23B-078 (2) 68 SOUTH MAIN ST BP-2016-1521
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23B-078 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: Porch Enclosure BUILDING PERMIT
Permit BP-2016-1521
Project# JS-2016-002591
Est.Cost:$20500.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JEFFREY BOTT
Lot Size(sq. ft.): 16117.20 Owner: SASSON HOWARD S&BETSY S GREE
Zoning: URB(100)/ Applicant: JEFFREY BOTT
AT: 68 SOUTH MAIN ST
Applicant Address: Phone: Insurance:
32 Pine Street (413) 530-6920 O
F L O R E N C E MA01062 ISSUED ON:6/28/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:Remove existing deck and build 121x 16' screen
porch on piers
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: FeeTvne:
Date Paid: Amount:
Building 6/28/2016 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fac: (413)587-1272
Louis Hasbrouck-Building Commissioner
File tt BP-2016-1521
APPLICANT/CONTACT PERSON JEFFREY BOrT yy,�
ADDRESS/PHONE 32 Pine Street FLORENCE (413)530-6920 0 -
'y{C�t J
PROPERTY LOCATION 68 SOUTH MAIN ST rggt{vrl+
MAP 23B PARCEL Qfl 001 ZONEURB(100)( P Ws, lam'"
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONINQFORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Type of Construction: Remove existing deck and build 12'x 16'screen porch on piers
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building,Plans Included:
Owner/Statement or License /
3 sets of Plans/Plot Plan gear/aft/gel zi h&c
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
Signature of 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 usa only
-"---
_
City City of Northampton Strewed Penrdt
-- - --� Building Department CwbtutOdvevmy permit
212 Main Street Sewe/SeptloAvs2aSty
JUN 2 G Room 100 water Wed Av�b My
Northampton, MA 01080 Two Sets of StrueturaiRent
Derr o=� phene 13-587-1240 Fax 413-587-1272 PIa'SitePBens
othe'Spear
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 •SITE INFORMATION
IA Properly Address ,,,,,,,,��{{t,, JrThis section to be completed by Oleo
eS <34 nl#1 MiIts 3+ Map LM
TL-47 t2 en GL rvwE' 01062- Zone Overlay District
Elm St.District CB District
SECTION 2.PROPERTY OWNERSHIPtAUTHORIZED AGENT
2-i Owner of Record:
Howard Sasson,Betsy Green bffi South Math Street,Florence,MA 01062
Marne do CurrentMailing Address'
413-586-6232
i^v II
- �`. "� Telephone
Signature
2.2 Authorized Agent: {j\y}\
J ecc l-< y ab , 3 2 lP(\ J5 J t .`SGC 6 �t
Name(Print) 1 Current Mailing Address:
Signet,_ Telephone
,$,ACTION 3.ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 20,000 (a)Building Permit Fee
2. Electrical 500 (b)Estimated
omo(6)of
Construction (f
3. Plumbing Building Permit Fee /{tl
4. Mechanical(HVAC) ✓(
5. Fire Protection // /�Q
8. Total=(1 +2+3+4+5) 20,500 Check Number tj0. /
This Section For Official Use Only
Building Permit Number Date
Issued:
Signature'Signature:
Building Commissionerllnspector of Buildings Date
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
"11�is colwnn to be Mini in by
Building Department
Lot Size 16117.2
Frontage 31.8 118
Setbacks Front 25 25
SLg
LAS R.35. L.41 R:35
gpf 65 65
Building Height 25 25
Bldg.Square Forage 1062 6.5 % 1120 7
Open Space Footage
(tut areaminusbldg&paved I%PO- 93 prbi s 91.5
pinking)
N of Parking Spaces 2 2
Fills
tvolnme&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW 0 YES 0
IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES O NO O
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 O
IF YES,describe size, type and Location:
E. Will the construction activity disturb(d(g"'aWring,grading,/e`�xcavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 4./ NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is regtured.
SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑1 Replacement Windows Alteration(s) ❑ Roofing 0
Or Doors O
Accessory Bldg. 0 Demolition ❑ New Signs (o] Decks [q Siding[O] Other(Cl
Brief Desafption of Proposed �f (
Work: .wwnvdWngdeck Wbun4 ewvm>]ima season rwm I f o&A�/l/b .aC'OCPAir rot et
t./71f jet%
Alteration of existing bedroom " Yes No Adding new bedroom % Yes No
Attached Narrative Renovating unfinished basement x Yes No
Plans Attached Roll -Sheet
Ba.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 construction within 100 R of wetlands? Yes No, Is construction within 100 yr. floodplain Yes No
f, Depth of basement or cellar floor below finished grade
k. WIN building conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION to-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, -T()WARD 5}SSSo,'J t 0G:1-Stit L2rcf ,A ,as Owner of thesubject
Property 1 J 6!!
hereby authorize ac ire. o `7' '
}s
to o rky�, in all mattersrelative o work uthorized by this building permit application.
L> Lt�--- j
Signature of owner I� ;'y. 111 Date li .. ! - j�7
I, 3 e �� 8��1 v ,as OwnerlAuthorized
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
�E. - IS - ((>
Signature of Owner/Agent( 1)J
'Date
SECTION 8.CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable (3
Name of License Holder: ) e 'a"a A G'. 5 O 3
License Number
31 PtVl-k.- 5-c- t L-0tl'Ac- M'R 0OD2-
Address Expiration Date
�, L( t;> c, 30 6 c),Z tC ,
Signature \ l\I Telephone 7 _ (iss ' .0t7
9.Registered Nome Improvement Contractor: Not Applicable 0
3-z{-fcv e 1 i, �TL G 1(elf\c_it k Hit—
Company
Company Name l Registration Number
3Z_ 1'kinre ;c Fi `�� e 7 wia 00;62_ & ZS {�
Address Expiration Date
TelephoneK 13 s 30. 65Zf)
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 >i No 0
II. - Home Owner Exemption
The current exemption for"homeown- ."was extended to includ awr_-occu:iedft cilia's + one(1) or two( dies
and to allow such homeow .- r. an individual for hire o does not possess a liven..,provided that thg ner acts
as au• raiser.C t • l ion Section 1083.5
inion .41 omeowner:Person )who own a parte .f land on which he/she re .es or intends to res ,on which there
is,ori -nded to be,a one or lw family dwellint : 'hed or detached strut --s accessory to such se and/or farm
s+ -s.A l„z to who a to pets mor. '. . one ho t• natwo- • :e-od sh, lot be con- e -do hom•owner.
'
ch"homeowner"shall submm" ng Official,on a form accep+. e to the Building Of tial t at he/she sh
es.ansible for : such WO, 1 ill .41r the build':- .-rmi.
As acting Construction iffirr your presence on the job site w' he required from ti to time,during a,: upon
completion of the work .r 'eh this permit is issued.
Also be advised that reference to Chapter 152(Workers' 'ompensation) and C ,ter 153 (Liao ' of Employers to
Employees for inj -s not resulting in Death)of the Mas °setts General Laws . notated, ou a be liable for person(s}
you hire to pert work for you under this permit.
The tinders':.A "homeowner"certifies and as'sum.. responsibility for corn. ance with ti• tate Building Code,City of
Northampton Ordinances,State and Local Zonas Laws and State ofM.".+chusetts O-. rel 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 150k
Address of the work: 63 J - /Y26i//1/ ST FLoi? C Z
The debris will be transported by: (it 14 f,'f
The debris will be received by: U A-<-e-7 (Zz C1 cic;:73
Building permit number: T
Name of Permit Applicant `J e- 1c- - 13,771-
s V S - l6 �lv_ 2) AT
1/4
Date --Signature of Permit Applicant
.., The Commonwealth of Massachusetts
Department of Industrial Accidents
t __,� t
F—is ,:_ Office of Investigations
ii �t6� 1 Congress Street,Suite 100
6 _ ii;t g
.ill:
- -� Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): 3p?1.t._ c—.e- ?,e,1 C
Address: SZ, c("`l . sr 1
City/State/Zip: t=1–C>v�'-S -C 4-1({ Phone 413 S3° .bYZ-0
Are you an employer?Check the appropriate box: Type of project(required):
1.[2:1 I am a employer with4. 0 I am a general contractor and I
f r have hired the sub-contractors
6. 0 New construction
employees (full and/or part-time).
2.0 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have 8. Q Demolition
workingfor me in anycapacity. employees and have workers'
P Y 9. ® Building addition
[No workers' comp. insurance comp. insurance.-
required] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.0 lam 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] t c. 152, §1(4),and we have no
employees. [No workers' 13.Q Other ._
comp. insurance required.] _
*My applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information.
f Homeowners who submit this affidavit indicating they am 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'camp.policy number.
l am an employer that is providing workers'compensation insurance for my employee& Below is the policy and job site
information.
Insurance Company Name:' ' //
Policy#or Self-ins. Lic.#: IA/EL '5-0000 tie Of Z7/cf1 Expiration Date: 6'z-lb
Job Site Address: G 0 �J-/72*/.2 5T fir -aert,?,C -e City/State/Zip: //lig 0/06 -'
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 certify under the pains and penalties of perjury that the information provided above is true and correct.
Sias stare: ' l„ar fit VS _ Date: 5 - 15 - /iii
Phone#: i c I N-(3 530 U94-.: C) ._....—...
t Official use only. Do not write in this area,to be completed by city or town official
, City or Town: Permit/License #
Suing 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#: