28-049 (8) 94 CAHILLANE TER BP-2016-1274
GIs#: COMMOWEALTH OF MASSACHUSETTS
Map.Block:28-049 TITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2016-1274
Project# JS-2016-002185
Est. Cost: $30000.00
Fee: $195.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MARK BONDE 67758
Lot Size(sq. ft.): 16247.88 Owner: MAHONEY JAMES&ELIZABETH
Zoning: Applicant: MARK BQNDE
AT. 94 CAHILLANE TER
Applicant Address: Phone: Insurance:
205 PARK ST (41j3) 535-9529 O WC
EASTHAMPTONMA01027 ISSUED ON.513/2016�0:00:00
TO PERFORM THE FOLLOWING WORK.REMODEL KITCHEN
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#A 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 Signature:
FeeType: Date Paid: Amount:
Building 5/3/2016 0:00:00 $195.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1274
APPLICANT/CONTACT PERSON MARK BONDE
ADDRESS/PHONE 205 PARK ST EASTHAMPTON010?7(413)535-9529 Q
PROPERTY LOCATION 94 CAHILLANE TER
MAP 28 PARCEL 049 001 ZONE
THIS SECTION FOR OFFIgIAL USE ONLY:
PERMIT APPLICATIQ CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REMODEL KITCHEN
New Construction
Non Structural interior renovations
Addition to Existin
Accessoa Structure
Building Plans Included:
Owner/Statement or License 67758
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON TRIS APPLICATION BASED ON
INFOJ.MATION 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: §
Finding 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
o lay
Signa re of Bui dmg 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.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
Department use only
City of Northampton Status of Permit:
Ccif Building Department curb cuttDr vewray Permit
L! N l 212 Main Street Seu+er/Septic Availability.
N Room 100 WaterNVell Availability
t l ' Northampton, MA 01060 Two Sets of Structural Plans
art
phone 413-587-1240 Fax 413-587-1272 Plot/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
i Map Lot Unit
j� Ir, f4k 010(e7 Zone Overlay District
El m St.District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
N 4<(Print) Current Mailing Address:
%'-b\:?�
elephhoone T
Signa re
2 ri nt:
L(z\If jb(l K)Iz)E 7-0 'S %A- QM
Name(Prin�44
Current Mailing Address:
L" 4 '�'1� �c�-t�.t`�k Lk ti's ✓ .
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(MVAC)
5. Fire Protection
6. Total=0 +2+3+4+5) Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all awllcable)
New House ❑ Addition ❑ Replacement3indows Alteration(s) E-1Roofing
Or Doors []
Accessory Bldg. ❑ Demolition ❑ New Signs 61 Decks
!D Siding ❑] Other[[pj�-"
Brief Description of Proposed
Work: '�Etdc _ N-�L ►_� i��� 1 i�11�1V1 �a Jf.��,�e 1 l�.i I i ALt,,i�
Alteration of existing bedroom Yes�o Adding now bedroom Yes "---90
Attached Narrative Renovating unfinished basement Yes &----No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing Oomglete the followina:
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.
1. 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
1 as Owner of the subject
property �---
hereby authorize
to act on my behalf, in air ma ters relative to work authorized by this building Permit application.
� t
�. ...2
Signa ure o et Date
as Owner/Authorized
Agent here6y declare that the statements and information on the foregding application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
AAJIr
Signature o Owne Agent Date
Section 4. ZONING Ali Information Musl lermit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bidg&paved
#of Parking Spaces
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
IF YES, date issued:
IF YES: Was the pegnit recorded atthe Registry of Deeds
��
v�� � ��x
NO \ ol— DONT KNOW YES ��
17
IF YES: enter 8onh | Page and/pr Dmcumnent#
!
/�� ���
B. Does the /r~� VV �~�iand�� NO �_� DONT KNOW YES �^�
IF YES, has permit been or need to be obtained from the Conservation Commission?
| /~`� �
Needs tmbeobtained Q--1
^����- 0bt�ned/ �� Date
)
--
C. Dmany signs exist nnthe pnoperty7 YES NO
0
|FYES, describe size, type and location:
D. Are there any proposed changes to or additions of Signs intended for the property? YES ~�'x�� NO
)
|FYES, describe size, type and location: �
E. Will the construction activity disturbhng.gmding excavation-or @UnQ)over 1 omit part plan
that v�||di�urbover 1 acre? YEF � � NO
��
\_7
/FYES,then aNorthampton Storm Water Management Permit from the DPW ierequired.
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SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: O�
tZJ N-. 7 � —
License Number
Address r— Expiration Date
40 - ?-
Sign ture Telephone
9.Restistered Home Improvement Contractor: j Not Applicable ❑
Companv Name Registration Number
olp
Address Expiration Date
Telephone Lit
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6))
Workers Compensation Insurance affidavit must be completed and sulpmitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the buildin$Lpermit.
Signed Affidavit Attached Yes....... No...... ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to iinclude Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hide who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 108.3.511.
Definition of 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,attachod 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 homeowner.
Such"homeowner"shall submit to the Building Official,od 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 j¢b 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(Workens'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.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws andl,State of Massachusetts General Laws Annotated.
Homeowner Signature
i
The Commonwealth of Massachusetts
Department of In�ustrial Accidents
Office of I njvestigations
1 Congress Sheet,Suite 100
Boston,MA'102114 2017
www.ma$s.gov/dia
Workers' Compensation Insurance Affidavitil Builders/Contractors/Electricians/Pl umbers
Applicant Information } Please Print Legibly
Name (Business/Organization/Individual): $
Address:
City/State/Zip: a!?V A#AE a!? ; 6162Phone
Are yo employer? Check the appropriate box: Type of project(required):
1.Wi ma employer with 4. C1 1 am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. [�New construction
2.C1 I am a sole proprietor or partner- listed on the attached sheet. 7. &Fremodeling
ship and have no employees These sub-contractors have g, C)Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insura6oce.t Building addition
required.] 5. C) We are a corporation and its 10.[3 Electrical repairs or additions
3.C1 I am a homeowner doing all work officers have exercised their 1 LCC Plumbing repairs or additions
myself. [No workers' comp, right of exemption per MGL 12 Cl Roof repairs
insurance required.] c. 152, §1(4)F and we have no
employees. [No workers' 13.�Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing thoir workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and than 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'camp.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:
Policy#or Self-ins. Lic. Expiration Date: 17
Job Site Address:Clt_�:-A1 1I L1 1 _ _ City/StatelZip: .(t K k�?U _ H P—r oo(0
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 MGI.;c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a cop} 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#te information provided above is true and correct.
Si ature: ASDate: _
Phone#: �lil
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 Cl6rk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disjposal Affidavit
In accordance of the provisions of MILL 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.
Address of the work:
The debris will be transported by: kyr2lr rnw5nz, Cain
The debris will be received by: 1- -� U��iLu , y r
Building permit number:
Name of Permit Applicant
Date Signature of Permit Applicant
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i All dimensions size designationsThis is an original design and must Designed:2/3/2016
given are subject to verification on a HNGLGGIES not be released or copied unless Printed:3/11/2016
job site and adjustment to fit job applicable fee has been paid or job
conditions. order placed.
Mahoney All Drawing#: I
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