23A-019 (3) 108 NONOTUCK ST BP-2019-0904
GIs#: COMMONWEALTH OF MASSACHUSETTS
Mao.Block:23C-019 CITY OF NORTHAMPTON
Lot,-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit. Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2019-0904
Project JS-2019-001508
Est Cost:$96629.00
Fee: $628.00 PERMISSIONIS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group, CHARLES BADO 059327
Lot Sjze(sp.R.): 9147.60 Owner: DIXON AMANDA C&BARRIE C
zoning? URB(100)/ Applicant: CHARLES BADO
AT. 108 NONOTUCK ST
Applicant Address: Phone: Insurance:
494 GREENFIELD RD (413)824-2318 SOLE PROPRIETOR
DEERFIELDMA01342 ISSUED ON:212212 01 9 0:00:00
TO PERFORM THE FOLLOWING WORK INTERIOR REMODEL
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 2/22/2019 0:00:00 $628.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-0904
APPLICANT/CONTACT PERSON CHARLES BADO
ADDRESS/PHONE 494 GREENFIELD RD DEERFIELD (413)824-2318
PROPERTY LOCATION 108 NONOTUCK ST
MAP 23C PARCEL( 19 001 ZONE URBII00)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
LOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: INTERIOR REMODEL
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included-
Owner/Statement or License 059327
3 sets of Plans/Plot Plan
THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INYOKMATION 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 PlanAND/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
C/- - L 4 -2-tz'
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.
Department use only
City of Orth � Stah. of Permit:
Building Dep rtment urb itlDrivewey Permit
212 M in S eek Eg 1 9 2019 .1 epf cAvailabilily
Roo 10 eter all AvailaMlgy
1" Northampt , M 0106 ` 410o of Structural Plans
phone 413-587-124 FaffC4Ab '%, '272 ite Rana
1,01'
,01 Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH AA ONE OR TWO FAMILY DWELLING
SECTION I -SITE INFORMATION pw` p an
1.1 Property Address: 2This section to be completed
by office
8 Nbh.�—v C'K i Map a ` c Lot OC � Unit
1 U2L�1Cis M 01 00— Zone Overlay District
0 Elm St.District CS Distinct
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
('cF'l t onl 1 0{� hror�`CZJr� �4 PI- Z& Cts
Name(Print) Curren)Mailing Address:
/ Telephone 44 rc� _ r,
Signora P V V ICJ
2.2 Authorized Aaenl: L ' CA 13� 4 l q c- ft M Ai(_ - 6-°^
c (-ts ts'-sero
Name(Pont) a ( Current Mallin Address: b 13-12
q1`), Rte+ 7 ZIF3
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com leledit ermita titan!
1. Building JC5 8V 2 (a)Building Permit Fee
2. Electrical J5, (b)Estimated Total Cost of
Construcdon from 6
3. Plumbing /1 Z Building Permit Fee n
4. Mechanical(HVAC)
5.Fire Pmteclion
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissimerllnepector of Buildings Data
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 in be filled In by
Building Depamnem
LotSize
Frontage
Setbacks Front
Side L' R' L- R:
Rear
Building Height
Bldg.Square Footage
Open Space Footage
(lar area minus bldg&Pamed
rarkineo
#of Parking Spaces
Fill.
voWme&Iuratimo
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO ® DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® 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 ® 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
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 1D
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or glling)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.
SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ ReplacementrowsAlteratlon(s) Roofing
Or Doors
Accessory Bltlg. ❑ Deraolition Er New Signs I[J] Decks IQ Siding(0] Other(IQ
Work
o
BriefDescriptionof Proposed Kl--vl i u2 R�rla�2.
Alteration of existing bedroom / Yes—No Adding new bedroom Yes >C No
Attached Narrative Renovating unfinished basement _Yes X_No
Plans Attached Roll -Sheet
Ga.If New house and or addition to eillsting housing,complete the following:
a. Use of building :One Family Two Family Other
It. Number of rooms in each family unit: Number of Bathrooms
C. Is there a garage attached?
it. 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 alts ched7
h. Type of construction
L Is construction within 100 ft.of we0ands? 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 OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,�\"'c (Y- ° as Owner of the subject
property
hereby authorize
to act on my be ,in ali matters relative tto�work authonzed by this building permit application.
// l9/%
Signature of 1^er 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.
