24C-168 (5) 63 FRANKLIN ST BP-2017-1385
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24C- 168 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: KITCHEN&BATH RENO BUILDING PERMIT_
Permit# BP-2017-1385
Project# JS-2017-002310
Est. Cost: $17600.00
Fee: $114.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: STEPHEN D ROSS 079160
Lot Size(sq. ft.): 6882.48 Owner: KENNICK JUSTIN H&MARGARET M BRUCHAC
Zoning: URB(100)/ Applicant: STEPHEN D ROSS
AT: 63 FRANKLIN ST
Applicant Address: Phone: Insurance:
36 SERVICE CENTER RD (413) 584-1224 () WC
NORTHAMPTON MA01060 ISSUED ON:6/I/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:KITCHEN CABINETS AND SHOWER
REPLACEMENT
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: O1: 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 7/5/2017 0:00:00 $114.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-1385
APPLICANT/CONTACT PERSON STEPHEN D ROSS
ADDRESS/PHONE 36 SERVICE CENTER RD NORTHAMPTON (413)584-1224 Q
PROPERTY LOCATION 63 FRANKLIN ST
MAP 24C PARCEL 168 001 ZONE URB(1001/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid1/4 SK
,\
Building Permit Filled out %
Fee Paid
Typeof Construction: KITCHEN CABINETS AND SHOWER REPLACEMENT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 079160
3 sets of Plans/Plot Plan tie G(ieastsC )]�eh')
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOfMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Man 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
eta
ZordiS t5-3/1
Sign. re of Bu din_-• ficial 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 40&Contact Office of
Planning&Development for more information.
Department use only
a1 -` City of Northampton Status of PermPermit:-11 ulldiny Departent Curb Cut/Driveway Permit
L. - 212 Main Street Sewer/Septic Availability
Room 100 Water/Weil Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 PIOUSite Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be comp by office
(43 Fr « 1ctx ri "a .� Map AC_ Lot [0 Unit
CYie Lis," ,i cir
Q (o tie o Zone Overlay District_,
Elm St.District_, CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
t- 3(rut Cre.C_ 634i, "a+.
Name(P �/� Cu - eel Add{e.s /'zi U /d Er
ai1N"" C4t✓ '-'— Telephone�/f;f�.��.--cv
Signet e
2a Authorized Agent
I> FZofl 34 St✓✓rc., (—fw (t4 Nl^/A M4
Name{ 'nt) Current Mailing Address:
g ore ... Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building /
3 a°0 +) {a)Buildrng Permit Fee
2. Electrical �) .at (b)Estimated Total Cost of
Bad- Construction from(6)
3. Plumbing /Ode W Building Permit Fee
4. Mechanical(HVAC) U —
6. Fire Protection `T[ 5- y-Ja
6. Total <'s
=(1 +2+3+q+5) '/' / Ud . X Check Number /� h/' il/J�/
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
4a r „ „ '07 j�mt(� 'c
7"`
Section 4. ZONING All information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Required by Zoning
Lhls column ria be(it(ed in by
Bonding Department
Setbacks Front
Side
1111
ftear�04
11
Building Hetghl_lMlra
iaIIIIMIMIIII
Bldg.Square Foot.
Open Space Footage -1111 -_
(Lot area minus bldg ee paved
ark in_1
----
A. Has a Speci ermit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW O YES
IF YES,date issued:
IF YES: Was the permit recorded at the Regist Deeds?
NO O DONT KNOW YES O
IF YES: enter Book Page and/or Document d
B. Does the site contain a brook, body of water or wetlands? NO 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 0 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. Will the construction activity disturb(clearing, grading,ex anon, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
W YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 6-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) LSA Roofing 0
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs IO] Decks [Q Siding(Q] Other MO
Brief Oescri7Qti�on yyf eraposed // ))
Work: Gfr'fclr w.. �u�.*-.... /S (She eJ44./ VK ski-^i+ii.—
Alteration of existing bedroom Yes Adding new bedroom Yes oY
Attached Narrative Renovating unfinished basement Yes t/` No
Plans Attached Roil -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 roam ' each tam unit: Number of Bathrooms
c. Is there a •-rage attached?
d. Propos:. Square footage of new constructio Dimensions
"`e
e. Numb: of stories?
f. Metho, of heating? Fireplaces or o.. .._ Number of each
g. Energy C . serration Complian - 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 Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT O_R�CONTRACTOR
)APPLIES FOR BUILDING PERMIT
p +" 1 Cel � rel
SPARC--C—' as owner of the subject
property ilii +�
hereby authorize •+ 4-- �. i l.o
to act on my ehalt in matt s relative to work authorized by this building permit application
5/3//17
Si natur o Owner ''^^ Date
i. �' frc V- Robs -.... ,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.
Si-b .._ t tar,
Print N.v:
- •natur of Owner/Agent Date
SECTION a-CONSTRUCTION SERVICES
8,1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: Sfrlohen .. Ross CS 71160
License Number
.3S Ser,/a Caner ntanthr olevA! 4-.28 ,0/7
Address awAeo,y Expiration Date
4/3•SSy-iaa.y
Signature Telephone
.. . :. _ . Not Applicable 0
SIe2hen less gement/ Cone/attar /-013417
Company Flame Registration umbo
36 &rots- &n'&r Alor1hanepk.J x,44 x040 ,$-y -Pole
Address Expiration Date
Telephoneld)f 5'3241-1224/
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.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 ❑ No 0
tlainntstainterfaanatton
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 te,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 a0 such work performed under the building permit,
As acting Censtruebion 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: 63 cr.-0.0_44.A. .54_
The debris will be transported by: M
The debris will be received by: V,--cy /7--t c .
Building permit number:
Name of Permit Applicant SA-e it„, D- Far c
Date Signature of Permit Applicant
AC RL? CERTIFICATE OF LIABILITY INSURANCE DATE 4/1 arenrE,
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDIT/ONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement an this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PROOIICER EMT Barbara Grynitiewic2
Webber & Grinnell FIORE (413)586-0111 FAX
( )ax WY.(413)566-6451
8 North Xing Street q sbgrynkierica@wbberandgrinnell.cont
INSURERS)AFFORDING COVERAGE XAICY
Northampton HA 01060 INSURER A:Eacelaior/Liberty ".. 11045
INSURED INSURER sA.1.N. Mutual
Stephen Ross INSURER C:
Attn: Aim Clairemont 1NSUREe D:
36 Service Center Road INSURER E:
Northampton MA 01060 INSURER F:
COVERAGES CERTIFICATE NUMBER:EXp 3/1/18 REVISION NUMBER:
THIS t5 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTNITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALU. THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
II,TR TYPE OF INSURANCE I I SUER.
POLICY NUMBER (MWDDNLICY EY'f IPOLICYOY ) LIMITS
X 'COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE IS 1,000,000
A CI.XMSMaOE X OCCUR IS CAMAGETO PINTO 15 100,000
`--RcEMISES(Fa oRrrtaeeY
®x8898898 3/112019 3/1/2018 MED EXP(Any one**AI 1,5 5,000
I PERSONAL A WV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: I I GENERAL ACGREI:OATE $ 2,000,000
POLICY' X PRO- .... ....... 2,000,000
JECT _...... LOC PRODUCTS-COMP/OPAGG $
—
OTHER
•AUTOMOBILE LIABILITY I tEsCOMBINEDIINOEUMT j
ANY AUTO • I BODILY INJURY(Per rpnon) 5
, - L OWNED SCHEDULED LBODILY INJURY(POP accident)'..,$
AUTOS i A NOWNED I I PROPERTY DAMAGE
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HIRAUTOS VY'Ps I i.HP`er ac64 lIt
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UMBRELLA LISS
OCCUR I EACH OCCURRENCE '.5
EXCESS LIAO CIAMSMADE I AGGREGATE S
DEC •
RETENTIONS S
WORNERS COMPENSATION , ( - X RIZ R 2;"--
AND RI' YIN E
I ANT ROFRIETOHPAPTEENESEC WE Yr/N'X/A• I EL.EACH ACCIDENT °5 500,000
OFFICERMEMBER EXCLUDED
B .(Mandatory In NH) 101LSD0B0065462016A 7/1/20161 7/1/2011 E.L.DISEASE-EA EMPLOY =S 500,000
X yes,desert*Urvbr
DESCRIPTOR 90 OPERATIONS beiw : . E.L.NDISEASE-POLICY LIMIT 5 500,000,
DESCRIPTiN OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Menusel Renatlu SchSuls.mvy b attached IMO N spam Si repotted}
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
**For Insurance Info Only** THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVIBIONa.
AUTHORISED REPRESENTATIVE /3
IR Webber, CIC CR:S/3A i f� da,___cL"T1 "
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