30C-056 (7) I 13 CLEMENT ST BP-2017-0127
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:30C-056 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ADDITION BUILDING PERMIT
Permit# BP-2017-0127
Project# JS-2017-000211
Est.Cost: $35000.00
Fee: $227R0 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
UseGrouo: KUEL MCQUAID 051394
Lot Size(sq. ft.): 14853.96 Owner: GREENE ROBERT A&PATTY A
Zoning: SR(1001/ Applicant: KUEL MCQUAID
AT: 113 CLEMENT ST
Applicant Address: Phone: Insurance:
131 FERRY ST (413) 537-5063 (1
EASTHAMPTONMA01027 ISSUED ON:8/4/20[6 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT MUDROOM ADDITION 14 X 5'6" &
REMODEL KITCHEN
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: OI: 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 Occuoancv signature:
FeeTvpe: Date Paid: Amount:
Building 8/4/2016 0:00:00 $227.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File# BP-2017-0127 to/4 ` OK
APPLICANT/CONTACT PERSON KUEL MCQUAID PteA, i2.W t&4)
ADDRESS/PHONE 131 FERRY ST EASTHAMPTON0I027(413)537-5063 O
PROPERTY LOCATION 113 CLEMENT ST
MAP 30C PARCEL 056 001 ZONE SR(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT y
Fee Paid i 50 ,Qa7
Building Permit Filled out
Fee Paid
Tvpeof Construction: CONSTRUCT MUDROOM ADDITION 14 X 5'6"&REMODEL KITCHEN
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 051394
3 sets of Plans/Plot Plan
THE�OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF kMATION 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
lemolition Delay
r y��
Signet e of l3vi i O 'tial 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.
.M
REXENE:
[1_
Department use only
Cr of Northampton Status of PermitJUL 28 20I6 I Bu ding Department Curb Cut'Dnveway Permit
12 Main Street Sewer/Septic Availability
neer.oeauumNcinseecnoxs Room 100 Water/Well Availability
NomWWMPTON IAA 010e0 Nnrt ampton, MA 01060 Two Sets of Structural Plans
phone 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 Property Address This section to be completed by office
II; CltrnV} S¢. Map Lot Unit
FLo{t,ac1 mit- 0 it _ Zone Overlay District
Elm St.District - CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: I:01, 4 4. int,-.4— {I
# P444i - SfCtr4-
✓ ii) clelnte} 14- Flersce. .,a- o 061
Name(Print) Current Mailing Address_
Telephone
Signature
2.2 Authorized Atent:
Kit_ //l c QuatCA ( E F�..zc 5+- k-kk5 ovtA4 }
Name(Print) Current Mailing Address 2, B LOZ.7
�r
r
Ag44-� 413 Sp 6
- 5 3 7-
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building , 1`00D (a) Building Permit Fee
2. Electrical (b)Estimated Total Cost of
-`0 O Q Construction from(6)
3 Plumbing Building Permit Fee 0Zl..50
t `000
4. Mechanical(HVAC) 9 -"
5. Fire Protection (/
6. Total= '6(1 +2+3+4 +5) j (5-67) ,Check Number I 'rent
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector/ of Buildings Date
email % /1✓e.(MtQ,iQV G C;NtcxcLe4-_ Ne.-{—
• V
Section 4. ZONING All Information Must Be Completed. Permit Can Be Semea Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Depammeni
Lot Size .. _.._ ._
Frontage
Setbacks Front
S L— R _. L _ R _ _ .
Rear
Building Height - "—
Bide. Square Footage _.- % - -
Open Space Footage _ _.._ % _.. --
(lotareamu,usbldg&paved _._ ___
parking)
#of Parking Spaces -_._..
Fill:
(volume&Lac aton)
A. Has a Special Permit/Variance/Findm er been issued for/on the site?
NO 0 DONT KNOW YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW Q YES Q
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES Q
er
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO 1-
IF YES, describe size, type and location:
E. Will theconstruction
ru over 1 lty disturb(clearing, grading,exc atlon, or filling)over 1 acre or is it part of a common plan
that win
acre' YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
a •
•
-*t• ',e
• p M1..
... . ' l
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aoolicable)
New House n Addition Replacement Windows Alteration(s) n Roofing E
Or Doors 0
Accessory Bldg. El Demolition ❑ New Signs ID] Decks [l= Siding [p] Other IC]
Brief Dessgigtioon 9.f'P;oRoseda I / l
Work // ``1 ''77 Co %MVt✓c� -O
! ON > d1 Ct-00VA a.m. K14CNit,. ce_wNoete_A
Alteration of existing bedroom Yes V No Adding new bedroom Yes 1/No /
Attached Narrative Renovating unfinished basement Yes t/ No
Plans Attached Roll -Sheet
Sa.If New house and or addition to existing housing, complete the following:
a. Use of building 'One Family t/ Two Family Other
b. Number of rooms in each family unit Number of Bathrooms
4F
c. Is there a garage attached? I
775.J)31° I. [ o
d. Proposed Square footage of 1newconstruction. Dimensions �i. k -,7, (0
e. Number of stories? f`` 11
f. Method of heating? EL ciC�C. 14 a5 ,1DO Fireplaces or Woodstoves N0 Number of each
g. Energy Conservation Compliance.'" � � lnI Masscheck Energy Compliance form attached?
��kh. Type of construction 4yyte Wood
i. Is construction within 100 ft. of wetlands? Yes /NO. Is construction within 100 yr. floodplain Yes t/ N0
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building andndZoning regulations? t/Yes No./
I. Septic Tank City Sewer V Private well City water Supply V
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS
((I AGENT OR CONTRACTOR APPLIES(FOR BUILDING PERMIT
I, ` `Vt7.t/`� A , k+ '� � )r-' , as Owner of the subject
property //// U II,, / ,,/
hereby authorize Y` ✓L At C I Ui Cry'
to act on my behalf, in all matters relative to work authorized by this building permit application.
R %lu-I+2 AA-- ?bait
Signature of Owner `1j Date
L kI, ^ f
Att�l C iXV toi
1 tom , 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.
KveI M aura
Print a e
7/2' /6
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Suoervi(1sor: o I Not Applicable £ q
Name of License Holder: Kuek Me- Q,f ej CC -05 (3 ` 4-
License Number
131 (ec2 S5- 1aJ ( I /7016
Address q Expirati n Date
ECS M
uAe A O O27
Sign Lure Telephone
Cw�� LH3 - 537-5063
a
9.Registered Home Improvement Contractor Not Applicable E
{(✓e l l� Mc QuctLaCoVASA7sfr���o� 106700
Comoanv Name R gistration Number
13i Fccc/C� frL 7/24 JZo ($
Address Expira on Dat
Ect-50.1nkesco / Telephone 413-537�3
0102 -7
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 E
11. - Home 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 I
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,von 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
,V ,, q"" _ Department of Industrial Accidents
Y Office of Investigations
600 Washington Street
x � Boston, MA 02111
m wovw.mass.gov/dia
Workers' Compensatfirri insurance Affidavit: Birilders/Contractaa's/Eiecttricfl s/Plumbers
Applicant Information Please Print Legdbiv
Name (Business/Organization/Individual):
Address:
City/State/Zip: Phone #:
Are you an employer? Check the appropriate box:
Type o roject(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
3 I ant a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
slip and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp. insurance comp. insurance.t
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.[1 I am a homeowner doing all work officers have exercised their 11._ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] ' c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
'_Any applicant that checks box-4l must also fill out the section below showing their workers'compensation policy mfmmation.
'Ho meowners 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 entitles have
employees. If the subcontractors 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.
Insurance Company Name:
Policy II or Self-ins. Lic. #: Expiration Date:
Job Site Address: City/State/Zip:
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
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 cer/tiffyy undererthe pains and penalties of perjury that the information provided above is true and correct
Signature: /v/le97. /_-7(�/(CGL!/ Date: 7/ 27(t r0
Phone it: 4H 3— S3 / — So co3 ( I
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 if:
City of Northampton
Massachusetts s
ior
^t4 DFr'SHT.' 'NT OF BUILDING INSPECTIONS. V,
(� 212 Main Street a Municipal Building
Y Northampton, MA 01000
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her
construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which
he/she resides or intends 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 home owner."
The building department for the City of Northampton wants any person(s) who seek to use the home
owner exemption, to act as their own construction supervisor, to be aware that by doing so you
become responsible for compliance with state building codes and regulations. The inspection
process requires that the building department be called to inspect work at various stages, which include
foundation/footings (before backfill). sonotube holes (before pour), a rough building inspection
(before work is concealed), insulation inspection (if required) and a final building inspection.
The building department requires these inspections before the work is concealed, failure to secure
these inspections can result in failure to obtain a certificate of occupancy until the work can be
inspected. •
If the homeowner hires other trades to perform work (electrical, plumbing & gas)the homeowner will be
responsible to make sure that the trades hired secure their proper permits in conjunction to the building
permit issued, and that they get their required inspections. Failure of the individual trades to secure
the permits and inspections as required can DELAY the project until such time as the proper permits
and inspections are made
understand the above.
(Home owner/resident's signature requesting exemption) -
I will call to schedule all required building inspections necessary for the building permit issued to me.
Date
Address of work location
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: /15 afyt o['t Sr
The debris will be transported by: kicial M c Q,fQ;c,�
The debris will be received by: (bus eau 2 ecy c1 , 2
Building permit number:
Name of Permit Applicant kuAG Qu "/l
—7/17 �16 � oiO- C
Date Signature of Permit Applicant
�Jl�/�6UP�4 S 5'' "'� /Y City of Northampton 7/3 Lem PN/ S
Building Department d/^��
i fieeft
Plan Review U
212 Main Street 06re
Northampton, MA 01660
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