTMENT OF BUILDI ?S.NG INSPECTIONS 7 */ 212 Main Street • Municipal Building JA. `a! Northampton, MA 01060 `,‘`� CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 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, S 150A. The debris will be disposed of in: 10 Y "[ , Location of Facility: c) 7 1(\(( A2/il,$ ri #63& t4s � I 0 ( 0 " The debris will be transported by: Name of Hauler: ' m ` LoRS- e Signature of Applicant: j.,,,,,) Date: y Jy 2 The Commonwealth of Massachusetts Department of Industrial Accidents N110= s) 1 Congress Street,Suite 100 .:.-0= Boston, MA 02114-2017 mow.. own mass.go6Idia Workers'Compensation Insurance AtTidavIE:Builders.iContractors/Eketrieians/Plumbers. TO BE FILED WITH THE PERNIITr1NC Attl'HORIT'k`. Applicant Information , p �, Please Printq Leecihlr Name(BusitnrsVOrganimtiortindividual): J 1CJ°A Coj..i M L)C � fr!'kj :�J l,� Address: q 6 S c City/State/Zip: c/'L-h /41 c1 ep, ©/Phoi e#: 7/3-s3S P/6 3.-- ire you an employer?Check the appropriate bast Type of pro Beet(required): i.E I am a tnp foyer with _ I ._._errtpla yees(futt and/or pan•timc 1.• 7. Ne 't)nbtruc`tion 'l0 I sin a sok proprietor or partnership and have no employees working for me in $_ emodeling any capacity.[No workers'comp.insurance required" t0 I am a hornool ner doing all work myself.[No worker n.'comp.iurance required]r 9_ ❑ Demolition 4.Q lam a t omoowner and will be hiring c ontraciurs to conduct all w ink un mu property. I will 10 Building addition ensure that all contractors either hao-e workers'compensation perrsation msuranc'e in are sole 11.0 Electrical repairs or addition, p ' tort with no employees. 12.0 Plumbing repairs or addition, .wpm a ge..,al contractor and I have hired d the sub-contractors listed un the attached sheet These sub-contractors have employees and have workers'comp.insurance. 130 Roof repairs b 60 We are a corporation and its trffu-ers have exercised their right of exemption per M(iL c_ 14_0Other 1.52.yr it4.and we have no employees.[No workers'croup.insurance required.] 'Any applicant that checks but 41 must also fill out the section below show ing their workers'compensation policy information. t Homeowners who submit this affickorit indicating they are doing all work and then hue outside contractors mini submit a new affidavit indicating suck (Contractors that check the,box mug atta►fted an additional sheet show in.the name of the subcontractors and state whether or not those entities have employee's. If the sub-cuntracarn 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. �� Insurance Company Name: i d N U o k)( FBA, t( � j Policy#or Self-ins.Lie. �' �oD703 �/ Expiration Date: � a �/o 7 Job Site Address: (s p) /J;V c S I i Cityi'StatetZip:NQ&.r'i'1J4A,p'i0,t l 'WA SS G'/G Z Attach a copy of the workers'compensation policy declaration page(showing the policy number and eipiratlon 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 forth ofa STOP WORK ORDER and a fine of up to 52.50.00 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 certif'and the p ihs and e allies of perjury that the information protidee�d a re is rue and correct Signature: �- Date: T /9 / Phone#: 53 ` e Official ial use only. Do not write in this area.to be completed by city or town official ( ity or Town; Permit/License# { Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing lnspcc t i t 6.Other Contact Person: Phone#: