16B-053 (2) 197 NORTH MAIN ST BP-2017-0519
GIS9: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 163-053 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2017-0519
Project# JS-2017-000848
Est. Cost:$500.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAY BOLAND 101880
Lot Size(sq.R.): 17685.36 Owner: WHITLEY RICHARD G
zoning: URBi1oo1/ Applicant: JAY BOLAND
AT: 197 NORTH MAIN ST
Applicant Address: Phone: Insurance:
12 PISGAH RD (413) 214-2414 WC
H U N T I N G T O N MA 01050 ISSUED ON:10/19/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:BASEMENT DOOR BULKHEAD 2" RIGID BOARD
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# 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 10/19/2016 0:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0519
APPLICANT/CONTACT PERSON JAY BOLAND
ADDRESS/PHONE 12 PISGAH RD HUNTINGTON (413)214-2414
PROPERTY LOCATION 197 NORTH MAIN ST
MAP 16B PARCEL 053 001 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
TvpeofConstruction: BASEMENT D KNEAD 2" RIGID BOARD
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 101880
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
`/approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:ss
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
Demolition D
�� /U-73//
Sig r 7.f Builds gO ficial 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.
- Department use only
i-it\.
r .v _ City of Northampton Status of Permit
Building Department Curb Cut/Driveway Permit
a q ,,n 212 Main Street Sewer/Septic Availability
OCT "'�0 Room 100 Water/Well Availability
vs Northampton, MA 01060 Two Sets of Structural Plans
EF1 o i u _` irnP ' 13-587-1240 Fax 413-587-1272 Plot/Site Plans
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
1 S 1'3. M\att Si 1 Map Lot Unit
F1-Dct 'C.e i (t A [710(-0Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2. er of Record:
" LCI \C N.—iCH
Name("P�rinntt/�� /� Current Mailing Address:
_3.tti `C^ `e Telephone
Signature
2.2 Authorized Ai ent:
Name(Print) /� Current Mailing Ad re s. r
j \fit �y7 t' " a‘U-Z� k(A
Signature -_* - Telephad one
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building -` O�C�� OU (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection ! ��
6. total=(1 +2+3+4+5) ADD .w Check Number /577pFy!G 'T (PC
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors E
Accessory Bldg. ❑ Demolition ❑ New Signs [Dl Decks ICI Siding[CI] Other[CO
Brief DescrOon of Proposed4,
Work: d-1 Ql>R�vv'Ln i 4-' -bboor -txaKhd Ct Cc. Z rt C#IA I )c);_
Alteration of existing bedroom Yes /- No Adding new bedroom Yes � No
Attached Narrative Renovating unfinished basement Yes >(No
Plans Attached Roll -Sheet
Ica.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 •- age attached?
d. Proposed Square •stage 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. - •ain 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, \Cl/ (RTd (--Z)-AM l 11 ,as Owner of the subject
property
hereby authorize
to act on my behalf,in al matte relative to work authorized by this building permit application.
n-P - Ik-(- 20 ( ,
Signa re of Owner Date
,he best of mykn zed
knowledge
he y decl re th e statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief. pet
Signed under the pains a pen (ties of pet
Print Na
lD I — � ( h
Sig re er/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holtler. i. /�
DI cZX
License Nubei
' ' 3 mADIGCO 1J� � (2a ICr)
Address JJ - 1 Expiration Date
Telephone 2 I (4- 2(-0
Si re Telephone
9. 'e istered Home •rovement Cont r Not Applicable ❑
1��c �wl�'nn _ 16 l/11
our an ameRegistratior Numb r
, A�� , m� � ID� ►D f0)DI )
Address ((--e�llff aa Expiration Date
Telephd�ey c LI1211 14
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 0
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 be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will he 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: It I�fl ‘rAvioliLS
n - 1r
` 1The debris will be transported by: )111L CI\ (� St LhC
The debris will be received by:
lA�uity Y�q rv�J )
Building permit number:
Name of Permit Applicant lti / iztj
O�A
il
Pka—
eagleir OF .
•
Ifs II .9 1 (c)
Date Signature of Permit Applicant
RISES Nan*Fkad,UuR 2 I Calm w 871121 I 33114.243215
ENGINEERING AwARISEteginshscom
OWNER AUTHORIZATION FORM
I x^1,4-a, � t
c cw of the property located et
le y 0� i(PluPws 5Y
�PratfortYZ}2-sPt nce- MA-I (OcaQ��
herebyatat= tc i )1IA+ct\S
an eetliatzad subcontractor for RISE Enphrshq,to act on my behalf to obtain a Oohing
pemit ad to perform work on my property.ThN form le or y r+Ed nth a signed connect
Owner%Signer
Deco
or H,^ (Aa )1gc, EdC
UUU
11II
SEP 202016
_ J
The Conwwnweahb of Masnacksamts
Department ofIndustrial Accidener
_,gyp_ _ Office of Investigations
'°,^ 1 Conte Stare;Sande 100
Roseau;MA 02114-2017
wwatormckevidia
Workers'Compensation Intranet Affidavit Bn1'NnaiCort7ctors/Eledfidns/Plmbers
Applicant Information '' 11-- Please Print Lea*
Name n�' l:_ 3f}� tolA Merl r -t- 77rn a IIOtY �) GT(tf]S
Addams: I .3_ `f2 s a_L R — `]
City/Statdz pWfid A- oID SD_ Pbonc s: y( 3- (417- 3( 3b
Am you w ek employers Cles4.ap�rski t la= Type of project(required):
1.0 I am a employer with 4. 0 1®a general contractor and 1 6. 0 New construction
(fi l aodror part-tme).• have hired the sub-rnotrra
acm
2. 1 am s sok proprierur or punter-
These
m the parched sheet 7. 0 ltmodelirrg
ship and have m employees These mbc°marma have a El Donation
employees and have workers'
working fame in any capacity. .ms�mma 2 9. 0 Budding addition
compMO tea'cam'insurance 5. 0 We are a corpastim Ind its 10.0 Electrical repairs or additions
required.]
officers have exercised their 11.0 Pho°bing repairs or additions
3.0 I am a homeowner doing all work
myself o workers' camp. ^ °f exam Per MOL
(N12.0 Roof repairs
imam remised.]t a 152,§1(4),and we have no 13.D Other
employees. (No weans'
--
caup.mvurmra required]
*Au),wallow that chats boa rI mar SA fill m sc=am Herow abo.ia their weaken'mmp'a policy information_
rIaan.smauto.0 ItdSeibrtidiorotaeyaedabsidwetaaddmpieamdeantrarmmatstmt•ac.added- uSorm<mei
lC__ata dat the&SSI a mat amebd s.SSmi eirw Ao.Kb®=alb ath-conam ad Mae whither or in that catkin have
mabym If du *- 1l !lave empbteee they amt provide thin.akee ems policy Ember.
I ad w eapigo that ap's.ag~km'a pe pais&a.. =for rag aapbiea edme rs mepaaey Slob site
befsesSa
Insurance Canny Name: u1l�,rd �a . SIe ' •
M (4, /-
Policy or Self-hal Licit . Pat)� 1,-1 5 q fl Expiration Daae: `l - L 2 b (p
Job Site Address: Icy IC�`nfu� r, el. City/Saoeaip: firer-oml c e2-
Mead,a copy of tie wean,'compensation policy deebrathou oreap
page(skewing the porky aaber and in,dm date).
Failure to aeon coverage as required order Semon 25A of MGL c 152 can lead to the hrglositim of criminal paohies of a
ire up to SL500.00 Mier oro-yer impra®mt,as well as clad penalter in the form of a STOP WORK ORDER and a fine
of up to 1250.00 a dry aid rhe nonce; Be advised that a copy of this statement may he forwarded to the Office of
Investigations of the DIA for imam coverage verifiaatiaa
Ido hare calif war Ole pubis darns a ep.4.,,duel aeh fbc.amarworated err nape area/mans
Signature: .a' r-5r Date: l i 7,0 V�
phoneN' 4 -
..
Offided wee en(a Do S nese b ars wenn*be coapiet/b d9'sr Dos skis.
City or Town: Permallieme#
fain Minority(circle track
t.Board of HMO 2.Bundles Department 3.City/ en Clerk 4.Eketrieel Impeder 5.Plsabiag Impen°r
6.Other
Cosset Penes: Piave N:
•
Ork Ira 910/
Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
Boston,Massachusetts 02116
Home Improvement Csntrtctor Registration
Rea,: 164603
r,-` ,^-: Type: DBA
=:,r Expiration: 10/262017 TM 270069
HOME ENERGY SOLUTIONS i Z ,
JAY BOLAND
12 PISGAH RD.
HUNTINGTON, MA 01050 r
Dpda AAies aid Mara cant Mart ream forelmage
Spa, a r ❑ Addams 0 Renewal 0 Busprasus
yt 0 Lost Card
be t... „eterfuc&O oCt„gym
"1 Office after Affairs&Basins Be,wdm Lieetese r.µaem.valid for mdired.I use wily
e (_. .iROva®(T CONTRACTOR before the expiration dace. Lf feed Marx tit
:i64 3 Typo Office dfc....«r Aeta ad Business Bepkdse
Expliatleitadentageffif DBA 10 pat Plass-S.ise 5110
BusM..MA02116
FIOI¢fS'FR67 _ ;_v
JAY BOLAND -
.. :
12 PISGNI RD. : .-__ _ :'.'
RJBNGION.MA 01050 _ �..,._ secret•
}t .—.-
�"e0O1iP Not valid without again
lip Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
ConstructionUcensirCe.-riwr Speriaft-
License:eSS4
•
SAY RIOL ND =`•
121lSGAHIID %OM r'.
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