29-404 (4) 46 SANDY HILL RD BP-2016-1060
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29-404 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-2016-1060
Project# JS-2016-001806
Est. Cost: $23537.00
Fee: $153.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 101342
Lot Size(sq. ft.): 22869.00 Owner: PREMO GREGORY
ZoningL Applicant: HOME DEPOT AT HOME SERVICES
AT. 46 SANDY HILL RD
Applicant Address: Phone: Insurance:
5 RIVERVIEW DR (401)935-2633 O Workers Compensation
NORTH PROVIDENCER102904 ISSUED ON.•31712016 0:00:00
TO PERFORM THE FOLLOWING WORK.-RENOVATE BATHROOM
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 $153.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1060
APPLICANT/CONTACT PERSON HOME DEPOT AT HOME SERVICES
ADDRESS/PHONE 5 RIVERVIEW DR NORTH PROVIDENCE02904(401)935-2633 Q
PROPERTY LOCATION 46 SANDY HILL RD
MAP 29 PARCEL 404 001 ZONE
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: RENOVATE BATHROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 101342
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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
D
Sig of Buil mg fficial 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 Boardof 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.
r Department use only r to ; f I tii
City of Northampton r a y ' ,,`
Status ofPerrritt
-�� � ' �
Building Department
'c�rb Cut/Drncew Y.Permits t L 5tLiMl
1(T{i�q ; 212 Main Street ;Sewer/SepCicgvaira"ij}IrkX
Room 100 i
orthampton, MA 01060 Twa�$efs otlStritctt� ai Ptartsl 11�} y II I ll 7'i'''
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oEr>r "O 41 -587-1240 Fax 413-587-1272
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APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE,INFORMATION
= This sectiorrtc be compiefediitiy'office
y,,.,' _
1.1 PropertV Address: -- -- _ _ _ -
t_i�-. —_:_ —. _••__—:_:.:.:::=i:=:,•l,r:_—..--.rr.�:�evc:r:i.{==jl----fie - - -
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SECTION 2.:-PROPERTY OWNERSHIP/AUTHORIZED.AGENT: : .
2.1 Owner of Record:
gad"?
Name(Print) Current Maili g Ad ress:
Telephone
Signature
2.2 Authori d Agent: 2W
Na a Pr' Current Mailing Address:
SI ature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS.
Item Estimated Cost(Dollars)to be Official Use'Only
completed by permit applicant
1. Building f �j (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
This--Section For Official'`Use Onl
Date
Building Permit Number: 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
Ttiis column to be filled in by •
Building Department
Lot Size
Frontage
Setbacks Front
' 1 :�..��1 R: ` I
-11
Side L:I R:_----.— L �-�---
Rear
Building Height `s G
Bldg.Square Footage
y
Open Space Footage % ! I
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill: } l
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued forlon the site?
NO 0 DONT KNOW Q YE5 0
IF YES, date issued: �� — �
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES Q
IF YES: enter Book _ Pagel and/or Document#1
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 i NO 0
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading,excavation,or filling)over 9 acre or is it part of a common plan
that will disturb over 9 acre? YES 0 NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
7
i
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicablg)
New House ❑ Addition ❑ Replacement Windows Alterations) Roofing ElOr Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [(--3] Decks [Q Siding(0] Other[
Brief Description�.f.Proposed
Work: p
Alteration of existing bedroom Yes No Adding new bedroom Yes No 67
Attached Narrative Renovating unfinished basement Yes No �
Plans Attached Roll -Sheet
6a If Ne'w.house.and or.adtllt>lon:to exi5tlng:h"ousina, comTete'the followenc:
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
I, as Owner of the subject
property
hereby authorize ! l
to act on my
behalf. in all
m.Jaytte,s�relative to work authorized by this building permit application.
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.
Signedu r the ains and penaltie o rjury.
,14W�'6
Print NYme
Signature o ner/Ag t Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not jApplilicable £
Name of License Holder: / U �" ]" p( 7-
License Numberi
F-
Addres,y) Expiration Date
Signature Telephone
9Re isfered_Home.lm rave
Not Applicable £
Company Nanie Registration Number
T,
/��
Add s --��� �- Expiration Date
G� n, Telephone
SECTION 10-WORKERS.'.COMPENSATION INSURANCE AFF..IDAVIT(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 Oiirii&Egempt><o
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,
I
— r
i
The Commonwealth of Massachusetts
Department of Industrial Accidents
0), ce of.Investigations
I Congress Street,Suite 100
Boston,MA 02114-2017
r www mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Ledbly
Name(Business/Organization/Individual):
Address: q09 604'`t , �/ l��t F
City/State/Zip: kJ i} 0 5L/._ Phone#: 57 � g �
Are you an employer?Check thea ropriate box: Type of project(required):
1.❑ I am a employer with 4. 1 am a general contractor and I
6. ❑New construction
employees (M and/or part-time).* have hired the sub-contractors
2_❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling j
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.El Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself.m seo right of exemption per MGI
y [N workers' comp.p 12.❑Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.�er
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 thea 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
— I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. r
Insurance Company Name: �` C140 7 r
Policy#or Self-ins.Lic.#: VV c, 0 { l Expiration Date: /
Job Site Address: City/State/Zip: YA�C� 4 / " �k
Attach a copy of the workers' compen tion policy declarations 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 D or insurance coverage verification.
Ido here cern and e p ns tr of perjury that the information provided above is true and co ecl
Si afore'. f (� rZ`-� Date:
���
Phone#: ,0` Z C� SCJ 7
i
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License# j
Issuing Authority(circle one):
I
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
i
6.Other
Contact Person: Phone#:
City of Northampton 212 Main Street, Northampton, Na 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: I' "
The debris will be received by: ��� r
Building permit number:
Name of Permit Applicant '
PPlicant
c
Date Sign-ature of Permit Applicant
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w, FINAL INSTALLATION QUOTE
Prenla rev 2/18118 QZf1 t)(1
cu slemer Nemo:
Final Coalgin;A _
DK TO FINAL
PON- 5241 2
Pre-Construction,Ilemalhlon,Removal,and Haul Away 5a,97o.t 6
Install any necessary Boor and aim protecuun
Remove e)o5ring won-mrwnied light
Tear out wa115 and[rolling completely
'fake up existltle floor .
Remove bathtub and Shower vahre
Remova all)obi laled debris from site
Eleclricet $4,650.45
Install GFQ ohrtk:tx at vanity and under towel bar
Install new retessad lighting
Install new bathfan(R switches)vented to ouhcdc
InM11 new vanity liCht
Install new electric baseboard heat to replace existing,
Install new re.crssed shower Ilgtlt svnthched indeuendently
Replace thermostat with new unit
Relocate existing light switch
Remnvc an job-related debris from site
Plumbing s3m125
Install thew chowervalve and tub drain
bismnneCt tNIeT and vanity plumbille
Remove toilet,YwRy tep and vanity
Set and plumb hew toilet
Connaatsnlr and rauoet pkimhing
Flooring Installation $1.478.40
Install new Concrete board substrate on floor
install new ceratiAc the flonr
Dryee&n Work a Painting $2,865,24
Install new rlrgprall In rmhe room
Paint room entire
Additional Charges(if applicable) $s,8s5.o4
Install conrrrtc board at tub waits
insiall cera mlc the an tub walls:two recessed nooks
install new taller,more narrow Window
Replarc bathroum door with barn-dour style door
;install new bathtub
Install nrw vanity base
InsulatA Rs required
Build 1/2 Wall with cap between Vanity and toilet
perm its
Plumbing
Building $262.54
Please note permit fees,N listed.are only estimated.By signing this KIW form the ctrcomer agrees to pay un3y the
permit fees cheesed for thb project Any difference between the estimated fee and the actual acressed fee will no
collected from or refwvied to the CUskomer.
Lead Sate Work Practices $4.44
Asoessos may be prwns in a nome Duni oetwcen 194W antt.lYAU ani r.cao mint may ne presART.in a nome buul
before 1478.Additional Charges may occur M the rustamer does not d19poFa of product per Federal Mandate of
Lead Safe Practices.
Gonaral Notes an the Project
ON RARF OCCASIONS,ADDI nONAL WORK IS D1500VI;RED AFTER A PRa)ECT HAS STARTED,THE
CUS IOMFR AGREES'IHAT THIS ESTIMATE hi VALID ONLY FOR IHE WORK LISTED AND I HAT AW
ADDITIQNAL WORK THAT iS Dr;COVERED AFTER THE DROJECT HAG AFGUN THAT WAS EITHER
MI66ED ON THE ORKMNAL BID OR ARISES DUE TO UNCORESEtN CIRCUMSTANCES WILL RESULT IN
ADDITIONAL CHARGES M IAT MUST BE PAID FOR BEFORE lHE WORK CAN BE r,OMPLETED.
r$22,01%.00
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Custenter Signature:
GC signage:
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Vanity Size
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home built 1971
height �° o
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200 amp service panel
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39-71'
—shower wall has deterioration on the bottom -
portion of back wall and appears the grout has Cl)
eroded away to open areas between tiles where bathtub
water has seeped into wallboard. There are no
water stains on any interior ceilings and no roof
penetrations that could be possible causes of a leak.
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City of Northampton
Building Department
Plan Review
212 Main Street
Northampton, MA 01060
https://mail.google.com/mail/#p nbox/153386ef830fad9d?projector=l 1/1