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31A-059 274 CRESCENT ST BP-2017-0233 GIS u: COMMONWEALTH OF MASSACHUSETTS Map:Block:3IA-059 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:ADDITION&RENOVATION BUILDING PERMIT Permit# BP-2017-0233 Project# JS-2017-000392 Est.Cost:$8000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TEAGNO CONSTRUCTION INC 108109 Lot Size(sa. ft.): 6490.44 Owner: BERGER DAN H& LAURA A Zoning: URB(100)/ Applicant: TEAGNO CONSTRUCTION INC AT: 274 CRESCENT ST Applicant Address: Phone: Insurance: 228 TRIANGLE ST (413) 549-0803 AMH ERSTMA01002 ISSUED ON:8/29/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:Foundation ONLY for Deck and enclosed three season porch on the rt side and an open porch, foyer, and bedrm on the It side 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: FeeType: Date Paid: Amount: Building 8/29/2016 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner N!NJ 0 File p BP-2017-0233 ?'ZO'- ` APPLICANT/CONTACT PERSON TEAGNO CONSTRUCTION INC ADDRESS/PHONE 228 TRIANGLE ST (413)549-0803 PROPERTY LOCATION 274 CRESCENT ST MAP 3IA PARCEL 059 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: Foundation for Deck and enclosed three season porch on the rt side and an open porch,foyer and bedrm on the It side New Construction Non Structural interior renovations Addition to Exi.Lina Accessory Structure Building Plans Included: Owner/Statement or License 108109 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFF�MATION 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 mit from Elm Street Commission Sign re o I uilding 0 lcial 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 the Office of Planning&Development for more information. Department use only Fr"- -;,_ City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit pub 24 212 Main Street Sewer/Sepias Availability IRS Room 100 Waterw/ell Availability oc susn�ue insreitcnoms Northampton, MA 01060 Two Sets of Structural Plans DEPNo aH 7o .MA .._- . -13-587-1240 Fax 413-587-1272 Plot/Site Pians Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address. This section to be completed by office 6 ? srFA 5 . Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT diaofAecord: mer Iv6 Vin 54 Name( roil, Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Do AM en 3. hceyNa 'zea . ' . Ci aa' l - /9/”411.,/crt di��,-2 Name(R nt) Current Mailing Address.L wh - 5-?2 "0,Y0 3 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. BuildingR(J^J.bt$T � (a)Building Permit Fee rA-.21 t LrC • — 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fe e AM171[ 4. Mechanical(HVAC) z� '/a'/ ti `A e /`y`�19 5. Fire Protection � .f/�rA1 (/ 6. Total =(1 +2+3+4+5) Check Number 1p rit6 This Section For Official Use Only Building Permit Number: Date at ed'. Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be tilled in by Building Dcpanmcnt Lot Size / `'35— Si .Sdr^+E . Frontage 7J ' J n-sr E Setbacks Front 2o, ' az.f Side L: /V R:G.6 L:/1.5 R:aa.�� �.� Rear rf/ ' 3a ' Building['eight l I, tdv uJko-ivare o�Y16r /c0(''I (2 " 7,0`)(S1 5VO Open Space F otage [/ Sr % Jr( q p V (Lot area minus bldg&paved //773 7'f ii3/° 6,s'It .. parkineI ) k # {]of Parking Spaces / I Fill: NIA Nn (volume Sr Location) rl A. Has a Special Permit/Variance/Findin ever been issued for/on the site? NO O DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the Re istry of Deeds? NO O DONT KNOW YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O ,�D.attee Issued: l� C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: T' D. Are there any proposed changes to or additions of signs intended for the property? YES O NO e, IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading, e vation,or filling)over 1 acre or is it pan of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. I SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House n Addition 21 Replacement Windows Alteration(s) n Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition E New Signs [C] Decks IC Siding[C] Other[C] Brief Description of Proposed,– Work: f r�,QC2- �45anrf " Q Work: F/%✓un,Frlce-' 0 k jx7h /row ,4' crcw/O2rh1 �–o�.e/6*Befi Alteration of existing bedroom Yes No Adding new bedroom Yes 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: a. Use of building -.One Family y. Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? v d. Proposed Square footage of new construction. Dimensions e. Number of stories? L 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 CIN). 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? x Yes No. I. Septic Tank City Sewer ?b/ Private well City water Supply Y. SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT *at pqn C :7' er ,as Owner of the subject property v hereby authorize $ • ¢Lr I. %O a et I, I T. to act •- y behalf, •n all s relative to wor auth.rized by this building permit application. —Ss 1y i& -downer Dat- %% 41 l. nsa?(I) TUy Nc7 .he Owner D° efeby declare that the statemments and information on the foregoing application are true and accurate,to the best of m wletlge andnbelief. Signed under the pains and penalties of perjury. .izLitt-C 1 : Tca,Pio Pri Or Signature of• /Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder'. :b'CN fid p J I�>pcip o c "e 3 V 2/Jci (' ��r�xl License Number y c , r3 a ) .� 7 ,,n1LI 4k o/Oo y . /-%'P Address Exc://o/0 'aatlon Date r 4/l _ � 6Y - Y76a Stu Telephone 9.Reaiste ed H e Impmvelmmovement Contractor: Not Applicable a laJy ❑q '4y/,a „' Raf 7 7 / T,✓ C-- //U�'7/0/ compel-1i Name Registration Number da-1 7rrc � � d Address Expiration ate iJ `x mo Telephone-L/f-tiP 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 No ❑ 11. - Home Owner Exemption 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 he 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 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 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: " The debris will be transported by: 7_)vc3.pgru J%wx 4c The debris will be received by: f� teC L° 7NJA« y� 9' jj i(d"/ ' '- Building permit number: Name of Permit Applicant 7)4/ Date Signature of Permit Applicant The Commonwealth of Massachusetts tr� Department of Industrial Accidents a_z, — Office of Investigations artie1= I Congress Street, Suite 100 ,5• Wi, %g = a' 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): /P(e4 o !Jd (beJiU/7/Z.G(77 C • Address:_,4)-ce City/State/Zip: *2irf- /4 @/OD,,i Phone#: 7/� - cr7 o.+20 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with .1c 4. ❑ I am a general contractor and I employees (full and/or part-time). have hired the sub-contractors 6. ❑New construction listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance required_] 5. ❑ We arc a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself. workers' right of exemption per MGL Y [No comp. 17.0 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 hox pl must also fill out the section below showing their workers'compensation policy information_ Homeowners who submit this affidavit indicating they are doing all work and Nen 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'comp.policy number lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: JI y Policy#or Self-ins. Lic. #: (N 2)-H ?A00b � 36/)0/S.Jy Expiration Date: /7/7 Job Site Address: ) 77 &ILt • City/State/Zip: ,220441/74/1.), zi# 0/D 60 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 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 c 1 ie pains •std penalties of perjury that the information provided above is true and correct Signature: 11 p Date:i�t-9�//+ Phone r1: /// )yam C 9 —d003 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#: