32A-211 15 BUTLER PL BP-2019-0136
GIS n: COMMONWEALTH OF MASSACHUSETTS
Man:Block:32A-211 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorv�FIRE DAMAGE BUILDING PERMIT
Permit# BP-2019-0136
Proiectft JS-2019-000193
Est Cost$13250.00
Fee:$86.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: BAYSTATE RESTORATION GROUP 056785
Lot Size(so.ft.): 8102.16 Owner. CAVANAUGH I MICHAEL&PATRICIA
Zonine:URC(10o1/ Applicant: BAYSTATE RESTORATION GROUP
AT: 15 BUTLER PL
Applicant Address: Phone: Insurance:
69 GAGNE ST (413) 532-3473 WC
CHICOPEEMA01013 ISSUED ON.-8/2120I8 0.00:00
TO PERFORM THE FOLLOWING WORK FIRE RESTORATION TO GARAGE- NEWROOF,
DRYWALL AND GARAGE DOORS
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 k 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 Shmatutc:
FeeType: Date Paid: Amount:
Building 822018 0:00:00 $86.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File k BP-2019-0136
APPLICANT/CONTACT PERSON BAYSTATE RESTORATION GROUP
ADDRESS/PHONE 69 GAGNE ST CHICOPEE (413)532-3473
PROPERTY LOCATION 15 BUTLER PL
MAP 32A PARCEL 211 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
TvoeofConstruction: FIRE RESTORATION TO GARAGE-NEW ROOF,DRYWALL AND GARAGE
DOORS
New Construction
Non Structural interior renovations
Addition m Existing
Accessory Structure
Building Plans Included
Owner/Statement or License 056785
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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:
Cub 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 Storni Water Management
m lition Delay
t eofBuil mg O Dater '4
Note: Issuance of a Zo g 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.
kF
Cit of N, rthampton Status
F 0 3 0 20103ull Ing epartment Colb it
2 2 M in Street 8P
t 1 _
Roo n 100 WaW/Well AVW Y„
UIRDING wsQ�jI�Vn t n, MAO Two Sets of S
AMP70N.MA�it7Ekl1� P +'
one - 9T-70 0 Fax 413-587-1272 ,
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION I -SITE INFORMATION P_ R- i3(,�
1.1 Property Address: This section to be completed by office
Map _ Lot IX ( I Unit
15 Butler Place Northampton Ma. 01060 zone. Owrlay District
Elm S4 District CS Dlstdd
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Michael Cavanaugh 15 Butler Place Northampton Ma. 01060
Name(Pont) Current Maillrg Address'.
Telephone
Signature
2.2 Authorized Anent:
�
A44a m�vzi req GA� ��s� ��� P ma nas
Nme aPnn y'� Curren Mailing Address:
s Sia-3�7 4
Sign ure Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed bpermit applicant
1. Building 13,000 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee �T
4. Mechanical (HVAC)
5. Fire Protection 250
6. Total=(1 +2+3+4+5) 13,29-0 Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
i
ryBBuuuliM/i� Com loonn/erllnsspectorr of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
'N—column to be filled in by
Building Depemnent
Lot Size
Frontage
Setbacks Front
Side L R:—
Rear Rear _...
Building Height
Bldg.Square Footage
Open Space Footage
C,otarea minus bldg&paved
apuking)
#of Parking Spaces
Fill: _.. _.
volume&Imanon -A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
IF YES, describe size, type and location:
E. Will the construction activity disturb(Gearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 8-CONSTRUCTION SERVICES
81 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Mark DaY)au
Licenae Number
75 Gilbert Rd Southampton Ma. 01073 CS-058785
Kid... Expiration Date
Ill e
9/9119
Signature Telephone
4135323473
B Realsterod Nome Improvement Contractor; Not Applicable ❑
1 iso 4-1
CwtityNams
Registration Number
Ay.��1�7G TcESTOe \01.� �QO JP (t-1 —%S
Address t�((��ff M Q Expiration Date
69 GAG,06 S'r (} OLOL3TelephpneAt3 Z2 3473
SECTION 18-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.152.§25C(6))
Workers Compensation Insurence 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 permt.
