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38B 1w Louis Hasbrouck<Iasbrouck northam tonma. ov> Fa9aarnpolo�, @ p 9 ...................._ ......... . ...... .................... ............ Re: Fort Hill smoke 1 message Louis Hasbrouck<Iasbrouck@northamptonma.gov> Fri, Oct 19,2018 at 2:55 PM To:Tom Malone<tom@ rain home.net> Those look good.You just need to tie the basement into the unit that has access. If both units are going to use it,you need 2; one tied to each unit. Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg (413)587-1240 office (413)587-1272 fax On Fri, Oct 19,2018 at 12:57 PM,Tom Malone<tom@rainhome.net>wrote: MY Of Louis Hasbrouck Nor 11 16-18 Fort Hill Terrace 1meneege Fri,Oct2 2018 at Louis Hasbrouck<|hoabmuoh6�nn�bam�nnmo�ov> . . � To:Tom Malone<tnm@nainhnmaoet> Tbm, There's not too much information unthe plans you sent; The house iaatwo family.Which unit has access tothe basement?Both? Are the smoke/co alarms connected to each other?To the rest of the house? I think the house was updated a while ago. What's the ceiling height? Minimum isO'8" | can't see how the stairs are laid out;why 2doors atthe top?FUsnhon?Tread depth, riser height? Are there windows orobulkhead? I don't want to have the project get underway and then have a significant problem. Louis Hasbrouck Building Commissioner City myNorthampton Town ofWilliamsburg (413)58T-1240office (413)5O7'1272fax VtkAr IS S� ��4'C•IGv ��� � �t sm�c•-,�co q+ q c%cw -am,L w..W oQcan ba,) .5q`z. ?C-Ar-�, 41��1 15 S' s�iv�rav'C,•/Gv Q c��w -�n.c.+�, wR-�� w.�1� .+,g a\c�t,n R�•Z s tnr�+c�t.�t cr-%\a�S e .. �� . " z .. . ,., .` x ` i�, ti; . . :�+ �_. ',fi � . ,. . � ` E �� ISS 5� c��w - ,r•c.L w�llS wNh s� R�.� oe Estimate 128 Ryan Road Florence,MA 01062 Date Estimate# 9/1112018 1693 Name/Address Susan Harrison 16-18 Forthill Ten-ace Northampton,MA 01060 Terms Project On receipt Harrison Basement Description 6-panel colonist Prehung interior doors 36 in.x 80 in. 4 Ea Install Lockset installation Standard 2-1/8 in.bore,factory bored 4 Ea Painting Plaster or drywall,latex Rough surface(walls and ceiling) 2676 SF Sweep,scrub and wash down of floor before epoxy 546 SF Polyurethane epoxy floor system 546 SF Electrician to code I Ea Project material,labor,subcontract Material,per job Labor,per job Subcontract,per job *Project Subtotal *Project Total Total $35,293.02 We propose to hereby to furnish material and labor-complete in accordance with the above specifications,for the sum total.Payments to be made as follows:half of full total upon acceptance,one quarter of full total upon the start of the project and the full balance due upon completion.All material is guaranteed to be as specified.All work to be completed in a manner according to standard practices.Any alterations or deviations from above specifications involving extra costs will be executed only upon written orders,and will become charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,t mado, d other necessary insurance. Acceptance of Proposal will commence with the home owners signature.Prices,specifications and con itions satisfactory d are hereby accepted upon signature.Rainbow Home Improvement is authorized to do the work as specified and to paid peci ed. Phone# E-mail Signature (413)885-9038 tomCa7,cainhome.net Page 2 Estimate ate ,W 12$Ryan Road Florence,MA 01062 Date Estimate# 9111/2018 1693 Mame/Address Susan Harrison 16-18 Forthill Terrace Northampton,MA 01060 Terms Project On receipt Harrison Basement Description Removal of insulation around box of house where work is being done 63 SF Removal of wood stairs Handrails 18 LF Removal of wood stairs Treads 104 SF Removal of wood stairs Risers 104 SF Removal of interior wall assemblies 2 in.x 4 in. 144 SF Waterproofing walls 2 coats 504 SF Stud walls 2 in.x 4 in., Thigh 4 968 SF (� Window opening fxaming,2"x 4"Over T to 3`wide(4 in.x 4 in.header) 2 Ea Door fi-aming,2"x 4"To 3'wide(4 in.x 4 in.header) 4 Ea Sprayed-on urethane foam insulation 0.5 SF Fiberglass batt insulation 5-1/2 in.Kraft faced,R-21,between studs 500 SF Gypsum drywall, 1/2 in.moisture-resistant grcenboard 968 SF Gypsum wallboard nailed or screwed Add for taping and finishing ceiling joints 968 SF Softwood molding,base 114 LF Softwood molding,casing 132 LF Install new stairs, 93 in.to 100 in.with 13 risers I Ea Ftal 7 Phone# E-mail 3)885-9038Signature tom(_a),rainhome.net Page 1 `� AC40RLY CERTIFICATE OF LIABILITY INSURANCE DATE(MIWDD/YYYY) 09/17/2018 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: M the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTA NAME:CT HOUSE King&Cushman Inc. PHONE (413)584-5610 1 F1AIC.MO.FALAx No: (413)584-9322 P.O.Box 447 E-MAIL ADDRESS: 176 King Street INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01061 INSURERA: Ohio Security Insurance Co. 24082 INSURED INSURER 8: WC Pool Rhi Construction Inc INSURER C: 128 Ryan Rd INSURER D: INSURER E: Florence MA 01062 INSURER F: COVERAGES CERTIFICATE NUMBER: CL1891702861 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING 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 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AOULSUOR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSO WVO POLICY NUMBERLIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR -17- 300,000 PREMISES Ea occurrence) $ MED EXP(Any one person) $ 15,000 A BKS58096603 10/03/2016 10/03/2019 PERSONAL aADVINJURY $ 1,000,000 GEN'LAGGREGATELIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECOT- F-�LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Package Modification $ AUTOMOBILE LIABILITY 11 NED SINGLE LIMIT $ Ea a cident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAO OCCUR EACH OCCURRENCE $ F� EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ r $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I I ER B ANY PROPRIETORMARTNER/EXECUTIVEE.L.ELEACHAccIDENT $ 100,000 OFFICER/MEMBEREXCLUDED? N/A 7PJUB1K06038417 11/30/2017 11/30/2018 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space le required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE 'J]� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However,the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply your insurance company's name,address and phone number along with a certificate of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required.Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number.in addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary). A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street Boston, MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 www.mass.gov/dia Form Revised 02-23-15 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees..However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings,in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia \ The Commonwealth of Massachusetts Department of Industrial Accidents s I Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name(Business/Organization/Individual): QA3:1-Ic Address: Q'T- G.yjt f\ Q.� ` City/State/Zip: OkOb)--Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. w construction 2. I am a sole proprietor or partnership and have no employees working for me in ❑ S. Remodeling any capacity.[No workers'comp,insurance required.] 9. El Demolition 3.a I am a homeowner doing all work myself[No workers'comp.insurance required.]t 41:11 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions p�Oprietors with no employees. 12.❑Plumbing repairs or additions S. l am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ROOf repairs These sub-contractors have employees and have workers'comp,insurance.* 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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. If the 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.#: 1�, ` Expiration Date: Job Site Address: ` �C�' l Y wN\ 'JTT'�&t/ City/State/Zip: \3WWV✓\, w w 6 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cern u der the pains and penalties o perjury that the information provided above is true and correct Si ature: Date: Phone#: 0jr1cial use only. Do not write in this area,to be completed by city or town offrciaL 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#: City of Northampton Massachusetts DWARTMWT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building Northampton, MA 01060 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 construction work being performed at: (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) 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. City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 BS ,•- �1a Massachusetts Residential Building Code Section 110.R5.1.2 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. Section 110.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner shall 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 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 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. City of Northampton j/ Massachusetts DEPAR77MT OF BUILDING INSPECTIONS y- 212 Main Street • Municipal Building Northampton, MA 01060 T3{ � •a;���Q' 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 performing 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 registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: lY-"�`1� �`hi''� Est.Cost: ' Address of Work: Date of Permit Application: 9-0 -(y 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 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 apply for a building permit as the agent of the owner: Qa�1-l� �� CC,..kVle,�.,\ l 6-1 S'SS Date Contractor Name 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 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: �� " �,.p Not Applicable ❑ Name of License Holder: \`I �•�L1r `i (—S—W 72 License Number woo - Address Expiration Date \3 -�0 3 V Signature Telephone 9. Registered Home Improvement Contractor. Not Applicable ❑ �- X rl�.s\�� C. (o Comp anyName ' - / Registration Number `r) Address Expiration Date SECTION Telephone -CIO) 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 build' g permit. Signed Affidavit Attached Yes....... No...... ❑ SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aiolicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors 1:3 Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [M Siding[[]] Other[Clj Brief Descri on of Prpppposed Work: •J���1n PG Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basementYes No Plans Attached Roll -Sheet Ga.If New house and or addition to existing housing comniete the followim: 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. 1. Septic Tank CitySewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property hereby authorize to act on m behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date 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 Signa Ire of Owner/Agent 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) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Findin ever been issued for/on the site? NO © DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the R gistry of Deeds? NO O DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW (2� YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © 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 IF YES, describe size, type and location: E. Will the construction activity disturb(Gearing,grading,ex vation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. �..s_w�.�_. _. _ __. . .�, �>�c � t �NT��I.?Mll r'ASCliIt3A"1R? T'-tt� o�;;rnnr�t.��,. . ;�;s��,,, t)epartment tie.only Jnr. City,of Northampto Statin of Pmt B8Qin Cie sten Curb Cutr'DrlveMrey Permit ( 212 Main Street Sewst'�Availab�ty, Water/woll AvailabHitlr Dw F tow two sea of Stsucturw Pians phone 41 -587-1240 Fax 413-587-1272 IIkrtlS(te Plans Other SPY APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: ,,j Map Loty',�,�Unit 1 Zone Overlay District Elm St District . CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Name(Print) CurrStkMail�ng ress `Ce Telephone Signature 2.2 Authorized Ascent: Name(Print) Current Mailing Ad ess: Signature, Telephone SECTION ESTIMATEDCONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed_by permit applicant 1. Building V51. (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of 06 Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5} 71CA 1 Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/inspector of Buildings Date -Fenn @ ra.�r1h a EMAIL.ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) File#BP-2019-0337 �1 APPLICANT/CONTACT PERSON THOMAS MALONE b/ �A ADDRESS/PHONE 128 RYAN RD FLORENCE (413)885-9038 1 PROPERTY LOCATION 16- 18 FORT HILL TER 0 MAP 38B PARCEL 027 001 ZONE URC(100) l `' SIG THIS SECTION FOR OFFICIAL USE ONLY: Q PERMIT APPLICATION CHECKLIST ED REQUIRED DATE / ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ' Fee Paid VlVZ Typeof Construction: FINISH PART OF BASEMIENT New Construction Non Structural interior renovations ` Addition to Existing_ U Accessory Structure Building Plans Included: Owner/Statement or License 055236 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 G, II 6 Signature of Building Official 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. �t 3 -- �p �_ �► P3� 16- 18 FORT HILL TER BP-2019-0337 GIs#: COMMONWEALTH OF MASSACHUSETTS MV-_ lock: 38B-027 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BASEMENT RENOVATION BUILDING PERMIT Permit# BP-2019-0337 Project# JS-2019-000547 Est.Cost: $35293.00 Fee: $228.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: THOMAS MALONE 055236 Lot Size(sq.ft.): 4007.52 Owner: HARRISON SUSAN Zonin%z:URC(100)/ Applicant. THOMAS MALONE AT. 16 - 18 FORT HILL TER Applicant Address: Phone: Insurance: 128 RYAN RD (413) 885-9038 WC FLORENCEMA01062 ISSUED ON:11/7/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.FINISH PART OF BASEMENT 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 Sienature: FeeType: Date Paid: Amount: Building 11/7/2018 0:00:00 $228.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner