23A-197 (2) 45 BEACON ST BP-2019-1368
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Bluck:23A- 197 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorv:renovation BUILDING PERMIT
Permit# BP-2019-1368
Project# JS-2019-002204
Est.Cost: $11000.00
Fee:$72.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use croup: Homeowner as Contractor_
Lot Size(sp.ft.): 10497.96 Owner: BITTEL RONALD D
Zoning: URB(100V Applicant: BITTEL RONALD D
AT: 45 BEACON ST
ApolicantAddress: Phone. Insurance:
45 BEACON ST
FLORENCEMA01062 ISSUED ON:5/37/2019 0:00:00
TO PERFORM THE FOLLOWING WORMBATHROOM REMODEL, BEDROOM - REPLACE
SHEETROCK, REPLACE WINDOW
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector or 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 Occuoancv signature:
FeeTFDe: Date Paid: Amount:
Building 5/31/20190:00:00 $72.00
212 Main Street,Phone(413)587.1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File N BP-2019-1368
APPLICANT/CONTACT PERSON BITTEL RONALD D
ADDRESSIPHONE45 BEACON ST FLORENCE
PROPERTY LOCATION 45 BEACON ST
MAP 23A PARCEL 197 001 ZONE URB(100
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
EN OSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tvpeof Construction: BATHROOM REMODEL.BEDROOM-REPLACE SHEETROCK,REPLACE WINDOW
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildings Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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 Variances
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
5.30- 20)4
Sigilklifi,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.
>:, v
tu�tiv MU Depanmenl use onty
-- City of Na or Permit:
.� Building a mend Cum uVDnveway Penna
212 Me S MAY 3 0 2019 /Septic Availabil ty
'�. R 1 ell Availability
Nonfhampto
phone 413-587-12 Fax T IInIN(;INSPO 060 7Mxo S Ce1RI Plans
Planslana
Otlwx Spedly
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION I-SITE M/FORMATION Er17Q%4 S 101aa5
1.1 Prooedv Addy 1: This s[a�UM to be congMOed by ounce
(�.7 �i4COn �Yre e� NW Let
zone Overlay Disldet
Ehn EL Bf ids CB Dleald
SECTION 2-PROPERTY OMIERNMALMIG1 DAGER
21 Omer Of Record:
f?Ae'/ L? !d rkw A-c
Nate(PMI) LYlhblt Maihp M- 3�D - o o Ib
Tdrp ou
22 AuthoraM Agent:
Nitre(Prsln CurM Melling Addleaa:
Signatioae Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
mm Estimated Cwt MOWS)to W Olhdal Use ONy
completed by pem* i®ri
1. Building ¢— GdO. G O (a)Building Permit Fee
2. Elect i®I ,t (b)Eslin i ted Top Cwt of
Construction horn B
3. P4anhing �- OO ni Q Building Perms Fee
4. Mechanical(HVAC) oZ
5.Fre PnnleUion
S. Toted=(1 +2+3+4+5) Check Number ^y
This Section Fair Official Use Only
Building Pemid Nurnber Date
Issued-
signature: S - 30 - 261q
Building cwmnmwwn
mm odo of Bk%P p Dna
bd4il/ 4GC� "l cam @ IY(a�ie- Al 9 grrla i
EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION S OESCANYTION OF PROPOSED WORK(check all aodicablei
New Holme ❑ Addition p ReplaoementWindows AltenVbn(s) Hoofing O
or Doors YY
Accessory iildp. ❑ D.nhoWlon p New signs IDI Backs 11-3 SNhha 1:31 Other Iq
Brief Description of Proposed 1 8s/��.�,. – reM .e�4neb �c(— ,6.CP
Work. I IM – J/hR'ak/
Alleratiah d eria6ng beftom Yea No Adding new bedroom Yes No
Attached Narrative Renouretig unfinished basermxm Yes No
Plans Amadned Rdl -Sired
Be.If New house and or addMon to existina housing,cornoiete the following:
a- the d building_One Family Two Family Other
b_ Number of moms in each(amity unit: Number of Bathrooms
c. Is there a garage attached?
it Proposed Square footage of new mnstmcbon Dimensions
e. Number of stories?
I, Method of Mating? Fireplaces or Wood doues Number of each
g. Energy Conserwffion Canpkame Masschedt EneW ConlpMarce form attached?
h. Type of consbuddon
i. Is mnstmcbon within 100 fl.ofwetlands?Yes No. Is ewlebucbm vAM 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will budding conform to the Budding and Zoning regulations? Yes No.
E Septic Tank_ Cry Sewer_ Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO DE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR OULOM 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 perms application.
Slowkwolownei Dale
1. �Qr4R7� �l//G/ as Owner/Authorized
Aged hereby declare iliat the statements and infomretion on the foregoing application are the and a=urare,to the best of my knowledge
and belief.
Signed ander/the pans arrd/perreNles of
Prim Name
Z a9Z
�\ The CommanweaBh of Massachnseft
Department of(ndastr/al Aceidentf
/ CongressSuite/00
Boston, MAA 021 01(/4-10/7
www.massgov/dia
%V rkers'Compensation Insnranee Affidavit: Builders/Cootraetors/Electricuns/1'lumbers.
TO BE FILED WITH THE PERMITTING AUTHOREM
tion Please Print Leffibh
Addreaa: 67 AV AV e.
Cily/ taR&Ur. ✓a 'IM) /rrrl r7O6�QPlhooe#: 5P/3-3.20 — $(o66
Arex�Baal ref elalkrel*a..a.irr Ina: Type orprolec(R9mat):
I.ptam aempby«with ullgm�f6111aW«pslav«f•
7-
8.1511temodeling
my c pacih.Igo xo,tus'auto.io,. , ,usixt I
d.�lan ahmaw mr Jnrta ail xad lmself lex xohcts'nulp.lm«slequi.d.l' 9. Demolition
d���/I I m a Imlxium aId x 11 W hirtug axn taus w mtdln ell wale m my pnymy. 1 x91 10❑Building addition
7"'tAw2 ran yl .manor...;u,•.m x a,at� ..,..ye uaim i n,.a «a.•..�u. I1OElecbiwJ npairs or dditions
lugnclors xiN m employes- 12.Whimbing rt�irs or additions
2❑Ionia
. eal. .1«sdlh 'mtei ne slbcama l,n I..m mtlr aaxMd Yrs I J.rr']Rarfrepairs
fk xm«r,lu�«..mrc,+mwy.��rla lw.exanu:v�„v �xx.u,«.
h.Elwe ac a m,prren attic..w.hone�nnr nrhl xt crexytxn pa Mfil.c. 14.pOOMr
152.411d1.sal xe lure m enw4,Yas.INo xahac'm,q.im,ums�ge,d.l
•Any aP ..,tha cher.Mac e I may iso fill w the section tick-•I M ace ploy inf«nmim.
•Iuh olhtsiifl ha it i,di ,,dv..dn:lle all x,A ad lhm himwlnidc asxmatws mo sbnlvan amdweiMilaingsWl.
:('o,lv cars note AIh,,h,,nwl atx in additiud5 1Jarxillr the Marc of 1h slAe nau«f ad Lee ivtl «MInose anVia Ime
i,.Pxm. If die sld,nuvan«s lase cnpby¢z.Ila,'ma pen Idc dlert xukas-torte.pdis aavbv.
/am art errq/oycr Maraprovidin,;wonlers'rnmprnsarion inavnnrarJ6rn9'nTbyRc Be%wirrhepn/icymrdjobaVe
informmion.
Insurance Company Name:
Policy#ser Self-ilw Lic.#: _ _ Expiration Dhdr _
Job Site Address: City/SlafdZip:
Attach a copy of the workers'compensation pulley declaration page(showing the policy ember and mishad"date}
Failure to secure coverage as required undo MGL c. 152,§25A is a criminal violation punishable by a fine up to SI,500.00
and/or one-year imprisonment,as well as civil penalties in the tom of a STOP WORK ORDER and a fine of up m$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for inslaance
coverage verification.
/de hereby cyyolifj under the pains surd pewr/6n ofperjrry de the wformsion provided above is nue andcm,,vve.
Simlahne:/I p
Phone 9, yi�'3e�[ti -2G OG,
Offmia/aseody. Qarewrlkhr Aseen,bbecrajdandby city or town oBciaL
City or Town: Permit/License#
Isswiag Aa+ierily(chicle rhe):
1.Board of Health 2.RuNd'og Deparlarert 3.CRyfl'wn Clerk 0.Electrical laspeeW 5.Plassbig lospeclor
6.Other
Contact Person: Phone#:
4
City of Northampton
^" Massachusetts
L
1212 M—n TOP nmZr Cl IIrSP ld3OBS i
212 lNin rti¢ " lLm 010 BullQivg
lortluwptm, here 01060
AFFIDAVIT
Home Improvement Contractor law
Supplement to Permit Application
Time Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations an detached one to four family homes. Prior to
performing work on such homes,a contractor must be registered as a Honk Improvement Contractor("I IIC").
M.GL Chapter 142A requires Uma the"ncwxsftuctc,% aleiatYan, mmvaem, repay modemrahw, c wvers '
improvement mnova, demoldan, or consim tion of an additim to any preexisting owneroccupied auddW aontalmng
at toast one but not more Man four dweaing umTs.._or to structures which are adjacent to such maidence orbuidirg"be
done by registered contractors.
Note:If the homeowner has contracted with//a corporation or LLC,that entity most be registered.
Type of Work: p �/yDl .� oa/ Fsl Co L_ 006, G
Address of Work: y� /9�-L Yr Yi2/ence 40#
Date of Permit Application: 1� 2
1 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 ownerocaipiod
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 RFSPONSIBILITES 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.
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice,l hereby apply for abuilding permit as the owner of the above property:
Date Owner Name and Signature,
City of Northampton
MMHMMCfnrH6,ttM .?
nim? ® 01F eolza>ae >Hae CIIFs
212 Main Street *n is W eui din,
M rtLee ' M 01060 YN. x�e0
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, 554, I acknowledge that as a condition of the building
penult all debris resulting from the construction activity governed by this Building Penult 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:
(Please print house number and street name)
Is to be disposed of at
1G���r��
(Please print me and of facif
Or will be disposed//of in a dJJumpstteer onsite rented or leased from:
�od�eY l?row/
(Company Na and Address)
Signature of Penult 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
�
4
- a r �
:.'t rr�sav®r or mrzozac �sescziws :.
: : � s � . ��� a 4
n,, r
Massachusetts Residential Building Code
Section IIO.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 farts 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 shall be exempt from
the licensing provisions of 780 CMR 11 O.RS,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 Fath)of the Massachusetts
General Laws Annotated, you may be liable for person(s)you hire to perform work for you
under this permit.
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applkable ❑
Nene of License Ibtder
License Numt e
Address Exp B Dale
Sgrulwe Teftpho he
9.Repiatemd Nonan knprosanwd Can"cbr: Not Applicable ❑
Campos Nfine Registration Nhmiher
Address bpkation Dale
TelepThmhe
SECTION lo-WORIffM CON-ENSATION INSURANCE AFFIDAVIT(LLG.L m
Workers Conpeasapon Insuance alfitlavn must be completed and subnilled with Sus application_Failure to provide this a8itlavtt will fesut
in the denial of the inuahGe of the building pemit.
Signed Affki2WAeadied Yes....... O No...... O
Information and Instructions
Massachusetts Gencral 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 eny/ayer 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 represematives of a deceased employer,or the
receiver or trustee of an individual,pamrerslup,association or other legal emrty,employing employees. However the
owner of a dwelling house laving cot more than three apartments and who resides therein,or the occupant of the
dwelling house of mother 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 reamed to heart employer."
MGL chapter 152.§25C(6)also stales that-every state or local licensing agracy shall withhold the maauce or
renewal ofa 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 repaired."
Addiliorally,MGI.chapter 152,§25C(7)states"Neither the coma nwalth mer any of its political subdivisions shall
crier into any comma for the performance of public work until acceptable evidence of compliance with the insmarce
requirements of this chapter have been pnsmted to the contracting authority."
Applicants
Please fill ad the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply subccmtmcta(s)secs),address(m)and phone number(s)along with their cenifiate(s)of
insurance. Limited Liability Ccmipmies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required 0 carry swrkers'armperrmfion insurance. Ifm LLC or UP docs have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
AmidenB for anfirmatim of inwnarce coverage. Abo be soreto sign and dale Ibe alydaviL The affidavit should
he 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 yin arc required to obtain a workers
compensation polity,please cell the Depmlment at the ncunbe,listed below. %elf-inseaed comp..should cruer their
self-insurance license number m the appropriate line.
City or Town Olfeials
Please be sure[hat the affidavit is compfete and primed legibly. The Oepamnent has provided a space a[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 pemnitflicerrse number which will be used as a reference number. In addition,an applicant
that must submit multiple permitl icrose applications in any given year,need only submit me affidavit indicating currem
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
iown)"A copy of the affidavit that has been officially stamped in uaAcd by the city or town maybe provided tothe
applicant as proofthat a valid affidavit is on file for future permits or liavua. A new affidavit must be filled and each
year. Where a Tame owner or citirau is obtaining a license in permit not related to my business or commercial venture
(i.e.a dog license or permit to bum laves ac.)said person is NOT required to complete this affidavit.
The Deparhnmt's address,telephme 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 At 617-727-7749
Revised 02-23-15 www.mass.gov/dia
Section 4. ZONING Al Information I t Be Cw*ted-Pmnk can m Dented one To Incomplete Info nwtion
Foisting Prxpcsed Required by Zoning
Tbiz m.m be filled in by
Bud&,ltrywomcat
W size
Frontage
Setbacks Front
Side 1. R: L R:
Rear
Building Height
Bldg.$quan;Footage %
Open Space Footage %
(la ana mous bldg a paved
At
of Parking Spices
Fill:
.d�Blwuml
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O 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 Doctment q
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 deed 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, desaibe sire, type and location:
D. Are there arty proposed changes to or additions of signs intended for the property? YES O NO O
IF YES, desaibe sire, type and location:
E NAI the construction activity disturb(deaing,grading,excavation,or ting)over 1 are or is it pal of a cummuon plan
duet will disturb over 1 acre? YES O NO O
IF YES.then a Northampton Slorm Water Management Penni)from be DPW is required.