23A-210 (4) 74 BEACON ST BP-2017-0387
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:23A-210 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:GARAGE BUILDING PERMIT
Permit# BP-2017-0387
Project# JS-2017-000636
Est. Cost: $48500.00
Fee:$115,00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ALLEN GUIEL 054248
Lot Size(sq. ft.): 18513.00 Owner: HENSLEY MARK T&KAREN THOMAS
zoning: URB(1003/ Applicant: ALLEN GUIEL
AT: 74 BEACON ST
Applicant Address: Phone: Insurance:
63 CHESTERFIELD RD (413 268-9200 1) WC
WILLIAMSBURGMA01096 ISSUED ON:9/23/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:DEMOLISH EXISTING GARAGE, BUILD NEW
16X36
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 ft Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Ojl; 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:
FeeTFpe: Date Paid: Amount:
Building 9/23/2016 0:00:00 $115.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
• 'H°r° . 1 01
File#BP-2017-0387 - `) C
H.
APPLICANT/CONTACT PERSON ALLEN GUIEL ( ` 19'2
ADDRESS/PHONE 63 CHESTERFIELD RD WILLIAMSBURG (413)268-9200 0 P(Lfl
PROPERTY LOCATION 74 BEACON ST '.1 O � 113#/`
MAP 23A PARCEL 210 001 ZONE URB(100)/ hi
J„ „>
THIS SECTION FOR OFFICIAL USE ONLY: ,µ� I„�n',f(S""_
PERMIT APPLICATION CHECKLIST N
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT `,
Fee Paid ('/Ci *63 '77 Wt //4-
Building Permit Filled out
Fee Paid
Typeof Construction: DEMOLISH EXISTING GARAGE, BUILD NEW 16X36
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
INFO ATION 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
Demolition Dela
v
z 9-0V ao/f
Signature of Biildiny r#ffrcial / Date
Note: Issuance of a/oning permit does not relieve a applicant's burden to comply with all zoning
requirements and • main 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.
rng,j 2('- 1 7 Department use only
City of Northampton Status of Permit:
SEP2 Building Department Curb Cut/Driveway Permit
0 2UI s 212 Main Street Sewer/Septic Availability_
Room 100 Water/Nell Availability
Dear or eslrxvG u:m='cnons Northampton, MA 01050 Two Sets of Structural Plans
NOrMHA:SSON,MA 62.0
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- This Property� Atltlre,s.s. � \ -t1� This section to be completed by office
1 CI 17eT7CcA e7QL�) Map Lot unit
k-LU1JZE \/S- Zone Overlay District
'�-G I`�-d Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
' MAioe ilENCLF 7 74' TeACDAv cr LLOCEn/CE MA Oh. z
, Name(..Print) Currant Maring Address. r
/tL4.J� .. Telephone y27 589-46N6
Signature C
2.2 horized A
cL6 C ` 6 63 e+Js�FfcL9 20 k3iu. t ueo
Nance(Print _ \ t ' Emmet Mailing Address: 01 0 i Co
k' iii; /s 5 q8 9i "� _____
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
I Item Estimated Cost(Dollars)to be Official Use Only F
completed by permit applicant
1. Building /40 ) -V CCX,) (a) Building Permit Fee
2. parities! 019D��C (h) Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee I�J(
J
4. Mechanical (HVAC) ,__
5 Fire Protection ��jj
6_Total = (1 +2+ 3+4+ 5) 18 son Check Number 5577
This Section For Official Use Only
Building Permit Number. _ Date
Ded.
Signature: __
Builmns Commissioner/nspector 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 filled in by
Building Department
Lot Size
Frontage
Setbacks Front
(�� q
L1t
Side L: / R: _ : ] )R: 5.7
Rear l615 S
Building Height '9 I _ Ce
Bldg. Square Footage `�5b + ,o .5-7(0Open Spare Footage v
(Lot area minus bldg&paved
I parking) _
01
#of Parking Spaces
Fill: CkA C5. )0 h rte._ gAR C W
(volume en Lcsanon) F8't`rY 1'�{C.EJU i r/e..eu.Q
A. Has a Sp cial Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW 0 YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW 0 YES 0
IF YES: enter Book Page and/or 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 Q , Date Issued:
C. Do any signs exist on the property? YES NO (7f) I
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES (9 NO 0
IF YES, describe size, type and location:
E. Will tie construction activity disturb(cleanng,grading.excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK icheck all applicable)
New House n Addition ❑ Replacement Windows Alterationts) I t Roofing n
Or Doors D
AccessoryBldg. ( Demolition ❑ New Signs [Cl Decks [q Siding ICI] Other[CI
wbriefork Ueamdf4 Des h a er p s d�p
c1 �STIyy� e )t £l � Lthil 3G
Alteration of existing bedroom Yes P' No Adding new bedroom Yes T No
Attached Narrative Renovating unfinished basement Yes K No
Plans Attached Roll -Sheet
da. If New house and or addition to existina housina, complete the followina.
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?
1. 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 belowfinished grade
k. Will building conform to the Building arid 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
ek New t E7 _ - ,as Owner of the subject
property
hereby authorize ,44_tFA/ !r L(LtL
M act on my b half, in all matters relative to work authorized by this building permit application.
//�.�� . /7— al
Signatureoff• her Lei Date
I, 4L/'
`ei 6u I , as Ower/Authorized
Agent hereby declare that the statements and infomiadon on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains - td penalti-s of perjury.
i t avteZ
Print Nan lip �U
Signature of Owner/Auent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Lic t Co struclion ervisor: Not a� L .l"/Appllliiccaable ❑/�
Name of License Holder: W Cu, (94ck
License Numb
404 = srP 2 UJ 00 •••
0(•S , OC( 9 it
Addre 1 , Expiration Date
Signal Il s Telephone
9.Recast yl ed Home Improvement Contractor: Not Applicable ❑
Ca Z-. —_ - /COCK./
CompanyName Registration Numbetl
(� _o'_ a 0 '13i !.� .ter ' 6107(t, oei - lc/ - 18
Address - ' /' /y Expiration Dale
Sk *. t, D Telephone q14 a1
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MG.L.c.152,§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted vial this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes A( 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 !cense,provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner:Person(s)who own aparcel of land on whic -/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or del,• ed structures accessory to such use and/or faint
structures.A person who constructs more than one home N o- ear I eriod shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,o i . form acceptable to the Building Official that he/she shall be
res.onside for all such work ierformed under the , ,ddin• •emit.
As acting construction Supervisor yourpresenc- en the job site will be required from time to time,during and upon
completion of the work for which this permit i Issued.
Also be advised that with reference to Ch.• Cr 152(Workers'Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you maybe liable for person(s)
you hire to perform work for you u.'Cr this permit.
The undersigned"homeowner' Tres and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,S : e and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signatu-e
\ The Commonwealth of Massachusetts
Department oflndustrialAccidents
L y-y- Office of Investigations
1 Congress Street, Suite 100
_mak : ;:; Boston, M4 02114-2017
'4++;-�,7 .c' www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractus/Electricians/Plumbers
Applicant Information /II Please Print Legibly
Name Business/Chganizationindividual): M(.(,,tyio CV)be_--
Address._(p?j a1&E3l l ebo_ v04-so
City/State/Zip
City/State/Zip: [a) 9 4
op 1 (09 r.••ne #:_ ��i ; : ?/ -
Are you an employer? Check the apprate box: Type of project (required):
1.r I am a employer with , 4. I am a general contractor and I 6. [ New construction
employees (full and/or part-time).* have hired the sub-contractors
2. I am a sole proprietor or partner- listed on the attached sheet. 7. r,-1 Remodeling
ship and have no employees These sub-contractors have g. Demolition
workingforme in anycapacity. employees and have workers'
P Y. 9. Building addition
[No ,vorkers' comp. insurance comp. insurance.[
required] 5. 1 1 We are a corporation and its 10. Electrical repairs or additions
3. 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 I 12. Roof repairs
insurance required.]r c. 152, §I(4), and we have no /+
employees. [No workers'
13. Other td 1
comp.insurance required] _
*Any sppbwnl that cheeks box 41 must also fill oat the section below showing their workers'compensation policy intormation.
t 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-contractors and state whether or not those entities 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 polity and joh site
information. ,,�1 f�
Insurance Company Name: /� 1 'SJ•S V `�CCFDRI/ _..
Policy#or Self-ins. Lic. ,#:: ,(0Sc O\U B .—�F(p(p(J(o 9 --,) - leo Expiration Date: OC/ ' 12- i IT
Job Site Address: 3c1 12 7 CC'(v ' 1 • City/State/Zip: 11,uµ iF/ I-16 0(06 C
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 fort 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 f. insurance coverage verification.
I do hereby eH under th,.,` and t%ties ofperjury that the information providedabove is true and correct
Si ature: lIl Date: 1 ' I 1 - t. w
Phone#. q i eli-I p O 911;1
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
Cnntart Percnn• Phone ii.
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, 854, 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,� y,as a "defined by MGL c 111, S 150A.
tE4(.
Address of the work: -7(1 77E4(..01`)
The debris will be transported by: 'VAoe,- \►JICk..69 1 l doCtI
The debris will be received by: r q 2t`fljcC. , GISRE29
Building permit number: I
Name of Permit Applicant it.E16 6urtr2
51.06
Date Signature of Permit Applicant
16'
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