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23A-004 (12)
BP-2023-0152 25 MEADOW ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23A-004-001 CITY OF NORTHAMPTON Permit: Demo PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0152 PERMISSION IS HEREBY GRANTED TO: 2023 REPLACE GARAGE WITH Project# ADU Contractor: License: DOUGLAS B THAYER DBA DOUGLAS THAYER Est. Cost: WOODWORKING 107699 Const.Class: Exp.Date: 04/07/2024 Use Group: Owner: JULIE STARR DAVID & Lot Size (sq.ft.) DOUGLAS B THAYER DBA DOUGLAS THAYER Zoning: URB Applicant: WOODWORKING Applicant Address Phone: Insurance: P O BOX 60322 (413)530-4785 6HUBGR15002 FLORENCE, MA 01062 ISSUED ON: 03/09/2023 TO PERFORM THE FOLLOWING WORK: DEMO GARAGE 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: , jui\ Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner Z-al< File #BP-2023-0152 APPLICANT/CONTACT PERSON:DOUGLAS B THAYER DBA DOUGLAS THAYER WOODWORKING P O BOX 60322 FLORENCE, MA 01062(413)530-4785 PROPERTY LOCATION 25 MEADOW ST MAP:LOT 23A-004-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $65.00 Type of Construction: DEMO GARAGE New Construction Non Structural Renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION_,PRESENTED: I 0 r L Approved Additional permits required(see below) 'W Y 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 S A ?4 L • ZONING BOARD PERMIT REQUIRED UNDER: § 3h a 3 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 a V a3 Sign ture of Building Official 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 f Planning&Development for more information. 1 v The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR rn-1-1Massachusetts State Building Code, 780 CMR MUNICIPALITY cc USE 1 Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 co I One-or Two-Family Dwelling '. This Section For Official Use Only Building armit Number: ge-2023--015 , Date Applied: i• ► ,' 3/ 3 Building Official(Print Name) I Signature I i Due SECTION 1: SITE INFORMATION 1.1 Property ddress: 1.2 Assessors Map&Parcel Numbers as rieadns- S)- 2't A co'', co k 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 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 Private 0 Zone: _ Outside Flood Zone?Check if yes❑ Municipal"On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: ,y ZstAkie S+a*r .2 5 /tealrh, sci- Name(Print) City,State,ZIP r 1 dve,rcA i1A ©to6a No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition Accessory Bldg. 0 Number of Units Other ❑ Specify:_ Brief Description of Proposed Work2: DowIt0111.2c 0V -Gtva4P SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 000- 1. Building Permit Fee: $ Indicate how fee is determined: u ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ "')p Op. List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ Mom," Check No. iaae Check Amount:61,% Cash Amount: 6.Total Project Cost: S V'( O 11 Paid in Full ❑Outstanding Balance Due: ASBESTOS REMOVAL All residential, commercial and institutional buildings are subject to Massachusetts Department of Environmental Protection (MassDEP) asbestos regulations at 310 CMR 7.15. Therefore, owners and/or operators (e.g. building owners, renovation and demolition contractors, plumbing and heating contractors, flooring contractors, etc.) need to determine al asbestos containing materials (AGMs), both friable and non-friable, that are present at the site, and whether or not those materials will be impacted by the proposed work, prior to conducting any renovation or demolition activity. Examples of commonly found ACMs include, but are not limited to, heating system insulation, floor tile and vinyl sheet flooring, mastics, wallboard, joint compound, decorative plasters, window glazing, asbestos containing siding and roofing materials and fireproofing materials. Failure to identify and remove all ACMs prior to its being impacted by renovation or demolition activities, can result in significant penalty exposure, and higher clean-up, decontamination, disposal and monitoring costs. A DOS certified asbestos consultant must be contracted to determine if asbestos is present and whether removal/repair is necessary. If the building is a state owned facility, contact DCAM and DOS. DOS provides a list of licensed asbestos abatement contractors and consultants. You may wish to inquire if a contractor has any history of violations. Only DoS licensed and DOS certified asbestos abatement contractors and consultants may be hired to perform asbestos related work in Massachusetts. Received by: Print Name Title Signature Date SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C S ` Q 7�g (' 1✓o u Q s �Il a\p License Number b [ Expiratio D e T Name of CSL Hol r List CSL Type(see below) 60), Go y�a No.and Street Type Description (.04l f) U Unrestricted(Buildings up to 35,000 cu. ft.) City/Town,State,ZIP / R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 SS (U Registered Home Improvement Contractor(HIC) O �t `rkS 1�a HIC R``-7n eggistration Number E piration ate HIC Compaq Name or HIC R4gistrant Name 1✓Ct'IF5 fi/aV Q Cjl'�la.,, ('G1n No.and Street Email ddress ) Y7fs5 City/Town,State,ZIP Telephone SECTION 6: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 0 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 Vtt 1t S 7)'1 Q �►i to act on my behalf,in all matt elative to work authorized by thi?building permit aplication. Prin er s Name(Electronic Signature Date SECTION 7b:OWNER' OR AUT• I RIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate : the best of my knowledge and understanding. 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 Improv ent Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under .G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Informatio on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is p, ed,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 bathroo Number of half/baths Type of heating sy em Number of decks/porches Type of cooling stem Enclosed Open _ 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton Massachusetts . * • DEPARTMENT OF BUILDING INSPECTIONS yi i✓. 212 Main Street • Municipal Building � 4 Northampton, MA 01060 Est+,y,< )i‘�' 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: V a 1 kr-A._ Qc \J s � The debris will be transported by: Name of Hauler: \ I a 19-6 Signature of Applicant: Date: .---,A5/0): The Contmonwealth of Ilassachusetts (e....'llill&IIIIII; , ) IMMO V 4 1111=( Department of Industrial Accidents 41.=.:.,......1.=111, .....allit 1.= 1 Congress Street,Suitt 100 --i l' —... Boston,MA 02114-2017 -. •z .,... www.mass.govldia Wr.irkers'Com pe US alma Insurance Affidavit: Builders/Contractors/ElectriciansiPlumbris. TO RE FILED WITII IIIE PERMITTING AUTHORIT11". Applicant Information Please l'rint 1.riiihls Name 4Busines.s,Organization,Individual 0: 5.Af1 Address: ft-_-)4kh)etS 1111* f 1/4/ 11 City/State/Zip: Phone 4: , , . are roe as eariplavell Check the apprupnate boa: Type or project(required): I.: I am a employer with emptoyees Unit milker pad-time).* 7. (J New construction ._.0 I am a sok proprietor or partnership and have no employees%.()dung for 1'60 in 8. E3 Remodeling any capacity iNo*otters'eurrip.insurance required,j 9. Q, D ehtion ..;.0 I am a horneowne7 doing all work myself.[No worksys"camp imuranoe remianai I' 1 I El BLit ding addition 4.0 I ant a homeowner and will be hiring txyroractori to..-.oriduct all work un rny property. I will ensure that all COistraetarl either have workers"Ccenpen.431}4.1n maurance or are sole ii 43 Electrical repairs or additions propnetors with nu employees 12.0 Plumbing repairs or additions DI Jen a yenta-al contractor and I have hired 64:sub-contractors listed on the anaitheil sheet. These sub-cuntmetors haw employees and base worieri comp.insurance.: B.0 Roof repairs 4.0 14.El()Mei.We ant a ootporaturn and its officers have extmeiseil then right of exestption per MIGL c. 132,11{4 and we have no employees.[No workers comp.insurance.requiresil *Any applicant that axe Li bin;1 mum Asti fill Out the section below showing then workers'einipaibatiun putts.)titietmaitimi f I lonwowners who submit this affidavit indicating the).art doing all work and then hire outside C47,111TA,Auft8 niu:4 stibnut a new at:idav it indhating'wk. :Contractors that check this box most attached an ailibtiorud sheet thow nig the mum C of the sub-c inaraetors and state whaler or riot thuwe zibli..n liar onployek:". If the suh-eontractors haw employees they must priv..ide their workers'i.mnp.pulley number I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Nan : ‘161(11x. 41(-Q 5 Same _ Policy#or Self-ins.Lk.4: Expiration Date: Job Site Address: City,'StateZip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under NIGL 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 S251 0.00 a day against the violator.A copy of this statement may be for. .irded to the Office of Investigations of the DLA for insurance coverage verification. I do hereby certify under the pains an .n allies of perjury that the Information provided i en' is true and ce•rrect. **\ Sienature: Dai... Phone 4: I I Official use only. Do not write in this area,to be completed by city or town official City or Town: PermiliLicense 4 , Issuing Authority (circle Line 1: I.Board of liealth 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector [ 6.Other ('Mil Act Person: Phone 4: �zl�l2z BUILDING DEPARTMENT DEMOLITION PERMIT SIGN-OFF SHEET Date: /4U �^ Address: a �,� rD0 S/ Building Use: Owner: /1i 1- i.,5 IZ_ Phone: Owner's Address: 85 ME,t,'Ifit/ Er-Ff Q/,enCe._. NO U 1/, LieS in UTILITY CUT OFF f 'hiscuas _ (Signature of Authorized Representative of Utility Department require As required by the Massachusetts State Building Code (780 CMR), a permit to demolish shall not be issued until a release from the utilities is obtained, stating that their respective service connections and appurtenant equipment have been removed or sealed and plugged in a safe manner. Eversource (Gas) Signature Title National Grid (Electric) Signature Title `e2121112 DPW (Water) K2e. .:1` . ►ics f k J 1 V w _DfiA Signature Title ^, `.Zy DPW (Sewer) 6i/k)U1(41614/ CC'_ (e�N J Signature Titl � 2 DPW (Storm water) Signature Ti DPW (Tree Warden) MCA.,. CI. t� 1� G �ALt WQl - S' ure Title DPW Director ig re Title Historic Comm. Review Signature Title 'tea...-- . _ „ _ - / .—