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13-035 (5) 370 NORTH KING ST BP-2020-0671 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 13-035 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Permit# BP-2020-0671 Proiect# JS-2020-001143 Est.Cost: $180000.00 Fee:$1170.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: GOUGEON BUILDERS 075029 Lot Size(sa. ft.): 102366.00 Owner: LAUREN ANGELIQUE&ANDREW M BUSTAMANTE zoning: Applicant. GOUGEON BUILDERS AT: 370 NORTH KING ST Applicant Address: Phone: Insurance: 1261 HAWLEY RD (413) 625-9337 WC ASHFIELDMA01330 ISSUED ON.12/5/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-28x28 HOME OFFICE ADDITION 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 12/5/2019 0:00:00 $1170.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2020-0671 APPLICANT/CONTACT PERSON GOUGEON BUILDERS ADDRESS/PHONE 1261 HAWLEY RD ASHFIELD (413)625-9337 PROPERTY LOCATION 370 NORTH KING ST MAP 13 PARCEL 035 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICA LIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildinp,Permit Filled out Fee Paid T eof Construction: 28x28 HOME OFFICE AD TION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 075029 3 sets of Plans/Plot Plan TH FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN ORMATION 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 Demolition Delay �t& � %"Z I :? q J Sign ure of Building Official I i 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. 1-2eraa-k7X � z�s Department use only City of Northampton Status of Permit: r .�1 Building Department Curb Cut/Driveway Permit I9 A, 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 7 1.1 Property Address: This section to be completed by office 1-1 �� NO K4 54. Map Lot Unit NU� �y �OY� I Zone_ Overlay District Elm St.District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record:- YK -,,,I iq i.r l L V1 Lw U5}�M +r- 3-76 N(A01 4011060 Nam Print Current Mailing Address: LJr g3fS Telephone ature 2.2 Authorized Anent: ll c _4�\ ! 1336 Name(Print) Current Mailing Addre s: `-/1,3 ctq7-1 Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building I S�04) (a)Building Permit Fee 2. Electrical17,000 (b)Estimated Total Cost of Construction from 6 3. Plumbing 00 J Building Permit Fee 4. Mechanical (HVAC) � ) I 5. Fire Protection 6. Total =0 +2 +3+4 +5) 1 el-lo ow Check Number Q This Section For Official Use Only a(J Date Building Permit Number: �CLd 7/ Issued: Signature: Building Commissioner/Inspector of Buildings Date J �r 40 Cticfs , [ o °@ 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: Rear Building Height Bldg. Square Footage % 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 © DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW ® YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW ® YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q , Date Issued: 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 [M Replacement Windows Alteration(s) Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding [O] Other[[J Brief Desc?9on of Propos Work: �S X, d cr �SWI-1, l homc z Alteration of existing bedroom Yes X No Adding new bedroom Yes UQ No Attached Narrative Renovating unfinished basement Yes 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 D _ b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? / d. Proposed Square footage of new construction. �L'I Dimensions 101 e. Number of stories? f. Method of heating? tV1 -A,' 5�1�� 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 r 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 0' Private well City water Supply SECTION 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,Z"1,1 I-Ar A(,L17tiJ�(,r, as Owner of the subject property hereby authorize od✓� to act on my beha all ma work authorized by this building permit application. /0 T" Si ner Date oV,4r L'J as Owner/Authorized Agent hereby Clare that t 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. L��L�i �OuG 4WD Print Nam Signat f wne gent Date SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Su ervisor: Not Applicable ❑ Name of License Holder: --T-G L S — 07S6,;� I f License jNumber A1� ,z Id , ce 330 1 /b l gc),?-0 Addr 1 Exp'ation Date AL 5-19 j17L Si r Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ - -- __ -- - - f (9-7;Z 1�j Company Name ( I Registration Number 60f-�Lh- Z V" I r`�, 1 I 19-e)h( Address d I /J Expi ation Date G r 6 Telephone`'I 1 3 51q L t,c�7_i 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....... 91 No...... ❑ \ The Commonwealth of Massachusetts Department of Industrial Accidents d I Congress Street, Suite 100 Boston, MA 02114-2017 �y www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information // f I Please Print Legibly Name (Business/Organization/Individual): 4, 0 oc� (3w idGf Address: { G! (ate City/State/Zip: k-Cvl Cff!,30 Phone #: 4.115 SIJ 4117 4,/ Are 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.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 10Building addition 4.❑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.E]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.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 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. I 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. /� _ _c Insurance Company Name: /SSD C i aI�--A �Oq)�a-s Lh Sy t ctncz 60., — Policy#or Self-ins.Lic.#: l� G``�DL Expiration Date: 11 Job Site Address: 37a &„ <M City/State/Zip:A/Au., UVJ A– UP Attach a copy of the workers' compensa ' n policy declaration page(showing the policy number End 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 ce fy un er the pains and penalties of perjury that the information provided above is true and correct. Si ature: Date: ft = Phone#: 1`!L1( fC1 ctllq 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 Massachusetts r -. A DEPARDENT OF BUILDING INSPECTIONS 1 212 Main Street •Municipal Building ` 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: 370 No k^s 5 4 . (Please print house nu ber and street name) Is to be disposed of at: VIJ(ty ' 'r_ G tf'� (Please prin na nd location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Sig a of P mit Applicant or Owner 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. 28' - - - - - - - - - - - - - - - - - - - - - - - - E:] El �5 Asphalt shingles. 000000 , OOQQQ. Engineered trusses. R-60 cellulose. DBL 2x4 walls— 9" with w/ R-34 cellulose 1/2 sheathinc 00 00 & vinyl siding. o l 1/2" drywall on walls and ceilings. N Insulated 2x4 wall separatin DBL 9.5 LVL carrying beam garage w/ 5/8 drywall. 4' frost wall in front(north & east) w/8' retaining wall at back (south). LSL joists w/ rim lagged to 27'-11 15/16" concrete. 1/411 = 1' Rat slab over 2" foam { 1 1 _/1 I v ' I� { 1 L N ch u iV �8 li r J-1 i'_ ri A-21-1111 LR - - - - - - - - - - - - - - - - - - - - - - - - - - - - ILLEIr fi 81 51-1111 III �� n �,�,� e %ire B � II I ��i �- - - - - - - - - - - - } IHill I Iui IIIIIIIII t11 �,4 4 North King Street I0 i i i (S-0 ISO !" 4- (50 3 .70�f ���, 8" concrete wall 2x3 stud wall Foileface ridged insulation 5/8 drywall Ll L111 I L---j Li Li L Fire separation Cross section of south retaining wall Y/— IT 11 - .S 70 Aj, any 5 �- 0O i 8" concrete wall. Vertical reinforcement #6 at 40" per. R404.1 .1 Brush on waterproofing. Gravel back fill. GW, GP, SW,SP. Per. R405.1 r r 0