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44-129 (5) 292 OLD WILSON RD BP-2019-0923 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:44- 129 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categorv: renovation BUILDING PERMIT Permit# BP-2019-0923 Proiea# JS-2019-001541 Est.Cost: $25500.00 Fee: $166.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: KENT HICKS 66104 Lot Size(sq.ft.): 290066.04 Owner: SIERROS KONSTANTINOS N&SUNITA B SIERROS zoning: Applicant. KENT HICKS AT. 292 OLD WILSON RD ApplicantAddress: Phone: Insurance: P 0 BOX 57 (413) 296-0123 O WC WEST CHESTERFIELDMA01084 ISSUED ON31612019 0:00:00 TO PERFORM THE FOLLOWING WORK.ADD HOME THEATRE TO GARAGE 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: 3/6/20190:00:00 5166.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File 4 BP-2019-0923 APPLICANT/CONTACT PERSON KENT HICKS ADDRESS/PHONE P O BOX 57 WEST CHESTERFIELD (413)296-0123 Q PROPERTY LOCATION 292 OLD WILSON RD MAP 44 PARCEL 129 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMITAPP LICACHECKLIST ENC L SED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid TvmeofConstruction: ADD HOME THEATRE TO GA GE New Construction Non Stmctoral interior renovations Addition to Existing Accessory Structure Building Plans Included- Owner/Statement or License 66104 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO MATION PRESENTED: proved 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 62e,- 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,,.Ori City of Northampton Status ofPennit � ,.• Building Department Curb.Cut/Driveway Permit 212 Main Street Sewer/Septic -'ty Room 100 Water/Well AvaAeGifOd+ _ Northampton, MA 01060 Two,sets of Strucho Plans \,M phone 413-587-1240 Fax 413-587-1272 PMt�Plem APPLICATION TO CONSTRUCT,AL R, OR MO ISH A ONE OR TWO FAMILY DWELLING SECTION 7 -SITE INFORMATION C t3 a 2019 1.1 Property Address: T s aeclion to be compd try office oFaT or nun DI"C.INSPEGTION$ nc-nrm.��.aa pen Lot Unit 292 Old Wilson Rd, Northampton, MA 01062 Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Konstantinos Sierros 292 Old Wilson Rd, Northampton, ?AA 01062 Name(Print) Current Mailing Address: 413-563-4591 1 Telephone Signature 2.2 Authorized Atil Kent Hicks PO Box 57, West Chesterfield, MA 01084 Name(Print) Current Mailing Address: 413-296-0123 Signature T� � Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Oficial Use Only completed by permit applicant 1. Building 16000 (a)Building Permit Fee 2. Electrical 5000 (b)Estimated Total Cost of Construction from 6 3. Plumbing 0 Building Permit Fee -{�, o 4. Mechanical(HVAC) I� II 5. Fire Protection 4500 t�' 6. Total =(1 +2+3+4+5) 25,500 1 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date pm @ kenthickconstruction.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) No alterations to existing dimensions 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 Sin Frontage Setbacks Front Side L: R: _. L R: Rear Building Height E quare Footagepace Footage % minus &paved #of Parking Spaces Fill: (volume&I.ncation) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW Q YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O 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 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 Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © 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 will disturb over t acre? YES O NO O IF YES, then a Northampton Storm Water Management Permit from the DPW is required SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑✓ Roofing ❑ Or Doors 3 Accessory Bldg. ElDemolition ElNew Signs [O] Decks jM Siding(O] Other(O] Brief Description of Proposed padltioning existing garagq conversion to llome Theater. 3levclgoorx,dewraliveceiling. Adding Hear Pump unit for HVAC. Work: Alteration of existing bedroom Yes No No Adding new bedroom Yes No No Attached Narrative Renovating unfinished basement Yes _ No Plans Attached Roll -Sheet 5a.if New house and or addition to existind housinl complete the following: 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? J. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of healing? 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 I. Depth of basement or cellar Floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . 1. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS 1kAGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, I ` ti' �t'��(U� , as Owner of the subject property Kent Hicks Construction Co. hereby authorize to act on my behalf/, in a,ji.mMlers relative to work authorized by this building permit application. 7 Signature of Owner Date Kent Hicks ,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. Kent Hicks Print Name -/ Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder-. Kent flicks License Number 634 Main Rd CS-066104 Address Expiration Date West Chesterfield, MA 01084 1/12/2020 Signature Telephone 11 413-296-0123 9. r. Not Applicable ❑ Kent Hicks Construction Co. Company Name 634 Main Rd. Registration Number West Chesterfield, MA 01084 120757 Address Expiration Date Telephone 413-296-0123 2/27/2020 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....._ (A No...... 0 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 700 Boston, MA 02/74-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITV. ADDlicant Information Please Print Legibly Business/Organization Name: Kent Hicks Construction Add ress:634 Main Road City/State/Zip:West Chesterfield, MA 01084 Phone#:413-296-0123 Are you an employer?Check the appropriate box: Business Type(required): 1.❑✓ I am a employer with 8 employees(full and/ 5. ❑Retail or part-time).* 6. ❑Restaurant,Bardialing Establishment 2.❑ 1 am a sole proprietor or partnership and have no 7. ❑Office andlor Sales(incl real estate,auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8. E]Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption yore. 152,§1(4),andwehave 10,F] Manufacturing no employees. [No workers' comp. insurance required]- I I ❑ Health Care 4.❑ We are a non-profit organimtioa,staffed by volunteers, with no employees. [No workers'comp. insurance req.] 12.❑v Other Construction 'Any applicant that checks box 41 most also fill out the section below showing their workers'compensation poury information. '9f We co,y rate movers have exempad themmlves,but the corporation has other employees,a workerscompensation policy is required and such an organization should check box q I I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name:Liberty Mutual Insurance Insurer's Address:62 Maple Ave. _ City/State/Zip: Keen, NH 03431-1625 Policy#or Self-ins. Lic.#XWO (19) 57 67 08 68 Expiration Date:04/05/2019 Attach a copy of the workers' compensation policy declaration 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 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 eerTify, uunndder he pains ena/ales of perjury that the information provided above is true and correct. S' natum ! Date 2/25/2019 Phone§:413-296-0123 Oficial use only. On not write in this area,to be completed by city or town oKciaL City or Town: Permit/License N Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4. Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phoned: www.mess.gov/die City of Northampton Massachusetts ' 1 DEPARTMENT OF BUILDING INSPECTIONS � 212 Main Street •Municipal Building OD ��• Northampton, MA 01060 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 facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: 451 0ld Wilson Rd, Northampton, MA 01062 (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: Casella Waste Systems, 25 Greens Hill Ln, Rutland VT 05701 (Company Name and Address) 2/25/2019 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 � c x DEPARTMENT OF BUILDING INSPECTIONS ?F 212 Nein Street • Municipal Building Northampton, MA 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 performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes, a contractor must be rogistered 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 mast he registered Type of Work: Residential remodel Est.Cost: 25, 500 Address of Work: 292 Old Wilson Rd, Northampton, MA 01062 Date of Permit Application: 2/25/2019 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: 1 hereby apply for a building permit as the agent of the owner: 2/25/2019 Kent Hicks Construction Co. 120757 Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the wrier of the above property: 2/234617 llonAk4— :f Dat Owner Name and Signature garage utility stairs and landing Platform 3 platform 2 1' 1/4" / b a platform 1 above % platform 2 above 20 PT sleepers rigid foam between center sleeper under joint '1 2x8 joists 5/8"separation for sheetrock '` b entry platform(2x8 joists) OWN MEN elEM WINE 2x10Joists use cutaft from 12 footers in platform 3 io N � 1 w .y a 01 n a m m z � o N v g4 3 Z w n S m Cc E 212 PROIER CLIENT West h COnMlld, A Q 2121/2019 Sierms Theater Konstantinos Sierros 634 Main Rd. O West Chesterfield,MA 01084 oaawN By (413)2960123 r BSN i