42-074 (11) i
97 GLENDALE RD BP-2020-0441
GIS#: COMMONWEALTH OF MASSACHUSETTS
ME:Block:42-074 CITY OF NORTHAMPTON
Lot:-001 I'ERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categorv: ADDITION BUILDING PERMIT
Permit# BP-2020-0441
Proiect# JS-2020-00075
Est.Cost: $12500.00
Fee: $81.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: STEPHEN CAMP 082531
Lot Size(sg.ft.): 4486.68 Owner: ODGERS CRAIG W
Zoning: Applicant. STEPHEN CAMP
AT. 97 GLENDALE RD
Applicant Address: Phone: Insurance:
46 EAST ST 413 527-7124 WC
EASTHAMPTONMA01027 ISSUED ON.1011112019 0.00:00
TO PERFORM THE =IBLE
OWING WORK:8X18 BACK PORCH ADDITION
POST THIS CARD SOIT FROM THE STREET
Inspector of Plumbing Inspec or of Wiring D.P.W. Building Inspector
Underground: Servic Meter:
Footings:
Rough: Rough House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire D artment 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:
Feer e: Date Paid: Amount:
Building 10/11/2019 0:00:00 $81.00
12 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2020-0441
APPLCCANT/CONTACT PERSON STEPHEN CAMP
ADDRESS/PHONE 46 EAST S EASTHAMPTON (413)527-7124 Q
PROPERTY LOCATION 97 G ENDALE RD
MAP 42 PARCEL 074 001 ZO E
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
.Building Permit Filled out
Fee Paid
TypeofConstruction: 8X18 BACK PORCH ADDITION
New Construction
Non Structural interior renovations
Addition to Existinp--
Accessory Structure
Building Plans Included:
Owner/Statement or License 082531
3 sets of Plans/Plot Plan
THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9KMATION PRESENT
_LZApproved Additional permits required(see below)
PLANNING BOARD P RMIT 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 PER IT 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 Ehn Street Commission Permit DPW Storm Water Management
Demolition Delay
O . 0 I)A 9
Sig ture of Building Official Date
Note: Issuance of a Zoning pe mit 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.
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Department use only
City of Nort am D / Status of Permit:
/r >> Building D part en C�l V& rb'CuVDriveway Permit
212 Mai Str et wer/ eptic Availability
Roor 100; OCT _ , ater ell Availability
Northamptgn, MA 01060 2019
wo S is of Structural Plans
phone 413-587-12407-1272 lot/ to Plans
NORTHgM /N�fNSpF Othe Specify
APPLICATION TO CONSTRU&,ALTER, REPAIR, RENO o� B EM 4ISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
` %e n J` 1.0— V-g4 Map Lot V 07c Unit
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Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Nam (Print) Current Mailing Address:
7i D � - 2
Telephone �
Signature
2.2 Authorized Agent:
Name(Print) 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 ( 2 (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
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: )d 1 hVig
Building Commissioner/Inspector of Buildings n Date
V
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....._.,,e--,'
Rear �--
Building Height
Bldg. Square Footage % „f
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW ® YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW Q YES 0
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 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained ® , Date Issued:
C. Do any signs exist on the property? YES Q NO Q
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: 11
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 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
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SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs (0] Decks (Q Siding[0] Other]
Brief Description of Proposedr, 1 ,K, � �,,//
Work: �[ �1C� ;/`(!vat
Alteration of existing bedroom Yes X No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes 14 No
Plans Attached Roll -Sheet
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, 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,
9-4 Ll") as Owner/Authorized
Agent hereby de are that the stat ents and information on the foregoing application are true and accurate,to the best of my"—knowledge
AM belief.
Signed under the pains and penalties of perjury.
Print Name
Signatur of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: , n Not Applicable ❑
Name of License Holder:
�/t�W O9G 32 ,
License Number
Address Expiration ate
Signature Telephone
(fell
9.Registered Home Improvement Contractor: Not Applicable ❑
skk �B rti3�-%vu✓ C� l3 Z
Com anv Name VRegistration Number
Address/ — {� l Expimdon Date
- Lvt [ .n1 '' o 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 41- %
I
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 s jiti
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: C o " A Est. Cost�/Z, idD.
Address of Work: e aJv1 e Ala
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 th gen f the owner: C
ate Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
ate Owner Name and ature
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City of Northampton
Massachusetts
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DEPARTMENT OF BUILDING INSPECTIONS 9
212 Main Street • Municipal Building
Northampton, MA 01060
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
s
� Massachusetts �� e.
> DEPARTMENT OF BUILDING INSPECTIONS �`-
`� 212 Main Street *Municipal Building y,
„ . Northampton, MA 01060
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:
9 2 (—'16 0 64,/' ,P__d- lm ,,
(Please print house number and street name)
Is to be disposed of at:
V,Al!-zvl dt6cy�l
(Please print name and foc6ition of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Na a nd Address)
ignature of Perm' pplicant or w er 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.
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The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Le ibl
Name(Business/Organization/Individual):
Address:
City/State/Zip: EAVje0w 114.(, Dl a 7 Phone #:
Are you an employer?Check the appropriate box:
Type of project(required):
l o I am a employer with_employees(full and/or part-time).* 7. New construction
❑I am a sole proprietor or partnership and have no employees working for mein 8. Remodeling
any capacity.[No workers'comp.insurance required.]
9. El Demolition
3.O I am a homeowner doing all work myself.[No workers'comp.insurance required.]i
10 Q Building addition
4.O I am a homeowner and will be hiring contractors 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
5,711 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ repairs
re airs
These sub-contractors have employees and have workers'comp.insurance.:
r,.❑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 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.
Insurance Company Name: Aa /of "e' d ., C, j
Policy#or Self-ins.Lic.#: (o r9 Z Vfl _38 qd Expiration Date: �! "
Job Site Address: G � ( Gv1 44 " City/State/Zip: ,/k" DLO G b
Attach a copy of the workers'compensation policy declaration page(showing the policy number and ex iration 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 d penalties of perjury that the information provided above is true and correct:
Si nature: Date: �� 7
Phone#: 2? 21
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#:
Stephen Camp Construction
46 East St.
Easthampton, Ma 01027
(413)527-7124
Submitted To: Criag Odgers Phone- 265-0650
Address : 97 Glendale Rd. Date 5-27-2019
Northampton, Ma 01060
A 8'x 18' back porch will be framed and will have 1 door with 6 windows.
The siding will be shakes to match and roof shingles to match.
The ceiling will be flat with finish plywood and the walls will have finish
Plywood also, the windows and door will be trimmed to finish.
Price for job $ 12,500.00
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Contractor Supervisors License number 082531
Home Improvement contractor Registration number 135204
I propose to supply materials and labor-in accordance with above specifications.
This proposal may be withdrawn
By us if not accepted withi 0 Days
Authorized Signature
Acceptance of proposal Signa
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