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17C-243 (5) 93 NORTH MAIN ST BP-2017-0591 GIS 4: COMMONWEALTH OF MASSACHUSETTS Mao:Block: I7C•243 CITY OF NORTHAMPTON Lot: 1001_ PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cates m ROOF BUILDING PERMIT Permit# BP-2017-0591 Project# JS-2017-000957 .sL cost$2000.00 _Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Grotto: PAUL MCCUTCHEON 062544 Lot Slulsu. R.): 10585.08 Owner: PARKER DAVID W JR&PA I Ric Iq M Zoning: URB(1001/SI(01/ Applicant: PAUL MCCUTCHEON AT: 93 NORTH MAIN ST Applicant Address: Phone: Insurance: 134 EASTHAMPTON RD (413) 564-3352 O WESTHAMPTONMA01027 ISSUED ON:I0/28/20I6 0:00:00 TO PERFORM THE FOLLOWING WORK:re-build small entrance roof on south side of house POST THIS CARD SO IT l5 VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House Ii Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Dcnsnmeot 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: FeeT'vpe: Date Paid: Amount: Building 10/282_0160:00:00 $65.00 212 Main Street,Phone(413)587-1240, Fax: (413)587.1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0591 APPLICANT/CONTACT PERSON PAUL MCCUTCHEON ADDRESS/PHONE 134 EASTHAMPTON RD WESTHAMPTON (413)584-3352 Q PROPERTY LOCATION 93 NORTH MAIN ST MAP 17C PARCEL 243 001 ZONE. URB(101)/SI(0)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT �� ry rv/1 Fee Paid Vt +2.1 �^ Building Permit Filled Qut +y-Y Fee Paid (� J T eof nstmction: re-build small entrance roof on south side of house New truction N. Struc :. tenor renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 062544 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO$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 Permit from Elm Street Commission Permit DPW Storm Water Management 7P - Signa fe .u'mg em 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. Pepartmant use only City of Northampton Status-offeedidLd- Budding Department Curf"siutlpr'iveway'Permit dddd.d. 1,212 Main Street SewerreepHCAYalIabiIty - "' " Room 100 Waiiimiif i(abttity Northampton, MA 01060 Two Sets of5tructural Plans phone 413-587-1240 Fax 413-587-1272 Plb S te'Ptana . _ Other Spedty 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 % N NAAJ1//Y577 Map Lot_, Unit 7'f/OXEN ` g/144 ,J i Zone Overlay District Elm St District CB District �,- SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 3.1 Owner of Record: lefilib AMA. PgP9'cp R- r X�,+% 73 N/1/44/1j .5 . t`—Vestemev_ au4 Name(Pr;t) Current Mailing Address: a,p q A01 .41 /tar Telephone _ Signature r�yi ', / .r ♦,r a' a r , CO 2. . hods- A•ent: aC—Otildese.024fl ItL1 FatsJ-G,b JP.1~ ( Na - (Print) '} • Current Mailing Address: r , r p tr p.2-c t— -31(49 Signature / Te-phone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building /5'E uilding /5 (a) Building Permit Fee 2. Electrical ( ,.yam r (b) Estimated Total Cost of W Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 5. Total=(1 +2+3+4+5) Check Number 10,. f! .p This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date Section A. ZONING AU Information Must Be Completed.Permit Can Be Denied Due To Incomplete information Existing Proposed Required by Zoning This column to be filled in by ( Beading Depanmem {{ Lot Size 1 ..._ _._ Frontage I._. - _... ....._j Setbacks Front Side LT. R1 _ I LIT-1 Rear { I I I Building Height I Bldg. Square Footage % r - Open Space Footage % _ area mhos bldg Rr paved IF It- parking)pad[(np) • #of Parking Spaces _ 1 L } Fill: _ -- �_ —.__. _.. 11 __. __. (volwmc,@ Location) A. Has a Special Permit/Variance/Findingever been issued for/on the site? NO © DONT KNOW e YES O IF YES, date issued:( l IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES O IF YES: enter Book Pager I and/or Document# B. Does the site contain a brook, body of water or wetlands? NO p DON'T KNOW O YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: j C. Do any signs exist on the property? YES O NO kg, IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO IF YES, describe size, type and location: I E. Will the construction activity disturb (clearing, gradin. excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO i114 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 1 Addition El Replacement Windows Alteration(s) I I Roofing l l Or Doors D (� Accessory Bldg. Demolition El New Signs [C] Decks [C] Siding ID] Other[f�i Brief Description of Proposed {,, \ riFed' ('` \ Werk: >^ 1-1C�.h�Cyd �� 1—JA-1VCIu CA f e '�[ CXV cc)O C U Alteration of existing bedroom Yes s... No Adding new bedroom Yes /\ N Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Ga.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 unitNumber 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 BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ii . . . r ',nil 0,k s 'Vi as Owner of the subject property hereby authorize I ` Y, �, ,�i to acts. my behalf, in all matters re tive to work authorized bythis building permit application. re C ."w • 1111111.1.111.111.1111.111.1111.11.11.1111C— — Signature of OwnerDate (� �q/ S Date I, t ' / _ ` L)ml--(sa , 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 der the pains and penalties of perjury. lo Print Name ge a1 4 , Signature of OwnerlAgent Date SECTION 8-CONSTRUCTION SERVICES ttI -8.1 Licensed Construction Supriisor. --�e^np -. _. _ ..NottApplicable 0 I _ Name of License Holger- �i�+l1t.S "�._ i �.1s>"t. 0S fl 7cal{i� License Nun�er + �*s ax u ♦ _ . Is • .a As / 't Zi 'I3 Address / Expiration Date /f Jit yf3fi„ /119 Signature Te ephone x. $.RecdatereH e Imp yemi ent Contracto(r'^� 11 t Not Applicable ❑ CGA ,1111 d� �t1's i-i.._..... a� Spa . Company Name Registration Nu mer CC R 4) /r j// Address Expiration Dale Telephone 203 311-11 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 K 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 789, 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 tha(hershe 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,duringand 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 persons) 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 150k Address of the work: The debris will be transported by: ,J.I�{� The debris will be received by: Ud,(,�y �i1DCy_ t , Building permit number: Name of Permit Applicant kiboibF G� @ fir Date Signature of Permit Applicant .Z\ The Commonwealth of Massachusetts Department of Industrial Accidents railOffice of Investigations t 1 Congress Street, Suite 100 I 71 Boston, MA 02114-2017 y7 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly 'Name diemessimgaNzateetereekee_ ,., ,mac Address: ra—..... ( >{-T Cj�RN�-1 _ t 1.J- t\itiAArzakVl City/State/Zip: y( 4 0 0 Phone#: 20) .3 4 E ..i— Are you an employer? Cheek the appropriate box: Type of project(required): 1.❑ I am a employer with- 4. Il I am a general contractor and I ,�..�employees(full and/or part-time).* have hired the sub-contractors 6. J New construction 2. IX 1 am a sole proprietor or partner- listed on the attached sheet, 7. LI Remodeling ship and have no employees These sub-contractors have 8. 9 Demolition workingfor me in anycapacity. employees and have workers' p 0' $ 9, ID Building addition [No workers' comp,insurance romp,insurance. required.] 5. 9 We are a corporation and its 10.0 Electrical repairs or additions 3.F I am a homeowner doing all work officers have exercised their I 1.0 Plumbing repairs or additions myself No workers' comp. right of exemption per MGL 12groof repairs insurance required.]] c. 152, §I(4),and we have no 13.-1 Other employees. [No workers' comp, insurance required.] 'My applicant that checks boxes I must also all out the section below showing heir workers'compensation policy information. r I lomeowners who submiuhis affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors 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 subcontractors have employees,They must provide their workers'camp.policy number. I am an employer that is providing workers'compensation insurance fir my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lie, #: Expiration Date: 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 criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as welt 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 fur insurance coverage verification. I do hereby certify(u r th pal, ndpenal fp y that the information provided above ' true {nd[-correct Shnature: r `.... ,Date: / 7/q [,6 Phone 4: tf/3-_ 3 t"f(� [9 -_ Official use only. Do not walk 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#: Lo S ?. 0,1E2\AAS, n ® %' Kms`v �c ® ZX C tr, Sit lG • S � GGl- - --!woo ^ a • \ WAS / -pc 13E2(5 '- • rbVQG�e-.\ l 10 93 AART‘ ineilAISC- H? --- ----/ U0 2 eit/C-Z r'iff �t8 Le i / fl/S �f/��y� P, 1 A24- 0\cu6 S 114 (:) ,cI U t4 ; C, _�.. x ce,ly 01- �� o — a _ I �,1 1 , I4; LH � I ;I fli i I a i r13/y gag i City of Northampton ,. . __. _.. _. - Building Department Plan Review 212 Main Street , i,:orhampton. MA 01060 j/ nieeo t ie a) arj,0II/ -.11 t( 93 Nc Qr44coM Sr lr7acet iM ZD - 7-17K T ,S7Th qx4 (PT" , '' ,,7l fads l\a;( 'I ( a 4 'H lit