31A-227 34 HARRISON AVE BP-2016-1449
GIS u: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:3IA-227 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 BUILDING PERMIT
emsta BP-2016-1449
Project 4 JS-2016-002490
Est Cost: $83796.00
Fee: $540.00 PERMISSION IS HEREBY GRANTED TO:
Qonst.Class: Contractor: License:
Use Group: MICHAEL MURPHY 0972908
Lot Size(sq. It.): 10105,92 Owner: LELIEVRE ROBERT
Zoning: URBU00V Applicant: MICHAEL MURPHY
AT: 34 HARRISON AVE
Applicant Address: Phone: Insurance:
45 NORTH WESTFIELD ST (413) 374-2470 WC
FEEDING HILLSMA01030 ISSUED ON:6114/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:KITCHEN RENO, INSTALL 3 WINDOWS&
EXTERIOR DOOR
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector or Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House p Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: 001: 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 6/14/2016 0:00:00 $540.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1449
APPLICANT/CONTACT PERSON MICHAEL MURPHY
ADDRESS/PHONE 45 NORTH WESTFIELD ST FEEDING HILLS (413)374-2470
PROPERTY LOCATION 34 HARRISON AVE
MAP 31A PARCEL 227 001 ZONE URB(1001/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid CCA* 7a cif 'DCVO —
Building Permit Filled out
Fee Paid
Typeof Construction: KITCHEN RENO,INSTALL 3 WINDOWS&EXTERIOR DOOR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 0972908
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
"Approved 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
Demoliti., D- .
Signa rirOf Build ng G 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.
- 9S.
_-
Department use only ,I
Ciy of Northampton Status of Permd
1,. / >ildina Department Curb CueDriveway Permit
j 212 Main Street Sewer/Septic Availabtl[ty
6t'� Room 100 Water/Well Availability
¢e`" Northampton, MA 01060 Two Sets of Structural Plans
+Pone 413-587-1240 Fax 4113-587-1272 PlotSite Plans
Otner Specify
APPLI 'TION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE CR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 -Property Ad ess' This section to be completed by office
3 y ✓✓y'JM A/C Map Unit
/ITO-r.,(a/74/ �f Zone Overlay District
Elm St.District _ CS.District.
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Ow/nn33r of Record:
I .. //
Ko 1 Le/itn t 3r /1Q4 .StM 4vC
Name(Print) Current Mailing Ad4ry ees/_ ./ /
4!7'
Telephone
Sic nature
2.2 A thorized Agent: -
�ti� ys' =5 f �c 1� s,
Name(Pont) Current Melling Adtlr1 K,5 I �j/ -i [vpjV
.L V/3. - 37y— 79' 70
Signature j Telephone
SECTION 3-ESTIMATED CONSTRUCTION C• TS
Item Estimated Cost(Dollars)to be Official Use Only
ompleted by permit applicant
1. Building X73 363 a (a)Building Permit Fee
2 Electrical ( (b) Estimated Total Cost of
S 6,7,5-3 Construction from (6)
3. Plumbing 4_5/,&. at Building Permit Fee
4. Mechanical (HVAC) J
5. Fire Protection A,6 y.2 �I ��//{
6. Total=(1 +2+3+4+5) `��y3 796 F,Check Number 73yf 6 7
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING ALI Information Must Be Completed Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be hued in by
Building Deparment
Lor Size
Frontage
Setbacks Front
Rear
Building Height
Bldg_Square Footage — - % — -
Open Space Footage
(1 ,area .n
mus bldg&paved __ _
D arking)
▪of Parking Spaces _-'_.
Fl:
(volume&Loceuoc) —. .. ----------. '
A. Has a Special Permit/Variance/Finding ever beer issued for/on the site?
NO 0 DONT KNOW Q YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
ND Q 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 0 DONT KNOW 0 YES 0
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 0
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 3
IF YES, describe size, type and Location:
E. Will the oonstmcion activity disturb(clearing,grading, excavation, or filling)over 1 acre or is it part of a common plan
that wID disturb over l acre? YES 0 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)
New House ❑ Addition ❑ Replacement Windows Alteration(s) c( Roofing n
Or Doors C
Accessory Bldg. ❑ Demolition ❑ New Signs (O] Decks [[] Siding;DI Other[DI
Brief Dejpriptio9 of(Pro sed A / alai-
Alteration
Work 010 Le �y']—ed' -teL a/43 if 3 4lr rl 4 eK ✓,ov
of existing bedroom Yes )/ No Adding new bedroom Yes _k No
Attached Narrative 4 '/Re ovating unfinished basement Yes X No
Plans Attached Roll -Sheet ae✓dy S f& e/
sa. 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
a Number of stories?
I 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
- , 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
1111111.11
I, AitAL 4[// h ,as Owner/Authorized
Agent hereby declare thaith stat ents 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. .
(14a„/ orpl
Pnn Name 1 /
rnitniti
7 r 7//6
Signature of Owner/Agent Da l
S_CTIONN 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supeer is�or: M // Not Applicable E
Name of Ficense Holder'. is
/ l
/(jf/��l J r Lier-pi,i CS - 09 79 o2
� / `t,/ f^ •
��LL License Nom-or
F /tear7L. (./t)AXt F( .k-i !s-L. // i !
Address F'eedizt r(& � Erpiratio late
_ Y13-3 7Y•z5J0 U 00530
Signature Irl Telephone
rr
9.R-ttstered Home lei movement Contractor: Not Applicable
e; s`rv` r . ea...wr
Com Name ....._ Registration Number m
ber
1St 6.4
ad s
sio Nicht, F74,4 trExpiration Date
aS4�uAvdn , e-T
....
O4.U7r Telephone 1Go-9r1—ea 31 egg 8S?
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.GL.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 Dwellings of one(1) or two(2)families
and to allow such homeowner io 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 Suriervisot 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 he 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,
•
The Commonwealth of Massachusetts
Department of Industrial Accidents
I�—: `' 1 Office of Investigations
^s j 600 Washington Street
, l r Boston, MA 02111
r www.mass.gov/dia
Workers' Compensation Insurance Affidavit: ]Builders/'Contractrays/,L'iectrieians/LPlan¢m&ners
Arn llicant Infformation n Please Print Legibly
Name(Business/Organization/Individual): .6. 9 j< _. p(..r.
1.4
Address: 4vo _ Jo km 1�—,,-l-clq 6Lid
City/State/Zip: no cJt J)oor cr, ,7t Phone #: 1tctang-74/7
Are you an employer? Check the appropriate box:
I am a general contractor and I Type of project (required):
I 4.
I am a employer with ❑
employees (full and/or part-time).* have hired the sub-contractors 6. ❑rc�fNew construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. !hl Remodeling
ship and 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. insuranceJ
required.] 5. ❑ We are a corporation and its 10.0 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 12.0 Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.D Other
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 arc 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 insurance 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 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 eerily"under the parr •. a-;4/des of perjury that the information provided above is true and correct
Signature: I _' Date: 6/0
Phone#: a/-r ^7//S Fria - 4'X1 - dee3 I
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
6. Other
Contact Person: Phone#:
City of Northampton
Massachusetts
k s a s
DEP-ART.laNT OF BUIFOINQ TNSPF.CTIDNS
a�.{�.. 212 MSR Sheet e Municipal Building 660.6
Northampton, MA 01060 \r^R1
T_NSf0CTOR �a
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER.EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 784CMR 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/footinas (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 occupancy 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 unfit such time as the proper permits
and inspections are made
understand the above.
(Home owner/residents 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 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: 3Sd1/45-ey?
The debris will be transported by: Qac-/ /
The debris will be received by: Qojyi� p yr,�/, �
Building permit number: et
Name of Permit Applicant pes_c7 /ad
c £ /
7 6 OQQ_
Date ' Signature of Permit Applicant
06/07/2016 15:13Ba&o Insurance Agency (FAX)1 860 623 0061 P,001/001
CERTIFICATE OF LIABILITY INSURANCE DATE 6/ 2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCERVaAL INancy Baiocchettl
Baio Insurance Agency.LLC PHONE 866 6235961
AEES Enk ) (n Nok
176 Main St ADDRESS n2nCY®baOO6Um0ce.LOIN
INSURER(S)AFFORDING COVERAGE NAIL0
East Windsor CT 06088 INSURER A. Zurich
INSURED
INSURERS
Perfect View Remodeling LLC INSURER C
1640 John Fitch Blvd INSURER D
INSURER!
South Windsor CT 06074 INSURER P:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWTHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE INS° WVO POLICY NUMBER IMMNOM9YI (MMIDDIYYYY) LIMne
COMMERCIAL GENERAL LIABILT'
f
C,. - aPEra:Eaa
}-E TR'M F^ ,F9FF aLL - E T
AUTOMOBILE LIABILITY - -'--
•
UMBRELLA!JAB it F -___L ,
EXCESS LIAR r
?'=Crcic'hY
WORKERS COMPENSA11ON
AND EMPLOYERS'LIABILITY '' >
Y IN
NIA 2E873074-15 04/03/2016 04/03/2017 E h 'I' { 500.000
(Mandatory in NH)
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ACORD 101,Additional Reruns Schedule,may be attached if more space is rtyuindl
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City Of North Hampton THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
212 Main St
AUTHORIZED REPRESENTATIVE
�I/
North Hampton,MA 01060 't61 ilHz2nItN
I
I ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
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