37-090 (3) 319 ROCKY HILL RD BP-2019-1250
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:37-090 CITY OF NORTHAMPTON
Lot;-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category,ACCESSORY APARTMENT BUILDING PERMIT
Permit# BP-2019-1250
Project# JS-2019-002015
Esc Cost: 546000.00
Fee: $726.00 PERMISSION IS HEREBY GRANTED TO:
Const,Class: Contractor: License:
Use Green, CHARLES BADO 059327
Lot Siu(sc. ft.), 628570.80 Owner: THEBERGE STEPHEN
Zoning, Applicant: CHARLES BADO
AT.- 319 ROCKY HILL RD
Applican(Address: Phone: Insurance:
494 GREENFIELD RD (413) 824-2318
DEERFIELDMA01342 ISSUED ON.5/9/2019 0:00.00
TO PERFORM THE FOLLOWING WORK.-NEW ACCESSORY APARTMENT
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: 011, 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:
FeeTyoe: Date Paid: Amount:
Building 51920190:00:00 $726.00
212 Main Street,Phone(413)587.1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019.1250
APPLICANT/CONTACT PERSON CHARLES BARO
ADDRESSIPHONE 494 GREENFIELD RD DEERFIELD (413)824-2318
PROPERTY LOCATION 319 ROCKY HILL RD
MAP 37 PARCEL 090 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
CLO REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled o
Fee Paid
Tvveof Construction, NEW Y APARTMENT
New Construction
Non Structural interim renovations
Addition to Exist
AcCesanry Structure
Building Plans Included:
Owner/Statement or License 059327
3 sets of Plans/Plot Plan
THE OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
RMATION 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 Pemti[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 yn
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 thou applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
ECEIV ((�''� Department use only
City of Nort am $afus of enmt
Building De a nt Cu Cut/ nveway Permit
`/ ' 212 Main Ire t Sewer/Se tic Availability
IIAY 6 2019
."!(; Room 00 Wa er/W Il Availability
Northampton, MA 1060 Tw Sets f Structural Plans
phone 413-587-1240 F udolk" INSPEC de fans
NORTHAMPTON,MAOI Olh,
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: � 'dL lj This section to be completed by office
1 Map ?�7 Lot Unit
Zone Overlay District
Elm SL District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
T{elik :54-
Name
4Name(Print)�`/ Current Mailing Address;
_ ' ,X Teleph -1
one .413 —
Signature
2.2 Authorized Aaent:
Namerint�) ^ Current Mailing Address:
1-1 (I SzH Z31Y�
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed brmilapplicant
1. Building n 6 (a)Building Permit Fee
2. Electrical S (b)Estimated Total Cost of
Constuctlon from 8
3. Plumbing B Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Budding Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Informat at Must Be Completed. Permit Can Be Dented Due To Incomplete Information
Existing Proposed Required by Zoning
Thu wlumn in be BgW in by
(j / q / Buil ding Depam,wnt
Lot Size 0/
(J g68 SIJ/ gbg
Frontage 1�'S' I
Setbacks Front eI—
SSS>_de L:61" R: ��/ L 61 f R: DO
Rear _
Building Height 30 30
Bldg.Square Footage % ci
Open Space Footage
(W vcu minus bldg&mond
Parking)
M of Parking Spaces Z"
Fill:
volumu&Lcnhiun
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW Qi 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 p
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES
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
IF YES, describe size, type and location:
E. WIII the construction activity disturb(clearing,grading,excavator,or tiling)over 1 acre or is it pan 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 aoolicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors O
Accessory BWg. Deraolklan ❑ New Signs [O] Decks [q Siding ]C3] Other[C:q
Brief Description of Proposed
Work: �IfMl PS�-L tW'l l�PA2TYIL-i�.�
Alteration of existing bedroom Yes_No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
ae.1f New house and or addition to eaistina housing complete the following.
a. Use of building:One Family Two Family Other 2�Qrt�P')lrM-
b. Number of rooms in each feimily,unit: S Number of Bathrooms
c. Is there a garage attached? 10Fb0J
2 ,
d. Proposed Square footage of new construction. Jim C Dimensions 1d X 3,D/.
e. Number of stones? I
f. Method of heating?Jk 'Pu I Fireplaces or Woodstoves 7G Number of each
g. Energy Conservation Compliance. ✓ Masscheck Energy Compliance form attached? ✓
In. Type ofoonstruction V
i. Is wnsW coon within lOO ft.of wetlands?_Yes ,�No. Is construction within 100 yr. floodplain_Yes No
j. Depth of basement or cellar floor below finished grade
it. 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 CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 1 as Owner of the subject
Prop, rty L 1
hereby authorize C ' `r`C�PS qt'f U
fto act on my behalf,i all matters relative to work eWhonmd by this building permit application.
Signature of O er j Data
I, as4usuidAuthorized
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 at perjury.
Gt4rk2lL�
Pnnt Name If
Signature of O mvlAgent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Nemepf Linenee er:HoldG Id�3�Ltss "�"r�1!/" VS—d�q q J2-,T-
Llcenae Nom er
'{ 1pfR (I2Ls"jrilst' tQ . festa Frm-"l A,fr ot?'IZ . // 06 t1j.
Address � p Expiration bate
2318
Signature Telephone
9.Raoistered Home Improvement Contractor: Not Applicable D
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMIPENSATION 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 Vas.._... D No......
City of Northampton
Massachusetts
DBPAR2N OF BUILDING INSPBC?IONS �,Lt
313 Nein S[reee • ftrucipal
Ah alaba \ es
Noru.NPcon, —:yy
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 perfomiug 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('THC").
M.G.L.Chapter 142A requires that the"reconstruction,aheration,renovation, repair, modernization,conversion,
improvement, removal, dvmotttion,or construction of an addition to any precrisfing ownenoccupiad 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.
Now:If the homeownm has contracted with a corporation or LLC,that entity must be registered.
Type of Work: Est.Cost:
Address of Work:
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(czplain):
—Job under$1,000.00
_Owner obtaining own permit(explain):
Building not owneroccupied
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
i
212A rn S OF B* ftnici INSPECTIONS
]33 Win 8[[*er Bunini01l auilClnyO�
BorNwpWn, IN 01060
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 shat) be exempt from
the licensing provisions of 780 CMR 110.115, 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
Massachusetts
1 f s
DSPAR9 OF BUZLDZNG INSPECTIONS
212 IYin Strut •Wnici"l Building \VY/
Northampton. Na D1060 .ry
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 oonstnlction work being performed at:
3 I 1
(Please print Reanh — na2me�)
Is to be disposed of at:
ku- ll, f 2faMoypu--
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or(eased from:
r6 -t t..�-r 2 U^AO VA . P•D. tax 2-9 7 , 4pr"(I)V4 t'
(Company Name and Address) Dio3�
Sig Blurs of PermN 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.
�\ The Commonwealth of Mossaehuseus
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Letibly
Name(Business/Organizaiowlndividual): C I4faKUic S SrRI�>o
Address: Aft -'t`1 of T3 T KfrN ('4tLf� RJ
City/State/Zip: LOLL\ N/2c 013'12 Phone#: 112 P 2* 2-1[b
Are you an empla,ma Check she appropriate box: Type
roffppcojeet(required):
1.❑I acmplaYer with employee:(mll®N«pen-time).• 7. E 1Vew construction
2. asole propricmr or paMcmhip and have no employs working foramin g, ❑Remodeling
any mpacity.(No workers'comp.insurance required)
3.❑l em a homeowner dol Ml workm If No wodrpi c d.]1 9. ❑Demolition
ng yae 1 omp.insurenee require
❑famahomwwnerandwlbehinn mmwcmductallworkmm lost) l0❑Building addition
4.
g wave Yn,sole .
are mat dl coawcmrs.miher have w«kers'compensation insurance or arc spm 11.[]Electrical repairs or additions
pmpderors with no empki ces' 12.❑Plumbing repairs or additions
5.❑I can a genal contractor and I have hind the cob<ontmsecor Usual m the'tbched And. 1 j.�Roof repairs
These sub-conrntorschaws employees and havc wohers comp.insurer
6.E]Weare a corporation end lits officers have exercised heir right ofexempdon Par MGL c. 14.❑Other
152,41(4),and we have are employees.[No worker'wary.insurance required]
*Any applicant can checks his NI must also fill out the section below showing heir workers'campwsation policy infomatiao.
t Homeowners who submit this affidavit iMienting hey art doing all work and hen hire wtside conttadors must submit a new anidavit indicating such.
ICamriver mat check this has.st attached an addidwal shed shanow,the tame of On sub-conasetars and start whener ar na hose entities havc
employees. Ifthe sub-coat crow, ave employees,they mast provide he,, workds'comp.policy comber.
fast"employer than is providing workers'compensation insurance for my employees. Below is the policy andjob site
information.
Insurance Company Names
Policy#or Self-ins.Lie.#c Expiration Date:
Job Site Address: City/Stam/Zip:
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 a 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.
I do hereby certify der tie p ins a peva of perjury than the information provided a is true and armee(.
S' t ' C Date
Ph # 82 { 2316
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/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
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,oml 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,parumrship,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 budding 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 mail 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 in your situation and,if
necessary,supply sub-mntractor(s)camels),address(es)and phone numbers)along with their cenificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability partnerships(LLP)with no employees other than the
members or parWers,are not required to carry workers'compensation insurance. If an LLC m LLP does have
employees,a policy is acquired. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Aho be sure to sign and date the affidavit. The affidavit should
be returned to the city our 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 ere 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 member 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 fm you W fill out in the even[the Office of investigations has to contact you regarding the applicant.
Please be sure m fill in die permtUlicense number which will be used as a reference number. In addition,an applicant
that must submit multiple permil/license applications in any given year,need only submit one affidavit indicating current
policy information(if isecessary)and order"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.#617-7274900 ext.7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.rnass.gov/dia
Titg of Mart labra matt _
"4
Aassarljsssrlls
s
DEPART,VENT OF BUILDING INSPECTIONS =e
212 Main Street a Municipal Building
Northampton, MA 01060
Fee Calculator for Residential Properties
Location : 3 t 4 f�'oct,( It t LL-
Square Footage Amount
Basement @ .20
16T Floor @ .50 9do eASd
2zLF4eor @ .50 (C f LrJ 1 9 2 1,6
Yz Floors, Finish Attic, Garage @ .20 90U be)
Deck / Porches @ .20
Total : f IM
Residential Building Permit Intake Checklist
Every Line Item must be completed.
Place a check if the item is included Property Address:
Indicate NA if the item doesn't apply Map:
DPW=Department of Public Works Block:
BOH=Board of Health Lot:
MECH=To Be Provided by Mechanical Contractor
Permit Application Complete and signed
Workmen's Compensation Affidavit Complete and signed
Construction Debris Affidavit Complete and signed
Proof of Sanitary Connection or Approved Septic DPW or BOH
Proof of Approved Water Source DPW or BOH
Driveway Permit,Staked&Approved DPW-Rich Parasiliti 587-4317
Trees Inspection—Significant Trees 350.12.4 DPW-Rich Parasiliti 5874317
Tree Protection in Place&Approved DPW-Rich Parasiliti 587-4317
Storm Water DOW—Doug McDonald 587-1582
House Number&Map/Lot Assignment DPW—Ann Furciniti 587-4300
Residential Fee Calculator Complete and totaled
Homeowner's Exemption Acknowledgement Signed and dated
Sprinkler Narrative Electronic copy—date to FD
Sprinkler Plans Electronic copy—date to FD
Fire Department Approval of Sprinkler Date Received from FD
Copy or Order Of Conditions Conservation
Pre-Construction Site Inspection Sarah LaValley 587-1263 Conservation
Copy of Special Permit Requirements Planning Dept.
Pre-Constructions Conditions Completed Planning Dept.
Plot Plan or Survey Dim to boundaries driveway,walkway&septic
HERS certificate Initial HERS Plan
Building Plans—Foundation-Label Rooms Dimensioned including footing
1" Floor-Label Rooms- Dimensioned with smoke and COs
2 Floor-Label Rooms Dimensioned with smoke and COs
3r° Floor-Label Rooms Dimensioned with smoke and COs
Porch Dimensioned with piers and connections
Decks Dimensioned with piers and connections
Sections Identify Framing and air sealing
Elevations Floor heights and mean roof height
Structural Floor Plans Manufacturer's or clearly shown in section
Structural Roof Plans Manufacturers or clearly shown in section
Truss Layouts Manufacture's layouts
Truss Calc Sheets Manufacture's specifications
Beam Layouts Manufacturers or clearly shown in section
Beam Calc Sheets for engineered beams Labeled to match plans locations
Electronic Plans if over 11"x 17"sized paper Email,CD,or thumb drive
mech Manual"J"Calculations By Certified Software
" Duct System Line Drawings Clearly Drawn with CFM for supply and returns
" Mechanical Equipment Specifications Spec sheets HVAC,HWH,HRV, ERV,Exhaust fans
.' Plans SAOXea &e
Rev 5-12-2017