31A-047 (4) 249 CRESCENT ST BP-2017-0730
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31A-047 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A)
Category: Bath reno BUILDING PERMIT
Permit I4 BP-2017-0730
Project# JS-2017-001214
Est.Cost: $2500.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: NATHANAEL ALMEKINDER 102079
Lot size(sq. ft.): 6969.60 Owner: WAKIN ELEANOR
Zoning: URB(100)/ Applicant: NATHANAEL ALMEKINDER
AT: 249 CRESCENT ST
Applicant Address: Phone: Insurance:
66 CLARK ST (413) 250-3007
EASTHAM PTON MA01027 ISSUED ON:11/30/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:BATHROOM RENO - TAKING DOWN TILE &
PUTTING UP DRYWALL
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*I 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 SiEnature:
FeeType: Date Paid: Amount:
Building 11/30/2016 0:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0730
APPLICANT/CONTACT PERSON NATHANAEL ALMEKINDER
ADDRESS/PHONE 66 CLARK ST EASTHAMPTON (413)250-3007
PROPERTY LOCATION 249 CRESCENT ST
MAP 31A PARCEL 047 001 ZONE URB(1,00)(
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FARM FILLED OUT (17,„i \
Fee Paid /,/)Bui ding Permit Filled out
Fee Paid
Winer Construction: BATHROOM RENO-TAKING L6WN TILE& PU t I ING UP DRYWALL
New Construction
Non Structeral interior renovations
Addition[ Existi
Acce5sory Structure
Building Plans included:
Owner/Statement or License 102079
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF 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: She 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
P- ilif a:
Sa:-# e of Bui ding O'mat 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.
/
Ninoparat'eut;aea otdy;r<,
/ City of Northampton StetpsaF Peml�x
0 Building Department curt+ ' Reinn r
212 Main Street •-' -,w'} . r
Room 100 tlfat9f/WellAvadabiidy
Northampton, MA 01060 Two Setsafsvuctural Plates
phone 413-5874240 Fax 413-587-1272 PlouSl flans
/� Other.Spec
IXRPI!CATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Properly Address: 1t 21Lc YEry(r \-- cit. This section to be completed by office i���^1�1 y``I rt\ Map Lot Unit
Zone Overlay District
(�� (A
Elm St.District,_ CB Dbhiet
SECTION 2•PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Chimer of Record:
Arvmel-
�f Name r• Curren 2-Vu A ress iI (•Z' 7.-2-1 / /] t ' ,'
2.2 Aut A ent:
NAA ww'' !!' (0 A \( 4 F 1
Name(Print) 'V� 1� 1 �� Current Mating gess -
Signature Telephone
SECTION 2•ESTIMATED CONSTRUCTION COSTS,
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building c'2C ' (a)Building Permit Fee
2 Electrical (b)Estimated Total Cost of
Construction from(n)
3 Plumbing Building Permit Fee
4 Mechanical(HVAC) _.,/�
5.Fire Protection p�[ ✓7' /-/
6. Totes=(1 +2+3+4+5) Check Number -15—gi '7 jG//*�
This Section For Official Use Only
Building Permit Number Date
aed:
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 filled in by
Building Department
Lot Size
Frontage _. .. ..
Setbacks Front
Side L. R:
Rear - ---
Building Height
Bldg.Square Footage --- %„ - -
Open Space Footage
(lot area minus bldg&pied
parking) -_
ft of Parking Spaces
Fill:
(volume&Location) _. . ... _ _
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW !J', YES O
IF YES: enter Book. Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 6 DONT KNOW O YES 0
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 O NO 0
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 O
IF YES, describe size, type and Location:
E. Will the construction activity disturb(clearing,gradin excavation,or tilling)over 1 acre or is it pad of a common plan
that will disturb over 1 acre? YEF O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House I I Addition ❑ Replacement Windows Alteration(s) ri Roofing ❑
Or Doors Q
Accessory Bldg.0 Demolition ❑ New Signs p) Decks ® Siding Ql Other E
BriefW of Proposed-RaDescriptionProposed-Ra -1at-tvA-nc J se 1(4_4.1.5 ..ieton i..1/n ,i .1 ({w{"-' I
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.oomolete 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
e. Number of stories?
C Method of heating? Fireplaces or Woedstoves -.�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 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 70.OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT� OR CONTRACTOR APPLIES FOR BUILDING PERMIT
N i,r-�())(ir'a // rk/ ,as Owner of the subject
property t,' k, `- A ,
, erebysuthorize I`f ri'-r ILA _.
t' Ato act on my be ,If in all matters relative to work authorized by this buildin• •-rcrnit application.
i
I, �1• t fl A l t . I "a " as OwnerlAuthorized
Agent heresy. are that the stat-ments 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.
N-Art 1�%1At.\ Mtrti 1t'icv1-'-"
iPrint�ameee,�,
!'2'�. 12� 2 at b
gnature of gent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction
. Suprvisor: Not Applicable ❑
Name of License Holdei. pNTtThDsH \C1 y4NiyCS
-i0LAJ91
License Number
GL, C,k14' g tAcrn kini- r' MA O l b'zl 314-A 2a I R
Address Expiratio Date
-- 413 2C0 9Uf-
Signalure Telephone
9.Reoletelad:HomeImprovement Con : Not Applicable ❑
1•)At t4kI�I I. l ILIiabe1
Company Name Registration Number
5fAm AS qre,ov E 11 1b _
Address Expir2ti4n Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.a 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. 0
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 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 he 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: 2-M I c (Wcalt 4
The debris will be transported by: I f Cott\s
The debris will be received by: \11,1 1 -VtAJ
Building permit number:
Name of Permit Applicant NAt1nt.tikt
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
it — 1 Office of Investigations
i s'ttg
E mii f 9 1 Congress Street,Suite 100
e I9a . p
v, Boston,MA 02114-2 01 7
%Lc www.mass.govldia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information p�+l� A.,_ ` �Ple�ase Print Legibly
Name (Business/organizazionnndividual): 147y 1 Tyt „A`��.r{'f�yyc�p\,� As Tit, -i NitiVl�'`---
Address:
-Address: G� C,I.At,,t� t I' '�R a l f11 V v P r'22 yY/!r 0���1'
City/State/Zip: Phone#: I I 2 1.-S-0 -22 06,11.
Are you an employer?Check the appropriate box: Type of project(required):
I.a I am a employer with 4. ® I am a general contractor and I
employees(full and/or parttime).* have hired the sub-contractors 6. 0 New construction
2.0 I em a sole proprietor or partner-
listed on the attached sheet. 7. i Remodeling
ship and have no employees These sub-contractors have 8. 0 Demolition
workingfor me in anycapacity. employees and have workers'
P 3 9. ®Building addition
[No workers' comp.insurance comp.insurance.]
corporation 5. 0 We are a corporation and its 10.® Electrical repairs or additions
3.01 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself [No workers' comp. right of exemption per MOL 12,0 Roof repairs
insurance required.]' c.152.§I(4),and we have no
employees. [No workers' 13.0 Other
comp.insurance required.] I
*My applicant hat checks box PI must also fill out the section below showing their workers compensation policy information.
'Homeowners who submit his 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 showmg 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.
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#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 ofa 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 certify under the pains and penalties of perjury that the information e provided above isand correct.
Si enature:�� -C� Date: 1 ) (i T 110
Phone#: L1 i'2, 2-L7 5 --27-06-7-
Official
a3
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: PermillLicense II
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 it: