32A-158 (5) 15 HAWLEY ST-UNIT 102 BP-2017-0054
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A- 158 CITY OF NORTHAMPTON
Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2017-0054
Project# JS-2017-000102
Est. Cost: $1500.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: KIM RESCIA 022464
Lot Size(su.ft.): Owner: SIDORE MICALA
Zoning:NB(101)/SI(0)/ Applicant: KIM RESCIA
AT: 15 HAWLEY ST - UNIT 102
Applicant Address: Phone: Insurance:
311 Locust St (413) 320-1831 0
F L O R E N C E M A 0106 2 ISSUED ON:7/27/2 07 6 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE SIDE DOOR TO APARTMENT UNIT
102
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 ft 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 7/21/2016 0:00:00 $100.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0054
APPLICANT/CONTACT PERSON KIM RESCIA
ADDRESS/PHONE 311 Locust St FLORENCE01062(413)320-1831 ()
PROPERTY LOCATION 15 HAWLEY ST-UNIT 102
MAP 32A PARCEL 158 000 ZONE NB(101)/SI(0)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid gal A 1/5b
Building Permit Filled out
Fee Paid
Typeof Construction: REPLACE SIDE DOOR TO APARTMENT UNIT 102
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 022464
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFDRMATION PRESENTED:
V 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
-7/22/f6
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 40K Contact Office of
Planning& Development for more information.
Version L7 Commercial Building Permit May 15,2000
Department use only
City of Northampton Status of Permit:
fte Building Department Curb Cut/Driveway Permit
�9 212 Main Street Sewer/Septic Availability
j Room 100 Water/Well Availability
'`. Northampton, MA 01060 Two Sets of Structural Plans
of ‘.c phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: /J This section to be completed by office
UtelE lo2-
<�^ - L Map .3 P/9 Lot [ 7 Unit
15''�Iyr��friaDS4, y ✓'/rut Zone Overlay District
WADY , - - ' ' r .1/�� % 1 / " k 01 °L o Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Icy , SIDoRE- 47Mvte-voE, N
Name( rint Current Mailing Address: 6/6 60
/' t 416.5E6,4t85634/3.5 ' , oo' )
Signature
btu_
Telephone
2.2 Authoriz d (tent:
K Iti
/ '2c % 3( / GoCus4
Name(Pent) Current Mailing Address:
' e l.1/at , p tO0
Signature £r Telephone Y / 3 1
SECTION -ES MATED •N'TRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building / 0 6�' (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) �OD
5. Fire Protection
6. Total =(1 +2+3+4+5) ! r _o(i lO D Check Number / 02
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition Rel--->ACI Additions ❑ Accessory Building
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use Other❑
Brief Description Enter a brief description ere. (�
Of Proposed Work: rP �- Sea 1�r , ( ,
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 0 A-2 ❑ A-3 ❑ 1A I ❑
A-4 0 A-5 0 16 ❑
B Business ❑ 2A 0
E Educational ❑ I 2B I ❑
F Factory 0 F-1 0 F-2 0 2C ❑
H High Hazard ❑ 3A 0
I Institutional ❑ 1-1 0 1-2 0 1-3 ❑ 3B ❑
M Mercantile 0 4 ❑
R Residential ❑ R-1 0 R-2 ❑ R-3 0 5A ❑
S Storage ❑ Si ❑ S-2 ❑ 56 ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
1s
2nd 2e
9 d 3,d
4m 41h
Total Area(sf) Total Proposed New Construction (sf)
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L. c.40,§ 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public 0 Private 0 Zone Outside Flood Zone Municipal ❑ On site disposal system❑
Versionl.7 Commercial Building Permit May 15,2000
S. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks From
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minae bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variant inding ever been issued for/on the site?
NO Q DONT KNOW YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW Q YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW O YES 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 O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO O
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 Q NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
II/ f (.x4 EP SC(CQ Not Applicable ❑
Company Name'.
Responsible In Charge of Construction
�31 I l� Sd : o , lata
Address
//y g✓4e_1.4 Y/3320/sy
Signa re Telephone
' Version!.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11 -OWNER AUTHORIZATION•TO BE COMPLETED WHEN
OWNERS AGENT
IOR CONTRACTOR APPLIES FOR BUILDING PERMIT
I M I L71 ,1Q
Si DT)ie
_ _, as Owner of the subject property
hereby authorize N1 t" r I`eSC IA to
act on y behalf, in all mat s relative to work authorized by this building permit application.
26 May 2ot 6
S na r f Owner�n1.- Date
) /
I, ✓'\ .fes SI 1 6c , 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.
K1
Print Name
Signature • ewner/Agent7et / Date
SEC ON 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
1
Name of License Holder: K1 1,-,\ 1:7PSC,) 62, i S 09a 16 /
License N ber
Address Expire n Date
111"2/J( e/,y 't 7/3 3Tn Ara/
Sig.:t • Telephone
SECTION 13-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 issuan e of the building permit.
Signed Affidavit Attached Yes No 0
•
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the 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.
Address of the work:
i
The debris will be transported by: d ?Sc_/
The debris will be received by: C iat 1r:,.G Lit
Building permit number:
Name of Permit Applicant 14 IAA., Pect,SCD
K/J//6 r_, f7 er/eZ4
Date Signature of Permit Applicant
Department oflndustria[Accidents
T .' = Office of Investigations
Io [ Congress Street, Suite 100
' Jr. Boston, MA 0 211 4-2 01 7
: a www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information �//� Please Print Legibly
Name(Business/Organization/Individual): I ,[ac I
Address: Si I ikcw C---. 1 V
City/State/Zip;+- iO P . fl (y,--0.., Phone#: , l3 �0 7L3 /
/
Are you an employer? Check the appropriate box: Type of project(required):
I.❑ I am a employer with 4. ❑ lam a general contractor and 1
,,_, employees(full and/or part-time).' have hired the sub-contractors 6. ❑ New construction
2:d7 I am a sole proprietor or partner- listed on the attached sheet. • 7. ❑Remodeling
ship and have no employees These sub-contractors have - g, Gl Demolition
workingfor me in any ca aci employees and have workers'
P ry 9. ❑ Building addition
[No workers' comp. insurance comp. corporation 5. ❑ We are a corporation and its 10.11]Electrical repairs or additions
officers have exercised their I LEI repairs or additions
3.❑ 1 am a homeowner doing all work
myself. [No workers' comp. right of exemption per MGL 12 ❑Roof repairs
insurance required.] t c. 152. §I(4),and we have no
employees. [No workers' 13.[1]Other
comp. insurance required.]
'Any applicant hat checks box#1 must also fill out the section below showing their workers'compensation policy information.
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
mployees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
ram an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
'reformation.
nsurance Company Name:
'obey#or Self-ins. Lic. #: Expiration Date:
lob Site Address: City/State/Zip:
%Itach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
'allure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
'me up to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
if up to 5250.00 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.
r do hereby certify un , epains 'alties of perjury that the information provided abov, ist'rue a,d rrect.
lir aturr .4 /(4i '_Li Date: /6 / r0
'hone#: - /3 ?0 / 3 1
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#: