38B-305 50 FAIRVIEW AVE BP-2020-0793
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:38B-305 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ADD BATH BUILDING PERMIT.
Permit# BP-2020-0793
Proiect# JS-2020-001373
Est.Cost:$13000.00
Fee: $85.00 PERMISSION IS HEREBY GRANTED TO.-
Const.
O.Const.Class: Contractor: License:
Use Group: JAMES O'SULLIVAN 66335
Lot Size(sa.It.): 11325.60 Owner: GILFORD PETER&ELISSA ALFORD
zoninaURB(100)/ Applicant. JAMES O'SULLIVAN
AT. 50 FAIRVIEW AVE
Applicant Address: Phone: /i�su�anee:
264 BUCK POND RD (413) 532-1312
WESTFIELDMA01085 ISSUED ON.111312020 0:00:00
TO PERFORM THE FOLLOWING WORK.ADDING NEW LAUNDRY AND BATHROOM TO
2ND FLOOR
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Bidldkig 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 Sip-nature:
FeeType: Date Paid: Amount:
Building 1/13/20200:00:00 $85.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
I
Department use only
City of Northamp on - - f Per;*
er ,it:
Building Depart ent Curb C UDn way Permit
i" 212 Main Stre t JAN 10 2 9wer/ epti Availability
- r Room 100 Water ell vailability
Northampton, MA 01r of r u,� in�r,inns S is of tructural Plans
phone 413-587-1240 Fa �►4�fiF ill,), AAA PI s
^- er
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
O Map Lge Lot ,3c)-�� Unit
G !T V Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: //
Name(Print) Current Mailing Address:
L6S/g ,�g �G� Telephone ��
-// "��
13 �
Signature �f!�5 ((
2.2 Authorized Agent: G10
-� Pv./X�A�c, �tJk VAN tj Wks'ELi�� MA
Name( int) Current Mailing Address:
!it3 - 53z-(31 7-56 --7qzy,
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building /1 n (a) Building Permit Fee
2. Electrical (b)o�� (b) Estimated Total Cost of
Construction from 6
3. Plumbing 4 06fl Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total= (1 +2+3+4+ 5) Check Number p�
/This Section For Official Use Only
Building Permit Number: �Y �f 7`� Date
Issued:
Signature: (!
Building Commissioner/Inspector of Buildings Date
1�7IsoM_cyakisTe-uLTV)tj @ (!(jMCt4s; NE l
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 %
(ILot 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 DON'T KNO YES
IF YES, date issued:
IF YES: Was the permit recorded_at the Registry of Deeds?
NO < DON'T KNOW 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 YES
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 N0�
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES rN0�
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,gradinci,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 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable��❑
Name of License Holder: 5 v' ` `� �i 1 N 0
License Number
+/
��`� J UN f-0 �� �� r i�u vin/1, -zi -z/
Addr ss Expiration Date
Lf -S3z -131Z ZSo =7 z
Signature Telephone
m��►SvN�C�'�NS�uc rid► L. C�mc�;
i9.Registered Home Improvement Contractor: Not Applicable ❑
16A) I S d
Compan Name Registration Number
Address Expiration Date
Telephone f3 .-.53e- "/3/Z
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...... ❑
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition Replacement Windows Alteration(s)J Roofing
Or Doors 164e' 1* ! 1, ;�
Accessory Bldg. Demolition New Signs [ ] Decks [ ] Siding[ ] Other[ ]
Brief Description of Proposed 7, 5c N K,
Work: '4I II (,j` N&W L..AI)tiNi✓ ':t ,41 J) kfm_ I6' `GNB
Alteration of existing bedroom Yes _No Adding new bedroom Yes �4 No
Attached Narrative Renovating unfinished basement Yes _ !�,4_ 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
lV w �� SA a as Owner of the subject
property
hereby uthonze �� i_ ' `I +k IU
to act o my behalf, in a matters relative to work authorized by this building permit application.
Signature of Owner Date
r�Wei •�� CJu I\v ti
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.
Signe under the pains and penalties of perjury.
Print e
—_S' C)
Signature of Owner/Agent Date
The Commonwealth of Massachusetts
Department of IndustrialAceidents
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.
Aimlicant Information Please Print Le ibl
Name (Business/Organization/Individual): \ u 1 N
Address:
City/State/Zip: C(" `•tIt d ld Phone #: 413 _.SJ' Z--/31 Z__
Am you an employer?Check the appropriate box:
Type of project(required):
I.0 I am a employer with employees(full and/or part-time).* 7. 0 New construction
AQ-1 am a sole proprietor or partnership and have no employees working for me in 8.�Remodeling
y capacity.[No workers'comp.insurance required.]
9. Demolition
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.
10 Building addition 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 11.0 Electrical repairs or additions
proprietors with no employees.
12. Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repair's
These sub-contractors have employees and have workers'comp,insurance.:
6.0 we are a corporation and its officers have exercised their right of exemption per MGL a 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.
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.
/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 c fy under the pains and penalties of perjury that the in formation provided above is trite and correct.
Signature: Date:
Phone#: Y1
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
J ; c.
q DEPARTMENT OF BUILDING INSPECTIONS R
` 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:
(Please print house number and street name)
Is to be disposed of at:
(P ease print naa and loc ion of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signature of Permit Applicant or Own6r 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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