29-388 (7) 52 BROOKWOOD DR BP-2016-1486
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-388 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGLLcc.1144/2�A)
Category: HANDICAP RAMP BUILDING PERMIT
Permit# BP-2016-1486
Project ft JS-2016-002547
Est. Cost: $6500.00
Fee: $0.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JOHN HOOGSTRATEN 142958
Lot Size(sq. ft.): 15725.16 Owner: HALE TED 0&REBECCA.1 OTIS
zo ino: Applicant: JOHN HOOGSTRATEN
AT: 52 BROOKWOOD DR
Applicant Address: Phone: Insurance:
P O BOX 415 (413) 268-7523 O
WILLIAMSBURGMA01096 ISSUED ON:6/15/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:MAKE ENTRANCE WHEELCHAIR ACCESSIBLE -
ADD RAMP, REPLACE SIDEWALK, REPLACE DOOR(SILL)
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 it 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:
FeeTvpe: Date Paid: Amount:
Building 6/15/20160:00:00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1486
APPLICANT/CONTACT PERSON JOHN HOOGSTRATEN
ADDRESS/PHONE P O BOX 415 WILLIAMSBURG (413)268-7523 O
PROPERTY LOCATION 52 BROOKWOOD DR
MAP 29 PARCEL 388 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT /��l
Fee Paid (1,c,„-ii /A2 a1 Y0ts
Building Permit Filled out
Fee Paid
Typeof Construction: MAKE ENTRANCE WHEELCHAIR ACCESSIBLE-ADD RAMP, REPLACE
SIDEWALK,REPLACE DOOR(SILL)
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 100999
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
roved 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 Pennit 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 Pennit DPW Storm Water Management
Demolition Delay
oor
Si•.: • e ." :wilding fficial 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.
='
City of Northampton Status ofPermit: Department use only
✓ V Building Department Curb CWDriveway Permit
212 Main Street Sewer/SepticAvalabiity
Room 100 water/Well AvadaSity
Ca/U:_ C_t1 Northampton, MA 01060 Two sets of Structural Plan
_ phone 413-587-1240 Fax 413-587-1272 PIot/SIe Plans
Other Specify
NL)IK
vryI� APPUCATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
'J
II SECTION 1-SITE INFORMATION
1.1 Prooerh Address:
This section to be completed by office
52, Bv00Lt000 it D.c Map Lot Unit
Pio+r..,tcc , M A , 01062— Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Rocorj:
RAIN Q t;s * "T• �.
FLA c.. s2 6roo kt, el 4l
�o or
IN _
Name Jy� Il '`-, Current Mabry Address:
- / J // Flo+w « M 2.
P� o1O6
Telephone
Signature 5 By - 31 5 3
2.2 Authorized Agent:
is LI $A00 p StCa h P.O. 130i4 14C , 1.4:11...vni\ew7 ,hit Pc
Name(Pn J Current Mailing Address: 0 o s6
J 1L-,, ,, _74.=. 263 - 2s23
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building .cit & 1500 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing BuildingjP Permit Fee /S
4. Mechanical(HVAC)
5. Fire Protection U
6. Total=(1 +2+3+4+5) 6I 50 O Check Number �0 702 `
This Section For Official Use Only
Building Permit Number Date
at
ed:
Signature:
I Building Commissioner/Inspector of Buildings Date
Section 4. ZONING An 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 it 5 A • t/—
Frontage Z $O +/—
Setbacks Front 3 b yp'
Side Lam- Rte— L: 30' R: SO'
Rear H/A
Building Height N/A
Bldg.Square Footage %u
Openpan Footage
&apg /
(LotaSpace
paved
#of Parking Spaces it /A
Fill: N/ X
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page ccc777��s and/or Document
���yy #
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ® Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO
IF YES, describe size, type and location: •
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO ,er
IF YES, describe size, type and location:
E. Wil the construction activity disturb(clearing,grading,exc�a 'on,or filling)over 1 acre oris it part of a common plan
that MI disturb over 1 acre? YES O NO
IF YES,then a Northampton Stoml Water Management
Permit from the DPW is required.
SECTIONS DESCRIPTION OF PROPOSED WORK(check all applicable) µ'
New House n Addition 1E1 Replacement Windows Alterations) Roofing n
Or Doors O 7—
Accessory Bldg. tEl Demolition ❑ New Signs [171 Decks [q Siding[CI] Other[I7j
Brief Description of Proposed 11
Work: Mas caTrawcc ja"k acr atcf SeiYl2 — sAi cawc‘pr •He,Acc Si I fW„c rci\Ac<-
)zrw- C5,-1>
Alterationnarratbedroom Yes No Addingnewbedroomiched Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Ga.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 constmction 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 budding 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, peat to O. 0 }i3 A- scan R "At= as Owner of the subject
property f1 l
hereby authorizz�� J o et R oo '�,,.,\v uk
to ad an-Ifj bAyialfl in all matters relative to*Ark authorized by this building pr•,tmlt application.
tie
Siena y,/ooff.,OOwwnner 11 Date / Co
1111111.. .111111
J e L T e 0 e c\r A.M ,as Owner/Authorized
Agent hereby declare that thetstatements and information on the foregoing application are hue and accurate,to the best of my knowledge
and belief.
Signed under the pains andel pen
�<alties of�peijury.
r�
Print Name
J �L� b/w/t 6
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 licensed Construction Supervisor:
11r1. Not Applicable 0
Name of license holder: .,•4r, Woe
J License Number
tOC Octkccont qct R9 . P.o . Soy. 4022525
Address Expiration Date
Itl i I k: w t : ko `N 1 19%. {\ o I O 9 12-/11 / t o t -/
Sg-\tu /I Telephone
/w\ 913 - 2 6 fs -75 2 3
y.Realslered Home Improvement Contractor:.nk. Not Applicable ❑
3 . 1�W � s�r w.. RAZ 4 S
Company Name Registration Number
P. o . Sex cos / 2-01g
Address Expiration Date
(�
:(Lt
fliPowei Sko MPi\ 0109(, Telephone Z6 &-7512.3
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 )4 No 0
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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.OUR 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 he,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
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: SZ 13=croKwc/0 Dr . Fie rcrt‘et—
The debris will be transported by: N oftA.ww krp'i oe Ca.,.c v rte_
The debris will be received by: -s{_
Building permit number: t 1
Name of Permit Applicant .S®L IA as
Date Signature of Permit Applicant
6c,A Lt, k.e on k
Mss L . el C 5 \ o (frj : I lkt taws 5 L wr IY(ANS cU./-
c-J1- -w.
The Commonwealth of Massachusetts
— Department of Industrial Accidents
Ia--`= b
I'='_lla Office of Investigations
�_
_r ;__ 1 Congress Street,Suite 100
' _`"�_�= Boston, MA 02114-2017
°''�t www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Kerr,"
t-rI� Please Print Legibly
Name (Business/Organization/Individual): 3 a I\ `*er'O cN 5 1`re.- `,',1r M1 _
Address: P. 0 • W e k 'l i i
• I I ` Phone
City/State/Zip: IJ a--+- s�_W*� M p( Phone #: 613 26 e-7 S 23
Are you an employer?Check the appropriate Cox:
I am a general contractor and I Type of project(required):
4.
L.❑ 1 am a employer with 0
employees (full and/or part-time).` have hired the sub-contractor 6. ❑New construction
2. i am a sole proprietor or partner-
"I, listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g, ❑Demolition
working for me in any capacity. employees and have workers'
cora . insurance.: 9. ❑Building addition
[No workers' comp. insurance P
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ l am a homeowner doing all work officers have exercised their I1.❑Plumbing repairs or additions
myself. [No workers' right of exemption per MGL
Y comp. 12.D Roof repairs
insurance required.] t c. 152,81(4),and we have no 1
employees. [No workers' 13.0 Other W..�-k G\4(I'
comp. insurance required.] T(8..vh 48,
'Any applicant that checks box Nl 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.
kContractors 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.
l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lie.#: 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ido hereby certify u er the pains and penalties of perjury that the information provided above is true and correct.
Signature: ', 1 Dt7kDate: b f l y /) b
Phone#: (41'3) 26K - 7523
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
ir
I
T
TOC.x,sr.Nn-
4vt5T HOUSE -foNr STOOP
1 I
(WI-PACS Liu sr.) I
&fLEV. O'D _ __
LEVEL.
'sags l61£ sic
F_-- RAMP I : e, s1-OPE --> .i T
I.SEGTIoN 0-1ff '� 4FLtV_-i') ���6' \ SECTl6R 6_1\ Q.cPLA o-E-.61tISTINy
__., __ ■ oNc, stogw AL K_
r / DD CVQB
SEH coucvcTE FLOOR. ) � � CITY OF NORTHAMPTON
• �O5T nooss L BUILDING DEPARTMENT
• iSEcTON. (t_2_
C __ _ _ 1 it---
GONT RMP These plans have been reviewed
//^ a And approved.
I-J ' %4 9LOP6
/// I Date 6-/5/-
I
g ��,
�sscTloN lb I 0 �� �
I Si natur•
A �O y 6L GNP 4
1 1 T T
[xIST. (t AR A4L �L�
_. _ Ul EKISTIN(r ASPHA LT OCIVGW AY
1414 AGC-E5511LE F.NtRAflc6. To SINGLE.
_. PAMILY ftEsIcrENC_E-
_PLAN _ V2 _ � 'O ONNE Es' REBEGGA OTI5 / TED RALE
(A.) 52 BRookW000 D¢ .
PL oR EN GE ,NII. 01062
CON rL AC-TOR. : -IDAN ROp GSTRAT EN
C. �o2252 5 NIC. REE. = VI B A
PATE of PLANS : G/I3/ le,
v� ON I{AuoR)CIL-
IMIJ
—' -
y.6W_GONF, 54.4.13. - - �.�� -LR4.
90.9T• .LONG. . .$LAM �as ��
o
v.r. -
�-2'E IID NMI _ 111.1Ge Ne-. 51oiWA4
_ __ -- ..
p.i.2«g �� I U
--).zica
„ /
%
z
£ 9 T 9 s • V L 9 8
,,,....ns....
r £OLO c CMe - f3coop- Erv.
' / 6 \ —S60TION 'o 6p0.,-(p yz"= \' c" 59
0
Il d \ Cr
N F
(!EW LtiNTILEV EREo 5�AR
P.
-- 4
t%,97 colic. 3i.1 r3 _19 4',H >
�a 9'g *.5z 1
fIt
LV,.. - L
°'9A, Peow s Q-EA11 �
1 1
i P~
O 6o. al.
P
, Ro oK WgoP OR�v=
1 13 _5E6-TON e NEW 5LAR 'R1-' I-o" G® 51T5 PLAN IN 7- S.
\2
4.
B