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24C-078 (8)
12 MASSASOIT ST BP-2019-1263 GIs#• COMMONWEALTH OF MASSACHUSETTS Map:Block:24C-078 CITY OF NORTHAMPTON Lot:.001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateaorv:renovation BUILDING PERMIT Permit# BP-2019-1283 Proiect4 JS-2019-002042 Est.Cost:$38000.00 Fee:$266.00 PERMISSION IS HEREBY GRANTED TO: Const.Clus: Contractor: License: Use Group: ROBERT OBEAR 088280 Lot Size(sc.ft.), 15942.96 Owner: FALLON JONATHAN M&LAURA A Zoning:URB0001/ Applicant: ROBERT OBEAR AL. 12 MASSASOIT ST AoallcantAddress: Piston Insurance, 47 W CHESTNUT HILL RD (413)367-2424 0 WC MONTAGUEMA01351 ISSUED 0#.•5/21/2019 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE EXISTING 2 STORY PORCH AND CONSTRUCT NEW PORCH 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 Find: Final: Final: Rough Frame; Gas: ,FFiXe Department Fireplace/Chimney: Rough: 0111, Insulation: Final: Smom: Finals THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Ogmancv Signature: FeeTvpe: Date Paid: Amount: Building 5121,120190:00:00 $266.00 212 Main Street,Phone(413)587.1 240,Fax:(413)587.1272 Louis Hasbrouck-building Commissioner File A BP-2019.1263 APPLICANT/CONTACT PERSON ROBERT OBEAR ADDRESMONE 47 W CHESTNUT HILL RD MONTAGUE (413)367-24240 ��s PROPERTY LOCATION 12 MASSASOIT ST �p1.l Q�L MAP 24C PARCEL 078 001 ZONE URUUM THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST LOSED REQUIRED DATE Z NINF FIL EDOUT Fes Paid k A Buildine Permit Filled out Fee Paid Tvneof Construction, REMOVE EXISTINGUTIMYPORCH AND CONSTRUCT NEW PORCH New Construction Non Structural interior renovations Addition to Existing Accessory Stmchare Building Plans Included: Owner/Statement or License 086260 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INTION PRESENTED: _IZApproved_Additional permits required(set below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Pin 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 Cm 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 _ 5-ZI•?0�9 Signftm of Building Official Date Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all waing 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. apartment use only — � City of Northampton a u 't Building Department Curb Cut/Driv y ermit A 212 Main BIT t MAY tfivv tic vaila iliry. 'I Room 100 Water/Well A ilebi ry Northampton, MA 0106 DF"OF nun IN.IN-PECTIONS CIU t Plans \.. phone 413-587-1240 Fax 413- -121TBnHAm-. t13 terns Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Protests Address: This section to be completed by office 12 Massasoit Street Map '2'/G Lot G 7 9 Unit Northampton, 7Ane Overlay District MA. Elm at Dlsmet ca olsmlot SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: John and Laura Fallon 12 Massasoit Street,Northampton,MA. Name(Print) Current Mailing Address'. Telephone Signature 22Aulhort tl enl: Obea� coon Company,Inc. 34 A East Main Street, Millers Falls,MA. 01349 Name Current Mailing Address: 413-537-5953 sig azure Telephore SECTION 3-ESTIMATED CONSTRUCTION COSTS hem Estimated Cost(Dollars)to be Official Use Only completed by permitapplicant 1. Building $38,000 (a)Building Penni Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee !_ 4. Mechanical(HVAC) /VA 5. Fire Protection 6. Total= 1 +2+3+4+5 $38,000 Check Number This Section For Official Use Only Building Permit Num r: DateIssued: Signature: 5-7-( -ZOJq Building Commissionerllnspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) $eC[1On 4. ZONING ALL Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to M fillod in by Building Department La Size Frontage Setbacks Front 45'5 Side L' R. L: 22'3 R: 37'11 Rear Building Height Bldg.Square Footage % Open Space Footage % (I.m area minus bldg&paved porianju #of Puking Spaces Fill: volume&Iucmion A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW ® 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 BookPage and/or Document IF 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 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. NAI the construction activity disturb(Gearing,grading, excavation,or filling)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(cheek all applicable) New House ❑ Addition ❑ Re lacement Windows Alterations) ❑ Roofing 0 Or gpprs ❑ Accessory Bldg. ❑ Demolition ® New Signs [0) Decks [© Siding[0] Other[pi Brief Description of Proposed Work: remove existing 2 story porch,construct new porch according to plans attached. Alteration of existing bedroom_Yes x No Adding new bedroom Yes x No Attached Narrative Renovating unfinished basement _Yes x No Plans Attached Roll -Sheet ea. H New house and or addition to existing houslna.comoWe the followlna: 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 a. Number of stories? I, Method of heating? 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 j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? YesNo. 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 see attached hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, Robert Obear(Obear Construction Company,Inc.) as Omer/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 a ins and penalties of perjury. Rob Print ignatuNe 4/30/2019 Sre of OwnerlAgaM Dale SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Nome of License Holder-. ROBERT OBEAR CS-086260 License Number 47 W STNUT HILL ROAD,MONTAGUE,MA.01351 7/10/2019 Atltlms Expiration Date 413-537-5953 sigrfatum Telephone 8.Realstered Home Improvement Contractor: Not Applicable ❑ OBEAR CONSTRUCTION COMPANY,INC. 152593 Company Name Registration Number 47 WEST CHESTNUT HILL ROAD,MONTAGUE,MA.01351 9/11/2020 Address Expiration Date Telephone 413-537-5953 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.a.182,§28C(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....... IX No...... ❑ City of Northampton �S MassachusettsftOC- • i DEPARTMENT OF BUILDING INSPECTIONS 212 Mxn street • l nicipal Build nq N.rtha ton, Hk 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 registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, impmvement, removal, demolition,or construction of an addition to any pm-existing owner-occupied building containing at least one but not more than tour dwelling units....or to structures which am adjacent to such residence or building"be done by registered contractors. Note:/f the homeowner has contracted with a corporation or LLC,that entity must be registered. Type of Work: CONSTRUCTION Est.Cost: $38,000 Address of Work: 12 MASSASOIT STREET,NORTHAMPTON,MA. Date of Permit Application: 4/30/2019 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 SSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDI ;th ERa •XT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit asagentof the owner: 4/30/19 ROBERT OBEAR 152593 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 a „ � Massachusetts L ;1' D ARTD T OF BUILDMG MS?WTIWS p Pa 212 wain Street • Municipal Building �rCl Northten, !A 01060 ryH pe 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 IIO.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 11 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 thejob 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 perforin work for you under this permit. City of Northampton +r. Massachusetts - DEPART 7 OF BUILDING =5PWTI0Na y� 212 Nain Street omuniclpal Build nq Northaeyton, M 01060 »Pec 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: 12 MASSASOIT STREET (Please print house number and street name) Is to be disposed of at: Amherst Trucking Company/Hatfield,MA. (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 4/30/2019 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. I The Commonwealth of Massachusetts Department of Industrial Accidents s I Congress Street,Suite 100 Boston,MA 02114-1017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Eleetricians/Plumbets. TO BE FILED WITH THE PERMITTING AUTHORITY, Applicant Information Please Print Leeibly Name (Business/OrganizatioNlndividuap: OBEAR CONSTRUCTION COMPANY,INC. Address: 34 A EAST MAIN STREET City/State/Zip: MILLERS FALLS,MA.01349 Phone#: 413-367-3053 Art you an employer?Crack the appropriate Duo: Type of project(required): L31 am u rmployer wdh 10 employees(Poll and/or part-time)' 7. 1p New construction 2.rllamasolepmpneororpmaershipmdhavenoemplomswarking sourest g. CjRemodeling my capacity.(No workers'comp.insurance accused 3 E I am a homcowmer doing all work myself[No workers compinsumnce raryired] 9. [11 Demolition 401 are a hommwner end will be hiring contractors to waded all work on my property. I will 10❑ Building addition emure matall contractors mthahave workers conpensatixamatranceoreic sole I L❑Electrical repairs or additions pmprleors with no employees. 12.[D Plumbing repairs or additions 5.E]1 am a general conaector and I love hired the sub-contractors listed on the auaehe l sheer. T13.�ROOf repairs These sub-contractors have employees and have workers'comp.insurance: 6.F11i'eareaoorpomfionarad ipomcexshaveemacoed their right ofexempion per MGLc 14.[—]Other 152.§I(4),and we have no employees.hNo om l as'swmp.insumnce required] 'Any optician mat clacks box PI main also fill out the section below showing their workers'compamation pubcy information I limners who submit this affidavit indicating they arc doing all work and men hire outside contractors must submit a new affidavit indicating such. $Com urs that check this box mast attached an additional sheet showing the more ofthe subcontmerors and state whether or not those entities have employces. Italie subcontractors have anployecs,flay must pmvidc their workers'comb-policy number I am an employer that is providing workers'compensation Insamnce for my employees. Below is the policy and job site information. Insurance Company Name: EMPLOYERS MUTUAL INSURANCE Policy b or Self-ins.Lic.#: 5H6-73-82-20 Expiration Date: 4/2020 Job Site Address: 12 MASSASOIT STREET City/State/Zip: NORTHAMPTON,MA. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Al c. 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 violrrc5qAclmy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verificatio I do hereby eerd i nd enoldev o(penhop that the information provided above is true and correct Si ata : Date: 4/30/2019 Phones: 13-537-5953 Oficial 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 or Health 2.Building Department 3.Cityrrown Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: