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38C-003 (4) q - Oc- x IFNI - ------------ QC�S'" A-DDIT',-3 ArtlD i f IoIJ 1 i k i i LA' x �!�•X 4 4 _. I i : i I, I I , � 1 1 I Z x Z. Jols o -- ---= I : i i I -_--: - - LPL' z --- �- -- - -- -- � �__----�3a l' `t-''tiv✓-1•�(ran7__ 12.-21 .- l±�sjltlt"'j'1pn� _� ' -- - to v �-ta ----- I _...--- --- --- --- -- --- - `—t7iA I , —---- ----- ' r i i -- City of Northampton Mail - Fwd: 194 Grove Street Wetlands https://mail-000gle.com/mail/u/0/?ui=2&ik=39211afc3d&view=pt&se... Charles Miller<cmiller @northamptonma.gov> Fwd: 194 Grove Street Wetlands 1 message Louis Hasbrouck<Iasbrouck @northamptonma.gov> Tue,Sep 16,2014 at 9:36 AM To:Charles Miller<cmiller @northamptonma.gov> The cons com is OK with the work at 194 Grove St.Are you dealing with the permit?You can issue. Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg (413)587-1240 office (413)587-1272 fax ----------Forwarded message---------- From:Sarah LaValley<slavalley @northamptonma.gov> Date:Tue,Sep 16,2014 at 9:31 AM Subject: 194 Grove Street Wetlands To: Louis Hasbrouck<Hasbrouck @northamptonma.gov> Hi Louis- The Commission issued a negative determination last Thursday for enclosing the overhang at 194 Grove. No special conditions,they are good to go at any time. Please let me know if you need anything else. -Sarah Sarah I.LaValley Conservation,Preservation and Land Use Planner City of Northampton Office of Planning and Sustainability 210 Main Street,Room 11 Northampton MA,o1o6o 413-587-1263 (City of Northampton E-mail is a public record except when it falls under one of the specific statutory exemptions.) (City of Northampton E-mail is a public record except when it falls under one of the specific statutory exemptions.) I of 1 9/16/2014 12:46 PM ILLJ ' d, QD Or. , 8M 'A � W V ku N ` CIS 00 . . ,00� � N �. SIDE Dooms , DO 2 3SnOH 3Wd?J3 DOOM CL ONVH83A0 j 0 l I,4ne oo c Nee- - I - ONb'713M 30 3003 C1330 '9� Z OMV7-L3M -do dol t - 3d8 NOW n 1 �` ,60 -P t i 'd1d N081 • � ' GN3037 _ co _ 961 30Vcl . `OS t >1008 Nd7d OS t nrHmnw `90 N6 N w008 The Commonwealth of Massachusetts trs Department of IndustrialAccidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information I Please Print Leaibly Name (Business/Organization/Individual): Address: l I City/State/Zip: �' f 1.��:�,/� Phone#: 1 �}/3 5,�� `I j��h) l e , �, & 7 ee l cl(l Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. I am a g eneral contractor and I 6. employees (full and/or part-time).* have hired the sub-contractors F-1 New construction 2.❑ I am a sole proprietor or pdrtner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have S. F-1 Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp. insurance.: required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t C. 152, §1(4),and we have no employees. [No workers' 131-1 Other 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: City/State/Zip: 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 of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 pains and penalties of perjury that the information:provided above is true and correct. Si_-nature: . _. . . ;Dater '�- - 'L�"2-v i Phone# l 5 ' 15-?y L I 4q 16 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#: ECTION 8-CONSTRUCTION SERVICES I 1 Licensed Construction Supervisor: Not Applicable ❑QC� ame of License Holder: U C J l D S 0 D C6 License Number A ddress Expir ion ate 3- 637- 063 ignature Telephone 'Reegistered Home Improvement Contractor: Not Applicable ❑ K,u-e,( Ac- 700 :ompanv Name Registration Number /-?, I MA 7/24 1kot 6 - ,ddress II,,'' Expir tion Da Telephone "Tl3`s 3 7--6 06 IECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Vorkers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result i the denial of the issuance of the building permit. Iigned Affidavit Attached Yes....... ❑ No...... ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) 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 10835.1. 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 form acceptable to the Building Official,that he/she shall be responsible for all such 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 of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,You may be liable 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 of Massachusetts General Laws Annotated. Homeowner Signature 'ECTION fi-DESCRIPTION OF PROPOSED WORK(check all applicable) 7 ew House ❑ Addition © Replacement Windows Alteration(s) ❑ TRoof ing ED Or Doors ❑ ccessory Bldg. ❑ Demolition ❑ New Signs Da Decks (❑ Siding M] Other(C8 rief Description of Pr pos d /ork: Ek$ATb�fl OY I-l-1-CNpry >f12E,4 $1bZ� 'Dooe 1" NtNG, Iteration of existing bedroom Yes No Adding new bedroom Yes No ttached Narrative Renovating unfinished basement Yes _ C No lans Attached Roll -Sheet a. If New house and or addition to existing housing, complete the following: Use of building:One Family Y Two Family Other Number of rooms in each family unit: �e Number of Bathrooms v2 Is there a garage attached? ND Proposed Square footage of new construction. O5 Dimensions X Number of stories? c2 Method of heating? C012GC-D A-1 (L ( W�� Fireplaces or Woodstoves Number of each Energy Conservation Compliance. Masscheck Energy Compliance form attached? Type of construction ST AN DA" - wo G D Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No Depth of basement or cellar floor below finished grade i.lo-r Aplot-V$t f Will building conform to the Building and Zoning regulations? Yes No. Septic Tank City Sewer Private well City water Supply ECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN WNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject -operty ?reby authorize VV Ft, M C au 63 0 act on my behalf, in all matters relative to work authorized by this building permit application. gnature of Owner Date as Owner/Authorized gent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge id belief. igned under the pains and penalties of perjury. int Name 7/10 ly gnature of Owner/Agent Date 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 P1ms Frontage 3-i Setbacks Front 1 Q .31 Side L:130' R 394 r L: R: Rear Building Height '*�L s-(o e—y Bldg.Square Footage ` S 2c % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO e DONT KNOW O YES O ,r "TES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES 1a � tu� .. -S, iias a permit been or need to be obtained trom the Conservation Commission*? '3U-r oJG Needs to be obtained O Obtained O , Date Issued: Ate PA C. Do any signs exist on the property? YES O NO (D' t \� 0� size,type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading, exc vation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: J Building Department Curb Cut/Ddveway Permit 212 Main Street Sewer/Septic Availability y be: ' osOc ons Room 100 Water/Well Availability pWmbin9 E1'jnclo�h2mptoo, 0'' orthampton, MA 01060 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 XTION 1 -SITE INFORMATION 1 Property Address: This section to be completed by office i ci x4 ( 0-oJe cST Map Lot Unit D L O&r C7 Zone Overlay District Elm St.District CB District _CTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT I Owner of Record: >0u0LAS 5CNToN G 12o\j c Si r raN /r1A me(Pent) Current Mailing Agddress: g 0 10 Cob Telephone mature (/Z !Authorized Agent: >O U G L.A 5 �� me(Print) Current Mailing Address: 0(04'0 14r3 . 5g& - 'f.T g t nature Telephone ;CTION 3-ESTIMATED CONSTRUCTION COSTS m Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant Building /if,°gyp (a) Building Permit Fee Electrical (b) Estimated Total Cost of Construction from 6 Plumbing Building Permit Fee Mechanical (HVAC) `b� ] �✓ -ire Protection Total=(1 +2+3+4+5) ,S 2 d Check Number This Section For Official Use Only ilding Permit Number: Date Issued: (nature: Building Commissioner/Inspector of Buildings Date 5 ('0 ( � �� File#BP-2015-0158 UO ` APPLICANT/CONTACT PERSON BENTON DOUGLAS M&KATE J GEIS ADDRESS/PHONE 194 GROVE ST NORTHAMPTON (413)586-4989 Q PROPERTY LOCATION 194 GROVE ST MAP 38C PARCEL 003 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: CONSTRUCT KITCHEN ADDITION&SIDE DOOR AWNING New Construction Non Structural interior renovations Addition to Existing- Accessory Structure Building Plans Included• Owner/Statement or License 106700 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION 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 Approv ealth Well Water Potability Board of Health ermit from Conser i�o`n Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management o " Signature of Building ficial 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. 194 GROVE ST BP-2015-0158 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38C-003 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Permit# BP-2015-0158 Project# JS-2015-000274 Est. Cost: $15900.00 Fee: $95.50 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KUEL MCQUAID 106700 Lot Size(sq.ft.): 74052.00 Owner: BENTON DOUGLAS M&KATE J GEIS Zoning: URB(100)/ Applicant: BENTON DOUGLAS M & KATE J GEIS AT. 194 GROVE ST Applicant Address: Phone: Insurance: 194 GROVE ST (413) 586-4982-0 NORTHAMPTON MA01 060 ISSUED ON:912212014 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT KITCHEN ADDITION &SIDE DOOR AWNING 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 Signature: FeeType• Date Paid: Amount: Building 9/22/2014 0:00:00 $95.50 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner