23A-044 19 WEST CENTER ST BP-2017-0150
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:23A -044 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
Penult# BP-2017-0150
Project# JS-2017-000246
Est. Cost: $12000.00
Fee: $78.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Grouo: ALLEN GUIEL 054248
Lot Size(sq. ft.): 13198.68 Owner: BIRD MARK J&SUSAN M CARLSON
Zoning: URB(100)/ Applicant: ALLEN GUIEL
AT: 19 WEST CENTER ST
Applicant Address: Phone: Insurance:
63 CHESTERFIELD RD (413) 268-9200 O WC
W I LLIAMSBU RGMA01096 ISSUED ON:8/3/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE DECKING/RAILINGS,FRAMING TO
STAY SAME SIZE
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:
FeeTvpe: Date Paid: Amount:
Building 8/3/2016 0:00:00 $78.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File# BP-2017-0150
APPLICANT/CONTACT PERSON ALLEN GUIEL
ADDRESS/PHONE 63 CHESTERFIELD RD WILLIAMSBURG01096(413)268-9200 0
PROPERTY LOCATION 19 WEST CENTER ST
MAP 23A PARCEL 044 001 ZONE URB(I00)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT & ]]��
Fee Paid ,551f 3 lYb
Building Permit Filled out
Fee Paid
Typeof Construction: REPLACE DECKING/RAILINGS,FRAMING TO STAY SAME SIZE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 054248
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
/ oved 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
• oli .• Delay ���
�'.�' ! .�
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.
Department use only
D City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
AUG - 3 2016 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
��� Northampton, MA 01060 Two Sets of Structural Plans
eORTMa�wrorv.1MAPEiylofe 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Properly Address: This section to be completed by office
C w�CJ"7 ��hJc. G5hMap Lot Unit
1Zone Overlay District
kl.Cl2E005—
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
AViv 1.31/4k 11 fie4 (evf , S4 Moto
Name(Print /I 1, Current Maim Address:,
IIVrLl"_w,\ul Tele honne i�- �V
Signature
2.2 A horized A ent:/?
IM.�1` V I G C._ 677 coecmar-f� 004-o '/y
Name Cu,iSM026ng Ade' L 11 (2 17 /
Signatur Telephone �61d�
SECTION 3-ESTIMATED CONSTRUCTION COSTS (f CEJ
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building C)Z7?) (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
i
6. Total=(1 +2+3+4 +6) I �C�'lZ7 Check Number JS3
11)
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING AU Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Budding 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)
tt of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Fin g ever been issued for/on the site?
NO 0 DON'T KNOW YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW O YES O
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NOcji
DON'T 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 ,pp,,D((��ate Issued:
C. Do any signs exist on the property? YES O NO tN)
IF YES, describe size, type and location: li'' 1Q
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO 01
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading, x vation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing ❑
1� Or Doors D
Accessory Bldg. LI Demolition Demolition New Signs [CO Decks [I¢ Siding[CI Other[CO
Brief Description of Propo ed r
Work: QFfacKs. t eaikcoaccj , tti91-]6 lb 974.1 c , g 4125
Alteration of existing bedroom Yes )0 No Adding new bedroom Yes •N No
Attached Narrative Renovating unfinished basement Yes -2a No
Plans Attached Roll -Sheet
sa. If New house and or addition to existing housing, complete the following:
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 CONTRACTORCO � APPLIES FOR BUILDING PERMIT
I, via j x]X „ .a ,as Owner of the subject
prope ff VVV���
hereby authorize
to act pn my be ,in matters relative to work authorized by this building permitmitt applicl`atioonn.
Signet reo Owner Date - `v
11111111111111.11.1.11111111.11.111111
I, 41.60 Gila-- , 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.
,& Gu`GL_
Pdnt Name t`
\4____D9- d k(li
Signature o er/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Syperyisor: Not
(Applicable
/�'r❑y� ,y/,�/�(
Name of License Holder: /T/ (oI EL Vj - " /; / v
License Number
th3 Cf1ESf6"tF(EL6 W uh u,(4'A9 (AOtU 09 . i z • I$
A•• s ^ I Expiration Date
u ) , 11G 968 q��
Si! Sit i. Telephone
9.Registered He lmorovemen}Contractor: Not Applicable 0
len
iLvrd �2�Iel /6ORO
Company Name Reistration Number
1v,a C0 nac•tel*) � • I�. I8
/Addresses 7��/, nye 1 , ' pry �/ d�,y�� ��O( ) 7 QQ L��,� Expiration ate
((t3 C{)&?Wez,� go_ kottow*(/w Telephone 'U;t/ag lr/"°
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.E.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 cbuiillding permit.
Signed Affidavit Attached Yes �1 No 0
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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
:•,.� The Commonwealth of Massachusetts
Department of IndustrialAccidents
t ` Office of Investigations
9 I Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers Compensation InsuranceAffidavit: Builders/ContradorsIEledridans/Plumbers
Applicant Information Please Print L(e�2ibly
Name(9usiness/Orgeniaadon/Individual): ,�r'y�c�.��, —� �tq)f� 6D (2L /O
Address: C-+1R,FIe fa,)� pp V/��
City/State/Zip: „ OK001 I\1- ( At Phone#: 4J Z 9(D' �a
` Are you an employer?Check the apprPolpriate box: Type of project(required):
1.❑ I am a employer with / 4. ❑ I am a general contractor and I
employees(full and/or part-time).*
have hired the sub-contractors 6. ❑New construction
listed on the attached sheet. 7. ❑Remodeling
2.❑ I am a sole proprietor or partner-
ship and have no employees These sub-contractors have g, ❑Demolition
working for me in any capacity. employees and have worked
[No worked comp. insurance comp. insurance.
= 9. ❑Building addition
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [Noworked comp. right of exemption per MGL
12.0 Roof repairs
insurance required.] t c. 152,§1(4),and we have no
employes [No workers 13.0 Other _
comp. insurance required.]
'Any appliraa that diecksbox#1 must Swfill of themotion below shaming thdrwakes ccovensatico polio/infamaicn.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
k ontractors 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-mMratashaoeemplqnas•they must providetter waked roup.polity number.
I am an employe that is providing worked compensation i nsvrancefor my employees Below is the policy and job site
information. 1
Insurance Company Name: // ra :a w. II+/ /� / �qI}1{� q
Policy#or Self-ins.Lic. #: kp S//tLy�v {Oyyu y�77 �-,T.
(()1 Expiration Date: CH -21 -1 1
Job Site Address: 19 W96-r reyry c . City/State/Zip: , [.�, a /r 4 Cl eq G
Attach a copy of theworked compensation policy declaration page(shawl ng 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 ofa
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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby \ oder th 'ns and pe ties of perjury that the information provided Bove is true and correct.
Signature: 'ik Date: ) ' t E/a
r'�
Phone#: LIi L1?, qZ&
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):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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:
The debris will be transported by: au( EL (01i 2UCT10f-
The debris will be received by: \141-12-1 g,€Ct1 CC
Building permit number: /� I
Name of Permit Applicant
Date Signature of Permit Applicant