23A-016 (15) 14 PARK ST BP-2020-0023
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23A-016 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT.
Permit# BP-2020-0023
Project# JS-2020-000040
Est.Cost: $19000.00
Fee: $123.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): 64033.20 Owner. SORKIN ROGER D& EVA CAMACHO-SANCHEZ
Zoning. URB(100)/ Applicant. SORKIN ROGER D & EVA CAMACHO-SANCHEZ
AT. 14 PARK ST
Applicant Address: Phone: Insurance:
14 PARK ST (413) 584-1005 O
FLORENCEMA01062 ISSUED ON.7/23/2019 0.00:00
TO PERFORM THE FOLLOWING WORK.-INTERIOR RENO - ADD BATH, ENLARGE
BEDROOM, KITCH RENO, STAIRS
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:
FeeType: Date Paid: Amount:
Building 7/23/2019 0:00:00 $123.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
SEE CLANSmTO
File#BP-2020-0023 ��
APPLICANT/CONTACT PERSON SORKIN ROGER D&EVA CAMACHO-SANCHEZ
ADDRESS/PHONE 14 PARK ST FLORENCE (413)584-1005 Q
PROPERTY LOCATION 14 PARK ST
MAP 23A PARCEL 016 001 ZONE URB(100)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT AP ION CHECKLIST
NCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tvpeof Construction: INTERIOR RENO- BATH,ENLARGE BEDROOM,KITCH RENO, STAIRS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
[lSlF09R4ATION 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 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
.5Demolition Delay
7Z5-26W
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 only
City of Northampton � ��� �aius of Kermit:
Building Depa` me r Cut/ riveway Permit
212 Main S reet Se4r/Se tic Availability
Room10 -Wat rNVe 1 Availability
Northampton, M 01 60 Two,Sets f Structural Plans
phone 413-587-1240 F x 41 - - ._.Plo#i�ite ans
DEPT Or r;un DING V
(3t�t2f S e I
NORI AMPTc p fy
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
_J
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
I �" PG1V-• _ 5+ . Map Lot 0 f6Q Unit
F(6r2r„c-� f 0 /176 Z Zone Overlay District
i
Elm St. District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
r '� /T Af-f� .5t. , E( r--mce 1A x1462
Name(Print) Current Mailing Address: T
262 . 270. x6 S' i
Telephone
Signature/
2.2 Authorized Agent:
Name(Print) I Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 112-1 0D0 (a) Building Permit Fee
2. Electrical b) Estimated Total Cost of
600 Construction from 6
3. Plumbing J�'gn Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protectiona'4 �� D 0 (�
6. Total =0 +2+3+4+5) '000 Check Number /
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: Z�j ZQr1
Building Commissioner/Inspector of Buildings Date
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 Zoning
�A AOto
This column to be filled in by
Building Department
Lot Size _.. __. .._...
Setbacks Front
Side L: _� R: L:� R
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location) _. ........ i ..._._ ,.. ..
A. Has a Special Permit/Variance/Finding ver been issued for/on the site?
NO 0 DON'T KNOW YES
IF YES, date issued
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DON'T KNOW 0 YES
IF YES: enter Book Page' and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:
f
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading,excavation,or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO
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 0
Accessory Bldg. ❑ Demolition L1CI New Signs [O] Decks [Q Siding [O] Other[d]
ptxu 2 ' �wS2 '
Brief Description of Pro os d —�qs e 3
--
Work: ?_" (
oor 4rnowx Wrt� Showerlt�ec,.� D21.10 non-IoAd'yeA/r�,
� /' wA a back .5tAI�RJt
Alteration of existing bedroom �/ Yes No Adding new bedroom Yes ✓ No Ckvid 5i•22.
Attached Narrative Renovating unfinished basement Yes fNo p one
Plans Attached Roll -Sheet!��
b2drao.�
6a. New hou a6d Aria" 11 fon a ox #in housln complete the followin
a. Use o ilding .- One Family �v_" Two Family Other
b. Number of room ' each family unit: W\ Number of Bathrooms
C. Is there a garage attached.
/ate Space
d. Proposed Square footage of new cons on. Nit Dimensions
e. Number of stories?
f. Method of heating? re ces o o Number of each
g. Energy Conservation Compliance. Massc Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetl Yes No. Is construction withi 0 yr. floodplain Yes No
j. Depth of basement or ce oor below finished grade
k. Will building orm to the Building and Zoning regulations? —�Yes No .
I. S ' Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT N
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 Date
I, 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.
Print Name
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: l Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9.Realetered Home Improvement Con r ��� 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....... 0 No...... ❑
City of Northampton
Massachusetts �� f�;
" DEPARTMENT OF BUILDING INSPECTIONS
' 212 Main Street • Municipal Building3,L �
F, Northampton, MA 01060 s3?jy , 1�41
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,
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 must be registered.
Type of Work:D k�, r o P Est.Cost. 3arb
v12W S ire baS e. 04-;�wrew,ode begr&o,.,
Address of Work: /
a r , ore-1Ce( 0/0 6
Date of Permit Application: r-T,,,e o f Zo i g
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:
Notwithstanding the above notice,I hereby apply for a building permit as the ow r of the above property:
o (I a Ri' or .,,
Dat wner Name and Signatu
_. City of Northampton
^ Massachusetts :.
DEPARTMENT OF BUILDING INSPECTIONSg a
212 Main Street • Municipal Building
Northampton, MA 010606""°��
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 shall be exempt from
the licensing provisions of 780 CMR 110.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 J{�
4 DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street *Municipal Building t.
b
Northampton, MA 01060 111 j
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:
IL� PO-k �+ , N0reV1HA
(Please print house number and shame)
Is to be disposed of at:
Va� V4
(Please print name 4nd locatA n of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
— 6 /30
S' natu P it 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 Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
XForkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Analicant Information Please Print Legibly
Name (Business/Organization/Individual): Roa4pr
Address:
City/State/Zip: 0 6 f 06 Phone #:-2-02- . 2-20-06,52—
Are
70.062Are you an employer?Check the appropriate box: Type of project(required):
1.[]I am a employer with employees(full and/or part-time).* 7. ❑New construction
2.M1 am a sole proprietor or partnership and have no employees working for me in $, &0emodeling
any capacity.[No workers'comp.insurance required.] 9. ffDemolition3. I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
4f]I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition
ensure that all contractors either have workers'compensation insurance or are sole I I.Q Electrical repairs or additions
proprietors with no employees.
12. 'Plumbing repairs or additions
-5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.�ROOf repairs
These sub-contractors have employees and have workers'comp.insurance.
6.F�We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workerscompensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/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 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 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 under the pains and penalties of perjury that the information provided above is true and correct.
G=
Signature: Date: 1-30 I
Phone#: 2(52- . 2--7o. 06
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 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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7/23/2019 City of Northampton Mail-14 Park St.
NorO
m Kevin Ross <kross@northamptonma.gov>
14 Park St.
1 message
Kevin Ross <kross@northamptonma.gov> Tue, Jul 23, 2019 at 9:21 AM
To: rsorkin99@gmail.com
Good morning Roger,
I am currently reviewing the permit application for the proposed work at 14 Park St.
I have some notes regarding the work:
Phase 1- The window in the new bathroom next to the shower stall needs to be tempered per
code. Any glazing 60" or lower needs to be tempered.
I will need information on the header where you will be removing the structural wall for the new
bathroom.
Phase 2-The 2 new posts will have to sit on new footings, not on the slab. What size will the new
micro-lam beam be? You will have to maintain a minimum of 6'8" headroom on the stairs.
Phase 3-Will require hard wire smokes thru out the house if they are not there installed.
Any questions please let me know.
Thank you,
Kevin Ross
Local Building Inspector
212 Main Street 587-1240
Northampton,MA 01060 Fax 587-1272
kross@northamptonma.gov
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