24D-089 64 NORTH ST BP-2016-1154
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24D-089 CITY OF NORTHAMPTON
I..ot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Categoryrenovation BUILDING PERMIT
Permit# BP-2016-1154
Project 9 JS-2016-001998
Est. Cost: $1500.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MICHAEL L HARRINGTON 102948
Lot Size(sq. ft.): 7100.28 Owner: HARRINGTON MICHAEL L
Zoning: URC(100) Applicant: MICHAEL L HARRINGTON
AT. 64 NORTH ST
Applicant Address: Phone: Insurance:
P O BOX 393 (4I3) 575-8345
NORTHAMPTON ,MA01061 ISSUED ON.•4/6/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.FOUNDATION REPAIR
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 4/6/2016 0:00:00 $100.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File 4 BP-2016-1154
APPLICANT/CONTACT PERSON MICHAEL L HARRINGTON
ADDRESS/PHONE P O BOX 393 NORTHAMPTON 01061 (413)575-8345
PROPERTY LOCATION 64 NORTH ST
MAP 24D PARCEL 089 001 ZONE URC000)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid 011 orfvv
Building Permit Filled out
Fee Paid
Typeof Construction: FOUNDATION REPAIR
New Construction
Non Structural interior renovations
Addition to Existing
Accessoty Structure
Building Plans Included:
Owner/Statement or License 102948
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOR TION 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
UeMlition Df.JAv
oey
Sign f Building AficKI 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.
Versionl.7 Commercial Building Permit May 15,2000
Department use only
ity of Northampton status of Permit:
APR - 1 2016 Euilding Department Curb Cut/Driveway Permit
212 Main Street sewer/SepticAvailability
i ops Room 100 WaterM/ell Availability
hampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify - -
APPLICATION TO CONSTRUCT, REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
L{
A)01L I Map Lot Unit
NOil P"T OA / /�
M f9 U 6
/61 Zone Overlay District
......... _.__..._ .... Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: �C L
2r �o(LTU rM
Name(Print) Current Mailing Address:
Signature Telephone
2.2 Autho ed Agent:,/
„ .
.. ��y ...
Name(Print) Current Mailing Address:
Signature Telephone
SECTI 3-E IMAT ONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com feted by permit applicant
1. Building ,,] (a) Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
c,
4. Mechanical(HVAC)
5. Fire Protection
6. Total= (1 +2+3 +4+5) 0 O a -tb Check Number
T_his_Section_For_Official--Use-Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
Version 1.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑
Brief Description ?Enter a brief description here.
Of Proposed Work: rd>(-)A QTV76 q �0
SECTION 5 -USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A AssemblyElA-1 ElA-211A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑
2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential R-1 ❑ R-2 R-3 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify
M Mixed Use ❑ Specify:
.............. _. ............ _._.. ..... ... .....
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
_ .
Existing Use Group: Proposed Use Group.
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): .....
SECTION 6 BUILDING HEIGHT AND AREA
OFFICE USE ONLY
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
Floor Area per Floor(sf)
ist
1 sc
..,. 2nd
2nd
___. . ....._.._...._ ..__._.__..........._..........__....._
rd
3
3rd
............. ...._.............__._.. ... .......
_. 4m
4in .. ..... ..
_.........................._..............._................_.................__........._..._........_........_..._.:
Total Area(sf) Total Proposed New Construction(sf)
Total Height(ft)
Total Height ft _
7.Water Supply(M.G.L.c.40,§ 54) 7.1 Flood Zone,lnformation: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone[] Municipal ❑ On site disposal system E]
Version L7 Commercial Building Permit May 15, 2000
S. NORTHAMPTON ZONING
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 Panting Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Findin er been issued for/on the site?
NO 0 DON'T KNOW YES 0
...
IF YES, date issued:
IF YES: Was the prr e 99 rmit recorded at the Reg' ry of Deeds?
NO 0 DONT KNOW YES 0
IF YES: enter Book Page an /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 Obtained 0 , Date Issu d
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 0 NO
- ------- IF YES,, describe size type and-location:
-- -
E. Will the construction activity disturb(clearing, grading,e
ion,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
Registration Number
Address __...
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
NameArea of Responsibility
...
Address Registration-Num ber
i
Signature Telephone Expiration Date
................... .. ..... ................ ..........
Name Area of Responsibility
Address Registration Number
Signature
Telephone Expiration Date
_... ..
Name Area of Responsibility
Address Registration Number
.......
Signature Telephone Expiration Date
.....
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
�� !!G�7 ', �L , _._. . .......... .. .."`"• .. Not Applicable ❑
Company Name:
Responsible In Charge o Construction
Address
Signatur i Telephone
i
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) —7
Independent Structural Engineering Structural Peer Review Required Yes (D No 0
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property
hereby authorize _ __ _._ . _ _.___. ____ __. to
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
as Owner/Authorized
Agent hereby declare that the statements and information on th foregoing a lication are true and accurate,to the best of my knowledge
and belief. ,
Signed under the pains.and penalties of perjury._„ __
f .
Print Name
�JG 17�
Signature o Owner/Agent v Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor. Not Applicable ❑
_. w.
Name of License Holder:
License Number
Address Expiration Date
Signature -- Telephone
SECTI N 3-W RKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6))
Workers Compensation Insurance affidavit must be comp) 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
The Commonwealth of Massachusetts
f Department of Industr fad Accidents
}= Office of Investigations
600 Ul'ashington Street
Boston, MA 02111
www.rnass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Bus iness/Organization/Indi vi dual): _
Address:
City/State/Zip: Phone#:
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
employees (full and/or part-time).* have hired the sub-contractors
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. [J Demolition
'
worl g for me in any capacity. 9. ❑ Building addition
woremployees and have workers
�
kers' comp.insurance comp. insurance.*
equired.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
�. 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.❑ oof repairs
employe
insurance required.] t c. 152, e es. [No workers' 44��-��1(4), and we have no 13 VOther -OUMOA--06
comp.insurance required.] t__ A
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
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.
lam az employer that is providing workers'compensation insitrance 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 aga st the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the D f r insur ce coverage verification.
I do_hereby certify e t e p and penalties of pe>jury that the information provided above is true and correct.
Sienature: Date: — " /
Phone#:
Of use only. Do not write in this area, to be completed by cit) or town offzciaL
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#:
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