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31B-061
11 LANGWORTHY RD BP-2017-0469 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31B-061 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:BASEMENT RENOVATION BUILDING PERMIT Permit# BP-2017-0469 Project# JS-2017-000780 Est.Cost:$12600.00 Fee: $82.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BILL LONGRIDGE 076661 Lot Size(sq.ft.): 4878.72 Owner: ALEXANDER H ANNE Zoning:URA(95)/URC(6)/ Applicant: BILL LONGRIDGE AT: 11 LANGWORTHY RD Applicant Address: Phone: Insurance: P 0 BOX 88 (413) 323-8977 0 SOLE PROPRIETOR B E LC H E RTO W N M A01007 ISSUED ON:10/13/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:UPDATE EXISTING 1/2 BATH IN BASEMENT, NEW PARTITION WALLS 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/0 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 10/13/2016 0:00:00 $82.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0469 APPLICANT/CONTACT PERSON BILL LONGRIDGE ADDRESS/PHONE P O BOX 88 BELCHERTOWN (413)323-8977 Q PROPERTY LOCATION 11 LANG W ORTHY RD MAP 3IB PARCEL 06 1001 ZONE URA(95)/URC(6V THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED Fee Paid Building Permit Filled out Fee Paid Tvpeof Construction: UPDATE EXISTING 1/2 BATH IN BASEMENT.NEW PARTITION WALLS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 076661 3 sets of Plans/Plot Plan THE FO WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION 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 Permit DPW Storm Water Management !; olition Delay 7Z- ; ��-7 Sig . • e o 1uil.mg icia 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. 3i8 - OCC i - - _ Department use only r :`� City of Northampton Status of Permit _ r'-et-H. %' Building Department Curb Cut/Dr ewayPermit 20\E 212 Main Street Sewer/SeptloAvalabillty •` \\ Room 100 Water/WelfA aflablllry �i orthampton, MA 01060 Two Sets of Structural Plans ,nrs"'e e 413-587-1240 Fax 413-587-1272 PIoVSItp'Plans 09y-s°" seN` Other Specify •PLICATION 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 I/ Lf}A/&WOO77r1-7 /204j, Map Lot Unit /V0 ,tryPrJn/ 414 OID 60 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: f}NNf, 41_0041v1)82 A o 40Pnw M# owe. N �pf� Name(Print) CureentZMarlin Address' / fr �p/`p� ,� �p �� lephone Signature ' I "' ;�"""� rytidOffr 4,5frtag05+n9t1 t6rMRf1—. CO/'j 2.2 Authorized Agent: j,, .DILL Lo A4rz/DFrr• PO Bog 4fj FrrZitatt 4 4- 0/Cbl Name(Print) Current Mailing Address: 69 3)c9-17-C-49-3 afore Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 0500.00 2. Electrical (b) Estimated Total Cost of /900. 00 Construction from(6) 3. Plumbing Zlorg, 00 Building Permit Fee 4- Mechanical(HVAC) "ilk 5. Fire Protection 6. Total =(1 +2+3+4+5) /Z600, 00 Check Number /77,), �d This Section For Official Use Only Building Permit Number: Date Issued: 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 filled in by Building Department • Lot Size 1 Frontage I.... ..._ II i 1 I Setbacks Front `_I I_ I I _-___iI Side L I RI 11 L:r IRI I i__ I Rear I I I. Building HeightI i Bldg. Square Footage __11-± 11 % 1 I I - I I Open Space Footage % _ _ I (Lot area minus bldg Ft isived rirl I I II, -- parking) #of Parking Spaces L. --1 I - 1 - Fill: [_ (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW O YES Cl IF YES, date issued:1 IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book I. Page 1 and/or Document # B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO lJ 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 L/ IF YES, describe size, type and Location: I ' E. WII the construction activity disturb(clearing,grading,exc ation,or filling)over 1 acre or is it part 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. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House [ ] Addition I Replacement Windows Alterations) Roofing ❑ Or Doors O Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding [0] Other[ ] Brief Description of Proposed dP2* 8/WLJ/arJa- i/_3f'j7{ t+J gAf Work: .f/EM/ OrbieffrjenJ Ci./Hua' in/ S41ceVerr✓f 7gn✓rt.,* 2aI1oMMLeZ Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes ✓ No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. 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 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, /fNNE Ala'At (A/\ , as Owner of the subject property hereby authorize fi/L-C--- Ln/J t'a'4c to act on my behalf, in all matters relative to work authorized by this building permit application, -C(- Signature of OwnerZLj4[' ( J�i .r/aDate !D/g /j' I, BitL— L-ON6-c-tbat" , 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 Name %/7A/( a uure of OwnerI- nl Date SECTION 8-CONSTRUCTION SERVICES -8:1 Licensed Construction Supervisor-- -- - - _ _. Not Applicable U. Name of License Holder: 13/L — LONirler Derr LS-0 .44 I Sot 8r3 License Number 3�I0 ,5t/r?nsfSF/a 1-D Tf2.01- X-rvwn/ 1t.4 0/00-- N7-6 1+- Address Expir on Date <Ractt Signature Telephone l • p 39oE Gsiflt. CoM 9.Registered Home Improvement Contractor: Not Applicable 0 LON6HD6C' 594 Company Name Registration Number Pa So>c 88 11117-0/H Address ExptiDate 390 S9rr,m-TeU a--a 414 Telephone('t9)S -s, $3 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 B' No ❑ 11. Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 he/she shall he 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 pennit 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 fie 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: /( Lbjerkk W /2?). ,l/p Grit gtfre,Th // 1'14-oio6 a The debris will be transported by: g;e.._ t-,o ie -,ate The debris will be received by: w-ezrowo p',i c SP:Mori Building permit number: Name of Permit Applicant Stu— Lo,✓67e-tDGg /0%0-0/6 Zat 7Y- Date Signature of Permit Applicant .\ The Commonwealth of Massachusetts �a>— Department of Industrial Accidents _'� Office of Investigations "�= I Congress Street,Suite 100 irs -'r�_ ®�9 Boston,MA 02114-2017 . �" www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Indiy.dCdiividual): /(�(� (—it"A 5,26 _� , ss .cii) /?a/• City/State/Zip: f',v _,r ,,,f / i 6 hone #: /5 ?-5- S 9-0 2) Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. E I am a general contractor and I U -yemployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. t am a sole proprietor or partner- listed on the attached sheet. 7. R'Aemodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance? 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.P-Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 , -F1umbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other _ __- comp. comp.insurance required.] *Any applicant that checks box el must also fill out the section below showing their workers'compensation policy inna-mtion. t Homeowners who submit his affidavit indicating they are doing all work and then lire 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 hose entities have employees. If the sub-contractors have employees,they must provide their workers'comppolicy 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 num her 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 pain and penalties of perjury that the information provided above is true and correct. Signature: de Date: /0/9-/2-0/G Phone#: 64/9) S 3 _ 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#: T -` i _ _. Iex, ryNfr i 1ld ut I 8 .err~ le a ` ! n 1 • M2 Ien. f'....--- a'1-<„ ---a 1 i IAY% - 1 E N> f ye yTR E� ti ° i k /fro , __._.� %SQFTWe/( in , . r •- q pR-ti oSES., f%HZGT777ai..) .v�'LL.S � , ,eizfai l6�t! �C 6 FlG!'k.p7�Lt,,c`k // / aan+9GT#V �,/q?,.�-�}.g ,y -pn1 rt.r„� gra", city of Northampton / "wilding Department Plan Review 2r+2 Main Street "'pion,MA 01060