24C-186 (4) 211 CRESCENT SI BP-2017-1116
GIS4: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24C- 186 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ALTERATION BUILDING PERMIT
Permit 4 BP-2017-1116
Project# JS-2017-001900
Est. Cost: $2500.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DANIEL HATHAWAY 081793
Lot Size(sq. ft.): 5924.16 Owner: CASCHETTA MARY BETH & MERYL COHN
Zoning:URB(100)/ Applicant: DANIEL HATHAWAY
AT: 211 CRESCENT ST
Applicant Address: Phone: Insurance:
2 OLD GOSHEN RD (413) 695-2937 O
W ILLIAMSBURGMA01096 ISSUED ON:4/6/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:ADDING SUPPORT TO FIRST FLOOR KITCHEN
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 14 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 4/6/2017 0:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck-Building Commissioner
File# BP-2017-1116
• APPLICANT/CONTACT PERSON DANIEL HATHAWAY
ADDRESS/PHONE 2 OLD GOSHEN RD WILLIAMSBURG (413)695-29370
PROPERTY LOCATION 211 CRESCENT ST
MAP 24C PARCEL 186 001 ZONE URB(IOQ)/
'PHIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid ' (5
Building Permit Filled out {vy,
Fee Paid
TypeofConstruction;: ADDING SUPPORT TO Flift ST FLOOR KITCHEN
New(7Clnstruction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building�Plans Included:
Owner/Statement or License 081793
3 sets of Plans I Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
(24c}tproved 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 Delay
9.-1V7
Signantre of Build ng *fficial 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,
Department use only
City of Northampton Status of Permit:
--- Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 WaterNyell Availability
i APR _ 6 L;' Northampton, MA 01060 Two Sets of Structural Plans
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
This section to be co feted by office
1.1 Property Address: `1 y1 (--11—e ` ittf
5-' o2"/C.` Lot
Unit
Map POiltima 411111-014
11-014
/�IDiD V�//�'��11 Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1Owner of Record:
SpUp C
4SC✓ ✓L-k1 1 I co 21omsca0- 2 P
o
vi-kkok, 0/060
NaCuleB /ilin3A 'va_h
Telepphonee
gnatu
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2660.bo
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection ,r
6. Total=(1 +2+3+4+5) I- ��(, Check Number/ g 57i? (j
This Section For Official Use Only
Date
Building Permit Number: Issued:
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: L: R:
Rear
Building Height
Bldg.Square Footage %
Open Space Footage
(Lot area minus bldg&paved
parking) - .
II of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Findin ver been issued for/on the site?
NO O DONT KNOW YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O . YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NODONT 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 O 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. WII the construction activity disturb(clearing,grading,e ea ion, or filling)over 1 acre or is it part of a common plan
that will disturb over I acre? YES O 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) I I Roofing pi
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks ❑ Siding®) OtherN_
Brief Description of Proposed 8194944 .P f %l e /bast" K't0 B C- kinds-67u
Work: a near
Alteration of existing bedroom Yes y/ No Adding new bedroom Yes No /
Attached Narrative Renovating unfinished basement Yes I/ 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
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, Magi Z. 601141 ,as Owner of the subject
Property {L�`
/^` Uw�
hereby authorize \U'�
?(Signature
on my behalf,in all matters relative to work auth)dzed by this building permit application.
Signature of Owner Date
111111111
I, ,as Owner/Authorized
Agent hereby declare 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 Name
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: l�L� Not Applicable 0
14-745771Name of License Holder: �9.vl� Jf'7t4�' ,,j C5 03/713
License Number
2 oU7 4- j Aj £0 Iul c Iblibe Li4
Addre Expiration Date
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable 0
.2.29/71)/C-2.- 4134/2nfvu / Ief"e441g
Company Name Registration/Number
Address Expiration ate
Telephone
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 bu,(ilding permit.
Signed Affidavit Attached Yes (11±C
xNo 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 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 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 he 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(1 CR5ctuf Ar4R,Popon M, d/ O V
The debris will be transported by: /2 ua- /.4-S /
The debris will be received by: uhvbahlAseciez
Building permit number:
Name of Permit Applicant Allt, t1-Jt"vruru 9
Date 3 , ,7 Signature Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
_x!Ni��.6 Office of Investigations
BE-=:\t=
h` 1 Congress Street,Suite 100
_/l/��/.-'"""'"���1 Boston,MA 02114-2017
www.mass.gov/dta
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information L .�,/"Please Print Legibly
Name (Business/Organization/Individual): d 'YL
lndividual): +A /(2i 'W C-
Address: Z O -Q 0.. t-K-zv �
+ 0 /
city/State/Zip: y(A:///JNYl3 ay)%Lr Phone#: $2 5 6G s 29 3 7
Are you an employer?Check the appropriate box:
Type of project(required):
I.0 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. ❑New construction
2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g. 0 Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance. 9. ❑Building addition
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
12.0 Roof repairs
insurance required.] * c. 152,§1(4),and we have no /94-04 �� ��
employees. [No workers' 13;7/Other
comp. insurance required.]
`Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infomtation.
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. lithe 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 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 for insurance coverage verification.
I do hereby certiA uncle the pains and penalties of perjury that the information provided above is true and correct.
Signature: (- Ip Date: Y. r3 i7
Phone#: y/-3 6 4 79
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#: