BP-2011-0569-24C-092 (2)BP-2011-0569
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Category: ADDITION
Permit # BP-2011-0569
Project # JS-20 11-000647
Est. Cost: $262000.00
Fee: $420.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: KENT HICKS 66104
Lot Size(sg. ft.): 15855.84 Owner: WICK DAVID B & MICHELE T
Zoning: URB(100)1 Applicant: KENT HICKS
AT: 59 MASSASOIT ST
Applicant Address: Phone: Insurance:
POBOX 57 (413) 329-4788 0 we
WEST CHESTERFIELDMA01084 ISSUED ON:11612011 0:00:00
TO PERFORM THE FOLLOWING WORK:REBUILD 2 STORY ADDITION
(KITCH,BEDRM,BATH & UNFINISHED 2ND FLR)
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 Si~nature:
FeeTme: Date Paid: Amount:
Building 116/2011 0:00:00 $420.00
212 Main Street, Phone (413) 587-1240, Fax: (413) 587-1272
Louis Hasbrouck -Building Commissioner
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ZdN{tJ~ oK PLAtJ Rt \J l£w File # BP-20ll-0569'
APPLICANT/CONTACT PERSON KENT HICKS
ADDRESSIPHONE POBOX 57 WEST CHESTERFIELD (413) 329-4788 0
PROPERTY LOCATION 59 MASSASOIT ST
MAP 24C PARCEL 092 001 ZONE URB(lOO)f
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
TypeofConstruction: REBUILD 2 STORY ADDITION (KITCH,BEDRM,BATH & UNFINISHED 2ND FLR)
New Construction
Non Structural interior renovations
Addition to Existing
Accesso.ry Structure
Buildimz Plans Included:
Owner/ Statement or License 66104
3 sets ofPlans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON TIDS APPLICATION BASED ON
INF0!J.M7O'ION PRESENTED:
pproved __ 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: "_________
Findingc.._____ Special Variance*
___--'Received & Recorded at Registry of Deeds Proof Enc1osed,_____
___Other Permits Required:
___Curb Cut from DPW ____Water Availability ___Sewer Availability
___Septic Approval Board of Health ____Well Water Potability Board ofHealth
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission ____Permit DPW Storm Water Management
/-5-//
Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with aU 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 ofMGL 40A. Contact Office of
Planning & Development for more information.
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
phone 413-587-1240 Fax 413-587-1272
Department use only
Status of Permit:
Curb CutJOtiveway Permit ________
Sewer/Septie Availability _________
WaterNoJeH Availability_________
Two Sets of Structural Plans ________
PloVSite Plans,_____
Other Specify,
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION I
1.1 Pme!!:W Adgreg: This section to be completed by office
Map Lot Unit
S ~ /'1~~ 1> i..t;5~,' f Zone Overiay District
J(J,II&", 1 AA Elm st. District CBDlstrict ,
ISECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
/t1;..:ic / c iJ, /./ .s-; /-1,.;; ..:rS<G~" 'J it. j()1;~1 , fo'; 11
I
Name (Prim) ~ Currem Mai~Address:
111l ~/ <?,..;; '/ s $!. . .s.-' ')£j .,
LI/~-"'?_ Telephone
Signature
2.2 Authorized i.ent: ·r t) -lip ll\ .5 ") W. d~, /&/ (:. r~ ~"l 4
.sPI-~~iJ{.-~~Md4 #, I II /~/~, L~
Name (Print) »L Current MaIling Address: 610b a
:/ JA iA .0)..1' I J. ... J_.., ~~ #3 -e=8f s¥rc) 1J,~-2,9& -0/.1:3• • (./7"\,
Signature "". tI ;
Telephone
SECTION 3 -I;STIMATED CQNSTRUCTIQN COSTS I
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building 2/6, '300~-(a) Building Permit Fee
.
2. Electrical (b) Estimated Total Cost of ID).,..t?P -Construction from (6)
3. Plumbing
J) /i)t) Building Pennit Fee
4. Mechanical (HVAC)
5. Fire Protection 301 'lOP-/.' /'"
6. Total =(1 + 2 + 3 + 4 + 5) :l 6':;J.. tJi/t) Check Number 111 'I/,} d'f-olO -
r This Section For Official Use Only /'\ .. .10 /) A .JI\ PA. A ....
Date I YU v-v I VV" v "\,J
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING AU Infonnatioo Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be fined in by
Building Department
Lot Size
Frontage
Setbacks Front
Side
Rear
L. L. R:--
Building Height ;,,' :<~ ,
Bldg. Square Footage 15t~ % 6-p O
Open Space Footage
(Lot area minus bldg & paved
J)arkil1ll.)
%
# ofParking Spaces d:2.-..
Fill:
(volume & Location)
A. Has a ~~ermit!Variance/Finding ever been issued forlon the site?
NO DONT KNOW YESt::J 0 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
0 0 0
IF YES: enter Book Page andlor Document #
"'>.-.... ~
B. Does the site contain a brook, body of water or wetlands? NO e--~DONT KNOW 0 YES 0-' ,"
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtafned , Date Issued:
0
o
C. Do any signs exist on the property? YES NOo e--
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
IF YES, describe size, type and location:
E. Will the construdion adivity distUrb (clearing, grading, ~~n,or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO <::::J
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
.-
SECTION 5-DESCRIPTlQN OF PROPOSED WORK (check all applicable)
New House o Addition Replacement Windows I Alteration(s) G
OrDoors 0 Roofing G-'
Accessory Bldg. 0 Demolition
121
o New Signs [CJ] Decks [CJ Siding [0] Other [Cl]
.... "-4''3£K' "'''(''''0 , ..r"'·'<f'r 'fwll"(lrCdI""",...,-,1;e1pvc-,'Y'·· -... ~~ .•• ~ .. ">". _'(a,,"',e:-I1:....
,/, ) ~ -I,(,.t:~,.... /It./:.,,/
Alteration of existing bedroom Yes ~No Adding new bedroom ---Yes No .~ ,
Attached Narrative Renovating unfinished basement Yes .,---' 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: 2> Number of Bathrooms,_--:;;k_'___
c. Is there a garage attached? A.JP 6, t:' ( J 1.::· I"" ) J
d. Proposed Square footage of new construction. / Sp 5/< (!-;PI. ....' Dimensions 17'.>1It. ,/2 0 YI7
e. Number of stories? ___....:;...2...-=_________
,11 /1. '" l'~/}s .
1. Method of heating? A/,~ £...,,,.,, /1"""\ f p.,.. -'" (If Fireplaces or Woodstoves ;V () Number of each
g. Energy Conservation Compliance. 5 '3 £ Masscheck Energy Compliance form attached? --"-~....;:~:...'~,____
h. Type of construction kJ .!'.( ,1 '
i. Is construction within 100 ft. of wetlands? ___ Yes ~No. Is construction within 100 yr. floodplain ___Yes ~
j. Depth of basement or cellar floor below finished grade __fe...'_________
k. Will building conform to the Building and Zoning regulations? /v~s No .
I. Septic Tank __ City Sewer / Private well City water Supply ~.
SECTION 7 •• OWNER AUTHORIZATION· TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, Y 41, ck.t'l k\ J( ZLr.. < , as Owner of the subject
property
hereby authorize ~/1 r:.J...,.:s
to act on my behalf, in all matters relative to work authorized by this building permit application.
~lQnawre of Owner
~ )/J ~~,/
i. m I cAu1.t w vl? I/). -c:; 0 -/0
Date
I, t-.I\ T ,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.
. I t:;l'
Date
,11"1 ..
SECTION 8 -CONSTRUCTION SERVICES I
8.1 ~:nsed co~tructiOn XiSOr:
Him:2t !..IB!!I! tl~d!r : t?t!-&t:. b' Not Applicable 0
ttltJ'(
License Number
L-/2., ~{)L1-
Expiration Date
FA ;3ox 6'4 lv:c'i./~4rJ.r.,t(,,1t-~4 OLOf'~(
Address' '/-1-U4/" "YL5'-21'd"c::?,/25S~ture Telephone
i. Reaistentsl H2!!!!! 1!!!I~r2V!m!!!t C2ntram;or:
Icu.l f Jl'~)1' L",".,.1./.'~ ~/!l'/' L'a-
ComDanv Name
f: fJ" t &' Y at)
Address· tjJt. -; ILli/~~(;'c t_i ~ A· Telephone7'l3 , 27{t>;23,
-
Not Applicable 0
f At) 12 51/
Registration Number
L -2,~ -2-.t/t..l..
Expiration Date
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...... 0
11. -Bome Owner Exemption
The current exemption for "homeowners" was extended to include Owner-occupied Dwellings ofone (I) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780. Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there
is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and! or farm
structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such "homeowner" shall submit to the Building Official, on a fonn acceptable to the Building Official, that be/she shall be
responsible for all sucb work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion ofthe work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability ofEmployers to
Employees for injuries not resulting in Death) ofthe Massachusetts General Laws Aonotated, you may be Hable for person(s)
you hire to perform work for you under this permit
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State ofMassachusetts General Laws Annotated.
H~nerSi£nMUI~_______________________________________________
,
.' .~'/..,;r/'~~j5i.V
The Commonwealth ofMassachusetts
Department ofIndustrial Accidents
Office ofInvestigations
600 Washington Street
Boston, MA 021/1
www.mass.govldia
Workers' Compensation Insurance Affidavit: Builders/ContradorslEledrieiansIPlumbers
Applicant Information Please Print Legibly
Name (BUSineSsiOrganil.atiOnlIndiVidUal):._----+t:::u..~...::y..L~4./_t-dL·_-'~t:.LI--.:.(_'______________
Address: eil JJ 0 f 5: ? .
/ / F I;!'· fj/~B1
City/State/Zip: ~) £ -? f c.../, & ,/c;;f-( £ W nhhone #: 11 :2.,~?I;. t2L z .3
Are you an employer? Check the appropriate box:
1. ~a employer with '2.-. 4. 0 I am a general contractor and I
employees (full and/or part-time). * have hired the sub-contractors
2. 0 I am a sole pi Opl ietor or partner
ship and have no employees
working for me in any capacity.
[No workers' compo insurance
required.]
J.D I am a homeowner doing all work
myself. [No workers' compo
insurance required.] t
listed on the attached sheet.
These sub-contractors have
employees and have workers'
coinp. insurance':
5. 0 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'
compo insurance required.]
Type of project (required):
6. 0 New construction
7. g--Remodeling
8. 0 Demolition
9. ~g addition
10.0 Electrical repairs or additions
11.0 Plumbing repairs or additions
12.0 Roofrepairs
13.0
•Any applicant that checks. box #I 1 IllIISt also fill out the section below shnwing 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 ofthe sub-contractors and state whether or not those entities have
employees. Ifthe sub-contractors have employees, they must provide their workers' compo policy number.
I am an employer that is providing workers' compensation insurance for ItU' employees. Below is the poUcy andjob site
information.
Insurance Company Name: 6 /'7.£..,..., ." I.:t:. li'C.~ / C
Policy # or Self-ins. Lie. #: tv'L' <?2?.2, 1/1 _Expiration Date: 51'-I:f ~ ~CJ/'
Job Site Address: ,5:'" ,hr /( -$ -(-<.' ~P" -( CityfState/Zip: .Ii~,.. It..y/~.) """"t A-
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition ofcriminal penalties ofa
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the fonn ofa STOP WORK ORDER and a fine
ofup to $250.00 a day against the violator. Be advised that a copy ofthis statement may be forwarded to the Office of
Investigations ofthe DIA for insurance coverage verification.
ains andpenalties ofperjury that the information provided above is true and co"ect.
Date: I L ,-/7 -/.??
Phone#: PJ-2"'1b' & /2 '6
Official use only. Do not write in this area, to be completed by city or town official
City or Town: PennitiLicense # _____________
Issuing Authority (circle one):
1. Beard &tHeaItIt 2. BuiJdi.ag Department 3. CHyfl'OWB Clerk 4. EledrieallBspedOr S. PIuIBbiu: IBSpeetor
6.0ther ____________
Contact Person: Phone#:
REScheck Software Version 4.3.0
Compliance Certificate
f-nf.1r~JV emil> 20031ECC
; r1(:'."itlor Northampton. Massachusetts
Cn'15tr !letK1 r I'.t'Pe Single Family
Glazi'19 ;·ro(l Pc/.:cntag(; 11%
H')flling Dc:gr(;(; Dil:J~, 6404
~;or~~ructlr;n Site OwneriAgent Ues:sne-/Contractor
eom~:P8uu
:';()!fI::a<l'lCH ~/ll)"ml;rr U!\' 906 Your UA: 536
Gross Cavity Cont. Glazing UA
Assembly Area or R·Value RNalue or Door
Perimeter U·Factor
:-xlshn9'1Dol Cathedral Cei'i'!g (no attic:. <34::' 20 () ?!'"> 0 30
f\ew noot Calredral Cei'ing \r<~ attic,' lOS 4? 0 ?5 :::.
AG'.",· \Nood Frame • 6" (> C ~,?87 H)O 25.0 .. :"
2 ,., \0·.... Win:lc'l':s Olh::1 It' U :!ou :<:l
=retill')!'!(l 'N"l,:ln'l'il'> Wood i-rCl!11~!·i)r)\)l.lle Fane vnr L~l'i'E ~14 0330 ~11
HCll>fW1Hn: 'y',1ilII 1 Sol~ CQrCI<J1\l ')' Maso1'y ~38 00 :~:H: 16
~Vall ncigll10,G
Dep1'! :::clo·."1 grade ! 0'
1"5ulallOn dep111: e.:
Hoo' 1 S at,)·::Jn-()'ade LnheatC'c ?/lil -00 :'18
Insulation d.::plh :;',:.1
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'/1al heigr! 5.0'
nc::lr t-clO\'l grado 3 G'
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calculall(;.ns subm tied with thl'! ptWIII appkahon -I1f!;:ro sed bUlll-ling f\as eoJd05'gr(':i 10 'TIOOllh'J 2003 Ieee 'oql.1hlmCr1::, In
HI-Sril<:lc!< Veu;IQr' 4,3<:' arc to .;orr·pl~' with tI-c flHl'ldalo' l'eCl.;IIelran,*, Il$le[ Ir 1 HI SCI ;f1ci+: Irsllf!r:l::r Checkl!'>: ! ' ,I, ... \" \ ' I ! j; \ r ..' " _.... ' .t-~.(, \.J ,~!,~~). .l.lf./ \ '.', 'tl! .' 'J I ';I,,I I" l' l V .. . . , ' ." " " \l ,.... '~ • "rJ"; ~---~--\. " \ t ;,,"'" ; 1
N;Jrtle • ! :\1" ' SIW111:\JrQ Cille
PIO;i:!t:1 IllI~ 11q::::11 :lato 1N::-::-il 0 :)!'l:~ U""l'Ime lC1C21·::;C:Sct,(,ci.; Wck.rck ,:tago'.) , 0; ~~
December 29, 2010
Kent Hicks
P.O. Box 57
West Chesterfield, MA 01084
Subject Property:
59 Massasoit Street
Northampton, MA 01060
Mr. Hicks
1. Corrected and stamped engineering for 1st and 2nd floor I-joist submitted electronically before
rough inspection.
2. Corrected and stamped engineering for roof system/beams submitted electronically before
rough inspection.
3. Room by room heat loss calculations submitted electronically before rough inspection.
4. Revised foundation drawing or SK.
5. The HRV manufacture requires 6' separation between intake and exhaust.
6. Plan set submitted electronically before rough inspection.
7. Structure conforms to 780 CMR ih addition 1 and 2 family with 2009 IECC prescriptive
requirements or RES Check 4.4.1 and mandatory requirements.
8. Smoke and CO detectors per code, plan and as noted.
. SO/CO outside the guest bedroom.
~~e~-
Assistant Commissioner of Buildings