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32C-281 (8) 100 WILLIAMS ST BP-2016-1058 GIS#: COMMON, WEALTH OF MASSACHUSETTS Map:Block: 32C-281 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2016-1058 Project# JS-2016-001800 Est. Cost: $10000.00 Fee: $65.00 PERMISSIONIS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HAYDENVILLE WOODWORKING & DESIGN INC 044314 Lot Size(sq. ft.): 5532.12 Owner: MALZONE WESLEY Zoning: URC(100) Applicant. HAYDEUVILLE WOODWORKING & DESIGN INC AT. 100 WILLIAM§ ST Applicant Address: Phone: Insurance: P O BOX 1070 (413) 253-3229 Workers Compensation AMHERSTMA01004 ISSUED ON:3/4/2016 0:00:00 TO PERFORM THE FOLLOWING WORK.-REBUILD FRONT PORCH (SAME FOOTPRINT) 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 CITiY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy §ignature: FeeType: Date Paid: Amount: Building 3/4/2016 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File# BP-2016-1058 APPLICANT/CONTACT PERSON HAYDENVILLE WOODWORKING&DESIGN INC ADDRESS/PHONE P O BOX 1070 AMHERST01004(41!,3)253-3229 PROPERTY LOCATION 100 WILLIAMS ST MAP 32C PARCEL 281 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid 71 W Buildiniz Permit Filled out Fee Paid Typeof Construction: REBUILD FRONT PORCH(SAME FQOTPRINT) New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildin Plans Included: Owner/Statement or License 044314 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: proved 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 CommissionPermitDPW Storm Water Management of 'o Signature of Ikilding 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. I- Department use,only City of Northampton Status of Permit- " — �Qjs Building Department Curb Cut(Driveway Permit 212 Main Street Sewer/Septic Availability E3JiLGIPaG INSPECT4N$ Room 100 Water/Well Availability NC1RTHAMPTON MA01061 orthampton, MA 01060 4Two Sets.of Structural Plans phone 13-587-1240 Fax 413-587-1272 Plot/Site Plans 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 X/ Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record:/ 71 VC -c W�• /'�a/ZG�G�- .d4V f�i F'<-14e P-10- 010 6 y x Name(Print) Current Mailing Addr s X13 -33 37 Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: I`i3 3Y8- 8733 Signature- Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com leted by permit applicant 1. Building j1/r joy/ o np (a)Building Permit Fee 2. Electrical u I� (b)Estimated Total Cost of t Construction from 6 3. Plumbing �/�1 Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) G O a Check Number J 2 This Section For Official Use Only Building Permit Number: . Dalte 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 `'6 Setbacks Front 3" . r7" Side L. R. L.,3- N�_ R::_ �_7, Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved arkin ) #of Parking Spaces Fill: (volume&Location) —A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO () DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0-11"DON7KNOW O YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained 0 Date Issued:Commission?­­__ 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 Q NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,oxcayation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. t SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition E2-1-' Replacement Windows Alteration(s) Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs Jr-1] Decks ff1 Siding[ice] Other[©] Brief Description of Proposed i r Work: QQae r-.o oa_ Q x 5 T►n ot -�rao_� o�-c f b u c ld +AS��` cc/TGA Gc d rncJ Alteration of existing bedroom r'es No Adding new bedroom Yes 'r No A d rative Renovating unfinished basement Yes ✓ No an: �Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building,One Family �''r Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? 14)0 _ d. Proposed Square footage of new construction. l 7rS` Dimensions 7-0 �'R"7—O e. Number of stories? f. Method of heating? /0,c- s a�•r c c- 4t12&n J „2 Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. U Masscheck Energy Compliance form attached? h. Type of construction 4.>, 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 y—C' k. Will building conform to the Building and Zoning regulations? i- Yes No. i. Septic Tank City Sewer ✓ Private well City water Supply SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, < Z'G r.! as Owner of the subject property hereby authorize l C.04 to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date L,,O,VG-,= 164AcS as Owne AuthonzQLi_ ge hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge an eiief. Signed under the pains and penalties of perjury. t,,010'Ak-0 /J400S Print Name 2l,�p�6 Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑�/ Name of License Holder: License Number --/J Address T Expiration Date /3 t3�'8 02]33 nature Telephone 9. Registered Home Improvement Contractor Not Applicable ❑ �Ltv c •. +air � as wQr . Camp ny Name11 /�} Registration Number So, a> acrd f J Wflt321r 4/,zc/c Address 7— Expiration Date Telephone y/.3 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....... 0-' 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.X. 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 Oficial,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 t The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston,MA',02114-2017 t www mass gov/dia Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers = Applicant Information Please Print Legibly Name(Business/Organization/Individual): Haydenvil;le Woodworking & Design. Inc. Address: P.O. Box 1070 City/State/Zip: Amherst, MA 01004 Phone#: (413) 665-7402 1 Are you an employer? Check the appropriate box: Type of project(required): I 1. 0 I am an employer with 9 4.111 am a general contractor and 1 6. ❑��emdling nstruction employees(full and/or part-time).* have hired the sub-contractors 2. Cr listed on the attached sheet. _ 2. ❑ I am a sole proprietor or partner- These sub-Contractors have 8. ❑ Demolition ship and have no employees employees And have workers' working for me in any capacity. comp.insutarice.$ 9. E r Building addition [No workers'comp.insurance 10.❑ Electrical repairs or additions required] 5.❑We are a corporation and its officers have exercised their 11.❑ Plumbing repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL c. 12.❑ Roof repairs myself.[No workers'comp. 152,§1(4),and we have no insurance required.]t employees.'jNo workers' 13.❑ Other comp.insurance required.] .Any applicant that checks box#I 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 mus 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 whetter 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 is providing workers'compensation insurance for my employees.Below is the policy and job site information. Insurance Company Name: A.I.M. Mutual InsuranceCompany Policy#or Self-ins.Lic.#: WMZ-800-8006257-2016'A Expiration Date: 07/01161l/17 Job Site Address: /00 r /it a►•rs City/State/Zip:�r�T+.4... �,.� /�� o�0 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required tinder Section 25A of MGT.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 pains and penalties of per�lury that the information provided above is true and correct Signat I Q Date: a�a91j1' Phone . (413) 348-2 3 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#: S\.Idtspections\PERMIT APPLICATION FORMS\workers Comp.off-pdfdoc HAYDENVILLE WOODWORKING & DESIGN, INC. i ^_ (413) 665-7402 www.haydenvillewd.com ,a MALZONE RESIDENCE 100 Williams St. ax�►�fl��G"c>,� Northampton, MA v Oxy �FPFIrr SCALE: '/"-1'o" DATE: 2/25/16 Gx6 j-ir REVISIONS: ' . Sc civet t f?r��{il G /'XN �rBPTm Is"�.f+•' WEST PLAN& ELEVATION 1 buy Fr i SECTION PORCH SKI ti y� u _ .