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23A-253 (4)
193 NONOTUCK ST BP-2017-0846 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23A-253 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 Permit# BP-2017-0846 Project# JS-2017-001415 Est.Cost: $85000.00 Fee: $553.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HANS DALHANS 101628 Lot Size(so. ft.): 10672.20 Owner: RAVETT ABRAHAM&REBECCA J MUL Zoning: URBUOOV Applicant: HANS DALHANS AT: 193 NONOTUCK ST Applicant Address: Phone: Insurance: 11 CHERRY ST (413) 977-6094 EASTHAMPTONMA01027 ISSUED ON:1/13/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:RENOVATIONG WING OF HOUSE & REMODELLING KITCHEN, BATHROOM & BEDROOM 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 CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 1/13/2017 0:00:00 $553.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0846 APPLICANT/CONTACT PERSON HANS DALHANS ADDRESS/PHONE 11 CHERRY ST EASTHAMPTON (413)977-6094 ) 0 PROPERTY LOCATION 193 NONOTUCK ST (ree'7 MAP 23A PARCEL 253 001 ZONE URB(100)/ ff///--- THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid �60 Building Permit Filled out Fee Paid Tyoeof Construction: RENOVATIONG WI HOUSE&REMODELLING KITCHEN,BATHROOM& BEDROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 101628 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON 1 FO 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 n day fir - 10,1/ —ice—i7 Signature of Buil.ung 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. DepartmeRtr$0*Tr City of Northampton Status of Permit: \ Building Department Curb Cut/Driveway Permit. „G►1 \ 212 Main Street Sewer/SepticAvailability ..4.6.0 9 W \ \ Room 100 WaterNJeltAvailability forthampton, MA 01060 iwoSets of Structural Pians phone 413-587-1240 Fax 413-587-1272 PlotSitePlans` V -APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE� ` I �O/R(DDEMOLISHHAA ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION Q0 4 N d e`" 1.1 PrAtlttl�ress: �/ Map This section to be completed by office 1 /Property Y S I \J:On O+ a CX St . Lot Unit t O / Zone Overlay District �� Q_/ 2 Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 2,1on— e_ctV iAAU-0e,V. t93 Non of,c 51- • fl ieivvC2.,VA Na (Prmp \ 1CMail ^ ess: U 6 n J d ( 0.sZ - \AijOQ Telephone Signature `— 2.2 Auth razed Agent: 1*.k, L/S ( 4(c-enH rr—lV - A-L‘RSCAl9tFAI C,,IMP:‘k - (IPA Name Pri Current Marling At dress (113 971 4oiq ature Telephone SECTION 3•ESTIMATED CONSTRUCTION COSTS ltem Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building / U200° (a)Building Permit Fee 2. Electrical I (b)Estimated Total Cost of �l 0/,V UO Construction from (6) 3. Plumbing Building Permit Fee 6 ) ppu 4. Mechanical(HVAC) ._ 5. Fire Protection Y(�J) -L/ 6. Total=(1 +2+3+4+5) QSO00 Check Number // C, 553 This Section For Official Use Only Building Permit Number: IIsssued: Signature: Building Commissioner/Inspector of Buildings Date op ( 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: L. R: Rear Building Height Bldg.Square Footage Open Space Footage %. (root area minus bldg&paved parking) #of Parking Spaces - - Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO S DON'T KNOW 0 YES O IF YES, date issued:, IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO SI DON'T 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 ® NO 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 IF YES, describe size, type and location: E. VVIII the construction activity disturb(clearing,grading,�vation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5•DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) al Roofing Or Doors RE Accessory Bldg. CIDemolition i I New Signs [0] Decks [q Siding Efitt Other[Dl Brief Description of Proposed ( q 1 1 '\ Work: t.Od 0-TVI J1.a OS �itie .a+,.d.�fe.tPkode\\,� tf_.\1 CA koc.\\ArjO'nx .( , Alteration of existing bedroom Yes A. No Adding new bedroom d1 .1 Yes No Attached Narrative Renovating unfinished base e Yes y No Plans Attached Roll -Sheet Ba.If New house and or addition to existinghousing,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 e. Number of stories? f. 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 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. _K'1-\ lLAA,\ 2_j\_ as Owner of the subject property \, hereby authorize \)0, ` GJS l .0-4-tar* �C. • to act on my behalf,imatters relative to work author e� d by this bbilding permit application. t °N\,. Qom-- \ I G ' 1 R- Signatu of Owner ` Date I, S / Crr S e.-(` cc_ I^! a,-/S. Co..r` IIN <. , as Owner/Authorized Age ereby declare th statements and informatiol the foregoing application a eF true anfl accurate, to the best of my knowledge and belief. Signed u der pains andopf perjury. PrintN m�� l /4-2 (kA .S Sign ture of Owned ent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: \ Not Applicable 0 Name of License Holder: O.'4S \J , a\C\e,N1S Cs 1Mca.?, License Number CVR S?- Fc,5, \A‘'Q\\Y\ Mtn 111ratio 3\110 Date Add -a- 4 , 113 S71 C-,0t Ex 'i'nature Telephone 9.Raoletered Nome Improvement Contractor: Not Applicable 0 '3Com an Name 1 Registration umber aC Q 5� �(9f act $ Address 4. if /,s, Expiration Date \RM f*or MP 00:)11 Telephone lt3 a 111 tC04q 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 0 No ❑ 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 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: ,N Q� 'ot1�o`c [ ,It2 1S2. The debris will be transported by: kOX _ 6c,\.WlIlv\ The debris will be received by: V c,.\\-kAt. � c U Building permit number: Name of Permit Applicant— v.v. Dr L kc,v 5 dot t i • Date Signature of Permit Applicant The Commonwealth of Massachusetts At y _ b Department of Industrial Accidents Office of Investigations retie- 1 Congress Street,Suite 100 IF I Boston,MA 02114-2017 www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organization/Individual): r s .US Address: U CC'\&AIL Sek CO City/State/Zip C GS� \V�a ir...Cil v� J"1t'a� O\Q lPhone #: l(3 S,1 pts Are you an employer?Check the appropriate box: Type of project(required): I.❑ I am a employer with 4. ❑ lam a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 3.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g, RI Demolition workingfor me in anycapacity. employees and have workers' a ty. 9. ❑ Building addition [No workers' comp. insurance comp, insurance., required.] 5. We are a corporation and its 10.*! Electrical repairs or additions L❑ I am a homeowner doing all work officers have exercised their I I.[/ Plumbing repairs or additions myselfcomp. [No workers' right of exemption per MGL y + c. 152, §I(4),and we have no 12. Roof repairs insurance required.] employees. [No workers' 13. Other comp. insurance required.] Sny applicant that checks box g l 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 suck .ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have nployees. If the sub-contractors have employees,they must provide their workers'comp.policy number. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site ;formation. rsurance Company Name: olicy#or Self-ins. Lic.#: Expiration Date: rb Site Address: City/State/Zip: .ttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of rvestigations of the DIA for i prance coverage verification. do hereby certif u e pa-r d penal 's of perjury that the information provided ab/gy ye is true and correct. n.,+�!/ Date: 07/ 7/1 6 hone#: 114-S T7) bo 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): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: