31A-295 (2) 86 VERNON ST r µ BP- 2012 -0907
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31A - 295 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit # BP- 2012 -0907
Project # JS- 2012- 001593
Est. Cost: $6150.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: THOMAS DOLAN 039281
Lot Size(sq. ft.): 5314.32 Owner: PHILIPS BRENDA J
Zonine: URB(100)/ Appikalti: "ii-la VAS i S L) L N
AT: 86 VERNON ST
Applicant Address: ,Phone: Insurance:
P 0 BOX 297 (413) 585 -0612 0 Workers Compensation
CHESTERFIELDMA01012 ISSUED ON :4/30/2012 0 :00 :00
TO PERFORM THE FOLLOWING WORK: EXPAND CLOSET,REPAIR PLASTER,DRYWALL
CEILING & BUILD BOOKCASE
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: ek Y— AO — l J
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: dec J i f-19 Ci
THIS PERMIT MAY BE REVOKED BY HE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND ' - r,. i►+
Certificate.of Occuilanci Si nature:
(t.4.
mop—
FeeType: Date Paid: Amount:
Building 4/30/2012 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : --- (40:y//,€j 7��,� - 0 F ,28 /
License Number
�,1t±:2p /.o U: oMz / 2 — 0 2" r)70/3
Address Expiration Date
/ L / / 5 7 9 7 / /
Signature Telephone
9.. Registered. Home 'improvementtontractorV., d,,. n.._. �,.. .,' Not Applicable ❑
% DOLikr/ 6Lov/Z°la (n hi/9/102 /a /9 l 0
Compan Name Registration Number
��. �5a6x 2 7 .!h P5 'Lh»1 /1�G� f f Z,, 20 / 2 _ Address Expirafion Date
Telephone aQy
_ SECTION 10- 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 ❑
The_ current_ exemption for "homeowners" was extended to include Owner occupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 1083.5.1.
Definition of 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.
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 pennit 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.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
o ... ampton er. tnanc - , ` a e r --o. Y
- . eneral: Laws .Annotated.
Homeowner Signature
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing n
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [D Siding [D] Other [D]
Brief Description of Proposed
Work: f .yank./ l AaSet /0 " / /Frzo, »W4/ . 0a/ wg/ Ce / � /,/ /d �ao /6 Ck s,
Alteration of existing bedroom Yes o No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
sa,:fif.New. o addition to existhi •hoi si iii ii tete7the.fol(ovviriq:
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 W ,
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, (3 k f k G(k 14 r /. /f r , as Owner of the subject
property
hereby authorize To g-i; Po /c
to act �/ on . y behalf, in all / GG matte/r�s relative to work authorized by this building permit application.
,. (
V ' /oC ` LZ
V/ / Z
Signature of Owner Date
I, ` /3h 24 K/ lea t 07 _ _ , as Owner /Authorized
Agent her y 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.
Print Name
Signature sf Owner /Agent Date
s •
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning I
This column to be filled it>~by
Building Department
Lot Size
Frontage
Setbacks Front
Side L.!_.. _ R...___._< L: _,.___.. R
Rear �.
Building Height
Bldg. Square Footage
Open Space Footage °
(Lot area minus bldg & paved,.
parking)
# of Parking Spaces —
Fill:
x
(volume & Location) -
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW Q YES
IF YES, date issued:'
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES
IF YES: enter Book Pagel and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained I Obtained , Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location:
D. Are tere an proposed changes to or additions ofsl is intended for the property YES 0 NO 0
Y o P j P >; g P P Y?
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO 0
IF YES, then a Northampton Storm WateriVianagement Permit from the DPW is required.
4
E V E Ci of Northampton ti f
B Tiding Department C �8+errrt�t
APR 1
8 ?��? 12 Main Street Sew Set� tAi�t[�
Room 100 ,ao ; r t Avatla 111' fiI7, xi�;F HfiT n
No hampton, MA 01060 T UO e? t ° : -, .: ra , wa �� . 7
- phone 413 - 587 -1240 Fax 413 - 587 -1272 1:'iotiS a s� - � f - ' t
Othfer Spec p " , : : : 5
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1- SITE INFORMATION
1.1 Property Address: This section to be completed by office
Ye Pe,‹v / fi Map Lot Unit
Zo Overlay District
/1/f /? ,7 a,Y�.�I7 /7
EIm, District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:r L
(�( 6KE— .1_ � � . _ _. _8 _ V f ! ' !? G j .[ - ` (,/f/ , .ILt u / tr__
Name (Print) Current Mailing Address:
y l — JaE 7dt�
30 i✓ t --W 1 i I Telephone
Signature
2.2 Authorized A ent: /
M e / /i tv ?,, SUQjp ? 6hejfeefr /e// /�G, DI�7 Z
Name ( P Current ailing Address:
y G 1:2%____-- 1 //3 -2 9'7 S/6
Signa Telephone
SECTION 3 - .ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building 'Permit Fee
6 /r0. s ' ✓
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire. Protection
6 Total = (1 + 2 + 3 + 4 + 5) 1 J5 °c Check Number 7 5
This Section Fo Official'Use Only
Date
Building Permit Number. Issued:
Signature:
Building-Commissioner/Inspector of Buildings ... Date
File # BP- 2012 -0907
APPLICANT /CONTACT PERSON THOMAS DOLAN
ADDRESS /PHONE P 0 BOX 297 CHESTERFIELD (413) 585 -0612 0
PROPERTY LOCATION 86 VERNON ST
MAP 31A PARCEL 295 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ,' 3 3 3
Fee Paid
Typeof Construction: EXPAND CLOSET,REPAIR PLASTER,DRYWALL CEILING & BUILD BOOKCASE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 039281
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF01RMATION 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
Demolition Delay
/J f 7 -b I2
Signature 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.
86 VERNON ST BP- 2012 -0907
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31A - 295 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit # BP- 2012 -0907
Project # JS- 2012- 001593
Est. Cost: $6150.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: THOMAS DOLAN 039281
Lot Size(sq. ft.): 5314.32 Owner: PHILIPS BRENDA J
Zoning: URB(100)/ Applicant: THOMAS DOLAN
AT: 86 VERNON ST
Applicant Address: Phone: Insurance:
P 0 BOX 297 (413) 585 -0612 () Workers Compensation
CHESTERFIELDMA01012 ISSUED ON:4/30/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:EXPAND CLOSET,REPAIR PLASTER,DRYWALL
CEILING & BUILD BOOKCASE
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 4/30/2012 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner