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06-026 (3)
BP-2021-2274 62 LEONARD ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 06-026-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair ` PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Penn it# BP-2021-2274 PERMISSION IS HEREBY GRANTED TO: Project# ROOF/DOORS/BATH RENO Contractor: License: Est. Cost: 35880 ALEX KOMLEV 103055 Const.Class: Exp.Date: 12/30/2022 Use Group: Owner: CAI SSE SUSAN D Lot Size (sq.ft.) Zoning: URA Applicant: ALEX KOMLEV Applicant Address Phone: Insurance: 710 FLORENCE RD 4133864739 FLORENCE, MA 01062 ISSUED ON:12/27/2021 TO PERFORM THE FOLLOWING WORK: ROOF/DOORS/BATH 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. 101 Signature: 4)‘, ., i I yQ " ii Fees Paid: $233.00 212 Main Street,Phone(413)587.-1240,Fax:(413)587-1272 Office of the Building Commissioner 1 y The Commonwealth of Massachusetts Ir Board of Building Regulations and Standards FOR Massachusetts State Building Code, 780 CMR MUNICIPALITY USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 7 !13 Date Applied: I. .71. . 1 a7 Building Official(Print Name) Signature I SECTION 1: SITE INFORMATION 1 2 operty Address: 1.2 Assessors Map&Parcel Numbers (eONcLr/ - kPh N2 4 0 1.la Is this an accepted street?yes 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❑ Private❑ Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP'I, / }!/ 2.?Owner'of Re ord: 5 5 L 6i5 /- ,i 0 J� Name(Print) City,State,ZIP C 2— L[0 n.k r� 2L (i0 9-4'//Y No.and StreetTelephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0' Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: F p//c i �•- o/ Ai 1/-Ai A' . �-C( G - �4 c� .- , rn /1 , 3 e.x/e r,or �tcbr_5 1 .n .l1b.- ndcw 5p/.c) 13.414 o0,h r',ia244/ SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ f' c 5 1. Building Permit Fee: $ Indicate how fee is determined: ' 0 Standard City/Town Application Fee 2.Electrical $ /Sa 0 0 Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ % 7 50 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees: $ Suppression) Check No. AtL Check Amount! 6.Total Project Cost: $ J JI 00 ❑Paid in Full 0 Outstanding Balance Due: v City of Northampton s Massachusetts s6 ( st1,\ DEPARTMENT OF BUILDING INSPECTIONS ..., ' 212 Main Street • Municipal Building �-`� ,,, Northampton, MA 01060 �fit ,�: / F T o\ 0ci ,n F P1\0' F R QBTAINING A BUILDING PERMIT FOR WINDOWS, DOOR ,` S,RENOVATIONS, ROOF MOUNTED SOLAR,ETC. 1. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work(Digital and hard copy). 3. Construction Debris Affidavit filled out and signed by applicant. 4. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance. 6. Energy Conservation Compliance Certificate (new /replacement windows). 7. Home owner's License Exemption Form(if applicable). 8. Note any Special Permit requirements (if applicable). 9. Energy Code—all new construction(Gut/Rehab) requires a HERS Rater Affidavit 10. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. 4 4.3 22 LA SECTION 5: CONSTRUCTION SERVICES 5.1 C• I struction Supervisor License(CSL) JD 3 O�5 �39����� ��! /r/�QU License Number Expiration Date Name of CSL Holder 'I0 A 0 re Dice R‘-/ List CSL Type(see below) No.and Street Type Description G/��G�CG �///� �l©� U Unrestricted(Buildings up to 35,000 cu.ft.) Clity//Town,State,ZIP/ R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding /' 386 �/7 t t r SF Solid Fuel Burning Appliances 7/3 4t Ill , /I QQ fie, I Insulation Telep one Email address v ') D Demolition 5.2 Registered Home Improvement Contractor(HIC) / ©y ,� 7/2A4207. go�� .� e0/j Lr�ci HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name ( N d Street Email ad r • - C Pee. /17i) o%LZ.— G 386-4739' City/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 V 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 to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic 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 re this application is true and accurate to the best of my knowledge and understanding.e 4,,vir._ /V712.9 21 P ner 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.gov/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" N. The Commonwealth of Massachusetts pi mits.-mum si. Department of Industrial Accidents I Congress Street,Suite 100 1/4 -- -I's Fill;E•r ' A"i,-.1's- 1111k._ Boston, MA 02114-2017 -'. ti,ww.mass.gor/dia II,. Ii.11.7 1 11 otters'Compensation Insurance Arr.:dal,it: Buiklers/Contractors/Electricians/Plumbers. TO HE FILED WITH THE 11:101111'ING.A.I.THORITV. Applicant Information Please Print Legiblr Name(HasinessfOrprozattotv lndradua1): i k (9045/0„c1,:r24. Address:_ 710 1i9re et c /IP . City/State/Zip: ,,cii-e 4 eit, 7 l 7 il--- 9 tad 2 Phone #:(9/5) 3 L5‘ - 973k Art yea 1111 enipluNer?elvevk the appropriate hoc Type of project trequired). i.c3 I 4111 a Crnployer with emplaces(fall ardor part.tinne).• 7. 1:3 New COMMICti011 .:.:0 ant a itite proprietor or partrknahrp and have no employees working for me in B Remodeling an ,--araory.fNo workers'ctunp.uthurarieu rec-loartril 0 Dem I am a homeowner doing all work myself[No workers*comp.insurame required 9. olitioni' 10 a Building addition 4.0 I apt a hornenAtner and will be brrnig...munitior%to conduct all work on my property. I will ensure that all coraraLturs colter Ine,e workers-compensation Wllranee et an 301e 11 4-3 Electrical repairs or additions proprietors with no employ.ees 12..E1 Plumbing repairs or additions SO I ant a general worm:tor aasil I lia..e hired the sub-contra:ton Listed on the Ithieflett&beet. 13C3 Roof repairs These sub-contractors base employees and have workers'comp.insurance.; 6.E3 Vie are a corporation and its officers have exercised then light of exemption per hilIGL e. 14.001:her 1:t2...§1(4),and we Its..e no einplinvets„[No workers'comp,izasorance requord.1 •Ari%appi it_iiii Ler.eli...•ks 1-k-k.; naLiar law fill out thIC itlaiOn bekr*An*.Uay then Winters'compensation policy intannatinia_ Fkrwoulber,who submit riu.iiitithatii isidscatiog they are doing all work and then hire elltiide contmetoft mtbi submit 3 Mel*strut/Nil iivitiLliting si.,-1 :'Contractors that check this Isos.muil allac hod an additional sheet showing the name of the Nntreuninacter,;In J.7:r.:Wilelhc7 ca not those emit],, Linplot.et, II.-.1•.c,i.1,-,:kinl:. 1,k.v..:...eirl..,:.ce,Its...,.ntr.i.:t priwide diem suit.tis comp.Folic!.number 1 ant an employer that is proriding worA.ers compensation insurance for on corp/oreeN. Beioi .iA the policy and job site informutirin. Insurance Company Name: Policy#or Self-ins.Lie. ti: Expiration Date: Job Site Address: City/State Zip: Attach a ropy of the vlorkers.compensation policy declaration page(showing the ludic!, number and expiration date). Failure to secure coverage.[:, required under NAGE e. 152, §25A is a criminal violation r unthluble by a tine up to$1,500.00 andlor one-year imprisonment_as well as civil penalties in the form of a STOP WORK ORDER and a tine 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 crt fication. 1 do hereby certifs.zs slier the pain.%and penalties of peJ-jury that the information provided oho ve is true and cm-rect. Signature: ov,•-i 7€ ----' Date: iz,/z/z_ z/ Phone#: /"5_)(3A1— 4'73, Official use only. Do not write in this area,to be completed by city or town official (it) or Tun: Permit/License# Issuing.kuthoritv (circle one): I. Board of Health 2. Building Delni rtment 3.City/Tovt n Clerk 4.Ele i I riCtil Inspector 5. Plumbing Inspector 6.Other Contact Person: Phimi. - City of Northampton Massachusetts ... � - t DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 sE jy 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: Location of Facility: The debris will be transported by: Name of Hauler: A4- d 4flai ,joq Signature of Applicant: �r� G• Date: /2-./7/2 City of Northampton xYrT a: Massachusetts DEPARTMENT OF BUILDING INSPECTIONS s 212 Main Street • Municipal Building Northampton, MA 01060 HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert full legal name), born (insert month, day,year), hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners' exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns 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 structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this day of , 20_. (Signature)