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42-043 (9) 669 WESTHAMPTON RD BP-2018-1040 GIS4: COMMONWEALTH OF MASSACHUSETTS Map Block:42-043 CITY OF NORTHAMPTON Lot -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGLLcc.1144/2�A) Category: KITCHEN RENO BUILDING PERMIT Permit 9 BP-2018-1040 Proiectd JS-2018-001884 Est.Cost: $15000.00 Fee:$97.50 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor: License: Use Group: DANIEL K DACRI 105989 Lot Size(sa. ft.): 25047.00 Owner: JOHNSON FRANCIS&LUCY HARTRY Zoning- Applicant. DANIEL K DACRI AT. 669 WESTHAMPTON RD Applicant Address: Phone. Insurance: 247 RIVERSIDE DR (617)543-2843 Workers Compensation FLORENCEMA01062 ISSUED ON.4/12/2018 0:00:00 TO PERFORM THE FOLLOWING WORK:KITCHEN RENO - COUNTER TOPS AND REPLACE CABINETS 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: FeeTvpe: Date Paid: Amount: Building 4/12/2018 0:00:00 $97.50 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File p BP-2018-1040 APPLICANT/CONTACT PERSON DANIEL K DACRI ADDRESS/PHONE 247 RIVERSIDE DR FLORENCE (617)543-2843 PROPERTY LOCATION 669 WESTHAMPTON RD MAP 42 PARCEL 043 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATI KLIST SNCL REQUIRED DATE ZONING FORM FILLED OUT Fee Paid l Buildm Permit Filled out Fee Paid Tyroof Construction: KITCHEN RENO -COUNT TOP DREPLACE CABINETS New Construction Non Structural interior renovations Addition to Existina Accessory Structure Building Plans Included: Owner/Statement or License 105989 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 Demolition Delay e of Build Kg ff a Dale Note: Issuance of a Z ing 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 dict standards of MGL 40A.Contact Office of Planning&Development for more information. Departrnent use only City of Northampton Status of Fina Building Department Curb CurlDmeway warmit 212 Main Street SeweNsepbcgwailatiillty Room 100 WatarAi Availability Northampton, MA 01060 Two Set of Strucbasl Plans phone 413-587-1240 Fax 413-587-1272 Plotrsile Plans - OtlrerSpec APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Prooertv Atltlres/sI/I , This section to be completed by office p�� uLyfdXr"I �� Maid zmLot_-0-10 unit Zone Ovamy District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Ill Owner of Record: nuc N (Purn Cuoent Mallin Atltl ' Telephone signarure 3 -s d y - n o s- 2.2 mhonced A eM: / Nam Current Mailing Address: Sign urs Telephone SECTION 3.ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Offidal Use Only coin leted by darmuta licant 1. Building / l/, (a)Building Permit Fee 2 Electncal V V (b)Estimated Total Cost of Consbuction from 6 3. Plumbing Building Permit Fee —1 4. Meohemmal(HVAC) / 5(/ 5. Fire Protection 6. Total-(1 +2+3+4+5) Check Number Ths Section For Official Use Only Building Permit Number: Date Issued Signature' Building Co rrerllnspedor of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR oil Section 4. ZONING All Information Must Be Complete.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning Tbvs column to be filled in by Building PeParwent Lot Size Frnntag, Setbacks Front ' Sid, L : L:_ R: Rear Hudd ng Height Bld, Square Footage Open Space Foo age - 0 ont arra mons bldg&pied Parking) H of Parking Spaces Fill: (volume&wcari,m A. Has a Special Permit/Variance/Fin/di�ng/eyet been issued for/on the site? NO O DONT 10 KNOW YES IF YES, date issued: IF YES: Was the permit recorded at theRegis y of Deeds? NO O DONT KNOW YES O IF YES: enter Book Page arid/or Document#' B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW YES IF YES, has a permit been or need to be obta.ned 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 © NO QO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grudim,'2xenyvatrn,or filling)over 1 acre or is R part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Stolen Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check II applicablel New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Q Or Doors ❑ Accessory Bldg. ElDemolition ❑ New Signs [O] Decks [C] Siding[p] Other[O] Brief Description of Proposed Work. Alteration of existing bedroom_Yes No Adding new bedroom Yes No / Attached Nanative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa.If New house and or addition to existing housirto,complete the tollowing. a. Use of building OneFani Two Family Other b. Number of rooms in each family unit. Numberof Bathrooms n Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stones f Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Maescheck Energy Compliance form attached? h. Type of construction I. Is construction within 100 ftof watlands? Yes No. Is construction within 100 yr. Floodplain_Yes No I. Depth of basement or cellar floor below finished grade k. Will building conformto the Building and Zoning regulations? Yes No I Septic Tank_ City Sewer Private well City water Supply SECTION]a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 1 -�� � as Owner of the subject property / hereby authonze h IT�1 tct on my behalfta,in I matters relative to work authorized by tt, building panni ppli - n. Signature er pal I, - f �'1 R6.() ,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 ury. Q Print Name ' Signature or JigiderlAgent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Conatructbn Su isor: Not Applicableec0 G Name of License Holder 1 Licen-/WN , �uT S Atldre Expiration ate 61� -Sy3_,>Z8y3 S,ni!IM Telephone 9.Re late t H vement Contractor: Not Applicable ❑ L h Scr) 16c?�� Comonnv Name Register gon Nu beer Address Expi lion D e Telephr ne SECTION lQ WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(8)) Workers Compensation lnsumnce affidavit must be completed aid s.ibmiffed with this application Failure to provide this affidavit will suance result in the denial of the isof the builtli)ZPN, _ Signed Affidavit Attached Yes.._. No...... ❑ City of Northampton Massachusetts A+s. srC4� V i " �I DF.PAR1ftEMP OF BUILDING INSPECTIONS = uz [ strcet a Municipal suilemng Cm �\ N.rth, ton, HER 01060 Fsrya h�a AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors perforating improvements or renovations on detached one to four family homes. Prior to performing work on such(tomes,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 ownerwccupied building containing at least one but net more than four dwelling units__..or to structures which are adjacent to such residence or building'be done by registered contractors. Note:If the homeowner has contracted with/a'corporation or LLC,that entity must he registered Typc of Work: -P J- {+' ,,� u6 .)�l �V�/ Est.Cost: Address of Work: 66 Wl �°IM Ck1 KLA O.U�L Date of Permit Application. 1 herebc certif, that Registration is not required for the following reason(s): Work excluded b} law(explain). Jab under$I U00 00 Ooricr obtaining oNim permit(explain): Building not owner-occupied 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 apple for a building permit as the agent of lire menet: YQr- -Dav, D,,( Date Contractor Name HIC Registration No. OR: Nohvithstanding the above notice. I herebc apply for a building permit as the comer of the above propem Date Owner Name and Signature City of Northampton =�( Massachusetts VF ARTlANP OF NULDA'G INSPECTIONS 212 l Strcet • M —pa 0vil g SFS�Cs \� l rt ptm, M 01060 Massachusetts Residential Building Code Section 110.R5.1,2 Homeowner: Person (s)who own a parcel of lard 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 strictures. A person who constructs more than one home in a two-year period shall not be consi fer,!d a homeowner. Section I IO R5.L3_1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.85, provided that if a homeowner engages a persons) for hire to do such work, then such homeowner ihall act as supervisor. Such homeowner shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all wch 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. fix the Commonwealth ofMassachuselts Department of i nduslrial Accidents 7 Congress Street,Suite 100 Boston,MA 02114-2017 ul tvanemasacgovIdia Workers'Compensation In atuxu reABidavit, General Businesses '10 BE FILED WITH THE PERMITTING Ap HIORIT1'. A li ant Information Please Print Legibly Business/Organc: ization Nam 1 Address: p lv-�+-+ Mil vlM�,�' II��1 C� y Citi/State/zip: l—�J IY✓lU ` 17 iL Phone#: E/T� Are con an employer?Check the appropriate box: Business Type(required). I ❑ f am a emphsyerwith employees(full and/ 5- ❑Rcuml oy�ri-time)." 6. ❑Restruram/Barhzting I staldshment 2 1I 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 rapacity. INo workers, romp_a suramo ns ared) R_ ❑Non-profit 3.❑ We are a corporation and its officer,have exercised 9. ❑Entertainment then right of exemption per a 152,§I(4),and we have 101❑Manufacturing no employees (No corkers comp_insurance mquhedl' 4We aroanon-profitorg anvatioa,staffed by coluntwrs; II Realm Cam .❑ wish no cmployeas IN.workerscomp-insurance my.] 12.❑Other '.1nv applicant IM1a checks Fnx al must also 111 nut Nc senior,helnx'sM1uwine nheir xod cn'compen,sown policy mfaricaton. ^lflhccoryommoff.—lino ceempned illyhxy_huuM1ecv oraniooha othaemplowe ,awor m mmpenamionpolie is quhedandsuehan batinn annnla cne�nnp a. t aro an emp/gVer fh�is provid/in^g»rockers/�Ampenso(ion insurancef-say employees. Relinchdrepolicyinformmtoa. Insurance Company Name: (a"l. Insurer's Address. Cit,/State/Lip: Policy Nor Self-M, L. 4 ham" 1r CTS �9 d`- " Expiration Date. Attach a copy of the workers' compensation poliy cdeclaration page(showing the pollee nom�ber..d�, Im.d.le). Failure to secure coverage as required under Section 25A of MCL a 152 can lead to the imposition of criminal penalties of a line up to$1,500 OU and/or one,car imprisonment,as well as cry it penalties in the form of a S OP WORK ORDER and a fine otup to$250.00 a day against the violator Bead,iscd that a copy of this statement may be forwarded to the Office of Investigations of rimmoscecovcmgevenficsmcn I do hereh certify,un r t naldes ofpeadury that the hsforsamon prmtided aba �a) my and correct. signs,are C— Date 4 lr (P ph..N — q3 a Official use only. Do not write in thb area,to be completed by city cr town official Cit%or Town: Permit/Lireme N Issuing Authority(circle one): 1. Board of Health 2. Building Department J. City/Town Clerk 4.Licensing Board 5. Selectmen's Office 6. Other Contact Person: Phone N: www.m sx_gov'die City of Northampton r` Massacnusetta �`_. �I - DEPdRTMENl OF BU"LDLNG SIiSP&CTIGNS j 212 1 n str t •+Wvcipal Building cn lbrNm¢Co+, . 01060 L�SY 0 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, 554, 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 facllty, as defined by MGL c 111, 5 150A. The debris from construction work being performed .it: C6� we ln�l y-1y-b _ (Please print house number and street name) Is to be disposed of at: (Pleas print name(Pleas print name a�j locatio of facility)locatio of facility) Or will be disposed of in a dumpsster onsite rented )r leased from: (Company Name and Address) l/ Signature of Permit Applicant or Owner Date If, for any reason,the debris will not be disposed o`as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be tlisposed. N 47 y N 22.3ji6,. `o \ 9" „�._.....�...35* 24-06' u" 6 3o-ij�6" -. 9.5A �o 24 _ � - ji6� mcN N Nvo , N lob-,J16" „� n •, 4 �7 . 29-914" 29-314" Ilk r