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24d-172 (5) 210 STATE ST BP-2017-0663 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block:24D- 172 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:ROOF BUILDING PERMIT Permit# BP-2017-0663 Project# JS-2017-001085 Est.Cost:$3850.00 Fee:$4000 PERMISSION IS HEREBY GRANTED TO: Const Class: Contractor: License: Use Group: MICHAEL STOSZ 2209 Lot Size(sa.ft.): 9234,72 Owner: SCHULMAN JOSHUA Zoning, URC(100)1 Applicant: MICHAEL STOSZ AT: 210 STATE ST Applicant Address: Phone: Insurance: 115 MARKET HILL RD (413) 374-4715 WC AMHERSTMA01002 ISSUED ON: TO PERFORM THE FOLLOWING WORK:RE-ROOF SECTION OF HOUSE/PORCH - 6 SQUARES 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 S40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Status of Poring' ,„ f' '" Building Department Curb Cut/gdveyway a nitvii, Main Street Sewer/Se� cAvaiiab8ity .4. a�ppp A Room 100 Water,Well Availability 7�'V I Northampton, MA 01060 Tans Sets df Structural Pians � "phdna 413-587-1240 Fax 413-587-1272 Plot/Site Plans p 2.-y :,__-- Other Specify. APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE / OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION L A 7'4[i-„; This section to be completed by office 1.1 Property Address: �,, I �I(7 �/ /+�C Uf Map Lot Unfl Zone Overlay District Elm St District c8 District- SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2,1 Owner of Record: Joshua Schulman 210 State St,Northampton, MA 01060 Name nnt} / Current Meiling Address: 646-734-4616 • / Telephone S g ature Name(P )){f/���\ ewreri Maaailliinn Address. �� Sipnatut I E� Teteellhhon+e t I SECTION 3-ESTIMATED CONSTRUCTION COST Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1, Building (..t jJ (a)Wang Permit Fee I —_ �� 2. Electrical (b)EstimatedConstruction TotalnCost of ConsWction from(6) 3. Plumbing Building Permit Fee 4, Mechanical(HVAC) 5. Fire Protection C.� 6. Total a(1 +2+3+4+5) Check Number Go /406/ This Section For Official Use Only Date Building Permit Number: //// �' Issued: _ le 011" Signature: il�lJ -- (Sam — a ___ 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 Depanment Lot Size -.. _ . .._ .. Frons ge Setbacks Front Side L: R:. L R: . Rear Building Height Bldg.Square Footage % Open Space Footage 4�e (Lot area minus Nag&paved pazkiag) #of Parking Spaces _ Fill: (volume&Location) .. _.-.. .. _. .. . ) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW © YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: 0. Are there any proposed changes to or additions of signs intended for the property? YES 0 N O IF YES, describe size, type and location: . E. Will 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? YES O NO 0 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 Q Replacement Windows Alteration(s) ❑ Roofing d Or Doors Q Accessory Bldg. El Demolition ❑tip. New Signs/ [Ci Decksg� (q m Siding Other[ Work Brief escnPtion of ProPased1 Q.1¢! g}. A+� - 9€J �fQtds Titus, t✓lr'I+ c r �' ""'r e. Alteration of existing bedroom XX_.- Yes No Adding new bedroom \ Yes No 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 balding;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 I. 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, e_, OSlwn SCLM)M'\1 ,as Owner of the subject property hereby authorize tfre Itis, C 052-- to act on y behalf.': all matters rel ive tonn work authorized by this building permit application.fir .V _-tom,._ t////// 4' signature of it er •may Date 411 I, 6 as Owner/Authorized Agent y :re that - statement and information on the foregoing application are true and accurate,to the best of my knowledge and b Signed under t'tains and pens les of pe'ury. I` (JlT6S Print Na - II iiv 14 i Signal 4•tt n•rt Date SECTIONS 8-CONSTRUCTION SERVICES 8.t Licensed Constructionn(I�S�upeIrvl8 : Not Applicableypl0 Name of License Holder; tit I CNa4I 5� )2d"f t(K i s ak 11 1 Imo ' License Number . Adr ss Expiration ate 1 , 1^! Doti 3 if Signet e !y .,.�� /Teel/e�phhone�*y j 1491‹7 t(J ry y t "11 J ✓ ` / "Ir7I l 9.R ,isteretl o el e t tont :ct e.' _ Not Applicableyy// 0 0 ._Di CO d. 4 CO rcrag 4-. i(((iq gqleq , eRegistration Number _ __ Address Expiration Date . it +1 61477 Telephone'l(3 1.1-71147(c 3//IV _ SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affid vit must be completed and submitted with this application.Failure to provide this affidavit will result in the denial of the issuance of the buil mg permit. Signed Affidavit Attached Yes No ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to inchide Owner-occupied Dwellings of one(I) or two(2)families and to allow such homeowner to engage an individual for him who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.51. 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 fano 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 be/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 Habig 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 The Commonwealth of Massachusetts Department of Industrial Accidents la 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: jJ.(t t9e./. J(Itll r3 The debris will be transported by: US I The debris will be received by: h((el ?ecvo{ w Building permit number: Name of Permit Applicant Am _>,■� • Date Signature of Permit Applicant