24A-103 (5) 7 TRINITY ROW BP-2016-1518
GIS u: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: 23A- 103 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: Deck BUILDING PERMIT
Permit BP-2016-1518
Project 0 JS-2016-002587
Est. Cost: $1500000
Fee5.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JDR BUILDERS
Lot Size(sQ.ft.): 18730.80 Owner: LAWTON ROBERT W&JULIA CAFRITZ LAWTON
Zoning URB(100)/ Applicant: JDR BUILDERS
AT: 7 TRINITY ROW
Applicant Address: Phone: Insurance:
P O BOX 4 (413) 665-7587
NORTH HATFIELDMA01066 ISSUED ON:6/24/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:Replace deck with 141x 16' framed for hot tub
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 6/24/2016 0:00:00 $65.00
212 Main Street. Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck-Building Commissioner
File f BP-2016-1518
APPLICANT/CONTACT PERSON JDR BUILDERS
ADDRESS/PHONE P O BOX 4 NORTH HATFIELD (413)665-7587
PROPERTY LOCATION 7 TRINITY ROW
MAP 23A PARCEL 103 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
BuildingPermit Filled out
Fee Paid
Type of Construction: Replace deck with 14'x 16'framed for hot tub
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO MATION PRESENTED:
VApproved 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
_ £f7/311C
Signature o Building Official 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 becompletedby office
/T7 RowMap 23l4r Lot °�A -163 Unit
Ft.011-E0C!L Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
& t-dc C7t ql2- 9 l✓l)NITV /ZV$ pbhec . M/. 97762.
riot) Current Mailing Address:
pne — 32m —73 00
Y Telep one
Sig ure
2. Authorized Agent:
Name(Pnnt Current Mailing Address:
Y—'791/3
Signature Telephone
SECTION . -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) ns
5. Fire Protection �/((/l/
6. Total =(1 +2+3+4+5) /sono Check Number T(j
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Dale
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 tilled in by
Building Department
Lot Size Ig560 113Sb
Frontage
Setbacks Front
Side L: R: L: R
Rear
Building Height Jif- ...xis-
Bldg.Square Footage °o
Open Space Footage /q y'r (J% I� ryr/ y
(Lot area mina.bldg&paved I52S /2. ! {'✓77 / U 2 .1
parking)
#of Parking Spaces 3
Fill: 9 a
(volume&Location) J�
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW Q 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 and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW O YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O 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 O NO
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 O NO e
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 n
Or Doors 0
Accessory Bldg. 0 Demolition ❑ New Signs (CI Decks Siding[C] Other[125
Brief DeschOen of Proposed
Work: PtM.u514 IZAl4 lett- /tr,a ,."I e- 1YrIL Mak _
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 construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces orWoodstoves 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
I, Cid 1(A
. ` Cecrj f 20 ,as Owner of the subject
property T
hereby authorize \ ] . 'b --e-o51
act on my behalf, in a m tie relative to work authorized by this building permit application.
�, � Date
g afore of Cwner \ ^y f pate
I, Z% '4 ,as Owner/Authorized
Agent hereby declare that th statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under tI—hef}�eeinsanand penalties of perjury.
Print Name
Signature of Owner/Age t Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Hewer \TA*C '�- F-a I c
License
/Number
JL`� , Nd, Gt.� r1A/{ . 61UGL `7 `7
Address Expiration Date
—
a -7Li - —79s-3
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable 0
-.Th a ., sB y NSs
Company Name Registration Number
JvX LG bil-fr f� d I a , ' 3—/O-4'X
Addre ,..g Expiration Date
Telephone_ L S "?, O 7
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(88
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-maxi 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,von may be liable for person(s)
you hire to perfont work for you under this permit.
Theundersigned"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
1 _rs /,
w•ate Office of Investigations
i=k.i�s l Congress Street, Suite 100
_ Boston, MA 02114-2017
\�� www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information \\/p) ��Q Please Print Legibly
Name (Business/Organization/Individual): k) U'L go(metes j1�-
Address: Ya 4
City/State/Zip: AJO.t1*11 ZtS, MkOCb GC _ Phone #:
Are you an employer? Check the appropriate box:
Type of project(required):
I.FB-Lam a employer with LI 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 the attached sheet. 7. I: Remodeling
ship and have no employees These sub-contractors have R. ❑ Demolition
workingforme in anycapacity. employees and have workers'
P ty. t 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
officers have exercised their 1 I.❑ Plumbing repairs or additions
3.0 I am a homeowner doing all work
myself. [No workers' comp. right of exemption per MGL 12 ❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]_
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t I lomeowners 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. —
InsuranceCompanyName:_ STIR Gq1✓GL,JALCO , /
Policy#or Self-ins. Lie. #: �y�C- 90 Vi ? £wt v
`1111 1 Expiration Date: 1 t7--I' 7
/
Job Site Address: 7 1iiit✓( ( City/State/Zip: Pwn - y7cu.& e7-6Vz_
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 t DIA for insurance coverage verification.
I do hereby certi un r •r th' . •m' and penalties of perjury that the information provided above is true correct
and
Signature: / 1' Date: 6- U- Ib/
Phone#: 37t{.- //i--�/�.r,
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 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: 7 rarnicri2v�
The debris will be transported by: cri)ul
` / / i'2— �UILQ AC.
V
The debris will be received by: v, 4Cctiti;k
Building permit number:
Name of Permit Applicant Sll?- 3,out- 2 1.00
Date Signature of Permit Applicant
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