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32C-212 (5) 41HOLYOKEST BP-2019-0762 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:32C-212 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Catecorv:ALTERATION BUILDING PERMIT Permit# BP-2019-0762 Proiect# JS-2019-001246 Est.Cost:$75000.00 Fee:$465.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: LEARY BUILDING COMPANY 104806 Lot Sizoso.ft): 9104.04 Owner: SHERR WILLIAM Zoning:URC(10o1/ Applicant. LEARY BUILDING COMPANY AT: 41 HOLYOKE ST ApplicantAddress: Phone., Insurance: 13 GLENDALE WOODS (413) 336-2611 SOUTHAMPTONMA01073 ISSUED ON.•2126/2019 0.00.00 TO PERFORM THE FOLLOWING WORK:CONVERT SINGLE FAMILY TO TWO FAMILY 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: Cas: Fire Department Fireplace/Chimney: Rough: Qi 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 226/2019 0:00:00 5465.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner N C,61) 5 PUT PLAN DECK File 4 BP-2019-0762 PLA05) 5E6 EMML / PLA-3 N0-r6S APPLICANT/CONTACT PERSON LEARY BUILDING COMPANY SACK uNtt 5f`0K6/C0 VEfL ADDRESS/PHONE 13 GLENDALE WOODS SOUTHAMPTON (413)336-2611 cuRREr-r' CO U PROPERTY LOCATION 41 HOLYOKE ST JEF rM AI (I 1 Ilk II MAP 32C PARCEL 212 001 ZONE URC(100V 'A t PtiL THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST REQUIRED DATE ZONING FORM FILLED OUT EN Fee Paid Building emit Filled out Fee Paid Typeof Construction: CONVERT SINGLE FAMILY TO New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 104806 3 sets of Plans/Plot Plan THE FOW.ONViNG ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INIF9111MATION 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 m 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 emalil'a Delay zzz 2-26-Zo19 Signa ofBw mg 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. I Deparmw+a usa m+y City of North mptgNECEIBuilding Dep rtmerrt- yPemlit 212 Main reet�! Availability ermit Room1 0 DEC 31 1Availability Northampton, A 01060 Sauclu al Plarre phone 41&567-1240 F 4 rA'ITHAMPION,' APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SffE INFORMATION �olk".5 1.1 Pmperty Addnass: This section to be completed by office of t 0'1c.ec ST �oRTNAMyToN MBP— Lot_ '�c� Una Zone Overlay Dlafdct Elm St.DYbkt CBD'mtrict.___ SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 21 O/snip,r of Record: �"' WILLAA" �ne rtf JAMt hS Ag-vr. Name(Ruff) ,r �. On�CIT ALIR' le7.�L _ .ate rre Sgnature 2.2�Autirorbad Aaent J(M /rRe 1 1� licueu& 4)-.Ps nay &)vwA*P-^- Name(P f Cumin�t -e"`Aditw ILI'It TBr ' SECTION 3ESTIMATED cc"mui cam - gem Estlmated Cost Polars)to be Official Use Only leant 1. Building qO 460 (a)Ruii Permit Fee 2. Elecbical !/ (b)Esibma ed Total Cost of 2Q DOO Consbuction from 6 3. Plumbing 50 , 1)00 Building Permit Fee IvLi-, 4. Mechanical(HVAC) 5.Fina Protection 000 6. Total=(1 +2+3+4+5) ,S 666 1 Check NuMc This Section For Official Una Only BuildingPermit Number: Date Issued: sigrrlsa: Z - Z G -2019 Bdlrq CommiesiaernnspaGor d&ldips Dam �M4 / .FAQaDQUII.D lr - z.y� EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) [aq:+;: YQ,JKfi82 (i:5[.^;•ryKioi:' cI1HELS H'' t+ki'l hlSiEr' .^.'i '[}}7�.tS t'L'30t,i a'4e w Ws.:ua e«:m i ;F Section 4. ZONING All Infomlation Must Be Completed.Pemlt Can Be Denied Due 1'o Innmryhte Infomletlon Existing Proposed Required by Zoning Thisc unnn to h fled in by Building Oryenn ant Lot Size Frontage Setbacks Front A Side L R: 6:L R: 0 0 Rear �- Building Height O Bldg Squirm Footage % L —� Open Space Footage % (Dat even mala Wild&pawl �.. #of Parking Spetes Fill: yd.&Ircevim A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO & DONT KNOW O YES Q 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 Jam, and/or Document/ B. Does the site contain a brook, body of water or wetlands? NO f�Y DONT KNOW O YFS 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 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs Intel Med for the properly? YES O NO IF YES, describe size, type and location. E. Will the eonstrucbm activity disturb(cleating,grading,excavation,orkainlg)over 1 acre orb k seadda donation,plan that will disturb over 1 ane? YES O NO 0 IF YES,Men a Northampton Storm Water Management Penns from the OPW is required. {I:,IIC 11 a It? ,; a L Sqq ;=I 0 qt'JW :,j_ :,je spip ;a pe Op4m116o %L 41' PA 9 062' K- D -NEO 10 PG XL aJs "J' aj xiqx, m mew- x VO xv (-7 16 id 'JL; Ul aw An, PQ bum S-0 161 -1 090 "u-, IGUWVAJ GAGAIVAI G"L 4Wj A. W! Of WC nQ IIL- ---- ----- SC 77", O"u C. U, .0 SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicablel New Nouse ❑ Addition ❑ Replacement Windows AKeraflorKs) Roofing ❑ Or Doors O Accessory Bldg. E3DemdKlon EJ New Signs IOD Decks I[] Siding POI Other I[:I Brief Description of Proposed Work: j! 1pkvtTf -M TOO 9tM1W UnAA✓ Alteration of wasting bedroom_Yes X No Adding new bedroom Yes K No Attached Narrative Renovating unfinished basement _ Yes —,J_No Plans Attached pull -Sheet sa.It New house and or addition to existina housing. complete the following: a. Use of building:One Family Two Family Other b. Number of moms in each family unitNumber 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 a Woodstoves Number of each g. Energy Conservation Compliance. Mas:%heck Energy Compliance form agached? h. Type of construction i. Is constructor,within 100 ft.of wetands? 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. L Septic Tank City Sewer Private well_ City water Supply SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BALDING PERMIT L as Owner of the subject properly hereby atMorize to act on myaiff.in all matters relative to work aulthoraed by this building permit application. Signature of Cwlt Dile I, .t,= lays/ ,as OwnerfAumorized Agent hereby dedere th the statement and Information me foregoing application are We and accurate,to the best o1 my knowledge and belief. II Signed under the pains and penahies of perjury. Print Name 0 SignaW ofl Def - _ . 9 uK C)N:6tlC 10(f tl, C2 x4K S��1'OIN@bkN4'+�S °:'.0 ,z.Nf.yS...:H6P:iSV'310N - n:' gf. '..OWh'FdEO MP.. q I I I C !i :'S ^ � �t'iv8 9Uq OL 3tjT(1�1pt!(O f{t3(Iyt(��TO�tU�CL�i}-}�n (kG l�;�O.M:blr �,.w0 .id 4 ) 0'= a,L.f _.. ,el 117 I ., :.'• y:{1iµ:=^; � � y(cb � luc.=f N uac v . .;,� vvl { �.: ut I �Fr'.�i!`r �i�`LC iso�T�N Ot.Fr3�6Q fC 4'.�Hl'cN37rL �$��3b-;j'^.ifi r SECTION 8-CONSTRUCTION SERVICES M Licensed Construction Supirvisor: Not Applicable Maine Of Li�"Okler � i r oc-I Loadlialkimber 3 (2(EUDAGE cJmos De �o f,�AMP n� 7 11 2 U E)Vmdon Db / Tsltp S.Realstersd Home Improvement Contractor: Not Applicable '.8 �FAr70 /'Juiulid la In __ i 1 ;�U� Number /Z �(E,.�fla� f.r.,f,es Ja. SOp%tl6MDiLN i -z c, Address Erpirabw Data Taleplos / /al SECTION 70.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(IA.G.L e.784,S 2SC(8)) Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit w1l result in the denial of the issuance d the buildrV permit. Signed Affidavit Attached Yes...__ No... C 2!'a.1...'P t. ';-iK'•['o ::'F! ;Nde .,/ ,.. S: Vtklpr?, v ? c �� a �r,1a� City of Northampton I4nusachunetta c t LamlHffiBr Or BUXLnLC LBBPE GKS 2121 in tux t AMmiuipal Building aortE.R ' b 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 I lome Improvement Connector("HIC"). M.G.L.Chapter 142A requires that the"reconsimction, alteration, renovation, repair, modernization, conversion, improvement, mmovat, demolition, or construction of an addition to any pre-exisarg owneroarspiad balding containing at least one but not mons than four dwelling unds.._or to stmctums which am adjacent to such residence or budding' be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity most be registered Type of Warlr Q(,z',2ATtDAS _____ Est. Cost: S axe Address ofWmk: to u6u/t3I.'.E /1/o2evi r(MP7au T ' Date of Permit Application: I hereby certify that: Registmfion is not required for the following reason(s): _Work excluded by law(explain): _Job under S 1,000.00 Owner obtaining own permit(explain): I _Building not owner-0ccupied -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.CWprer 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: 1 hereby apply for a building permit as the agent of the owner. Date Contractor HIC Registration No. OR: Notwithstanding the above notice,l hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature V... . "'P.Or All, yl ;cqr hl r.l ^t1'd V:{' t1r E4S ??{F 71t if i>:.'C bt,K11 ,f 1 MK i':Qk;Y i. l )fr tli 1.10" '01 A}Lr 111 ^ClI�I1?11 ' ; r+e, + t ii OKP s.( 'XI al ,", 9I,( 1 /%_i+r1Hk 'OtiKtiKY 0, Ill If "i, IA IAL OV a±'/f7K .,f d?t titi2 i'Of lti}.1If IMV 134: •,` 1 Af xOt r:it. Uh , 1:. (Ykl'!I✓'.l:t fif! 11,(t>f.-.r to 6JY ! t ; F;AU 6tVi' I-:;ran t/i.KY- _:P •e1W l`4rCV-11 I'4 r` r�4 yr Vl'o1 I . r ' f '.l.i. 61 K-dtl'll _..o' ,, .ca01 { .{:cs :.ou_..�'[k .LG.. .1a•d cu ,. , rc ,m : v _,.,i ,c _. i. .. ..._.,row iw4,m uK f<w el 91 'a,umrru cv{ n t , n: jn4irlavueu;Lu],ei nrf; ;b}rifc,uQu[r 1 iryur. linlluli.�mcl too:r:rcPa:. i'su ufkill'!lJJ. MB Vll U.Wlnl Ql. UOISL d ?t'e' Oiz �4 • i::7t'7S O� 'v1i:L�Nsuil�F'Ou City of Northampton �f // Maaeachuaettn . � U&P11nDffiR' OP BUILUIBC IBSPZ=MS �_ f 212 H St t B Idip J� Bo.t-o tm, M 01060 Massachusetts Residential Building Code Section I IO.R5.1.2 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, 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 homeowner. Section 1 IO.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR I I O.R5, provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner shall act as supervisor. Such homeowner shall submit to the Building Official, on 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 job 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 (Workers' 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. alu to .;.I. iPit i! ,, r, o,. "ab!oi�J.' Ir , 1..',InJsc I � s..l,:� ❑ .:-.r!nl to ll•-;or if Ir, �j, , , lar. r:rl a til' it ..r,,r�r. . it { !:r. ;�, l 1, , .p';.�. , .. urr:r.,,..1 n• ; G .Lf'; . _ 1;1 a,nru:. ffln) nbcm ,nrli,�-.aln;a .. rar u.i,r.I r aILI' ,- , 9u%,.. IC. ')Q I ifil, (W i! ,.!, . ,��;, Ex i, dta u! nL.)Ij! I pl LLr. Ivuur,j n i(jiII ;yr p,jgi 1,,- ,Uu a.. !j cr j'f T) 7prl..-Wr Ip., .r1IU .':r.i1L1 A TJ, ri. 4Lt?rI- r ' .r.' ru` b�.r .u,c"• s ".r:!,' �0'!!� i».r.a l' ar fp 1, e pu,mc 1 _ . /nJ i ;ua�-r;r,ln 1,,.��c,.EJI ,�.r ;, .. �r- p .; u+ ,� � .�r. t;�c:I,y 1 � . '� ;uq � 5y U� ;,r •r � iwl;� zr IIM',> 7rc 'Zdor r. fo p ,cauwT. 'If ITWeD-MP',(I' V1_ - ,u, III In ,_t!? :,wLr .P.; rrir, n, r : I�75.14 MIf 1' it. C-1; rl, pr, , 14-- U+. Itf .91J,.�% alt Illy ",..'•f * C I OC I.PY.U'l I') '-,LIf!f- yj`G ".a �,fUtr('( !�6J1('GU;1-.i; i1'dlr ill. fi:'i N iCY CL c. Ht J021. � � isYYY>8'H A �CPUI u£".Sl$ip r� q yl4aacc�ra2.{'x r;r4:}. of p c L pli crirbI- ,u City of Northampton tessssohueetts �aaa®r w eouoakc �cws ; 212 Ms - St t B Idl g M pry rr ee�� �r rr rF�MrrmMM+Rt ' im 010" In accordance of the provisions of MGL c40, S54, 1 acknowledge that as a condition offt 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: ,Anw'vE �T ase print h (Plenumber and street name) Is to be disposed of at: `I LI I r4 QEl' Ple print nGaLCofS �gJ facility) Or will be disposed of in a dumpster onsite rented or leased from. (Company Name and Address) Signatube of Perm' cant c er 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. W�soq 'vu.sc-5714 el IF Ti P (.I _ 'f.'J ✓J � , ,Inti ) 16..:jktq ' a��i v.r 1. _ -tr n:e:c vPVIY .^^. dC n :. c+,•.rca. s. .. Co;l ! c. fLd6 � .. . Y3.,1 •. . Oli The Commonwealth of Massachusetts DIndustrial Accidents I Congress Street,Site 700 Boston, MA 02114-2017 wwrv.massgov/dia Ukkers'Compennation Insurance Affidavit:BuiMerstContmctora/Eimtricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print t e ibly Name(Bmincss/Orgmi/ati(mOrtdividW): /"e Address: IS /.�..oac_ /.,}raos Da OtY/Statc/Zif) AA blo Phone 0: Are, .....pFya!Clerk On pr.arhac hoc Type ofproject(reguired): 1.❑I soon n wiwo,wA nlployco(foil nada part-sawt. 7. ❑New coostrmtimt 2.❑I sm a sole",va nm putnanisip.M have on employers w ins for on,in g. lQ'Remodeling ally a ondy.INo woflu,M'camannum en iec no to rd.I /u�, 3.❑lem•Molmwmv dome+il pork myidr lNa wakes' 9. Demolition w�.4�arequired.I' 4.❑I am a homawar W will be how,conhactors on c oct all wmk on my no", I will 10❑Building addition ensure that ft coMrsov.enter have workers'con,nnu ion rtw..nuo or are sole I I.❑Electrical repairs or additions v`nvnano wnh no Moons. 12.❑Plumbing repairs or additions SCI I an•gveml wntrwlor W I have hired the subca uonu rs Bard on W eructed ehaa_ tb� 13.0Roof repairs wbcanaxtars haveeoploy sn W have w .*co" m lnarce. �We.eacapnmon Win oflioes Wve cxocisd dwir riglvofexengnon pe MGL.. 14.❑Other 6�jAQp 132,§Il4k W wn have no cnn kr .(No wakai mat.imumac re uilm.l 'Any applicant aur chats box MI mat shsn fill ore the senion hebw stowing onto worteos'canwmwtion polity in6xoo.tiun. f Hwncowars who subvm Mrs affidevn mdiMing Ney arc Mid all wort W cher hire nunide meuauus must sudnit a ouw and.n mdienvlg such_ TCMIIactnR aYl that th6 hnx Ima amflCd en addltl0�ul shM 5hawing aK M1VM of I14 SYb<DatraelnR W SIaLL whither IX M1M IIgS¢Cm11C5 MV¢ employed. If lhe.ubcunlmcmrs Mve ernpMyaz,Ihey mlm Provide Ihcir waken'wow.polity number. 1 am an employer that Lc providing workers'compensation insurance for my employees Below is rhe policy and job site informaaan. Insurance Company Name: Policy N or Self-ins.Lia M: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compeasation policy declaration page(showing the policy number 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 5250.00 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,certify r e peva/lief ofperjary that the information provided abort is ore and correct Si ature: Date: a is Phone q: off cid ase only. Do not write in this area,to be compiered by city or town official. City or Town: Permit/License B Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.Cityrrown Clerk 4. Electrical Inspector S Plumbing Inspector 6.Other Contact Person: Phone p: i! 6 i 1 ...p 1 l .tiv 1m ,•. II - O �- V,e n:.n'\f(n nu UV v.<, i \. \'. ✓v v(ls.tm, i0 1 .i'i ,r ,.Iv:LI;u+ Nylr�i o{lwtic '.\1f•1l 4iMuuu9aubw Sq•y.ay,.. ay.Vs:.,uat',,.ucq yw:Vp Ot •r. Faf V.pc(\IYI ,. ._ ,ve c)l,r. :.• a I.a wi .'al:Pb ft �i 1p(?'-: !r'tr -.t, 1 .:1q'I ,.T -'.' 7irl ra„ of'Y Ir xne.r..". rwlbanaxltiu bl,uei ns�ra.aq. 1 bell,.r-.p•1w IN6 tpg Wj!0 -UwPA, :ulrt gefel {«m \::,p0.•:. {uu +l,tnle p. =,nC>.v.wolf.�N�u;'.V,\solo,;cc(v\I'm .',m 1. !, „ ..... tp,.bury,,:,.aru}hiy.,le Yu. If I - ' " CI vl - I i t 11.,n.. p rp..agn L ry ,mr l..i'<.t ;CL*.i 1'.rinaGrl; tO NC F.:Pt-ir lr(,Ui.;71V b(MAILI / , Ili 111081.11' ,e"r.rs\a, �,aub•wo-:w:an jo,t inG rjLlgfj,q;gnll9cv,Cuu1\wclou�,kicr.utrd:,u.,gmnp.•:.- x.N'.w Ypll'lC1•if'.n.p5� - (jryllr,U',TCtµS11d-iU11 - : (o\\lisszx ytuct' jng�, tOt1 llrbw,.t{useu f\}�u,in2ttlu(•�{�s�,\!t\v. �Frmv. 153 The Commonwealth of Massachusetts DIA Use Only Department of Industrial Accidents Office of Investigations-Dept 153 t Catqua Street,%ke 10&&,stop,Massaeimests 01114-2017 bttp://www.nusagov/die- IRVOtAVIO mi: AFFIDAVIT OF EXEMPTION FOR CERTAIN CORPORATE OFFICERS OR DIRECTORS Chapter 169 of the Acts of2002 amended M.G.L. c. 151, ,¢1(4) by adding the fallowing paragraph.- "This aragraph:"This chapter shall be elective for an officer or director of a corporation who owns at least 25 percent of the issued and outstanding stock of the corporation. Notwithstanding section 46, these provisions shall apply only if the corporate officer provides the commissioner of industrial accidents with a written waiver of his rights under this chapter. Said commissioner shall promulgate^regplations to carry out the purpose of this paragraph. Violations of this paragraph slmlf subject the corporation to the penalties set forth in section 25C." RlrsuanT to M.rr.L. c- 152,. §1(4)as aotendeci, i/Wr. the undet�igned offtcers of Leary Building,kw- IOU taut Mai"ain Road;Westfield.MA 01085 PisiCrOraYr rd Addwi each holding at least 25%of the issued and outstanding stock in said corporation, do hereby invoke the right to be exempt from the provisions of M.G.L. c. 152, §25A and therefore are not required to carry a workers' compensation policy covering the undersigned corporate officer(s)or director(s). I/We the undersigned do also waive any and all rights to make claims for benefits as defined in M.G.L. c. 152 for any injuries that may be sustained while in the employ of the above-named corporation. Further,Uwe the undersigned do understand that,should the above-named corporation hire or have in its employ any employee(s)in addition to the undersigned corporate officer(s)or director(s), said corporation is required to obtain workers' compensation coverage for the employees)as prescribed by M.G.L. c. 152, §25A. I/We the undersigned have read and understand the statements and obligations as delineated above and - I/we have checked the appropriate box below my/our name(s) indicating my/our desire to be e9wript.or not to be exempt from the provisions of M.G.L.c. 152. Signed unkler the pains and pesillies of perjury: .-- /_ T'arnnry A Leary,President 0711IY2014 Prise Name&Title __— Ds!(messhdd/yyyy)_ Q Imy rightoexanption or Q I wish NOT m exercise my right of exemption Signature. PdntName&Title. Date(mm/dd/yyyy) F1 I wish to exercise my right of exemption or ❑ 1 wish NOT to exercise my right of exemption siputme pint Nerve At Tide Dere(mm/dd/yyyy) rl I wish to exercise my right of exemption or Q t wish NOT to exercise my right of exemption Signature Print Name&Tide Date(mm/ddtyyyy) 1 wish to exercise my right of exemption w ❑ I wish NOT in exemise my right of exemption N, AJ&EUGreLE CORPORATE 0MCERS MUST SIGN, THERE CAN BE NO MORE THAN 4 SIGNATURES. INaerrrfr)OHa `ost becA. Farm 153-7rtn1e MY Of Louis Hasbrouck<Iasbrouck@northamptonma.gov> Re: 41 holyoke st 1 message Louis Hasbrouck<lhssbrouck@northamptonma.gov> Fri,Jan 11,2019 at 5:19 PM To:tim@learybuilding.com Cc: Kevin Ross<kross@northamptonma.gov> One more thing; You can get started as long as you understand that you'll need to figure out how to meet code for fire separation. Once we go over it next week,we'll issue the permit. Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg (413)587-1240 office (413)587-1272 fax On Fd,Jan 11,2019 at 5:16 PM Louis Hasbrouck<Iasbrouck@northamptonma.gov>wrote: Tim, A few things; We need plans and a plot plan for the deck/stairs/egress on the back of the building;it looks like there's plenty of room but you need to show setbacks (20'rear and 10'sides). Both units need current code smoke and CO detectors, including the basement as part of the 1st floor unit. I've attached the code pages for 2 family fire separation.The wilings/floor separations need to go to the exterior sheathing,the vertical separation needs to go to the mof deck at the lop and to the 1 st floor ceiling on the bottom and the 1 at floor walls under the 2nd floor unit also need to be rated. I highlighted some of the specific code sections. This construction part of this job is going to come down fire separation/fire backing details. Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg (413)587.1240 office (413)587-1272 fax On Thu,Jan 10.2019 at 10:21 AM <tim@learybuilding.com>wrote: Hey Louis, Attached are the plans for fire separation for 41 hoyoke at. It's pretty straight forward,with adding hardwired smokes and fire rated drywall. Hopefully this is sufficient, I'm not much of an architect. Anyway, hopefully we can get this underway so I can keep my guys going. Let me know if you need anything else, and thanks! MY of Louis Hasbrouck <Iasbrouck@northamptonma.gov> Re: 41 holyoke st 1 message tim@learybuilding.com<8m@learybuilding.com> Tue, Jan 22, 2019 at 11:19 AM To: Louis Hasbrouck<Iasbrouck@northamplonma.gov> Cc: Kevin Ross <kross@northamptonma.gov> Hi Louis, I did get the email,and I'm putting together the plans for the egresses out the back with the proper setbacks. I should have them finalized tomorrow for approval. Sorry for the late response -Tim Leary President Leary Building Company Inc On Jan 22, 2019,at 10:53 AM,Louis Hasbrouck<Iasbrouck@northamptonma.gov>wrote: Tim, Did you get the email with plan notes I sent on the 11th? Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg (413)587-1240 office (413)587-1272 fax On Thu, Jan 10, 2019 at 10:21 AM <tim@learybuilding.com>wrote: Hey Louis, Attached are the plans for fire separation for 41 holyoke at. It's pretty straight forward,with adding hardwired smokes and fire rated drywall. Hopefully this is sufficient, I'm not much of an architect. Anyway, hopefully we can get this underway so I can keep my guys going. Lel me know if you need anything else,and thanks! q' ; — I L. RoeeR ,buT IwWOti fWNW.'r^ls kT eolu f+*s 6 -VIAS o,, 4l., Jo /oar-! p.rtt CEUCI � PNLs iuvax+cVvc � t F17.;- V &f$-VAS 1 ur (p IwoCs lupN KDUT ' FI NIti itl't � I � ya� ol�l V� lilll,( it II_ , �III_� .., �IIII _1'�, I ; i• i -_ sm U�T JA