24D-239 (2) 176 PROSPECT ST BP-2017-0049
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24D-239 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
Permit# BP-2017-0049
Project ft JS-2017-000091
Est.Cost: $80946.00
Fee:$526.00 PERMISSION IS HEREBY GRANTED TO:
Gonst. Gass: contractor: License:
Use Group: ADVANCED MITIGATION & RESTORATION GROUP LLC
056861
Lot Size(sp.tt.): 6795,96 Owner: SULLIVAN SEAN T&LAURIE A
Zoning:URtif1007/ Applicant: ADVANCED MITIGATION & RESTORATION GROUP LLC
AT: 176 PROSPECT ST
Applicant Address: Phone: Insurance:
40 MAINE AVE (413) 527-3473 WC
EASTHAMPTONMA01027 ISSUED ON:7/19/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.'REPAIR LEFT SIDE FIREWATER DAMAGE &
REPAIR STAIRS
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:
FeeTvoe: Date Paid: Amount:
Building 7/19/2016 0:00:00 $526.00
212 Main Street,Phone(413)587-1240,Fax:(413)587.1272
Louis Hasbrouck—Building Commissioner
f C._::(_ ,;; __,.._--I... Department use only
City of Northampton status of Permit:
ja, 1 8 2016 Building Department Curb Cut/Driveway Permit_
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
DEPT.OF BURIDNG NSPECT1RNa
NORTHAMPTON MA MOO Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 PloifSite Plans
Other Specify ,,,,,,,_
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
i.i Property Address:
Pig
�/, This section to be completed by office
IOC
dress Pi ,C1"'` Pal J Map_,,,,, Lot J'31-
3 Unit
'�1QF-t rl (10/\J/ ///i�9�-t�//t�prn' Zone Overlay District
`'" `(26=2( Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: SI LpDy1_tees
sad) i7(a.lLWA, t . C L &ai-f>Lie fl.beri L , Mrs 01%,9
(' Name(P Current Mai n1Mdress /.`t 5���_ CV I
V'I
Telephone
!! �� Signature air - ,,//
2.2 Authorized Agent' 7U mA/ " M '-
-(iJ1r' 7 : t .1 I/ `" it -I ' ' i' , //+/+'111 r1�.�44/��_ `r%r4s1/J/?, 71910//u mA't
Name • bt) /Current Mallin Ad<lee9s: t✓t09
Signatu. Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (95;0-0()
(a)Building Permit Fee —
2. Electrical -�YJfy�(J�(.+t1t re° (b)Estimated Total Cost of
iConstruction from(6)
3, Plumbing 1a. r7) syr) Building Permit Fee 50
4, Mechanical(HVAC) -7 ca)- L/(
5.Fire Protection
6, Total=(1 +2+3+4+5) �YQ> Check Number _,_/,
This Section For Official Use Only
Building Permit Number: Date
Issued:
if
Signature: / r- f ((y}}—//J,(j
g :. mmsnspecror of Buildings — ___�f---�'--9-�-Date
_ _ !�
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition C Replacement Windows Alteration(s) ❑D Roofing
Or Doors L7
Accessory Bldg. ❑ Demolition New Signs [7] Decks [p Siding [o] Other[C]
Brief Deecripption of Propose¢ r ao kit ( ' Ft Ls(k-r
Work: FYt5cA)3k cr. 54h EL. LfS^r N]. WAIL FF LootinY, .) ct jg,4-- Nth? <F,rt.irCet
Alteration of existing bedroom_ Yes_f No Adding new bedroom Yes V No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
ea.If New house and or addition to existing housing, complete the following,(fo
a. Use of building :One Family ✓
_ Two Family Other ✓ FAT I L.
b. Number of rooms in each family unit: (p Number of Bathrooms /
c. Is there a garage attached? k3 0
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?_OJ
1, 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? wd Yes No.
I, Septic Tank City Sewer Private well City water Supply
SECTION 7a -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS A OR CONTRACTO-. i "PLIES FOR BUILDING PERMIT
k L 'ef�,,, a - . Iy{;aa t - ,as Owner of the subject
•
properly won
hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
.11.1111.11111111.111.111
.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 4, ZONING AU Information Must Be Compteted,Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to Pc Filled in to
Pudding Deem-mem
Lot Size
Frronta ete_ ._.
Setbacks Front
Side L: R: L: R'
Rear
Building Height
Bldg. Square Footage
Open Space Footage
{Lot arca minus bldg&`pa'ed
parking)
#of Parking Spaces,
Fill:
haaaac&L.,caiom
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O 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 Gre DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO Cr
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,exc ation,or filling)over 1 acre or is it part of a common plan
that will disturb over I acre? YES O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Sttine/vivisor: ��r; \J �± Not Applicablebl ❑/
Name of License Noldec: .7)21(17771E1/0 f":;�TLt,Otd( / O ((l?(c' /
Ltcenea umber
10 //M,4)8 4,/e, . Q4 dlii/ i[ / S/42 /a7,W/(6o
Address Expiration Da e
Signature Telephone
9,Registered Home Improvement Contractor: Not Applicable ❑
r
Aii/fi lk'E/ onnn,v ' E. n ro, /s ,. /&2'2/7
Company Name 4 Registration Numb•r
fPP2rn MP
. ' .. a,q '' m4 (may
Address Expiration ✓ e
'elephon(o7 J -
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M,G.L.c. 152,§25C(9))
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 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,presided that the owner acts
as supervisor.CMR 780, Sixth Edition Section I08.3.Ll.
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 duelling,attached or detached structures accessory to such use ands 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 shaft 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
v The Commonwealth of Massachusetts
fre_' Department of Industrial Accidents
tij *") lt Office of Investigations
v`
I Congress Street, Suite 100
�
°p Boston, MA 02114-2017
.-s)y/
7_,- www.mass.govidia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
eName (Business;brgaolwunnllndividuap: 65{/UCL fnr/Crn(.[([r(L.th .ta7V. C'!R()op
�'c )22AD 1&, A t ..
Address: � �f t7
CitylStatelZi. -". 11/r�!% d. n1 � Phone m /. A !_
Are von an employer?Cheek the appropriate box: Type of project(required);6
1.[el am a employer with 4, Q 1 am a general contractor and IE New construction
employees (full anWor part-time).' have hired the sub-contractors
listed on the attached sheet 7, 9 Remodeling
2.0 I am a sole proprietor or partner-
ship and have no employees These sub-contractors have g 9 Demolition
working for me in any capacity. employees and have workers' 9 J Building addition
[No workers' comp. insurance comp. insurance.+
required.] 5. 9 We are a corporation and its 10-9 Electrical repairs or additions
officers have exercised their 1i. Plumbing repairs or additions
3.❑ I am a homeowner doing all work P
myself. [No workers` comp, right of exemption per MGL myself Roof repairs
insurance required] ' e. 152,§I(4).and we have no
employees. [No workers' i; 9 Other
comp.insurance required.]
"Any applicant that checks box rR must also fill out the section holm showing their workers'compensation policy information.
°Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must suborn a new a ILduvn indicating such.
leonvactors that chock thin box mesa attached an additional sheet showing the name of the mb-coniranursend state whether or ton these entities have
employees. If the sub-contractors have employees.they must provide their workati comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and joh site
information. may'
Insurance Company Name:l-
ei,Vett( e,�S
Policy#or Self-ins, Lic. #;_Vt—J.D 571.1-- 1,4189 Expiration Date:`/,7� 3/. :
7 _ /.f
r P d t (2j i4 ll1 OJ ()
Job Site Address: I / eh j' CityiState2i
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 andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine
of up to 5250.00 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 cern der she pains zf,p nettles of perjury that the information provided �booy is true and correct.
Signature: -DCut✓r p s -/1J Date: 7jG/1 /CP.
Phone#: 9k /6„"1 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):
I. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5-Plumbing Inspector
6.Other
Contact Person: Phone II:�,,, �,_,_
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 150k
Address of the work: / 7/ no fir;r sr- /Jp:PTfl,v27/01,7 f/l o/Z0
The debris will be transported by: /2 W1/4209/01 i (-tic7e
The debris will be received by: /2? X4 ,04'A tc1?sL
Building permit number:
Name of Permit Applicant fv.)VAAr4) h1 n-tei{{T/pd ) q'l2i egTJo0 eko p
24d
th/lA
Date Signature of Permit Applicant
4% Advanced Mitigation & Restoration Group, LLC
rx..ra n ea..�z G C O 40 Maine Ave.
xRESTORATION GROUP Easthampton, Ma 01027
(413)527-FIRE (3473)
Commissioner Hasbrouck, July 18, 2016
Subject Request for Waiver
I request that you grant a modification to waive the requirement for control construction for the Sullivan
Real Estate Project located at 178 Prospect St. Northampton, Ma 01060 because the work is of a minor
nature,will not affect health, accessibility, life and fire safety,or structural requirements and its impractical
in that the cost of control construction is considerable when compared to the cost of the proposed work.
All work will be completed within the prescriptive requirements of 780 CMR. Thank you for your
consideration. "Mass Amendments,sections 107.1 allows for an exclusion from control construction for
this project" �7 /'
Sinn!_ y. p`
lel/.
Megan Schipper
Office Manager
-fr4Aken Pat Advanced Mitigation & Restoration Group, LW
4.4140 Maine Ave.
1/.F Teta C!
r Easthampton, Ma1
6627
527-FIREmpn, a 1RESTORATION GROUP (413) 0)
To Whom it May Concern July 18,2016
Desotiplion of repairs to be done at property address 178 Prospect St. in Northampton, Ma 01060 Is also to
include the stairease....Staircase repair-to sure up the staircase- new Cads, new risers, and sister all
joists.
Sin ereiy, 1;XJ
te
M an Schipper
Office Manager