15B-001 (4) 7 1 CCIJ.)if"Ic
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 160105
Type: DBA
Expiration: 6/2512016 Tr# 255417
D & D MASONRY & CHIMNEY -
NICHOLAS DOUP -
12 KATI LANE _
PALMER, MA 01069
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------------------_...
Update Address and return card.Mark reason for change.
Address Renewal Employment Lost Card
SCA 1 f: 1XA-075111
License or registration valid for individul use only
Office of Consumer Affairs&Business Regulation
"ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
;�#egistration: 160105 Type:
Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
x iration: 6/25/2016 DBA Boston,MA 02116
D&D MASONRY&CHIMNEY
NICHOLAS DOUP
12 KATI LANE PALMER,MA MA 01069 Undersecretary Not valid without signature
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Super isor
License: CS-102135
Nicholas J Doup
12 Katie Lane
Palmer MA 01069
� � Expiration
Commissioner 08/15/2016
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: ` Not Appli cable ❑
Name of License Holder: C-5 /02-(35
License Number
12 lc (1--1/i S 2-01 tk7
Address Expiration Date
Signature Telephone
8.Realstered Home Improvement Contractor: Not Applicable ❑
Company Name —T Registration Number
Address // Expiration Date
Telephone Yt S u'Y Y y Y Y
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...... ❑
.1,1, - Horne-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 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 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
Y
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors 71
Accessory Bldg. ❑ Demolition ❑ New Signs [I:31 Decks (M Siding[01 Other[ED]
Brief Descripttii4,n of roposed
Work: lS w I�.-� ( -e— 6',; 0t�✓�,..
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 hoiuse and or,additien to existing housing, complete the'foilowinct:
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. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
�1��' as Owner of the subject
property
/i 'f /Slat }�./ 17�°
hereby authoriz �
to act on my half, in all matters relative to work authorized by this buildi g permit application.
Signatur Owner Date
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.
Signed under the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
so
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
Frontage
Setbacks Front
Side L: R: L:,- R:
Rear
Building Height
Bldg.Square Footage
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 DON'T KNOW 0 YES
IF YES, date issued::
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW 0 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued: ,
C. Do any signs exist on the property? YES 0 NO 0
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 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 0 NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
aeprtttnt tts rl fi"k ,
Y'
of Northampton at elfi t j
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�� — 2014 Iding Department curb �3n€i�+� Syrrrl 'gym
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12 Main Street Sswrl �clfil n
Electric,Plumbing&Gas inspec►bna Room 166 y tee =,) 0� y r
Northampton,MA 01060 mpton, MA 01060 �w0Ses Stttlfel 11e �
phone 413-587-1240 Fax 413-587-1272 Ptr lSttC,a 1
tither'Sp6Ify
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
1.1 Property Address:
*3U� C ,� #�.t r Map —'—i.�- Lot (` � Unit
f ce .S
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
/11 l
N ma a(Print Current Mailing Address:
Telephone ��3
Signat +•� J J
2.2 Authorized Agent:
!"V
i��� �1 �C� bra N — ��
D
Name rint) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed bv permit applicant
1. Building G L,� 1 oo (a)Building Permit Fee
2. Electrical 1 (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) 4/.30 Cs Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File# BP-2015-0416
APPLICANT/CONTACT PERSON D&D MASONRY&CHIMNEY
ADDRESS/PHONE 12 KATI LANE PALMER (413)348-9839
PROPERTY LOCATION 308 CHESTERFIELD RD
MAP 15B PARCEL 001 001 ZONE RR(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(2)FLUES WITH FIREPLACE
New Construction f
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included: ,f
Owner/Statement or License 102135
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INI,(�RgATION 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
De elay
Signature of B ding 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.
308 CHESTERFIELD RD BP-2015-0416
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 15B -001 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2015-0416
Project# JS-2015-000745
Est. Cost: $13000.00
Fee: $78.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: D & D MASONRY & CHIMNEY 102135
Lot Size(sq. ft.): 2073456.00 Owner: MELNIK ALICE E
zoning: RR(100)// Applicant: D & D MASONRY & CHIMNEY
AT. 308 CHESTERFIELD RD
Applicant Address: Phone: Insurance:
12 KATI LANE (413) 348-9839
PALMERMA01069 ISSUED ON.1011412014 0:00:00
TO PERFORM THE FOLLOWING WORK.CONSTRUCT (2) FLUES WITH FIREPLACE -
makeup air & gaskeited glass doors rquired
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 10/14/2014 0:00:00 $78.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner