12C-055 10 HAROLD ST BP-2017-0513
GIS COMMONWEALTH OF MASSACHUSETTS
Map:Block: 12C-055 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL
Lcc.1144/2�A)
Category: renovation BUILDING PERMIT
1 � I T
Permit# BP-2017-0513
Project# JS-2017-000840
Est. Cost: S37500.00
Fee: S244.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: THOMAS AQUADRO 083682
Lot Size(sq. f.): 10977.12 Owner: LEIBOWITZ SUE
Zoning: RI(100)/URA(100)/WSP(1001/ Applicant: THOMAS AQUADRO
AT: 10 HAROLD ST
Applicant Address: Phone: Insurance:
38 LINSEED RD (413) 348-4444
WEST HATFIELDMA01088 ISSUED ON:10/18/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE EXISTING SIDING AND INSTALL
CEDAR CLAPBOARDS, BATHROOM REMODEL, KITCHEN CABINETS AND FLOORING
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 10/18/20160:00:00 $244.00
212 Main Street. Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File k BP-2017-0513
APPLICANT/CONTACT PERSON THOMAS AQUADRO
ADDRESS/PHONE 38 LINSEED RD WEST HATFIELD (413)348-4444
PROPERTY LOCATION IO HAROLD ST
MAP 12C PARCEL 055 001 ZONE RUl00)/URA(100)/WSP(I 0011
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid ` 1
Building Permit Filled out ("ryh. d `T
Fee Paid
Tvpeof Construction: REMOVE EXISTING SIDING AND INSTALL CEDAR CLAPBOARDS.BATHROOM
REMODEL KITCHEN CABINETS AND FLOORING
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 083682
3 sets of Plans/Plot Plan
THE FOLLOWING 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
De 'tion De ay
M17/7
of Build' is 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.
rCv " tF r- - / -(r - Depa•trnr L =r s i
Oi' ' Ci hicrthzmp4o➢
Buucina Dee eni gurti a /ury ,iyF€rmit — -
ag I ,a 212 Madn Sae& IB2aarsep48-8aallabiliy
C!Tl 100 V✓ terlry d,v Ilabllt-
I ' Norlh npton 'k 01060 wo Se c St a oral PI ns
1 rvonn„M+e, t.. . ghoRa 413-587-1240 Fax 413-587-1272 lot Slt Plar - 1�
1Otnr=SpeGTfy n -_ — I
APPLICATION TO CONSTRUCT ALTER,REPAIR, RENOVATE CR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE INFORMATION
1 1 Prooer 'Address: This ec mn to be rompletetl by onm=
/n fhte#LP 5T M p Lo _ ere - Unit
F,zjvt o,vcz in ,Zoe Overlay DTs nct
F --ElmSf Gstrci GS:District,
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
-sue 0GEtlbu/t f7 /01{A([IL➢ ST
Nan rinp Current Mailing Address
V 3 53i k jiT
X Telephone
Signa ure
2.2 Authorized Agent:
Name(Printf Current Mailing Address:
Siomture Telephone i
11
L SECTION 3-ESTIMATED CONSTRUCTION COSTS
item 1 Estimates Cost(Dollars)to be Official Use Only I
completed by permit aoollcant
1. Building F I (a)Building Permit Fee
Zi2P, I
2. Electrical /y (b) Estimated Totai Cost of
467 OOP Construction from (6)
3. Plumbing �/ I Building Permit Fee j
Soo I
1 4. Mechanical (HVAC) �
5. Fire Prcteo ion O ��yy / I f{ �[/�
B. Total=(1 +2+3+2+5) X37 607) Check Number 6/0 /�'�7 /
This Section For Official Use Only
Building Permit Number: Iss
te Issued:
I -
ISly-nature: I
Suii_^iny Commssior,er/Inspector of Pui]dings Yate I
: •;ai 1 , . _ 11-9 (1041 .4s7-.. : er .
Seal sr, 4. ZONING All ink rmaton Mus:Se Compiced.Permit Can BeDenied o o;ncompiete fcr,aden
Existing Proposed Req.iired byZoning I
This [ to be ltet r by 1
Building Department
Lot Size _---
Setbacks Fronto
Side L=�. R-�4..-I _..._ 112i._ _____, _. _,„...._:
Rear .7S_, i-
Building Height ii .E , i r
I
Bidg.Square Footage /in) — /u
iOpen Space Footage o (
r arammus bldg&paved I _ 11 vaning) I
of Paridng Spaces --. I ""—'
(volume&Iom:iot) l'I. -- t
A. Has a�S`'p�ecia�l P mit/Variance/r ndine ever been issued for/onthe site?
V
NO DONT KNOW YES 0
IF YES, date issued:.
IF YES: Was the permit recorded at the Regir yi of Deeds?
NO 0 DON'T KNOW YES 0
IF YES: enter Book - yA Page and/or Document if,
_,
B. Does the site contain a brook, body of water or wetlands? NO F=J DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued: i
__
C. Do any signs exist on the property? YES : NO
Jr Y_S, describe size, type and tocation: i
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
—
IF YES, describe size, type and location: _
Will the construction activity disturb ring, grading ex ora r, orf ling; over l acre or is it part of a common plan
that will disturb over I acre? YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from me DNA/is required.
v L I
SECTION 6-DESCRIPTION OF PROPOSED WORK!check alt ao,oficabie''
I
New Nouse n I Addition, fl Replecamsrt Windows Alter tion(s) Rooiimg n 1
Or Doors
Accessory Bldg. U Demolition n New Signs ID] Docks I, SidingX Other[D] J
Brief Description of Proposed /1&'oVe £) *N7 X4fl/aNd i�VS✓A CC CLU/iK CAFl/'pnAK,�
Werk: rem/Lk bk/APe Sortv4Kfhlt Rilc%N ?'A4%t- 4t&/r/m iMf- Pied
cwee
Alteration of existing bedroom Yes V Na Adding new bedroom Yes 1/ No
Attached Narrative Renovating unfinished basement Yes ,/ No
Plans Attached Roll -Sheet
ea if New house and or addition to existing hocshcicoma ete the following:
a Use of building : One Family Two Family Other I
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 F
e. Number of stories%
f Method of heating' Fireplaces or Woodstoves Number of each
g. Energy Conservation Compeance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 10C 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.
L 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, Su-e L//Ay 0/12_ ,as Owner of the subject
property /J
hereby authorize ` l rnAs' ATu ADRO
to act my beh I in ��))atter r iatt to w k authorized by this building permit application.
tt/ttkik /0 / /V ibb.N1/6
Signatur of Owner Date
I Llpvt AS AV l A DRO as Owner/Authorized
That Agent hereby declare at the statement and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and
ccppenalties of perjury.
lOhl& S ApuADgl7
Print Name
D / ...0
Signature of Owner/ 1_nt Date
SEC T!ON 3-CONSTRUCTION SERVICES 1
$,1 LicnseC Constr= 2cn Supervisor: AQUA
�. Nott Apppec/e�ble�C
Name oe License Holo ni S /IPs ii AIM a
License Number
,-7P) / >'5eea R ci a r i A. _ �rz�J-l8 _
Address c ackae:a Date
. 4t ifl3-3y$'-415LP51 _ i
Signature Telephone
3, Reoistered Homelmokovement Contra torLL /Ap�p�li/cavle-,Eta
I/�5 aF3
Compares Name Registration Number
c__-
----kijnms , QV&PRO r ii-9-/6
Address Expiration
����, ,�1 ���/d1 �/�^^ !!JJ (, �� ��y> Expiration Date
C329'"rui?�a......tfJQiT Mini 'QL1t Tele'phone%3:.7'#F" /4
SECTION 10 WORKERS'COMPENSATION INSURANCE AFFIDAVIT( .G 4 t 152 §25C(€))
Workers Compensation Insurance affidavit mutt be completed and submitted with this application Failure to provide this affidavit will result
in the denial of the issuance of the building permit
Signe Affidavit Attached Yes ... E ht;r
B.. .. .€ansa ± ler rE9enr :aaR
The current exemption far"homeowners"was extended to include Owner-occupied Dwellines of one(1) or two(2)families
and re allow such homeowner to engage an individual for hire who does noteassess a license,provided that the owner acts
as supervisor.CMR 7,50, Sixth Edition Section 108.3.5,1_
Definition of Homeowner:Person(a)who own a parcel of lend 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 suchuse 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 ander the bnildinE permit.
As acting Construction Supervisor your presence on the job site will be required f cm time to time,daring and upon
completion ofthe work for which this permit is issued.
Also be advised that with reference to Ohapter 152(Workers' Compensation) and Chapter 153 (Liabil:ty of Employers to
Employees for injuries not resulting in Death)ofthe Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perfomr work for you under this permit
The undersigned"homeowner"certifies and assumes responsibilliry 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„
i
•
ti
The Commo:mve a r o `a.5.5 e✓' re3e',s
Deparmer,-1 of Ma Tt'i&A n s
Ls
nit"» .. u? itwyw"iv'.rc5
690 Wariflinc”,r
3C5273,MA 62111
%Yorkers' Cowpe sation 'irasmrau Builee2.51Con-tro^.•ternTillectrishsrrstli burnmbers
Aiopol'icast IIniorinaciom P➢ease Print Lee ihiu
Name (6cr s&Organizrieraldividual): t ' N
Address:_a i/tf C 'P d RCS.
b
Cit} Stat '7sp Ar : •t_� Phone : 1
_.. ..
Are you an employer? Check the appropriate box: Tmp of project(required):
1 I I I am a employer. with 4. I am a general contractor and I
employees (hila and/or par' i -ce). have hired the sub-contractors fi ❑ '4ew construction
y
2.❑ i am a sole proprietor or Fanner-
chip
fisted on the attached sheet 7. ❑Remodehing
ship and have no employees These sub-contractors have g. ❑Demolition
working for ole in any capacity. employees and have workers'
9. ❑Building addition
[No workers' compinsurance comp. insnrance.+
required_] - _ We are a uarporation and its 10_❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 214 Plurnbingrepasa or additions
myself. [leo workers' comp. right of exemption per MGL
12.n Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
( comp.insurance required.)
oolioant that chemo box#1 must also f511 out the section below showing their workers'oor peasanon policy information.
TI-So meownets who submit this affidavit indluating they are doing eli work and Ybenhhe outside=tractors must submit a new a'.Ydavit indicating such.
;Contractors that check this box must attached an additional shoe:showing the name of the submonvactors and state whether or not those entices have
employees- hthe sub-couttaczors have employccs,they must provide their works'comp.policy number.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Comnany 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 number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can Iead 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 foini 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 he forwarded to the Office of
Investigations of the DIA.for insurance coverage verification.
1 do hereby certify under,th'pains and penalties of perjury that the information provided above is true and correct.
SrLmatke: Date: AYAI A2,16
Phone#:
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Peraut'L Lease#
Issuing Auto ty(cert le one):
I. Board of Health 2. Building Department 3. City/Town Clerk k . Electrical Inspector Plumbing Inspector
.( 6. Other
Contact Person: Phone ',:
City of Nortamoton
tetta
ra s
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Fo P.-_ . lis t_6C
aaaossa
IHSPE C Od
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOIVai OWNER ET'_Eb'td'TION ACKINOWLEDGE-M NT
The Stale of Massachusetts allows the homeowner the right under 78ECMR 105.3 4 to act as his/her
construction supervisor. The state defines"Homeowner"as, Person(s) who owns a parcel on which
he/she resides or intends 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 home owner."
The building department for the City of Northampton wants any person(s) who seek to use the home
owner exemption, to act as their own construction supervsor, to be aware that by doing so you
become responsible for compliance with state building codes and regulations. The inspection
process requires that the building department be caped to inspect work at various stages,which include
foundatiorifootines (before backfill). sonotube holes (before pour), a roucn buildino inspection
(before work is concealed). insulation inspection (if required) and a final buildino inspection.
The building department requires these inspections before the work is concealed, failure to secure
these inspections can rasa& in failure to obtain a certificate of occupancy until the work can be
inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas)the homeowner will be
responsible to make sure that the trades hired secure theft proper permits in conjunction to the building
permit issued,and that they get their required inspections. Failure of the individual trades to secure
the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made
understand the above.
(Home owner/resident's signature requesting exemption) ij
will call to schedule all required building inspections necessary for the building permit issued to me.
Date
Address of work location
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions or MOL 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: /,9 Wheat?) c. r/o,PPM,r.0
The debris will be transported by: All)/be ECT ✓r
The debris will be received by: Ad/IA-cps-2-7iockl
Building permit number:
Name of Permit Applicant —7-1(0-41 As )QUA Dw
Date Signature o" Permit Applicant
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