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38B-282 (4) 16 WINTHROP ST BP-2020-0133 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:38B-282 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: KITCHEN RENO BUILDING PERMIT Permit# BP-2020-0133 Proiect# JS-2020-000212 Est.Cost: $65000.00 Fee: $422.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: CARL WOODRUFF 109983 Lot Size(ssy.ft.): 10410.84 Owner. GERSTLE KATHERINE&JENNIFER WERNER Zoning: URB(100) Applicant. CARL WOODRUFF AT. 16 WINTHROP ST Applicant Address: Phone: Insurance: 122 PLEASANT ST#109 (315) 854-4024 WC EASTHAMPTONMA01027 ISSUED ON.8/2/2019 0:00:00 TO PERFORM THE FOLLOWING WORK:KITCHEN RENO, NEW WINDOWS IN SUNROOM, ADDING GAS STOVE 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 sigin:ature: FeeType: Date Paid: Amount: Building 8/2/2019 0:00:00 $422.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2020-0133 APPLICANT/CONTACT PERSON CARL WOODRUFF ADDRESS/PHONE 122 PLEASANT ST#109 EASTHAMPTON (315)854-4024 PROPERTY LOCATION 16 WINTHROP ST MAP 38B PARCEL 282 001 ZONE URB000) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSE REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: KITCHEN RENO,NEW WINDOWS IN M,ADDING GAS STOVE New Construction Non Structural interior renovations Addition to Existing Accesso Structure Building Plans Included: Owner/Statement or License 109983 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQRMATION PRESENTED: 9,1 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 Demolition Delay 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. y rip �E C E I ViherSpecify_ Department use only Cit of Northa to rmit: Building Depa met iveway Permit ' y 212 Main St et AUG - 1 ?�) cAvailability ( ROOM 10 Availability -"' NOrthamptOn, M 010 0 Structural Plans phone 413-587-1240 Fa 418�58F' � �'�"'` ns --`NORTHAM ON.tV' fy APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE ORDEMOLISHCA ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION i�/��`� AP— av' ! 3 3 1.1 Property Address: 16 Winthrop Street This section to be completed by office Northampton, MA 01060 Map rJpp Lot A 8c�' Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Katie Gerstle and Jen Werner 16 Winthrop Street, Northampton, MA 01060 Name(Print) Current Mailing Address: 413-320-1954 Telephone Signature 2.2 Authorized Agent: Carl Woodruff 122 Pleasant Street, Easthampton, MA 01027 Name(Print) Current Mailing Address: 413-527-9000 re Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $65,000 (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) Check Number Mdo This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date Carl @ oxbowdesignbuild.com 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 filled in by Building Department Lot Size Frontage 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 Full: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW ® YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW (D YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained ® , Date Issued: C. Do any signs exist on the property? YES 0 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 0 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 W 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 Vyindows Alteration(s) Roofing Or Doors V] Accessory Bldg. ❑ Demolition ❑ New Signs (0] Decks [Q Siding[0] Other[EQ Brief Description of Proposed Work:Kitchen remodel removing wall between kitchen and sunroom replacing sunroom windows, adding gas heating stove. Alteration of existing bedroom Yes V No Adding new bedroom Yes V No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Emailed to Louis 6a. If New house and or addition to existing 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 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? 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, _3 ������� vV �� V ,as Owner of the subject property hereby authorize Carl Woodruff to act on my behalf,in all matters relative to work authorized by this building permit application. 7t�� VV_____e_2 $//// q Signature of er I Date ICarl Woodruff ,as Owner/Authorized Agent hereby n the forego declare that the state is ation oing application are true and accurate,to the best of my knowledge and belief. Signed un r the pains and penalties perjury. Carl Woodruff, Agent � �� Drier Alamo SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Carl Woodruff CS-109983 License Number 122 Pleasant Street, Easthampton, MA 01027 03-04-2020 Address ✓ Expiration Date 413-527-9000 Si Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ Carl Woodruff 186013 Company Name Registration Number Oxbow Design Build 09-20-2020 Address Expiration Date 122 Pleasant Street, Easthampton, MA 01027 Telephone 413-527-9000 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....... m No...... ❑ City of Northampton s Massachusetts DEPAR729ENT OF BUILDING INSPECTIONS Y 212 Main Street • Municipal Building Northampton, MA 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, 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: Remodeling and window replacements Est. Cost: $65,000 Address of Work: 16 Winthrop Street, Northampton, MA 01060 Date of Permit Application: Aug 1, 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 ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAIGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: Aug 1, 2019 Carl Woodruff 186013 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 The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston,MA 02114-2017 www massgov/dia Wurkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITMG AUTHORITY. Anolicant Information Please Print Legibly Name (Business/Organization/Individual): Oxbow Design Build Address: 122 Pleasant Street City/State/Zip: Easthampton, MA 01027 Phone #: 413-527-9000 Are you an employer?Check the appropriate boa: Type of project(required): 1.M I am a employer with 6 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ®Remodeling any capacity.[No workers'comp.insurance required] 3.1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 10E]Building addition 4.❑I am a homeowner and will be hiring contractor;to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.r7 I 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.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q 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 workers'compensation 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. bed q Insurance Company Name: L i be � M U 1 uca Policy#or Self-ins.Lic.#: �Cl,.1S (Zo) S7 71 F7 Expiration Date: Job site Address: 16 Winthrop Street City/state/zip:Northampton, MA 01060 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 p n nal 'es of perjury that the information provided above is true and correct Si attue: Date: XLA Phone#: '9000 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#: City of Northampton r ' Massachusetts DEPART!►9NT OF BUILDING INSPECTIONS . 212 Main Street •Municipal Building d. Northampton, MA 01060 ssl�yO11 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: 16 Winthrop Street (Please print house number and street name) Is to be disposed of at: Alternative Recycling (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) - Aaa2az�i enata -43fer it App6cant 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.