35-043 (12) 971 RYAN RD BP-2021-0082
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35.-043 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Deck BUILDING P E RM I T
Permit# BP-2021-0082
Proiect# JS-2021-000127
Est.Cost: $6000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: THOMAS MALONEdba RHI CONSTRUCTION INC 055236
Lot Size(sa.ft.): 19994.04 Owner: GOSMIAN DUTCH
Zonin : Applicant- THOMAS MALONEdba RHI CONSTRUCTION INC
AT. 971 RYAN RD
Applicant Address: Phone: Instirance:
128 RYAN RD (413) 885-9038 WC
FLORENCEMA01062 ISSUED ON.7/21/2020 0:00:00
TO PERFORM THE FOLLOWING WORK:ADD GROUND LEVEL 16X16 DECK
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.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 7/21/2020 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
G -D1G
a The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
t / Massachusetts State Building Code,780 CMRMUNICIPALITY
USE
BW ding Permit Application To Construct,Repair,Renovate Or Demolish a •Revised Mar 2011
�flrl One-or T K o-Family,Dwelling
- This Section For Official Use Only
umber: l, 5- Date Applied:
Building Official(Print Name) Signature VU TD-W—
SECTION 1:SITE INFORMATION
1.1 Property A ress: 1.2 Assessors Map&Parcel Numly
_..41 \ MGr1 CL
1.1a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(R)
1.5 Building Setbacks(ft)
Front Yard Side Yards' RearYard
Acquired Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L o.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ . Zone: _ Outside Flood Zone? Municipal❑ On site disposal system 17
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
O�•�ci. ' (c,.���n ff1 �.t1 �3.-rte, {� 0 �O(t, 2.
Name(Print) City,State,ZIP-
0%
No.and S Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ AccessoryBldg.❑ INumberofUnits I Other ❑ Specify
Brief Description of Proposed Work2:
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use 0*
Labor and Materials)
1.Building S 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: S
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Sureon) $ Total All Fees:$
ssi
�\ Check No. Check Amoun _Cash Amount:
6.Total Project Cost: $ ('� ,U U p Paid in Full 0 Outsiatt ing Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
ofs -ass ?--s i.
License Number Expiration Dote
Name of CSL Holder U
List CSL Type(see below)
No.and Street Type Description
�(0 U Unrestricted(Buildings up to 35,000 cu.fl.
R Restrictcd-1&2 Family Dwelling
Citymwn,State,ZIP M Mason
RC Roofing Covering
WS Window and Siding
SF Solid Fuel-Burning Appliances
�n I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(AIC)
ILLkT �kv +r �Gt b Isi;s v - o
Cr tr HIC Registration Number Expiration Date
HIC Compan Name orHIRegistrantName
(VANoNo�nStreet 1� ��°�` IY address
'�l1ti n�Oyol;L `1k3` � Email ss
City/Town,State, P 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.......... No...........O
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:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pairis and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's N(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an o%imer 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.sov/oca Information on the Construction Supervisor License can be found at ww%y.mass.aov/dns
2. When substantial work is planned,provide the information below:
Total floor area(sq.fr.) (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 1
Type of cooling system Enclosed Open
3. '`Total Project Square Footage"maybe substituted for"Total Project Cost"
i
i
The City of Northampton
Building.Department
212 Main Street
Northampton,Massachusetts 01060
Phone(413) 529-1402
Fax (413) 529-1433
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance with the provisions of MGL c40, 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_ _ _ _ _ _ _ _ _ _ _
�� :
Signature of Applicant: _ ___ ___ ___. ___ _Date._
The Coinmonwealth of Massachusefts
Department oflndustialAccidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www.ntassgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERNIITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(Business/Organizadon/Individual);
Address:
City/State/Zip: Phone#:
Are you an employer?Check:the appropriate box:
Type of project(required):
l.LJ
a employer with employees(full and/or part-time)' 7. E]New construction
2. I am a sale proprietor or partnership and have ao employees working for in 8. F-1 Remodeling
any capacity.[No workers'comp.insurance required.]
3.17 lam a homeowner doing all work myself(No workers'comp.insurance inquired.)t 9• Demolition
[�4.[]l am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition
ensure that all contractors either have workers'compensation insurance orate sole 11.[]Electrical repairs or additions
proprietors with no employees.
12.Q Plumbing repairs or additions
5.Q I am a general contractor and I have hired the sub-contractors listed ou the attached sheet 13.[]Roof repairs
These sub-contractors have employees and have workers'comp_insurance.: . oeP
6.❑We area corporation and its officers have exercised their right of exemption per IvIGL c. 14.E]Other. r4i0 V".
152,§44),and we have no employees.[No workers'comp.insurance required.]
Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then 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 subcontractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
Yam an esiployer Heat is providing workers'compensation insurance for my employees. Below is file policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lica.M n Expiration Date.
Job Site Address: City/State/Zip: ' T(Q .
Attach a copy of the workers' compensation 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$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 verification.
Ido hereby cerfify under the pains and penalties of erjnrythat th b1forination provided above is true and correct.
�% --� _ ,l
Sienature: �,,,,/ Date'
Phone#: �—`
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 Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Estimate
128 Ryan Road
Florence,MA 01062 Date Estimate#
6/4/2020 1769
Name/Address
Dutch and Caitlin Cosmian
971 Ryan Road
Florence,MA 01062
Terms Project
On receipt Cosmian Deck
Description
Degrade area where new deck is to be installed to create drainage away from house and try to keep away from new deck
1
Deck, 16'X 16'Pine,pressure treated decking
256 SF
General hand excavation
6 CY
Backfilling by hand
6 CY
Sona tubes
24 LF
Placing ready-mix concrete in columns
6 CY
Recycle fees
I Ea
Building permit fees
1 LS
Project material,labor,equipment,subcontract
Material,per job
Labor,per job
Equipment,per job '�r
Subcontract,per job
*Project Subtotal
U �
'Project Total
Total $6,000.00
We propose to hereby to furnish material and labor-complete in accordance with the above specifications,for the sum total.Payments to be made
as follows:half of full total upon acceptance,one quarter of full total upon the start of the project and the full balance due upon completion.All
material is guaranteed to be as specified.All work to be completed in a manner according to standard practices.Any alterations or deviations from
above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.
All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado,and other necessary insurance.
Acceptance of Proposal will commence with the home owners signature.Prices,specifications and conditions are satisfactory and are hereby
accepted upon signature.Rainbow Home Improvement is authorized to do the work as specified and to be paid as specified.
Phone# E-mail
Signature
(413)885-9038 tom@rainhome.net