12C-075 26 MARY JANE LN BP-2016-1204
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map-.Block: 12C-075 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-2016-1204
Project# JS-2016-002071
Est. Cost: $9550.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 101342
Lot Size(sq.ft.): 12153.24 Owner: GOTTSCHALK LAURA B
Zoning: RI(100)//URA(l00)/WSP(100)/ .Applicant. HOME DEPOT AT HOME SERVICES
AT. 26 MARY JANE'LN
Applicant Address: Phone: Insurance:
5 RIVERVIEW DR (401)935-2633 O Workers Compensation
NORTH PROVIDENCER102904 ISSUED ON:4/19/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.-RENOVATE KITCHEN
POST THIS CARD SO IT IS VISIBLE FROM THE §TREET
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 4/19/2016 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File# BP-2016-1204
APPLICANT/CONTACT PERSON HOME DEPOT AT HOME SERVICES
ADDRESS/PHONE 5 RIVERVIEW DR NORTH PROVIDENCE02904(401)935-2633 Q
PROPERTY LOCATION 26 MARY JANE LN
MAP 12C PARCEL 075 001 ZONE R1000)/URA(100)/WSP000)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
734`-
Building Permit Filled out
Fee Paid
Typeof Construction: RENOVATE KITCHEN
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:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR TSpecial 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
De el
11-1s--161
Signature of Building Off c al 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 Pf Health,Conservation Commission,Department
of public works and other applicable permit granting authprities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
_L
Department use only,
' — City of Northampton Status of Permit: "
Building Department Curb Cut/Driveway Permit
e� 212 Main Street Sewer/SepticAvailability
14 2011 Room 100 Water/Well Availability "
lorthampton, MA 01060 Two'SetsofStructural Plans'
4 3-587-1240 Fax 413-587-1272 Plot/Site Plans
hon_i}�E w,„A A 01m Lu
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
2 /11 �j �-> � L� _ ,� Map Lot ' Unit
1112-7 �,�J�-��/ Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: 77
Name�(jrint) Current Mailing Addr 119 ,Q 9/'t� Civ Telephone /� � r�
Signature T/J ^ ✓
2.2 Au orize Aoent:
Name(P' Current Mailing Address:
Si ture Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building L'— (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) Z> � ,Check Number
This Section For Official Use Only
Building Permit Number: IIsssued:
Signature:
Building Commissioner/Inspector of Buildings Date
t
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 0 DONT KNOW 0 YES 0
................._
IF YES, date issued:li
..............................
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q YES 0
IF YES: enter Book Page, and/or Document
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q 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 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 0 NO 0
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 0 NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORDS(check all a golicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors 1771
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [O] Other[ED]
Brief Descripti n of Propose v y7' �� �� '51l� /.ry0 CI
I IF
Work: 1� L _ -• ev
Alteration of existing bedroom Yes No Adding new bedroom Yes No 'GaIO�L/v
Attached Narrative Renovating,unfinished basement Yes No C �5
Plans Attached Roll -Sheet
sa. If New house and or addition to existing housing:�ormlete 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
I, �/'Jy �J1� as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters re ative k authorized by this bu lding permit/application`.J
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 pa'pis and penalties of Y. /r
Print Name
Signatu f Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction S�uDeer'v�isor: Not Applicable £
Name ovLicense Holder: ]j�� C`� — J��� Y�
�J
License Number
Addre s
Expiration Date
Signature Telephone
4> �--7 53
,
9.Registered Home Im rovem Not Applicable £
"t Contractor:
Company Name Registration Number
Ad re s' q�) Expiration Date
v/ Telephone p �r
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....CAP-", No...... £
11. zw Home Owner Exemptions
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
ne Camnzonwea!M of Plassachwera
DeprarrG;zentofIna us,—IdAcddefds_
` Offwe ofinva-tallow
' a 1 C01i107ess S&64 Suaze 100
ziJWIS:i32IlS_gavIdic
vYor"s-els'Pompenrsationinsurance Affida-sqtaBuilrierslContractorslo,Iectricians/Flumbers
-,M)I1Calai Rill),IIla On t i
j�; Please P�ac�,e�`b�
?Mame(Business/OrQR ' 'onJraa ideal): � �JS'J�- -,'*l�t:y+ tf 7` 1 1 e-�9 'L
Address: �,'Cl
CI�flStatelZm" ry PI74IlZ �i v 9, b
�..re you an employer? Check the appropriate boN:
Type of project(required):
� 1.❑ I�a a�loyer with 4. �1 am geaeGal contractor and z
!
employees(nL m- d/orpart-time).:;: ha re hired te sub-contractors s- [3New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheer. 7. Q Remodeliag i
shipand have no employees These sub-contractors have
Y S. Q Demolition
For`_ng for me in any capacity. employees rad have.workers'
9_ ❑Biding addition
P%!G rorker�' comm inin-2nce coma_instnonce.=
rued} 5. ❑ etre are a cotporation and its IO.Q Electrical repairs or additions
3.7j Tan s homeowner doing all wo]k officers bavo exercised their 1 Ln Phimbing repairs or additions
uryseli_ N- o workers' comp. ,.Q t of exeqaption per brIGL f
insurance requirt i-J t c.152 1(4), lZ' f repAim
§ and we have no
employees.rKo workers' 13. Q
camp.ince required.]
},y aDpheant L32t chem ball'!--mustalso ill otic.the sectionheiow showinw Asir:vor3:rs'compensation Policy inEb mation.
T:Toaeowne;swaosubmitthisawdavitiadicatingtbeyn-adoiagarwo*and 0=hkeoutside matmctarsmunsabutitanrwafdwitindic5masuck
2Conmctors ihat cheer:this cox must attacbad as additiouol she:tshowinS the none o:tho sew-conhactors mod state whether or not ffiose ent-rties have
cmpioyces. K the sub-coru-aaots have cmplu.v=,they mnst provide their wur*ra,comp,poucyrmmber.
I a;;n an employer that is providing Workers'compensation buzlrance for nxy employees Ilelow is the policy and job site
injonrrarion. _
Lnsurance Company Norte: � C;�-y
Policy m or Self-ins.Lic.tk ��% 01 110 3
ITxpiratianDate: 3N17
lob Sir Address: City/StatelZip: "�✓ v
i tfach a copy of the worlrersr canoe fi policy declara-don page(shaving the polity number and a iration date). f
Failure to secum coverage as required under Section 25A ofiIIM c.152 can lead to the imposition of cibninal penalties of a
fine up to 31,S00.00 and/or one-year imprisomneint as well as civil penalties to the form of a STOP WORK ORDER and a fie '
of ug to 5250.00 a dap against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA.far insurance coverage vet cation.
!
X do hereby ce the 'inr p o erjury that the h?fomwdortprovided above is true and correct
Simlature: w�� ' Date: �'
_ f
Phone :
i
,
Official use ordy. Do not write in this area,to be carnpleted ky city or toim of WaL
City or Town: P$rmit/License#
Issuing,Authority(circle one):
3.Board of Health I Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
5.Otber ;
Contact Person: Phone#:
i
- 1
Mike
From: Barbara Roth [barbara@jrcremodel.com]
Sent: Friday, April 08, 2016 11:36 AM
To: Mike
Subject: New Northampton Permit Needed
Attachments: Gottschalk-Dwg.pdf; Gottschalk Signed FIQ.pdf
Please submit for new permit -
Laura Gottschalk
26 Mary Jane Lane
Northampton, Ma 01062
413 585-8425
laurabgotts a live.net
Contract & Drawing attached
Barbara Roth
JRC Remodeling LLC
413-353-1110
1
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: 7 &6� -�F-
7
The debris will be transported by:
The debris will be received by: /BG'fz�
Building permit number:
Name of Permit Applicant
pN
lJ �
Date Signature of Permit Applicant
{
FINAL!Nr$T'ALt.ATION QUOTE
CtnttunerNeaaee moo'LSuta SI11t2A1$
FlrceR Daalya Revls,eo 311 Oil B to fnclude GleGakW costs and 3111118 to dela*lam inais countertops
ter: tai ti$31 OK TO MNAL
Pra►Cotaslrvenal,Deva otlttme.flemWvd.and Hour,Away #1,See.01
ttatall ariv necomary fluor and Site aroWtion
Rermwe existing counterbas and ca&ii naa;
Remove all Job-related delarin from stir
NO removal of the existing bodaolash a antinpAtaii In tMs estlnWte
PN Dolt Cabinet ittatedlatton tt a6TSa
Catrinat lna¢alta5on(include..WAIL Baca.knttudas&Wivos,Filters,St ibe,Toa Kirit,Handles.a Knoba.)
0imom AAmenfUlY or kt8tallaMWet $0.00
Moldilav
l i W $0.40mg,each isyer ancad separately lincludas twowne at m>rnxgt.1 as filler as bacrry�is chorgm m a
saparae laver)
NO MOL rXNG INSTALLATION M ING.UDIQ
Elr4tdCa1 3a,85D.62
ocrito wirtng for new refrigerator irstation
Remo wlring to wall ntaefnt exhaust fan
QenW extstingckxk&AIet
Install new arcuit to frtimWave
Install new circult for refrigerator
Install four rww counter outlets per cleariral evde
RWlocate switch for garbage disposal
Install new Switch ant light in entryway(owner leo supply light
PfimibMnp ;t,g07 J0
0t/connect link and deshwasher plumbing
Raconnectlink and dishwasher Plumbing after new to ntertaps are in pie"
/lpptfamca Wwwaft" i5pa 10
t`,lseonrwct and remove refrigerfrtor,range and dishwasher
install and cpnriatt range,raffh,erAtor and dtahwasher
Fleeting sew soct#pttyh installation T0.00
NOFtt' lNGWORK 151NCIUDEo
Drylvadif Work a E+MnttreQ ti'w7t
close LAP oke stoveaige and vent holes at link wall and melee drywall repairs
Tiled area at aid thrauil f ft-waff vent to be rapaired with tine
Supplied by the homeowner
NO psi"is included In tN$estimate
Additional Charge$(lf appito")
pD.oD
Peatntts
Plumbing
Building
phase now permit fees,if listed,are only animated.By illtriksg IN&KiW farm the customer
tgr9es tp stay
Only thepermittem aaested for tMe profecL Anydiffaresix;betwean the estimaaed lea end the attwl
aceataed fee will ba t'xMacted from m refunded to the cuslKimar,
Low Sate Work Practk"
Atuoolos May pe present in a roma bung oatwean 1yq ani,2Y,l0 ant}Lego paint may De prtscM m A name
built before 1978-Additional ctraraes may occur if tine tultpnier does not dispose of product Der Fedarat
Mandel»of L*od Safe Proctkas
Notep on flea 110101e0
ON RAKE OCCASIONS,ASI MkIAL WORK IS o WVEI 3Fp AFTER A PROJM HAS STARTED,THE
CUSTOMER AGREE-8 THAT THIS ESTIMATE IS vALiD ONty FpR THE WORK LiBTEU AND THAT ANY
ADDITIONAL WORK ThiA'f tS DMOOVERED AFTER THE ARtCAW-cT Wt�3 BErLIN W-r WAS FITHER
MISSED ON THE ORK3114AL BID Qt{ARISE$DUE TO UNFORESeM CIRCUMSTANCES tWL. THER T
W AUDITIONAL C,f1hR(;G£THAT MUST BF PAIfD FOR B&OW Tf(F WOAK CAN BE;CQMPLf MM
terser signatum.- :
ACsiflnenew:_ — Dow—
ozsa9G899sL << Lo
s03ax3 oo:sL 90-"-9L02ZIZ d
195"
30" 36" 30" 3011—/ 69"-
31'
302T— 65 s" 37" 30"
120"
W3036 BUTWMSC301236 BU T j
018X24DP8 TT
SB33 BUTT DASH-106 821 n iFt
i
r
Fu}lin ceramic the under � ry
'o {,*rgera r eon
Customer flas extra tjes
Ar;,.,.i er here
DD
CUStO Iter would ike to range thils
cabinet so tihaf she can have a raci:us
a'the encs of the countertop r
q3l6R
o
UT
021 BUTT W1836L _
i
i
73121R'
-,
37" 75" 3"
871,
195"