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23D-174
BP-2023-1418 30 BAKER HILL RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23D-174-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1418 PERMISSION IS HEREBY GRANTED TO: Project# GARGE/ADDITION/PORCH Contractor: License: Est.Cost: 170000 MATTHEW KOZUCH CS-106644 Const.Class: Exp.Date:09/25/2024 Use Group: Owner: LLC ANKUDOWICH MASS PROPERTIES Lot Size(sq.ft.) Zoning: URB Applicant: MILL RIVER DESIGN BUILD Applicant Address Phone: Insurance: 30 BAKER HILL RD 4133418893 WC2-315-624269-013 FLORENCE, MA 01062 ISSUED ON: 11/01/2023 TO PERFORM THE FOLLOWING WORK: BUILD NEW 20X30 GARAGE AND NEW 12X28 ADDITION AND 10X20 PORCH 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: .7/17 Fees Paid: $1,105.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner File #BP-2023-1418 Z-0 1� APPLICANT/CONTACT PERSON:MILL RIVER DESIGN BUILD 30 BAKER HILL RD FLORENCE, MA 01062 4133418893 PROPERTY LOCATION 30 BAKER HILL RD MAP:LOT 23D-174-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $1,105.00 Type of Construction: BUILD NEW 20X30 GARAGE AND NEW 12X28 ADDITION AND 10X20 PORCH New Construction Non Structural Renovations Addition to Existing . Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans/Plot Plan Driveway Grade% THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON FNIRMATION 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 Dem lition Delay e : i' ' Tict 10/ 13 a3 Si;ii ature of Building 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. RECEIVED p cfi A 2 2023 The Commonwealth of Massachusetts * Board of Building Regulations and Stan rds R Massachusetts State Building Code, 780 C DEPNo 434La To tis ;`'a` AL TY Building Permit Application To Construct,Repair,Renovate r Demolish a Revised Mar 2011 One-or Two-Family Dwelling This S tion For Official Use Only Building Permit Number: 1i 3 .. /y/ 3 Date A plied: • T X%Ofo I i/i/a3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1`�1QProperty Address ikk k 1 1.2�ss3ess�ors Map&Parcel Nu i -LA 1.1 a Is this an accepted street?yells >l no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: LSD LOD Zoning District Proposed Use Lot Area sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 10 30 6 2-5- zv SO 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zoye? Public Private❑ Check if yeses Municipal On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owns!'tkok I -- LV c-k Ff o i c .e. MA o/o6p Z Name(Print) 6`!� City,State,ZIP gakQdrAkt`t in 3141 $8$3 , ktllt'►Jere ,I,Cltit- No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) ❑ Addition 12K. Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: 6`j't1 Q ACI.J ZQ'.) 30 I S'ld'1 n QaJ' 2_ Q. /1e,w 12)t2 okd`pit04 -Y 1DXZ.o P°tst_� . NO w �1 )6LUJ GAL) Sonk Q, - ` g 9 sr-F. � at etk 1 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ (7 0 000 1. Building Permit Fee: $ Indicate how fee is determined: / ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees $ +j Suppression) Check No.al% Check Amoun . t.)�O Cash Amount: 6.Total Project Cost: $ 1-1-0 i 000 0 Paid in Full 0 Outstanding Balance Due: N 1ON 5: CONSTRUCTION SERVICES 15.1 Construction Supervisor `7j Supervisor License(CSL) Ja."'"CS-1666 r� q /Z 5/Z �t f��7Zl,��`h License Number ! Expirationa."'" Name of CSL Holder 3© Q\„i&e.c- \ \\ List CSL Type(see below) V No.and Street Type Description J� / Unrestricted(Buildings up to 35,000 Cu.ft.) V-10 C�. \C( "� )\ 0 f E s,`� R Restricted I&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding ` SF Solid Fuel Burning Appliances qv, \ c13 1`\K►( t(- jer 7SQ.c}uAkcti cap 1 Insulation Telephone Email address \1 D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1 ?LJZv7 \ 0t'\-Q HIC Registration Number xpiration ate HIC Company Name or HIC Registrant Name Z-S e pV\c c). cC16t`1 No.and Street` \l Email address City/Town,State,ZIP 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 p/ No.... ......❑ 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 Y 'l t hf V� �f S 1 ii (Li/id to act on my behalf,in all matters relative to work authorized by this building permit application. f a.k4 \ * 0 10/it/2-3 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained''AA' in this application is true and accurate to the best of my knowledge and understanding. 1"1,aA oZLiciA. I0/1/7 3 Print Owner s or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) I°9(') (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) 10' U Habitable room count r Number of fireplaces 1 Number of bedrooms 3 Number of bathrooms Number of half/baths 0 Type of heating system pfct� R'ir R.)Ct,ik,ct Number of decks/porches t Type of cooling system cCcc J r Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" CITY OF NORTHAMPTON SETBACK PLAN ' f MAP: /3 k LOT: 1 LOT SIZE: 100 IX 131,3 5 REAR LOT DIMENSION: (OO REAR YARD Z0 5I • 2c� SIDE YARD SIDE YARD r S��� goo FRONT SETBACK I C FRONTAGE 100 The Commonwealth of Massachusetts A 1 1, Department of Industrial Accidents ? 1= 1 Congress Street, Suite 100 � ��_ Boston, MA 02114-2017 ei: ..' www.mass.gov/dia 'Cearkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information ` Please Print Legibly _ Name (Business/Organization/Individual): ,Jj i//, f\.1V(' ti 1�e s /��y1 A4/ .. /C.i Address: .�O cs.k ' M t \ \.r! City/State/Zip: -F( U e t. ✓l L e MA (),a 2.Phone#: LI l 33 L/( ?1p"q 3 Are you an employer?Check the appropriate box: Type of project(required): I.[am a employer with_ ,3 employees(full and/or part-time).* 7. V[fNew construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 0 Building addition 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or arc sole 11.[Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.01 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[I Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.11]Other 152,§1(4),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. i.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 sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ll r Insurance Company Name: L-,1 13 tt'� i� \0 c^-\ C Policy#or Self-ins.Lic.#: �"�/L� - 1 r.) " (e z`11 1... C(� 0 1 3 Expiration Date: .5—/z / Job Site Address: 3 0 j� `1,11,\ ika City/State/Zip:ty P: cfOfeACe MA oI0a2Z. 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. I do hereby certiif�/y'��under the pains and penalties of perjury that the information provided above is true and correct. Signature: /�" ray f Date: la 7(1 /Z-3 Phone#: `'L-U - 341 88c 3 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#: QMAM� City of Northampton ,? V S:" Cam. Massachusetts ••? f DEPARTMENT OF BUILDING INSPECTIONS a a 212 Main Street • Municipal Building yvi If � Northampton, MA. 01060 ss v ',hoc CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 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: \icJ 1_L` e c c The debris will be transported by: Name of Hauler: jv ',I( kte1 1�srgvi iu;/ol Signature of Applicant: ��� -� .„A : 10443_.l