24C-179 (4) 199 CRESCENT ST BP-2017-0201
GIS p: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:24C- 179 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-2017-0201
Project if JS-2017-000339
Est.Cost: $6000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
use Group KEITH HAMILTON 074129
Lot Size(sq.ft.): 21605.76 Owner: COOK BRIAN 1&DEBORAH C
Zonine: URB(1001/ Applicant: KEITH HAMILTON
AT: 199 CRESCENT ST
Applicant Address: Phone: Insurance:
3 LORD ST (413) 587-0763 O WC
EASTHAMPTONMA01027 ISSUED ON:8/16/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF, NEW FIR DECKING 6
X 12 PORCH
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 tt 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 8/16/2016 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0201
APPLICANT/CONTACT PERSON KEITH HAMILTON
ADDRESS/PHONE 3 LORD ST EASTHAMPTON01027(413)587-0763 Q
PROPERTY LOCATION 199 CRESCENT ST
MAP 24C PARCEL 179 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT � �f�.7
Fee Paid /
Building Permit Filled out
Fee Paid
Tyoeof Construction: STRIP&SHINGLE ROOF,NEW FIR DECKING 6 X 12 PORCH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 074129
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO TION PRESENTED:
pproved 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
h- . itis..
iset.-1S-CfL ,Y11/2—/ICY
Signa ure of Buil.in 0 icial 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.
r- art Us an_
Cry of Nicrharip,IonI �s a�arP rr t
RECEIVED B [ming o a ent rim Cu Cnver a ?n1 - - 1
212 Main [rest tie c/Septic-lva ab :r - I
ME 162116 Room 102 HA t rMl ilAvailacitw-.
I Plo rar9^,'.on MA 21062 �Tn esti tutu al Pl r
1 - •ne , 13- ,87-12442 Fax 413 087-1272 Io3Sde Plans -
DEPT OF BUILDING 1 SPEC-MINS
NORT6AMArON MA 01060 OH'eY.Sp _ Y
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE CR 0=MOL!SH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
7.1 Prooertv Address Tn(s=ecncn to be completed by office
I
( 4q CteSGen. 1 SI
Zon _ OverlayD1 tat
VcD,Q ' "C0 1 kr7 -ilia. elm rte --ce os.rc.
SECTION 2•PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
1)66v0.k C . Coop
191
cve_c 4f Sf Nc ` Ctrs }011,00\
Name(Pdn:) Current Mailing Address:
U---‘,47<__ ul3 - 5a?- 2zz3
Telephone
oigneture
2.2 Authorized Aae :
cif l til. ; ,�
S'.nacre 3 1 o eel S f: fasf�r y .�4
-- Prnt) �� Current Mailing Address': r
Ili — za ) - 1(((t<
ll
epho e
I
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be Cffdal Use Only
completed by permit applicant
1. Building .71a
6 tee ¢ a (a) Building Permit Fee
2 Electrical J (b) Estimated Total Cost o`
Construction tram(s)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6- Total=(1 +2+3-4tc) I,Check Number 73S/ 4105
This Section For Official Use Only
Building Permit Number Dae
Issued:
Signature:
Building Commissiocerinspector or Bullance 'Dale
Email : li2a
Sec"."icn p. %OPIiNG ) v l Intornafor N.c•t BeCompLe ed.v Ca:Be _n ed Due To I^_empl=e Infordanen
_.
ExistingProposed Rennin-dalcoda:
by Zoning 1
'-} I ^vrz,o , ntEl li s.by Jams/mem 1 .-
' e.'"6
I IL
Lot Size ,� <,. t . ..-....._ l
IFrontage I.a
SeObuces Fgni ,
�-
L -. &�-_. L_—_ R_..�__
Side _
Rear
I
tui n7ing Eeigh: _..,....,,�
tW_
Bleig.Square FooaKe r ._. 1 �.—..,
Opert Space Footage % I ._
1 a.z _nu lgEr ,^L l I i
b l p
of Perldz Soacus ( '..-- I "^'— I __ -
I I I (lj
��� J I
,wn &� a)tcI' J
A. Has a Special Permit/Variance/Fin�d'in
^\g ever been issued for/on the size?
V
NO 0 DONT KNOW YES 0
IF YES, date issued:)
1F YES: Was the permit recorded at the Registry of Deeds? p`'� I
NO 0 DON KNOW T. YES '0
;F YES: enter BookGag+: and/or Document F: 1
B. Does the site contain a brook, body of water or wetlands? NO : DONT KNOW 0 YES 0
1F YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , bate Issued:.
C. Do any signs exist on the property? YES 0 NO 0
F YES, desoqtne size, type and ro atioa ,.,... _. ' -
Are there any proposed ch nes to or additions of signs intended for the property? YES 0 NO 0
__-.. '._.__.___ _
iF YES, ceseri!':e size, tie and?potation:
E \nIl he construction activity dl tura (clearinggrading, excavation, or (ling)ec'er 1 acre ore it panof a common plan
that will disturb over acre? YES NO O
!PRES,then a Northampton Storm °nce tdan ._r nt Fermi from m he DPW s required
I
. .
•
SECTION S-DESCRIPTION OF PROPOSED WORK(check all aociiczble)
New House n Addition I Replacement Windows i Altera:ion(s) I I I PocTmg
Or Doors C
Accessory Bldg- ❑ I Demolition ❑ New Signs 11723 Decks 'T Siding(C? Other(7
Ede Descroption of Papose pp /� �+ [� r �] / y//�
Work-S T iro T4,a`C� ^\rn c Ae.co ,Veit) cif )PCiIIr4, rigid, 1OTc_ln
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
GailNEW Itrjse and orad etaon tQ existtru3 FAOGSOfid-OOITD eke`th fofrow nq:
i
a Use of building_One Family Two Family Other
b. Number of rooms in each family unit:"' Number of Bathrooms
C. Is there a serape attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f Method of heating? Fireplaces or Woodsoves Number of each
9. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
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 Suooly
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, Dekrock C , Coo K- as Owner of the subject
property � ��
hereby authorize KF Vf le
to act on my behalf, In all matters relitfWit
tive to work authorized by this building permit application.
1'. /5 /6
Signature of Owner Date
_ it a'r'=.aa`>< -7" a itki-ar N Y wwu=Yv d , '
le i / a A , as OwnerrAuthorized
Agent ' e by declare tha,the sta emente and information on the foregoing application are true and accurate, to the best c`my knowledge
and belief.
Signed under th-pains a, . penalties of rerjcry.
As Si _I a :CAAPI tame
SAnature ofO n-,Anent Date 1
_..SECT/05i 8-CONSPRUCTION SERVICES
9.1 Licunsm.7 Construction -uoervisor: f :Vat Ari cable L
-� i
Noma 33 074( / 9
/ License Number
Aa, HAS
Abdress —om Eaptration Date
e 1rce7-- 763
.longtime Telephone
P,.Real=tered.Hbme Improveman£Cor =_.or ' _ Not Applicable £
_htelf—kMIM btd, (n f i'n (
Corn ant,Address Name r"e. t Expiration Registration Number
I LL
yy p Date
Telephone a93 V 7—C7
SECTION 19-WORKERS'COMPENSATION INSURANCE AFFIDAVIT 00.G L.c.152.§2EC(6))
Workers Compensation insurance affidavitvit must be completed and submitted with thie app.ieation,Failure to provide this affidavit will result
in Me denial or the issuance of the bur dura perish.
Signed Affidavit Attached Yes E
ea.e ..tae. .i.e..tion
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or nvo(2)families
and to allow such homeowner to engage au individual for hue who does not possess a li:ease,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 accessoryto such use and/or farm
strucnses.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 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 torn time to tt'ne,during and upon
completion of the work for which this Hermit is issued.
Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153 (Liability ofEmployers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may he 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 oft Massachusetts General Laws Annotated.
Homeowner Signature
f'' The Cotnmonvenithr loracsachnse s
Depcvra sets w aciactotolAccidentS
I.-16 Office �"",�I Y r. n,CdonC
cebb ,i 660 Washington Sired
ci '
Boston, MA i32111
-Aro- wonv.mangoondiet
Workers' Cowsyperrsasfoti kostirsoace A5 ilri'li'.t Rune er /Ccur r, err Li etclelaas/P➢es.'obeys
A!a,a:Pt/ant In oressazi an Please Print Lesafipdv
i (y ry
Name (Pusiressiirgganza on/Sndit,dual). ( y I t . I 4 4_•Cr OAT\ AC,. .
Address! 3 4.,.0 cri # , y,,(
City/State/Zipa _E. . CH�._ !_ Phone—. Ci J� QL `u
Are you an ernp/oy v Check the appA priate box:
1. I am a employer with
4. ❑ I am a general contractor and I Type of Newprcoct(reqconed):
employees (full and/or part-time).* pave hired the sub coir actors @. New construe ion
2,❑ I am a sole proprietor or partner- listed on the attached sheet, 7. Li 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' co- p. insurance nomP insuran e
reqs r.3] 5. We are a corporation and ds 0.0 Electrical repairs
or additions
3.7 I ami homeowner doing all work officers have exercised their 1 i.[fl Plumbing repa;rs or additions
myself [No workers' comp. right of exemption per MI- 12,E Roof repairs
insurance required.] ' c. 152, §I(4), and we have no
employees. [No workers' 13.0 Other_,,,_
comp, insurance required.)
*Any applicant that checks box pi.must also fill out the section below showing their workers'couipessa:on policy information.
'Ho meownere who submit this ailida•,it indicarims they are doing all work and then hire outside cm:tractors must.submit a new affidavit indicating such.
tConuactors that check this box most attached an ad i onal sheet showing the name of the submontracmrs and stare whether or not those entities have
employees- If the sub-contractors have employees,they mustprovide their w=orkers'comp,policy number.
.f am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. ^ /,,
Insurance Company Name: i` e,u '(9 t t / ^�
Policy#or Sell-ins. Lie, #: 4) W G 3 (�/ 0 L7 2 �" , Expiration Date: ?-ter
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 crani"at penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penaltes 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 Off ce o:
Investigations of the DIA for insurance coverage verification.
I do hereby creridfj+Qr he ,ains and pen es of erjmy that the information provided above is true and correct.
Simat e: • - Date: X 576. .,
Phone#: I'jr 3,:t Ji—r `=7 �. _._
•
Official use only. Do not write in this area, to be completed by city or town official F
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 p.;
City of g-ri ru.lva::3:wton
,
l Ji.
17)=TE,NT OF SUZIZING I , =ONS y
11 -y^�
212 gain Straito gnnicipal Buni1Eng
Northam:22in, MA 01013 `ti._.✓'�'::
_ SPECTOR
Louis l esbrouok Chuck Miller
3uIdina Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
1 The State of Massachusetts allows the homeowner the right under 7S0C49P, 108.3.4 to act as his/her
construction supervisor. The state defines "Homeowner"as, " Person(s) who owns a parcel on which
he/she resides or intends to be,a one or ONO 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 home owner."
The budding department for the City of Northampton wants any person(s) who seek to use the home
owner exempton, to act as their own construction supervisor, to be aware that by doing so you
become responsible. for compliance with state building codes and regulations. The inspection
process requires that the building department be called to inspect work at various stages, which include
foundationlfootinas (before backfiif. sonotube holes (before pour). a roach buildrna inspection
(before work is concealed). insulation inspection (if reouirsd) and a final buildina insoection.
The building department requires these.inspections before the work is concealed, failure to secure
these inspections can result in failure to obtain a certificate of occupancy until the work can be
inspected.
if the homeowner hires other trades to pedorrn work(electrical, plumbing &aas) the homeowner will be
responsible to make sure that the trades hired secure their proper permits in conjunction to the building
peanii issued,and that they oat their required inspections. Failure of the individual trades to secure
the permits and inspections as required can DELAY the project until such time as the proper permits
and inspections are made
understand the above,
(Home owner(resident's signature requesting exemption)
will call to schedule all required building inspections necessary for the building permit issued to me.
Date
Address of work location
City of Northampton 212 Mabi Street, Northampton, NLA 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: 1 ? 1 l nl( 5
The debris will be transported by: ,lp( �( ; 11-0/17 bui 0 e f (04.C- ,
The debris will be received by: Va I ley e{//i6)
Building permit number:
Name of Permit Applicant K4 (1-1-\ a/j4 I i
7,i
Date "7-157-M Signature of Permit Applicant