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31A-063 (2) 179 ELM ST BP-2019-0925 GIs#: COMMONWEALTH OF MASSACHUSETTS Ma J13-1mk:31A-063 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Cauntorv:renovation BUILDING PERMIT Permit# BP-2019-0925 Proiect# JS-2019-001542 Est.Cost:512000.00 Fee:$78.0o PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: STEPHEN CAMP 082531 Lot sixdsa.R.): 15115.32 Owner. SALLOOM SIMON Zonina:URB(100y Aoafican . STEPHEN CAMP AT. 179 ELM ST ADolicantAddress: Phone: Insurance: 46 EAST ST (413) 527-7124() WC EASTHAMPTONMA01027 ISSUED OM3/412019 0:00:00 TO PERFORM THE FOLLOWING WORK:KITCH AND BATH RENO, CLOSETS "SEE NOTES ON PLAN** 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: QIP. 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: FeeTyne: Date Paid: Amount: Building 3/42019 0:00:00 $78.00 212 Main Street,Phone(413)587.1240,Fax:(413)587.1272 Louis Hasbrouck–Building Commissioner N6:6o5 Oe6at5 RFf lvnWr File#BP-20IM925 CALLLV 2-2$-Iq APPLICANT/CONTACT PERSON STEPHEN CAMP ADDRESS/PHONE 46 EAST ST EASTHAMPTON (413)527-7124 Q PROPERTY LOCATION 179 ELM ST MApc NpTtr-S C2" F�-A MAP 31A PARCEL 063 001 ZONE U"(100 THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid / Typeof Construction: KITCH AND BATH RENO.CLOSETS New Construction Non Structure]interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 082531 3 sets of Plans/Plot Plan THE FO WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFgWdATION 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 )A Z -Zf3-za9 Si a of Building Official Date Now: 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. A , Department use only City of Nort IBM C E I V E uI ertnlL Building De artrb Curiveway Permit 212 Main Stre t Be eric Availability Room 00 F F 2 W ter Availability Northampton, MA 1060 6 2019 T sf Structural Plans phone 413-587-1240 Fax 13-587-1272 PI Sens OFPT OF nNtoINC.INSPEC rdy 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 / Z/M Map :>(A Lot n U 32_UnIt Zone Overlay District Elm SL olaldcl Ca District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: JDG f//y SY //DiAf'Ws✓ Name(Print) Current Maiing Address: Telephone Signature 2.2 Authorized Agent: � W Nems(Poor)) Cunent Melling Address: 5-Z7- /ZY Signa re Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be OfBclel Use Only completed by rmit applicant �p 1. Building (a)Building Permit Fee A OOD. M 2. Electrical JD re (b)Estimated Total Cost of �S Construction from 6 3. Plumbing 2-5-00, Builtling Permit Fee 4. Mechanical(HVAC) rl 5.Fire Protection 8. Total=(1 +2+3+q+5) Check Number This Section For Official Use Only Date Building Permit Num r. Issued: r' Signature: Building Commissionedinsi,ector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) p ' 0 � ('4 , 4 Lo— 8 61'"I (.M_ Section 4. ZONING Aa Information Must ee completed.Pi unit Can Be Denied Due To Incomplete Information ' Existing Proposed Required by Zoning This column to be fillw in by Building D,.., Lot Size Fronts e Setbacks Front -- - Side L: R: L_. R: Rear Building Height - -- Bldg.Square Footage """" —"" % -- Open Space Footage _ . % _.... -- (Lot arca minus bldg&paved 4 olParking Spam Fill: _._. . . .. .. volume&Location) .___ .._... A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW O YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T 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 or is it pan of a common plan that wall disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. -• t _ The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations to 600 Washington Street "' • Boston,AM 02111- www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/OrgmiizadoMndividual): *ktl� (/lra•{( - Address: q( City/State/Zip: 1027 Phone#: 27 ' 2/2 Are you an employer?Chedk the appropriate boa: Type of project(required): LM I am a employer with i 4. ❑ I am a general contractor and I employees(full and/or part-time). • have hired the mb- mtacton 6. ❑New construction 2,❑ I am a sole proprietor orparmtt- listed on the attached sheet. 7:-[ Remodeling — -- - ship and have no einplayees - These sub-contractdis have 8. ❑Demolition workingfor me in an capacity. employees and ban workers' Y is ty 9. E]Building addition [Nonworkers'comp.instnance comp. a urairsoO corporation_ 5. ❑ We are a corporation and is - ]0.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption par MGL 12 ❑Roof repairs insurance required.]t c. 152,§I(4),and we have no employees.[No workers' - _ 13.0 Other comp. insurance required] *Any applicant thatchecks Waist t ntalao out fin the section below showivgthebork wers'mp nensation policy imbricatiimbrication.bron. t Homeowners who submit this affidavit indicating they are doing all work and thin hire outside contractors must submit anew affidavit indicating such. tContracton that check this box moat atmchcd an additional sheet showing the mase ofthe sub ntraceors and state whether or not those mines have enpleyees. If me aub<onmc[ors have employees,they rwstpmvide Nem workers'comp.polirynurrber. lam an employer that fsprovidbrg workers'corspensation insurancefor my employees. Below is thepolicy andjob site information. - InsuranceCompanyName:&-e vY1GNLlM,I S en Policy#or Self-ms.Lic.#: /CCn S4 2y& � �D 9 7 Z Expiration Date:y l Job Site Address: I2 f LZ/pt ��KeY- City/Smtwzip: / /Ylw Alo6 D Attach a copy of the workers'compensation policy declaration page(showing the policy number and ezpintiau 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$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 DIA for insurance coverage verification. I do hereby cenify under the pains,afnd penalties ofperjury that the information provided above is true and correct signature. , d= Date- Phone#: Z7 . 2/ Official use only. Do not write in this area,to be completed by city or town official _Ci yryarTown: .. . _- .___----.__:_._. _ ._. __ 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#: Versionl.7 Commercial Building Permit May 15,2000 CTION 10-STRUCTURAL PEER REVIEW(780 CMR 11011) _ .ndependent Structural Engineering Structural Peer Review Required Yes © Y No 4 SECTION 11-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby author¢e'_ act on my behalf,in all matters relative to work authorized by this building permit application. .Signature of Owner - Dale - as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my krarMedge alvaief. , Sip%d under the pains and enables of penury. -t Print No -- - Sgnature of OwnedAgent Date — SECTION I2-CONSTRUCTION.SERVICES 10.1 Licensed Construction Supervisor: Net Appliiccable/❑ Name of License Holder: -_-._-CIS2� 5�71..__-....._ ' Ucense Number Addresf �_ Expiration Date Signature Telephone ��— SECTION 13-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 buildin permit Signed Affidavit Attached Yea - No Q SEC N 5.DESCRIPTION OF PROPOSED WORK(check all applicable) New Nouse ❑ Addition ❑ Replacement Windows Afteration(s) ❑ Roofing ❑ Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [Ol Decks [O Siding[C3] Other[B�I Brief Descripti of Proposed Work: —s / }G' Alteration of existing bedroom_Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement _ _Yes No Plans Attached Roll -Sheet en.N New Cause and or addition to existing housing, complete the following. a. Use of building: One Family Twp 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 stades? I. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance forth attached? h. Type of construction i. Is construction withln 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 1C0NTRACTOR APPLIES FOR BUILDING PERMIT I, SSM 0✓ �Q./10OA7 as Owner of the subject Property /1 hereby authorize �-��.. � (. to act on my behat,in all Hers relative b wo uthorized by this building permit application. Signature offOOmer �r// � � Date I, J74VAew� t.✓ham .as Owner/Authorized A99o{hereby di that the stat encs and information on the foregoing application are true and accurate,to the best of mmyRROWIbEge a d belief. Signed under the npains and penalties of perjury. !/ Prim Name _ — 1 zz- ZG Signet of OwnerlAgenl D e SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ^- y Not yA�p(ppllicable ❑ Name of License Hol or �fJWI /lG b� License Nuu mber Atltlroas Z Espiralion Dale Signa re 141Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ 5�.1,/ c��0(°®�,,s�,,.�1-�-.✓ /3 s toy Company a! me�,y —� �r Reg scrag tion5Numbye�r Address ( Eipiraeon Date Telephone / 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...... ❑ Stephen Camp Construction 46 East St. Easthampton, Ma 01027 (413)527-7124 Submitted To ; Simon Salloom Phone- Address : 63 Dryads Green Date—2-24-2019 Northampton,Ma 01060 We hereby submit this estimate for—Framing& Kitchen Cabinets The framing will be done according to the drawings. I will supply all framing materials needed. The kitchen cabinets will be installed by me. (Cabinets will be supplied by customer) I will supply the building permit Price=$ 5000.00 Contractor Supervisors License number 082531 Home Improvement contractor Registration number 135204 I propose to supply materials and labor-in accordance with above specifications. This proposal may be withdrawn By us if not accepted within 30days Authorized Signature Acceptance of proposal Signature_ , 14_4 3/8' G'-6 3/8' 27-0 5/6 k4' BATH a'-I I 1/0 2'-1 1 112" V w _ KITCHEN .�li BEDROOM I'-10 7/8" r L N � / CORRIDOR iCL 4 1 1 _ 8 !' 2-6 X72' 3 �� S ------------ cl ---- \ 1 �f\\ CL 1111T. TTAI i DINING ROOM _ LIVING ROOM .__.c__ --I 2'-8 112" ri ` 21'-9 5/8' �_ 1/4 ENTRY 4 o� 10 EW tAPeaao G-G 3�8 5'or- 5pvwo?- P&A 1W-4 3/8" C09,4-0 CL BATH 14-0 1/4' KITCHEN ED .41 MASTER� BEDPOOM CL -AA 10-N 12'-0 7/6' GO POWDEP 10 CORRIDOR ROO G-1 1/2"- W/D 15T. STAT DINING ROOM CL LIVING ROOM '-0 112' �--j L 21'-65/8' ENTRY 29'-4" Jun 210012:19a Stephen Camp 14135277124 p.i City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste 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. Address of the work: !79 G�/� S7 �//✓J2 G ✓ s1�w r The debris will be transported by: �'✓��s����a- 1��/ The debris will be received by: 11'41'le4l Building permit number. Name of Permit Applicant er1J Date Signature of Permit Applicant