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32A-034 (2) 68 CHERRY ST BP-2017-1444 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A-034 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2017-1444 Project# JS-2017-002408 Est.Cost:$9300.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: use Grouo JAMES FLANNERY 103061 Lot Size(sq.ft.): 4486.68 Owner: ROSENBLATT KENDRA&ALIDA ENGEL Zoning:URC(100)/ Applicant: JAMES FLANNERY AT: 68 CHERRY ST Applicant Address: Phone: Insurance: 1 LOVEFIELD ST (508)294-4052 WC EASTHAMPTONMA01027 ISSUED ON:6/16/2017 0:00:00 TO PERFORM THE FOLLOWING WORK STRIP & SHINGLE ROOF 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: FeeTeoe: Date Paid: Amount: Building 6/16/2017 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use only arHA..ero City of Northampton Status of Permit: `re " " Building Department Curb CiNDdveway Permit ' A 212 Main Street Sewer/Septic Availability _S4 .,1 cif. I . Room 100 WaterM/ell Availability !;trt Northampton, MA 01060 Two Sets of Structural Plans Vir 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 69—f 7 •1(wy 1.1 IPro/p�eMAtltlmu:K.rThis section to be completed by office t-pS Crnl a. Map 74 Lot 03 / Unit NovcUiamron, Ma O1O1U0 Zone Overlay District Elm St District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Vfrrlrn 2OSmiola14 l 08 Crlerry S-E. N06-narnpron, Ma Name(PO ry) ^ / Current Mailing Address: 01 o 00 ]�lrJ� OYC Telephone V �/V/l/ Signature 2.2 uthorized Agent: t. MPS FIGYWWRJJ i wit o nS 1. Holvola, Ma01a¢) Name(Print) Current Mailing Address: Signature Tele5cia 2q4 • 40 . SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) �,j (� Ci0 . U Check Number /ct ,p/�� G ilia i This Section For Official Use Only Building Permit Number: Date - Issued / [JUN 1-2 tut Signature: a6%--- //-i 6/ts// Building Commissioner/Inspector of Buildings o_rcC NJate' "-S Ihasbrouck © northamptonma.gov EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 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 Depammcut 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) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES 0 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? NO O 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 O , Date Issued: C. Do any signs exist on the property? YES O NO O 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,grading,excavation,or filling)over 1 acre oris it part of a common plan that will disturb over 1 acre? YES O NO O 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) n Roofing W Or Doors 0 Accessory Bldg. 0 Demolition 0 New Signs [O] Decks (q Siding[0] Other[O) Brief Description of ProposedIS t i ^ c c t2 oo f Work: `(�(� 1� Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Sa.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 APPLIE S FOR BUILDING PERMIT I, \C /oQoSt / /kF , as Owner of the subject property ,^yy�p Flan ,�/J r� /j��, y (� [„ y� hereby authorize al 1 €S FlanI ei lq l YL° I"CJ] o mdnf i no)ng .,eS to act on my ehalf,in all matters relative to work authoriz ylh5 building ermit application. J Signet of Ownerate �/J(` y��Q�/7 ate I, VU 1 I K S f1(I 1 I Ili _ , as Owner/Authorized Agent hereby declare that the statements and information the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Pri tNamj f 11 Firtn ne rc u i -1117 Signature of Owner/Agent Date J SECTION 8-CONSTRUCTION SERVICES 8.1 Li -nsed Constnlctlo Su•:rvisor:. Not Applicable 0 Name of License Holder: i/. ICJ / a L L . License Number IJ t5 r lb 1 , 1 CL 0 16 ____ 111_21_61,_ Address Expiration Date I 14 2 I _ I . Signatu = / r Telephone 9. 'e!I tered Home lm•rovem •n - •r.. Not Applicable 0 i" = [ . a ' R01 .I meq_$ Company Name r Registration Number Address ,�tt p,D 4. Expiration Date Telephone'1(3 2 OR C•J v!1 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 ❑ No 0 City of Northampton 43 r a r `ae el z. Massachusetts ti=ss. src.. `der fg f DEPARTMENT OF BUILDING INSPECTIONS m 212 Main Street •Municipal Building ,` Ca._ Z \�m ; Northampton, MA 01060 ss v' .ur.p�` Debris 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. The(debris from mcconstruction work being performed at: u . (Please print house number a street name) Is to be disposed of at: \Q\IQ€r> ci 1`!l (Plea print name and location of cility) Or will be disposed of in a dumpster onsite rented or leased from: morons 2412- (Company �`.N_a—m�e_'a(��nnld Address) Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts ire Department of Industrial Accidents ffi"_1i�E' Office of Investigations �'= I 600 Washington Street $r v_i Boston, MA 0211.1 Vr} .I * www.mass.gov/dia Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information j'� ytr j''� / /y�/� ,� PleeassePrriint Legibly Name(Business/Organization/Individual):. ( X es-6 q I IW l�Q 1201100 4 la Address: ! P 1 _ � City/State/Zip: It fl/... ,kill _ 1 II b Phone#: 4k3 S 203 59525(44.) Arg y9u an employer?Check the appropriate box: Type of project(required): 1. I am a employer with /I 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El I am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working far me in any capacity. workers'comp.insurance. 9_ ❑Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.C I am a homeowner doing all work right of exemption per MOL I I.❑ Plumbing repairs or additions myself./No workers' comp. C. 152,§1(4),and we have no 12.0 Roof repairs insurance required.]' employees.[No workers' 13.0 Other comp. insurance required.) *Any applicant that checks box ui must also fill out section below showing their workers'compensation policy information. t Homeowners who submit.this affidavit indicating they ate doing an work and then hire outside contractors must submit a new affidavit indicating such. +Contractor that check thin box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy infunnation. Imo an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. i� �1/`, I \^ 1� �y �f'/tel Insurance Company Name T"� �r,-'}N l }'� k' `a,\A T q C)LtW'' 1 /� '^'} ��. Policy#or Self-ins.Lie.k:/'s y� WC\2_'3%4'(.QE 1Expiration Date: 4-\21 } t } `q Job Site Address: (Co ecce �� 11 Sac —City/Staee/Zipp 1\, t�LMCf Attach a copy of the workers'compensaaiba policy declaration page(showing the policy number and expiration date).°CUD 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 DR for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: - 1 /1 Date: 1Q `U Phone#: 1 41x '2.0 ` ` — ' Official use only. Do not write in this area to be completed by city or town offrciat 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 i Contact Person: ,... Phone#: 1