25-023 (2) 139 RIVERBANK RD BP-2019-1282
GIS u: COMMONWEALTH OF MASSACHUSETTS
Mao.Blxk:25-023 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateaorr ELECTRIC BUILDING PERMIT
Permit# BP-2019-1282
Project# JS-2019-002051
Est Cost,$10000.00
Fee-05 00 PERMISSION IS HEREBY GRANTED TO:
Const Class: Contractor: License:
use Group: Homeowner as Contractor_
Lot Shre(sp.ft.): 7579.44 Owner: REARDON 914EILA M&CYNTHIA M REARDON
zoning: Applicant. REARDON SHEILA M & CYNTHIA M REARDON
AT: 139 RIVERBANK RD
Applicant Address: Phone: Insurance:
139 RIVERBANK RD
NORTHAMPTONMA01060 ISSUED ON.-511412019 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE AND REPLACE WALLBOARD,
INSULATE
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: 1i!➢. 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 sletmmr••
FeeTvoe: Date Paid; Amount:
Building 5/14,20190:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File 4 BP-2019-1282
APPLICANT/CONTACT PERSON REARDON SHEILA M&CYNTHIA M REARDON
ADDRESS/PHONE 139 RIVERBANK RD NORTHAMPTON
PROPERTY LOCATION 139 RIVERBANK RD
MAP 25 PARCEL 023 001 ZONE
THIS SECTION FOR OFFICIAL USEONLY:
MIT P ICATION HECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT Ll
Fee Paid
Buildina Permit File out
Fee Paid
T e fCons coon: REMOVER L CE WALLBOARD INSULATE
New Construction
Non Structural interior renovations
Addition to Ex' ting
Accessory Structure
Building Plans Included_
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9XMATION 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 Cutfrom 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
_5- 1_N ZDi9--
Signa ure of Building Official T~ 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.
r Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
gepartmen4use....cNY
City of Northam on
Building ant rya ,
?, r. 212 Mainain S tre t MAY ) 3 c
.1 �{ Room 100 A Hablljty
Northampton, MA 1 PT OF SUILDur,In of crural Plans
phone 413-587-1240 Fax - j W$P/omr theme '
Other Spedfy '.
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
115 R'V EX Q�vf— Map Lot Unit
_ I Zone Overlay District
O10 (o0
Elm St.District CB District
SECTION 2-PROPERTY OW NERSHIPIAUTHORIZED AGENT
2.1 0 ener of Record:
I}6LA I EH«t f ` ` N7}�,ry � . - t�on� (3q 111 ✓ERA/n-f�k
Na Pnm `�-ttl`v I � CugeN,MaiuspA orel� AtA .OI�`F"
TeN n i ,51t 1b3
gnat ire
2.2 Authorized Aoent:
Name(Pdnh Curent Mailing Address'.
SgnaUn. Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Esbmated Cost(Dollars)to be Official Use Only
com feted by permit applicant
1. Building D L`f�O w (a) Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6, Total=(1 +2+3+4+5) Q Q. 00 Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued_
Signature:
Building Canmssioner/Irepeclor of BuildwS., Date
Tb0150 @ CTMA l � CO
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 to be filixt in by
Building Depanmou
Lot Size . ._.. _.
Frontage
Setbacks Front
Side L .. f R: U R
Rear
Building Height
Bldg.Square Footage
Open Space Footage
ILot area minus bldg&paved
Pi
k of'Parking Spaces --
Fill:
(wwmr&Locanom
A. Has a Special Permit/Variance/Finding everj9e
sued f r/on the site?
NO 0 DONT KNOW QES
IF YES, date issued:
IF YES: Was the permit recorded at the Registds?
NO O DONT KNOW OY S O
IF YES: enter Book and/or Document #
B. Does the site contain a brook, body of water or ? NO ® DON'T KNOW O YES O
IF YES, has a permit been or need to be obtaithe Conservation Commission?
Needs to be obtained O Obtain , Date Issued:
C. Do any signs exist on the property? YES ONO AhIF YES, describe size, type and location:
D. Are there anyproposed changes to or additions intended for the property? YES ONO
IF YES, describe size, type and location:
E. WII the construction activity disturb(clearing, grading, ion, or filling)over 1 acre or is it part of a common plan
that will disturb over t acre? YES ONO
IF YES,then a Northampton Storm Water Managemet from the DPW is required.
I
SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑
Or Doo s D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding[01 Other[[ZQ
Brief Description of Proposed 1
Work: f JF.t �I Du. iy L ��� L« -
Alteration of existing bedroom_Yes--)O�No Adding new bedroom Yes —20L No
Attached Narrative Renovating unfinished basement Yes NO
Plans Attached Roll -Sheet
Be.If New house and or addition to existina Housing,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?
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 farm attached?
h. Type of construction
1. 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 .
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 as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Data
N&JfC1 as Owner/Authorized
Ag t hMdeclarthe tatements and information on t foregoing application are true and accurate,to the best of my knowledge
an- belief.
Signed under the pains pdpenalfies of perjury
;signature
am
ot Owner1Agen l Data
SECTION 6-CONSTRUCTION SERVICES
6.1 Licensed Construction Supervisor- Not Applicable ❑
Nam.of License Holder:
License Number
Address Expiration Date
Signature Telephone
9.Registered Home Imoroyemerd Contractor, Not Applicable ❑
Company Name Registration Number
Address Expiration 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...... ❑
City of Northampton
Massachusetts
A (ry s
�l D212 anin S OF BUILDING, MniINSPECTIONS
212 Main Sweet • MuM 011 BVIItling y V4
w•- NaxCLempton, !A 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 most 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 owoeroccupied 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: 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(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
Date Contractor Name HIC Registration No.
OR
Not stsn o e notice,I hereby aap y f r a building permit as the owner of the above property:
Dfite Owner Name and Signature
City of Northampton
Massachusetts
DEPART T OF BUILDING INSPECTIONS
212 Mein rtz , a Municipal Builtling i.
� Northempton, !A 03060
Massachusetts Residential Building Code
Section I IO.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 I IO.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
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
A F
.t DEPAAI'NENT OF BDZLDING INSPECTIONS
212 Main sttaat a M Cipal Building
Northampton, M 01060
3�
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:
/- r�1 F � -"� f�ch
ase pnnthouse number ands ee 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:
- -r 2„ o• iia 39
(Company Name and Address) /�O �_� IA-A-
Ololob- 0039
h' .AqAQ)' �*o'h 0�0'—
ignature of Permit pplicant or O ner 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 ofMassachusetts
Department oflndustrialAccidents
1 Congress Street,Suite 100
Boston,MA 01714-1017
nnvn:massgosatdia
ll orkers'Compensation Insurance Affidavit:Builders/Contractors/Elearlcians/Plumbers.
TO BE FILED WITH THE PERNIMING A UTH0RJVY-
Applicant Information Pl e P "nt Leeibiv
Name(Business'/Organi2atiom'ladividualj_�,-
Address:
City/state/Zips_ Phone#: _
Aro you an employs"'Cheek the appwp laabax: Type of project(required):
l�I am a employer was mplayees(Poll aud/n' vat-mat) 7. 0 New construction
2.❑iamasole pmprimmrrr pmmerchipardbro-no anillmeca working formeN 8. O Remodeling
anyeapt,ty (No workea'com,ansamwe required.]
9. ❑Demolition
}0[am ahomww,crdoiny ail work myse2!(Na nrk«s'crzmp.msraanee rcyoited7'
10[�Building addition
4;01 ammmwoom a homeowner moi will 4 hinny cermactnrs n uct all work on my property. [will
e nmtniiew,taneus eiuur have workers' peamslnn,mwan�emarc sok II Electrical repaint or additions
ro,meme,we,no employee.,. 12.❑Plumbing repairs or additions
5 M I mreyenmal rarmoo,arta rlurvetimd We sda',mumro. 1nioluaNe ouches sheet 13.❑Roof rupturesThew sob-aonuvemrs have employees.and hive workers'comp.ma
14.[]O[her�
6.❑we no,acnrparwchi Nld Its Cn14mhm'ea%e.RlkmrtheV loan
, coftx Oslnper mat-
152,
('ft
i58,41141,mdwehave ao elzgdayees.[No uarkeri wap inaumncc requdN.]
'Aay applicant NuI checks box#I mv51 ales fill out Ne snwon below showin6 Poets worken"aoarro amion pol'my irron alion.
'violmvwa o,who s Smit Nis affidsva indicating ml are dning ail work and rhea him O'c"e"'an elms mu4 submit a new ands...indicatory rncia.
:r onwcmm mbar cheek Nis box anal vara had an addenaral Ao,,showing Ne name aaw ser-cwervar rs and state wheNer or not stow entities have
roployees. U'Ne suhmnnuaas have employers,Noy moat provide Nov workers'coop.policy number.
I ant an employer that is providing workers'compensation insurancefor my employees. Below is the policy and job site
infnrmation-
Insurance Company Name:_,,,,,- -. -
Policy A ar Seif--ins.Lie.* xpiration Dater
Jab Site Address: Cty/Samc/Zr1c _
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date)-
Fairure 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 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 here erd ad h pains and penaldes ofperjury that the information provided above is true and correct
P mic#:
E=�--
only. Do nm rvrite in this area.In be rnmplaed by city or fowrz official.
Town:_____„ Permit/License&,,,,,hority(circle one):
Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
sou— Phone to
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 ajoint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee often 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 bean 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 cenificate(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 permiMicense number which will be used as a reference number. In addition,an applicant
that most 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 proofthat 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 Departments 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