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DEMOLITION REVIEW APPLICATION Activity Tracking Sheet Property: 121 Hinckley Street Map 23D Parcel 149 Year Built 1900 Address: 121 Hinckley Street Received in Building Department: November 9, 2015 Referred from Building Department: November 9, 2015 Action Taken/ Northampton Historical Commission Action Taken Bv: Entire Commission X Sub-Committee of the Commission Commission Designee/ Staff Date Action Taken: November 19, 2015 Initial Determination N/A Public Meeting held N/A Public Hearing Held Determination Made: X Property has been determined not to be Significant according to Ordinance definition. No further action will be taken. Demolition Permit may be issued. Property has been determined to be Significant according to the Ordinance definition and a Public Hearing has been/will be scheduled. Demolition Permit may not be issued at this time. Public Hearing has been held, Property was determined Significant but not Preferably Preserved. No further action will be taken/ Demolition Permit may be issued. Photo documentation may be required. Public Hearing has been held. Property has been deemed to be Preferably Preserved. The demolition review period has been initiated. No demolition permit may be issued until the Historic Commission approves an alternative plan or the twelve month period concludes. Alternate plan has been approved/ delay terminated. Demolition may or may not be approved as part of plan. Twelve month time period has expired, demolition permit may be issued. Referred by: Sarah LaValley Date: November 19, 2015 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9._Realstered Home Improvem nt Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone 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...... ❑ 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 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 La and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all auplicable) New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑ Or Doors r, Accessory Bldg. ❑ Demolition 0 New Signs [r3] Decks [M Siding[C3] Other[C] Brief Description of Proposed Demolision of existing residential structure Work: Alteration of existing bedroom Yes xxx No Adding new bedroom Yes xxx No Attached Narrative Renovating unfinished basement Yes x No Plans Attached Roll -Sheet sa.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. 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 Tom Friedman 1, ,as Owner of the subject property Terrence Reynolds hereby authorize to act on my behalf, in all afters relative to work authorized by this building permit application. IV3111 Signature of Owner Date I, ,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 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 1.25 acre 1.25 acre Frontage Setbacks Front 5 _ Side L:>15' R: 10 U- R:- Rear >20' - Building Height 2 stp - Bldg.Square Footage 1300 % 0 Open Space Footage % (Lot area minus bldg&paved 1+ao >40 1.21n 100 parking) #of Parking Spaces 2 0 Fill: volume&Location - - A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW Q YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW Q YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES ® NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO Q IF YES, describe size, type and location: E. Will the construction activity disturb(Gearing,grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. T:7� Department use only City of Northampton Status of Permit Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability o=` " Room 100 Water/Well Availability �. Northampton, MA 01060 Two Sets of Structural Plans ooh phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans W` Other Specify 0 P (CATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit 121 Hinkley Street, Florence Zone Overlay District Elm St.District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Tom Friedman 88 Washington Ave,Northampton,MA 01060 Name(Print) Current Mailing Address: 413-320-8557 / Telephone Signature 2.2 Authorized Ascent: Terrence Reynolds 152 Maplewood Terrace,Florence,MA 01062 Name(Print) Current Mailing Address: 413-387-8078 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a) Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number: Issued: ed: Signature: Building Commissioner/inspector of Buildings Date File#BP-2016-0644 APPLICANT/CONTACT PERSON FRIEDMAN THOMAS H& ADDRESS/PHONE 88 WASHINGTON AVE NORTHAMPTON01060(413)320-8557() PROPERTY LOCATION 121 HINCKLEY ST MAP 23D PARCEL 149 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT 04 FQ Fee Paid Building Permit Filled out Fee Paid Typeof Construction: DEMOLISH SFH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildine 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: 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. 121 HINCKLEY ST BP-2016-0644 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23D- 149 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category: demolition BUILDING PERMIT Permit# BP-2016-0644 Project# JS-2016-001081 Est. Cost: Fee: $75.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sa.ft.): 54450.00 Owner: FRIEDMAN THOMAS H& Zoning: URB(100) Applicant: FRIEDMAN THOMAS H & AT: 121 HINCKLEY ST Applicant Address: Phone: Insurance: 88 WASHINGTON AVE (413) 320-85570 NORTHAMPTONMA01060 IS:>C/1,'D ON.11/30/2015 0:00:00 TO PERFORM THE FOLL0JVING WORK:DEMOLISH S F H POST THIS CARD SO IT IS VI' 'j' 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 Depart! t Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVC:' "' 13Y THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND RECI .'LIONS. Certificate of Occupancy Sionature• FeeType• Datc ;'aid: Amount: Building 11/30/201�7 $75.00 212 M:. n Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner