37-022 (4) 24 MOUNTAIN LAUREL PATH BP-2018-1003
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:37-022/o-ay CITY OF NORTHAMPTON
Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorv: Porch Enclosure BUILDING PERMIT
Permit# BP-2018-1003
Project# JS-2018-001822
Est.Cost:$15000.00
Fee: $98.0o PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor., License:
Use Group: KAREN CARTER 70008
Lot Size(su. 11): Owner: MACLEOD PEGGY L
zonine: Applicant: KAREN CARTER
AT: 24 MOUNTAIN LAUREL PATH
Applicant Address: Phone: Insurance:
223 MAIN ST (413) 221-7419
LEEDSMA01053 ISSUED ON:41612018 0:00:00
TO PERFORM THE FOLLOWING WORKCHANGE PART OF ROOFED IN PORCH TO
CONDITIONED OFFICE SPACE
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 4/6/2018 0:00:00 $98.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File# BP-2018-1003
APPLICANT/CONTACT PERSON KAREN CARTER
ADDRESS/PHONE 223 MAIN ST LEEDS (413)221-7419
PROPERTY LOCATION 24 MOUNTAIN LAUREL PATH ��I
MAP 37 PARCEL 022 000 ZONE 1
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION EJLLFCKLIST
NCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildine Permit Filled out
Fee Paid
TypeofConstruction: CHANGE PART OF ROOFED IN.RDReH TO CONDITIONED OFFICE SPACE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 70008
3 sets Qf Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO�NIATION 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
Dem lition Delay
Signat uildin fri i Date
Note: Issuance of a Zonin ermi[does not relieve a applicant's burden to comply with all zoning
one
and obtain 1 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.
Ir U7ts�t5 -h s-t/rY {yj Oril�4y
Department use only
City of Northampton Status of Permit:
.vf Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Sre 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 completed by office
2 A M'OV V77 q i,AvP-e - PAS Map 377 Lot__.n22 Unit
Zone T— Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: . r
p � R�GL .Z �1GUu�P� N 6AtJR�2 PA`(� 1
Name(Print) ICurrent MailinRAd q /
l'✓�z '�CL�2/ 7��/� Vt�VZ�
Telephone ' I
Signature
2.2 Authorized Agent: 2 2—3 Vl 1 ,
O�/t�Tl Z-Ct�S) /14,9- C !O 5
Name(Print) Current Mailing Address:
G?t -, - 22r - 7 `t
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building y/ 2-ed (a)Building Permit Fee
2. Electrical ' r6� (b)Estimated Total Cost of
Construction from 6
3. Plumbing �� Building Permit Fee
7 �
4. Mechanical(HV
5. Fire Protection-
6,
rotecton6. Total=(1 +2+3+4+5) Check Number 60
This Section For Official Use Only
Building Permit Number: Date
Issued.
Signature:
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows AIteration(s) Roofing
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [q Siding[p] Other[I7]
Bnef Description of Proposed
WorkLLth0V PAwr Dr: (G� 1206FEf1 '-1N flok 1+ To C)/✓A'Tr L`EA inFFzy-- 5PALf: 1®
Alteration of existing bedroom_Yes ZNo Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa. If New house and or addition to existin housin DO lets the followin
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 stones9
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attachedl
h. Type of construction
i. Is construction within 100 It of wetlands? Yes No. Is construction within 100 yr. floodplain_Yes_No
I. 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, as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner / Dattel n��n-,�
I, 1- rA P F 1.1 F. �fl'R. y� 1 kl��� L fc/..�L'�- (ltti 1'rn/�Q li� as Owner/Authorized
Agent hereby declare that the statements and mform ion on the foregang appkcahon are true and accu e,to the best of my knowledge
and belief
Signed under the pains and penalties of perjury.
KA-PM—IJ E • CkP-10P-
Print Nam
Signature of Owner/Agent Date 1 k
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
22 �t 1f CS — -7(003
Address Expiration Dale
LCIS MA
telephone 0 (�
Signature ~
X113 - z )- r ----7� /
9. Registered Home Improvement Contractor: Not Applicable ❑
Comoanv Name Registration Number
Address7
� ( Fxpimtion Date
2 MAID �• CO) 4A L/d5a Tele hone / �
q i 15 2d%
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....... Ur No..... ❑
City of Northampton
Massachusetts
DSPANTN " OP BUILDING INSPECTIONS ;t T
313 Main Street *Municipal Building JF n
Eor[hemp[on, MA 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c40, 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 construction work being performed at:
k ou zl—h p) ('AkNL- 7 F�
(Please print house number and street name)
Is to be disposed of at:
V l.i�y �cayc�. i NC
(Please p nt name and location of facility) S
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and 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
Department of Industrial Accidents
US
1 Congress Street,Suite 100
Boston,MA 02114-2017
www.mms.gov/dia
Workers'Compensation Insurance Affidavit:General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.
A licant IHformation Please Print Legibly
Business/Organization/Name: _ �Q� CA--Q--fYZ `n Prb.(TTW
?Z -_5 .^'
Address: VTI N ST
City/State/Zip: t SIA OID 1-b Phone#: �j 13 —22-(
Are y9uan employer?Check the appropriate box: Business Type(required):
1.E I am a employer with�_employees(full and/ 5. ❑Retail
or part-time)-- 6. ❑Restaumnt/Bar/Eating Establishment
2.0 1 am a sole proprietor or partnership and have no 7 ❑Office and/or Sales(incl.real estate,auto,etc.)
employees working for me in any capacity.
[No workers' comp.insurance requiredl S. ❑Non-profit
3.0 We are a corporation and its officers have exercised 9. ❑Entertainment
their right of exemption per C. 152,§1(4),and we have10.❑ Manufacturing
no employees. [No workers'comp.insurance requiredl*
4.0
We are a non-profitorganization,staffed byvolumeers, II.❑ Health Care
with no employees. [No workers'comp.insurance req.I 12,❑Other
*Any applicant that cheeks box 01 must also fill out the s fion below showing their workers'compensation policy immustion.
**If the wtporate officers have exempted themselves,but Ne emponuon hos other employees,.workers'compensation policy is reyuirsd and such an
organization should chock box#1.
I am an employer that u provide workers'compensation insurancefor my employees. Below is the policy information.
Insurance Company Name: /�
Insurer's Address: PO box 3SS6
city/State/Zip: Orli FL- 3;?-KO 2- - 3�5_(b
Policy #or Self ins.Lic.# h�Pj 127q.j Expiration Dale:
Attach a copy of the workers'compensation policy dechrration 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$1500.00 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 certify,under the pains and penalties of perjury that the information provided above is true
/and correct.
Signature: �/2 '7 � /J Date
�7
Phone#:
I �i — z2I / 'II \
Offrc4d use only. Do not wrhe in this area,to be completed by city or town official.
City or Town: PermittLicense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Cilyfrown Clerk 4.Licensing Board 5.Selectmen's ice
6.Other
Contact Person: Phone#:
www mass.gov/dia
City of Northampton
:y� ss
/ Rassachusetts
l �• ' S s
DEPAETNENT OF BUZZ.DING INSPECTIONS
212 Main Street a Municipal Building
Northampton, M, 01060
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation COCABR") regulates the registration of contractors and
subcontractors perforating improvements or renovations on detached one to four family homes. Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by reeistered contractors.
Note:If the homeowner has contracted with N corporation or LLC,that entity must be registered.
Type of Work: (� E NO V,*Tt U tJ Est.Cost. / '0
Addressof Work: 2-A µAouwrAi4 LAvaeL- PTR
Date of Permit Application: A faR l L
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
_Job under$1,000.00
_Owner obtaining own permit(explain):
_Building not owneroccupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
I�tt rlC � i2-g7 /9
Date Contrac—tortuwne HIC Registration No.
OR:
Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
Pre- Construction Agreement
DATE: March 5, 2018
EST# PM352018
CUSTOMER: Peggy MacCleod
am ree 24 Mountain Laurel Path
Phone 413-221-7419 Northamton, MA 01060
MA CS UC. 70008 Hl 124718
email: arbetkar@crocker.com
karencartercarpentry.com
PURPOSE
1 Clarify existing conditions that impact new work specifically those not readily
visible above the ceiling finish and below the porch floor
2 Determine materials and installation methods and accociated costs
3 Review ori incl proposal and revise accordingly
4 Develo construction time-line
5 eview
with wner
6 Procure Building Permit
PAYMENTSCHEDULE
Due Upon Accepatance of this proposall $500.00
CONSTRUCTION AGREEMENT(Sign to accept proposal)
This is an agreement betweeb►Caren Cart ensed Construction
Supervisor(C ntractor) l ��
(Date: lb t8 ), sole proprietor of K�reen Ca?r Cdarpentry and
PeggyM c#A cd(Homeo%A < �o
(Date: 3H1IFS ) of property at 24 Mountain Laurel
Path; Northampton, MA 01060 for the scope of work as outlined above.
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24 Mountain Laurel Path: Convert front porch to office
Specifications
- enclosed office with access to living room, 8 feet long ending
before outdoor light fixture.
- 2x6 framing,0~ lG (' ,;L
- siding: hardie plank (if possible, saved from house decor),
primed but unpainted (Peggy will paint)
- exterior trim posts at edge of living room and eastern corner
- high efficiency wall insulation - rock wool? denim? Foam? cele
- 36" x 25" Pella double casement window with 12" x 25" fixed
panes above to match living room
- interior birch trimmed windows and doorway to match main
house
- birch baseboards to match house
- cathedral ceiling with R I N sw'r710 lk)
- sheet-rocked walls and ceiling
cured solid birch floors, mixed widths to match main house
**30" wide glass/windowed door between office/living room,
installed as either a pocket door, sliding barn door, or standard
hinged swing to inside
**EcoBuilding Bargains by Peggy