31A-059 274 CRESCENT ST BP-2017-0233
GIS u: COMMONWEALTH OF MASSACHUSETTS
Map:Block:3IA-059 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&RENOVATION BUILDING PERMIT
Permit# BP-2017-0233
Project# JS-2017-000392
Est.Cost:$8000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: TEAGNO CONSTRUCTION INC 108109
Lot Size(sa. ft.): 6490.44 Owner: BERGER DAN H& LAURA A
Zoning: URB(100)/ Applicant: TEAGNO CONSTRUCTION INC
AT: 274 CRESCENT ST
Applicant Address: Phone: Insurance:
228 TRIANGLE ST (413) 549-0803
AMH ERSTMA01002 ISSUED ON:8/29/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:Foundation ONLY for Deck and enclosed three
season porch on the rt side and an open porch, foyer, and bedrm on the It side
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 it 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 8/29/2016 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
N!NJ 0
File p BP-2017-0233 ?'ZO'- `
APPLICANT/CONTACT PERSON TEAGNO CONSTRUCTION INC
ADDRESS/PHONE 228 TRIANGLE ST (413)549-0803
PROPERTY LOCATION 274 CRESCENT ST
MAP 3IA PARCEL 059 001 ZONE URB(100)/
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: Foundation for Deck and enclosed three season porch on the rt side and an open porch,foyer
and bedrm on the It side
New Construction
Non Structural interior renovations
Addition to Exi.Lina
Accessory Structure
Building Plans Included:
Owner/Statement or License 108109
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFF�MATION 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
mit from Elm Street Commission
Sign re o I uilding 0 lcial 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 the Office of
Planning&Development for more information.
Department use only
Fr"- -;,_ City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
pub 24 212 Main Street Sewer/Sepias Availability
IRS Room 100 Waterw/ell Availability
oc susn�ue insreitcnoms Northampton, MA 01060 Two Sets of Structural Plans
DEPNo aH 7o .MA .._- . -13-587-1240 Fax 413-587-1272 Plot/Site Pians
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
6 ? srFA 5 . Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
diaofAecord:
mer Iv6 Vin 54
Name( roil, Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Do AM en 3. hceyNa 'zea . ' . Ci aa' l - /9/”411.,/crt di��,-2
Name(R nt) Current Mailing Address.L wh - 5-?2 "0,Y0 3
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. BuildingR(J^J.bt$T � (a)Building Permit Fee
rA-.21 t LrC •
—
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fe
e
AM171[
4. Mechanical(HVAC) z�
'/a'/ ti `A e /`y`�19
5. Fire Protection � .f/�rA1 (/
6. Total =(1 +2+3+4+5) Check Number 1p rit6
This Section For Official Use Only
Building Permit Number: Date
at
ed'.
Signature:
Building Commissioner/Inspector of Buildings 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 tilled in by
Building Dcpanmcnt
Lot Size / `'35— Si .Sdr^+E
.
Frontage 7J ' J n-sr E
Setbacks Front 2o, ' az.f
Side L: /V R:G.6 L:/1.5 R:aa.��
�.� Rear rf/ ' 3a '
Building['eight
l
I,
tdv uJko-ivare o�Y16r /c0(''I (2 " 7,0`)(S1 5VO
Open Space F otage [/ Sr % Jr(
q p
V (Lot area minus bldg&paved //773 7'f ii3/° 6,s'It
.. parkineI )
k # {]of Parking Spaces / I
Fill: NIA Nn
(volume Sr Location) rl
A. Has a Special Permit/Variance/Findin 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 Re istry of Deeds?
NO O DONT KNOW YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O ,�D.attee Issued:
l�
C. Do any signs exist on the property? YES O NO
IF YES, describe size, type and location: T'
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO e,
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading, e vation,or filling)over 1 acre or is it pan 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.
I
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House n Addition 21 Replacement Windows Alteration(s) n Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition E New Signs [C] Decks IC Siding[C] Other[C]
Brief Description of Proposed,–
Work:
f r�,QC2- �45anrf " Q
Work: F/%✓un,Frlce-' 0 k jx7h /row ,4' crcw/O2rh1 �–o�.e/6*Befi
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
ea.If New house and or addition` / to existing housing, complete the following:
a. Use of building -.One Family y. Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached? v
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
L 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 CIN). 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? x Yes No.
I. Septic Tank City Sewer ?b/ Private well City water Supply Y.
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
*at pqn C :7' er ,as Owner of the subject
property v
hereby authorize $ • ¢Lr I. %O a et I, I T.
to act •- y behalf, •n all s relative to wor auth.rized by this building permit application.
—Ss 1y i&
-downer Dat- %%
41
l. nsa?(I) TUy Nc7 .he Owner D°
efeby declare that the statemments and information on the foregoing application are true and accurate,to the best of m wletlge
andnbelief.
Signed under the pains and penalties of perjury.
.izLitt-C 1 : Tca,Pio
Pri Or
Signature of• /Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder'. :b'CN fid p J I�>pcip o c "e 3 V 2/Jci
(' ��r�xl License Number
y c , r3 a ) .� 7 ,,n1LI 4k o/Oo y . /-%'P
Address Exc://o/0
'aatlon Date
r 4/l _ � 6Y - Y76a
Stu Telephone
9.Reaiste ed H e Impmvelmmovement Contractor: Not Applicable a laJy ❑q
'4y/,a „' Raf 7 7 / T,✓ C-- //U�'7/0/
compel-1i Name Registration Number
da-1 7rrc � � d
Address Expiration ate
iJ `x mo Telephone-L/f-tiP
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. - 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
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 he 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
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: 7_)vc3.pgru J%wx 4c
The debris will be received by: f� teC L° 7NJA« y� 9'
jj i(d"/ ' '-
Building permit number:
Name of Permit Applicant
7)4/
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
tr� Department of Industrial Accidents
a_z, — Office of Investigations
artie1= I Congress Street, Suite 100
,5• Wi,
%g = a' Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): /P(e4 o !Jd (beJiU/7/Z.G(77 C •
Address:_,4)-ce
City/State/Zip: *2irf- /4 @/OD,,i Phone#: 7/� - cr7 o.+20
Are you an employer? Check the appropriate box: Type of project(required):
1.0 I am a employer with .1c 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 workers'
comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance
required_] 5. ❑ We arc a corporation and its 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions
myself. workers' right of exemption per MGL
Y [No comp. 17.0 Roof repairs
insurance required.] ' c. 152, §I(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks hox pl 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 Nen 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
employees- If the sub-contractors have employees,they must provide their workers'comp.policy number
lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: JI y
Policy#or Self-ins. Lic. #: (N 2)-H ?A00b � 36/)0/S.Jy Expiration Date: /7/7
Job Site Address: ) 77 &ILt • City/State/Zip: ,220441/74/1.), zi# 0/D 60
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 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 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 c 1 ie pains •std penalties of perjury that the information provided above is true and correct
Signature: 11
p Date:i�t-9�//+
Phone r1: /// )yam C 9 —d003
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#: