25C-235 (8) 183 BRIDGE ST BP-2016-1065
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 25C-235 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categorv: Deck BUILDING PERMIT
Permit# BP-2016-1065
Project# JS-2016-001811
Est. Cost: $12000.00
Fee: $78.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: THAYER STREET ASSOC INC 045159
Lot Size(sq. ft.): 19079.28 Owner: RANSOM FREDERIC
Zoning: SC(67)/URC(33)/ Applicant: THAYER STREET ASSOC INC
AT. 183 BRIDGE ST
Applicant Address: Phone: Insurance:
8A COATES AVE (416) 665-4018 Workers Compensation
SOUTH DEERFIELDMA01373ISSUED ON:3/7/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPAIR DECK (SAME FOOTPRINT) - per
engineered plans
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 3/7/2016 0:00:00 $78.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File# BP-2016-1065
APPLICANT/CONTACT PERSON THAYER STREET ASSOC INC
ADDRESS/PHONE 8A COATES AVE SOUTH DEERFIELD01373 (416)665-4018
PROPERTY LOCATION 183 BRIDGE ST
MAP 25C PARCEL 235 001 ZONE SC(67)/URC(33)/
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: REPAIR DECK SAME FOOTPRINT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
N
Building Plans Included:
Owner/Statement or License 045159
3 sets of Plans/Plot Plan
THE FOL WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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
e elay
Sb ure B Aldi is MT 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.
Department use only
City of Northampton status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
ROOM 100 Water/Well Availability
Northampton,MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 PIot/Site Pians
Other Specify
APPLICATION 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
J / Zone Overlay District
Elm St.District CS District
SECTION 2.PROPERTY OWNERSHIP/AUTHORIZED AGENT 71
2.1 Owner of Record: a2gr3 U((IQ /(/lrck Pr
Na Print) F7�WVl Current Mailing ddr s:
o � s��-3 2
Telephone
Signature
2.2 Authorized Agent:
Name(Print)p' Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building / - U (a)Building Permit Fee f i
e
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) r'
5.Fire Protection ! .
6. Total=(1+2+3+4+5) z Check Numbe
This Section F r Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings 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
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 (D' YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® DONT KNOW YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES ® 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 ® NO
kv
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION S.DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑ _
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks ( Siding[OJ Other[I:7J
Brief Description of Proposed
1,
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Pians 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: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
I. 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.
1. Septic Tank City Sewer Private well T City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
property1S �(„?� CAK XQy i as Owner of the subject
her y authorize
C
c on my behalf,in relative to work authorized by this bupermit application.
W/ ol
Signature of Owner Det
I, as11ilwaser0 uthorized
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
Signatgre o4�gent Date
The Commonwealth of Massachusetts
Department of Industrial Accidents
W
Office of Investigations
1 Congress Street, Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Ledbly
Name (Business/Organization/Individual):
Address:
City/State/Zip: Phone #:
Are an employer? Check the appropriate box: Type of project(required):
1. I am a employer with ��Q 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. E]New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑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.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 1 L❑ 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' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box#1 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.
1 am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site
information.
Insurance Company Name: 4C-u_ cz_. _
Policy#or Self-ins. Lic. #: ��'R L /-f :/2 Expiration Date:
Job Site Address: 1?,X Ali /��,�., �1` ,� 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 forth 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 ofperjury that the information provided above is true and correct
Signafore: Date:
Phone#: - (1'2,
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#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction
J/Supervisor: 1 Not Applicable ❑
Name of License Holder: I/e-
N /i7r Ty
/ License Number
Addres Expiration Date
1h4W zi���
Signature Telephone
9.Registered Home Improvement:Contractor. Not Applicable ❑
Company� Registration Number
Z,�zc .S,
Address Expiration Date
ey (�,C-16-1, - S /E��'� _�N�� Telephone�a-,/,,/,r—/fides
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....... V11 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 Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
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:
r
The debris will be transported by: /�"/x 6 CC
The debris will be received by: I/V'Z Q f&ll/
Building permit number:
Name of PermitA u
Applicant
T
Date Signature of Permit Applicant
THAYER STREET ASSOCIATES , INC .
General Contractors a&. Residentlal,,ICozziisaerciaiiliastitutional;'Historical
March,4,2016
Chuck Miller
Assistant Building Commissioner
City of Northampton
I request that you grant a modification to waive the requirements for control construction fc
( EGRESS STRUCTURAL IMPROVEMENTS)at( 183 BRIDGE STREET) in Northampton, becaus
work is of monor nature,will not affect health,accessibility, life safty or structural requiren
and is impratical in that the cost of control construction is considerable when compared to t
of the proposed work.Thank you for you consideration. Mass Amendments section 107.1 z
for an exclusion from control construction
Respectully
101=ZURYLO
TNAYER STREET ASSOCIATES INC.
8 Coates Ave.S. Deerfield, Ma.
F
X
S
3
y
8 Coates Ave-South Deerfield,NLA 01371 as (41 i 665-40113s fax(413) 665-11.42 Es thaverstreetassociates.com