38B-054 17 HEBERT AVE BP-2022-0105
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:38B-054 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: demolition BUILDING PERMIT
Permit# BP-2022-0105
Project# JS-2022-000186
Est.Cost: $10000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DANIELLE MCKAHN 114308
Lot Size(sq. ft.): 12893.76 Owner: PIONEER DEVELOPMENT
Zoning: URB(100)/ Applicant: DANIELLE MCKAHN
AT: 17 HEBERT AVE
Applicant Address: Phone: Insurance:
32 PERKINS AVE (413) 320-7208
NORTHAMPTONMA01060 ISSUED ON:7/27/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:I NTERIOR DEMO
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 Signatur; • if
.
FeeType: Date Paid: Amount:
Building 7/27/2021 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
RE CETV
COT
The Commonwealth of Massac sett, `�U 2 7 �421fR
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Board of Building Regulations and tan.:rds
fIPALITY
Massachusetts State Building Cod- 7810 e• ' 3 SE
NORT OUILOINr
Building Permit Application To Construct,Repair,Renov. ±' I eril1Q? b r1u Mar 2011
One-or Two-Family Dwelling
0
This ection For Official Use Only
Buildin Permit Number: _��` �v Date Applied:
,KEUi►,�1 Koill? Z Z
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
17 Hebert Avenue 38B 054
1.1a Is this an accepted street?yes no X Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
URB 13,068 56
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public MI Private El _Zone: Outside Flood Zone? Municipal❑ On site disposal system El
Check if yes®
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Pioneer Development LLC Northampton,MA 01060
Name(Print) City,State,ZIP
32 Perkins Avenue (413)329-7208 danimckahn@gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building W Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition Ca Accessory.Bldg. 0 Number of Units 1 Other 0 Specify:
Brief Description of Proposed Work2: Interior demolition in preparation for renovations
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 10,000 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
•
3.Plumbing $ 2. Othei Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:,
Check No./Oleo Check Amount Cash Amount:
6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
Massachusetts _ .-
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
F's
1►'^"� Northampton, MA 01060
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW
1 & 2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES,
FENCES, GROUND MOUNTED SOLAR, ETC.
I. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specifications of proposed work. (Digital and hard copy)
3. Site plan with location of proposed structure(s) and set backs.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (new/ replacement windows).
8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable).
9. Note any Conservation and/or special permit requirements (if applicable). 10.
Driveway Permit (if applicable).
11. Proof of Water and Sewer entry fees paid (if applicable).
12. Trench Permit - public land by DPW/ private land by Building Dept.
13. Stretch Energy Code - all new construction will require a HERS Rater Affidavit to be submitted with permit
application before issuance of permit.
14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS-114308 6/1/2023
Danielle J McKahn License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
32 Perkins Avenue
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
Northampton,MA 01060 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
(413)320-7208 danimckahna,gmail.com I Insulation
Telephone Tiiiiiratidress., D Demolition
5.2 istered Home Improvement Contractor(H t�AP,
-7 -2 .13
P�[f rr 'Gi, (L.�.a v— (.f Uh HIC Registrationa Number Expiration Date
(HIC�Cpgr Narpe or HIC Ijggjcapt Nag",�
No.and Strtreeet /` i /'/ir/J� ‘eid/ii di* a Email address
ity/Town,State,ZIP ) phone
t•-.....___ECTION 6:WORK,ERS=E-6MFENSATION 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 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S 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.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
cot tainp l in diis.application is true and accurate to the best of my knowledge and understanding.
i • / i 1 .
4.
Danielle McKahn, Managing Partner, Pioneer Development LLC 7/26/2021
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed_ Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
The Commonwealth of Massachusetts
Department of Industrial Accidents
44.0,1 1 Congress Street.Suite 101)
Boston, MA 02114-2017
www.inasgoWdia
Workers Compensation Insurance.kffidas it:Bniklers'ContractorsfElectrienins/Plum hers-
It)1*.FILL')% liii Fill PERAll I ING ACT1101t1ri.
.knolicant Inforniatioti Please Print Ltibl
Name isusincc4,Or:amyl:at-ion Individual Pioneer Development LLC
Address' 32 Perkins Avenue
Uit Stale Zip: Northampton, MA 01060 Phone (413) 320-7208
Are'no an ruathr,< < hi ilp it ln . 1:4 IV of project(requiredt:
la man a employer with employees(full maim pitri.nmer..1' D Ne`o. ..7-Litistruction
2,0 am a hale ponprietor pittriershrp and have no employ witting for me in .8.. Reincaleling
any L-apacity.[NM workers'camp.insunmor Prquarixt]
. Demolitiori
AM a hiarimrwrinathring ith went myself.Piro VeMirM..i.alor,tmtalraTh:c rhiptred„)
Ei Building addition
4.0 I am a hormiewrim and will he hiring rannrarnorki tindurn all wink on an proven). I will
cabin*:rfriar ail owarrectura-either hakewir ,.:.4grrelyAlMingt manran We Mile I I CI Electrical rtqiairs or additions
proprietors with no employees
2_[J Plumbing repairs or additions
am a grthentir:cintractor and I havt hard Elm:siab-culartnewri,halal on the mucked.theet
3111trrepairS
Thew:r,tati-ciatithicion itwor ernpinyec,and Iia workers etarrip.innitranr:ebr are sole proprieter -
14_1nerthet
6.:3 We are a corprwation and itt officers hat Cekineitred then right of exert:whoa pea Mal c.
152, arid we hate no iantilitttres.iNit rniters'comp.insurance required.]
'Any applicant that dux:Ls twat al mew al ithowing their workers'compernamon pole informatwitt
f Hisearrowneis who sirtsinn digs affidarn indtrilid4!•in ,t daragall weal and then lair miriade L'Irinthernes mug sabrain a tuviafiIw.it Ifxrdiestaw sutch..
:Cortirsierors drat check this box must attached an additional sheet sh ':'iu iltirs and state lainther stOt Thom:.Lnfutic,ha.
employees If die sialt-coritractiesh10.,c caretio.:eek.diet num:pito, °
I am an employer that is providing workers'compensation insurance fin.ray emplInves. Below is the policy and fob site
infOrmation.
Insurance Company Name:
Policy#or Self-ins.Lie.#: Expiration Date:
Job Site Address: CitvSlate Zip:
Attach a copy of the'0 torkers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure co rage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
andior one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage urt lie at Fort.
I do herein cent) ii.nefur tIrc palm.,and penalties of perjury that the Information provided above is true and correct
Signature:,muu4.,',4/ Data::
7/26/2021
Phone (413)320-7208
Official use only. Do not write in this area.to be completed by city or town official
City or-rov$n: Pertnitilieethe#
Issuing Authority (circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Mumbling Inspector
' 6.Other
Contact Person: Phone#:
City of Northampton
Massachusetts � '
' DEPARTMENT OF BUILDING INSPECTIONS
4,
p`k 212 Main Street • Municipal Building ��
',14—^�"� Northampton, MA 01060 s;%Pi tir
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: Valley Recycling, 234 Easthampton Rd, Northampton, MA
The debris will be transported by:
Name of Hauler: Allen's Roll Off, 26 Log Plain Rd, Greenfield, MA
�Signature of Applicant: ,,.i, A , . _ Date: 7/26/2021
Pioneer Development LLC—17 Hebert Ave. Subcontractors(Demolition& Renovations)
Patrick Reardon, Home Improvement Contractor(H.I.C.), 399 Plain Rd, South Deerfield, MA 01373, sole
proprietor/no employees.
Chris Morin,Carpenter/Handyman, 26 Captain Lathrop Drive South Deerfield, MA 01373, sole
proprietor/no employees.
Roca, Inc., 29 School Street, Springfield, MA 01105.This company has employees and carries worker's
comp insurance.
Christopher Salva,CTS Plumbing& Heating Co.,200 Old Belchertown Road, Ware, MA 01082,sole
proprietor/no employees
Fernando Blanco, Blanco Electric LLC, 190 Sewall St, Ludlow, MA 01056.This company has employees
and carries worker's comp insurance. Policy#: (21)7178-46-90
Other Subcontractors TBD.All will be either sole proprietors/no employees or will carry worker's comp
insurance.