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29-015 (3) 24 HICKORY DR BP-2020-1285 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-015 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:GARAGE BUILDING PERMIT Permit# BP-2020-1285 Project# JS-2020-002156 Est.Cost: $26500.00 Fee: $173.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ALL-TEK BUILDERS INC 107074 Lot Size(sg.ft.): 19209.96 Owner: DUPUIS ROLAND J Zoning. Applicant: ALL-TEK BUILDERS INC AT. 24 HICKORY DR Applicant Address: Phone: Insurance: 88G INDUSTRY AVE (413) 736-0099 () WC SPRINGFIELDMA01104 ISSUED ON:6/30/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-EXTEND EXISTING GARAGE OUT 7.5 FEET TO MAKE 2 CAR GARAGE POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector o1'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 6/30/2020 0:00:00 $173.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit Iz 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability ?' r- Northampton, MA 01060 Two Sets of Structural Plans rN hone 413-587-1240 Fax 413-587-1272 Plot/Site Pians CD Other Specify ON TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING i SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office q Map "l Lot C2 / Unit 24 Hickory Drive Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Roland J. Dupuis 24 Hickory Drive Name(Print Current Mailing Address: 4134783861 �4 A ", Telephone Signature 2.2 Authorized Aqent: 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 , . - (a)Building Permit Fee c. G 2. Electrical NA (b) Estimated Total Cost of Construction from 6 3. Plumbing NA Building Permit Fee ] �] 4. Mechanical (HVAC) F t 5. Fire Protection NA 6. Total = 0 +2 + 3+4 +5) Check Number This Section For Official Use Only .. 5� Date Building Permit Number: Issued: Signature: CLA, lu Building Commissioner/Inspector of Buildings Date rjdup10tech@comcast.net @ EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) __ ._ . � ,� .,. . ;<< ,,, I. .. , .. y,. " � � { _ . ' �' i _., ' _ .. __ ,r t , � i� � .:� ,4, , .� � ,i � L ^_ _. �; .,, � -f.r .. , : . __ { . .:� �.. � _ ._ SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition Replacement Windows Alteration(s) E✓ Roofing Q✓ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [E:3] Decks [p Siding[CI] Other[CQ Brief Description of Proposed Extend existing garage out 7.5 feet to make it a 2 car garage Work: Alteration of existing bedroom Yes x No Adding new bedroom Yes x No Attached Narrative Renovating unfinished basement Yes x No Plans Attached Roll -Sheet ea. If New house and or addition to existing housing, complete the following: a. Use of building : One Family X Two Family Other b. Number of rooms in each family unit: 6 Number of Bathrooms 2 c. Is there a garage attached? yes 1 d. Proposed Square footage of new construction. 1 5 0 Dimensions 7.5 X 20 e. Number of stories? One f. Method of heating? natural gas - warm air Fireplaces or Woodstoves yes Number of each ] g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction Frame i. Is construction within 100 ft.of wetlands? Yes no 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 V 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. 3C Signature of Owner Date I, li 1 06,1 19 l breL4- � \c �r �,L as Owner/Author 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/A0-61 Date SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: II Not Applicable ❑ Name of License Holder L`J A �- l Ddec�'� C -9 — 10-7 07 License Number �N t.K tNce ✓ � f'2�at, N`(�S /nA Z - `'j — ZOL Address Expiration Date ---41J 1 Z 2-2 Signature Telephone 9_.Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Date t c 1A �6,rctt L Telephone Z 3%u,.ie?V 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 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 15,801 Frontage 100 Setbacks Front 100 Side L: 166.5 R: 128.7 L: R: Rear 125.3 Building Height Bldg. Square Footage 1876 1 1.87 Open Space Footage % (Lot area minus bldg&paved 1392: 88.13 parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ® DONT KNOW ® YES Q 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 Q DONT KNOW Q YES O 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 © NO (F) 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 e 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 Q NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. City of Northampton Massachusetts F��S `.c 'N DEPARTMENT OF BUILDING INSPECTIONS ja 212 Main Street a 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: ISI4 k L r,ra y e LA rq cm Est. Cost: -5'c)C/ Address of Work: Z'4 }-{•c k-0 ry Ar.V-(— Date -(Date of Permit Application: Z 3 T✓r- 2 2 V 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 owner of the above property: Date Owner Name and Signature The Commonwealth of Massachusetts = Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 5 >'` www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aaplicant Information Please Print Le¢ibly Name (Business/Organization/Individual): A j I — —1i L ,\ �r Z C_ Address: g:L 6 -fr.. JL, _t A61 tAJ City/State/Zip: 14 AiS a11 PHone#: 4 I Are you an employer?Check the appropriate box: Type of project(required): I.B)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. E] Remodeling any capacity.[No workers'comp.insurance required.] 3.M I am a homeowner doingall work myself 9. [:]Demolition y [Ivo workers'comp,insurance required.]t 100 Building 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 1Electrical repairs or additions proprietors with no employees. . 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ p 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.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Jr f R r 'J76u ►Ade-�C_t C--o^ RAI- Policy#or Self-ins.Lic.#: O 14'6 w L D 1-S Z610 Expiration Expiration Date: 2 p n"'Z� T Job Site Address: 0 f A, City/State/Zip: N a r 40-"44otl AAss Attach a copy of the workers'compensation polky 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 ins an enalties erjury that the information provided above is true and correct Signature: - Date: L 3 T•� ZUZ-0 Phone#: 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 DEPARTMENT OF BUILDING INSPECTIONS �'• 212 Main Street •Municipal Building �!! Northampton, MA 01060 f f "• ,1a 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 pri t house number"and street name) Is to be disposed of at: /�o r-�'►��r� �-o r� � rAN s i-�r S-�-�b�✓ (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: t (Company ame-and Address) Signature of Permit 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. /2S FIX �1 Q. v- L1Apz" I I STY Q tl , 1 1 -zra'• e'T ` j m r fi ' l 1 - .t I hereby report that the premises shown on this plan is not located within a Flood Hazard Area as shown on Department of H.U.D. Federal Insurance Administration Maps, Community Number 250167-0001A Identificati at Pr By- at TO THE COUNTRYWIDE FUNDING OWNER, ND TI4E 'raw I,TTI.r.. INS. ()I- N.Y._nNI.Y D11PUIS, ROLA"ID .1. i-OCATION2 To the best of my knowledge, infonna- 24 fiICKORY DRIVE, FLORENCE, MA ion and belief, I hereby report that I ave examined the premises and that this ALMER HUNTLEY,JR. Q ASSOCIATES, INC. nspection plat shows the improvement or SURVEYORS -ENGINEERS -PLANNERS mprovements as located on the premises de- 125PLEASANT STREET P. O. BOX 568 cribed, that the improvement or improve- NORTHAMPTON, MASSACHUSETTS 0I060 ents are entirely within lot lines , and hat there are no encroachments upon the remises described by the impr0ve.j,1en�; mprovements of any adjoining premises , - xcept as indicated. I further report that '��� sL here are no easements of record affecting � w'As DATES . ie tract shown hereon�cept as noted, tNOMPSON No 28008 Comrn wiN ealth of Massacth '-,,tis - Division of Professional Urersure Board of Building Regulations and Standards Constrbn Superviscr CS-107074 F-Aptres:OZW,2021 WAYNE C ALBRECHT 93 INDEPENDENCE ROAD FEEDING HILLS MA 01030 A Corr rpissioner Commonwealth of Massachusetts Division of Professional Licensure Hoistl'ng Engineer HE-176751 czpires:02109/2022 WAYNE C ALBRECHT 93 INDEPENDENCE ROAD FEEDING HILLS MA 01030 ,nu,ll Commissioner r