38D-027 (4) 14 HAMPDEN ST BP-2016-1211
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38D-027 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ELECTRICAL BUILDING PERMIT
Permit# BP-2016-1211
Project# JS-2016-002051
Est. Cost: $25014.00
Fee: $163.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: KITCHENS OF DISTINCTION 081778
Lot Size(sq. ft.): 5619.24 Owner: BENT APRIL
zoning: URB(100)/ Applicant: KITCHENS OF DISTINCTION
AT. 14 HAMPDEN ST
Applicant Address: Phone: Insurance:
P O BOX 1225 (413) 569-1100 WC
SOUTHWICKMA01077 ISSUED ON:4/21/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL KITCHEN
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 4/21/2016 0:00:00 $163.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File# BP-2016-1211
APPLICANT/CONTACT PERSON KITCHENS OF DISTINCTION
ADDRESS/PHONE P O BOX 1225 SOUTHWICK01077(413)569-1100
PROPERTY LOCATION 14 HAMPDEN ST
MAP 38D PARCEL 027 001 ZONE URB(100)
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: KITCHEN&DINING ROOM ADD RECEPTACLES AT COUNTERS �G
New Construction Akt!:� t
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 081778
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFF03A+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
olition elay
Sig o uil ing O ficial 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 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
Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
_ Telephone
Signature
2.2 Authorized Agent:
Ole-�,bjj1SJ1J?G4*h)
4 6qX 1!�e� *y
Na Current Mailing Address:
eo
Signature Telephone
SECTION 3-ESTIMATED CONST TION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building O d ' to 3 (a)Building Permit Fee
2. Electrical f Of (b)Estimated Total Cost of
a Ub Q Construction from 6
3. Plumbing y . Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2 +3+4 +5) Z j U `�, la 3 Check Number
This Section For 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 O DON'T KNOW O YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW Q YES Q
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q Date Issued:
C. Do any signs exist on the property? YES Q NO Q
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 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 Q NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) 7
New House [] Addition Replacement Windows Alterations) Roofing
Or Doors D N I
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding[01 Other[tom]
Brief Description of Proposed l+cA m�
Work: K �/
Alteration of existing bedroom Yes No Adding new bedroom Yes !\ No
Attached Narrative Renovating unfinished basement_ Yes _No
Plans 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 c s u do 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
1, _ as Owner of the subject
property
hereby authorize (( j (J Q
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 the:foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and/penalties of perjury.
Print N
Signature of Owner/Agent Date /
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: �F Q �� ���►!�
` ! I W 1 t �C[L!i/ I LicenseCS 0 e9 r/ �,11179
Address Q/03� Expiration Date
9464W 9
�64'SignatureTelephone 5 2—(j //
9. Registered Home Improvement Contractor: / -(k(, Not Applicable ❑
k4thow
Companv NameRegistration Number
sq
� Ca/� � cSd�
Address fir Expiration Date
= Telephone A113 SM /
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....... ❑ No...... ❑
11. - Home Owner Exemption /U/4
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to 1110w 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.
/ Iso be Avised that with reference to Chapter 152(Workers'Compensation) and Chapter 153 (Liability of Employers to
1,mployees for inj uries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perforin 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.
Homemi ner Signature
The Commonwealth of Massachusetts
} Department o f Industrial Accidents
Office o f Investigations
I Congress Street, Suite 100
Boston, MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address: A
City/State/Zip. O �r Phone #:
Are you an employer? Check the appropriate box: Type of project(required):
1. I am a employer with -7 4. ❑ I am a general contractor and I
employees (fall and/or part-time).* have hired the sub-contractors 6. r_1 New construction
2.❑ 1 am a sole nroprietor or partner- listed on the attached sheet. 7. remodeling
shipand 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.
1
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 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] + c. 152, §1(4), and we have no 13.E] Other
employees. [No workers'
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 must submit a new affidavit indicating such.
'Contractors that check this box mist attached an additional sheet showing;the name of the sub-contractors and state whether or not those entities have
employees. It 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:_�JISJ)9 CWlCO if
Policy# or Sell-ins. Lic. #: 67 Y 060 5D -7 //4C Expiration Date: r
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 sccurc coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S 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 statemenj may be forwarded to,the Office of
Investigations of the DIA for insurance coverage verification. 0�(,It/ I /s/(I
Ido hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
�( Signature: _ Date:
1� Phone#: Mz
(6�z� LgL— , —
Official use onk'v. Dv 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#:
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:
The debris will be transported by: 0')e o W �'
The debris will be received by:
Building permit number:
Name of Permit Applicant �j 2
doI (a Z�
Date ignature of Permit Applicant
Kitchens of Distinction
599 College Highway
Southwick, NSA, 01077
Bill TO: Bent Resi� Ship To: Same As Bill-To: Date: 2/17/2016
14 Hampden Street
Northampton,Mass,01060
Phone: 413-335-9746 /413-575-2295 Designer: Ryan Ha 530-9172 Cell
Office Use DESCRIPTION PRICE
Kitchen B-ti hton Cabinetry-AIIPlywood Construction $9,107.00
0,) ac)AuWood.•Maple Paint.•Shade
Door Style: Meadowview Raised Panel Semi Overlay
DrawerFront. Matching Slab
Dining Room Dining Room in Cherry Inset $2,967.00
Finish:Bourbon
Door Style:Hr bland Raised Panel-MatcAh2g Slab Drawer
Carpentry includes the folio . Take Doom Half mall $3,560.00
Frame and Sheetrock new half wall. Install all new
.kitchen cabinets, hardware, toekick, ..fillers
Plumbing Estimate includes disconnect and $2,910.00
reconnect of sink, faucet, G.D, Dishwasher, move `✓�� Q67�'
Gas line -Install new sinkin Dining Room ro
(Cut and Cap Lines -Provide new Shutoffs)
Labor Total $6,470.00
Materials Total $12,074.00 �Io'".
Sales Tax $754.63
Terms 40%Down-40% On Start oflnstall Total: $19,298.63
Balance on Completion Deposit: 47,700.00
Approval: - RN Balance- $11,598.63
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