31A-240 (8) 55 KENSINGTON AVE-UNIT 1 BP-2017-0159
GIS#: COMMONWEALTH OF MASSACHUSETTS
Man:Block: 31A-240 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
Pennit# BP-2017-0159
Project# JS-2017-000255
Est.Cost: $25000.00
Fee: $175.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MICHELE OCONNOR-ST PIERRE 105558
Lot Size(sq. ft.): 5096.52 Owner: NOHO PROPERTIES INC
Zoning: URB(100)/ Applicant: MICHELE OCONNOR-ST PIERRE
AT: 55 KENSINGTON AVE - UNIT 1
Applicant Address: Phone: Insurance:
17 TRUMBULLE RD (518) 428-2402
NORTHAMPTON MA01061 ISSUED ON:8/8/20I6 0:00:00
TO PERFORM THE FOLLOWING WORK:RENOVATE ENTRYWAY, KITCHEN & BATH -
UNIT 1
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 fl 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 8/8/2016 0:00:00 $175.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-20I7-0159
APPLICANT/CONTACT PERSON MICHELE OCONNOR-ST PIERRE
ADDRESS/PHONE 17 TRUMBULLE RD NORTHAMPTON0106I (518)428-2402
PROPERTY LOCATION 55 KENSINGTON AVE-UNIT I
MAP 3 IA PARCEL 240 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT 147
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: RENOVATE ENTRYWAY,KITCHEN&BATH-UNIT I
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owned Statement or License 105558 /Q
3 sets of Plans/Plot Plan �f�0""—
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
v.,npproved 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 Play
ire of Buildi g 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.
IT(
Ve ,mil.7 Commercial Buitdin_Permit Ma 15,2000
��� I Department use only
s ort <mpton Status of Permit
♦.�a:c+= x<c to±, De.artment Curb CutvOriveway Permit
I) l —i-.-2. „-'t .treet Sewer/Septic AvailabilityI.
_,_,
Room 100 Water/Well Availability
{� Northampton, MA 01060 Two Sets of Structural Plans_, _
phone 413-587-1240 Fax 413-587-1272 Pint/sae 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: This section to be completed by office
55 KENSINGTON AVE, UNIT l Map Lot Unit
NORTHAMPTON MA 01060
Zone Overlay District
Elm St.Dlatrlct CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
NOHO PROPERTIES, INC 17 TRUMBULL RD NORTHAMPTON MA
Name(Print) Current Malting Address:
(518)428-2402
Signature Telephone
2.2 Authorized Anent:
MICHELE OCONNOR ST PIERRE 17 TRUMBULL RD NORTHAMPTON MA
Name(Print) • Current Mailing Address:
(518)428-2402
Signature V r. y _ Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTg
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 520,000-06 (a)Building Permit Fee
2. Electrical $2,000.00 (b)EatCost of
Construction stimtedTofromal (6)
3. Plumbing $3,000.00 Building Permit Fee �C
4. Mechanical(HVAC) 7 2 4 j`t j 25,000 r T
5. Fire Protection
6. Total all +2+3+4+4 Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
Versionl.7 Commercial Building Ewalt May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations 0 Existing Wall Signs 0 Demolition 0 Repairs 0 Additions 0 Accessory Building
Exterior Alteration 0 Existing Ground Sign❑ New Signs 0 Roofing Change of Use❑ Other 0
Brief Description Enter a brief description here. {CEt3OVAt ib .J f{,N+r 31 1
Of Proposed Work: E.Nii- ,,,(a - K.t1GEt6ru . (3 ASH
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 0 A-2 0 A-3 ❑ IA 0
A-4 0 A-5 0 1B ❑
B Business 0 2A 0
E Educational 028 t 0
F Factory ❑ F-1 0 F-2 0 2C ❑
H High Hazard ❑ 3A 0
I Institutional 0 I-1 0 I-2 0 k3 0 3B 0
M Mercantile 0 4 0
R Residential 0 R-1 ❑ R-2 0 R-3 ❑ 5A 0
s storage 0 s-1 ❑ 5-2 0 5B 1 ❑
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
Boor Area per floor(sf) iteilw
1" ( ibT 1,' 133a
2^' 1337 2 ( 337 •
-
3rd 1312 3" ( 3 ( 2_
4" 4"
Total Area(sr) 424 3 Total Proposed New Construction(si)
C35( gem 0M r7
Total Height(ft) 31 Ove
Total Height ft 3/
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
PublicZone[71 i Private D Zone Outside Flood ZoneMunicipal ] On site disposal system
Version).?Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
Thie column to be filled in by
Building Department
Lot Size
Frontage I
Setbacks EVA
e5
i6 able IP 5 R: l t.: 5 It 5
CV-tst , Rear
el
\‘) Building Height 3I 3
Bldg,Square Footage 4 LI 3 'O 4 z/3
Open Space Footage / ,,
(Lot area minus bldg&paved 70
parking) _
#of Parking Spaces
Fill:
(vo{ me&Locatioi
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW ® YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW 0 YES O
IF YES: enter Book Page andtor 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 U NO W
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 ID
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 O NO tl(!2_,J
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version27 Commercial Building Pemdt May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 118(CONTAINING MORE THAN 35,800 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect: /9-42 Clef I MPtR ICS ,9c51Gw .lam'
045147
" '
- - • II • UNIO' • l -
-- •: 1070 C/ Not Applicable ❑
Name(Registrant):
53 SOUTH UNION ST PLAINFIELD MA 01070 Reglstratton Number
AddressAi. .�
_ , �`—'—' (413)634-0091 Expiration Date
Signe/re Telephone
9.2 Registered Professional Engineerls):
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
MICHELE OCONNOR ST PIERRE Not Applicable 0
Company Name:
MICHELE OCONNOR ST PIERRE
Responsible In Charge of Construction
17 TRUMBULL RD NO HAMPTON; A 01060
Address f,
/j({(({.,�1t1 (518)428-2402
Signature Telephone
Version1,7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(T80 CMR 11011)
Independent Structural Engineering Structural Peer Review Required Yes Q No Q I
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
MICHELE OCONNOR ST PIERRE as Owner of the subject property
hereby authorize MICHELE OCONNOR ST PIERRE to
al m��b
act on fghalf,�" matters�elative wo authorized by this building permit application.
i1 �j 7(2IG
Signature of Owner / ' Date
I, tiL Ci(r V1A Still-e YJ252 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 en (ties of perjury. f�
/4 Li Oto'n11Uhi styli g-
Print Nam pq
/V� (K Cc — 7/Z f/J Y_
Signature of timer/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction SuoarWSor: Not Applicable rj
Name of License Holdet' MICHELE OCONNOR ST PIERRE CS105558
License Number
17 TRUMBULL RD NORTHAMPTON MA 01060 01/301201
Addresy Expiration Da
IIIc) f 2 (5I8)428-2402
Signature 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
kr the denial of the issuance of the building permit.
Signed Affidavit Attached Yes 0 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: 55 <t vt 5 Aei -61k A
The debris will be transported by: J Jch_5
The debris will be received by: 41Pl' 1 k A�
Building permit number:
Name of Permit Applicant Muel-Gl/ C e� -
- 21 - lb, it(4-
Date Signature of Permit Applicant
•
The Commonwealth of Massachusetts
a Department of Industrial Accidents
,=1,44= I Office of Investigations
eiio
=km= I Congress Street, Suite 100
SIMBoston,MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/organization/individual): Matt it C (,V 1'k v104 ,"`j/^f RtIAN{
Address: 11- [yQ t% I Yt( ;,g_a �g� Phone /
City/State/Zip: 4a vt410 41A A ` [
. Re#: 5(% Lh ft 2 't u
Are you an employer?Check the ap ropriate box: 'Type of project(required):
1.❑ I am a employer with 4. 0 1 am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6, New construction
2. I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have g. 0 Demolition
workingfor me in anycapacity. employees and have workers'
9. Building addition
[No workers' comp, insurance comp.insurance.
required.] 5. 0 We are a corporation and as I0.0 Electrical repairs or additions
3.11p I ant a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
12.0 Roof repairs
insurance required.] r c. 152, ys 1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]_
"Any applicant that checks box#1 must also fill out the section Slow 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-contractorsand state whether or not those entities have
employees. If the sub-couaactorr have employees,they must provide their workers'comp.policy number.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
InsuranceCompany Name: _
Policy#or Self-ins. Lie. #: Expiration Date:
Job Site Address: City/Stare/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
fee up to S1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 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.
I do hereby certify detry'!re pal//ryryaa�A/nd pen(a�I • ,of�perjury that the information providedaboveis true/ and correct
Signature: L/ t,yt 'fir Date: i /21/I Y
Phone#: c [ D LIZ. ri o t
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#:
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55 Kensington Ave
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