23A-246 (7) 185 NONOTUCK ST BP-2016-1003
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map-.Block: 23A-246 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cate(ory: renovation BUILDING PERMIT
Permit# BP-2016-1003
Project# JS-2016-001696
Est. Cost: $4000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: CHARLES ESKETT 032407
Lot Size(sq. ft.): 9408.96 Owner: GRAY CAROL J
Zoning: URB(100) Applicant: CHARLES ESKETT
AT. 185 NONOTUCK ST
Applicant Address: Phone: Insurance:
135 FISHERDICK RD (413) 967-5635
WAREMA01082-9788 ISSUED ON:2/11/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.-SISTER JOIST, ADD HANGERS & NEW LOLLY
COLUMNS
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:
FeeTyne: Date Paid: Amount:
Building 2/11/2016 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File# BP-2016-1003
APPLICANT/CONTACT PERSON CHARLES ESKETT
ADDRESS/PHONE 135 FISHERDICK RD WARE010829788(413)967-5635
PROPERTY LOCATION 185 NONOTUCK ST
MAP 23A PARCEL 246 001 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: SISTER JOIST ADD HANGERS&NEW LOLLY COLUMNS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 032407
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORNAXION 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: §
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
li ' n Delay
i e o uild' g OfArial 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.
i]epartment use only ,, i i
—� City of Northampton Status ofP�rrn�t J� �'r
BBuilding Department Ct7rb Cu#lDrietuay Perm#
FE
212 Main Street SewerLSepiicAuaila6Elrty �'
1 4{
L ; ' M II'il
Room 100 �IVeter/l/1fe7tAva�labilityy
DEPT.C'P SUII f i s _ 4.,'•!;i 1 J
N0�17 'AMF:C !;IXC , , N rthampton, MA 01060 TWalSets~ofStructrJral Plans77
� {
--p-ho---6-6413-587-1240 Fax 413-587-1272 P1ot/Site Plans T �2
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section eted by offs
e com
to b PI ce
r, �.,•,� `1 I �- - r
c A G /v t 1'5=
ap
SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT-
2.1
2.1 Owner of Record:
Name(Print) Current Mailing Addre s: �-.
M/ - ;)W7 -/O 75
III" ;-�;,f 4� Telephone
'Signature
2.2 Authorized Agent:
Name Print,, � Currentrrent Ma�Address:
SLS
;
C,
Signature
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS.
Item Estimated Cost(Dollars)to be Official Use-Only
completed by permit 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=(1 +2+3+4+5) Check Number
ThisSection For Official Use'Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/lnspector'of Buildings.' Date
.
- ~
�
�
�
�
Section 4. ZONING AU 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
Rear
Building Height
Bldg.Square Footage %
Open Space Footage
(Lot area minus bldg&paved
#of Parking Spaces
A. Has aSpecial Permit/Yariamce/Findingever been issued for/on the site?
v-� /��
'�~� Y/ \~�
NO ��' DONT KNOW YES �~�
IF YES, dateisued:
IF YES: Was the permit recorded at the Registry of Deeds? /
NO �� -�
D0NKNOYY /ES
���
IF YES: enter Book Pag and/or Doc ument#
�� ��
B. Does the� ��site body NO �^� DONTKNOY� ��, YES \�� �
IF YES, has permit been or need to be obtained from the Conservation Commission?
Needs to be obtained r-� Obtained �~� Date Issued:
. ��' �~/ ' .
C. Doany signs exist onthe pnoperty �� ��� YES �~� N� \=�
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 0
IF YES, describe size' type and location:
E. Will the construction activity disturb(clearing, gradingexcavation,orfiUing)over I acre oriaitpart ofacommon plan
that �oe? YES �� NO � �
. v=� »�'
IF YES,then a Northampton Storm Water Management Permit from the DPW is required. �
^ ''
/
'
/
^ �
' |
' / J
�
/ �
SECTION b-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition F7Replacement Windows Alterations) ❑ Roofing ❑
Or Doors l�
Accessory Bldg. ❑ Demolition ❑ New Signs [lam] Decks (Q Siding [01 Other[M]
Brief Description of Proposed p-' 7— / `/ /
Work: 4,L 6- L Q C' [;`i-7 5��. e O�cf1S/T/7/�G /7i`fl�6t le-
Alteration of existing bedroom Yes ��N0 Adding new bedroom Yes '� No
Attached Narrative Renovating unfinished basement Yes N
Plans Attached Roll -Sheet
_ ieIf NwoadditotoXstiqhsaeeusngcfe fhe follow�ng:
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? 0
d. Proposed Square footage of new construction. Dimensions
e. Number of stories? .I
f. Method of.heating?,Y0 1 ' 1 /2' 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 4----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
hereby authorize
to act on y behal , in otters relative to ork authorized by this building permit app ication.
ignature of Owner ate
1 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
Y
SECTION 87 CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable £
f _{
Name of License Holder: �) .� G, S S A1141- C7 /� ,� /e /r7
License Number
Address Expiration Date
Signature Telephone
9;Regisfered Home lm �ovemen Contractor , _ �.____ __,�-___ __.___.�_ Not Applicable £
— y` X, cT, S
Company Name Registration Number
Address / Expiration Date
es
V1 ,4 /��: C /� . Telephoney//
SECTION 10-WORKERS'.COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c-1 52,§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...... £
7 77-
'll . Home Q�yner Egeffipt>lon
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-vear 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,
i
The Commonwealth of Massachusetts
Department of bidustrial Accidents
i Office ofnvestigations
x 600 Washington Street
- i Boston,M4 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Bu alders/Conntrzctors/Elect>ricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): t, I14
Address: / JC G
City/State/Zip: Phone #:
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. F-1 I am a general contractor and I 6. ❑New construction
e,pployees (fall and/or part-time).* have hired the sub-contractors
rem
2. I am a sole proprietor or partner-
listed on the attached sheet. 7. odeling
ship and have no employees These sub-contractors have g, �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. Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
fHo meowners 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 isproviding 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 painsand penal ' s ofperjury that the information provided above Ls true and correct.
Simature.
Date:
Vf
Phone#
Of 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#:
City of Northampton
Massachusetts
f DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
` r^ Northampton, MA 01060
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
F
f Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her
n supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which
des or intends to be, a one or two family dwelling, attached or detached structures
o such use and/or farm structures. A person who constructs more than one home in a two-
yearperod shall not be considered a home owner."
The building department for the City of Northampton wants any person(s) who seek to use the home
owner exemption, to act as their own construction supervisor, to be aware that by doing so you
become responsible for compliance with state building codes and regulations. The inspection
process requires that the building department be called to inspect work at various stages, which include
foundation/footinqs (before backfill) sonotube holes (before pour) a rouqh building inspection
(before work is concealed), insulation inspection (if required) and a final building inspection
The building department requires these inspections before the work is concealed, failure to secure
these inspections can result in failure to obtain a certificate of occupancy until the work can be
inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be i
responsible to make sure that the trades hired secure their proper permits in conjunction to the building
permit issued, and that they get their required inspections. Failure of the individual trades to secure
the permits and inspections as required can DELAY the project until such time as the proper permits
and inspections are made
� understand the above.
(Home owner/resident's signature requesting exemption)
will call to schedule all required building inspections necessary for the building permit issued to me.
)ate
address of work location
i
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste 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.
Address of the work:
The debris will be transported by:
The debris will be received by:
Building permit number:
Name of Permit Applicant
Date Signature of Permit Applicant
'Jassacriusetts Deoartmem'
Board of Building Reguiartcns ira S
C e n S C, CS-032407
am-, )f .Iz ..
CHARLES H ESKETT,JR
136 FISHERDICK ROAD
WARE MA 01082
01/09/2018
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 114941
Type: DBA
Expiration: 11/10/2017 Tr# 272530
ASSOCIATED CONTRACTORS
CHARLES ESKETT JR.
135 FISHERDICK RD
WARE, MA 01082
Update Address and return card.Mark reason for change.
71 Address F] Renewal L-1 Employment Lost Card
.1010-th 11
_j
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 114941 Type: Office of Consumer Affairs and Business Regulation
Expiration: 11/10/2017 DBA 10 Park Plaza-Suite 5170
Boston,MA 02116
ASSOCIATED CONTRACTORS
CHARLES ESKETT JR.
135 FISHERDICK RD
WARE,MA 01082 Undersecretary Not valid without signature
ACC>RV CERTIFICATE OF LIABILITY INSURANCE
7`M"'°'°Y"'"'
2/8/1
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THS
CERTIFICATE DOES NOT AFFIRMAIMLY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AurHoFttzEo
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT, If the certificate holder is an ADDITIONAL INSURED lhe policy(Hes) Trust be endorsed. If SUBIROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to lfle
certificate holder In lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
St. Germain Insurance, Inc. 1iH_DW_ FAC d
P.O. t413 967-6 4ZAX N : (413) 967-9537
.O. Box 630
m.StGermain@StGormainIne.com
246 West Street RT 32 INSURERS)AFFOROING COVERAGE HJUC 8
Ware, HA 01082-063 INSURERA:Safetv Indemnitv
INSURED iNsvRERe:Safe_,tv, Insurance
C Henry Eskett Jr & Charles H
INSURERC:
Associated Contractors INSURERD:
133 Fisherdick Rd -INSURER E.:
Ware, MA 01082 INSURER F: i 6—
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATE). NOTWTHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POU—EW LINTS
1M WVD POUCY NUMBER -MMAIDCY DryYyy
-TYPE—OFINS-1UR INSURANCE A
I GENERAL LIABILITY BMA0021581 i 5/4/151 5/4/161 EACH OCCURRENCE
B _Ls __1X000 X0o o
r_DA_M0kGE TO RENTED
100
7X 1 COMMERCIAL GENERAL LIABILITY 1ko-9-
$
CLAIMSMADE X �OCCUR MED EV("ore pe aori) s, __10"000
PERSOML&ADV INJURY IS 1,000.000
GENERAL AGGREGATE is 2,000.000
GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS-COMPIOP AGG s 2.000,000
POLICY PRO- LOC $
JECT
I AUTOMOBILE U[A81UTY
A Y 16212261 2/13/16! 2/13/17 ACE .1 is 500,000
ANY AUTO BODILY INJURY(Per person) $
ALLOWNED SCHEDULED
BODILY INJURY(Per accident) s
X AUTOS AUTOS
T
AUTOS
NON-OWNED C
HIREDAUTOS, $
UMBRELLA LIAB OCCUR I EACH OCCURRENCE
EXCESS LtAB CLAIMS-MADE'
AGGREGATE
VVDRQ:�C RETENTION$ Is WC STATUOTH_
OMPENSATION , I
AND EMPLOYERS'LIABIUTY YIN i
ANY PROPRIETORIPARTNEREXECUTIVE El EACH ACCIDENT
NIA{OFFKE RIMEMBER EXCL UDED?
filanda"In NH) g_4,DISEASE-EA EMPLOYEE[ $,,
S,deaf=cribs under
OF OPE RATIONS below EL.DISEASE-POLICY L WAIT
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DESCRIPTION OFOPERATIONS tLOCATIONS IVEHICLES (Aftsch ACORD 101,Addftmal Remarks Sdwxkdo,it more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF'SHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Carol Gray ACCORDANCE WITH THE POLICY PROVISIONS.
185 Nonotuck St
Florence, HA 01062 AUIHORIZED REPRESENTATIVE
JJames J St Pierre
0 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and loco are reoistered marks of ACnpn
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