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BP 370 N King addition
File # BP-2020-0671 APPLICANT/CONTACT PERSON GOUGEON BUILDERS ADDRESS/PHONE 1261 HAWLEY RD ASHFIELD (4 13) 625-9337 PROPERTY LOCATION 370 NORTH KING ST MAP 13 PARCEL 035 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: ZONING FORM FILLED OUT Fee Paid Buildino Permit Filled out Fee Paid T eofConstruction: 28x28 HOME OFFICE AD 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 LI ST REQUIRED DATE THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN FORMATION 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 Signature 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 of . Planning & Development for more information. City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 Department use only Status of Permit: Curb Cut/Driveway Permit-------- Sewer/Septic Availability ________ _ . Water/Well Availability _________ _ 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 This section to be completed by office ) 1-.. 2-~ Map -----1~-+--Lot __ ~2~..J ____ Unit ___ _ Zone _______ Overlay District _____ _ 1-------------------------E~lm St. District ________ CB District ____ _ SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: A- 2.2 Authorized Agent: ~jhc,; ~ auj eoo Name (Print) ( Signature SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item 1. Building 2. Electrical 3. Plumbing / ooi) 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) J ~ Obi) Telephone Telephone Official Use Only (a) Building Permit Fee (b) Estimated Total Cost of Construction from 6 Building Permit Fee Check Number This Section For Official Use Onl Date O f3.3 <:r Building Permit Number: e,9-d Q -U 7/ Issued: __________________ _ Signature: ------------------- Building Commissioner/Inspector of Buildings Date 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 11 11 I Frontage I 11 11 I Setbacks Front CJ CJ CJ Side L:CJ R:CJ L:l . I RI I CJ CJ ---- Rear CJ CJ CJ Building Height CJ CJ CJ Bldg. Square Footage CJ CJ % CJ ==:J CJ Open Space Footage CJ r--I % [ -I C 1 CJ (Lot area minus bldg & paved oarking) # of Parking Spaces CJ CJ CJ Fill: C 1 (volume & Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW © YES 0 IF YES, date issued:!.__ ____ __, IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW CB YES O IF YES: enter Book I I Page~[----';;;_..]__, and/or Document #L.__ B. Does the site contain a brook, body of water or wetlands? NO @ DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: I...._ ____ ___. ' C. Do any signs exist on the property? YES Q NO ® IF YES, describe size, type and location: l~~~--:==~.------------------ D. Are there any proposed changes to or additions of signs intended for the property? YES Q IF YES, describe size, type and location: I NO ® 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 @ · . IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK (check all applicable) Replacement Windows Alteration(s) D Or Doors D Roofing D New House D Addition Accessory Bldg. D Demolition New Signs [DJ Decks [0 Siding [DJ Ottier [DJ Brief Descr~yon of P,ropos££. Work: ./9-: yn O 'CC _}Jd;~ (vi oM, a-fuc.z;,) Alteration of existing bedroom ___ Yes ____Q£__ No Adding new bedroom Yes Qt No Attached Narrative Renovating unfinished basement ___ Yes ()(_ No Plans Attached Roll -Sheet &a. 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. ___ t--'-J_t.,_( ____ Dimensions 'J.J/x 2''iL1 e. Number of stories? I -------------- f. Method of heating? fVl 1'v\1 5\2\1} Fireplaces or Woodstoves _____ Number of eacli __ _ g. Energy Conservation Compliance. _________ Masscheck Energy Compliance form attached? ______ _ h. Type of construction ______ _ i. Is construction within 100 ft. of wetlands? ___ Yes L___ No. Is construction within 100 yr. floodplain ___ Yes __ No " j. Depth of basement or cellar floor below finished grade __ '--_/ _________ _ rA. Yes No. k. Will building conform to the Building and Zoning regulations? -------- I. Septic Tank__ City Sewer r:/.... Private well __ _ City water Supply Q( SECTION 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS -AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT work authorized by this building permit application. /_./; zr Date Signed under the pains and penalties of perjury. C,ouJ e-t/11'\. Date , as Owner of the subject SECTION 8 • CONSTRUCTION SERVICES Not Applicable D (_ ':) -o7SrJ;) j License Number 1 It I 2-Q?--O Exp~ationfoate Telephone Not Applicable D Company Name Gour'°" B cdk:>, Address t-==l 1 / '3 ;t4 19,;), ¥-/ Registration Number 11bolff-( Expifationbate ..:...cR--b---=._(----=-+:==i=..:,....-----==-~~f--L"'-'-=-....L......f+-=-'-'-""''--=0-Telephone t-./13 s,q C(f,1 lf SECTION 10· WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) I 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 ....... 69 No ...... D The Commonwealth of Massachusetts Department of Industrial Accidents 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. Applicant Information Please Print Legibly Name (Business/Organization/lndividual):_~c;~o~~'--1---~-~-(5~"~'-J~J~· c~r= ___ ... ~----------------- City/State/Zip: Are you an employer? Check the appropriate box: I.~ I am a employer with ?, employees (full and/or part-time).* 2.D I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.o I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4.o 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 proprietors with no employees. 5 -0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers' comp. insurance.t 6.o We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. D New construction 8. D Remodeling 9. D Demolition 10 ~uilding addition 11. D Electrical repairs or additions 12. D Plumbing repairs or additions 13.0Roofrepairs 14.00ther _______ _ • 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. tcontractors 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. /' Insurance Company Name:~~-Q~()~C ~i '\..__t_~..cc..J_C_rt--+-f?-' ~-,..,. ..... C:=:S=---.-. .... L __ n.'-"-=S..,._v.c...c< ft.c.n .... C,{....__,,,L,~O-~ ________ _ Policy # or Self-ins. Lie. #:_l.\)~C,~l_-_.S-._'6<_D_-_~_o_\_t,.--'('-0_'-..._f -'-:;l.._o_c=s-;-'-;4._._ __ Expiration Date:---'/'-'-f--~~'--'S-:,,__, ..._a--4 __ _ Job Site Address: . · City/State/Zip: Ak<1"~ mA-6ffl.6 Attach a copy of the workers' compensa · n policy declaration page (showing the policy numbe; ~expiration date). Failure to secure coverage as required under MGL c. I 52, §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 ofa STOP WORK ORDER and a fine ofup to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office oflnvestigations of the DIA for insurance coverage verification. I do hereby ce ify u~er the pains and penalties of perjury that the information provided above is true and correct. Si ature: . A Date: -~ C, 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 ff own Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other ___________ _ Contact Person: ___________________ Phone#: ______________ _ City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 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 nuber and street name) Is to be disposed of at: Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 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. r I I I I I I I I I I I I I 1-._ _ _..'----- I I I~ I I~ I I I I 15 I I ~I I I I I I I I I I I I I I I I I I I I I I I I I ...... ~ I (X) 13'-1 7/16" 12'-11" 5: 12 5 : 12 3068 7 7 ' ,,1 ,. " "/ \" \• l • ' 1 ," 1 \' ") ... 7 ' -., (' < ,,_,..., .,., ., • .. ..., ., ., ·1 J ' '.1 • 7 ., 1 ., 1 • 1 .. -., '/ ., ,, ·/ ., ' ,. ' 1 ' ·t i \> •J_ J ., : ' 1 ' -' ., ' I I I I I I 9'-3" I: - I 1 '-2'l 8' -I . I 11 I I i Ii~ I 1~m I • ~ 11:1 ·1 11 I I I 11 (.,.) I I I 4" " c":: I [' :· ' ~ ~~====~~~~~~ ...___: I N I 11 [ I I 11 I I I I\ I I I I I 1 I I 11 I I I I I 1 I L ' I ~~gJ_LT_L _L --=:-._1-T -~ -_ _':=:Jlii=------il=r=:-=r... ,-------~, IJ_ 11---~~~-1101or---~-=-=-= I_ :c :c :c :c -l 1 ~ C -l IT -~-++---Asphalt shingles. r _L -\ co Engineered trusses. R-60 cellulose. DBL 2x4 walls-9" with w/ R-34 cellulose 1 /2 sheath in & vinyl siding. 1 /2" drywall on walls and ceilings. Insulated 2x4 wall separati 11'-U' -== garage w/ 5/8 drywall. DBL 9.5 LVL carrying beam ::,,llJJl ~ C ---• r· !' ------------27'-11 15/16" -----------~ 1/4"=1' 4' frost wall in front(north & east) w/8' retaining wall at back (south). LSL joists w/ rim lagged to concrete. Rat slab over 2" foam --4' 10" 111 I I [ I I I I I I 1 1 D I D I I I I I 1, I 1 11 I : I I I I I : I I -~ ' I;