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11C-006 (6) 6 HEFFERNAN ST BP-2017-0105 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: IIC-006 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-2017-0105 Project JS-2017-000177 Est.Cost: S25000.00 Fee: S 162.50 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JESSE MONTGOMERY 077410 Lot Size(sq.ft.): 8189.28 Owner: POLLARD MARY ELLEN Zoning: URA(1001/ Applicant: JESSE MONTGOMERY AT: 6 HEFFERNAN ST Applicant Address: Phone: Insurance: 40 OAK ST (413) 585-8482 F L O R E N C E MA 01062 ISSUED ON:7/27/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:DIVIDE ONE BEDROOM TO 2 &ADD BATH 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 it 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: FeeTvpe: Date Paid: Amount: Building 7/27/2016 0:00:00 $162.50 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File N BP-2017-0105 APPLICANT/CONTACT PERSON JESSE MONTGOMERY ADDRESS/PHONE 40 OAK ST FLORENCE01062(413)585-8482 PROPERTY LOCATION 6 HEFFERNAN ST MAP I IC PARCEL 006 001 ZONE URA(1001/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid gfpl i Building Permit Filled out Fee Paid Typeof Construction: DIVIDE ONE BEDROOM TO 2&ADD BATH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 077410 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: s-4pproved 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 Demo "in a- ay Sig o :wilding 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. n141 City of Northampton it - Building Department menti+3) -Y.�p� hum a a` ` ' ., 212 Main Street EEnrI\JED Room 100 usv ' r,-n v �' r., ;4 Nath pton, MA 01060 s ,1•;.uzCa�u ��, 1 ,pIrrIg1813 58- 240 Fax 413-587-1272 a e_c .."ia5 cil. ' 1 )C ALTER REPAIR RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 457h1314eotlb fgieeS2oipaTaRpe 1.1 Property Address: Nr ,: 4 (o LF<Fz vK St. Vii = Leech , / Y, 0t0S3 b i ' y a ',fr-rtttr-,-±- Ellr'e t f,(sftl'uN_ GB D tZteyc— a.a,�= _SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: V Ellen er.w.• (o k-Ee cman S-i-. Le '. l44 N rim(P j Carrot Maili�np Addres' eLas ///'�LP�r one 5 S8S cPdbc� Telephone Signature 2.2 Authorize, •ent: c-}e /I/I 55C / crnjc Ylte') cio Co. k 5+ . fL cvm ice oiebrj, Name(Print) �� JJJ Current Mailing Address: lit s —sef 84Oa Signature _rI Telephone SE ION 3-ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be - Official Use Only completed by pend applicant _ • 1. Building /5 C15o (a) Building Permit Fee 2. Electrical 0 (b)Estimated Total Cost of 3, U Construction from(6) 3. Plumbing S ISO Building Permit Fee 4. Mechanical(HVAC) 3 or 5. Fire Protection / 6. Total=(1 +2+3+4+5) .;731 coo Check Number y/r2I 1/441•45 This Section For Oficial Use Only Date Building Permit Number: - Issued: Signature: Building Commissioner/Inspector of Buildings _Date • I�asO Section 4. ZONING All Information Most Be Completed. Pemnt Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be fillet in by Building Debarment Lot Size I _Frontage I Setbacks Front / I I Side L: I RED LJ I RI i J I r L-I 1 i I Building Height L I in—_,J Bldg.Square Footage C i % i , I l-'-1 Open Space Footage v & % 4_.J (Lotea minusbldgpaved I I L I I 1 I I i parking) #of Parking Spaces C 1 i Fill: —_._ (volume&Location) - A. Flag a Sp I Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 • IF YES: enter Book 1i Page and/or Document#! 1 B. Does the site contain a brook, body of water or wetlands? NO er-DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained Q , Date Issued: I C. Do any signs exist on the property? YES Q NO er IF YES, describe size,type and location: 1 D. Are there any proposed changes to or additions of signs intended for the property? YES (3 NO er IF YES, describe size, type and location: I E. WII the construction activity disturb(clearing, grading,exca on,or filling)over 1 acre oris it part of a common plan that will disturb over 1 acre? YES Q NO - 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 Alterations) Roofing C Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [CI] Decks [0 Siding[o] Other[CT Brief Description of Proposed Work: Aco DftTH �9tid �� .. rre, Er -n one b ch-ran mef-� o in - � Alteration of existing bedroom ✓ Yes_No Adding new bedroom Yes _No / • Attached Narrative - Renovating unfinished basement Yes ✓_No Plans Attached Roll -Sheet ea.]tNewt cruse atid:reicii ifton'foeclstinq.hot ship''.aimpfet tNe folkWliis( a. Use of building:One Family Two Family Other b. Number of moms 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 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 / Y Ctf Leen (D‘Gwwndl as Owner of the subject property I hereby authorize 3P55 ��"[ to on m ehalf,in all a rs dative h work a000fififiorized 4tj: building pe it application. ,a,G.- I -- 7 /30,/6 Signature of Owner Da I, /- I CClen Pte-nar,. - .S5e / W ,asowner/Authorized Agent hereby eclare that the statements and info alien on the foregoing applicati are true an accurate.to the best of my knowledge and belief Signed under the pains and penalties of perjury. Lllr Ant tC wrc,.rct �- P nt Name iiip air, h_ t 7 PV /6 Signature of rA•ent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor:upe'' /y) Not Applicable E V Name of License Holder: essc / ti^"IlJ�aev 07"7 Litt) License Number L-Ip ow K 5f , f(o+ercc x'19 o+Eba i al l / Ii Address f Expiration ate 'a/3- 5-86T-8 ifl Telephone 9.Registered9fiomelmproveplenYEairfraefiir , ,,,_ , = Not Applicable £ Te5De M n omen s-i I�15S Comoany ame Registration Number (-10 oe 1c 5 f- s/-2 / ; AddPss Expire on Da (� ©L elCa Telephone .0315 12),U -i/ga SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§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 E 11 -=Home Ova er EseuiPti itt The current exemption for"homeowners"was extended to include Owner-occupied Dwellings 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-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 be/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,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 Armotated. 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 150A. Address of the work: (, t-l-c ?nnor1Si-. Leek M4- The debris will be transported by: J c_M The debris will be received by: lrel Building permit number: Name of Permit Applicant ces5e M ovv)c neol —7 an it -• Date ignature of Permit Applicant The Commonwealth ofMassachusetts • r� Department of Industrial Accidents • t _E Office of Investigations tI _ 600 Washington Street Boston,MA 02111 T` . www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information � A Please Print Legibly Name (Business/Organization/Individual): "fes5C 1140-v lcn',1c� Address: L10 O--& �G 5+ . / C City/State/Zip: CI O( kte A44 ( CC/a Phone#: t-1 l )--5t96 p t'(e',2 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 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. 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 insurance. required.] 5. Weearea corporation and its 10.❑ Electrical repairs or additions 3.❑ 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 MGL 12.0 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. tHo meovmers who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContmctors 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerafy under th- •-' ties ofperjury that the information provided above is true and correct Si+ amre: � �' - - Date: 1 90 i 6 Phone#: 13— zj&f-- cl lad. Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: < City of Northampton �U q � 4 � V 7!rBuilding Department / Gcen rA /nsuwJ PlanReview212MainStreetli //, ‘P/ Northampton, MA 01060 4b4lrM „Frn*r'` PRO / __30 6 Florence, NIA 413-585-8482 / 6'2-1/2" / _ 18' 1.' / 6'2-1/2" / DH DH 4. / 14'7-1/2" / 2x4 — CONSTRUCTION (TYP.) LU BEDROOM 1 L V e — NO W r ;h V / 13'0" / ;y, v) N N z - ZQ 10'4-1/2"/ y 0 1 ;Li . Li Qw < 2 11-3/4 / 5'11-1/2" ^, u.. �..._. --\\`‘. 5-7/16"--m ' '�. O :As HALL N 0 oC t/') Z w 0 DH " 1 1 O LCL W toil STAIRS N DH ' ' —,t ° O W I1 II J W WW ■ . . I W N 4, w4, BEDROOM 3 N LI a 0 in Z • BEDROOM 2 N LL N M r in - JobID:JCM#004 O in / 4'4-1/4" 1,, 3' 1-1/2" t 5'6-1/2" / _I / 3' 1-1/2" 4'4-1/4" DATE: 06.11.16 3.9-3/4' ; / ,\ _ \ \ \ REVISIONS: _ # 1 DATE: 77 # 2 DATE: DH -"� �DH——fir— \ # 3 DATE: — # 4 DATE: / 6'2-1/2" 18' 1" it' 6'2-1/2" / PAGE / 30 6" / EXISTING 2ND FLOOR 1 SCALE 1 /4" = 1 '0" OF 2 EXISTING 2ND FLOOR Scale 1/4" r • -,; • . • , •• 4,4* _ A •.3 r • f r . • ,01!"- •4, rr. 5, • a 3$' • • - - _ — I .1 F • • •.2 • e • !rig -• • • • • • SCM 4b44F rM PROVtMs'� 30 6" I'lura ncc, MA 413 - 585-8482 6' 2-1 /2" i 18' 1" ' - ..• / 10' 4-1 /2" E.--- cH 12' 14/2" / / = W N ( . U ID '..) l' F--- 1.1.1 NLA CHASE O t7Z > � Q2 ',. 5'11-1/2" /1/ 0 0 � N BEDROOM 12_ - E Z w (60 o� BEDROOM 2 o rt w Lu LuZ k/ 5' 6-1/4" , Liu lr) i --- c_ ~ /. 4' 4-1 /4" / �r CLOSET CLOSET /3' 1-1/2"/ 4' 4-1-L4" / Job ID .JCM#004 N DATE: 06.11.16 \ ;p r REVISIONS: # 1 DATE: # 2 DATE: # 3 DATE: i rte_ r-- -_ - # 4 DATE: k 4' 4-1 /4" 3' 8-112" 5' 3" - ,' 3'10-3/4", 5' 2-3/4" 3' 8-112" ,I 4' 4-1 /4" /I, PAGE PROPOSED 2ND FLOOR 2 SCALE 1 /4" = 1 '0" OF 2 PROPSED 2ND FLOOR Scale 1/4" f • 4