Loading...
18C-169 (3) I � r'%%,Yrr _�L• Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR eglatration: 100364 Type: xpiration: 6116/2016 Private Corporatio THOMAS C.McCARTHY GENERAL CONTRACT Thomas McCarthy 3 BRODERICK ST Easthampton,MA 01027 Undersecretary r C F ssachusetts -Department of Public Safety gciard of€3u !ding Regulations and 5tandards,r* Con% ruction Supenisor License: CS-053221 THOMAS C-MCCOTH1i, 3 BRODERICK ST EASTHAMPTONMA `x pl ratao;i >rture+5s c?rer 05/23/2015 _,! r eft• ,,:+ ,t,.• % office of Consumer Affairs&Business Regulation SOME IMPROVEMENT CONTRACTOR Type: 1�eg#stration: 100364 �xpi ration: 6/16120 16 Private Corporatia THOMAS C.McCARTHY GENERAL CONTRACT Thomas McCarthy 3 BRODERICK ST _ Easthampton,MA 01027 Undersecretary Massachusetts -Department of Public Safety Board of Building Regulations and Standards License: CS-053221 THOMAS C MCCt 3 BRODERICK ST 10NIF EASTHAMPTON Expiration Commissioner 05123/2017 The Commonwealth of Massachusetts • Department of Industrial Accidents = j Office of fit vestrgations 600 Washington Street Boston,MA 02111 www.mass govfdia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectriciansiTiumbers Applicant Information Please Print Lezibly Name(Business/Organization/Individual): 14e""4-5 �� ���E✓2 t!!�� �cwt�'�t'rr��� „�b�j Address:2&0, ee W/ -C i r City;State/Zip: LrA i A.4 kild e ,_ Phone.#: q , UL S J{f Are you an employer?Check the uppropriate box: Type of project(required): 1.[Z-1 am a employer with q. I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2.n I am a sole pi oprietor or partner- listed on the attached sheet, 7. [ Remodeling ship and have no employees These sub-contractors have S. Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers'comp. insurance comp.insurance.) required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their I L Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ g eP mysclf. [No workers'camp. right of exemption per MOL 12.❑Roof repairs insurance required.]t c. I52,§I(4),and we have no 13.[] Other employees.[No workers' comp.insurance required.] Any applicant that checks box#1 mart also fill out the section bclow 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 anew 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 crnployecs. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and jab site information. Insurance Company Name: lVf'Z t% U 1�^5' L si l� �Gr-►�;�' "' Policy# or Self-ins.Lic.#: T& Expiration Date: } � job Site Address: 6 ik 8.7-i�:�'�� � V"� � � City/State/Zip:X641 1-1 11144`may /M 4-0/0,? Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a Cure up to 51,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WOFX:OPMER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. T de hereby certib,underr Ilse/pains andpenahies ofperjury that tie information provided above is true and correct. Sig aturc: ✓�" C1 %`'�"'t' Date: !ti ! S _ Phone 4: ' �.. ' 1 yl Official use only. Do not write in this area, to he coniplered by city or town off ciaL City or Town: PermitfUcense#_ Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 9:` SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: 1 Not/Applicable , (❑ Name of License Holde '/p1 e_1 4-r 191, C C rl it l t License Number 0-, IVIV,0t02 0.s -,;) J ­L47 Address Expiration Date Signature Telephone 9.Reaistered Hume Improvement Contractor: Not Applicable ❑ :96:!j oa e Cr MC- C A0? 6'cmedg ( �'c'�r, •c°, T� r /00.1(09/ Company Name Registration Number 1qn. 0SIG- ,�l Address ,r Expirafion Date 4 C r Telephone ills 5z2 7 Sjq( 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...... ❑ 11. - H me Owner Exemption 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 108.3.5.1. 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 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. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors E] Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [❑ Siding[!_] Other[I Brief Description of Proposed �A'W f Work: �:J4L IZ, _06E-i �(M'1 p� keMAO y e ( � r Alteration of existing bedroom Yes _No Adding new bedroom_ Yes X No 1 f Do of Attached Narrative Renovating unfinished basement Yes x No Vila �t Plans Attached Roll -Sheet `� r 6a.If New house and or addition to existinsahousna, complete the#ollown : 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 WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 �U �°� (i(/ + y1 K I as Owner of the subject property hereby authorize to a on y behalf,in all matted relative to work authorized by this building permit application. Signature of Owner Date 1+it`��.�y 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. Signed under the pains and penalties of perjury. Print Name 4' Signature of Owner/Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in 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: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW 0 YES 0 IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page 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 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acme or is it part of a common plan that will disturb over 1 acre? YES 0 NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only f Northampton Status of Permit. �5 � � %..':: I ing Department Curb Cjt/DrivOWAY,Permit l 2 Main Street Sewer/Septic Avsiiabillity JUN 152015 Room 100 Water/Well Availability N a pton, MA 01060 Two Sets of Structural Platte Electric,Plumbiny, 1240 Fax 413-587-1272 PlotrSite Plans Northampton,MA 0MVM tither S+ecify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: j VtA r This section to be completed by office Map tot Unit P c s t Fc -)- (�v OS Zone Overlay District "e �.4� a(" P , ©�6 6 Elm St.District CB District SECTION 2-PROPERTY OWNERSHIPJAUTHORIZED AGENT 2.1 Owner of Record: 6 e e- .r Na r t) Current Mailing Address: Telephone 1i Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building ;? /il i10 (a)Building Permit Fee 2. Electrical CJ ' (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) �{('� (!} i ° Check Number This Section For Official Use Only ate Building Permit Number: Issued: Signature: Building Commissioner/inspector of Buildings Date File#BP-2015-1310 APPLICANT/CONTACT PERSON THOMAS C MCCARTHY ADDRESS/PHONE 3 BRODERICK ST EASTHAMPTON01027(413)527-5141 PROPERTY LOCATION 63 HATFIELD ST-UNIT 2 MAP 18C PARCEL 169 001 ZONE URB000)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: REPAIR REAR PORCH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 053221 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ION PRESENTED: pproved 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 on elay ey Si r f uil m Of cia 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. 63 HATFIELD ST-UNIT 2 BP-2015-1310 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18C- 169 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-2015-1310 Project# JS-2015-002402 Est. Cost: $2900.00 Fee: $55.00 PERMISSION IS HEREB"r GRANTED TO: Const. Class: Contractor: License: Use Group: THOMAS C MCCARTHY 053221 Lot Size(sq. ft.): 0.00 Owner: WINNIE ROBERT A Zoning URB(100)/ Applicant: THOMAS C MCCAR.THY AT: 63 HATFIELD ST - UNIT 2 Applicant Address: Phone: Insurance: 3 BRODERICK ST (413) 527-514.1 Workers Compensation EASTHAMPTON MAO 1027 ISSUED ON.611612015 0:00:00 TO PERFORM THE FOLLOWING WORK:REPAIR REAR 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: 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 Sisnature: FeeType• Date Paid: Amount: Building 6/16/2015 0:00:00 $55.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner 63 HATFIELD ST-UNIT 2 BP-2015-1310 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18C- 169 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-2015-1310 Proiect# JS-2015-002402 Est.Cost: $2900.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: THOMAS C MCCARTHY 053221 Lot Size(sq. ft.): 0.00 Owner: WINNIE ROBERT A Zoning: URB(100)/ Applicant: THOMAS C MCCARTHY ,AT_ - 0-3 G-IATFI L !_3T - !jr4lT 2 Applicant Address: Phone: Insurance: 3 BRODERICK ST (413) 527-5141 Workers Compensation EASTHAMPTONMA01027 ISSUED ON.6/16/2015 0:00:00 - TO PERFORM THE FOLLOWING WORK:REPAIR REAR 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: ( otin wL Q k 7-7-15 k S Fogs: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: o �- ��•��C��. THIS PERMIT MAY BE REVD D HE CITY—.UF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND G Certificate of Occu an si nature: r` .t FeeType: Date Paid: Amount: Building 6/16/2015 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner