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38B-079
185 SOUTH ST BP-2017-0322 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 388-079 CITY OF NORTHAMPTON Lot:-001 PERSONS CON 7 xACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) category: ROOF BUILDING PERMIT Permit# BP-2017-0322 Projects JS-2017-000528 Est.Cost: $8800.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: llse QI0IIP NEWMAN'S CONSTRUCTION 64690 Lot Siae(sq. ft.): 50965.20 Owner: I S5 SOUTH STREET LLC Zoning: URB00011 Applicant: NEWMAN'S CONSTRUCTION AT: 185 SOUTH ST Applicant Address: Phone: Insurance: 697 BRIDGE ROAD (413) 586-0273 WC NORTHAMPTONMA01060 ISSUED ON::91912016 0:00:00 TO PERFORM THE FOLLOWING WORK:COVER OVER 1 LAYER OF SHINGLES WITH SHINGLES 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 CFFY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy signature: FeeType: Date Paid: Amount: Building 9/9/2016 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner w t"i -D Department use only I City of Northampton Status of Permit: Building Department Curb CuttDrlveway Permit 212 Main Street Sewer/SepticAvailability Room 100 WaterNvellAvauabildy cavo - Northampton, MA 01060 Two Sets of Structural Plans — pnone 413-587-1240 Fax 413-587-1272 Plotrsne 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' rThis section to be completed by office & � , ' 5 �Jt4/. 5t Map Lot Unit dNrPIE� MOnn' Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: loco iofe /IS. sc)ot-e, St Name(Pnnt) Current Mailing Address: Telephone Signature 2.2 NAuthori ed Agent: (Print) j Current Mailing Address: \� Signature yne -SFd - )oTi3 9 Telephone SECTION 3-ESTIMATED CONSTRUCTION.COSTS I J CO Item Estimated Cast(Dollars)to be Official Use Only completed by permit applicant 1. Building - (a)Building Permit Fee Z Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 4�[ 6. Total=(1 +2+3+4+5) Check Number Kw& 7a This Section For Official Use.Only Building Permit Number -Date- „......--.7. Issued: / Signature:aeveo".........:Se 7 7�E Building Commissioner/Inspector of buildings - Date hect,on 4. ZONING 1 Atl information Must Be Completed, Permit Can Be Denied Due To Incomplete irformmtllon Existing ! Proposed Required by Zoning This solemn so he Sled e by Buiidieg Oepa,mem Lot Size Frontage ..__ ___ —, _. _...._. Setbacks Front "___. Side L — R: _ .., L:_�R .__ _. ____. __.__. Rear _._ ._..._. _ Building Height _.-... _. - --. — _. Bldg,Square Footage Open Space Footage __. _ % I __.. I --- (Lot Area minus bldg&paved -- oarkine #of Parking Spaces Fl: (volume&Location} A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES O IF YES: enter Book Page and/or Document B. Does the site contain a brook, body of water or wetlands? NO a DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained © , Date issued: C. Do any signs exist on the property? YES r0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES a NO Q IF YES, describe size, type and Location: E. WW the construction activity disturb(c/'le�aring,grading,excavation or filling)overt acre or is it part of a common pian that will disturb V ever 1 acre? YES NO O IF YES,then a Northampton Blom—TVs Rater Management Pam a from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House fl Addition fl Replacement Windows Alteration(s) n Roofing Or Doors C Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[pl Other[DJ Brief Description of Proposed II ��.// Work. �a a - ( I. < Z J1•_ _ ft Skii-7 & Alteration of existing bedroom Yes No Adding new bedroom Yes • Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. 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 a Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance farm 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 CONTRACTOR APPLIES FOR BUILDING PERMIT I. as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner q Date l�n•v A� I�) / /1 as Owner/Authorized Agent heredare 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. - Print Nits A 6 Signatur:it Owner/Agent at: ISECTION 8-CONSTRUCTION SERVICES E.1 Licensed Construction Supervisor: Nol Applicable ❑ Name of License Saxer: CS —06-t6 t}' 0 License Number C G /Caress n t 7 Yti LLA.) /}}•�A(l�CPt MlDle 7 ( ratn f oKi, NiotziN Signa- e Telephone Are. /3 - 516—tom 9. ---Fire. Nome fm:rov..:-nt C. . .r ' Not Apoticabte ovj ❑ °moan Name Registration Number . EG.'cr( te heL _-- Address/,fit—... p awe.en Dat- PI dl QI P Telephone/3 Sam'- es- - `- SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L x.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 0 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 1083.5.1. Definition of Homeowner: Person(s)who own a parcel of land on which helshe 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 sauctures.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 Supenpor your presence on the fob size will be required from time to time,during and upon completion of the work for which this permit is issued. Also be adbised that with reference to Chapter 152(Workers'Compensation) and Chapter 133(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated.von may be liable for person(L) 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 S1assachuseas —_..x_ Department of industrial Accidents ____„;.,, _[ Office of Investigations 600 Washington Street Boston, MA 02111 _ _ www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information rr--'' 11 I Please Print Leaibis- Name (Businesv0;sanizarton'Individual): �t�w M/ ) S one., (p-I/ p {1C3 Address: �.,q�] },�n..D� (-?--iq-uq t . � 4 City/State/Zi p: J d • Phone#: 3 — • c.)— Are you an employer? Check the appropriate box: Type of project(required): I.❑ 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. ❑Neo'construction I am a sole proprietor or partner- \I listed on the attached sheet. i. ❑ Remodeling s.ip and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance CO .mpinsurnnce. 9. ❑Building addition required_] 5. ❑ We are a corporation and its 1Q❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 I.❑Plumbing repairs or additions myself. [So workers' comp. right of exemption per MGL 12E Roof repairs insurance required.] ` c. 152, §1(4L 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 below showing their worker'compensation policy infonraion. r homeowners who submit this affidavit indicating they are doing all work and then hire outside conmactors must submit a new affi demi_inti adng such. liConeactors that check this box must attached an additional sheet showing the natm of the sub-mntractoa and state whether or not those endues have employes. If the sub-contractors have employes,they must provide their workers'corrin.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 It or Self-ins.Lic.4: 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 51,500.00 andior 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 DLA for insurance coverage verification. I do hereby certify uncle/the pains and penalties of perjury that the information provided above isttrue and correct Signature: J_ al Date: `Z I !6 Phone , / — 86 - A05 Official use only. Do not write in this area, to be completed by city or town official City or Town: PermitLicense 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 n: 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 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. lithe 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 Z, 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 Construction Debris Affidavit In accordance with the provisions of MG.L. c. 40 § 54, all debris resulting from any work -- _< covered-by-a-Building Permit shall be disposed of in a-properly licensed disposal facility, as defined by M.G.L. c. 111 § 150A.,�pto - - +ThedAddress of Work: Irk' - J°OI 9k- -The debris_will be_transported by: ebns-willbe-transportedby: NtE„.;rofa-YdS - - S The debris will be received at: \la It YYY N t -Ciec7,`^ Signature of Permit AppLcanf bate cC/6/1-6 Building Permit Number: / Proposal Page Na. of Pages Proposal V A . NEWMAN'S CONSTRUCTION 697 Bridge Rd. Northampton, MA 01060 1212 413-586-1093 PROPOSAL SUBMITTED TO PHONE DATE �/�I f a — _ I STREET J�IAME CITY.STATE and ZIP CODE JOB LOCATION nen / ARCHITECT DATE OF PLANS OB PHONE 1 We hereby subm,t Specifications and estimates for ec, ert1 a F—CoQ oufvC I-c-74VL =--.nS\Ll' Al r.0 it t.0 w,,; v.\L.1.0.-• Mr2y €&,q t. cA. A-LL, 2515 2 fztJ2S I _L,\s4xl 1 cz k. \--Evz_. 6.222rts412 hs\ Vr.f-2` CA ‘..)416k - ar2ocin]D c In,tinhy k fr( S 101c,.i-�t\S Ty, ovt favi- N..y (ti 5 vn"k �L+aS\ 21` J}/Lu_,ttnnnu we\ 5r t . .L.•i"-ill r C•ctS er 1 r2�S 'iN52`c C`,u r'2 HS\--- -1( to...1 :-)4,-,,,,-, S�'L'H-sr- SEtFLti,. ]!�>2 I�IXV` _ GS A-_> /)`e�Z(�`e Y� jl Stall 19-14C_\At -.- C_I-U c s\i\,;,-i 125 awhvzf i F Rt?-5_R 1i (Cc (c Cipt S A-Tlath . 5 `CNSrlk ' a u_._. \i� - i C . C^ vL v int propose herebto furnish material and labor—complete in accordance with above specifications, for the sum of: /lv4 �G a Sl iJ9 ✓vC �c .."--<:° o dollars($ ). Payment o be e4as lbws. l//+ � /' l /lz_I_— rf% jintli2 GI' Gat0/- L pQIFIC£" ,�'L UPC ( o-mT± 1--� oe�l , All material is guaranteed to be p it d. All work 10 be pleted in a workmanlike Authorized manner according to standard ce involving extra costs l yI deasoondaurvctra k e is be an extra 'Watt" lyeyottocy dodOtheess wi fie awn Nye: Phis proosl h e \O u lrotl by Workman's Compensation Other GO days.„, Acceptance of proposal —The above prices,specifications -Ct--- \---_,_s--,S--------_-.- \\ and conditions are satisfactory and are hereby accepted You are authorized Signature N to do the work as specified. Payment will be made as outlined above. \ Date of Acceptance: Signature__..—._ f/7))