23A-081 (3) 51 CHESTNUT ST BP-2018-0006
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23A-081 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Bath reno BUILDING PERMIT
Permit# BP-2018-0006
Project# JS-2018-000019
Est. Cost: $4300.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 6446.88 Owner: MAZESKI WILLIAM F& DEBRA A
Zoning: URB(100)/ Applicant: MAZESKI WILLIAM F & DEBRA A
AT: 51 CHESTNUT ST
Applicant Address: Phone: Insurance:
(413) 584-0638 O
FLORENCEMA01 062 ISSUED ON:7/6/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:REMODEL BATHROOM
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 It 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:
FeeTene: Date Paid: Amount:
Building 7/6/2017 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2018-0006
APPLICANT/CONTACT PERSON MAZESKI WILLIAM F&DEBRA A
ADDRESS/PHONE FLORENCE (413)584-0638 O
PROPERTY LOCATION 51 CHESTNUT ST
MAP 23A PARCEL 081 001 ZONE URN 100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
CLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid 11/1 /1\1
Buitding,Penntt Filled out (17R" l l
Fee Paid 4'�+�
�peof Construction: REMODEL BATHR M
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Not Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
VApproved 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
_ Demolition Delay
_
/X4 "�..� 776/i 7
Signature of Building Official Date
Nate: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 40k Contact Office of
Planning&Development rot more information.
•
�;_ Cit f Northampton - :
, -rt e, / ildin Department a 2 ^ '
{ h 2 Min Street �- I
' . s ,,,��rri /,.mpt n,1MA O1 O6O � • '"
. ice ` hon 4'k . 87-1240 Fax 413-587-1272 - . ;"` ^ ° '. <; )'.'i
� 0
ON . •N T: T • T - - PA- - • .T .- r . I i •R I • FAMI Y •W IN
1.
SECTION 1 -SITE INFORMATION
1.1 Property Address' 6\ C`1+,keui C ^y This section to be completedQby office
t M>c O" W\ Map „,7 34 - Lot OAt Unit
F\Drence AA 0\0Co2
Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: Oe bra Ma 2e,SY-1
5\ C,hestn)n Stree}
Name(Print) Curie Maili tidies
(W13 5� - 663'?
De_bro( Mazeskl _ Telephone
Signature
2.2 Authorized Aaent:
a,an k.\\e3) l27 overImK dr; ve _
Name(Print) Current Mailing Address:
ear t (q 0 5-61 - 5526
Sign /reTelephone
SECTION 3-E 'ATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building .45C°
(a) Building Permit Fee
2. Electrical 00 (b) Estimated Total Cost of
800 (b)
from(6)
3. Plumbing I aO L Building Permit Fee
4. Mechanical (HVAC) N IA
5. Fire Protection
6. Total= (1 +2+3+4 +5) y, MO Check Number 027/ Gb
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
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SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable,
New House ❑ Addition ❑ Replacement Windows Alteration(s) LJ Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [CI] Decks [0 Siding [0] Other Do]
Brief Description ofropase.
Work: Aten nd%I }hrUoni
Alteration of existing bedroom Yes v No Adding new bedroom Yes V No/
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Ba.If New house and oraddition 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?
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
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, �,1O r o1 1 1//1 pl[ \ , as Owner of the subject
property
hereby authorize Stan v^E.AO Q I0
to act on my behalf,in all matters relative to work autI1 rized by this building permit application.
Signature of Owner r, L Date
1, �)Q� Ma Ze.SEI 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.
Signed under the pains and penalties of perjury.
`aknrck Ma2e,Sk1
Print Name
Signature of Owner/Agent Date G joy?
r City of Northampton
e
/ r ' v Massachusetts ti?' :rr
s s
,F { i a DEPARTMENT OF BUILDING INSPECTIONS g'� T
m•r s • ?L
212 Main Street nicipal Building '.`i„ 0Cs
Northampton, !W 01060
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: j 4'7%COC)✓✓1 Ren 60te,EC __ ( Est. Cost: '0-// o oo . a a
Address of Work: �` C\\Pjj t' 5
R „ -1
n
Date of Permit Application: Tu ciQ, ,c Q,o Fl
I hereby certify that:
Registration is not required for the following reason(s):
_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 ENTERLNG INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME 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:
6 9-77 Se9iJ kc-Lc odmG
Date Contractor Name U HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of jthe above property:
C —VP—.7 Cobra M k-1 'Dk_ /Q
Date Owner Name and Signature
•
i >
City of Northampton
zc ,9r Massachusetts
y
Ye t" . .' DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street •Municipal Building !<
Northampton, MA 01060 1'ik: .gr0
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:
-S7 CfrAEsTUUT 57+tcern
(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:
&1/cK(,E_S 7Z-Lr etc,
(Company Name and AddresW)
Signal ofit licant or Owner Date
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.
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."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
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 affidavit 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
he returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
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 permit/license 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,
please 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
Boston, MA 02111
Tel. #617-727-4900 ext 406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 5-26-05
www.mass.gov/iia