Signed Af idi Attached Yes...... 40 NO...... ❑
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑✓
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks I0 Siding(D] Other[QJ
Brief Description of Proposed Small Ore caused damage to inside of garage.New roof,drywall,garage done.
Work:
Alteration of existing bedroom_Yes X No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes x No
Plans Attached Roll -Sheet
ea.If Now hole"An I or addition to axistina hadahta rwmolata the followin :
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?
J. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodsloves 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
I, ,as Owner of the subject
property �J
hereby authorize �g iela I (�� /SgyST�G
to act on my behalf,in all matters relative to work authorized by this but ding permit application.
Signature of
f�Owner Date
.
i, I ' P,2 r O I l(�/�l(-")Z' ,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.
Signeq a der the pains and penalties of perjury.
mato M 21
re
e r �
Signature of OwnerlAgent Data
City of Northampton
.tet Massachusetts ass °e
G
S
\ G DEPARTMENT OF BUILDING INSPECTIONS Z :T
212 Main Street • Municipal Building Ca
\ ' No[Nav¢[on, HA 01060 `yjd5
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, afteretion, 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 unifs....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:If the homeowner has contraac�cctJ
ted with a corporation or LLC,that entity must he registered.
Type of Work/smFASTogt AWiaO Est.Cost: /3t2S0
I
Address of Work: /S 93,'l[.C4e P1--
Date
7LDate of Permit Application:
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 ENTERING 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:
p7plor L,i 9d i S-0 V7 g
to Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
The Commonwealth of Massachusetts
Department of Industrial Accidents
7 Congress Street,Suite 100
021
Boston,MA 02774-2017
www.massgov/dia
Rorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Lesibb,
Name(Business/Organiv tion/individual): STATE ..Srlxpgr o ebaie
Address: fol 60e11/E S-r- C7rf/j"Pee MA Old) '2
City/State/Zip: Phone#: �/3 S 3 Z 5,173
Are you an employer?Check the appropriate box:
Type of project(required):
Tlamaemplocrivith �� employers(full and/or pen-time}" 7. []New construction
I am a sole proprietor or paroership and have no employees working for me in S. [] Remodeling
any capacity.INo workers'comp.insurance required.)
3[]I am a homeowner doing all work myself [No workers'comp.iwarance rtyuimdd' 9. E3 Demolition
q.[]I am a homeowner and will be hiringtmetors to conduct all work on 10� Building addition
con y progeny. 1 will
e mat all contractors tupne
es either have woe 'compensation inseor ee.mle ll.[]Eleehical repairs or additions
prsmoporio s with no employee,. 12.E]Plumbing repairs or additions
5❑ m nn
I aa general coector and 1 have hired the mb-cuhuc
ntors listed on the entered sheet
iumrai r--');tr[ycf r¢pairs
These sub-conhactors have employees and have workers'wmp.
h[]Weare a corporation pairs ofllcem have exercised their debt decoration per MGL c
152,§hr,and we have no employees.[Ne workers'comp-insurance nyuir d.]
'Any applicant that checks an.pl most also fill out the sceuon below showing their workerscompensation policy information.
t Homeowner who submit this affidavit indicating they are doing all work and Nen hire outside contractors most submit anew affidavit indicating met,
tCornractom that check this box must attached an additional sheet showing the name of the sub<ontmctors and state whether or not those entities have
employees If the sub-contmemrs have employees,they must provide their workers'comp-policy number.
7 am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site
information. M
Insurance Company Name:
Policy#or Self-ins. Lic.ifFL'L IA^J(7 yAD D k'77ani SW Expiration Date�/
Job Site Address: /S III-L eie rl- city/State/ziptAtil"
�Wrooskl /PI`} OI000
Attach a copy of the workers'compensation policy declaration page(showing the policy comber 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 venftcaf n.
I da hereby e ify oder the pain enaInes of faced that the information provided ab ere i true and correct.
Si store pp ` r� Dat.
J _3q75
: ab t
Phone#: ' J -J 73
Official use only. Do not write in this area,to be completed by city or town ofel
City or Town: Permit/Lic nsc#
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#:
City of Northampton
' Massachusetts
a. s
, DEPARIMENT OF BUILDING INSPECTIONS � .a
m
212 Hain Street •Municipal Building
' Northampton, NA 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, 554, 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:
/S t3✓rLEG YLf/Q�
(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:
lC��✓BLIL &A,)tLQ.S olfc.o�Q-
(Company Name and Address)
Signature of PernA Applican 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.
HOME IMPROVEMENT AGREEMENT
aystateamr.eona.nup Phone: (413) 532-3473
This AGREEMENT is made and entered into on 120 by and between.
Homeo r Inf rm 'on("Owner") Contractor Information Name (`Contractor')
Name: MA LH✓k' Cpd Company Name: Baystate Restoration Group,LLC.
Street. dress(No P.O.Box): Contractor/Owner: Mark Daviau,Manager
S Street Address: 69 Gagne Street
City/'Sown ,Q/AKTF ff1r- ldA) City/Town: Chicopee
State fVj$V Zip Code. Dl0 b D State. MA Zip Code:01013
Last four(4)of SSN or FIN No.: �! Federal ID No: 47-1852658
Homel'Im— Z03 2-46 fa06L Salesperson: rnf�lD rn�.�l
Cell Phone: Contractor Registration No: 180478
Work Phone: Registration Exp.Date. November 30,2019
WORK TO BE PERFORMED;MATERIALS TO BE USED;SPECIAL ORDER MATERIALS;PERMITS;AND TIME
LINE. Conmemr agrees m perform the work for Own,, as further derated on Exlilbit A, which is attached hereto aid
incorporated herein Exhibit A also sets myth (b the materials expected to be used for the project, (u) a list of all special order
marecals that need to be received pdor m rhe commencement of the services to be provided by the Contractor;bs)permits inquired,
(iv) the schedule for the Contractor's performance;(v).,mart,a,if any;and O any other contracts,exhibits,schedule,, plans,or
documents material to the services to be performed by the Contractor.
TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE
The Contractor agrees to provide the work,furnish the material and labor specified above for the sum of
$ 21,524.12 (I4tis amount includes all finance charges,if any).
Payments will be madj according to the following SCHEDULE:
$500.00lDeductible
$ 4,801.03 Due upon signing the contract,(shall not noceed the greater between 1/3 total
contract price or the cost of special order materials).
$ 4,801.03 Due at completion ofroof
$4,801.04 Due at the completion drywall
$_4,801.04 Due upon completion of paint.
$ 1,819.98 Due upon completion of the Contract.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
Twa identical copies rifts,cannot[mos[be completed and signed One copy,hould ger to the Owner,and one kept by the Contrera[.,
O ver: BAYS E RESTORATION GROUP,LLC
/
tinted Name',l, m"'luo a,. (;,a".nrvp4 eJ By(Panted sine): 11Y)Off!� /11L)
Date: 7--2 C Dare: -7�02(�
P" ed Name �S--
Date: 2L�G C.
Owner may cancel this Agreement if it has been signed by a party thereto at a place other than at the address
of the Contractor,which may be his main office or branch thereof,provided Owner notifies the Contractor in
writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than
midnight of the third business day following the signing of the Agreement See attached Notice of
Cancellation for an explanation of this right.
hila agreement s,objet[m the terms in comitans contained h—including those ser fora,on ecanv Schedule or Exhlbu references herein and
Mose located nn the¢verse side of any page of Mi,Agreemen[,a Schedule or en clo. it rekrenced heain Owvea h¢eby a knw(e'dges tut Owntt
nae re�ewea au Me amt,and rnnManm aria ag.ee,m bnnnd,nm Lerma aria rnndienm. own¢fNea1F� owner INoal�l !_
I