18D-038 (4) 241 JACKSON ST-HAMPSHIRE HEIGHTS BP-2017-0094
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: 18D-038 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-2017-0094
Project# JS-2017-000160
Est. Cost: $184864.00
Fee: $1294.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class Contractor: License:
Use Group; D P CARNEY INC 99798
Lot Size(sq, ft.): 438649.20 Owner: NORTHAMPTON CITY OF NORTHAMPTON HOUSING AUTHORITY
HAMPSHIRE HEIGHTS'
Zoning: URB(10O)VWP(IO1/HB(Ol/ Applicant: D P CARNEY INC
AT: 241 JACKSON ST- HAMPSHIRE HEIGHTS
Applicant Address: Phone: Insurance:
34 HORSE SHOE CIRCLE (413)967-7124 (0 WC
WAREMA01082 ISSUED ON:7/2572016 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE ROOF BLDGS 2,3,4,6,8,9,10,11,12,19
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 7/25,120160:00:00 $1294.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File M BP-2017-0094
APPLICANT/CONTACT PERSON D P CARNEY INC
ADDRESS/PHONE 34 HORSE SHOE CIRCLE WARE01082(413)967-7124 0
PROPERTY LOCATION 241 JACKSON ST-HAMPSHIRE HEIGHTS
MAP 18D PARCEL 038 001 ZONE URB(100)/WP(IO1MB(0)/
THIS SECTION FOR OFFICIAL USE.ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT /,.` �y p
Fee Paid /7n`/Vr uj�) f,1
Building Permit Filled out
Fee Paid
Tvpeof Construction; REPLACE ROOF BLDQS 2,3,4,6,8,9 10,11,12,19
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Incl -ed:
Owner/Statement or License 99798 '/
3 sets of Plans I Plot Plan ±. (eC(to,y
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
_Demolition Delay
,ft . a�Sr(S
Sign re of Buildmg'O mal 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.
07/22/2@616 14 : 13 From : 4135821350 Northampton Housing Page : 2/2
Jul 22 t 12:46p DP Camey Consbuction 413-967-9100 p.1
Version Commercial Building Perdu May 15,2000
Depaahentuse only
City of Northampton Statusot Permit - -
Building Department Curd Gut/Driveway Penna - . .
212 Main Street SewenSepdcAvaiabmty - •
Room 100 Water/Wee Avallatiwty '
Northampton,MA 01060 Tao Sets ofSoctural tats •
phone 413-687-1240 Fax 413.587-1272 Phut itePlals
Other Specify
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Propety Address This section to be completed by office
(T$u existing buildings) 2 3,4,6,8 9, Map /fp Lot 3 Uri
241 Jackson Street 1O,1 L,12,19 '
• Northampton,MA 01060 Zone Overlay District
.. _ _._ _._... . ._. Elm St District CB District
SECTION 2-PROPERTY OWNERSWPJAUTHORIZEDAGENT
2.1 Owner of Record;
• Northampton Housing Authority __ _ 49 Old South Street,Northampton,MA 01060
Name(Print) - docent/eats Address. .. ..
& f / , (433)5$4-4030
eft Sipeful% `�"`� viy Tsephone
2.2 Authorized A.est
P.
a_ .. Horses_
D P. Camay Gonsttucaon Inc. 34 Horseshoe Circler Ware,MA 01082
Nano(Prim) -... Current Mello Address•
)
(413)967-7124
Signature T. _ Telephone
SECTION . -ESMATED CON6TRUCTION
ttem... Esttn Cost(tours)to be Olfidat Use Only
eted by permit applicant
1. Building
$184,6644.00- (a)Building Permit Fee
2. Electrical ___ _ ..____.
{C}Es ned onEri m of
Construction from 16)
... .._ . .....
3. Plumfrng
4. Mecharocal(HVAC) $1$4.$64.00
5.Fire Padectbn
B. Tota={t s2.3+4+57 Check Number
This Section For ONIGaI Use Only
Building Permit Number Date
Issued
Signature:
Building Co nmisticrmrNnpedordi Bui4Fgs Date
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations 0 Existing Wall Signs 0 Demolition Repairs 0 Additions 0 Accessory Building
Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Roofing Change of Use❑ Other 0
Brief Description Roof replacement at Hampshire Heights Apartments.
Of Proposed Work:
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 0 A-2 0 A-3 ❑ to I ❑
A-4 0 A-5 0 18 0
B Business 0 2A ❑
E Educational ❑_ 2B I ❑
F Factory 0 F-1 ❑ F-2 0 2C ❑
H High Hazard 0 3A 0
I Institutional ❑ I-1 ❑ 42 0 -3 0 _... 3B ❑
M Mercantile 0 4 0
R Residential ❑ R-1 0 R-2 0 R-3 D 5A ❑
S Storage ❑ E-1 0 S-2 0 58 ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(st)
1st
god
3M 3i0
4e
Total Area(sf) Total Proposed New Construction(sf)
Total Height(ft)
Total Height ft
1.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public [3 Private ❑ Zone Outside Flood Zone❑ Municipal 0 On site disposal system[!
Version I.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
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&paged
Patting)
#of Parking Spaces
Fill:
(volume&Location) j
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW O 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 It
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES C?
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained U Obtained Q , Date Issued:
C. Do any signs exist on the property? YES O NO C}
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 0
IF YES, describe size,type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 are or is it part of a common plan
that will disturb over 1 acre? YES O NO O
IF YES.then a Northampton Storrs Water Management Permit from the DPW is required
Version l.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES•FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 180 CMR 116(CONTAINING MORE THAN 3E000 C.F.OF ENCLOSED SPACE)
St Fteg$stered Architect:
Green ' •'ver Actitl YWAS Not Applicable 0
Name(Registrant):
(I 44..‘c tiD)i Pi'D\Rt ReeLCQre bWtm� 5�8p _!7
Registration Number
Address to nos
Equation Date .`.
Signature Telephone
9.2 Registered Professional E risky
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number �..---
Signature Telephone Expiration Date
9.3 General Contractor
D.P. Carney Construction, Inc. Not Applicable 0
Company Name:
Eiterbeelle -Oath ek Carne]
Responsible In Charge of Construction
34 Horseshoe Circle,Ware, MA 01082
'Address r 5-755 7(413)2'471'•99416
Sig � TelePtKKu
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes O No
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Northampton Housing Authority as Owner of the subject property
hereby authorize D. P. Camey Construction,Inc. to
act on�7my-be�half, in all matters relative to work authorized by this building permit application.
C. t. /�,y//�,�,q� 07/22/2016
Signature of Owner "UV ""'" Date
111111111111111111
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 under the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable D
Name of License Roller Daniel P. Camey CS-099798
License Number
34 Hors-.-+ de,Ware,MA 01082 08/19/2017
<ddres Expiration Date
(413)967-7124
�$ia Telephone
SECTION 13 ORKERS' OMPENSATION 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
At The Commonwealth of Massachusetts
.
Department of Industrial Accidents
t=lt��l Office of Investigations
s',", s 1 Congress Street,Suite 100
"�'• Boston,MA 02114-2017
.-4-...:411, www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):D.P.Carney Construction,Inc.
Address: 34 Horseshoe Circle
City/State/Zip: Ware,MA 01082 Phone#: 413-967-7124
Are you an employer?Check the appropriate box:
contractor and I Type of project(required):
i. 15 4.l am a employer with ❑ I am a general
employees(full and/or part-time).' have hired the sub-contractors 6. ❑New construction
2.❑ I ant a sole proprietor or partner- 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'
[No workers'comp.insurance comp.insurance] H. ❑ Building addition
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MOL 12.0 Roof repairs
insurance required]' c. 152, §1(4),and we have no Roofin
employees. [No workers'
13.0Other 9
comp. insurance required]
"Any applicant that checks box R I must also fill out the section below showing their workers'compensation policy information.
'Homeowners 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 Nis box must attached an additional sheet showing the nuns of the sub-contractors and state whether or not those entities have
employees- lithe sut-contractors have employees,they must pmvidetireu workers'comp policy timber.
7 am an employer that is providing workers'compensation insurance for my employees Below a the policy and job,vile
information.
Insurance Company Name: Granite State Insurance Company
Policy#or Self-ins.Lie.#: WC009930624 Expiration Date: 1111512016
Job Site Address: 79 Michelman Avenue City/State/7ip:Northampton, MA 01060
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.
1 do hereby r under the pal and,-nutrias of perjury that the information provided above is true and correct
Signatur-: a DatalJuly 2.1,2016
Phone#: 'to,124 �.
9 Official use only. Do not write in this area,w be , .. ed by city or town official
Project: Project Address:
City or'town: Permit/License#
l Issuing Authority(circle one):
' I.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: 241 Jackson Street. Northampton, MA 01060
The debris will be transported by: All-Waste Removal , Inc.
112 East Longmeadow Rd. , Hampden , MA 01036
The debris will be received by: United Waste Management
686 Main Street, Holyoke , MA 01040
Building permit number:
Name of Permit Applicant D. P. Carney Construction , Inc.
July 22 , 2016 Y` r_
Date Sign ur- .f Permit A..licant