24D-258 (3) 133 CRESCENT ST BP-2016-1265
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24D-258 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 RUILDING PERMIT
Permit# BP-2016-1265
Project# JS-2016-002174
Est. Cost: $261000.00
Fee: $1697.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SACKREY CONSTkUCTION 040714
Lot Size(sq. ft.): 12632.40 Owner: SANDERS PEIGGY
Zoning: URB(100) Applicant: SACKRE ( CONSTRUCTION
AT. 133 CRESCENT ST
Applicant Address: Phone: Insurance:
83 SOUTH MAIN ST (413) 665-9995 O Workers
Compensation
SUNDERLANDMA01375 ISSUED ON:5/3/201 '0:00:00
TO PERFORM THE FOLLOWING WORK: ONVERT 2 FAMILY TO SINGLE FAMILY
POST THIS CARD SO IT IS VISIBLE FROM THE §TREET
Inspector of Plumbing Inspector of Wiring D.P.W4 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:
FeeT_ype: Date Paid: Amount:
Building 5/3/2016 0:00:00 $1697.00
212 Main Street,Phone(413)5l37-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1265
APPLICANT/CONTACT PERSON SACKREY CONSTRUCTION
ADDRESS/PHONE 83 SOUTH MAIN ST SUNDERLA 01375 (413)665-9995 Q
PROPERTY LOCATION 133 CRESCENT ST
MAP 24D PARCEL 258 001 ZONE URB(100)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATIQN CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid 72 77 _
Building Permit Filled out R
Fee Paid
Typeof Construction: CONVERT 2 FAMILY TO SINGLE FAMILY
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 040714
3 sets of Plans/Plot Plan
v
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 sPermit DPW Storm Water Management
oliti n
Si ure of BuAlii�gfbfficial Date
Note: Issuance of a Zoning permit does not relieve a applic#nt's burden to comply with all zoning
requirements and obtain all required permits from Board f Health,Conservation Commission,Department
of public works and other applicable permit granting auth;rities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
a � 1
Department use only
City of Northampton Status of Permit.
a Building Department :Permit
212 Main Street
Sewer/Septic Availability
IPR 27 2016 Room 100 WaterNVell Availability "
Northampton, MA 01060 Two Sets of Structural Plans
DEf T y p one 413-587-1240 Fax 413-587-1 X72 Plo.t/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
_ `
3` �t ? 3 � C{I�.j.� S Map Lot Unit
Zone: Overlay District
EM St.District GB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Telephone J
Signature
2.2 Authorized Agent:
cJ6 � L a s . A-" S', Sj kZ
e(P K t Current Mailing Address:
.)1o3 - 6 (03 `
,Sig re Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
7— CFD
2. Electrical (b) Estimated Total Cost of
Construction from(6
3. Plumbing ' tl�—U Building Permit Fee
4. Mechanical (HVAC) -Z 0 �� I
5. Fire Protection
6. Total=(1 +2+3+4+5) ply—P Check Number
This Section For§fficial Use Only
te
Building Permit Number: IIssisued:
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
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 DONT KNOW 0 YES 0
....................
IF YES, date issued:'
.......... .......................
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW O YES 0
........ _._._.. __......
IF YES: enter Book Page; and/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 obtainedQ Obtained Q , Date Issued W,A.
C. Do any signs exist on the property? YES 0 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 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 C)
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
i
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs',[0] Decks [M Siding[O] Other[ED]
Brief Description of Proposed �^
Work: elav\Vt'tJ�.'t Pt9�ISft�lcs 2 r
- INyukk'IC,, -Co kmt Lh
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 housthe following:
a. Use of building : One Family f Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached? t�iS
d. Proposed Square footage of new construction. Dimensions
e. Number of stories? p
f. Method of heating? Cr t�&k(_l-,o to Fireplaces or Woodstoves Number of each Riki PCA
g. Energy Conservation Compliance. Mosscheck Energy Compliance form attached?
h. Type of construction UJ
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 PE�RMIT
I, - k as Owner of the subject
property J
eFeb
C/fid Cor,)3LL
to act on m in aematle4 rel f e to work authorized by this building permit application.
Sig of Owner Date
I, �g"'t4 Go,'Q13 as Owner/Authorized
Agent hereby declare that the statements and info ation on the foregping application are true and accurate,to the best of my knowledge
and belief.
Signed under(the pains and penalti�°f perjury.
JY JAc:
Print Name
Signature of Own Dale
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: /Not Applicable £
Name of License Holder: d�cht K a fi ,--+ � 5- (2)—`79 ')>.S 4
p License Number
10/I Y te
Address Expirati Dat
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable £
Company Name Registration Number
8 _� StN�r`}-�0 c�. S c�•,—�-Oy4l���►—� `1 / --2—`I°
Address Expiration D to
Telephone )(0 3'(P G C(
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'
The current exemption for"homeowners"was extended to include Owner-occupied Dwellines 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
The Commonweath of Massachusetts
Department of 1ltdustrial Accidents
Office of Investigations
( -• �' 600 Washington street
-'- Boston, CdA 02111
V
x www.mgss.gov/dig¢
Workers' Counpenns2Uou Inssumnee Affadavni: Builders/CoIlntrzetors/ERectiric!2ns/?Rumbe>rs
Afp»lneaant Information Fle2se Print Legibly
Name (Business/Organization/Individual): S 4ck,
Address: S . w,�t x
City/State/Zip: J u r�.iw4Xt.t�kys,p V� /� Phone #: ( j 3 5
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
employees (full and/or part-time).
* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on tho attached sheet. 7. ❑ Remodeling
These sub-contractors have
ship and have no employees 8. ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.$ 9. ❑ Building addition
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.] t c. 152, §1(4�, and we have no 13.❑ Other
employees. [No workers'
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
tHo meowners 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.
I am an employer that is providing workers'compensation insugrance for my employees. Below is the policy and job site
information.
Insurance Company Name: 1
Policy#or Self-ins. Lie. #: Expiration Date: 1 -7
Job Site Address: 1 3 ( " ( 3 :5 C-"SC,.,L .PT- . �Z6&4 City/State/Zip: �T
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 MGA,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 certi under the pains and penalties ofperjury that',the information provided above is true and correct.
Signature: Date: Z J
Phone#:
Official use only. Do not write in this area, to be completed 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 cf Northampton u
i l
f
Massachusstts 1,L{:
f s DZ2ART1�MNT OF BUZZDZiNG 11MVECT OBT5 �
�. 212 Main Street ® Municipal Building •�:- �v.
Northampton, MA 01060 Jprh VLt%"
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her
construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which
he/she resides or intends 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 home owner."
The building department for the City of Northampton wants any person(s)who seek to use the home
owner exemption, to act as their own construction supervisor, to be aware that by doing so you
become responsible for compliance with state building codes and regulations. The inspection
process requires that the building department be called to inspect work at various stages, which include
foundation/footings (before backfill) sonotube holes (before pour) a rough building inspection
(before work is concealed), insulation inspection (if required) and a final building inspection.
The building department requires these inspections before the work is concealed, failure to secure
these inspections can result in failure to obtain a certificate of occupancv until the work can be
inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be
responsible to make sure that the trades hired secure their proper permits in conjunction to the building
permit issued, and that they get their required inspections. Failure of the individual trades to secure
the permits and inspections as required can DELAY the project until such time as the proper permits
and inspections are made
I understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit issued to me.
Date
Address of work location
I
City of Northampton L212 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: ����� �,��� S �,
The debris will be received by: ') LLAi u kr7 C�j 9G--
Building permit number:
Name of Permit Applicant S A, -; -' C4*-L e,
Date Snature of Per it Applicant
i 071147111 u
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WINDOW SCHEDULE
Key MAKE Model Type Rough Opening Jamb Header Head HT. Remarks QTc"' j
A integrity ITAWN2927 Awning 2'-5"x2'-33/8" 4lite 5INS'oL "Cti .
Wood Ultrex avTSW
B Integrity ITDH3056 2W Double Hung pair 5'-0"x 4'-8 t/4" 4/1 1 . 1?
Wood Ultrex �--- ----�
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C Integrity ITDH3056 Double Hung 2'-6"x 4'-8 t/4" 4/1 2
Wood Ultrex ( - 6
D Integrity ITDH3068 2W Double Hung pair 5'-0"x 5'-8 1/4" 4/1 Cottage Style 3
Wood Ultrex
E Integrity ITDH3068 Double Hung 2'-6"x 5'-8 1/4" 4/1 Cottage Style 3
Wood Ultrex __ I
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F Integrity fTC2939 2W Casement pair 4'-8"x 3'-3 5/$" 4 lite 1
Wood Ultrex
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DOOR SCHEDULE
-Key MAKE MODEL STYLE SIZE TYPE ROUGH OPENING #Jack JAMB LOCKSET
Studs
1 T.B.D. 1/4 lite,2 panel 3068 LH
wl2 sdlts.
2 T.B.D. 1h lite, 2 panel 3068 RH
3 Integrity ISFD6068 French Door 6068 i
Wood Ultrex Slider
4 Jeld Wen Pro-Core Rockport,5panel 4068 Pair j I
5 Jeld Wen Pro-Core Rockport,5panel 2868 RH isi I
6 Jeld Wen Pro-Core Rockport,5panel 2668 RH I s
7 Jeld Wen Pro-Core Rockport,5panel 2068 LH
B Jeld Wen Pro-Core Rockport,5panel 2868 Pocket frame C�7-0 ,.
9 Jeld Wen Pro-Core Rockport,5panel 2668 RH
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10 Jeld Wen Pro-Core Rockport,5panel 2668 RH
11 Jeld Wen Pro-Core Rockport,5panel 21068 LH so�
12 Jeld Wen Pro-Core Rockport,5panel 2668 RH a '�
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13 Jeld Wen Pro-Core Rockport,5panel 2468 LH
14 Jeld Wen Pro-Core Rockport,5panel 2868 Pocket frame n__._ .,_._ _,_......... . .....-..-�,. __.._...
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16 T.B.D. Garage Door 8070 Overhead Dr. { ,
17 -P'i�� � `I `a 1 "' �L�tvS — � 1 ;F�_M.t r r-L�Aj
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