L t'Fr2 f_L-:s
Pnnl Name^
Signature of OwnerlAgent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Suservisor: Not Applicable ❑
Name of License Holder'. GI`" ,Z (J� e6y(� �5 ' OS I32-}
License Number
((�o(i � wl�
Eryirati n Datafff
Signature Telephone
S.Registered Home Improvement Contractor: Not Applicable ❑
k, / c IGg319
Company Name Registration Number
143(17--02-1
Address Ezpirati&Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(8))
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 Ves.._._ ❑ No......
City of Northampton
Massachusetts m= <<e
L
212 Main Street OF BUILDING INSPECTIONS
Y3E Main rhesa lNnicip10 auiltlinq
No[Nampion, Mt 01060
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 perfot»mng 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 owneroccupied 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.
Now:If the homeowner has contmeted with a corporation or LLC, that entity must be registered
Type of Work ('br lL R L"'"(o 2 Est. Cost: C �2q
AddressofWurk: The hfor-bT.luL F37 . FI--oKUu'rr-a r f` 0i06Z
Date of Permit Application: 7-II7-oI 9
I hereby certify that
Registration is not required for the following reason(s):
_Work excluded by law(explain):
_lob 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:
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
City of Northampton
Massachusetts
G
L
0 .. S OF BUILDING ZNSFSOTZONa
212 .in
31Y Macveec Municipal aui161ng V• s
NoiNampCon, he OSOfiO •Yj�'�\0C
Massachusetts Residential Building Code
Section I I O 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, oar 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 1 I O.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
Oficial, 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
- „
lrassaehusetts
c
s
DSPARTN6NP OF BUILDING INSPECTIONS
212 Main Street *Municipal Building
Northampton, NA 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:
1 OP
(Please print house number and street name)
Is to be disposed of at:
(Please print name and location of facility)
Or will be disposed d in a dumpster onsite rented or leased from:
�L G nti fl-c,-oJ/at-- _ ( lZ L_ Lo n�a 2J. kt� P�e
(Company Name and Address) p1O '
i,f /lo/
Signature of Permit Applicant or Owner Dat
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
1 Congress Street,Suite7
Boston, MA 02174-4-20017
wltmu.mass.gov/dia
WWorkers'Comptionation Insurance Affidavit:Builders/Contmeton/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leeibly
Name(Business/OrganizAtoMndividua0:
Address: �MtA
City/State/Zip: K kLx:1 r-1M o1'�42 Phone#: 1413 BZW 231 8
Are you an employer?Check the approprtale baa: Type of project(required):
I Q I a employer wntn employees(than amNor Part-tlme)! 7. [3 New constIDCtion
Irl a sole proprietor nrpatm,rship and have no employees waking for me in S, Remodeling
any capacity.[No workers'comp,insurance required.]
3.[J I am a homeowner doing 91 vi myself IN.workers'comp in co mrce required.]t 1 ❑Demolition
n
4.Q I am a homeowner and will he hiringI O Building addition
worketacto conductalawskce ram sale . Twill
ensure that all wno-acwa,eimcr have workems'eompensatioo msuancemarc sole I1.C]Electrical repairs or additions
proprieors with no emplmyas. l2.QPlumbing repairs or additions
5. I am a general contactor and I have hired the s hremuscrors listed on the attached shen. -
These sub-connacma have,employees and have workers comp ivnance. 13. Rauf reports
6-❑We am..,area.and,.,officers have cast cd their right of exemption per MGL c. 14.[:]Other
152,91(4),and we neve ro employees.[Nt workom%wmp_mar rams n,mici
*Any sections,fiat choke box on must atm fill out the section below showing chair womkers'wmpensation policy inrcarnerort
the ..who submitriasafifidevo indicating they are doing all work and then hire outside cuntracmrs must submit a new affidavit indicating men.
IConuacors that check this box mast attached an addidnnal shat snowing the time tram,sub-com enctora and sure whNsr arms those code®have
employees. Ifficsob<on[racbre.pmaw,mpltyees,ninny mostprovideaheir wmk,m omp.pelicynumber.
I am an employer that is providing workers'compensmion insurance for my employees. Below is the po0ry andjoh site
information
Insurance Company Name:
Policy#or Self-ins.Lic.#r. Expiration Date:
Job Site Address: City/State/Zip:-
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failare to secure coverage as required ceder MGL a 152,425A 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 5250.00 a
day against me violator.A copy of this statement may be forwarded m the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby cerafy oder(i pains and pens 'es of perjury that the information provided/ah is is true and correct
Sia at
Phome#
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Towa Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#: