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23B-041
190 NORTH ELM ST BP-2017-0275 GIS a: COMMONWEALTH OF MASSACHUSETTS Man:Block:238-041 CITY OF NORTHAMPTON Lot PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERNIIT Permit d BP-2017-0275 Projects JS-2017-000469 Est Cost$5300000 Fee: $345.00 PERMISSION IS HEREBY GRANTED TO: cost.class: Contractor: License: Use Grov MARK SARAFIN 053434 Lot Size(so.ft.): 15942.96 Owner: PANTAR HOME SOLUTIONS LLC Zoning:URB(I00)/ Applicant: MARK SARAFIN AT: 190 NORTH ELM ST Applicant Address: Phone: Insurance: 42 Pomeroy Meadow Road (413) 527-7812 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON:9/6/2016 0:00:00 TO PERFORM THE FOLLOWING WORK REMODEL KITCHEN & 2 BATHS, OPEN WALL BETWEEN KITCHEN/DINING ROOM PQST 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: Eire 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 4/6/20160:00:00 $345.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File R BP-2017-0275 APPLICANT/CONTACT PERSON MARK SARAFIN ADDRESS/PHONE 42 Pomeroy Meadow Road SOUTHAMPTON (413)527-7812 PROPERTY LOCATION 190 NORTH ELM ST MAP 236 PARCEL O 1 001 ZONE URB(1001/ THIS SECTION FOR OFFICIAL USE ONLY: PERMITAPPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FARM FILLED OUT . a / Fee Paid — '- 3 qO Building Permit Filled out Fee Paid IypeoLConstruction: REMODEL KITCHEN&2 BATHS,OPEN WALL BETWEEN KITCHEN/DINING ROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 053434 3 sets of Plans t Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: pproved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:S 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:Si 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 D-' . " •- ay ' dr/0" . . /7.7 Sipatu - o Rut.' g 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. ..--- --F Department use only -- City of Northampton Status of Permit Building Department Curb Cut/Driveway Permit $l6 3 0 2016 212 Main Street Sewer/SepticAvailabilty Room 100 WaterANell AvailabiMy DEM OF wunmo:N:;PEcnONS Northampton, MA 01060 Two Sets of Structural Plans "OF'"`°r"'"'M14°'°60 phrme-413-587-1240 Fax 413-587.1272 Plot/Site Plans Otis Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 ProceAv Atltlreas: This section to be completed by office �c\O 4‘,041/4‘-i‘ E"w' 5y- Map Lot Unit .n, Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: aorn? Claris. S©Lvrza.a..S �L G b ._� _ i 1 vu Name(Print) fj,-(,//'. ! Current Mailing ddress: �f�y4" �l C�tts'�� %/At�.64L.P Telephone Sign ur ?.2 Authorized Anent: t't af( I I'mt:0o "3QDY ft`� d - Name(Pri I3Y ✓ Current Mailing Ads: LIR.-K.a `} St otia ? Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Buildingu 41'a06•a�,} r (a)Building Permit Fee 2. Electrical 11 00Q (b)Estimated Total Cost of tit Construction from(6) 3. Plumbing (` 1 ,.., Building Permit Fee I ///��/ 4. Mechanical(HVAC) .rS�✓75 5. Fire Protection 6. Total= (1 +2+3+4+5) I 3boo Check Number /0y 9'3 9 This Section For Official Use Only f ate Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date SECTION 5-DESCRIPTION OF PROPOSED WORK(check all appllcahle) New House ❑ Addition ❑ Replacement❑Windows Alteratlon(s) 24 Roofing E1 Or Accessory Bldg. ❑ Demolition ❑ New Signs [CQ Decks IC Siding a Other[CI Brief Descpplion of�p�7o�ppsed`, ('� V. l- 1y l� (i Work: %Awl W'C1 Kt 4014 &NJ) aCIA4k5 even w;V. Ot\wfY.n \\At1/4" ta ly}irn% �/ See oikkaeht eC Alteration of existing bedroom Yes No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes ____X_No Plans Attached Roll -Sheet sa.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 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 SE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 24,77 11f NAAS So I-07313AS J L2-6 , as Owner of the subject Properly hereby authorize _ J -WC`Avii. e x?U%\h c-1 to act on my behalf, ' ail matters relative to work authorized by this buildingppermit application. ell /11. ,a4-6-40/7 P zP-/fi &pa}d�lret onf Owner \ �+ Date 1.111.111.1111111111.11111111.11.111.1111.11 I, V v\'*+K `G ,)va?W F\.✓•. ,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 Na [} Signature of Owner/Agent Date Section 4. ZONING AU Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning (Lis column to be lilted in by Building Department Lot Size Frontage Setbacks Sidc �� Side L: R: L: R: Rear Building Height / Bldg.Square Footage 9r; Open Space Footage (l of arca minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW Q YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES Q IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO Q 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 Q , Date Issued: C. Do any signs exist on the property? YES Q NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO (3 IF YES, describe size, type and location: E MI the construction activity disturb(clearing, grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YEE Q NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed construction Supervisor: Not Applicable ^0 Y • Name of License Holder: \vwt(L SAv7AC c\x." 5yo ] 3yT1 }, tett ��}{ License Number Atldrs a_cdi /1� b,b+ Expiration Date S nature Telephone 9,Registered� Home improvement Contractor: Not Applicable 0 t 7qxxRu,"Z�4Fln u. 1ae" 1-±ntg71 l Company Name IM (n� �wa, �f I1` rrAA�� Registration Number 4 PoAA?Kr V'tr Do 1C,W%%Ai /M /MA '11- I LO Address4,-3 3- Expiration Date U Telephone Arl) ^-42)1 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.182,§25C{S)} 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(1) or two(2)families and to allow such homeowner to engage an individual for hire who does riot possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 10 83.5.1. Def-mition 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 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: \SO \\o.&,-\A rSc..\ 5 The debris will be transported by: ^$ S f� So 5 The debris will be received by: v .A-\\-may KrEy�.w\i Building permit number: Name of Permit Applicant �\N\'. c� 2Dw,avw Date Signature of Permit Applicant The Commonwealth of Massachusetts - _— Department oflndustrialAccidents I•._ t =.40,-= ' Office of Investigations E=IFS= t 1 Congress Street,Suite 100 r -A. �¢q'� Boston,MA 02114-2017 Nar'W�*�' www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/OrganizatioMndividual): l w.,* K 5u..z,A(—.'�. Address: 4-4 a Po...r.,n„ , W ec,grow VC c9 City/State/Zip:SatA y,t,,, �1(/A,i,. 6\61.3 _ Phone#: y13-Sam--'cSI"D Are you an employer?Check the appropriate box: 4. 1 am a general contractor and I Type of project(required): I. Lam a employer with y. ❑ 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, 0 Demolition working for me in any capacity. employees and have workers' 9 0 Building addition [No workers' comp. insurance comp. Insurance.' required.] 5. 0 We are a corporation and its 10.0 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' right of exemption per MGL Y comp. 12.0 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 box a I must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are 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'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. A Insurance Company Name: 14 f \ OA. _ Policy#or Self-ins. Lic. #: JIAC-[06-(ppa 11 o36a — r�'Ci CO 4 Expiration Date: l4 _\5— \-}' Job Site Address: )41.0 v\ . t,2 A.,.,. '2$ re t city/State/Zip: (K Vv 1w 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 Covera verifi tion. I do hereby certif u d th ins pe es o du,y that the information provided above//� is true and correct. Sienature: �� Date: (8 -D8—ILo Phone#: 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 it: IQt) � 1 <31,47_442 -1- • v47_4Q-V\\ (2-'ew1049'''21 of\ \n0.\} P),At‘.", ©qe... \\ ARfo ke.-N->Ye,n \1�\0L.t,,-. \\ 5 �zpi� _ _. - 1 — _