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39A-003 (3)
86 CONI ST BP-2016-1347 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 39A-003 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2016-1347 Project# JS-2016-002313 Est. Cost: $13800.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: J D RIVET & CO INC 050230 Lot Size(sq.ft.): 12327.48 Owner: SERVICE PROPERTIES INC Zoning:NB(100) Applicant: J D RIVET & CO INC AT. 86 CONZ ST Applicant Address: Phone: Insurance: P O BOX 51068 (413) 543-5660 Workers Compensation INDIAN ORCHARDMA01151 ISSUED ON.5117/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF 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 Siznature: FeeType: Date Paid: Amount: Building 5/17/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Department use only RECEIVED City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit # 17 2016 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability rthampton, MA 01060 Two Sets of Structural Plans WX°FMMDM 41 7587-1240 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 (.Onl' S5t Q Map Lot Unit R Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: rn�^5 l tv Na rint) Current Mailinq Addres _ ij,.1 Telephone atur 2.2 Au orized A ent: e(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building„ Ic- a�^ ISS "L (a) Building Permit Fee 2. Electrical ll (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) _ Check Number M This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date �,. �h 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 2,Z) N/, Bldg. Square Footage % r 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 9 DON'T KNOW ® YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DON'T KNOW © YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW ® YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained ® , Date Issued: C. Do any signs exist on the property? YES 1� NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO (� IF YES, describe size, type and location: W 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 ® NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding[1--3] Other[O] Brief Description of Proposed Work: --Ne, eA1, �j��✓�� k5 WG ti►�� Alteration of existing bedroom Yes No Adding ew bedroom Yes x No Attached Narrative Renovating unfinished basement Yes _2_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 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 er as Owner of the subject property L hereby authorizes to act on b �Mtterselative to work authorized by this building permit application. Si ture of O er 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 and r the pains and penalti s of perjury. Print Name "W- AA6 Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 7 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: JAN V 2�LCe Gs o SU2-30 License Number � .SbM M& Olv!�; 7/z//2v 1,6 x Address Epion Dat t Si Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone 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 Exemution 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 ne Commonwealth of Hassachoseft Depai�tof.TndusbialAccldents Office of hmstigadow 600 Washington Street Boston,DSA 02ZIl wwwtmast�gotiddia Workers'Compensation Insurance Affidavit:EvAdere/Contractors/E2ectridana/Plambers A iftaut lnformadon Name(g pct„ : J.D.Rivet & Co., Inc. Adm: 1635 Page Blvd. Springfield, MA 01104 per* 413-543-5660 Are you an employer?Check the appropriate born Type of prof pct(regaiseM: 1.[A I am a employer with 6 5 4. [3 I em agemeral cm6aator andI s Lave hired the mons 6. Now oaasfstedian employees sole (Rcpt ietor r parftwe- �d on the attached shut 7. []Remodeling 2.0 Iona a sopa pmprisetororparta�. ��eab-eta�� ship and Lave no employees � and Lava water' S. ❑I=only wo*US for me 1n any cgxwlty, 9. 0 BuMEmS addhion [No wostme comp.bmnance cmpp.iosmmca.! mqWrod-] S.❑We are a corporedou and its 10.0 Beard repairs or&Melons 3.0 I am a homeowner doing all work offices have wmcbed their 11.0 Plumbing repairs or additions .tayW£Wo wad='GUI,. rlghtofcmmp ioapwMOL 12.M Roofrepubs inscruice l t a IA J1(41 tmdwe haven ampbYeea.[No wadoers• 13.0 Other jasuxa=c `�gapptt�tt�+a�hmtdt moot also 8f1 ow da 000Boa batoW o6ovotagthdcvia�a'eompmosadoa m>lw . tHoweoMMwhosabmitdhd8davi kdwdagdayam&bgdtwadcaadttuotdroo idaaoaf naatoabdtaaawamdavtttadtomtogsveb. kbAhoe=thAcb@**BboxwMatmdod= tdaat gdmcowaithameadaasawbeaherarmudmteeaddeohave �+P ifthesubeoatracoas havo aomyloyas„ttioyamotp�evhtoQmFr Mroeloaos'oomp.poltay amdaz �for�f �than tr prot+ldtr�wortpwar'�i�umus for ury en�ployeeer. BaJow�s lhelao�atrdJob elle yastnsmoeCtnpaayNamet American Casualty Df Reading PA p0jy#0r ,Imo,k 5092136486 PxphadtmDate: 5/1/17 Job SiteAddressi U b n Z j /hAN Z-)(o Attach a copy of the worlcoW aompeandu polky declsratica pap(dwwlag the policy umber sad; n date). Failara to st'cuaro oaverago as required ander Season 2SA gfMM a Moon leadto the hmposidon of a imiael penalties of a &a up to SIAM amdlorocbvur*dsonment ea WA as chip pesmMW b,do fou ofa STOP W=OEM ad fms of up to SM 00 a day Wind flea vlaWor.Be advised tbat a copy ofthis teatemalmsy be forwarded to the Office of Ion udgedoms of ft DIA for inumu a coverage veddoodon. !do bar3by die !►eRamies 4fP tdras the t�onsamiob provided above true andoorrad DOW Of/7dad ase w* Do cwt wft n tblsore4 t,becoWded by*ortowu qofdd C1W or Town: . Permit2lcrose i# Sewing Amthoft(drde one): 1.Board of Raalth 2.Building Depaotmneat 3,City/Tom Clerk 4,Ll Add Inspector 5.Pltamblag lnspoctor d.other Contac!Petaon: 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: C�n � The debris will be transported bv The debris will be received by: Building permit number: Name of Permit Applicant �. h Date Signature of Permit Applicant